Respiratory Flashcards
LRTI
pneumonia
acute bronchitis - bronchi or bronchioles
Pneumonia defn
inflammation of lung tissue in the alveolar space
Aspiration Pneumonia is?
due to the aspiration of food or fluids
impaired swallow
anerobic bacteria
signs of pneumonia?
auscultation?
percussion note?
bronchial breath sounds: HARSH inspiratory and expiratory due to consolidation around the airways
focal coarse crackles
dull to percussion : lung tissue filled wih sputum or collapsed
Percussion findings respiratory exam why dull?
increased tissue density
more solid tissues : consolidation
mass (cancer)
fluid
sputum
pleural effusion is sometimes said to be stony dull
Percussion findings respiratory exam why hyper resonant?
too much air
pneumothorax
what is the sepsis indication sin LRTI?
tachypnoea
tachycardia
hypoxic
hypotense
fever
confusion
CURB-65 /CRb-65
confused?
urea >7mmol/l
RR >30
BP : <90 systolic or 60 diastolic
65 > age
atypical pneumonia
cannot be cultured in the normal way / detected by gram stain
Mx of atypical pneumonia?
macrolide
fluoroquinolones
tetracyclines
Infected water systems > atypical pneumonia > which investigations?
legionella pneumophilia
SIADH = hyponatraemic
urine antigen test
SOB, cough, unwell but with target lesions?
rash is erythema multiforme : pink ring with pale center
Mycoplasma pneumoniae
neuro symptoms in some patients
atypical pneumonia with the mnemonic: “Legions of psittaci MCQs
Legions – Legionella pneumophila
Psittaci – Chlamydia psittaci
M – Mycoplasma pneumoniae
C – Chlamydophila pneumoniae
Qs – Q fever (coxiella burnetii)
PCP mx?
co trimoxazole
fungal pneumonia
Ix pneumonia
CXR
FBC
renal profile : urea / aki
CRP
sputu
blood cultures
urinary antigen tests
when does CRP start to rise?
6 hours from onset and peaks 24-48 hours
mild pneumonia tx ?
5 days oral
amoxicillin
doxy
clarithromycin
Complications of pneumonia?
sepsis
ARDS
pleural effusion
Empyema
Abscess
Death
Acute Bronchitis - defn
Oedematous large airways
production of Sputum
3 weeks
self resolve
viral
Mx of Acute bronchitis is dependent on what lab measure?
CRP >100mg/l
offer abx - DOXY
analgesia
good fluid intake
what is the name of the respiratory stimulant used when NIV or intubation is not appropriate?
In COPD acute exarcebation
Doxapram
NIV - inclusion criteria COPD
Persistent respiratory acidosis
(pH < 7.35 and PaCO2 > 6)
despite maximal medical treatment
Potential to recover
Acceptable to the patient
IPAP
inspiratory pressure - air is forced into the lungs
positive airway pressure
EPAP
pressure during expiration – stopping the airways from collapsing
most common cause of COPD exarcebations?
bacterial:
haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
what Abx in COPD exacerbation?
Amoxicillin
Clarithromycin
Doxycycline
admission criteria for COPD?
severe breathlessness
acutely confused
cyanosis
oxygen sat <90% on pulse oximetry
Oxygen therapy secondary care
COPD before blood gases?
28% - WHITE venturi mask
4L/min
Severe exacerbations requiring secondary care: COPD
O2 therapy
nebulised bronchodilators
> Salbutamol : Beta2 adrenergic agonist
muscarinic antagonist : Ipratropium bromide
IV hydrocortisone
IV theophylline
BiPaP pressures COPD
EPAP: 4-5cm H2O
IPAP: 12-15cm H2O
CXR findings of COPD
hyperinflation
bullae:
flat hemidiaphragm
exclude lung cancer
Severity of COPD - FEV1
> 80% : Stage 1 mild
50-79% : Stage 2
30-49% : Stage 3
<30% : Stage 4
LTOT : COPD
pO2 <7.3 kPa,
pO2 of 7.3-8 kPa
1) secondary polycythaemia
2) peripheral oedema
3) pulmonary HTN
oral PDE-4 inhibitors such as roflumilast reduce risk of?
?
Idiopathic pulmonary fibrosis
acute SOBOE
dry cough > 3 months
finger clubbing
Interstitial fibrosis : drug which reduces fibrosis and inflammation by inhibiting tyrosine kinase?
nintedanib
Pirfenidone
reduces fibrosis and inflammation through various mechanisms
pulmonary fibrosis
