Respiratory Flashcards
Define pleurodesis
Pleural space is artificially obliterated by adhering the pleural surfaces
What does VATS stand for?
Video assisted thoracoscopic surgery
What is the key feature of COPD on spirometry?
FEV1/FVC
What is the key feature of restrictive lung diseaes on spirometry?
FVC
What happens to FEV1 in COPD?
It is decreased
How will pleural effusion sound on percussion?
Dull
How will pneumothorax sound on percussion?
Hyper-resonant
How will haemothorax sound on percussion?
Dull
How will empyema sound on percussion?
Dull
How will asthma sound on percussion?
Hyper-resonant
How will consolidation sound on percussion?
Dull
How will COPD with hyperinflation sound on percussion?
Hyper-resonant
How are breath sounds over consolidation?
Increased
How are breath sounds over pneumothorax?
Decreased
How are breath sounds over empyema?
Decreased
What are possible causes of reduced percussion at a lung base?
Consolidation
Collapsed lung
Pleural effusion or thickening
Elevated diaphragm
What are the signs of severe COPD?
Prolonged expiratory phase
Accessory muscles of breathing
Pursed lip breathing
Hyperinflation with reduced chest expansion and hyperresonance
What is the most common group of pathogens for nosocomial pneumonia?
Gram negative enterobacteria
In which populations should you have an increased index of suspicion for klebsiella pneumonia?
Alcoholics and nosocomial
What are the 3 most common pathogens for mild community acquired pneumonia?
Pneumococcus>HiB>mycoplasma pneumoniae
What is empirical treatment for mild community acquired pneumonia?
Amoxycillin 1g tds orally OR doxycycline 100mg bd orally
What is empirical treatment for moderate community acquired pneumonia?
Benzylpenicillin IV (or amoxycillin PO)
PLUS
Doxycycline 100mg bd orally (or clarithromycin 500mg bd)
What is best empirical treatment for severe community acquired pneumonia?
Ceftriaxmone 1g IV PLUS azithromycin 500mg IV
What is the most common pathogen for nosocomial pneumonia?
Pneumococcus
How would assess severity of pneumonia?
CURB-65
Confusion, urea elevated, RR>30, blood pressure low, age>65
What is the single most important predictor of severity of pneumonia?
Resp rate
What is the nature of onset of Sxs in bacterial pneumonia?
Fulminant/rapid acute onset
In which population should you have an increased index of suspicion for moraxella catarhalis pneumonia?
Elderly
signs of pulmonary hypertension
right ventricular heave
loud P2, 4th heart sound
prominent v wave in JVP
What test is most commonly used to Dx PE?
CTPA
what ECG pattern do you get with PE
S1Q3T3 - prominent S wave in lead I, and Q and T wave inversion in Lead III
Rx of TB
RIPE rifampicin isoniazid pyrazinamide ethambutol
3 examples of pathogens that are transmitted by airborne
TB
measles
varicella
Dx of asthma on respiratory function tests
FEV1/FVC below expected
AND
200ml AND 12% improvement in FEV1 with bronchodilator
which lung cancer is the most common?
adenocarcinoma
which lung cancer has the worst prognosis?
Small cell carcinoma
which mutations are mostly associated with adenocarcinoma?
KRAS and EGFR
Do squamous cell carcinomas of the lung tend to be located peripherally or centrally?
Central
Do adenocarcinomas of the lung tend to be located peripherally or centrally?
Peripheral
standard Tx of Stage 1 lung cancer
lobectomy and mediastinal lymph node dissection
standard Tx of stage 2 lung cancer
lobectomy and mediastinal lymph node dissection + adjuvant chemotherapy
standard Tx of stage 3a lung cancer
no standard treatment! - Chemo + radiation OR - resection then chemo OR - chemo + radiation then resection
standard Tx of stage 3b lung cancer
chemo and radiation only
No surgical treatment
standard Tx of stage 4 lung cancer
Palliative Rx only
What drug should be given for MRSA pneumonia?
Vancomycin
At what vertebral level does the trachea begin?
C6
What is a typical tidal volume?
500ml
If the lung is full of fluid, how will vocal resonance sound?
Louder
What is the majority of acute epiglottitis caused by?
HiB
What level must PaO2 drop below before it has an effect on ventilation?
~50mmHg
What is the double fold of pleura inferior to the hilum called?
Pulmonary ligament
Inhaled foreign bodies tend to travel where?
Right main bronchus to right lung
What is the most viral common causes of croup?
Parainfluenza
What are the 4 most common viral causes of pneumonia?
Parainfluenza 3
Respiratory syncytial virus
Influenza virus
Adenovirus
What clinical feature particularly distinguishes influenza from other respiratory tract infections?
Muscle aches
What is a normal pulmonary artery sys/dias blood pressure?
25/8 mmHg
Where are peripheral chemoreceptors that contribute to respiratory regulation?
Carotid bodies and aortic arch
What percentage of acute sore throats are caused by viruses?
70%
What is a typical total lung capacity?
5.7L
What is the most common viral cause of pharyngitis?
Adenovirus
What’s the most common bacterial cause of a sore throat?
Strep pyogenese
What are the most common pathogenic agents for acute exacerbation of chronic bronchitis?
Haemophilius influenzae
Streptococcus pneumoniae
An unconscious supine patient who vomits will most likely have fluid in which lung segment?
Apical segment of the lower lobe of the right lung
What changes are there in ABG in Type 2 respiratory failure?
Low PaO2 and high PaCO2
What is the incubation period of influenza?
1-5 days
What is a typical minute ventialtion?
7-8 L/min
What are the 3 most common viral causes of URTI?
Rhinovirus
Corona virus
Adenovirus
Where would painful irritation of the costal parietal pleura be experienced?
Thoracic wall (because parietal pleura is innervated by branches from intercostal nerves)
What percentage of people have viridans streptococci in their URT?
100%
What are the side effects of short acting beta 2 agonists?
tachycardia,
tremor and
hypokalemia
Define cor pulmonale
Right sided heart failure caused by pulmonary hypertension
What are 3 distinguishing features of the right main bronchus compared with the left main bronchus?
Shorter, wider and more vertical
What percentage of pneumonia is due to bacteria?
85%
What are the 2 most common causes of the common cold?
Rhinovirus and coronavirus
How is Type 1 respiratory failure diagnosed?
PaO2 less than 50 mmHg, with evidence of respiratory compensation.
How could you assess whether alveolar ventilation is adequate?
PaCO2
Sleep deprivation of how long will result in cognitive performance equivalent to BAC of 0.05?
18-24 hours
How many sleep cycles are there in a night typically?
4-6
Which nerve passes in front of the lung root?
Phrenic nerve
Which nerve passes behind the lung root?
Vagus nerve
GOLD criteria for staging COPD?
Mild = FEV1 80-100%
Moderate = FEV1 50-80%
Severe = FEV1 30-50%
Very severe = FEV1 less than 30% or less than 50% plus chronic respiratory failure
What is the single most effective thing you can do to improve long term outcome in asthma?
Written asthma action plan
What colour are all SABAs?
Blue/grey
What colour are all LABA/steroid inhalers?
Purple or red
What colour are all anticholinergic inhalers?
Green
What are the criteria for long term oxygen therapy?
PaO2 less than 55mmHg
OR
PaO2 less than 60mmHg and RHF or increased haematocrit
What are the criteria for portable O2 therapy?
Increased distance in 6-minute walk test
AND
Improvement in SpO2% sats
Treatment for mild hospital acquired pneumonia
Amoxycillin + clavulonic acid
Treatment for moderate hospital acquired pneumonia
Ceftriaxone
or
Cefotaxime
Treatment for severe hospital acquired pneumonia
Piperacillin
AND
Tazocin
Treatment for hospital acquired pneumonia in ICU (or at risk for multi drug resistance)
Piperacillin
PLUS
Tazocin
Which ABx should be given for an acute exacerbation of COPD?
Amoxycillin
OR
Doxycycline
Management of acute asthma attack
O SHIT ME! Oxygen SABA Hydrocortisone Ipratropium bromide (Anticholinergic) Theophyline Magnesium Everything else (chest physio, intubation)
Mx of acute exacerbation of COPD
Steroids (prednisilone 37.5mg for 5 days)
O2 with target 88-92% SpO2
Nebulised salbutamol/ipratropium
Abx (amoxycillin or doxycyclin)
Pharmacological Mx of COPD
1 Short acting bronchodilator (SABA or ipratropium)
2 Add a long acting bronchodilator (LABA or LAMA)
3 Add an inhaled GCS
Consider low dose theophyline
Consider prophylactic Abx (macrolide)
