Respiratory Flashcards
Which of the following may be seen on a chest X-ray in a patient with a pulmonary embolism?
a) Collapse
b) Consolidation
c) Atelectasis
d) Peri-hilar opacities
e) Central wedge of airspace opacity abuting the mediastinum.
C.
Described chest radiographic signs include:
Fleischner sign: enlarged pulmonary artery (20%)
Hampton hump: peripheral wedge of airspace opacity abuting the pleura and implies lung infarction (20%). Or - focal peripheral hyperlucency secondary to oligaemia resulting in a collapsed appearance of vessels distal to the occlusion. Central pulmonary vessels may also be dilated
Westermark sign: regional oligaemia and highest positive predictive value (10%)
Pleural effusion (35%)
Atelectasis
Raised hemi-diaphragm
Knuckle sign - abrupt tapering of a vessel on chest X-ray
Palla sign - enlarged right descending pulmonary artery
Chang sign - dilated right descending pulmonary artery with sudden cut-off
50% of CXRs are normal.
Which of the following is a feature of a severe asthma attack?
a) Unable to speak
b) Pulsus paradoxus
c) Pulse oximetery <80%
d) FEV1 <30% predicted
e) Hypercapnia on blood gas
B.
Severe:
Drowsy / paradoxial chest wall movement / can talk in words / HR >120 / Pulsus paradoxus >12mmHg / may have central cyanosis / Peak flow <50% / pulse ox <90% / PCO2 >40 mmHg
Extremis:
Coma / resp rate low or agonal / unable to speak / HR >140 / Palpable pulsus paradoxus / central cyanosis / quiet chest / cant perform a peak flow / sats <80% / ABG shows hypercapnia and hypoxaemia
Which of the following are correct in the PERC score for PE?
a) HR > 110
b) HR > 120
c) Age > 40
d) Sats <92% on RA
e) Sats <94% on RA
E.
PERC score:
Age >50 yrs
HR >100
O2 sats on RA <94%
Prior history of DVT/PE
Recent trauma or surgery
Haemoptysis
Exogenous oestrogen
Clinical signs suggestive of DVT
Which of the following scores you 3 points on the Well’s criteria for PE?
a) Previous history of DVT/PE
b) Recent immobility
c) Haemoptysis
d) Alternative diagnosis less likely than PE
e) Cancer
D.
Well’s criteria for PE:
Previous Hx of DVT/PE +1.5
HR > 100 +1.5
Recent immobility or surgery +1.5
Clincial signs of DVT +3
Alternative Dx less likely than PE +3
Haemoptysis +1
Cancer +1
Results 3 tier model:
<2 = Low probability
2-6 = Intermediate probability
>6 = High probability
Results 2 tier model:
1 - 4 = Low risk
5+ = High risk
