Respiratory Flashcards
Pt presents with fever, night sweats, pleuritic chest pain, dyspnea. They’re coughing and bringing up some blood.
The pt is tired and has noticed weight loss + bone pain.
What investigations should be carried out?
TB SUSPECTED
Elevated ESR/CRP. Anaemia.
CXR - Nodules
Tuberculin skin test (Mantoux) - cannot differentiate active vs latent
Sputum smear microscopy + ZN STAIN = acid-fast bacilli
Mycobacterial Culture - Mycobacterium Tuberculosis
TB Management
RIPE RI
2 months of:
- Rifampicin
- Isoniazid
- Pyrazinamide
- Ethambutol
THEN 4 months:
- Rifampicin
- Isoniazid
What are the 4 classifications of pneumonia?
Community-acquired (CAP)
Hospital-acquired (HAP)
Pneumonia in immunocompromised
Aspiration pneumonia
Causes of CAP
Mycoplasma pneumonia
H. influenza
Strep Pneumonia
Pneumocystitis jiroveci - HIV/AIDS
Respiratory syncytial virus - young kids
Pneumonia investigations
CXR - lobar/patchy/diffuse shadowing
Silhouette sign - loss of structural borders
Pneumonia treatment
Supportive +
Empirical:
Non-severe - amoxicillin + erythromycin
Severe - Clarithromycin + Co-amoxiclav
Then specific Abx
Then Repeat CXR after 6 days
Antibiotic for S. pneumoniae
Amoxicillin/ benzylpenicillin
Antibiotic for M. pneumoniae
Erythromycin/ clarithromycin
Antibiotic for C. pneumoniae
Erythromycin/ clarithromycin
Antibiotic for C. psittaci and C. burnetti pneumoniae
Doxycycline
Antibiotic for Legionella spp. pneumonia
Clarithromycin +/- Rifampicin
Most common lung cancer. 2nd most common.
Most common = SSC
2nd = Adenocarcinoma
Pt presents with cough, haemoptysis and chest pain. They have lost weight and are short of breath.
You observe finger clubbing and tests reveal anaemia.
Likely diagnosis?
Lung cancer
Pt presents with progressive SOB + Finger clubbing. You note bilateral basal end-inspiratory crackles.
Likely diagnosis? RF?
Asbestosis
RF: Occupation - builder
Hypoxia + Hypercapnia
Type 2 Respiratory Failure
Management of acute pulmonary oedema
High flow O2 IV Furosemide IV Morphine GTN Urgent CXR
Asbestos exposure is a RF for which cancer?
Mesothelioma
Cancer of pleura
Pt recently underwent a parathyroidectomy. She is becoming increasing SOB. RR 24, O2 drops to 83%, HR 118, BP 108/64, temp 37.9
She’s struggling to swallow food. She has no arrhythmias; her pupils are reactive. There are no rashes or abnormal bruising.
Likely diagnosis? Management
Neck haematoma, 2o to parathyroidectomy
Open surgical wound, to release pressure
Initial management of a tension pneumothorax
Cannula into 2nd ICS MCL
Anaphylaxis tx
IM Adrenaline
Pt has had a 2 wk history of productive cough, worsening SOB and left back pain.
His obs reveal RR 22, O2 92%, temp 37.7
Auscultation reveals coarse crackles in the left lung base.
Likely diagnosis?
Pneumonia
- fever
- productive cough
- hypoxia
- unilateral coarse crackle
Pt has had a 2 wk history of productive cough, worsening SOB and left back pain.
His obs reveal RR 22, O2 92%, temp 37.7
Auscultation reveals coarse crackles in the left lung base.
Likely diagnosis?
Risk assessment?
Pneumonia
- fever
- productive cough
- hypoxia
- unilateral coarse crackle
CURB-65
18-month old pt presents with barking cough and inspiratory stridor, witch accessory muscle use. He responds well to dexamethasone.
Likely aetiology? Pathophysiology? Mx?
CROUP - PARAINFLUENZA VIRUS 1
Pathophysiology:
Inflammation of larynx + trachea
Mx: Steroids + nebulised adrenaline
Causes of RESPIRATORY finger clubbing
Asbestosis Bronchiectasis Cancer (lung) Do NOT say COPD Empyema
Interstitial Lung Disease
Extrinsic allergic alveolitis
Triggers
Presentations
Acute vs chronic
Hypersensitivity reaction to ORGANIC dusts/ moulds
Trigger:
- organic dust - fungus
- keeps birds
Acute: asthmatic px
Chronic ILD px
- progressive SOB
- dry cough
Pneumoconiosis
Triggers
Presentations
Interstitial lung diesase due to inhalation of INORGANIC dusts
- miners
- silicosis
- asbestosis
How to tell difference between extrinsic allergic alveolitis and pneumoconiosis
EAA: ORGANIC
Pneumoconiosis: INORGANIC
Signs of a SEVERE asthma attack
- inability to speak complete sentences
- RR >25
- Peak flow 33-50% predicted
Signs of a LIFE-THREATENING asthma attack
BECCS
Bradycardia Exhaustion Confusion Cyanosis SILENT chest
