Respiratory Medicine Flashcards
Caused by hypersensitivity-induced lung damage due to variety of inhaled organic particles
Extrinsic Allergic Alveolitis
Farmer + Dyspnea + Cough + DIffuse micronodular shadowing
Extrinsic Allergic Alveolitis
Other name for Extrinsic Allergic Alveolitis
Hypersensitivity Pneumonitis
In extrinsic allergic alveolitis, what findings will you appreciate?
- CXR
- bronchoalveolar lavage
- Blood
- Diffuse micronodular shadowing
- Lymphocytosis
- No eosinophilia
A tumor in the apex of the lung causing Horner’s syndrome (miosis, anhidrosis, ptosis)
Pancoast Tumor
Pancoast Tumor, a carcinoma that occurs in the apex of the lung, causes compression of what structures structures which result in the following signs:
- Hoarseness
- Ipsilateral ptosis
- Ipsilateral miosis
- Ipsilateral anhidrosis
- SVC syndrome
- Sensorimotor deficits
- Recurrent laryngeal nerve
2-4. Stellate ganglion - Superior vena cava
- Brachial Plexus
What type of pneumothorax occcurs in tall, young males with no apparent reason?
Primary Spontaneous Pneumothorax
Diagnostic and Management for primary spontaneous pneumothorax
Erect CXR
<2cm - conservative management (give O2 supplement)
>2 cm (or distressed) - aspirate with needle
Management for secondary spontaneous pneumothorax
<1cm - conservative management (O2 supplement)
1-2cm - needle aspiration
>2 cm - chest drain
Management for Tension Pneumothorax
Needle Decompression
Percussion and Auscultation findings of CONSOLIDATION
Dull, crackles
Percussion and Auscultation findings of PLEURAL EFFUSION
Dull, Decreased breath sounds
Trachea Away from effusion
Percussion and Auscultation findings of ATELECTASIS
Decreased breath sounds
Trachea TOWARDS collapsed lung
Percussion and Auscultation findings of TENSION PNEUMOTHORAX
Hyperresonant, Reduced breath sounds
Trachea Displaced away from affected side
CAP needing antibiotics + PCN allergic or Taking Warfarin
Doxycyline or Clarithromycin
CAP needing antibiotics + PCN allergic + taking warfarin + taking statins
Doxycycline
Remember Clarithromycin-statin can cause rhabdomyolysis
Warfarin + (Clarithromycin OR Doxycycline) interaction
Increases the anticoagulation effect of warfarin —> Monitor INR
Prophylactic antibiotic for HIV patient whose CD4 <50
Azithromycin
Prophylactic antibiotic for HIV patient whose CD4 <200
TMP-SMX
Most accurate test to diagnose Bronchopleural Fistula
CT
A patient scores >4 in Two-level Wells score. What’s the next step?
What if patient did not score >4?
Arrange for CTPA
D-dimer. If positive, then arrange for CTPA
CTPA could not be done to a patient since patient has an allergy to a contrast media (or with renal impairment)
Do V/Q scan
What initial investigation should be done on a pregnant patient if PE is being suspected?
CXR - to rule out other causes of dyspnea like pneumonia or pneumothorax.
In a pregnant patient, CXR is abnormal and PE is being suspected, what is the imaging modality of choice?
CTPA
In a pregnant patient, CXR is normal yet PE is still being suspected, what is the imaging modality of choice?
V/Q scan
Pulmonary embolism is being suspected on a hemodynamically stable patient, however, CTPA is still not being done. What should be done?
Apixaban or Rivaroxaban
In terms of imaging investigations for PE in pregnancy, what are the differences between a CTPA and a V/Q scan?
CTPA - good for baby, bad for mommy since it had higher radiation to maternal breast tissue (increased risk of BRCA for mom)
V/Q - more risk of radiation to fetus but lower radiation to maternal breast tissue (increased risk of childhood cancer)
Suspected PE + Pregnancy + with symptoms of DVT
Next investigation?
Duplex ultrasound
If confirmed: continue LMWH therapeutic dose
Blood works findings in a patient with Legionella pneumonia
Treatment?
(LOW) Sodium, Albumin, Lymphocytes
and Elevated Liver Enzymes
Small cell Lung CA, in terms of:
- Association with smoking
- Central or peripheral
- Paraneoplastic ssx
- Associated with smoking
- Central
- SCLC - SIADH, Cushings, Lambert-Eaton Myasthenic Syndrome, Clonus or Central
FVC and FEV1/FVC of obstructive diseases?
Examples of Obstructive Diseases
FVC > 80%
FEV1/FVC < 0.7
Asthma, COPD, Cystic Fibrosis, Bronchiectasis
FVC and FEV1/FVC of Restrictive diseases?
Examples of Restrictive Diseases
FVC < 80%
FEV1/FVC > 0.7
Pulmonary Fibrosis
Interstitial Lung Disease
Neuromuscular Diseases
Thoracic cage deformities
Cough + DOB + hemodynamic or respiratory compromise + post-thoracic sx + pneumonectomy or lobectomy + X-ray (high-fluid level that is normal and low air-fluid level that is abnormal)
Bronchopleural Fistula
Anticipatory Meds given and for what indication?
SC MORPHINE
- for pain and breathlessness
SC HALOPERIDOL
- for n/v
SC MIDAZOLAM
- for anxiety, delirium and agitation
SC HNBB
- for death rattle
Non-blanching rash in a pediatric age group + isolated thrombocytopenia
ITP
Immediate treatment for management of acute exacerbation of asthma in adults
O2 sat goal of 94-98%
Salbutamo 5mg nebulized with O2
Hydrocortisone 100mg IV or Prednisolone 40-50mg PO
Childhood asthma: child is on a very low dose ICS and using SABA ≥ 3x/week
Add a LABA
***For a child < 5 y/o, add LTRA instead
Childhood asthma: child is on a very low dose ICS + LABA and using SABA ≥ 3x/week
Increase ICS dose
Screening test for tuberculosis in a patient with BCG vaccine
IFN-gamma testing (Do not do Mantoux testing as Mantoux testing may be positive in a patient who had a BCG vaccine)
