Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine and Surgery Mushkies > Respiratory Mushkies > Flashcards

Respiratory Mushkies Flashcards

1
Q

Resp exam around the bedside examination?

A
  1. Inhalers
  2. Peak flow meter
  3. Nebuliser
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Resp exam general inspection?

A
  1. Airflow obstruction = pursed lip breathing, splinting diaphragm
  2. Cushingoid
  3. Cyanosed
  4. Cachectic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Resp hand features?

A
  1. Clubbing
  2. Tar staining
  3. CO2 retention flap
  4. Bounding pulse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Resp exam face?

A
  1. Plethora (raised Hb)

2. Central cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs of core pulmonale?

A
  1. Raised JVP
  2. Left parasternal heave
  3. Loud P2 +/- S3
  4. MDM of tricuspid regurg
  5. Ascites and pulsatile hepatomegaly
  6. Peripheral oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

2 ddx for a COPD pt in PACES?

A
  1. Asthma

2. Bronchiectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chronic bronchitis defn?

A

Cough productive of sputum on most days for >=3m on >2 consecutive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Emphysema defn?

A

Alveolar wall destruction with airway collapse and air trapping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COPD Ix?

A
  1. Bedside = PEFR, BMI, Sputum MC+S, ECG (RVH)
  2. Bloods = FBC, ABG, CRP, Albumin, a1-At levels
  3. Imaging = CXR(acute = consolidation/pneumothorax, chronic), Echo (cor pulmonale)
  4. Spirometry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why ix BMI for COPD?

A

BMI is an independent RF for mortality in COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Why Ix albumin in COPD?

A

Malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chronic COPD CXR findings?

A
  1. Hyperinflation = >10 posterior ribs, flat hemidiaphragm
  2. PHTN = prominent pulmonary vessels
  3. Bullae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Spirometry CXR findings?

A

Obstructive picture

  1. Raised TLC and RV (residual volume)
  2. FEV1 < 80%
  3. FEV1/FVC < 0.7
  4. Reduced transfer factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mx of COPD?

A
  1. General
  2. Medical
  3. Surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

General Mx of COPD?

A
  1. MDT = GP, dietician, physio, physician, specialist nurse
  2. Smoking cessation = support programme, NRT< varenicline
  3. Pulmonary Rehabilitation therapy
  4. Co-morbidities = dietary support, CV risk Mx, vaccination (pneumococcal and seasonal influenza)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medical Mx of COPD?

A
  1. Inhaled = antimuscarinics, b-agonists, ICS
  2. Oral = theophylline
  3. Home emergency pack for acute exacerbations
  4. LTOT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

LTOT indications for COPD?

A
  1. Stable non smokers with PaO2 < 7.3 or

2. PaO2 <8 + cor pulmonale/polycythaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Surgical Mx of COPD?

A
  1. Bullectomy

2. Lung reduction surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

BODE index?

A

Tool to predict mortality in COPD

  1. BMI
  2. Obstruction = FEV1
  3. Dyspnoea = MRC score
  4. Exercise capacity = 6 minute walk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mx of acute COPD exacerbation?

A
  1. Controlled O2 therapy = sit up, 24% O2 via Venturi mask SpO2 88-92%
  2. Nebulised bronchodilators = Salbutamol 5mg/4hrs, Ipratropium 0.5mg/6hrs
  3. Steroids = 200mg IV hydrocortisone, Prednisolone 40mg PO 7-14 days
  4. Abx
  5. NIV if no response = repeat nebs and consider aminophylline IV, BiPAP if pH <7/35 and/or RR>30
  6. Invasive ventilation if pH < 7.26
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Inspection of asthma pt?

A
  1. Paraphernalia = inhalers, peak flow, nebulisers

2. General = Cushingoid, Oral thrush

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Inspection of asthmatic chest?

A

Harrison sulcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DDX for asthma in PACES?

A
  1. Normal
  2. COPD
  3. Pulm. oedema –> cardiac asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Asthma defn?

A

Episodic, reversible airway obstruction due to bronchial hyper-reactivity to a variety of stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Asthma Ix?

A
  1. Bedside = PEFR, BMI, Sputum MC+S
  2. Bloods = FBC, IgE, ABG, CRP, Albumin, a1-At levels
  3. Imaging = CXR(hyperinflation)
  4. Spirometry
  5. Atopy = skin-prick testing, RAS
  6. Peak flow diary = diurnal variation > 20%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Asthma spirometry?

A
  1. Reduced FEV1, raised RV
  2. FEV1/FVC < 0.7
  3. > =15% improvement in FEV1 with b-agonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Asthma Mx?

A
  1. General = MDT, TAME patient

2. Medical = 5-stage BTS guidelines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Ddx for acute severe asthma?

A
  1. Pneumothorax
  2. COPD acute exacerbation
  3. Pulmonary oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acute severe asthma admission criteria?

A
  1. Life threatening attack
  2. Severe attack persisting despite initial Rx
  3. May discharge if PEFR > 75% 1hr after initial Rx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Acute severe asthma when to discharge?

A
  1. Been stable on discharge meds for 24 hours

2. PEFR > 75% with diurnal variability <20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How to TAME an asthma pt?

A
  1. Technique for inhaler use
  2. Avoidance of allergens, smoke, dust
  3. Monitor w/ peak flow diary
  4. Educate = emergency action plan, specialist nurse, need for Rx compliance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute severe asthma discharge plan?

A
  1. TAME pt
  2. PO steroids for 5 days
  3. GP appt w/in 1 week
  4. Resp clinic w/in 1 month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Acute asthma Mx?

A
  1. Sit up
  2. 100% O2 via non-rebreathe mask aiming for 94-98%
  3. Salbutamol 5mg and Ipratropium 0.5mg
  4. Hydrocortisone 100mg IV and Prednisolone 40mg
  5. Write no sedation on drug chart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Life threatening asthma Mx?

A
  1. Call ITU
  2. MgSO4 2g IVI over 20 mins
  3. Neb salbutamol every 15 minutes (monitor ECG)
  4. Consider aminophylline
  5. Consider ITU transfer for invasive ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Classification of causes of pulmonary fibrosis?

A
  1. Upper

2. Lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Causes of upper pulmonary fibrosis?

A

A TEA SHOP

  1. ABPA
  2. TB
  3. EAA
  4. Anklyosing spondylitis
  5. Sarcoidosis
  6. Histiocytosis
  7. Occupational (Silicosis, berylliosis)
  8. Pneumoconiosis (e.g. Coal worker’s lung)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Causes of lower pulmonary fibrosis?

A

STAIR

  1. Sarcoidosis
  2. Toxins = BANS ME
  3. Asbestosis
  4. IPF
  5. Rheum = RA, SLE, SS, Sjogrensm PM/DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Toxins that cause lower pulmonary fibrosis?

A

BANS ME

  1. Bleomycin
  2. Amiodarone
  3. Nitrofurantoin
  4. Sulfasalazine
  5. MEthotrexate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pulmonary fibrosis Ix?

A
  1. Bedside = PEFR, ECG (RVH)
  2. Bloods
  3. Imaging
  4. Spirometry
  5. Other = Echo (PHT), BAL, lung biopsy (UIP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pulmonary fibrosis bloods?

A
  1. FBC = anaemia exacerbates dyspnoea
  2. ABG = low O2, high CO2
  3. IPF = ESR, CRP, ANA, RF
  4. EAA = positive precipitins
  5. CTD = C3/C4, RF, ANA, Scle70, centromere
  6. Sarcoid = ACE, Ca
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Pulmonary fibrosis imaging?

A
  1. CXR = reticulonodular shadowing, low lung volume

2. HRCT = fibrosis, honeycombing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Pulmonary fibrosis spirometry?

A
  1. Reduced TLC, RV, FEV and FVC
  2. FEV1/FVC > 0.8
  3. Reduced transfer factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Pulmonary fibrosis Mx?

A
  1. MDT = GP, physician, physio, specialist nurses, palliative
  2. Conservative = stop smoking, pulmonary rehab
  3. Medical = cause and complications
  4. Surgery = lung transplant offers only cure for IPF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Medical Mx of pulmonary fibrosis?

A
  1. Cause = Steroids for EAA/Sarcoid/CTD

2. Complications = Codeine phosphate (antitussive), HF (triple therapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

IPF prognosis?

A

50% 5 year surviva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Classification of causes of bronchiectasis?

A

Congenital and acquired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Congenital causes of bronchiextasis?

A
  1. CF
  2. PCD/Kartageners
  3. Young’s syndrome (azoospermia + bronchiectasis)
  4. Hypogammaglobulinaemia (XLA, CVID)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Acquired causes of bronchiectasis?

A
  1. Idiopathic
  2. Infection = Pertussis, TB, measles
  3. Inflammation = RA, ABPA, IBD
  4. Malignancy/foreign body –> obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Bronchiectasis Ix?

A
  1. Bedside = PEFR, urine dip (proteinuria e.g. amyloidosis)
  2. Bloods = FBC, Serum Ig, Aspergillus (RAST, precipitins, IgE), RA (anti-CCP, RF, ANA)
  3. Imaging = CXR, HRCT
  4. Spirometry = obstructive
  5. Other = bronchoscopy, CF sweat test, Aspergillus skin prick testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Bronchiectasis CXR?

A

Tramlines and ring shadows (bunch of grapes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Bronchiectasis HRCT?

A
  1. Signet ring sign = thickened dilated bronchi and smaller adjacent vascular bundle
  2. Pools of mucus in saccular dilatations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Bronchiectasis complications?

A
  1. Recurrent infections
  2. Pulmonary HTN
  3. Massive haemoptysis
  4. Cachexia
  5. T2RF
  6. Amyloidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Bronchiectasis Mx?

A
  1. Conservative
  2. Medical
  3. Surgical = may be indicated in severe localised disease or obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Conservative Bronchiectasis Mx?

A
  1. MDT = GP, physician, physio, dietician, immunologist

2. Physio = postural drainage, active cycle breathing, rehab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Medical Bronchiectasis Mx?

A
  1. Abx for exacerbations or prophylactic azithromycin
  2. Bronchodilators
  3. Vaccination e.g. influenza, pneumococcus
  4. Underlying cause = Immune deficiency (IVIG), ABPA (steroids), CF (DNAase, Creon, ADEK vitamins)
56
Q

CF defn?

A

Autosomal recessive mutation in the CFTR gene on Chr 7, which leads to thick secretions that has deleterious effects on multiple organ systems

57
Q

CF pathophysiology?

A

Decreased luminal Cl secretion and increased Na reabsorption –> viscous secretions

58
Q

Systems affected by CF?

A
  1. Bronchioles –> bronchiectasis
  2. Pancreatic ducts –> DM, malabsorption
  3. GIT –> distal intestinal obstruction syndrome
  4. Liver –> gallstones, cirrhosis
  5. Fallopian tubes –> reduced female fertility
  6. CAVD = male infertility
59
Q

CF Dx?

A
  1. Immunoreactive trypsinogen (neonatal screening)
  2. Sweat test: Na and Cl > 60mM
  3. Faecal elastase = pancreatic exocrine function
  4. Genetic screening
60
Q

Cf Ix?

A
  1. Bedside = PEFR, Sputum MC&S
  2. Bloods = FBC, LFTs, clotting, ADEK levels, OGTT
  3. Imaging = CXR (diffuse tramlines and rings), abdo US (fatty liver, cirrhosis, pancreatitis), spirometry (obstructive)
61
Q

CF Mx?

A
  1. MDT = GP, physician, physio, dietician, specialist nurse
  2. Chest
  3. GI = Creon, ADEK, Insulin
  4. Other = Fertility and genetic counselling, DEXA
  5. Surgical = heart-lung transplant
62
Q

Chest Mx of CF?

A
  1. Physio = postural drainage, active cycle breathing
  2. Abx = acute infections and prophylaxis
  3. Mucolytics = DNAase
  4. Vaccination = flu, pneumococcus
  5. Segregate from other CF pts (risk of transmission of Pseudomonas and Burkholderia
63
Q

Prognosis of CF?

A

Mean survival 35 years but rising

64
Q

Primary ciliary dyskinesia defn?

A
  1. Autosomal recessive defect in ciliary motility, leading to poor mucociliary clearance, and subsequent chronic recurrent inflammation and bronchiectasis
  2. Reduced sperm motility in males –> infertility
65
Q

Kartagener’s syndrome?

A

PCD accompanied by situs inversus, chronic sinusitis and bronchiectasis

66
Q

What % of PCD pts have Kartageners?

A

50%

67
Q

Young’s syndrome?

A
  1. Bronchiectasis
  2. Rhinosinusitis
  3. Azoospermia
68
Q

Yellow nail syndrome?

A

AKA Primary lymphoedema associated with yellow nails and pleural effusion

69
Q

ABPA defn?

A

A type I and III hypersensitivity reaction to Aspergillus fumigatus, with subsequent airway inflammation and bronchiectasis

70
Q

ABPA Ix?

A
  1. Raised IgE and eosinophilia

2. Positive skin prick test or RAST

71
Q

ABPA Mx?

A

Prednisolone and bronchodilators

72
Q

3 Ddx of dull lung base?

A
  1. Effusion
  2. Consolidation
  3. Collapse
  4. Malignancy
73
Q

Causes of pleural effusion classification?

A

Transudate and exudate

74
Q

Transudate causes of pleural effusion?

A
  1. CCF
  2. Renal failure
  3. Liver failure (hypoalbuminaemia)
  4. Meigs’ syndrome
  5. Hypothyroidism
75
Q

Exudate causes of pleural effusion?

A
  1. Infection = Pneumonia, TB
  2. Inflammation = RA, SLE
  3. Malignancy = primary or secondary
  4. Infarction = PE
  5. Trauma
76
Q

Transudate effusion pathophysiology?

A

Due to increased hydrostatic pressure or reduced plasma oncotic pressure

77
Q

Exudate effusion pathophysiology?

A

Inflammation leads to increased capillary permeability

78
Q

Transudate protein level?

A

<30g/L

79
Q

Exudate protein level?

A

> 30g/L

80
Q

Light’s criteria?

A
  1. If the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
    a. effusion:serum protein ratio >0.5
    b. effusion:serum LDH >0.6
    c. effusion LDH is >2/3rds upper limit of normal
81
Q

Pleural effusion diagnostic pleurocentesis, what will you send the fluid for?

A
  1. Chemistry = protein, LDH, pH, glucose, amylase
  2. Bacteriology = MCS, auramine stain, TB culture
  3. Cytology
  4. Immunology = RF, ANA, complement
82
Q

Resp exam chest scars?

A
  1. Lateral thoracotomy, anterior thoracotomy
  2. Clamshell scar
  3. Chest drain scar
83
Q

Differential for thoracotomy in resp exam?

A
  1. Lobectomy/wedge resection
  2. Pneumonectomy
  3. Abscess/empyema
  4. Lung transplant
84
Q

Indications for lobectomy/pneumonectomy?

A
  1. 90% for bronchial carcinoma
  2. Bronchiectasis
  3. COPD (lung reduction surgery)
  4. TB (historic, upper lobe)
85
Q

Lobectomy operative mortality?

A

7%

86
Q

Pneumonectomy operative mortality?

A

12%

87
Q

Lung cancer types?

A
  1. NSCLC

2. SCLC

88
Q

NSCLC subtypes?

A
  1. SCC = 35%, highly related to smoking, centrally located, PTHrP –> raised Ca
  2. Adenocarcinoma = 25%, female non-smokers, peripherally located, 80% present with extrathoracic mets
  3. Large cell = 10%
89
Q

SCLC?

A

20% of lung cancer, highly related to smoking, central location, 80% present with advanced disease

90
Q

Complications of lung cancer classification?

A
  1. Local
  2. Metastatic
  3. Paraneoplastic
91
Q

Lung cancer local complications?

A
  1. RLNP
  2. Phrenic nerve palsy
  3. SVCO
  4. Horner’s
  5. AF
92
Q

Lung cancer metastatic complications?

A
  1. Pathological fracture
  2. Hepatic failure
  3. Confusion, fits, focal neuro
  4. Addisons
93
Q

Lung cancer paraneoplastic complications?

A
  1. Endo = SIADH, ACTH (Cushings), Serotonin (Carcinoid), PTHrP (Primary HPT)
  2. Rheum = poly/dermatomyositis
  3. Neuro = cerebellar degeneration, peripheral neuropathy
  4. Derm = acanthosis nigricans, thrombophlebitis migrans
94
Q

Lung cancer Ix?

A
  1. Bedside = ECG, PEFR
  2. Bloods = FBC, U&E, LFTs, bone profile
  3. CXR
  4. Cell type = percutaneous FNA/endoscopic transbronchial biopsy
  5. Pulmonary function tests = fitness for surgery
95
Q

Lung cancer staging Ix?

A
  1. CT
  2. PET
  3. Radionuclide bone scan
  4. Thoracoscopy, mediastinoscopy
96
Q

Lung cancer Mx?

A
  1. General = MDT, stop smoking, optimise nutrition and CV function
  2. NSCLC
  3. SCLC
  4. Palliative care
97
Q

NSCLC Mx?

A
  1. Chemo = platinum based + biologics
  2. Radio
  3. Surgery = rx of choice of no metastatic spread –> wedge resection/lobectomy/pneumonectomy
98
Q

SCLC Mx?

A

.Usually disseminated at presentation, some benefit with chemo

99
Q

Lung cancer palliative Mx?

A
  1. Analgesia = opiates for pain and cough
  2. Radiotherapy = haemoptysis, bone or CNS mets
  3. SVCO = dexamethasone + radiotherapy or intravascular stent
  4. Chemical pleurodesis for persistent effusions
100
Q

Lung cancer prognosis?

A
  1. NSCLC = 50% 5 yrs w/o spread, 10% w/ spread

2. SCLC = 1-1.5 years medial survival treated, 3m untreated

101
Q

Pneumonia Ix?

A
  1. Bedside = Sputum MC+S. urine (Pnemococcal Ag, cold aggultinins)
  2. Bloods = FBC, U&E, CRP, LFT, Culture, ABG
  3. Imaging = CXR
  4. Special = Pleurocentesis, BAL
102
Q

Pneumonia Mx?

A
  1. Conservative = Analgesia, Oxygen, Fluids, Chest Physio

2. Medical = Abx

103
Q

Complications of pneumonia?

A
  1. Septic shock + MOF –> ITU
  2. Parapneumonic effusion/empyema/abscess –> drainage
  3. Resp failure –> ventilation
104
Q

Pneumonia f/up?

A

CXR at 6 weeks to check for underlying Ca and resolution

105
Q

Classification of pneumonia?

A
  1. Anatomically

2. Aetiologically

106
Q

Anatomic classification of pneumonia?

A
  1. Bronchopneumonia = patchy consolidation of different lobes
  2. Lobar pneumonia = fibrosuppurtaive consolidation of a single lobe (congestion –> red –> grey –> resolution)
107
Q

Aetiological classification of pneumonia?

A
  1. Community acquired = SP, SA, HI, MC, Atypicals, viruses
  2. Hospital acquired = >48hrs, Pseudomonas/MRSA/gm -ive enterobacteriacaeae
  3. Aspiration
  4. Immunocompromised
  5. Atypical
108
Q

Aspiration pneumonia RFs?

A
  1. Stroke
  2. Bulbar palsy
  3. Reduced GCS
  4. GORD/Achalasia
109
Q

Aspiration pneumonia typical site?

A

Posterior segment of RLL

110
Q

Aspiration pneumonia organisms?

A

Anaerobes

111
Q

Aspiration pneumonia Mx?

A

Co-Amoxiclav

112
Q

Immunocompromised pneumonia causes and mx?

A
  1. PCP = Co-trimoxazole
  2. TB = RIPE
  3. Fungi = amphotericin
  4. CMV/HSV = ganciclovir
113
Q

Atypical pneumonia?

A
  1. Refers to organisms which cause atypical generalised symptoms and bronchopneumonia
  2. Often presents with fever, headaches, myalgia
  3. Poor correlation between clinical and X-ray findings
  4. Often intracellular
  5. e.g. Mycoplasma, Chlamydia, Legionella
114
Q

CURB-65 score?

A

Severity of pneumonia

  1. Confusion: AMTS <=8
  2. Urea >7mM
  3. RR > 30
  4. BP <90/60
  5. > =65
115
Q

CURB-65 score interpretation?

A
  1. 0-1 = Home Rx
  2. 2 = Hospital Rx
  3. > =3 = Consider ITU
116
Q

SIRS - MODS spectrum?

A
  1. SIRS
  2. Sepsis
  3. Severe sepsis
  4. Septic shock
  5. MODS
117
Q

SIRS defn?

A

An inflammatory response to a variety of insults manifest by >=2 of:

  1. Temp >38 or <36
  2. HR > 90
  3. RR >20 or <4.6kPa
  4. WCC > 12 or <4 or >10% bands
118
Q

Sepsis defn?

A

SIRS with a presumed or confirmed infectious process

119
Q

Severe sepsis defn?

A

Sepsis with at least 1 organ dysfunction or hypoperfusion

120
Q

Septic shock defn?

A

Severe sepsis with refractory hypotension

121
Q

MODS defn?

A

Impairment of >=2 organ systems, such that homeostasis cannot be maintained without therapeutic intervention

122
Q

Old management of TB?

A

It was believed that lower PaO2 would inhibit TB proliferation, and therefore inducing apical collapse was a treatment

123
Q

3 complications of old TB?

A
  1. Aspergilloma in old TB cavity
  2. Bronchiectasis
  3. Scarring predisposes to Bronchial Ca
124
Q

TB subtypes and pathophysiology?

A
  1. Primary
  2. Primary Progressive
  3. Latent
  4. Secondary
125
Q

Primary TB features?

A
  1. A non-immune host who is exposed to M. tuberculosis may develop primary infection of the lungs (childhood/naive)
  2. Organism multiplies at pleural surface –> Ghon focus
  3. Macrophages take TB to LNs –> nodes + lung lesion = Ghon complex
  4. In 95%, cell mediated immunity and delayed hypersensitivity controls infection
  5. Fibrosis of Ghon complex –> calcified nodule (Ranke complex)
  6. Rarely may lead to primary progressive TB
126
Q

Primary progressive TB features?

A
  1. Resembles acute bacterial pneumonia
  2. Mid and lower zone consolidation, effusions, hilar LNs
  3. Lymphohaematogenous spread –> extrapulmonary and miliary TB
127
Q

Latent TB features?

A
  1. Infected but no clinical or CXr signs of active TB
  2. Non-infectious
  3. May persist for years
  4. If weakened host resistance –> reactivation
128
Q

Secondary TB features?

A
  1. Usually reactivation of latent TB due to reduced host immunity
  2. May be due to reinfection
  3. Typically develops in the upper lobes
  4. Hypersensitivity –> tissue destruction –> cavitatation and formation of caseating granulomas
129
Q

Dx of Latent TB?

A
  1. TST, if positive –>

2. IGRA

130
Q

Dx of Active TB?

A
  1. CXR = mainly upper lobes –> consolidation, cavitation, fibrosis, calcification. if suggestive CXR –>
  2. Take >=3 sputum samples (one AM), may use BAL if cant induce sputum –> microscopy for AFB (ZN stain), culture on Lowenstein-Jensen media (Gold standard)
131
Q

When is PCR helpful for TB?

A

Can Dx rifampicin resistance

132
Q

Tuberculin skin test defn?

A

Intradermal injection of purified protein derivative, with induration measured at 48-72 hours

133
Q

TST False +ive causes?

A
  1. BCG
  2. Other mycobacteria
  3. Previous exposure
134
Q

TST False -ive causes?

A
  1. HIV (infection)
  2. Sarcoid (inflammation)
  3. Lymphoma (malignancy)
135
Q

IGRA defn?

A

Pt lymphocytes are incubated with M.TB specific antigens –> IFNy production if previous exposure, will not be positive if just uses BCG (as BCG uses M.bovis)

136
Q

IGRA example?

A

Quantiferon Gold

Medicine and Surgery Mushkies (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions