Respirology Flashcards
Lights criteria
fluid is exudative if:
protein:serum protein >0.5
LDH:serum LDH >0.6
Effusion LDH level greater than two-thirds the upper limit of the laboratory’s reference range of serum LDH
causes of exudative effusions
Malignancy Infection Inflammatory Iatrogenic connective tissue disease Abdominal fluid Lymphatic abnormalities Endocrine
Common inflammatory pleural effusions
Acute respiratory distress syndrome (ARDS), asbestosis, pancreatitis, radiation, sarcoidosis, uremia
Common lymphatic pleural effusions
Chylothorax,
malignancy
lymphangiectasia
Common connective-tissue pleural effusions
Churg-Strauss disease,
lupus,
rheumatoid arthritis,
Wegener granulomatosis
endocrine causes of pleural effusions
Hypothyroidism,
ovarian hyperstimulation
Abdominal fluid causes of pleural effusions
Abscess in tissues near lung,
ascites,
Meigs syndrome,
pancreatitis
iatrogenic causes of pleural effusions
Drug-induced,
esophageal perforation,
feeding tube in lung
causes transudative effusions
Atelectasis: Due to increased negative intrapleural pressure Cerebrospinal fluid (CSF) leak into pleural space: Thoracic spine injury, ventriculoperitoneal (VP) shunt dysfunction Heart failure Hepatic hydrothorax Hypoalbuminemia Iatrogenic: Misplaced catheter into lung Nephrotic syndrome Peritoneal dialysis Urinothorax: Due to obstructive uropathy
conditions which may cause exudative or transudative effusions
Amyloidosis Chylothorax Constrictive pericarditis Hypothyroid pleural effusion Malignancy Pulmonary embolism Sarcoidosis Superior vena cava obstruction Trapped lung
define pleurisy
inflammation of the parietal and serous lung pleura
life threatening causes of pleurisy
PE
Pneumothorax
pneumonia
MI
common clinical presentation of pleurisy
sharp, focal pain that worsens with movement
aetiologies of viral pleurisy
influenza
coxsackieviruses
adenovirus
Epstein-Barr virus
Treatment of Pleurisy
NSAIDS inc. Indomethacin
Uncomplicated parapneumonic effusions aetiology and radiologic appearance
sterile exudate in pleural space
Small to moderate and free flowing
uncomplicated parapneumonic effusions - pleural fluid characteristics
pH>/7.2 glucose >/60 mg/Dl WBCs/< 50,000/mm3 LDH /<1,00ounits/L Negative gram stain and culture
Complicated parapneumonic effusions. ethology and radiographic appearance
Bacterial invasion of pleural space
Moderate to large, free flowing or loculated on imaging
Complicated pleural effusions - pleural fluid characteristics
pH <7.2 glucose <60mg/dL WBCs >50,000/mm3 LDH> 1,000 Units/L Positive or negative gram stain and culture
Treatment uncomplicated parapneumonic effusions
antibiotics
treatement complicated parapneumonic effusions
antibiotics and drainage
pathogenesis uncomplicated parapneumonic effusions
movement of fluid from lung parenchyma to the pleural space due to increased hydrostatic pressure
Pathogenesis of complicated parapneumonic effusions
persistent bacterial invasion into the pleural space, further lowering the pleural fluid glucose 9utilized by bacteria) and increasing LDH (from lysis of neutrophils)
absolute indications for chest tube drainage of parapneumoic effusions
fluid glucose<60mg/dl and pH<7.2
Physiological changes to oxygen levels with air travel
Cabin altitudes are pressurized to 8000 feet. Here, the fraction of inspired oxygen reduces from 0.21 to 0.15. This correlates to an oxygen drop of 89-94% in healthy individuals. Healthy people also compensate for this small degree in drop.
Evaluation of Hypoxic patients for air travel
> 95% no further testing
92-95% no testing unless risk factors present (e.g. previous dyspnoea during air travel/ unable to walk 50m, FEV1<50%) Hypoxia simulation test for patients with risk factors.
<92% supplement with oxygen without further testing patient on home oxygen therapy - increase oxygen flow rate 1-2l/min from base line
Criteria for hospice eligibility in advanced lung disease
Severe irreversible chronic lung disease
disabling dyspnoea at rest (FEV1<30%)
Progressive end stage disease (increased number of ER and hospital visits)
Hypoxemia PaO2<55mmHg or pO2 <88%
hypercapnia >50mmHg
Unintentional weight loss >10% body weight over 6 months
Resting tachycardia
sarcoidosis diagnosis criteria
compatible clinical and radiological manifestations
exclusion of other diseases with similar presentation
histopathologic evidence of non-caseating granulomas
PFTs expected in Asthma
FVC: normal/dec. FEV1: dec. FEV1/FVC: dec. Brochodilator resp.: reversible CXR Normal DLCO: normal/inc.
PFTs expected in COPD
FVC:normal/dec. FEV1: Dec. FEV1/FVC: dec. Bronchodilator resp.: partially reversible/non reversible CXR: normal DLCO normal/dec.
PFTs expected for late stage COPD
FVC: Decreased +/++
FEV1: Decreased ++
FEV1/FVC: Decreased++
Bronchodilator response: usually nonreversible
CXR: Hyperinflation, loss of lung markings
DLCO: decreased
Fat Embolism Syndrome Triad (FES)
Hypoxemia
Neurological abnormalities
Petechial Rash
most sensitive test for CTEPH
V/Q SCAN
chronic respiratory acidosis needs to be present for how many days
4-5 days
For chronic respiratory acidosis the kidney compensates 4mEq/l of bicarbonate to XmmHg increase in pCO2
10mmHg increase in pCO2
COPD under age of 65 should be tested for
A1- Antitrypsin
HIV
