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Royal college IM > Respirology > Flashcards

Respirology Flashcards

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1
Q

Lights criteria

A

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

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2
Q

causes of exudative effusions

A 
Malignancy
Infection
Inflammatory
Iatrogenic
connective tissue disease
Abdominal fluid
Lymphatic abnormalities
Endocrine
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3
Q

Common inflammatory pleural effusions

A 
Acute respiratory distress syndrome (ARDS), 
asbestosis, 
pancreatitis, 
radiation, 
sarcoidosis, 
uremia
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4
Q

Common lymphatic pleural effusions

A

Chylothorax,
malignancy
lymphangiectasia

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5
Q

Common connective-tissue pleural effusions

A

Churg-Strauss disease,
lupus,
rheumatoid arthritis,
Wegener granulomatosis

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6
Q

endocrine causes of pleural effusions

A

Hypothyroidism,

ovarian hyperstimulation

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7
Q

Abdominal fluid causes of pleural effusions

A

Abscess in tissues near lung,
ascites,
Meigs syndrome,
pancreatitis

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8
Q

iatrogenic causes of pleural effusions

A

Drug-induced,
esophageal perforation,
feeding tube in lung

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9
Q

causes transudative effusions

A 
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
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10
Q

conditions which may cause exudative or transudative effusions

A 
Amyloidosis
Chylothorax
Constrictive pericarditis
Hypothyroid pleural effusion
Malignancy
Pulmonary embolism
Sarcoidosis
Superior vena cava obstruction
Trapped lung
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11
Q

define pleurisy

A

inflammation of the parietal and serous lung pleura

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12
Q

life threatening causes of pleurisy

A

PE
Pneumothorax
pneumonia
MI

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13
Q

common clinical presentation of pleurisy

A

sharp, focal pain that worsens with movement

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14
Q

aetiologies of viral pleurisy

A

influenza
coxsackieviruses
adenovirus
Epstein-Barr virus

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15
Q

Treatment of Pleurisy

A

NSAIDS inc. Indomethacin

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16
Q

Uncomplicated parapneumonic effusions aetiology and radiologic appearance

A

sterile exudate in pleural space

Small to moderate and free flowing

17
Q

uncomplicated parapneumonic effusions - pleural fluid characteristics

A 
pH>/7.2
glucose >/60 mg/Dl
WBCs/< 50,000/mm3
LDH /<1,00ounits/L
Negative gram stain and culture
18
Q

Complicated parapneumonic effusions. ethology and radiographic appearance

A

Bacterial invasion of pleural space

Moderate to large, free flowing or loculated on imaging

19
Q

Complicated pleural effusions - pleural fluid characteristics

A 
pH <7.2
glucose <60mg/dL
WBCs >50,000/mm3
LDH> 1,000 Units/L
Positive or negative gram stain and culture
20
Q

Treatment uncomplicated parapneumonic effusions

A

antibiotics

21
Q

treatement complicated parapneumonic effusions

A

antibiotics and drainage

22
Q

pathogenesis uncomplicated parapneumonic effusions

A

movement of fluid from lung parenchyma to the pleural space due to increased hydrostatic pressure

23
Q

Pathogenesis of complicated parapneumonic effusions

A

persistent bacterial invasion into the pleural space, further lowering the pleural fluid glucose 9utilized by bacteria) and increasing LDH (from lysis of neutrophils)

24
Q

absolute indications for chest tube drainage of parapneumoic effusions

A

fluid glucose<60mg/dl and pH<7.2

25
Q

Physiological changes to oxygen levels with air travel

A

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.

26
Q

Evaluation of Hypoxic patients for air travel

A

> 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

27
Q

Criteria for hospice eligibility in advanced lung disease

A

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

28
Q

sarcoidosis diagnosis criteria

A

compatible clinical and radiological manifestations
exclusion of other diseases with similar presentation
histopathologic evidence of non-caseating granulomas

29
Q

PFTs expected in Asthma

A 
FVC: normal/dec.
FEV1: dec.
FEV1/FVC: dec.
Brochodilator resp.: reversible
CXR Normal
DLCO: normal/inc.
30
Q

PFTs expected in COPD

A 
FVC:normal/dec.
FEV1: Dec.
FEV1/FVC: dec.
Bronchodilator resp.: partially reversible/non reversible
CXR: normal
DLCO normal/dec.
31
Q

PFTs expected for late stage COPD

A

FVC: Decreased +/++
FEV1: Decreased ++
FEV1/FVC: Decreased++
Bronchodilator response: usually nonreversible
CXR: Hyperinflation, loss of lung markings
DLCO: decreased

32
Q

Fat Embolism Syndrome Triad (FES)

A

Hypoxemia
Neurological abnormalities
Petechial Rash

33
Q

most sensitive test for CTEPH

A

V/Q SCAN

34
Q

chronic respiratory acidosis needs to be present for how many days

A

4-5 days

35
Q

For chronic respiratory acidosis the kidney compensates 4mEq/l of bicarbonate to XmmHg increase in pCO2

A

10mmHg increase in pCO2

36
Q

COPD under age of 65 should be tested for

A

A1- Antitrypsin
HIV

Royal college IM (18 decks)

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