Respirology Flashcards

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
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.
26
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
27
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
28
sarcoidosis diagnosis criteria
compatible clinical and radiological manifestations exclusion of other diseases with similar presentation histopathologic evidence of non-caseating granulomas
29
PFTs expected in Asthma
``` FVC: normal/dec. FEV1: dec. FEV1/FVC: dec. Brochodilator resp.: reversible CXR Normal DLCO: normal/inc. ```
30
PFTs expected in COPD
``` FVC:normal/dec. FEV1: Dec. FEV1/FVC: dec. Bronchodilator resp.: partially reversible/non reversible CXR: normal DLCO normal/dec. ```
31
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
32
Fat Embolism Syndrome Triad (FES)
Hypoxemia Neurological abnormalities Petechial Rash
33
most sensitive test for CTEPH
V/Q SCAN
34
chronic respiratory acidosis needs to be present for how many days
4-5 days
35
For chronic respiratory acidosis the kidney compensates 4mEq/l of bicarbonate to XmmHg increase in pCO2
10mmHg increase in pCO2
36
COPD under age of 65 should be tested for
A1- Antitrypsin HIV