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Yr 5 - A&E > Revision > Flashcards

Revision Flashcards

1
Q

What are some iatrogenic causes of a pnuemothorax?

A

1) Positive pressure ventilation
2) Central line insertion
3) Lung biopsy

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2
Q

How is a pneumothorax measured in size on a CXR?

A

Measured horizontally from lung edge to chest wall (at level of hilum)

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3
Q

Mx of a 1ary pneumothorax:

A

1) If rim of air is <2cm and patient is NOT short of breath –> discharge

2) If >2cm and/or SOB –> aspiration, then chest drain if aspiration fails

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4
Q

Mx of 2ary pneumothorax:

A

1) If patient is >50 y/o and rim of air is >2cm and/or patient is SOB –> chest drain

2) If rim of air is 1-2cm –> aspiration (then chest drain if aspiration fails)

3) If rim of air is <1cm –> O2 & admit for 24h

ALL patients should be admitted for at least 24 hours

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5
Q

What are the 3 classifications of pneumothorax?

A

1) Spontaneous (can be 1ary or 2ary)

2) Traumatic

3) Iatrogenic

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6
Q

What are the 2 types of spontaneous pneumothorax?

A

1ary & 2ary:

1ary –> no underlying lung pathology

2ary –> underlying lung pathology e.g. COPD

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7
Q

1ary vs 2ary pneumothorax?

A

A pneumothorax is termed primary if there is no underlying lung disease and secondary if there is.

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8
Q

Mx of a pneumothorax in a 52 y/o patient with COPD with 2.1cm rim of air on CXR?

A

Chest drain insertion (due to age, size & COPD status)

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9
Q

Mx of a pneumothorax in a 21 year old with no lung pathology that is 1.5cm and no SOB?

A

Discharge, reassess in 2-4w

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10
Q

Mx of a pneumothorax in a 21 year old with no lung pathology that is 2.1cm and is SOB?

A

Aspirate (then chest drain if that fails)

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11
Q

Where is a chest drain located in a pneumothorax?

A

Triangle of safety

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12
Q

Is the needle inserted above or below the rib when inserting a chest drain in a pneumothorax?

A

Just above - to avoid neurovascular bundle that runs just below the rib.

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13
Q

Once the chest drain has been inserted in a pneumothorax, what should you do?

A

Get a CXR to check position

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14
Q

A surgical/SC emphysema is a potential complication of a chest drain.

What is this?

A

Collection of air in the subcutaneous tissue.

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15
Q

What surgical method is used to correct a pneumothorax?

A

Video-assisted thoracoscopic surgery (VATS)

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16
Q

What are the 3 surgical options for pneumothorax?

A

1) Abrasive pleurodesis (direct irritation)

2) Chemical pleurodesis (chemical irritation)

3) Pleurectomy

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17
Q

Why is tension pneumothorax an emergency condition?

A

It creates pressure inside the thorax to push the mediastinum across, kink the big vessels in the mediastinum and cause cardiorespiratory arrest.

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18
Q

What type of bacteria is aspiration pneumonia associated with?

A

Anaerobic bacteria

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19
Q

What CRB-65 score indicates the need to consider hospital assessment?

A

More than 0

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20
Q

What organisms cause atypical pneumonia? (5)

A

1) Legionella

2) Mycoplasma pneumoniae

3) Chlamydia psittaci

4) Chlamydophila pneumoniae

5) Q fever

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21
Q

Which causative organism of pneumonia is particularly associated with high fever, rapid onset and herpes labialis?

A

Strep. pneumoniae

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22
Q

What 2 organisms typically cause pneumonia in CF patients?

A

1) Pseudomonas aeruginosa

2) S. aureus

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23
Q

What organism typically causes pneumonia in patients with cystic fibrosis or bronchiectasis?

A

Pseudomonas aeruginosa

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24
Q

Which type of pneumonia causes hyponatraemia? Why?

A

Legionella pneumophilia

Can cause SIADH

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25
Q

Initial screening test for Legionella pneumophila (Legionnaires’ disease)?

A

Urine antigen test

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26
Q

What type of severity of pneumonia does Mycoplasma pneumoniae cause?

A

Milder pneumonia

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27
Q

What type of pneumonia can cause neurological symptoms in young patients?

A

Mycoplasma

28
Q

What type of pneumonia often present a dry cough and atypical chest signs/x-ray findings. Autoimmune haemolytic anaemia and erythema multiforme may be seen?

A

Mycoplasma

29
Q

What type of pneumonia causes mild to moderate chronic pneumonia and wheezing in school-age children?

A

Chlamydophila pneumoniae

Be cautious, as this presentation is common without chlamydophila pneumoniae infection.

30
Q

What type of pneumonia is linked to exposure to the bodily fluids of animals?

A

Coxiella / Q fever

The typical exam patient is a farmer with a flu-like illness.

31
Q

What type of pneumonia is typically contracted from contact with infected birds?

A

Chlamydia psittaci

The typical exam patient is a parrot owner.

32
Q

What type of pneumonia is classically seen in alcoholics or diabetes?

A

Klebsiella

33
Q

What is Pneumocystis jirovecii pneumonia (PCP)?

A

A fungal pneumonia

34
Q

What is the treatment for Pneumocystis jirovecii pneumonia?

A

Co-trimoxazole

35
Q

Management of COVID-19 pneumonia?

A

Respiratory support (e.g., oxygen), dexamethasone and monoclonal antibodies.

36
Q

What is idiopathic interstitial pneumonia?

A

A group of non-infective causes of pneumonia

37
Q

FBC in bacterial pneumonia?

A

Neutrophilia (raised WCC)

WCC and CRP are raised roughly in proportion to the severity of the infection.

38
Q

When does CRP peak?

A

After 24-48h

39
Q

1st line Abx in the management of low-severity CAP?

A

Typical –> amoxicillin

Atypical –> macrolide e.g. clarithromycin

5 day course

40
Q

Management of moderate and high-severity CAP?

A

Dual abx –> amoxicillin + macrolide e.g. co-amoxiclav + clarithromycin

7-10 day course, typically IV

41
Q

When should all cases of pneumonia have a repeat CXR?

A

6 weeks after clinical resolution

42
Q
A
43
Q

After how many days of starting Abx should inflammatory markers be repeated in pneumonia?

A

3 days

44
Q

Which lung is more affected in aspiration pneumonia? Why?

A

R lung as R bronchus is wider and more vertical

45
Q

What is the pulmonary embolism rule out criteria (PERC)?

A

Recommended for use when a clinician estimates a LESS THAN 15% probability of a PE.

Used to decide whether further investigations for a PE are needed.

If all criteria are met –> no further investigations.

46
Q

When is PERC used?

A

If clinician estimates probability of a PE is <15%.

47
Q

What Wells score indicates that a PE is likely?

A

> 4

48
Q

What Wells score indicates that a PE is NOT likely?

A

≤4

49
Q

What does a Wells score of 4 indicate about a PE?

A

PE is not likely

50
Q

What conditions can cause a raised d-dimer?

A
  • PE/DVT
  • Malignancy
  • Pneumonia
  • Pregnancy
  • HF
51
Q

If d-dimer is negative in suspcted PE, what is next step?

A

Consider alternative diagnosis and stop anticoagulation

52
Q

When would a VQ scan be indicated over a CTPA in a PE?

A

1) Renal impairment

2) Contrast allergy

3) Risk from radiation e.g. pregnancy

53
Q

ABG results in PE?

A

respiratory alkalosis

54
Q

If patient has active cancer, what is 1st line anticoagulation in PE?

A

DOAC

55
Q

When is anticoagultion stopped after an provoked vs unprovoked VTE?

A

Provoked - 3 months (except active cancer)

Unprovoked - 6 months in total

56
Q

1st line anticoagulant in PE in pregnancy?

A

LMWH

57
Q

Mechanism of warfarin?

A

Vitamin K antagonist

58
Q

1st line anticoagulation in patients with antiphospholipid syndrome?

A

Warfarin (also require initial concurrent treatment with LMWH)

59
Q

What makes up the Wells score for PE?

A

Clinical signs & symptoms of DVT (minimum of leg swelling and pain with palpation of deep veins) –> 3

Alternative diagnosis is less likely –> 3

HR >100bpm –> 1.5

Immobilisation for more than 3 days or surgery in previous 4 weeks –> 1.5

Previous DVT/PE –> 1.5

Haemoptysis –> 1

Malignancy (on treatment, treatment in last 6m, or palliative) –> 1

60
Q

What score can be used to help identify patients with a PE that can be managed as outpatients

A

Pulmonary Embolism Severity Index (PESI)

61
Q

If there is a strong suspicion of a PE but a delay in scans, what should be done?

A

Offer treatment dose of DOAC in the meantime

62
Q

What is the target INR in patients who suffer from recurrent PEs?

A

3.5

63
Q

What is the most common organism cause an acute exacerbation of bronchiectasis?

A

H. influenzae

64
Q

Where does Klebsiella typically cause pneumonia?

A

Upper lobes

65
Q

What type of lesions does Klebsiella pneumonia cause?

A

Cavitating

66
Q
A

Yr 5 - A&E (8 decks)

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