Revision Resp

Question 1

Commonest pneumonia organism

Answer 1

S.pneumo
Heamophilius

-> covered with Amox
Mycoplasma
Klebstriella

Question 2

Pneumonia examintaion

Answer 2

Increased percussion DULLNESS
expansion decreased on the side
Trachea central
increased tactile vocal stimulus, and vocal resonance (muffled in EFFUSION)
Coarse crackles/Bronchial breathing
(normal is vesicular)
extra-when find the right spot, ask patient to whisper 1-2-3 and hear it louder

but if consodilation + collapse(cancer)- trachea wont be central

Question 3

Pneumonia Mx

Answer 3

CURB65 check-
and then ABx COVER- give before MCS resuts
<1- HAP in home mx- AMOX
>2 <4- Admit to hospital with co-amox and clarythro
>4- ITU

HAP–
broader Abx cover

6w after CXR

Question 4

What are you worried about if a pneumoniae pt doesnt get better? what does it change?

Answer 4

consider sceptic shock-especially if obs are going wrong

SEPSIS 6
Abx, O2, Catheter
Take culture, Urine output, ABG for lactate

if BP v low- stat dose of fluids
consider vasopressor- noradrenaline (only if JVP visible/KNOW theyre not dry=need ITU

Question 5

What is Noradrenaline?

Answer 5

Potentiate a1 and b receptors-causes strong vasopression to keep the BP high (in sepsis or other)
very useful in Sepsis
MAKE SURE PT NOT DRY-DISASTER

Always talk to ITU if you give it- theyll need to go

Question 6

Tension Pneumo management

Answer 6

Check which side it is for sure.CXR can be rotated

Then want to drain
16G in the 2nd intercostal space in mid axilla
and then consider chest drain
//causes

if not IVC is not working and die

Question 7

Clubbing causes

Answer 7

Resp- (top cause is cancer->CF->bronchoectasis)
TB, Bronchiectasis, cancer,
Pulm fibrosis
Cystic fibrosis

heart-
Infective endocarditis
Cyanotic heart disease

Question 8

Signs of Hypercapnia

Answer 8

Flap
Bounding pulse
vasodilation
mental changes
drowsiness

Question 9

Mx of Acute severe asthma

Answer 9

High dose O2
Nebulised salbutamol, Nebulised iatropium bromide, IV steroids
then check senior-> Discuss MgSO4, Aminophylline, discuss with ITU and anesthesia

Question 10

Sx of severe/Life threatening asthma

Answer 10

ABG-normal CO2/high is BAD–with low/normal O2=> the more severe the lower theO2 (but can mimic long term COPD)
Acidosis
cyanosed
Tachycardic
silent chest
Pulsus paradoxus-bp up 20mmhg on expiration (measure by manual BP-set it high and see if you can heart only if breath out)

cant complete sentence
PERF <33%

Question 11

Pancost syndrome sx

Answer 11

Invasion of nerve plexus by lung tumour

causes- Ptosis, Anhydrosis, reduced pupil-miosis
can affect arm

Question 12

Endocrine manifestations of Lung Cancer

Answer 12

SIADH
ACTH
-> classically Hypernatremia is a signs
and Hyperparathyroidism

Question 13

Signs on exam of obstructive lung disease

Answer 13

Hyperexpansion, barrel chest
tracheal tug-
Decreased expansion
Hyperresonant
Expiratiory wheeze

Question 14

Sign of exam on obstructive pulm disease

Answer 14

Hyperexpanded chest-with barrel
tracheal tug
Reduced expansion
Expiratory wheewe
hyperresonant

Question 15

Exam signs of Pleural effusion

Answer 15

like consodilation-
decreased expansion
STONY DULL TO PERCUSS
Reduced vocal fremitus
reduced air entry
normal trachea

commonly in exam- plaster on base from the base

Question 16

Effusion Ix and Mx

Answer 16

CXR, USS can confirm
Drainage/sampling for cause-protein content, LDH, MCS, protein