The Rest Flashcards
what are the risk factors for developing chronic pulmonary infection
Abnormal host response
Abnormal innate host defence
Repeated insult
examples of abnormal host response
immunodeficiency
immunosuppression
examples of abnormal innate host defence
damaged bronchial mucosa e.g. smoking
abnormal cillia e.g. Hartenager’s Syndrome, Youngs Syndrome
abnormal secretion e.g. CF
examples of repeated insult
aspiration e.g. NG feeding
indwelling material e.g. NG tube in wrong place
what is a common presentation of intrapulmonary abscess
weight loss, lethargy, cough, weakness, usually a preceding illness
what type of pneumonia is likely to cause intrapulmonary abscess and what is the mechanism
Staph Pneumonia -> Cavitating Pneumonia -> Abscess
type of poor host immune response that could lead to intrapulmonary abscess
Hypogammaglobulinaemia
what is the indicators of a simple parapneumonic effusion
Clear fluid
pH more than 7.2
LDH less than 1000
Glucose more than 2.2
what are the indicators of a complicated parapneumonic effusion
pH less than 7.2
LDH more than 1000
Glucose less than 2.2
Requires Chest Tube Drainage
what is the definitive signs of a empyema
Frank pus
X-ray - “D sign”
what are preferred for ridding an empyema
Small bore seldinger type drains
what suggest chronic bronchial sepsis
No bronchiectasis on the HRCT
Confirmed positive sputum results
what causes steatorrhoea
exocrine complications of CF
what is a headache on wakening suggest
CO2 retention headache
what can cause CO2 retention
Snoring due to hyperventilating
signs of metabolic acidosis
increased CO2 production
increased resp rate
“breathlessness”
what is stridor
predominantly inspiratory wheeze due to large airway obstruction
causes of stridor in children
croup, epiglottis, diphtheria,
Foreign body
Anaphylaxis
angioneurotic oedema
causes of stridor in adults
neoplasms - larynx, trachea, major bronchi anaphylaxis Retrosternal goitre bilateral vocal cord palsy Wegener’s granulomatosis
what is tracheomalacia
flaccidity of the tracheal support cartilage which leads to tracheal collapse especially when increased airflow is demanded.
what investigation should be avoided in acute epiglottis
Laryngoscopy
signs of anaphylaxis
Flushing, pruritus, urticaria, Angioneurotic oedema Hypotension leading to shock Stridor Wheeze
what is OSA
Intermittent upper airway collapse in sleep
what is the best treatment of OSA
Remove underlying cause
Continuous positive airway pressure (CPAP)
what tool is used to diagnoses OSA
Epworth score
what organism may colonise in CF patients
Staph aureus
Pseudomonas aeruginosa
Burkholderia cepacia
Aspergillus
what are causes of pulmonary venous hypertension
LVF
Mitral regurgitation
Mitral Stenosis
Cardiomyopathy
what are causes of pulmonary arterial hypertension
Hypoxic - COPD, OSA
PE
clinical signs of pulmonary hypertension and right heart failure
central cyanosis if hypoxic
Raised JVP with V waves
RV heave
Tricuspid regurgitation
risk factors for DVT and PE
Thrombophilia Contraceptive pill Pregnancy Surgery Immobility
what is the 1st line investigation of DVT
Ultrasound Doppler Leg scan
what the ABG of a PE
Decreased PaO2
Decreased SaO2
(Type 1 resp failure
PaCO2 normal or low)
when is a CT pulmonary angiogram used in PE
image pulmonary artery filling defect - only pick up larger clots in proximal vessels
when is a leg and pelvic ultrasound used in PE
to detect silent DVT
when is gas transfer factor (DCLO) used in PE
to measure perfusion defect
what is the first line recommended initial investigation for PE
Computed Tomographic Pulmonary Angiography (CTPA)
what is the initial treatment of PE
Low Molecular Weight Heparin (LMWH)
And
Warfarin
when would thrombolyse be used
Massive PE + Hypotension
when should heparin be stopped in PE
3-5 days
when INR >2
how long is warfarin continued in PE treatment
for 3-6 months
how is Warfarin and Heparin reversed
Warfarin - Vit K1
Heparin - protamine
what is the pathology of diffuse pleural thickening
Extensive fibrosis of visceral pleura with adhesion to parietal pleura
