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36 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What are the criteria for nosocomial pneumonia?
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new pulm infiltrate
lobar consolidation on CXR fever leukocytosis purulent secretions |
investigations, signs and symptoms in hospital
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What is the criteria for CURB 65?
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Confusion
Uremia Respiratory rate > 30 Blood pressure <90 > 65 yrs old |
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What is the presentation of typical pneumonia?
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Upper respiratory tract signs
Sudden onset high fever Seen in elderly, post URTI less systemic signs CXR lobar pneumonia matches Sx |
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What is the presentation of atypical pneumonia?
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Gradual onset of fever
Prodrome Myalgia, headache, malaise younger pts, birds, epidemics v. few systemic Sx CXR may be more serious |
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What are most common organisms which cause typical pneumonia?
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S. pneumoniae
H. influenza Klebsiella Staph |
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What are the most common organisms which cause atypical pneumonia?
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Legionella
Mycoplasma chlamydia morexella viruses |
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What does Mx of pneumonia depend on?
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Severity
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What is empirical AB therapy for mild pneumonia?
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Amoxicillin
(+/- erythromycin) can manage as outpatient |
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What is empirical AB therapy for severe pneumonia?
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benzyl IV + doxycycline + roxithromycin
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What are the main factors affecting the PSI score?
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age
hospitalisation coexisting illness signs results of investigations |
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What are the investigations you should do to calculate PSI?
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FBE
WCC U&E BSL Hemato% ABGs CXR - pleural effusion |
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What are the pulm causes of clubbing?
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NSLC
P fibrosis Suppurative lung diseases |
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What are the causes of an exudate?
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Idiopathic
Inflammation Malignancy CTDs Vascular |
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What are the causes of a transudate?
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CCF
hypoalbumin Constrictive pericarditis hypothryoid abdo disease |
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What are the signs of chronic bronchitis?
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cough
purulent, blood, foul sputum cyanosis reduced chest expansion reduced BS hyperesonant PN wheeze or crackles RHF |
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What are the signs of obstructive airways disease?
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Use of accessory muscles
Purse lip breathing Barrel chest hyperresonant PN reduced BS wheeze, crackles reduced VF and VR |
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What are the exacerbators of COPD?
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Infection
Smoking Medication Oesophageal reflux disease Kardiac causes (AMI, CF) Exacerbation of asthma |
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What are the signs of COPD?
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cyanosis
palmar erythema barrel chest reduced chest wall movt tracheal tug accessory muscle hyperresonant PN reduced BS reduced VF and VR wheeze signs of cor pulmonale side Fx of meds |
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What are side Fx of B-agonist?
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Tremor
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What are the side Fx of steroids?
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Cataracts
Unable to sleep, ulcers Striae Hump Infections N Glaucoma S Bone loss AVN Diabetes M D |
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What is proper inhaler technique?
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undo cap
shake the inhaler breathe normally clasp mouth tightly over press down while inhaling hold breath for as long as psb wait 1 min then repeat |
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What would you see on CXR for COPD?
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hyperexpanded lung fields
<50% of cardiac diameter flattened diaphragm bullae reduced peripheral markings signs of PHT |
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What other investigations would be useful in COPD?
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FBE
ABGs lung function tests w/ DLCO HRCT |
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What may be seen on spirometry that would suggest COPD as the cause?
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reduced FEV1
reduced or normal FVC (< FEV1) reduced FEV1/FVC ratio 40% FEV1 predicts severity |
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What is the pharmacological Mx of COPD?
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SABA/LABA
steroids ipratropium bromide Theophylline ABs mucolytics Rx RHF LTOT |
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What are the priciples of Mx of COPD?
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Confirm diagnosis & severity
Optimize lung function pharmacol Preserve lungs Develop support plan Xacerations managment |
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What are the Cx of COPD?
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empyema
cor pulmonale ARF polycythemia PT lung carcinoma |
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What are the signs of cor pulmonale?
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raised JVP
RV heave tender liver ascites peripheral edema cough dyspnea loud P2 cyanosis pansystolic murmur |
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What are typical asthma presentations?
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wheeze
SOB chest tightness nocturnal cough sputum production |
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When taking HX of chronic conditions, you should ask:
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- diagnosis
- severity - symptoms this time - precipitants this time - other relevant qns |
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How would you manage a patient acutely?
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ABCs
oxygen Salbutamol hydrocortisone IV pulse oximetry then look for cause |
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What else should you always look for and treat besides the lung problem?
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RVF
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What tests would you like to do if you suspected RA?
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FBE
RF CXR Xray of hands ESR, CRP synovial fluid analysis |
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What Xray changes would you see in RA?
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periarticular swelling
juxtaarticular osteopenia loss of joint space loss of articular cartilage erosion subluxation & deformity |
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What changes would you see in a CXR associated with RA?
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pleural effusions
nodular opacities p fibrosis cardiomegaly (pericardial eff) |
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What are the side effects of methotrexate?
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mouth ulcers
liver cirrhosis SOB nausea diarrhea cough |
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