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Flashcards in Resp Deck (25):
1

Describe the MRC dyspnoea scale

1 - Strenuous exercise
2 - Hurrying on the level/ slight hill
3 - Normal speed on the level
4 - After 100yds
5 - Getting dressed

2

Name and describe the scoring system used to assess the risk of a VTE event?

Wells Score

3

Describe the Well's Criteria for assessing DVT risk

RFs (1 point each)
Prev. DVT
Prev. (within 6 months) / active Ca.
Paralysis / Cast of lower limb
Major surgery within 12 weeks

Symptoms (1 point each)
Unilateral calf swelling
Unilateral swollen superficial veins
Unilateral pitting oedema
Unilateral leg swelling
Localised tenderness along deep venous system

If 1 or less do D-dimer, if neg exclude, if pos do US
If 2 or more do D-dimer and US if both neg then exclude, if US neg then treat as if pos and repeat US in 1 week.

4

Describe the Well's Criteria for assessing PE risk

Clinically suspected (3 points)
Alternative diagnosis is less likely than PE (3)

RFs
Prev. DVT or PE (1.5)
Prev. (within 6 months) / active Ca. (1)
Major surgery within 12 weeks (1.5)

Symptoms
Tachycardia (1.5)
Haemoptysis (1)

Score >2 High probability of PE
Score 1-2 Moderate
Score 0 Low

d-dimer in low/moderate and exclude PE if neg, CTPA required if pos.
CTPA in high risk

5

In those with a well's score of 3.5 and who have CKD how would you diagnose a PE

VQ scan (ventilation-perfusion)

6

How to differentiate between a consolidation and effusion on an X-ray

Effusion will obscure the whole lung causing a homogenous appearance rather than a patchy appearance.
Effusion will pool in the bottom of the lungs, will form a meniscus and will blunt the costophrenic angle (on an erect film)
Consolidation will appear patchy as it will not enter the bronchi or bronchioles.

7

How to differentiate between consolidation and effusion on examination

Vocal fremitus and resonance will increase with consolidation and decrease with effusion. (Sound travels more easily through denser materials)

Consolidation described as dull whereas effusion is described as stony dull.

Coarse crepitations with consolidation which should disappear if the pt. coughs

Consolidation can cause bronchial breathing

8

Other than infection what are the other causes of consolidation

Fluid (pulmonary oedema)
Blood (pulmonary haemorrhage)
Cells (Ca.)

9

What is an empyema

Pus in the pleural cavity caused by bacteria and neutrophils.

10

What is pulmonary oedema and what is it caused by

Transudate in the lung parenchyma caused by pulmonary hypertension secondary to L. heart failure.

11

What is the name of the criteria used to distinguish between transudative and exudative causes and when is it used?

Light's Criteria
Used if protein count is between 25-35g/L. If <25 then transudative and if >35 then exudative.

12

Causes of transudative and exudative plural effusions?

Transudative
Pulmonary Hypertension (2° LHF / CHF / PE)
COPD
Interstitial lung disease

Exudative
Malignancy
Infection (TB / Pneumonia)
Trauma (Pulmonary haemorrhage)
Inflammation (Rheumatoid / asbestos / PE

13

How do you diagnose and treat a pleural effusion?

Diagnosed via US-guided pleural aspiration to obtain a biopsy which is then sent to cytology, biochem and micro to determine whether it is exudative or transudative.

Diuretics for transudative
Treat depending on cause for exudative (embolectomy, abx or tumour removal)

Chest drain to manage symptoms (do not remove more than 2L due to risk of reexpansion pulmonary oedema)

14

Under what circumstances can a pleural effusion be assumed to be transudative

A bilateral pleural effusion can be assumed to be transudative

15

What is a chylothorax?

Chyle in the pleural cavity due to disruption of the thoracic duct.

Caused be lymphoma or metastatic carcinoma.

16

Causes of a persistent cough?

COPD
Lung Ca
Interstitial lung disease
Infection (Cold, Pneumonia, TB, Post nasal drip)
Iatrogenic (ACEi or NG tube)
Allergies (Asthma, Hayfever)
GORD due to acid reflux causing inflammation)
Laryngeal irritation (Ca. and glottic cysts)

17

Where should you refer a patient who is suffering from COPD and is having problems with SOB on exertion?

To pulmonary rehab which will improve exercise tolerance, help stop smoking and educate the patient about health and inhaler technique

18

What is pneumonia?
What is the difference between pneumonia and LRTI?

Inflammation of the lung parenchyma caused by infection visible on CXR.
If CXR is negative then it is an LRTI

19

Signs and Symptoms of an LRTI

A productive Cough (green/yellow)
SOB
Pleuritic chest pain
Pyrexia

Area dull on percussion
Coarse crackles on inspiration
Increased vocal resonance
Bronchial breathing

Confusion due to infection
Cyanosis due to reduced perfusion

20

Differentials for pneumonia?

TB (rule out with blood culture)
PE (consider if consolidation not seen on CXR may need CTPA to rule out)
Bronchiectasis / COPD (timescale)
Pulmonary oedema (rule out with infective markers)

21

Investigations for pneumonia?

Basic obs (tachypnoea, pyrexia, hypoxia, tachycardia and hypotension)
Sputum and blds for culture (bronchial lavage can be used to obtain sputum)
FBCs (leucocytes raised), U+Es (sepsis), LFTs (sepsis), CRP (raised)
CXR

22

What organisms are responsible for community-acquired pneumonia and how do you treat them?

Streptococcus Pneumoniae
Haemophilus Influenza
Mycoplasma pneumonia

If mild-moderate treat with oral Amoxicillin (Clarithromycin / Doxycycline if pen allergic)

If severe treat with IV co-amoxiclav and clarithromycin

If Staph is suspected use Flucloxacillin
If MRSA is suspected use vancomycin or teicoplanin

23

What organisms are responsible for hospital-acquired pneumonia and how do you treat them?

Pseudomonas spp.
Gram -ve bacilli
Anaerobes

Treat all with IV abx. An aminoglycoside (Gentamicin) and a cephalosporin (ceftriaxone)

24

Describe the CURB-65 score.
What is it used for a what are the Criteria?

Used to determine the severity of pneumonia for management and prognosis.

Confusion <9 on the abbreviated mental test
Urea >7mmol/L
Respiratory Rate >30 per min
BP <90mmHg Systolic
65 < Age

25

How would you treat a patient with pneumonia based on their curb-65 score?

0-1 oral amoxicillin