Respiratory

Question 1

What must you ALWAYS remember with chest pain.

Because Ryan, you always forget this differential.

Answer 1

PULMONARY EMBOLISM

Question 2

What type of pneumonia is assocaited with erythema multiforme?

Answer 2

Mycoplasma pneumonae

Question 3

What does base excess indicate?

Answer 3

The metabolic component. -2 to +2. Over two is metabolic alkalosis, below -2 is acidosis

Question 4

What is the difference between Type 1 and Type 2 respiratory failure

Answer 4

Type 1 - Low o2 and low C02

Normal PH and bicarbonate is normal

Type 2 - Low O2 and high C02

Ph is Low (acidosis) and Bicarbonate is normal or high if it is acute.

Question 5

What is a normal PH?

Answer 5

7.35-7.45

Question 6

What do ABGs tell you?

Answer 6

1. Oxygenation via gas exchange
2. Ventilation control via C02
3. Kidney function via bicarb

Question 7

What should p02 be?

Answer 7

11-13 or 10 below inspired air. Normal ‘on air’ is 21kPa

Question 8

What is acidosis?

Answer 8

PH

Question 9

What is alkalosis?

Answer 9

PH > 7.45

Question 10

What five things need to be considered when interpreting ABGS

Answer 10

1) How is the patient? Eg did they have a head injury or MI? if head injury low resp drive so high Co2. IF MI now O2 but high lactic acid

2)Oxygenation levels

3)Alkalotic or acidotic?

4) Resp component - Look at C02 levels. is this high or low?

5) Metabolic component - Look at bicarb. Is this high or low?

Question 11

Study this table

Question 13

How can you tell if the problem is respiratory or metabolic?

Answer 13

Look at the oxygen consumption and the base excess.

If oxygen is normal but base excess isn’t then it is metabolic.

If oxygen isnt it is respiratory

Question 14

What compensation is quick and what is slow?

Answer 14

Quick - Respiration rate

Longer - bicarb

Question 15

What does it mean when there is a mixed picture? I.E raised bicarb and low Co2 or raised Co2 and low bicarb?

Answer 15

Mixed acidosis or alkalosis

Question 16

What is normal bicarb?

Answer 16

25

Question 17

What is a normal value for base excess?

Answer 17

-2 to +2

Question 18

What does a base excess >+2 mean?

Answer 18

Metabolic alkalosis

Question 19

What does a base excess of below -2 mean?

Answer 19

Metabolic acidosis

Question 20

• Patient on room air
• High Co2
• Low O2
• Low PH
• Normal bicarb

Answer 20

Respiratory acidosis with no compensation

Question 21

• Low o2
• High co2
• Normal PH
• High bicarb

Answer 21

Respiratory acidosis with full compensation

Question 22

• Low o2
• Normal Co2
• High PH
• High bicarb

Answer 22

Metabolic alkalosis with no compensation

Question 23

P02 of 18.8 on 40% O2

Low O2

High Co2

Normal bicarb

Low PH

Answer 23

Respiratory acidosis with no compensation and impaired oxygenation

Question 24

Cardiac arrest on 50% O2

Low O2 (7.5)

Low PH

High Co2

Low bicarb

Answer 24

Mixed acidosis and impaired oxygenation

Question 25

COPD on 85%

Low O2 (19.5)

High co2

Low Ph

High bicarb

Answer 25

Respiratory acidosis with incomplete compensation and impaired oxygenation

Question 26

What is type 1 respiratory failure, what would an ABG show and what could cause it?

Answer 26

Low 02, normal or low C02. Pneumonia PE Lung fibrosis

Question 27

What is type 2 respiratory failure, what would an ABG show and what could cause it?

Answer 27

Low O2, high Co2 Opiate overdose COPD Respiratory muscle paralysys

Question 28

What are some examples of resipratory acidosis?

Answer 28

Drug overdose Airway obstruction Hypoventilation

Question 29

What are some examples of resipratory alkalosis?

Answer 29

Hyperventilation (eg panic attack) Pain Aspirin overdose

Question 30

What are some examples of metabolic acidosis?

Answer 30

DKA CKD Diarrhoea of bicarb

Question 31

What are some examples of metabolic alkalosis?

Answer 31

Vomiting HCL CF Antacid abuse

Question 32

What **four** things do you comment on when interpreting ABGs?

Answer 32

Alkalotic/Acidotic Cause - Resp or metabolic Compensation - none/partial/full Oxygenation - impaired/hypoxic/normal

Question 33

How do you enter with an ABG and what do you do first? What are some contraindications?

Answer 33

30-45 degrees Allens test Local sepsis Mastectomy Anticoag

Question 34

How long has an ABG got to be processed what do you need?

Answer 34

10 mins Patients 02 sats Patients temperature

Question 35

What do you think with acidosis and increased lactate?

Answer 35

Sepsis

Question 36

What are the findings for acute lung presentations?

Answer 36

Question 37

What causes clear and watery of pink froffy sputum?

Answer 37

Acute pulmonary oedema

Question 38

What causes clear and grey mucous sputum?

Answer 38

COPD or chronic bronchitis

Question 39

What causes white mucous sputum?

Answer 39

Asthma

Question 40

What causes yellow purulent sputum?

Answer 40

Acute infection

Question 41

What causes green sputum?

Answer 41

Chronic infection

Question 42

What causes rusty red sputum?

Answer 42

Pneumoccocal infection

Question 43

What are CURB65 criteria what does this mean for management?

Answer 43

Score one for each of the following in relation to pneumonia: **C**onfusion **U**rea \> 7 **R**R \> 30 **B**P \<90 systolic of 60 diastolic **6**5 - over 65 0 - 1 - In the community 2 - Consider short stay 3 - 5 Inpatient

Question 44

What is pleurodesis and when is it used?

Answer 44

Fusion of the visceral and parietal pleura Used for recurrent pleural effusions of pneumothoraces eg cancer

Question 45

what are the signs of COPD on CXR/

Answer 45

Hyperinflation flattened diaphragm Reduced lung markings

Question 46

What is the FEV1, FVC and the ratio for obstructive and restricted?

Answer 46

Question 47

What are some differences between asthma and COPD?

Answer 47

Question 48

What are the lung causes of clubbing?

Answer 48

**B**ronchiectasis **B**ronchial carcinoma **C**F **F**ibrolising alveolitis **L**ung abscess **E**mpyema **M**esothilioma

Question 49

What are the non respiratory causes of clubbing?

Answer 49

CV - Atrial myxoma, Bacterial endocarditis GI - IBD, cirrhosis Other - Graves, idiopathic

Question 50

What are the common causes of atelectasis?

Answer 50

* Bronchial carcinoma * foreign body * Mucous plug **They all reduce air entry** * Post surgical - pain and opiods reduce breathing * Tumour * Pneumothorax **They stop expansion**