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Y4 Respiratory Medicine > 1. History and Examination > Flashcards

1. History and Examination Flashcards

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1
Q

What resp disease can cause persitent fever with night sweats and weight loss

A

Chronic TB and ca eg. lymphoma

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2
Q

Causes of instantaneous breathlessness

A

pneumothorax, PE, pulm oedema+ paroxysmal noctural dyspnoea, ?AMI

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3
Q

Causes of breathlessness, seconds to mins

A

Asthma, aspiration, anaphylaxis and psychogenic

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4
Q

Causes of breathlessness, minutes to hours

A

Acute bleeding, met acidosis

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5
Q

Causes of breathlessness, hours to days

A

Pneumonia, COPD exacerbation, LVF

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6
Q

Causes of breathlessness, days to weeks

A

Pleural effusion, bronchiectasis, CCF

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7
Q

Causes of breathlessness, weeks to months

A

PF, lung ca, TB, CCF

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8
Q

Causes of breathlessness, months to years

A

Diffuse parenchymal lung disease, COPD, CCF

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9
Q

Risk factors for PE include

A

Prolonged immobilsation, hormonal treatment, recent hospitalisatioon

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10
Q

COPD examination findings

A

Hyper-inflated chest ( due to loss of lung elasticitydue to loss of alveolar walls)
Reduced CS distance
Reduced cardiac and hepatic dullness, increased resonance
Quiet breath sounds, prolonged expiratory phase and polyphonic wheeze

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11
Q

Pneumonia examination findings

A

Decreased expansion on side of pneumonia
Dull on percussion
Increased breath sounds, bronchial, increased vocal resonance, whispering pectroriloquy

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12
Q

Lobe collapse examination finding

A

Reduced expansion on side of collapse
Trachea displaced to side of collapse
Dull on percussion
Absent or reduced breath sounds

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13
Q

Pneumothorax examination findings

A

Reduced expansion on side of pneumoT
Trachea pushed away to other side ( not tension)
Tracheal deviation to sign of pneumothroax and mediastinal shift ( tension)
Resonant
Absent/ reduced breath sounds

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14
Q

Pleural effusion examination findings

A

Reduced expansion on side of pleural effusion
Trachea pushed away
STONY dull
Reduced vocal resonance and breath sounds

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15
Q

ILD examination findings

A

Expansion normal
Vesicular breath sounds with fine late inspiratory crackles

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16
Q

Dull percussion in left midzone with bronchial breath sounds, enhanced vocal resonance and whispering pectiloquy, with possible rub

A
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17
Q

Large volume of sputum may suggest?

A

Bronchiectasis

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18
Q

What does mucopurulent sputum suggest

A

Bacterial infection

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19
Q

What does mucoid sputum suggest

A

Chronic bronchitis or asthma

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20
Q

What does cough commonly suggest

A

Asthma, chronic bronchitis, bronchial carcinoma, bronchiectasis,

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21
Q

Is asthmatic cough dry or productive?

A

Usually dry, and at night or early morning

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22
Q

Define cough in chronic bronchitis

A

Productive cough for most days during at least 3 consecutive months for at least 2 successive years
Usually in winter - repeated chest infections
Usually sleep undisturbed

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23
Q

Define cough in bronchiectasis

A

Loose cough productive of large volumes of sputum, may be precipitated by changes in posture, repeated chest infections

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24
Q

Define cough in bronchial carcinoma

A

Usually persistent and may be blood stained, may have hoarse voice + bovine cough

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25
Causes of haemoptysis
- May be first Px of malignancy, presents during infection and can be intermittent or persistent - Infarction - often assoc with pleuritic chest pain, bright at first then becomes dark - Infection - especially in TB, may be seen in bronchiectasis
26
Cuase of polyphonoic vs monophonic wheeze
Asthma and bronchitis vs fixed lesion like carcinoma
27
What is one sign of CO2 retention in COPD pts
Morning headaches
28
What does loss of contour on CXR mean
Increased density in structure in contact with heart, diaphragm etc.
29
What can elevated hemidiaphragm suggest
Volume loss of the lung ( tumour, collapse or atelectasis), or pressure from below ( bowel dilatation, mass, abscess)
30
What is common sign in pleural effusion
Meniscus sign
31
Sign of penumothorax
Loss of lung markings
32
What does enlargerd hilum mean
Lung ca /sarcoidosis (hilar LN)/ pulm hypertension (Pulm art)
33
COPD CXR
Large lung fields with hyperlucency, flattened diaphragms and narrow mediastinum Emphysema - May have reduced lung markings, esp in upper zones
34
What is the characteristic feature of bronchiectasis CT
Signet ring apperance
35
CXR of ILD
Generally increased interstitial marking, reduced lung volumes Key feature of IPF is honeycomb lungs May also have groundglass appearance
36
CXR of pneumonia
Airspace shadowing ( due to pus), air bronchogram, may have blunted CPA and loss of heart border USUALLY only on one side May have small meniscus suggesting effusion
37
Lobar pneumonia CXR
Will have discrepancy between consolidated and non consolidated lung
38
Main sign in pneumothorax CXR
Absence of lung markings
39
What may cause a pneumothorax and how are these seen on CT
May seen apical bleb that has burst
40
Test for lung cancer
EBUS
41
How should peak flow be carried out.
Make 3 attempts and write the highest value
42
How does airflow obstruction affect spirometry
Lower FEV1 and VC, takes longer to reach VC also - air comes out more slowly Disprop reduction in FEV1 compared to VC Flow volume loop shows very low maxiumum flows in mid and late ex due to small airways collapse ( well preserved early flow but airways eventually become narrower) But inspiration doesn't take that much effort
43
How does emphysema affect airflow
Destruction of alveolar walls leaves airway supported and collapsible Lung volume 50 or 100% higher than pts without airflow obstruction
44
How does PF affect lung volume
Collagen scarring of lung parenchyma causes stiffening and shrinkage of the lungs, with loss of lung volume Tissue at lung bases replaced by fibrous tissue and progressively moves up to midzone. Stiffening occures as fibrous tissue is layered down, restricting lung expansion
45
How to measure lung volume
Helium dilution- measure degree of dilution at equilibrium after 10 mins rebreathing Plethysmography- breath air from box with mouthpiece closed off, increased in lung volume increases pressure in box, so smaller lung volume will result in lower increase in box pressure
46
Obstructive disease: Lung Volume IC VC RV
Increased volume, reduced IC and VC, high RV
47
How to measure pulmonary gas exchange, what is measured
Gas transfer test, measures Tco and Kco ( corrected per lung volume)
48
What reduces Kco
Emphysema, anaemia, severe fibrosis ( V/Q mismatch)
49
How does CO2 affect oxygenation through airways
CO2 dilates airway, so failure of lobar blood supply results in airway in that lobe constricting
50
How does lobar hypoxia affect arterioles
Constricts pulm arterioles and reduces blood supply to that lobe
51
What causes reduced Q
Reduced Q- parenchymal lung disease- infxn, inflmtn, process leading to fibrosis
52
What causes reduced V
Tumour, lobar pneumonia, pneumothorax, asthma
53
Why is CO2 usually not raised with Hypoxia * TIRF
CO2 mostly carried as bicardb with high capacity for transport, increased ventilation in normal areas can shift more co2 out O2 is insolube and must be carried by Hb, saturated Hb can't compensate
54
Causes of TIRF
V/Q mismatch Mild to mod asthma, pulm oedem, lobar pneum, pneumoT, tumour in main bronchus, IPF
55
What does TIIRF suggest about V and lung tissues
Insuff lung vent overall If pulm, means generalised severe airflow obst or V/Q mismatch andnot enough normal lung regions to correct CO2. Eg. Severe airway obstruction (COPD/ Asthma) If extpul means globally impaired alv ventilation eg. opiates, head injury, neuropathy or myopathy (Eg. MND) , kyphoscoliosis ,
56
How does restrictice lung disease affect flow volume loop
It gets smaller, peak may get higher ( more squashed) as disease gets worse
57
What does high FeNO suggest
High prob of asthma
58
If FENO and Spirotmetry done but results still unclear, what should be done
Direct challenge tes, can use metacholine
59
Is there resp compensation for metabolic alkalosis
No
60
Main cause of resp acidosis
Hypoventilation
61
Causes of metabolic acidosis
DKA, lactic acidosis ( acid overproduction) Renal failure ( decreased elimination) Increased acid ingestion (drug overdose) Bicarb loss ( diarrhoea)
62
Causes of resp alkalosis include
Hyperventilation Raised ICP Over-ventilation in ITU
63
Main causes of metabolic alkalosis are
Excessive vomitting, diuretic therapy, hypokalemia, bicarb ingestion
64
When to give NIV (BIPAP) in COPD
If progressively acidotic, heading towards decompensated TIIRF, higher risk of mortality
65
What do millary nodules in the lungs suggest and what else may be seen
TB, cavitation observed
66
Which zone are lung lesions more common in
Middle/ Lower Zone
67
Which zones do CMP and sillicosis affect more
Middle/ upper zones
68
Which zone is affected in Sarcoidosis
UZ nodules
69
What does airbronchogram suggest
INFXN
70
haematological cause of breathlessness
Anaemia
71
Causes of pulmonary hypertension
Narrowed, thickened or damaged pulmonary arteries or left heart disease reducing right heart flow
72
Sx and signs of pulm hypertension
SOB, weakness, fatigue, chest pain, syncope, haemoptysis, May have ascites, elevated JVP, hepatomegaly, peripheral oedema, parasternal heave, TR/PR
73
Ix for pulmonary hypertension
Echocardiogram initial ix, ECG may show right vent strain
74
Mx for pulm hyperT
Treat underlying causes- duuretics if decompensated RHF LTOT, Digoxin to improve cardiac output
75
Which type of heart fialure is pulm hypertension linked to
RHF
76
Causes of pulm hypertension
CTD, VTE, damage to pulm arteries lung or heart disease ,
77
Risk factors for pulm hyperT
Apart from above causes, obesity, sleep apnoea, bbeing female, family hx for PAH
78

Y4 Respiratory Medicine (6 decks)

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