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Y4 Respiratory Medicine > 1. History and Examination > Flashcards

1. History and Examination Flashcards

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
Q

Causes of haemoptysis

A
  • 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
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26
Q

Cuase of polyphonoic vs monophonic wheeze

A

Asthma and bronchitis vs fixed lesion like carcinoma

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27
Q

What is one sign of CO2 retention in COPD pts

A

Morning headaches

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28
Q

What does loss of contour on CXR mean

A

Increased density in structure in contact with heart, diaphragm etc.

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29
Q

What can elevated hemidiaphragm suggest

A

Volume loss of the lung ( tumour, collapse or atelectasis), or pressure from below ( bowel dilatation, mass, abscess)

30
Q

What is common sign in pleural effusion

A

Meniscus sign

31
Q

Sign of penumothorax

A

Loss of lung markings

32
Q

What does enlargerd hilum mean

A

Lung ca /sarcoidosis (hilar LN)/ pulm hypertension (Pulm art)

33
Q

COPD CXR

A

Large lung fields with hyperlucency, flattened diaphragms and narrow mediastinum
Emphysema - May have reduced lung markings, esp in upper zones

34
Q

What is the characteristic feature of bronchiectasis CT

A

Signet ring apperance

35
Q

CXR of ILD

A

Generally increased interstitial marking, reduced lung volumes
Key feature of IPF is honeycomb lungs
May also have groundglass appearance

36
Q

CXR of pneumonia

A

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
Q

Lobar pneumonia CXR

A

Will have discrepancy between consolidated and non consolidated lung

38
Q

Main sign in pneumothorax CXR

A

Absence of lung markings

39
Q

What may cause a pneumothorax and how are these seen on CT

A

May seen apical bleb that has burst

40
Q

Test for lung cancer

A

EBUS

41
Q

How should peak flow be carried out.

A

Make 3 attempts and write the highest value

42
Q

How does airflow obstruction affect spirometry

A

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
Q

How does emphysema affect airflow

A

Destruction of alveolar walls leaves airway supported and collapsible
Lung volume 50 or 100% higher than pts without airflow obstruction

44
Q

How does PF affect lung volume

A

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
Q

How to measure lung volume

A

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
Q

Obstructive disease:
Lung Volume
IC
VC
RV

A

Increased volume, reduced IC and VC, high RV

47
Q

How to measure pulmonary gas exchange, what is measured

A

Gas transfer test, measures Tco and Kco ( corrected per lung volume)

48
Q

What reduces Kco

A

Emphysema, anaemia, severe fibrosis ( V/Q mismatch)

49
Q

How does CO2 affect oxygenation through airways

A

CO2 dilates airway, so failure of lobar blood supply results in airway in that lobe constricting

50
Q

How does lobar hypoxia affect arterioles

A

Constricts pulm arterioles and reduces blood supply to that lobe

51
Q

What causes reduced Q

A

Reduced Q- parenchymal lung disease- infxn, inflmtn, process leading to fibrosis

52
Q

What causes reduced V

A

Tumour, lobar pneumonia, pneumothorax, asthma

53
Q

Why is CO2 usually not raised with Hypoxia * TIRF

A

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
Q

Causes of TIRF

A

V/Q mismatch

Mild to mod asthma, pulm oedem, lobar pneum, pneumoT, tumour in main bronchus, IPF

55
Q

What does TIIRF suggest about V and lung tissues

A

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
Q

How does restrictice lung disease affect flow volume loop

A

It gets smaller, peak may get higher ( more squashed) as disease gets worse

57
Q

What does high FeNO suggest

A

High prob of asthma

58
Q

If FENO and Spirotmetry done but results still unclear, what should be done

A

Direct challenge tes, can use metacholine

59
Q

Is there resp compensation for metabolic alkalosis

A

No

60
Q

Main cause of resp acidosis

A

Hypoventilation

61
Q

Causes of metabolic acidosis

A

DKA, lactic acidosis ( acid overproduction)
Renal failure ( decreased elimination)
Increased acid ingestion (drug overdose)
Bicarb loss ( diarrhoea)

62
Q

Causes of resp alkalosis include

A

Hyperventilation
Raised ICP
Over-ventilation in ITU

63
Q

Main causes of metabolic alkalosis are

A

Excessive vomitting, diuretic therapy, hypokalemia, bicarb ingestion

64
Q

When to give NIV (BIPAP) in COPD

A

If progressively acidotic, heading towards decompensated TIIRF, higher risk of mortality

65
Q

What do millary nodules in the lungs suggest and what else may be seen

A

TB, cavitation observed

66
Q

Which zone are lung lesions more common in

A

Middle/ Lower Zone

67
Q

Which zones do CMP and sillicosis affect more

A

Middle/ upper zones

68
Q

Which zone is affected in Sarcoidosis

A

UZ nodules

69
Q

What does airbronchogram suggest

A

INFXN

70
Q
A

Y4 Respiratory Medicine (6 decks)

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