CCC - Respiratory Flashcards
If breathlessness has sudden onset what are DDx?
- pneumothorax
- PE
- FB
If breathlessness has a mins/hr onset what are DDx?
- airways (inflammation/obstruction)
- chest infection (pus)
- acute heart failure (fluid)
If breathlessness has a days/weeks onset what are DDx?
- above (chronic/non-resolving)
- ILD
- Malignancy/large pleural effusion
- neuromuscular
- anaemia/thyrotoxicosis
What is the management of a pneumothroax primary <2cm?
discharge repeat CXR
What is the management of a pneumothroax primary >2cm/SOB?
aspiration, if unsuccessful chest drain - analgesia (regular)
What is the management of a pneumothorax secondary <2cm?
aspiration
What is the management of a pneumothorax secondary >2cm?
chest drain
How do you know if primary or secondary?
- primary: healthy
- secondary: predisposing e.g. COPD
How do you know the distance of the pneumothroax?
edge of heart and chest wal
Why might you have recurrent SOB after 2 hrs of chest drain?
rexpansion pulmonary oedema
What is a quick way to determine the axis?
- Lead I and II: overall negative?
- Yes: axis deviation - Look at avL: overall positive?
- Yes: left axis deviation
- No: right axis deviation
What is the inital treatment in PE?
- LMWH
2. Thrombolysis: if haemodynamic compromise (hypotensive systolic <90 unstable)
Why do you not give warfarin as inital PE management?
have a paradoxically pro-thrombotic effect initally
How can you see pulmonary oedema on chest x ray?
fluffy shadowing
How can you see a PE on x ray?
- Area of hypovoelamia (PE)
- Western Mark sign
- Focus of olgemia
- Rarely shown as PE usually normal X ray
When may you see large bollous (bulla) on xray?
COPD
What should you not put in with large bollous?
drain
How can you see pulmonary fibrosis on an X ray?
reticular nodular shadowing
What are DDx of pulmonary fibrosis?
- connective tissue disease, RA
- Drugs
- Asbestosis (ship builder)
What may hyperexpansion with a flat diaphragm on an xray suggest?
COPD
What could be a cause of upper lobe consolidation?
TB
What would interstitial/alveolar shadowing (fluffy) on CXR suggest?
- heart failure
- pneumonia
- pulmonary oedema
What would homogenous shadowing suggest?
pleural effusion
What are the different opacities on a CXR you can comment on?
- Interstitial/alveolar shadowing
- Reticulo-nodular shadowing
- Homogenous shadowing
- Masses/cavitations
If you are unsure for a diagnosis what should you state?
- Infection
- Inflammation
- Malignancy
If there is cardiomegaly what should you say?
increase cardiac shadow not big heart as may be normal heart but fluid around
Cardiomegaly or pericardial effusion (likely latter as globular looking)
What are DDx of bilateral hilar lymphadneopathy?
- infection: TB
- inflammation: sarcoidosis
- malignancy: lymphoma
When might there be pleural plaques on CXR?
by asbestos (different from asbestosis which is pulmonary fibrosis)
What may a blunted costophrenic angle mean?
fluid
How should you compare L vs R upper/mid/lower zone?
- alveolar,intersitital shadowing
- reticulonodular shadowing
- homogenous shadowing
What should you look at in the peripheray of a CXR?
- Pneumothroax
- Plueral thickness
- Costophrenic angles
- Diaphragm
- Heart
- Mediastinum
What is another option for PE management?
CTPA
