DPD Deck - RESP Flashcards
What are 3 important questions to ask in a respiratory history?
Ask about cough, sputum, and hemoptysis
What are 4 signs that may lead you to think a patient has a PE?
Sudden onset SOB
Signs of DVT
History of DVT/PE
Patient has been immobile, has had surgery or malignancy
What causes SOB within seconds
PE
Pneumothorax
A foreign body
What causes SOB within minutes-hours?
Chest infection (pus) Airway inflammation/obstruction Acute heart failure (fluid accumulates)
What causes SOB within days-weeks?
Chest infection, airway inflammation/obstruction, heart failure that is CHRONIC or NON-RESOLVING Interstitial lung disease Malignancy Large pleural effusion Neuromuscular Anemia/thyrotoxicosis
What are the 2 types of pneumothoraces?
Primary and Secondary
What is the management plan for a patient with a PRIMARY PNEUMOTHORAX
Step 1: Supplemental oxygen
Step 2: Determine if it is <2 or >2 cm
IF <2 cm: DISCHARGE patient and repeat CXR
IF >2 cm or SOB: Perform aspiration, if that fails insert a chest drain
Give analgesia - regular
What is the management plan for a patient with a SECONDARY PNEUMOTHORAX
Step 1: Supplemental oxygen
Step 2: Determine if its <2 or > 2 cm
IF <2 cm: Aspiration
IF >2 cm: Insert chest drain
Give analgesia - regular
How do you determine whether an ECG has a normal axis?
Look at leads 1 and 2
If one of them is overall more negative then it is NOT a normal axis
How do you determine if an ECG has right or left axis deviation?
Ensure there is abnormal axis deviation from leads 1 &2 Look at aVL Is there positive deflection: YES - there is left axis deviation NO - there is right axis deviation
What is the sign on an ECG for right bundle branch block?
MaRRoW
That is: an M on V1’s QRS and a W on V6
What is the sign on an ECG for left bundle branch block?
WiLLiaM
ie: there is a W in V1 and a M in V6
What is the management of a patient with PE?
Step 1: Is this patient haemodynamically unstable?
Step 2: YES - Begin thrombolysis
NO - Start patient on Low molecular weight heparin
Step 3: Perform a CT angiogram
Step 4: Once diagnosis is confirmed - start the patient on warfarin
What does a FEV1/FVC ratio of >70% indicate?
RESTRICTIVE lung disease
What does a FEV1/FVC ratio of <70% indicate?
OBSTRUCTIVE lung disease
DDx of progressive SOB, dry cough, clubbing, FEV/FVC ratio >70%?
Idiopathic fibrosing alveolitis Connective tissue disease Rheumatoid arthritis Drugs Asbestosis (ship builder's disease)
When presenting an X-RAY how do you start?
This is a PA/AP CXR of
“Patient’s name and DOB”
“Taken on (date)”
“At (time)”
Comment on the quality of the film:
Rotation
Inspiration
Penetration
How do you determine whether an x-ray is rotated?
Look at the spine on the x-ray, are the spinous processes equidistant to each clavicle
How do you determine the penetration of the x-ray?
If the x-ray is ‘too white’ then it is underpenetrated
What are the different opacities on a CXR and what do they indicate?
- Interstitial/alveolar shadowing (fluffy white): pus from pneumonia, fluid from heart failure or blood from a pulmpnary haemorrhage
- Reticulo-nodular shadowing: pulmonary fibrosis
- Homogenous (white) shadowing: Pleural effusion
- Masses/cavitations
How can you differentiate between a pleural effusion and collapsed lung?
A pleural effusion will PUSH the trachea away from the pathology. The collapsed lung will PULL the trachea towards the pathology
What is a globular heart a sign of?
Fluid around the pericardium, i.e PERICARDIAL EFFUSION
Name 3 causes of bilateral hilar lymphadenopathy
Infection - TB
Inflammation - Sarcoidosis
Maligancy - Lymphoma
What should you look for in a CXR other than opacities?
Pneumothorax
Pleural thickening
Costophrenic angles - are they sharp?
The diaphragm
The heart (should be less than 50% of the chest)
The mediastinum - check for lymphadenopathy
