from oxford clinical handbook Flashcards
What do the different colours of sputum mean?
Clear - chronic bronchitis Green/yellow - pulmonary infection Black - smoke, coal dust Red - haemoptysis Frothy white/pink - pulmonary oedema
Role of US in respiratory medicine
Mostly in guiding drainage of pleural effusions/empyema
When are radionuclide scans used in chest medicine?
V/Q mismatch - occasionally in PE.
What is used to stage lung cancer?
CT
Also for diagnosis and for guiding biopsies
What is the use of HRCT in lung diseases
Diagnosis of interstitial lung disease and bronchiectasis.
When are the different types of lung biopsy indicated?
Percutaneous needle aspiration: in peripheral lung, under radiological guidance.
Transbronchial biopsy - during bronchoscopy for diagnosing diffuse lung diseases.
Causes of bronchiectasis
CF
Kartagener’s syndrome
Post infection: measles, pertussis, pneumonia, TB, HIV
Clinical features of bronchiectasis
Persistent cough, purulent sputum, haemoptysis.
Finger clubbing, coarse inspiratory crepitations.
Wheeze!
CXR signs of bronchiectasis
Thickened bronchial walls (upper lobes if CF).
Otherwise more common in lower.
Ring shadows.
Investigations for bronchiectasis
Sputum culture CXR HRCT Spirometry (often obstructive) Bronchoscopy (site of haemoptysis, exclude obstruction)
Serum immunoglobulins, CF sweat test (elevated Na and Cl)
What is the aetiology of carcinomas of the bronchus?
19% of all cancers
(basically 1/5)
40,000 deaths per year
Which hormones are can be secreted by small cell cancers of the lung?
SIADH
ACTH
Which lung tumours can secrete PTH? (hypercalcaemia)
Usually squamous cell carcinoma
What are the clinical markers for a severe asthma attack?
Inability to complete sentences
Pusle > 110
RR > 25/min
PEF 35-50% of predicted
How is chronic bronchitits defined?
Clinically, as cough and sputum production on most days for 3 months of 2 successive years.
Symptoms improve with cessation of smoking
Why is chronic bronchitis more dangerous than emphysema?
Patients rely on hypoxic drive (there is no breathlessness), yet they are cyanosed.
Insensitivity to hypercapnia.
May develop cor pulmonale.
What are the signs of COPD on CXR?
Hyperinflation
Flat hemidiaphragms
Large central pulmonary arteries
Bullae
What are signs of COPD on ECG?
Right atrial and ventricular tachycardia due to cor pulmonale.
What are the stages of COPD?
Stage 1 - FEV1 > 80% of predicted
Stage 2 - FEV 50-79
Stage 3 severe - 30-49
Stage 4 very severe - < 30% of predicted.
FVC alway < 0.7
Is it possible to see pleural effusion in a supine CXR?
only if very large, usually not
What are the clinical features of hypercapnia?
Headache Vision problems Peripheral vasodilation Bounding pulse and tachycardia Tremor/flap Papilloedema Confusion, drowsy, coma
Which conditions cause transudates
Cardiac failure, constrictive pericarditis, fluid overload
Hypoproteinamia due to nephrotic syndrome, cirrhosis or diet
Meig’s syndrome
Hypothyroidism
Exudates are caused by
increased leakiness of pleural capillaries due to infection, inflammation or malignancy
Differentials for bilateral hilar lymphadenopathy on CXR
TB Metastatic disease Sarcoidosis Lymphoma Pneumoconioses
