Interactive Cases in General Medicine 2 Flashcards
In pulmonary oedema, crepitations are (unilateral/bilateral)
Bilateral
If there is sudden onset breathlessness, it could be pneumothorax, PE, or pneumonia. How can you differentiate
Pneumonia if wheeze, breathlessness, cough, sputum, haemoptysis, weight loss
PE if signs present e.g. previous DVT, immobility, surgery, malignancy
Pneumothorax otherwise if sudden onset
What can cause increased JVP?
Right heart failure secondary to pulmonary hypertension (secondary to COPD/PE)
When dealing with breathless patients, look at the onset. Describe how breathlessness onset affects ddx
Seconds: Pneumothorax, PE, foreign body, (anxiety)
Minutes:
Airways inflammation/obstruction, chest infection, acute heart failure, pulmonary haemorrhage
Days/weeks:
Any of the above unresolved,
interstitial lung disease, malignancy/large pleural effusion, anaemia/thyrotoxicosis, neuromuscular
No lung markings on a lung in a CXR is consistent with a?
Pneumothorax
How do you manage someone with sudden breathlessness and suspected pneumothorax
CXR to exclude pneumothorax (or to confirm pneumothorax)
Start them on oxygen
IF pneumothorax present in X-ray - do CHEST DRAIN:
Primary pneumothorax:
Less than 2cm, discharge, repeat x-ray. Greater than 2cm, Aspiration/chest drain (if aspiration unsuccessful), pain relief.
Secondary pneumothorax (existing lung disease): Less than 2cm, aspiration. Greater than 2cm, chest drain, pain relief.
Fluffy air space shadowing on a chest x ray can be due to?
Pus or fluid
This could be a pulmonary oedema (only case when its unilateral after a chest drain has been inserted into one lung)
Pleural aspiration is done under the guidance of?
Ultrasound
In which type of respiratory failure is CPAP used?
Type 1 respiratory failure
What is the most appropriate next step in the management of suspected PE
LMWH
BiPAP is given to people with what type respiratory failure
Type 2
If pt has bullies lung disease, do NOT …
Aspirate/chest drain
How to differentiate between obstructive and restrictive lung disease
FEV1/FVC ratio <70% = obstructive
FEV1/FVC ratio >70% = restrictive
Fibrosis is (obstructive/restrictive)
Restrictive
Look at fluffy vs reticular nodular shadowing
DO IT
How should a CXR be presented? (starting spiel)
This is a PA/AP CXR of:
- Name and DOB
- Taken on (date)
- At (time)
Comment on rotation, inspiration, penetration (too white = underpenetrated)
The left hemidiaphram MUST be visible where?
Behind the heart
If it isn’t visible there, something is wrong
Describe what the following opacities could mean:
- Interstitial/alveolar shadowing
- Reticulo-nodular shadowing
- Homogeneous shadowing
- Masses/cavitations
- Interstitial alveolar shadowing (fluffy) = fluid (pulmonary oedema), pus (pneumonia), blood
- Reticulo-nodular shadowing / Homogeneous shadowing = pleural effusion
How does the trachea deviate in a pleural effusion vs lung collapse?
Pleural effusion Pushes trachea AWAY from effused lung
In Collapse, the trachea Comes towards collapsed lung
How to approach looking at CXRs?
- Compare R vs L U/M/L zones: looking for alveolar/interstitial shadowing, reticulonodular shadowing, homogeneous shadowing
- Follow the periphery:
Is it pneumothorax? Look at pleural thickness, costophrenic angles, diaphragm, heart, mediastinum
