Lecture 2 - Resp Flashcards
Which aspects of a patient’s history would point to a diagnosis of Pneumothorax?
Sudden-onset SOB
No cough, sputum or haemoptysis
Risk factors consistent with Pneumothorax (Tall, history of COPD)
Absence of risk factors/signs of PE/DVT
How would you categorise the causes of SOB?
Onset.
Seconds (sudden): Pneumothorax, PE, FB
Mins/Hrs: Airway Disease (Obstruction/Inflammation), Chest infection (Pus), Acute Heart Failure (Fluid)
Days/Weeks: Chronic Causes, Interstitial Lung Disease, Malignancy, Large Plueral Effusion, Neuromuscular, Anaemia/Thyrotoxicosis.
Which diagnosis is suggested by this CXR?
Pneumothorax
No lung markings on affected side
Mediastinum deviated away from the lesion
How would you manage a Pneumothorax?
Start on Oxygen, prescribe analgesia.
Depends on size and cause.
Primary < 2cm: Discharge, perform a repeat CXR.
Primary > 2cm / SOB: Aspiration, Chest drain if unsuccessful.
Secondary < 2cm: Aspiration
Secondary >2cm: Chest drain
A Pneumothorax patient improved after chest drain insertion. However, they complain of recurrent SOB after 2 hours. What is the cause of the recurrent SOB indicated by the repeat CXR seen here?
Re-expansion Pulmonary Oedema as a complication of Chest Drain insertion.
What does this ECG show?
PE
RAD, RBBB
Blocked Pulmonary Artery leads to strain on the right side of the heart, hence you see right-sided changes.
How do you identify Axis Deviation (according to Amir Sam…)?
Look at I & II, is either of them negative overall?
If yes:
Look at AVL
In LAD, AVL shows a positive QRS complex.
In RAD, AVL shows a negative QRS complex.
How would you manage a patient with PE?
1) Start the patient on Low Molecular Weight Heparin.
2) Thrombolysis if Haemodynamically Compromised.
How do you identify Bundle Branch Block?
Look at V1
if it looks like an M and is broad - RBBB
If it looks like a W, and is broad - LBBB
What do these scans show?
Contrast enhanced scans show the location of a pulmonary embolism.
Oligaemia where vessels have collapsed distal to the clot.
What would typically be seen in the history and examination of a patient with COPD-linked Bullous Disease?
Lack of lung markings and fluid-air levels on CXR/CT
Decreased breath sounds, hyper-resonant percussion notes.
History of COPD/Smoking.
How is FEV1/FVC used to distinguish between different lung diseases?
>70% indicates Restrictive disease.
<70% indicates Obstructive disease.
What is seen on this CXR?
Pulmonary Fibrosis
Reticular nodular shadowing (lines and dots)
What would be your Ddx in a patient with:
Dry Cough
FEV1/FVC >70%
Progressive SOB
Clubbing
Fibrosis on CXR
?
Idiopathic Fibrosing Alveolitis
Connective Tissue Disease (eg. RA)
Drugs (eg. Methotrexate)
Asbestosis (look for occupational history)
What does this CXR show?
Emphysema in COPD
Hyperexpansion
What does this CXR show?
Right Upper Zone Consolidation
What does this CXR show?
Pleural Effusion.
Homogenous Shadowing
What does this CXR show?
Right Lung Collapse
Tracheal deviation towards the collapse.
What does this CXR show?
Cavitating Lesion
Area of shadowing with an Air-fluid level.
What does this CXR show?
Cardiomegaly/Pericardial Effusion
Heart size > 50% of the lung fields.
What does this CXR show?
Bilateral Hilar Lymphadenopathy
