more resp Flashcards
diagnosis of copd
Fev1
FEV1/FVC <
80% and 0.7
(FEV1 < 30% is in severe copd)
if pleural fluid to serum ratio is less than 0.5
transudate
most common cause transudative pleural effusion is
congestive heart failure
-CGH is most common cause of bilateral pleural effusion but can also cause uniltaeral plueral effusion
transudate causes
cirrhosis
nephrotic syndrome
heart failure
risk factors for bronchiecatsis
rheumatoid arthritis and immunosupressive therapy
coarse crackles is
fine crackles is
bronchiectasis
pulmonary fibrosis
—are causes of finger clubbing
chronic suppurative respiratory infections
– is a well recognised cause of finger clubbing
bronchogenic carcinoma
PULMONARY FIBROSIS 3C’S
CLUBBING
CYANOSIS
COUGH
on ct embolus appears
grey
Ct of aortic dissction
linear flap within the lume of aorta
CT of malignnancy
irregular mass and enlarged lymph nodes and localised spread
-nosebleeds, nagal congestion, joint pains, cxr-nodules, positive p-ANCA
granuolmatosis with polyangiitis
21y/o difficulty breathing and swallowing, drooling, fever not rccieve any immunisations as a kid
epiglottitis
12y/o sore throat, no cough general malaise, swollen neck lymph nodes
Pharyngitis so do throat swab
CF patient with acute chest pain, breathlessness and hypoxia
pneumothorax
Cf patient with hypoxia, tachcardia and chest pain, onset not so sudden and accompanied with increased sputum , fever
pulmonary exacerbation of CF
subclavian line insertion is highly associated with
iatrogenic pneumothorax
costochondritis
chest pain worse on inspiration, chest wall tenderness
where does needle aspirate go
chest drain go
2nd intercostal space mid clavicular line, side of decreased breath sounds
5th intercostal space mid axillary, side of decreased breath sounds
tension pneumothorax first treatment
needle aspirate -2nd intercostal
hypercalcaemia is associated with
squamous cell carcinoma
cancer in hilar mass common of
squamous ?not 100% sure
Pulmonary alveolar proteinosis
typically in male smokers aged 20-50
- bilateral perihilar alveolar opacities similar to pulmonary oedema
- needs repeated intevention therapies
- end inspiratory crackles, cough , restrictive pattern,SOB
bopisy-granular eosinophillic material with PAS positive
alcoholic and lower zone consolidation
aspiration pneumonia
first line mamanegement of severe asthma attack
salbutamol by oxygen driven nebuliser
The volume of air that can be forcibly be blown out after full inspiration
Forced Vital capacity
not vital capacity!
measure of the carbon monoxide uptake by the lungs from a single inspiration over a set period of time
Diffusing capacity (DLCO)
what is common post bone marrow transplant, with cough and wheeze on auscultation, obstructive on spirometry
bronchiolitis obliterans
drug induced lung disorderss have – patterns
restrictive
fine crackles in lung bases indicates
fluid in the lung and not in the pleural spaces
pericardial effusion would cause
decrease cardiac output, distant heart sounds, hypotension and distended neck veins
history of hyperlipidaemia and hypertension(risk factors)
new audible systolic murmur at apex(most likely mitral valve regurg)
fine crackles in bilateral lung bases
pulmonary oedema
differentials for nocturnal cough
asthma, gord, sinusitia with post nasal drip and congestive heart failure
gord is exacerbated by
stress and lying flat
small numerous opacities in upper lung zones with hilar lymphadenopathy. hilar lymph nodes may show egg shell calcification
silicosis
cxr of tension pneumothorax
tracheal deviation to the contralateral side and depression of the hemidiaphgram ipsilaterally
FeNo> x is indicative of asthma
40ppb
x% increase in fev1 post bronchodilator is indicative of asthma
12
greater than - FEv1 follwing bronchodilator supports diagnosis of aasthma
greater than x% variability in PEFR suports diagnosis of asthma
200ml
20
factory worker
asbestos
most patient have what type of resp failure
type 1
cause of low sodium in small cell lung cancer
syndrome of inappropriate antidiuretic hormone secretion
may cause increased air trapping and increased thoracic pressure or irritation of the bronchioles worsening symptoms but it can be used carefully in ICU but need to watch so not always best
CPAP
clubbing, fine end inspiratory crackles, bibasal reticular nodular shadowing
idiopathic pulmonarry fibrosis
type 2 resp failure
low 02 and high c02
COPD
tesnion pneumothorax may present with
asymetrical chest moveemnt
hyper resonant hemithroax
absent breaths sounds
tracheal deviation
transudate effusionn is caused by
increased capilllary hydrostatic pressure or decreased oncotic pressure
exudate effusion caused by
increased capillary permeability
renal failure causes what effusion
transudate
surface landmark bewteen middle and lower right rib= oblique fissure
rib 6
smoker, chronic dyspnea, shpyeard worker, copd treatment not working, cxr- fine reticular opacitieis in lower zones, ct- interstitial thickening and ground glass opacity in upper lungs
asbestosis, pneumoconisosis, respiratory bronchiolitis associated lung disease ?
RB-ILD
not asbestosis as absence of pleural plaques
pneumocconiosis occurs in coal miners and those exposed to coal dust
exposed to pigeon droppings, pulmonary nodules and mediastinal lymph nodes
Histoplasmosis
large pneumothorax sponatenous w no trauma
14F chest drain insertion over a seldinger wire
what gives bilateral perihilar consolidations
pneumocytis jirovecii
post chemo and low neuttrophils
neutropenic sepsis
first line treatment for neutropenic sepsis
antibiotic eg tazocin ( pipperacilin and tazobactam)
- recurrent chest infection
- crackles and wheeze in left upper zone of chest
- CXR- mass w irregular border in left upper zone
adenocarcinoma
PERIPHERIES of. lung
squamous are more central and associated w smokers
asbestosis dont particularly present with
chest pain
thickening of pleura
mesothelioma
white completely opacificed lung after chest drain from penumothorax
iatrogenic haemothorax as bleeding
- sudden SOB that come without warning
- tightness in chest
- resolves within a few mins
Panic attack
holly leaves on CXR
calcified pleural plaques- not asbestosis- generally considered benign but are related to asbestos exposure
