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Med 1 > OSCE Respiratory > Flashcards

OSCE Respiratory Flashcards

1
Q

Interstitial Pulmonary Fibrosis Causes

A
  1. Idiopathic- Cryptogenic alveolitis
  2. Iatrogenic
    - Methotrexate
    - Amiodarone
  3. Extrinsic Allergic Alveolitis
    - Bird fancier’s
    - Farmer’s lung
  4. Inhaled antigen
    - Asbestosis
    - Coal worker’s Pneumoconiosis
  5. Systemic disease
    - RA
    - Sarcoid
    - SLE
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2
Q

Respiratory causes of clubbing

A

A- Asbestosis/ Abscess
B- Bronchogenic carcinoma, brochiectasis
C- Cystic Fibrosis
E- Empyema

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3
Q

Findings in CONSOLIDATION

A

Dull percussion note
Reduced breath sounds + bronchial breathing
Increased vocal resonance
No mediastinal shift

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4
Q

Findings in Collapse

A

Dull percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift towards collapse

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5
Q

Findings in Pneumonectomy

A

Dull percussion note
Absent breath sounds
Absent vocal resonance
Mediastinal shift towards absent lung

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6
Q

Findings in Effusion

A

Stony dull percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift away if large effusion

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7
Q

Findings in Pneumothorax

A

Hyperresonant percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift away from pneumothorax

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8
Q

Indications for Lobectomy/Pneumonectomy

A
  1. Bronchogenic Ca- 25% of non-squamous cell ca is resectable
  2. Bronchiectasis
  3. Trauma
  4. TB
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9
Q

Causes of consolidation in lung

A
  1. Pneumonia
  2. Malignancy
  3. Infarction
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10
Q

Causes of bronchiectasis

A

Congenital
- Kartagner’s, Primary Ciliary Dyskinesia

Post Infective
- Pneumonia, TB, Pertussis

Immunodeficiency
- Hypogammglobinaemia

Systemic/Other
- RA, UC

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11
Q

Causes of Horner’s Syndrome

A
  1. Central lesion- stroke/tumour/MS
  2. T1 lesion- neurofibroma
  3. Brachial plexus lesion- pancoast tumour(apex of lung), trauma- birth injury(Klumpke’s)
  4. Neck lesion- carotid artery aneurysm
  5. Cluster headaches
  6. Chest drain insertion
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12
Q

Causes of Pleural effusion (Transudate)

A

Protein < 30 g/L

  1. Left Ventricular Failure
  2. Volume overload
  3. Hypoalbuniaemia
  4. Meig’s Syndrome
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13
Q

Meig’s Syndrome triad

A
  1. Pleural effusion
  2. Ascites
  3. Benign ovarian mass
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14
Q

Causes of Pleural Effusion (Exudate)

A 
(EXTRA- Light's Criteria- for exudative)
Protein > 30 g/L
1. Infection: TB, Pneumonia
2. PE
3. Inflammatory process- RA, SLE
4. Malignancy- Bronchiogenic Ca, Mesothelioma
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15
Q

Causes of FINE bi-basal creps

A
  1. Pulmonary oedema

2. Interstitial Pulmonary Fibrosis

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16
Q

Causes of COARSE bi-basal creps

A
  1. Pneumonia
  2. Bronchiectasis
  3. CF
17
Q

Causes of peripheral cyanosis

A
  1. Peripheral Vascular Disease
  2. Raynaud’s
  3. Heart Failure
  4. Central cyanosis
  5. Shock
18
Q

Causes of central cyanosis

A
  1. Hypoxic lung disease
  2. Cyanotic congential shunt (R to L)
  3. Methemoglobinaemia- drugs and toxins
19
Q

Causes of SOB

A 
Respiratory
Obstructive lung disease: COPD, Asthma
Restrictive lung disease- IPF
Infectious (pneumonia, TB, pleurisy)
Pulmonary oedema
Pulmonary effusions
PE
Pneumothorax
Cardiovascular
Congestive Heart Failure
MI
Pericardial effusion
Anemia

Metabolic
Acid-base imbalance

20
Q

Causes of Hypercapnia

A
  1. Airway diseases- COPD
  2. Sleep Apnea
  3. PE- gas exchange affected
  4. Genetic- Guillain Barre- neuromuscular weakness
  5. Neuromuscular- alpha-1 anti-trypsin deficiency
21
Q

Causes of elevated JVP

A
  1. RHF
  2. PE
  3. SVC obstruction
22
Q

Causes of Candida

A

Immunosuppression due to:

  • HIV
  • Steroids
23
Q

Conclusion of resp exam

A
  1. Peak Flow
  2. Pulmonary function test
  3. Chest X Ray
  4. ABG
  5. Cardiac exam
24
Q

Examining for tracheal deviation

A

Placing your index and ring finger of the right hand on the head of each clavicle, use the middle finger of the same hand to palpate the trachea in the sternal notch. Roll you finger across the trachea in the horizontal plane to assess for deviation.

25
Q

Causes of reduced chest expansion (less than 5)

A

Normal- 2 to 5 cms

  1. Fibrosis
  2. Collapse
  3. Effusion
  4. Pneumothorax
26
Q

How do you differentiate between consolidation and pleural effusion

A
  1. Both are dull to percussion (though effusion is classically ‘stony dull’)
  2. In effusion vocal resonance is decreased or absent, in consolidation vocal resonance is increased.
27
Q

Causes of wheeze

A
  1. COPD

2. Asthma

28
Q

Dull to percuss

A
  1. Consolidation
  2. Pleural effusion
  3. Lobectomy/pneumonectomy
  4. raised hemidiaphragm
29
Q

Raised Hemidiaphragm

A
  1. Identical findings to effusion
  2. CXR to differentiate
  3. Occurs due to phrenic nerve palsy
  4. Caused by trauma, malignancy or surgery
30
Q

Signs of Hyperinflation

A
  1. Increased AP Diameter
  2. Intercostal drawing/Hoover’s sign(dome of D flattened)
  3. Apex beat not palpable
  4. Hyper resonant percussion
  5. Reduced cricosternal distance(less than 3-4 finger breadths)
31
Q

Features of bronchial breathing

A
  1. Inspiration and expiration length is the same.
  2. Loud and blowing
  3. Audible gap between inspiration and expiration
  4. Reproducible stethoscope over trachea.
32
Q

Commonest types of lung cancer

A
  1. Non- Small Cell Carcinoma 80-85% of all cases, smokers, M>W
33
Q

Investigations Idiopathic Pulmonary Fibrosis (7)

A
  1. Bloods- raised CRP, Ig. ANA positive, Rheumatoid Factor +, ABG- PaO2 low, PaCO2 high
  2. CXR
  3. HRCT
  4. PFT- restrictive factor
  5. Lung Biopsy** gold standard
  6. BAL- disease severity, if lymphocytes present good prognosis,
  7. DTPA scan- V/Q
34
Q

Chest X Ray Findings IPF

A
  1. Honeycombing
  2. Reduced lung volume
  3. Bi-lateral lower zone retic-nod shadowing

Med 1 (2 decks)

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