OSCE Respiratory Flashcards
Interstitial Pulmonary Fibrosis Causes
- Idiopathic- Cryptogenic alveolitis
- Iatrogenic
- Methotrexate
- Amiodarone - Extrinsic Allergic Alveolitis
- Bird fancier’s
- Farmer’s lung - Inhaled antigen
- Asbestosis
- Coal worker’s Pneumoconiosis - Systemic disease
- RA
- Sarcoid
- SLE
Respiratory causes of clubbing
A- Asbestosis/ Abscess
B- Bronchogenic carcinoma, brochiectasis
C- Cystic Fibrosis
E- Empyema
Findings in CONSOLIDATION
Dull percussion note
Reduced breath sounds + bronchial breathing
Increased vocal resonance
No mediastinal shift
Findings in Collapse
Dull percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift towards collapse
Findings in Pneumonectomy
Dull percussion note
Absent breath sounds
Absent vocal resonance
Mediastinal shift towards absent lung
Findings in Effusion
Stony dull percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift away if large effusion
Findings in Pneumothorax
Hyperresonant percussion note
Reduced breath sounds
Reduced/absent vocal resonance
Mediastinal shift away from pneumothorax
Indications for Lobectomy/Pneumonectomy
- Bronchogenic Ca- 25% of non-squamous cell ca is resectable
- Bronchiectasis
- Trauma
- TB
Causes of consolidation in lung
- Pneumonia
- Malignancy
- Infarction
Causes of bronchiectasis
Congenital
- Kartagner’s, Primary Ciliary Dyskinesia
Post Infective
- Pneumonia, TB, Pertussis
Immunodeficiency
- Hypogammglobinaemia
Systemic/Other
- RA, UC
Causes of Horner’s Syndrome
- Central lesion- stroke/tumour/MS
- T1 lesion- neurofibroma
- Brachial plexus lesion- pancoast tumour(apex of lung), trauma- birth injury(Klumpke’s)
- Neck lesion- carotid artery aneurysm
- Cluster headaches
- Chest drain insertion
Causes of Pleural effusion (Transudate)
Protein < 30 g/L
- Left Ventricular Failure
- Volume overload
- Hypoalbuniaemia
- Meig’s Syndrome
Meig’s Syndrome triad
- Pleural effusion
- Ascites
- Benign ovarian mass
Causes of Pleural Effusion (Exudate)
(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
Causes of FINE bi-basal creps
- Pulmonary oedema
2. Interstitial Pulmonary Fibrosis
Causes of COARSE bi-basal creps
- Pneumonia
- Bronchiectasis
- CF
Causes of peripheral cyanosis
- Peripheral Vascular Disease
- Raynaud’s
- Heart Failure
- Central cyanosis
- Shock
Causes of central cyanosis
- Hypoxic lung disease
- Cyanotic congential shunt (R to L)
- Methemoglobinaemia- drugs and toxins
Causes of SOB
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
Causes of Hypercapnia
- Airway diseases- COPD
- Sleep Apnea
- PE- gas exchange affected
- Genetic- Guillain Barre- neuromuscular weakness
- Neuromuscular- alpha-1 anti-trypsin deficiency
Causes of elevated JVP
- RHF
- PE
- SVC obstruction
Causes of Candida
Immunosuppression due to:
- HIV
- Steroids
Conclusion of resp exam
- Peak Flow
- Pulmonary function test
- Chest X Ray
- ABG
- Cardiac exam
Examining for tracheal deviation
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.
Causes of reduced chest expansion (less than 5)
Normal- 2 to 5 cms
- Fibrosis
- Collapse
- Effusion
- Pneumothorax
How do you differentiate between consolidation and pleural effusion
- Both are dull to percussion (though effusion is classically ‘stony dull’)
- In effusion vocal resonance is decreased or absent, in consolidation vocal resonance is increased.
Causes of wheeze
- COPD
2. Asthma
Dull to percuss
- Consolidation
- Pleural effusion
- Lobectomy/pneumonectomy
- raised hemidiaphragm
Raised Hemidiaphragm
- Identical findings to effusion
- CXR to differentiate
- Occurs due to phrenic nerve palsy
- Caused by trauma, malignancy or surgery
Signs of Hyperinflation
- Increased AP Diameter
- Intercostal drawing/Hoover’s sign(dome of D flattened)
- Apex beat not palpable
- Hyper resonant percussion
- Reduced cricosternal distance(less than 3-4 finger breadths)
Features of bronchial breathing
- Inspiration and expiration length is the same.
- Loud and blowing
- Audible gap between inspiration and expiration
- Reproducible stethoscope over trachea.
Commonest types of lung cancer
- Non- Small Cell Carcinoma 80-85% of all cases, smokers, M>W
Investigations Idiopathic Pulmonary Fibrosis (7)
- Bloods- raised CRP, Ig. ANA positive, Rheumatoid Factor +, ABG- PaO2 low, PaCO2 high
- CXR
- HRCT
- PFT- restrictive factor
- Lung Biopsy** gold standard
- BAL- disease severity, if lymphocytes present good prognosis,
- DTPA scan- V/Q
Chest X Ray Findings IPF
- Honeycombing
- Reduced lung volume
- Bi-lateral lower zone retic-nod shadowing
