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Finals > PACES - Resp > Flashcards

PACES - Resp Flashcards

1
Q

Resp causes of clubbing

A

Cancer
Bronchiectasis
Emphysema
CF
Fibrosis

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2
Q
A

Wheeze - asthma

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3
Q
A

Vesicular breath sounds

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4
Q
A

fine Inspiratory crackles - Fibrosis if not changed by coughing

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5
Q
A

Coarse crackles

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6
Q

What are the indications for a lobectomy?

A

Localised cancer
TB
Abscess
Empyema
Emphysema

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7
Q

how does interstitial lung disease present?

A

Progressive SOB on exertion
Dry cough
Malaise, fatigue
Weight loss

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8
Q

What might you see on examination of a patient with interstitial lung disease?

A

Clubbing
Scars
Reduced chest expansion
Fine late end-inspiratory crepitations that do not clear with coughing but do quieten/disappear on leaning forwards

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9
Q

What are the underlying causes of interstitial lung disease (and their signs)

A

Rheumatoid arthritis: peripheral symmetrical deforming polyarthropathy (swan neck deformity, Z thumb, ulnar deviation at wrist, may have nodules) NB: the cause of the pulmonary fibrosis may be RA itself or methotrexate use in an RA patient

Amiodarone: slate grey appearance, pacemaker, may be in AF, photosensitivity

Connective tissue disease: cutaneous signs of systemic sclerosis, lupus, dermatomyositis

Ankylosing spondylitis: question mark posture, protuberant abdomen

Radiation: may have radiation tattoo on chest wall, lymphadenopathy

Sarcoidosis: cutaneous signs of sarcoidosis

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10
Q

What causes upper zone fibrosis

A

BREAST

Berylliosis

Radiation e.g. for breast cancer

Extringic allergic alveolitis, pneumoconiosis e.g. coal workers

Ankylosing spondylitis, ABPA (Allergic bronchopulmonary aspergillosis)

Silicosis, sarcoidosis psoriasis

Tuberculosis (and histoplasmosis and histiocytosis-X)

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11
Q

What causes lower lobe fibrosis?

A

RASIO

Rheumatoid arthritis

Asbestosis

Scleroderma, SLE, Sjogrens (and poly/dermatomyositis)

Idiopathic pulmonary fibrosis

Others: Drugs- methotrexate, bleomycin, busulphan, cyclophosphamide, nitrofurantoin, isoniazid, amiodarone, phenytoin, carbamazepine, gold, sulphasalasine.

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12
Q

How would you investigate lung fibrosis?

A

Bedside: ECG, ABG

Bloods: FBC (eosinophilia, anaemia, polycythaemia), CRP, ESR, Autoimmune screen including antibodies, serum ACE

Imaging: CXR, High resolution CT

Special tests: Lung function tests, Biopsy, Echo (Pulmonary HTN)

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13
Q

What signs might you see on CXR of someone with pulmonary fibrosis?

A

Bilateral reticulonodular interstitial infiltrates (parenchymal shadowing)
Ground-glass/honeycombing if advanced
Volume loss

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14
Q

Which signs might you see on HRCT of a patient with pulmonary fibrosis?

A

Reticulation
Ground glass (usually good response to steroid treatment)
Volume loss
Honeycombing

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15
Q

How would you manage Pulmonary Fibrosis?

A

Conservative: Stop smoking, remove triggers, vaccines, pulmonary physio

Medical: Treat cause. Manage infections. Steroids. Immunosuppressants (Azathioprine)

Surgical: Lung Transplant

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16
Q

How would bronchiectasis present?

A

Shortness of breath
Chronic productive cough: thick, smelly, purulent sputum
Haemoptysis
Recurrent infections
Pleuritic chest pain
Weight loss
History of childhood infections, sinusitis, subfertility

17
Q

Which signs might you see in a patient with bronchiectasis?

A

Clubbing
May have scars
Reduced chest expansion
Early coarse inspiratory crepitations that alter with coughing but do not quieten/disappear on leaning forwards
Wheeze, inspiratory clicks

18
Q

Which complications of bronchiectasis might you be able to pick up on on examination?

A

respiratory failure (oxygen, cyanosis, CO2 retention flap)

cor pulmonale (RV heave, loud P2, raised JVP, peripheral oedema)

infection (bronchial breathing, antibiotics at bedside, fever)

19
Q

What might cause bronchiectasis?

A

Cystic Fibrosis: young, thin, short, PEG, portacath/Hickmann, signs of chronic liver disease

Kartagener’s Syndrome: Dextrocardia

Connective tissue disease: peripheral symmetrical deforming polyarthropathy, cutaneous signs of lupus

Yellow Nail Syndrome: yellow nails, lymphoedema

COPD, HIV, Post-infective (TB, pertussis, measles)

20
Q

How might you investigate bronchiectasis?

A

Bedside: ABG (Resp Failure), ECG (R.Heart Strain)

Bloods: FBC (anaemia, eosinophilia), CRP, Autoimmune screen, HIV test, Aspergiluus percipitins and IgE

Sputum MC&S

Imaging: CXR, HRCT

Lung Function tests, Biopsy, Sweat test

21
Q

What might you see on CXR of a patient with bronchiectasis?

A

Tramlines (diseased bronchi side on)
Ring shadows (diseased bronchi end on)
Gloved finger: mucoid impactions in large air ways
Hyperinflation
7% normal CXR

22
Q

What might you see on HRCT of a patient with bronchiectasis?

A

Signet ring sign- thickened end-on dilated bronchus >1.5 times larger than adjacent pulmonary artery
Tram tracking
Ring shadows
Volume loss
Flame and blob sign: mucus plugging

23
Q

How would you manage bronchiectasis?

A

Conservative: Stop smoking, vaccines, physiotherapy

Medical: Treat cause, steroids, bronchodilators, ABx

Surgical: Lobectomy, Transplant

24
Q

What are the main complications of bronchiectasis?

A

infection (Pseudomonas, Haemophilus influenzae), Empyema, Cor Pulmonale, Anaemia, Secondary amyloidosis

25
Q

How does pleural effusion present?

A

Dyspnoea

Cough

Pyrexia

Haemoptysis

Pleuritic chest pain

Weight loss, rash, abdominal swelling, peripheral oedema

26
Q

What might you see on examination of a patient with a pleural effusion?

A

Reduced expansion
Trachea displaced away from side of the effusion

Apex beat shifted away from the side of the effusion
Stony dull percussion note
Decreased vocal resonance
Reduced air entry/breath sounds
Bronchial breathing may be present above the effusion

27
Q

Which signs might indicate that malignancy is the underlying cause of a pleural effusion?

A

clubbing, cachexia, lymphadenopathy, tar staining, radiation burns, Horner’s syndrome, small hand muscle wasting, hypertrophic pulmonary osteoarthropathy (HPOA), evidence of chemo eg. hair loss, resection scars, mastectomy scars

28
Q

Which signs might indicate that infection is the underlying cause of a pleural effusion?

A

chest drain scar, iv cannula, iv antibiotics, febrile

29
Q

What are the main transudate causes of pleural effusion?

A

CCF
Cirrhosis
Nephrotic Syndrome

30
Q

What would your differential be for a pt presenting with a likely pleural effusion?

A

Lower Lobe collapse

Lobectomy (would expect to see a scar)

Raised hemidiaphragm eg. phrenic nerve palsy, hepatomegaly

Basal consolidation

Pleural thickening eg. pleural plaques

Mitotic mass

31
Q

What are the main exudative causes of pleural effusion?

A

Malignancy
Infection
PE
Sarcoidosis
Connective Tissue Disorders

32
Q

How would you investigate a Pleural Effusion?

A

Bedside: ECG (RH Strain) ABG (Resp Failure), Dipstick (Proteinuria)

Bloods: Routine + CRP/ESR, AI Screen, Lipid profile

Sputum MC&S

Pleural Fluid analysis. Can use USS here

Imaging: CXR, HRCT

33
Q

How would you manage pleural effusion?

A

Conservative: O2, analgesia, physio, fluids

Treat the cause

34
Q

Which drugs can cause pulmonary fibrosis?

A

BANS ME
Bleomycin
Amiodarone
Nitrofurantoin
Sulfasalazine
Methotrexate

Finals (12 decks)

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