PACES - Resp Flashcards

1
Q

Resp causes of clubbing

A

Cancer
Bronchiectasis
Emphysema
CF
Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
A

Wheeze - asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
A

Vesicular breath sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A

fine Inspiratory crackles - Fibrosis if not changed by coughing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

Coarse crackles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the indications for a lobectomy?

A

Localised cancer
TB
Abscess
Empyema
Emphysema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does interstitial lung disease present?

A

Progressive SOB on exertion
Dry cough
Malaise, fatigue
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How does pleural effusion present?
Dyspnoea Cough Pyrexia Haemoptysis Pleuritic chest pain Weight loss, rash, abdominal swelling, peripheral oedema
26
What might you see on examination of a patient with a pleural effusion?
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
Which signs might indicate that malignancy is the underlying cause of a pleural effusion?
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
Which signs might indicate that infection is the underlying cause of a pleural effusion?
chest drain scar, iv cannula, iv antibiotics, febrile
29
What are the main transudate causes of pleural effusion?
CCF Cirrhosis Nephrotic Syndrome
30
What would your differential be for a pt presenting with a likely pleural effusion?
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
What are the main exudative causes of pleural effusion?
Malignancy Infection PE Sarcoidosis Connective Tissue Disorders
32
How would you investigate a Pleural Effusion?
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
How would you manage pleural effusion?
Conservative: O2, analgesia, physio, fluids Treat the cause
34
Which drugs can cause pulmonary fibrosis?
BANS ME Bleomycin Amiodarone Nitrofurantoin Sulfasalazine Methotrexate