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ICM Matrix > Resp > Flashcards

Resp Flashcards

1
Q

What does a sputum sample film show in acute bronchitis?

A

Neutrophil granulocytes (inflammatory WBCs)

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2
Q

What pathogen causes influenza?

A

RNA virus - orthomyxoviridae

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3
Q

How is influenza diagnosed?

A

Clinical diagnosis

- viral culture - PCR

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4
Q

What are the symptoms of influenza?

A
  • Coryzal symptoms
  • Fever
  • Headache
  • Non-productive cough
  • Sore throat
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5
Q

What is croup?

A
  • Inflammation of the upper respiratory tract
  • acute laryngotracheitis
  • due to viral infection
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6
Q

What organism is most responsible for croup?

A
  • Parainfluenza

- RSV

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7
Q

What are the symptoms of croup?

A

Seal-like barking cough

  • runny nose
  • fever
  • stridor
  • voice hoarseness
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8
Q

How do you diagnosis croup?

A

Clinical diagnosis

- Significant resp impairment ( O2 <95%)

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9
Q

Is RSV contagious?

A

Yes

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10
Q

What is the most common complication RSV?

A

Bronchiolitis

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11
Q

How is RSV spread?

A

air droplet

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12
Q

What are the RSV symptoms?

A

Cold-like symptoms:

  • low grade fever
  • wheezing
  • chest congestion / rhinorrhea
  • SOB
  • Cough
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13
Q

What is bacterial pneumonia?

A
  • bacterial mediated inflammation

- infection of the lung tissue in which the alveoli become filled with MO, fluid & inflamm cells

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14
Q

What are the most common microorganism causing bacterial pneumonia?

A
  • streptococcus pneumonia
  • H.influenza
  • staphylococus aureus
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15
Q

What are the key symptoms for bacterial pneumonia?

A
  • Green Productive Cough*
  • SOB
  • Fever
  • Chest pain
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16
Q

What are the key signs for bacterial pneumonia?

A
  • Increased tactile & vocal fremitus
  • Dullness to percuss
  • Bronchial breath sounds
  • Late inspiratory crackles
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17
Q

Investigations for pneumonia?

A
  • CXR : to identify location and extent

- CRP : inflammation

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18
Q

What score is used to admit pt to hospital with pneumonia?

A

CRB-65
> 3 = urgent admission
> 2 = hospital management
0 = conservative management at home

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19
Q

What are the key symptoms for viral pneumonia?

A

Non-productive cough

Systemic symptoms:

  • fever
  • runny nose
  • myalgia
  • fatigue
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20
Q

What are the investigation findings for viral pneumonia?

A
  • Viral PCR

- CXR : more likely bilateral consolidation

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21
Q

What is acute bronchiolitis?

A
  • Acute viral infection of the LRT

- Characterised by epithelial destruction, cellular oedema & airwary obstruction by inflamm debris & mucus

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22
Q

Most common cause of bronchiolitis

A

RSV

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23
Q

what are the symptoms of acute bronchiolitis?

A
  • Fever
  • Cough
  • Poor feeding
  • Apnoea
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24
Q

What are the signs of acute bronchiolitis?

A

Clinical diagnosis: < 2 presenting with 1-3 days hx of coryzal symptoms

  • persistent cough
  • tachypnoea or chest recession (both)
  • wheeze or crackles OA (both)
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25
Q

Investigation for acute bronchiolitis

A

CLINICAL DIAGNOSIS

  • check 02 sats
  • CXR not recommended unless evidence of deterioration
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26
Q

What is acute epiglottitis?

A

Cellulitis of the supra-glottis - may cause airway compromise.
- Airway emergency in children

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27
Q

What is the most common cause for acute epiglottitis?

A

H.Influenza

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28
Q

What are the symptoms of acute epiglottitis?

A
  • Sore throat
  • Stridor
  • Tripod position : lean forward + extending neck.
  • Dysphagia
  • Fever
  • Drooling
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29
Q

What are the signs for acute epiglottitis?

A

High - pitched inspiratory wheeze

* DO NOT EXAMINE THROAT*

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30
Q

What are the investigation finding for acute epiglottitis?

A

Lateral neck radiograph - THUMB SIGN

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31
Q

What are the complications of acute epiglottitis?

A
  • Abscess formation
  • Sepsis
  • Pneumothorax
  • Meningitis
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32
Q

What is pertussis?

A
  • Whooping cough
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33
Q

What organism causes pertussis?

A
  • Bordetella Pertussis
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34
Q

How is pertussis transmitted?

A
  • Sneeze or cough (airborne)
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35
Q

What are the 3 phases of symptoms called in Pertussis?

A

1st phase = catarrhal

  • runny nose
  • malaise
  • sore throat
  • low-grade fever
  • dry cough

2nd phase = paroxysmal (1-6 weeks)

  • short expiratory burst followed by inspiratory gasp (whoop)
  • thick mucus secretions

3rd phase = convalescent (3 months)
- gradual improvements in cough frequency + severity

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36
Q

What are the key symptoms should you suspect for pertussis?

A

Acute cough > 14 days w/ no apparent cause w/:

  • paroxysmal cough
  • inspiratory whoop
  • Post-tussive vomiting
  • undiagnosed apnoeic attack
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37
Q

How to diagnose pertussis?

A

Nasopharyngeal swab

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38
Q

What is empyema?

A

Defined as the presence of frank pus in the pleural space.

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39
Q

What are the common infection causing empyema?

A
  • Due to post pneumonia
  • Anaerobic, staph & gram-negative infections
  • Klebsiella: alcoholism, currant jelly-like sputum.
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40
Q

What are the symptoms of empyema?

A
  • SOB
  • Fever
  • Pleuritic chest pain
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41
Q

What are the signs of empyema?

A
  • Tachypnoea
  • Reduced breath sounds
  • Dullness to percuss
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42
Q

What are the investigation findings of empyema?

A

CXR: blunting of the costophrenic angle or effusion on affected side
CRP & WCC- raised in infection

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43
Q

What investigation is diagnostic for empyema?

A

Thoracentesis: aspiration of the frank pus

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44
Q

What is chronic bronchitis?

A

Long-term inflammation of the lining of the bronchial tubes

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45
Q

What are the symptoms of chronic bronchitis?

A
  • Cough
  • Sputum
  • Fatigue
  • SOB
  • Chest discomfort
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46
Q

What is emphysema?

A

Condition causes SOB due to damaged alveoli in the lungs

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47
Q

What are the signs and symptoms of emphysema?

A
  • SOB (progressive & at rest)
  • Fatigue
  • Central & peripheral cyanosis
  • Persistent wheeze
  • Productive cough
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48
Q

What are the signs of emphysema?

A
  • ” Pink puffers”
  • Accessory muscle use
  • Barrel chest
  • Hyper-resonance on percussion
  • Absent or quiet breath sounds on auscultation
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49
Q

What are the investigation for emphysema?

A
  • Bloods: Serum Alpha 1-antitrypsin
  • CXR
  • Sputum culture
  • Lung function test
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50
Q

What does COPD stand for?

A

Chronic Obstructive Pulmonary Disease

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51
Q

What is COPD?

A
  • Airflow limitation

Group of progressive lung disease including chronic bronchitis & emphysema (treatable but not curable)

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52
Q

What is the pathophysiology of COPD?

A

CB: damage to endothelium impairing the mucociliary response to clear mucus & bacteria – airway deformation & narrowed lumen

EMP: enlargement of alveoli, leading to decline in gas exchange

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53
Q

What deficiency causes COPD?

A

Alpha 1-trypsin

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54
Q

What are the symptoms for COPD?

A
  • SOBOE (progressive)
  • Chronic cough
  • Regular sputum production
  • Wheeze
  • Weight loss
  • Fatigue
  • PND
  • Ankle swelling (cor pulmonale)
  • Chest pain
  • Haemoptysis
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55
Q

What are the signs for COPD?

A
  • Frequent LRTI
  • Cyanosis
  • Raised JVP
  • Cachexia
  • Barrel chest
  • Accessory muscle use
  • Purse lip breathing
  • Crackles OA
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56
Q

How is COPD diagnosed?

A

Clinical features + spirometry

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57
Q

What investigations are carried when suspecting COPD?

A
  • Spirometry
  • CXR
  • ABG
  • Sputum culture
  • Serum alpha 1-trypsin
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58
Q

What spirometry findings confirms persistent airflow obstruction?

A

A post-bronchodilator FEV1/FVC < 0.7

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59
Q

How is the severity of COPD classified?

A

Post-bronchodilator FEV1/FVC < 0.7

FEV1 (of predicted)
> 80% : Stage 1 - Mild - symptoms should be present to diagnose COPD in these patients

50-79% : Stage 2 - Moderate

30-49% : Stage 3 - Severe

< 30% : Stage 4 - Very severe

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60
Q

What are CXR findings in COPD?

A
  • Hyperinflation
  • Bullae
  • Flat haemodiaphragm

(exclude cancer)

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61
Q

What are the asthmatic features when treating COPD?

A

1) any previous, secure diagnosis of asthma or of atopy
2) a higher blood eosinophil count
3) substantial variation in FEV1 over time (at least 400 ml)
4) substantial diurnal variation in peak expiratory flow (at least 20%)

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62
Q

What are the complications of COPD?

A
  • Secondary polycythaemia : Increased haematocrit due to long-term hypoxia
  • Respiratory acidosis: indicates BiPAP
  • Recurrent chest infections
  • Cor pulmonale
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63
Q

What can a large bullae in CXR in COPD mimic?

A

Pneumothorax

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64
Q

What type of bacteria is Haemophilus influenza?

A
  • Gram negative rod
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65
Q

What is asthma?

A

Chronic respiratory condition associated with airway inflammation and hyper-responsiveness.

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66
Q

What is asthma associated with?

A

Eczema + Hay fever

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67
Q

What features is required for the classification of moderate asthma?

A

1) PEFR 50-75% best or predicted
2) Speech normal

3) RR < 25 / min
4) Pulse < 110 bpm

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68
Q

What features is required for the classification of severe asthma?

A

1) PEFR 33 - 50% best or predicted
2) Can’t complete sentences

3) RR > 25/min
4) Pulse > 110 bpm

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69
Q

What features is required for the classification of life-threatening asthma?

A

1) PEFR < 33% best or predicted
2) Oxygen sats < 92%

3) ‘Normal’ pC02 (4.6-6.0 kPa)
4) Silent chest, cyanosis or feeble respiratory effort
5) Bradycardia, dysrhythmia or hypotension
6) Exhaustion, confusion or coma

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70
Q

What are the features of klebsiella pneumonia?

A
  • RF: alcohol and diabetes
  • ‘red-currant jelly’ sputum
  • Upper lobe
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71
Q

What are the common symptoms associated with asthma?

A
  • Wheeze
  • Chest tightness
  • SOB
  • Cough
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72
Q

What are the clinical signs associated with asthma?

A
  • OBS : HR > 110, RR > 25
  • Tracheal deviation
  • Widespread wheeze OA
  • Chest deformity/ hyperinflated chest ( chronic asthma)
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73
Q

When do symptoms of asthma commonly present (timing)?

A
  • Worse at night
  • Early in the morning
  • In response to exercise
  • Allergen exposure
  • Cold air
  • After taking aspirin or BB
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74
Q

What does normal PaCO2 in acute asthma indicate?

A
  • Exhaustion

This is classified as life-threatening

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75
Q

When is chest X-RAY indicated in acute asthma?

A

Not routinely done”

  • life-threatening asthma
  • suspected pneumothorax
  • failure to respond to treatment
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76
Q

What investigations are considered in asthma?

A

1) Spirometry : < 70 % in FEV1/FVC suggests airflow limitation
- -> normal spirometry does not r/o asthma
- -> BDR: confirms diagnosis, > 12% improvement, with an increase in volume of > 200ml is positive result

2) Peak flow : > 20% variability is positive result
- ->support diagnosis

3) FENO testing : esonophilic airway limitation support diagnosis (> 40 ppb)
4) Allergy testing

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77
Q

What is sleep apnoea?

A

the interruption of sleep as a result of a narrowing of the throat

78
Q

What symptoms can indicate sleep apnoea?

A
  • Loud snoring
  • Day time sleepiness
  • impaired concentration
  • Unrefreshed on waking
  • Witnessed apnoea: choking noises while sleeping
79
Q

What should you examine for in sleep apnoea?

A
  • Enlarged tonsils
  • small jaw
  • nasal blockage
80
Q

What questionnaire is helpful in diagnosing OSAS?

A

Epsworth sleepiness questionnaire

81
Q

What investigations can be carried out in sleep apnoea?

A
  • Polysomnography : sleep study to measure apnoea /hypoapnoea episodes
  • Lung function
  • Endoscopy
82
Q

What is Pulmonary Embolism?

A

One or more emboli from a thrombus in the vein, lodged in and obstructing the pulmary arterial system causing resp dysfunction

83
Q

What are the risk factors for PE?

A

1) Immobilisation
2) Surgery in the last 4 weeks
3) Previous DVT/PE
4) Malignancy
5) Increased coagulability

84
Q

What is the triad of symptoms for PE?

A

1) SOB
2) Chest pain
3) Haemoptysis

  • cyanosis
  • unilateral leg swelling
  • syncope
85
Q

Signs of PE

A
  • Tachycardia
  • RR > 20
  • Raised JVP
  • Pleural rub
  • Hypotension
86
Q

What score is used for PE?

A

Wells score :

1) DVT
2) PE is #1 diagnosis OR equally likely
3) Heart rate > 100
4) Immobilization at least 3 days OR surgery in the previous 4 weeks
5) Previous, objectively diagnosed PE or DVT
6) Haemoptysis
7) Malignancy w/ treatment within 6 months or palliative

87
Q

What is the 1st line investigation for PE?

A

CTPA

> 4 points on Well’s

88
Q

When is CTPA contraindicated?

What is 1st line in this case?

A

Renal impairment - due to contrast
Pregnancy

1st line in above = V/Q scan

89
Q

When do you offer D-dimer test?

A

< 4 points on Well’s

90
Q

If CTPA is negative, what is the next step if DVT is suspected?

A

Proximal Leg USS

91
Q

What ECG changes is associated with PE?

A

1) Large S wave in lead I
2) Q wave in lead III
3) Inverted T-wave in lead III
* S1Q3T3*

4) RBBB
5) RAD

92
Q

What might you see on an ABG in PE?

A

Respiratory alkalosis

93
Q

If a pt has PE + hypotension, what would you do?

A

Thrombolyse (alteplase)

94
Q

What is 1st line medication in PE without hypotension?

A

DOAC - apixaban or rivaroxaban

95
Q

What is another criteria used in PE?

A

pulmonary embolism rule-out criteria (the PERC rule)

  • -> all the criteria must be absent to have negative PERC result, i.e. rule-out PE
  • -> this should be done when you think there is a low pre-test probability of PE, but want more reassurance that it isn’t the diagnosis
  • -> a negative PERC reduces the probability of PE to < 2%
  • -> if your suspicion of PE is greater than this then you should move straight to the 2-level PE Wells score, without doing a PERC
96
Q

What is the PERC?

A

Criteria:

1) Age > 50
2) HR > 100
3) O2 < 94%
4) Previous DVT or PE
5) Recent surgery or trauma in the past 4 weeks
6) Haemoptysis
7) Unilateral leg swelling
8) Oestrogen use

97
Q

If Well’s score is > 4 points, what does it mean and what is the algorithm?

A

PE likely:

1) CTPA
2) Delay in CTPA, interim anticoag until scan

98
Q

If Well’s score is < 4 points, what does it mean and what are the next steps?

A

PE unlikely:

1) D-dimer test
- -> If + , CTPA
- -> if - , stop anticoag and consider alternative diagnosis

99
Q

What is the possible CXR finding in PE?

A
  • Typically normal

- Possible wedge-shaped opacification

100
Q

Which score is used when starting and continuing anticoagulation in PE?

101
Q

What is Cor Pulmonale?

A

Right ventricle failure through pulmonary artery htn due to lung disorder

102
Q

What can cause Cor Pulmonale?

A
  • PE
  • Acute respiratory distress syndrome
  • Chronic : COPD
103
Q

What are the symptoms of COR Pulmonale?

A
  • SOB
  • Chest pain
  • Fatigue
  • DIzziness
  • SOBOE
  • Ankle swelling
104
Q

What are signs associated with Cor Pulmonale?

A
  • Left parasternal heave* (sign of right ventricular hypertrophy)
  • S3, S4 + pansystolic murmur
  • Intercostal recession
  • Systolic bruits
  • Raised JVP
  • Increased HR
  • Crackles
105
Q

What are the ECG findings associated with Cor Pulmonale?

A
  • Increased P wave amplitude
  • PR depression
  • RAD
106
Q

What investigation can be carried out for Cor Pulmonale?

A

CXR = rught artial size + pulmonary artery enlargement

CTPA/MRI of the chest

V/Q scan = PE or RHF

107
Q

Painful rash + cough = diagnosis?

A

sarcoidosis

108
Q

What pathogen is the most common cause for fungal pneumonia?

A

Pneumocystis Jiroveci

Typically seen in patients with HIV

109
Q

What are the symptoms and signs associated with Pneumocystis Jiroveci?

A
  • dry cough
  • SOB
  • Fever
  • exercise induced desaturations
  • absence of chest signs
110
Q

What is pneumocystis pneumonia?

A
  • fungal infection in one or both lungs

- common in people with weakened immune system (AIDs)

111
Q

What is pneumocystis jiroveci also known as?

A

Pnuemocystis carinii pneumonia (PCP)

- most common opportunistic infection in AIDs

112
Q

What is a common complication of PCP?

A

pneumothorax

113
Q

What investigations are carried our for PCP?

A
  1. CXR: bilateral interstitial pulmonary infiltrates but can present with other x-ray findings e.g. lobar consolidation.
  2. Sputum often fails to show PCP
  3. Special test: bronchoalveolar lavage (BAL) - often needed to demonstrate PCP (silver stain shows characteristic cysts)
114
Q

When is PCP prophylaxis indicated?

A

all patients with a CD4 count < 200/mm³

115
Q

What is Tuberculosis?

A
  • Infection caused by Mycobacterium tuberculosis that most commonly affects the lungs
116
Q

What are the symptoms of TB?

A
  1. Coughing > 3 weeks
  2. Haemoptysis
  3. Night sweats
  4. Unintended weight loss
117
Q

What are the investigations carried out for TB?

A

1) Chest x-ray
- upper lobe cavitation is the classical finding of reactivated TB
- bilateral hilar lymphadenopathy

2) Sputum smear
- 3 specimens are needed
- rapid and inexpensive test
- stained for the presence of acid-fast bacilli (Ziehl-Neelsen stain)
- -> all mycobacteria will stain positive

3) Sputum culture
- the gold standard investigation
- more sensitive than a sputum smear and nucleic acid amplification tests
- can assess drug sensitivities
- can take 1-3 weeks

4) Nucleic acid amplification tests (NAAT)
- allows rapid diagnosis (within 24-48 hours)
- more sensitive than smear but less sensitive than culture

118
Q

What is the gold standard investigation for TB?

A

Sputum culture

119
Q

What are the side effects of the drugs used in TB?

A

Rifampicin = hepatoxicity , orange tears & urine

Isoniazid = hepatoxicity, peripheral neuropathy

Pyrazinamide = gout

Ethambutol = optic neuritis

120
Q

What should all patients with TB be tested for?

121
Q

What is Bronchiectasis?

A

Permanent dilatation of the airways secondary to chronic infection or inflammation.

122
Q

What are the symptoms of Bronchiectasis?

A
  1. Persistent production of mucous
  2. Cough >8 weeks
  3. SOB
123
Q

What are the signs for Bronchiectasis?

A
  1. Coarse crackles
  2. Wheeze
  3. Stridor
  4. large airway rhonchi (snore-like)
124
Q

What are the investigations for Bronchiectasis?

A
  1. CXR (1st line)
    - Tramlines
    - honey-combing
  2. High-resolution computered tomography (gold-standard)
    - bronchial wall dilation
  3. Spirometry
  4. Assess for cystic fibrosis
125
Q

What are the most common organisms causing Bronchiectasis?

A
  • Haemophilus influenzae (most common)
  • Pseudomonas aeruginosa
  • Klebsiella spp.
  • Streptococcus pneumoniae
126
Q

What is Cystic Fibrosis?

A
  • An autosomal recessive disorder causing increased viscosity of secretions (e.g. lungs and pancreas)
127
Q

What are the presenting features of Cystic Fibrosis?

A
  • neonatal period : meconium ileus, less commonly prolonged jaundice
  • recurrent chest infections
  • malabsorption: steatorrhoea, failure to thrive
  • other features (10%): liver disease
128
Q

What are some other features associated with Cystic Fibrosis?

A
  • short stature
  • diabetes mellitus
  • delayed puberty
  • rectal prolapse (due to bulky stools)
  • nasal polyps
  • male infertility, female subfertility
129
Q

What test is used for diagnosis of Cystic Fibrosis?

A
  • *Sweat test**
  • patient’s with CF have abnormally high sweat chloride
  • normal value < 40 mEq/l, CF indicated by > 60 mEq/l
130
Q

What is Pulmonary Hypertension?

A
  • Mean pulmonary arterial pressure > 25 mmHg at rest
131
Q

What are the symptoms of Pulmonary Hypertension?

A
  • Chest pain
  • Exertional SOB
  • Fatigue
  • Syncope
132
Q

What are the signs of Pulmonary Hypertension?

A
  • Large A wave in JVP
  • Peripheral cyanosis
  • Parasternal - right ventricular heave
  • Peripheral oedema
133
Q

What are the special tests carried out in Pulmonary Hypertension?

A
  • Echo : dilated R ventricle with impaired function
  • Cardiac catheterisation : essential for diagnosis
  • CT or MRI : enlargement of pulmonary arteries
134
Q

What are the ECG findings in Pulmonary Hypertension?

A
  • RAD
  • R wave in V1
  • Inverted T wave in right pericardial leads
  • RBB
  • Tall peaked p waves in lead II
135
Q

What does SSRI in 3rd trimester cause?

A
  • Pulmonary HTN in newborn
136
Q

What is Pleural Effusion?

A

Fluid collect between the parietal and visceral pleural surfaces of the thorax

137
Q

What is the aetiology of Pleural Effusion?

A
  • if the normal flow of fluid is disrupted with either too much fluid production or not enough being removed.
138
Q

What are the symptoms of Pleural Effusion?

A
  • SOB
  • Non productive cough
  • Pleuritic chest pain
139
Q

What are the signs of Pleural Effusion?

A
  • Quieter breath sounds
  • Decreased or absent tactile fremitus
  • Dull to percuss
  • Reduced chest expansion
140
Q

How can Pleural Effusion be classified?

A

According to the protein conc:
1. Transudate (< 30 g/L)

  1. Exudate (> 30g/L)
141
Q

What investigation are carried out for Pleural Effusion?

A

Imaging:

  • Posterioranterior (PA) chest x-ray
  • USS: for pleural aspiration
  • Contrast CT : investigate underlying cause

Pleural aspiration :
- fluid sent for pH, protein, LDH, cytology and microbiology

142
Q

What is light’s criteria?

A

Used to distinguish between transudate and exudate

143
Q

What are the pleural findings indication in pleural effusion

A
  1. low glucose: rheumatoid arthritis, tuberculosis
  2. raised amylase: pancreatitis, oesophageal perforation
  3. heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
144
Q

When is pleural fluid sampling diagnostic?

A
  • Pleural infection : all pt with pleural effusion associated with sepsis or pneumonia
    1. Fluid = purulent or cloudy –> chest tube for drainage
    2. Fluid = clear but pH < 7.2 –> chest tube placed
145
Q

What are the pleural findings in empyema?

A

Turbid effusion with :

  1. pH < 7.2
  2. low glucose
  3. high LDH
146
Q

What is Pneumothorax?

A
  • when air gain access to & accumulates in the pleural space
147
Q

What are the types of pneumothorax?

A
  1. Primary - occurs without a cause
  2. Traumatic - results of trauma. commonly - stab wound
  3. Tension - large amount of air present within the lung causing the lung to deflate
148
Q

What are the symptoms of pneumothorax?

A

Symptoms onset sudden:

  • SOB
  • Pleuritic chest pain
  • sweating
  • tachypnoea
  • tachycardia
149
Q

What are the signs for pneumothorax?

A
  • Absent breath sounds
  • Trachial deviation
  • Hyperressonance on percussion
150
Q

What are the investigations for pneumothorax

A
  • CXR
  • CT : differentitate between emphysema + pneumothorax
  • Bronchoscopy
151
Q

What is the management of secondary pneumothorax if < 1 cm?

A
  • Admit + give oxygen for 24 hours + review
152
Q

What is the management of Primary Pneumothorax?

A
  1. < 2 cm + no SOB = discharge
  2. Otherwise, aspirate
  3. > 2 cm or SOB = chest drain inserted
153
Q

What scoring system is used for suspected obstructive sleep apnoea?

A

Epworth scale

154
Q

What would the finding of TB be on a chest radiograph?

A

Upper zone fibrosis

155
Q

What is pleurisy?

A

Inflammation of the pleura which compromises lubrication and results in pain

156
Q

What are the signs of pleurisy?

A
  • Reduced breath sounds
  • Pleuritic rub
  • Rapid/shallow breathing
157
Q

What are the symptoms of pleurisy?

A
  • Chest pain
  • sharp stabbing pain
  • worse on inspiration

Dependent on cause:

  • cough (productive)
  • systemic symp: fever, rigors
  • SOB /altered breathing
158
Q

When is a diagnosis of pleurisy made?

A
  • When other differentials have been confidently excluded
159
Q

How to investigate pleurisy?

A

Tests done to r/o other causes:

  • bloods : trop, ABG, D-dimer
  • X-Ray: pneumothorax, pleural effusion
  • CT: show the condition of the pleura
160
Q

What are the 2 types of lungs cancer based on histology?

A
  1. Small Cell Lung cancer (SCLC)

2. Non- Small Cell Lung Cancer (NSCLC)

161
Q

What are the different types of NSCLC?

A
  1. Adenocarcinoma
  2. Squamous
  3. Large cell
  4. alveolar cell carcinoma
  5. bronchial adenoma
162
Q

What are the features of lung cancer?

A
  1. Persistent cough
  2. haemoptysis
  3. dyspnoea
  4. chest pain
  5. Weight loss
  6. hoarseness
163
Q

What the examination findings of lung cancer?

A
  1. Fixed monophonic wheeze
  2. supraclavicular lympadenopathy or persistent cervical lympadenopathy
  3. Clubbing
164
Q

What is the investigation used for definitive diagnosis for lung cancer?

A

Biopsy guided by CT or bronchoscopy

165
Q

What is the first line investigation when suspecting lung cancer?

A

CXR

- can give false negative

166
Q

What is the referral criteria for 2WW pathway for lung cancer?

A
  1. CXR suggest lung cancer

2. > 40 y/o + unexplained haemoptysis

167
Q

What is the criteria to offer urgent CXR to assess lung cancer?

A

> 40 y/o + 2 or more of:

  • cough
  • fatigue
  • SOB
  • Chest pain
  • weight loss
  • appetite loss
  • smoker
168
Q

What are the electrolyte disturbances caused by small cell lung cancer?

A
  1. ADH –> Hyponatraemia

2. Secretes ACTH –> Cushing’s

169
Q

What are the features of squamous?

A
  • PTH –> hypercalcaemia

- clubbing

170
Q

Which type of lung cancer may secrete beta-hCG?

A

Large cell carcinoma

171
Q

What are the common site for metastases from lung cancer?

A
  • Brain
  • Bone
  • Abdo (Liver)
  • Prostate
  • Adrenal
  • Kidneys
172
Q

What investigation is carried out metastatic tumours?

173
Q

What is carcinoid tumour?

A

Slow-growing tumour that originate in cells of the diffuse neuroendocrine system

174
Q

What is carcinoid syndrome?

A
  • Usually occurs when metastases are present in the liver + release serotonin into circulation
175
Q

What symptoms does carcinoid tumour cause?

A

Entire body involvement:

  • Flushin
  • diarhhoea
  • bronchospasm
  • hypotension
  • valvular stenosis (right)
176
Q

What are lung nodules?

A

Circular/round structures on CXR/CT <3cm

177
Q

What can cause lung nodules?

A
  • Benign tumours
  • lung infection
  • scars from previous infection
  • cancer
  • Autoimmune disorder
178
Q

What is

Idiopathic pulmonary fibrosis?

A

Chronic lung condition characterised by progressive fibrosis of the interstitium of the lungs.

179
Q

What are the features of Idiopathic pulmonary fibrosis?

A
  1. progressive exertional dyspnoea
  2. bibasal fine end-inspiratory crepitations on auscultation
  3. dry cough
  4. clubbing
180
Q

What investigation is used for diagnosis of Idiopathic pulmonary fibrosis?

A

High - resolution CT scan

181
Q

What is the CXR finding for Idiopathic pulmonary fibrosis?

A

bilateral interstitial shadowing - typically small, irregular, peripheral opacities -

  • ‘ground-glass’
  • later progressing to ‘honeycombing’
182
Q

What is Pneumoconiosis?

A

Accumulation of dust in the lungs
- and response of the bodily tissue to its presence

AKA - Black lung disease

183
Q

What is the CXR finding for pneumoconiosis?

A
  • Upper zone fibrosis
184
Q

What are the symptoms of pneumoconiosis?

A
  • SOBOE

- Cough (black sputum)

185
Q

What are the examination findings for pneumoconiosis?

A
  • Normal chest exam

- crackles OA

186
Q

What is Sarcoidosis?

A

Multisystem disorder of unknown aetiology characterised by non-caseating granulomas
–> Small patches of red and swollen tissues

187
Q

What are the features of Sarcoidosis?

A
  • SOB
  • Dry cough

Acute:

  • eythema nodosum
  • bilateral hilar lymphadenopathy
  • swinging fever
  • polyarthralgia
  • Hypercalcaemia
188
Q

How is Sarcoidosis diagnosed?

A
  • No diagnostic test, largely clinical
189
Q

Obstructive picture of spirometry?

A

Reduced FEV1 (<80% of predicted normal)

Reduced FVC (less than the FEV1 drop)

FEV1/FVC ratio <0.7

190
Q

Restrictive picture of Spirometry?

A

Reduced FEV1 (<80%)

Reduced FVC (<80%)

Normal FEV1/FVC (>70%)

ICM Matrix (15 decks)

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