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Sarah's Yr6 PACES > Resp > Flashcards

Resp Flashcards

1
Q

Clinical signs of pulmonary fibrosis

A

Inspection: clubbing, central cyanosis, tachypnoea

Auscultation: fine end-inspiratory crackles which do not alter with coughing

Signs of associated AI disease e.g. RA, SLE, systemic sclerosis

Signs of treatment e.g. Cushingoid

Discoloured grey skin - amiodarone as cause

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2
Q

Investigations for pulmonary fibrosis

A

Bloods: ESR, RF, ANA
CXR: reticulonodular changes, loss of definition of heart borders, small lungs
ABG: type I respiratory failure
Lung function tests: FEV1/FVC >0.8 (restrictive), low TLC (small lungs)
Bronchoalveolar lavage: exclude infection prior to immunosuppressant use)
HRCT: distribution aids diagnosis
Lung biopsy

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3
Q

Treatment for pulmonary fibrosis

A

If inflammatory –> immunosuppression (steroids)

If UIP - pirfenidone (antifibrotic agent)

Single lung transplant

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4
Q

Causes of basal lung fibrosis

A

Usual interstitial pneumonia (UIP)
Asbestosis
Connective tissue disease
Aspiration

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5
Q

Clinical signs for bronchiectasis

A

Room: sputum pot +++

Gen: cachexia and tachypnoea

Hands: clubbing

Chest: mixed character crackles that alter with coughing, occasional squeaks and wheeze

Cor pulmonale: SOB, raised JVP, RV heave, loud P2

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6
Q

Investigation for bronchiectasis

A

Sputum culture and cytology
CXR: tramlines and ring shadows
HRCT thorax: signet ring sign (thickened dilated bronchi larger than adjacent vascular bundle)

To find specific cause:
Immunoglobulins - hypogammaglobulinaemia
Aspergillus RAST/skin prick testing - ABPA (upper lobe)
Rheumatoid serology
Saccharine ciliary motility test (nose to taste buds in 30mins) - Kartagener’s
Genetic screening - CF
Hx of IBD

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7
Q

Causes of bronchiectasis

A

Congenital: Kartagener’s and CF

Childhood infection: measles and TB

Immune OVERactivity: ABPA and IBD associated

Immune UNDERactivity: hypogammaglobulinaemia, CVID

Aspiration: chronic alcoholics and GORD, localised to right lower lobe

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8
Q

Treatment for bronchiectasis

A

Physio - active cycle breathing
Prompt abx therapy for exacerbations
Long-term treatment with low-dose azithromycin 3x week
Bronchodilators/inhaled corticosteroids if airflow obstruction
If localised –> surgery

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9
Q

Complications of bronchiectasis

A 
Cor pulmonale
Secondary amyloidosis (dip urine for protein)
Massive haemoptysis (mycotic aneurysm)
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10
Q

Clinical signs of old TB

A

Inspection:

  • chest deformity and absent ribs
  • thoracotomy scar

Palpation:

  • tracheal deviation towards the side of the fibrosis
  • reduced expansion

Percussion:
-dull percussion but present tactile vocal remits

Auscultation:
-crackles and bronchial breathing

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11
Q

Historical techniques to treat TB

A

Plombage: insertion of polystyrene balls into the thoracic cavity

Phrenic nerve crush: diaphragm paralysis

Thoracoplasty: rib removal but lung not resected

Apical lobectomy

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12
Q

Serious side effects of TB drugs

A

Rifampicin: hepatitis, increased metabolism of OCP

Isoniazid: peripheral neuropathy (treat with pyridoxine) and hepatitis

Pyrazinamide: hepatitis

Ethambutol: retro-bulbar neuritis and hepatitis

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13
Q

What to tell patients about to commence TB therapy

A
  1. If your eyes become yellow, stop tablets and ring nurse immediately
  2. If reds begin to appear less red, ring nurse
  3. If you develop tingling in your toes, continue tablets but tell them at your next clinic visit
  4. Your secretions will turn orange/red. Don’t wear contact lenses
  5. OCP may fail, use barrier contraception
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14
Q

Causes of apical fibrosis

A

TRASH

  • TB
  • Radiation
  • Ankylosing spondylitis/ABPA
  • Sarcoidosis
  • Histoplasmosis/ hypersensitivity pneumonitis
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15
Q

Clinical signs of lobectomy

A

Inspection:

  • Chest wall deformity
  • Thoracotomy scar - same for either lower or upper lobe

Palpation:

  • Trachea is central
  • Reduced expansion

Lower lobectomy: dull percussion note over lower zone + absent breath sounds

Upper lobectomy: normal exam OR hyper-resonant percussion note over upper zone and dull percussion at base where hemidiaphragm has lifted

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16
Q

Clinical signs of pneumonectomy

A

Inspection:
-Thoracotomy scar

Palpation:

  • Reduced expansion on side of pneumonectomy
  • Trachea deviated towards the side of the pneumonectomy

Percussion:

  • Dull percussion note throughout hemithorax
  • Absent tactile vocal fremitus beneath thoracotomy scar

Auscultation:

  • Bronchial breathing in upper zone
  • Reduced breath sounds throughout remainder of hemithorax
17
Q

Clinical signs of single lung transplant

A

Thoracotomy scar
Normal exam on side of scar
May have signs on opposite hemithorax

18
Q

Clinical signs of double lung transplant

A

Clamshell incision - from on axilla, along line of lower ribs, up to the xiphisternum to other axilla

19
Q

Indications for single lung transplant

A

‘Dry lung’ conditions: COPD, pulmonary fibrosis

20
Q

Indications for double lung transplant

A

‘Wet lung’ conditions: CF, bronchiectasis, pulmonary hypertension

21
Q

Clinical signs of COPD

A

Inspection:

  • Nebulizer/inhalers/sputum pot
  • Dyspnoea, central cyanosis, purses lips
  • CO2 retention flap, bounding pulse, tar stained fingers

Palpation:
-Hyperexpanded

Percussion:
-Resonant with loss of cardiac dullness

Auscultation:

  • Expiratory polyphonic wheeze
  • Reduced breath sounds at apices
22
Q

Clinical signs of cor pulmonale

A
  • Raised JVP
  • Ankle oedema
  • RV heave
  • Loud P2 with pan systolic murmur (TR)
23
Q

Investigations for COPD

A

ABG: type II respiratory failure

Bloods: high WCC (infection), low A1AT (younger patients/FH), low albumin (severity)

CXR: hyper-expanded and/or pneumothorax

Spirometry: low FEV1, FEV1/FVC <0.7 (obstructive)

Gas transfer: low TLCO

24
Q

Possible COPD treatments

A
  • Smoking cessation (clinics and nicotine replacement therapy)
  • Pulmonary rehabilitation
  • Exercise
  • Nutrition
  • Vaccinations: pneumococcal and influenza
  • Mild (FEV1>80%): beta-agonists
  • Mod (<60%): above + tiotropium
  • Severe (<40%): above+ inhaled corticosteroids

-Long-term oxygen therapy: 2-4L/min via nasal prongs for at least 15hrs a day

Surgical:

  • Bullectomy
  • Endobronchial valve placement
  • Lung reduction surgery
  • Single lung transplant
25
Q

Criteria for LTOT in COPD:

A
  • Non-smoker
  • PaO2<7.3kPA on air (or evidence of cor pulmonate and PaO2 <8kPa)
  • PaCO2 that does not rise excessively on O2
26
Q

Treatment for acute exacerbation of COPD

A
  • Controlled O2 via Venturi mask - MONITOR CLOSELY
  • Bronchodilators
  • Antibiotics
  • 7 days of steroids
27
Q

Clinical signs of pleural effusion

A

Palpation:

  • Asymmetrically reduced expansion
  • Trachea displaced away from effusion

Percussion:

  • Stony dull percussion note
  • Absent tactile vocal remits

Auscultation:
-Reduced breath sounds with bronchial breathing above

28
Q

Signs that may indicate cause of pleural effusion

A

Cancer: clubbing, lymphadenopathy, mastectomy

CCF: raised JVP, peripheral oedema

CLD: leuconychia, spider nave, gynaecomastia

CRF: AV fistula

Connective tissue disease: RA hands, SLE butterfly rash

29
Q

Causes of a dull lung base and their other signs

A

Consolidation: bronchial breathing and crackles

Collapse: tracheal deviation TOWARDS, reduced breath sounds

Previous lobectomy: reduced lung volume

Pleural thickening: similar to pleural effusion + normal tactile vocal fremitus, may have 3 scars = previous pleuradesis

Raised hemidiaphragm due to hepatomegaly

30
Q

Pleural effusion: causes of transudate

A

Protein <30g/L

Congestive cardiac failure
Chronic renal failure
Chronic liver failure

31
Q

Pleural effusion: causes of exudate

A

Protein >30g/L

Neoplasm
Infection (empyema=low glucose and pH<7.2)
Infarction
Inflammation:RA and SLE

32
Q

Clinical signs of Cystic Fibrosis

A

Inspection:

  • Small stature
  • Clubbed
  • Tachypnoeic
  • Sputum pot (purulent++)
  • Portacath or Hickman line/scars for long-term abx

Palpation:
-Hyperinflated with reduced chest expansion

Auscultation:
-Coarse crackles and wheeze (bronchiectatic)

33
Q

Pathophysiology of CF

A

Thickened secretions block various lumens:

Bronchioles –> bronchiectasis
Pancreatic ducts –> loss of exocrine and endocrine function
Gut –> distal intestinal obstruction syndrome
Seminal vesicles –> male infertility
Fallopian tubes –> reduced female fertility

34
Q

Treatment for cystic fibrosis

A
  • Physiotherapy - postural drainage and active cycle breathing techniques
  • Prompt antibiotics
  • Pancrease and fat-soluble vitamin supplements
  • Mucolytics (DNAse)
  • Immunisations
  • Double lung transplant
  • Gene therapy in trials
35
Q

Clinical signs of pneumonia

A

Inspection:
-Tachypnoea, O2 mask, sputum pot

Palpation:
-Reduced expansion

Percussion:
-Dull

Auscultation:
-Focal coarse crackles, increased vocal resonance and bronchial breathing

36
Q

Investigations for pneumonia

A

Bloods: WCC, CRP, urea
Blood and sputum cultures
Urine: Legionella and pneumococcal antigens, haemoglobinuria (mycoplasma)
CXR: consolidation with air bronchogram, abscess and effusion

37
Q

Common organisms in CAP

A

Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae (esp. in COPD)
Chlamydia pneumoniae

38
Q

CURB-65

A 
Confusion
Urea >7
RR >30
BP systolic <90 or diastolic <60
Age >65

Hospital admission if 2/5

Sarah's Yr6 PACES (3 decks)

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