Resp. Exam Flashcards
What are the causes of interstitial lung disease?
pulmonary fibrosis
- Idiopathic
- cryptogenic fibrosing alveolitis - Inhaled antigens
- Bird Fancier’s Lung
- Farmer’s Lung - Inhaled Irritant
- Asbestosis
- Silicosis
- Coal Worker’s Pneumoconiosis - Systemic Disease
- SLE, RA, Sarcoid, Systemic Sclerosis - Iatrogenic
- Methotrexate
- Amiodarone
- Radiotherapy
What are the causes of Horner’s Syndrome?
1) Central Lesion
- Stroke/Tumour/MS
- Syringobulbia
2) T1 Lesion
- Spondylosis
- Neurofibroma
3) Brachial Plexus Lesion
- Pancoast Tumour
- Cervical Rib
- Trauma/Birth Injury (Klumpke’s)
4) Neck Lesion
- Tumour
- Carotid Artery Aneurysm
- Sympathectomy
5) With Cluster Headaches
What are the features of Bronchial Breathing?
- Loud and Blowing
- Length of Inspiration = Expiration
- Audible Gap between Inspiration and Expiration
What are the causes of bibasal crepitations?
1) Fine
- Pulmonary Oedema
- Interstitial Lung Disease
2) Coarse
- Bronchiectasis
- Cystic Fibrosis
- Bibasal Pneumonia
What are the causes of pleural effusion?
1) Transudate (Protein <30g/L)
- LVF
- Volume overload
- Hypoalbuminaemia
- Meig’s Syndrome
2) Exudate (Protein >30g/L)
- Infection e.g. TB, Pneumonia
- Infarction e.g. PE
- Inflammation e.g. RA, SLE
3) Malignancy e.g. Bronchogenic, Mesothelioma
What are the examination findings in consolidation?
Dull percussion, bronchial or reduced breath sounds, increased vocal resonance
What are the examination findings in a collapsed lung?
Mediastinal shift towards the collapse, dull percussion, decreased or absent breath sounds, decreased or absent vocal resonance
What are the examination findings in effusion?
Mediastinal shift away if big, stony dull percussion, decreased or absent breath sounds and decreased or absent vocal resonance
What are the examination findings in a pneumothorax?
Mediastinal shift away if tension, hyper-resonant percussion, decreased or absent breath sounds and decreased or absent vocal resonance
What are the examination findings in a pneumonectomy?
Mediastina shift towards, dull percussion, absent breath sounds, absent vocal resonance
What are the examination findings if a patient has had a lobectomy or pneumonectomy?
SAME AS COLLAPSE
Mediastinal shift towards, dull percussion note, decreased or absent breath sounds and decreased or absent vocal resonance
May also see thoracotomy scar on chest
Indications: Bronchogenic Ca, Bronchiectasis, Trauma, TB
What examination findings would be found in a raised hemidiaphragm?
SAME AS EFFUSION
Mediastinal shift away if big, stony dull percussion, decreased or absent breath sounds, decreased or absent vocal resonance
Use a CXR to differentiate
Due to phrenic nerve palsy caused by thoracic surgery, trauma, malignancy
What are the signs of hyperinflation?
- Reduced cricosternal distance with or without tracheal tug
- Increased A-P diameter
- Intercostal Indrawing (Hoover’s Sign)
- Apex beat not palpable
- Hyper-resonant percussion
What do you look for in a patient’s hands in a resp. exam?
- Clubbing = ILD, CF, Ca, Bronchiectasis
- Peripheral Cyanosis = PVD
- Tar Staining = Smoking/Coal Mining History
- C02 Retention Flap = Resp. Failure
- Koilonychia = Iron Deficiency Anaemia
- 1st webspace wasting - Pancoast Tumour
- Tremor = excessive use of beta-agonists or theophylline bronchodilators
- Pulse = bounding in C02 retention (C02 acts as vasodilator)
What are the causes of a raised JVP?
Cor Pulmonale, Acute Severe Asthma, Tension Pneumonthorax SVC Obstruction
When is the trachea deviated towards a pathology?
- Lobar collapse
- Pneumonectomy
When is the trachea deviated away from a pathology?
- Large pleural effusion
- Tension Pneumonthorax
What does each percussion note show?
Resonant, Hyper Resonant, Dull, Stony Dull
Resonant - normal
Hyper Resonant - Pneumothorax, Emphysematous Lung
Dull - Lung separated from chest wall e.g. pleural fluid/consolidation/collapse
Stony Dull - Pleural Effusion
When does reduced vesicular breathing occur?
If there is a thick chest wall e.g. pleural thickening or if there is a reason for conduction of sound to be reduced e.g. emphysema
When does bronchial breathing occur?
Associated with pneumonic consolidation. Also at border between lung and pleural effusion (due to compressed lung)
Breath sounds are low and blowing, inspiration and expiration are similar length, audible gap between inspiration and expiration
What are the causes of crackles?
- Early inspiration = small airway disease such as bronchiolitis
- Mid-inspiration = pulmonary oedema
- Late inspiration = interstitial lung disease, COPD, pneumonia
- Throughout inspiration and expiration = bronchiectasis
What are the differentials for consolidation on CXR?
- Pneumonia
- TB
- Lung Cancer
- Lobar Collapse
- Haemorrhage
Explain the CURB65
C - confusion = MMT 2 or more points worse U - Urea > 7.0 R - Resp. Rate >=30 B - BP >=90 systolic or >=60 diastolic 65 - Age over 65
What are the causes of a non-resolving pneumonia?
CHAOS
C - Complication = empyema, lung abscess
H - Host = Immunocompromised
A - Antibiotic = Inadequate dose, poor oral absorption
S - Second Diagnosis = PE, Cancer, Organising Pneumonia
What are the differential diagnoses for haemoptysis?
1) Infection
- Pneumonia
- TB
- Bronchiectasis/CF
- Cavitating lung lesion
2) Malignancy
- Lung Cancer
- Metastases
3) Haemorrhage
- Bronchial Artery Erosion
- Vasculitis
- Coagulopathy
4) Other
- PE
What are the causes of a transudate pleural effusion?
Pleural protein <30g/L
Common - heart failure, cirrhosis, hypoalbuminaemia (nephrotic syndrome or peritoneal dialysis)
Less common - hypothyroidism, mitral stenosis, PE
Rare - constrictive pericarditis, SVC obstruction, Meig’s Syndrome
What are the causes of an exudate effusion?
Pleural protein >30g/L
Common - malignancy, infection e.g. TB, HIV
Less Common - inflammatory e.g. RA, pancreatitis, connective tissue disease
Rare - yellow nail syndrome, fungal infections, drugs
What is the Light’s Criteria?
If pleural fluid protein level is between 25 and 35g/L then use the Light’s Criteria.
It is exudate if one or more of the following:
- pleural fluid/serum protein >0.5
- pleural fluid/serum LDH >0.6
- pleural fluid LDH > 2/3 of the upper limit of normal
