Resp SC Flashcards
Tracheal deviation causes towards side of the lesion:
Upper lobe fibrosis
Upper lobe collapse
Pneum/lobectomy
Pleural effusion vs consolidation
Pleural effusion - reduced vocal resonance
Consolidation - increased vocal resonance, bronchial breath sounds
Both have dull percussion note
X-ray findings of copd
lung hyperinflation (\>rib 10) with flattened hemidiaphragms small heart bullous changes
barrel chest + increased retrosternal space on lateral x-ray.
Upper zone causes of pulmonary fibrosis
S - silicosis (massive fibrosis)
C - coal workers pneumoconiosis
H - histiocytosis (pulmonary langerhans histiocytosis - “cystic”)
A - allergic bronchopulmonary aspergillosis
A - ankylosing spondylitis
R - radiation
T - tuberculosis
S - sarcoidosis
Causes of lower zone predominant pulmonary fibrosis?
D - dermatomyositis, polymyositis
R - rheumatoid arthritis
A - asbestosis
S - scleroderma
C - cryptogenic (ideopathic) pulmonary fibrosis
O - “other”; drugs
Indications for pneumonectomy
Tuberculosis
Malignancy
Bronchiectasis
Indications for lobectomy
Infection - Tuberculosis, abscess
Malignancy/nodule
Bronchiectasis/CF
COPD (volume reduction)
Findings in pneumonectomy
Thoracotomy scar
Ipsilateral tracheal deviation
Dull percussion note throughout
Absent breath sounds
Ipsilateral apex beat deviation (mediastinal shift)
Ipsilateral rib flattening
Reduced chest expansion
Findings in lobectomy
Thoracotomy scar
Ipsilateral tracheal deviation (may not be if M/L lobe)
Dull percussion note over resected lobe
Absent breath sounds over resected lobe
Rib flattening over effected region
Reduced chest expansion
Differential for dull percussion note with reduced/absent breath sounds + reduced vocal resonance
Pleural effusion
Raised hemidiaphragm
Lobectomy
Pleural thickening
Collapse
Respiratory causes of clubbing
CF
Suppurative lung disease (bronchiectasis, lung abscess, empyema)
ILD (IPF)
Lung cancer/mesothelioma
TB
Features of COPD
Barrel chest
Pursed lip breathing
Hyper-resonant percussion note
Quiet BS
Expiratory wheeze
Forced expiratory time >6 seconds
Tracheal tug (hyper-expanded chest)
Tracheal deviation away from side of the lesion:
Large effusion
Mass
Features on HRCT of usual interstitial pneumonia (UIP)?
2 condition associated with this
Honeycombing
Traction bronchiectasis
Reticular opacities
Subpleural (peripheral) and basal predominance
Idiopathic pulmonary fibrosis, RA
Features on HRCT of non-specific interstitial pneumonia (NSIP)?
Name 5 causes
Ground glass opacities
Reticular opacities
Traction bronchiectasis
Diffuse changes - may have subpleural sparing
Idiopathic, drugs, scleroderma, hypersensitivity pneumonitis, HIV
3 major causes of consolidation
Infection
Infarction
Malignancy
5 causes of bronchial breath sounds
Lung fibrosis
Lobar pneumonia
Lobar collapse
Above a pulmonary effusion
Lung cavity
Differentiating feature of diaphragmatic palsy
Paradoxical inward motion of the abdomen during inspiration when the patient is SUPINE
Upper border of the liver?
What does it indicate if there is resonant percussion note below this level?
5th rib, right MCL.
Resonant percussion below this level indicates hyperinflation
What is HPOA?
What causes it?
Periostitis, digital clubbing and painful arthropathy of the distal joints
Associated clubbing + tenderness
Causes:
- Primary lung carcinoma
- Mesothelioma
Causes of bronchiectasis
- Acquired
- childhood infection (TB, pertussis, pneumonia)
- RA, sjogrens
- recurrent aspiration
- localized obstruction
- ABPA - Congenital
- CF
- primary ciliary dyskinesia
- hypogammaglobulinemia (may also be acquired)
4 causes of lung collapse
Features on exam?
Malignancy
Mucus plugs
Tuberculosis
Hilar lymphadenopathy (i.e. sarcoid)
Ipsilateral tracheal deviation, dull percussion note, reduced chest expansion, reduced breath sounds, reduced percussion note
Indications for home O2
PaO2 <55
SpO2 <88%
On room air
obstructive severity
mild (>70%)
moderate (60–69%)
moderately severe (50–59%)
severe (35–49%)
very severe (<35%)
