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Clinical exam > Resp SC > Flashcards

Resp SC Flashcards

1
Q

Tracheal deviation causes towards side of the lesion:

A

Upper lobe fibrosis
Upper lobe collapse
Pneum/lobectomy

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2
Q

Pleural effusion vs consolidation

A

Pleural effusion - reduced vocal resonance

Consolidation - increased vocal resonance, bronchial breath sounds

Both have dull percussion note

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3
Q

X-ray findings of copd

A 
lung hyperinflation (\>rib 10) with flattened hemidiaphragms 
small heart 
bullous changes

barrel chest + increased retrosternal space on lateral x-ray.

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4
Q

Upper zone causes of pulmonary fibrosis

A

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

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5
Q

Causes of lower zone predominant pulmonary fibrosis?

A

D - dermatomyositis, polymyositis
R - rheumatoid arthritis
A - asbestosis
S - scleroderma
C - cryptogenic (ideopathic) pulmonary fibrosis
O - “other”; drugs

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6
Q

Indications for pneumonectomy

A

Tuberculosis
Malignancy
Bronchiectasis

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7
Q

Indications for lobectomy

A

Infection - Tuberculosis, abscess
Malignancy/nodule
Bronchiectasis/CF
COPD (volume reduction)

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8
Q

Findings in pneumonectomy

A

Thoracotomy scar
Ipsilateral tracheal deviation
Dull percussion note throughout
Absent breath sounds
Ipsilateral apex beat deviation (mediastinal shift)
Ipsilateral rib flattening
Reduced chest expansion

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9
Q

Findings in lobectomy

A

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

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10
Q

Differential for dull percussion note with reduced/absent breath sounds + reduced vocal resonance

A

Pleural effusion
Raised hemidiaphragm
Lobectomy
Pleural thickening
Collapse

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11
Q

Respiratory causes of clubbing

A

CF
Suppurative lung disease (bronchiectasis, lung abscess, empyema)
ILD (IPF)
Lung cancer/mesothelioma
TB

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12
Q

Features of COPD

A

Barrel chest
Pursed lip breathing
Hyper-resonant percussion note
Quiet BS
Expiratory wheeze
Forced expiratory time >6 seconds
Tracheal tug (hyper-expanded chest)

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13
Q

Tracheal deviation away from side of the lesion:

A

Large effusion
Mass

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14
Q

Features on HRCT of usual interstitial pneumonia (UIP)?

2 condition associated with this

A

Honeycombing
Traction bronchiectasis
Reticular opacities
Subpleural (peripheral) and basal predominance

Idiopathic pulmonary fibrosis, RA

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15
Q

Features on HRCT of non-specific interstitial pneumonia (NSIP)?

Name 5 causes

A

Ground glass opacities
Reticular opacities
Traction bronchiectasis
Diffuse changes - may have subpleural sparing

Idiopathic, drugs, scleroderma, hypersensitivity pneumonitis, HIV

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16
Q

3 major causes of consolidation

A

Infection
Infarction
Malignancy

17
Q

5 causes of bronchial breath sounds

A

Lung fibrosis
Lobar pneumonia
Lobar collapse
Above a pulmonary effusion
Lung cavity

18
Q

Differentiating feature of diaphragmatic palsy

A

Paradoxical inward motion of the abdomen during inspiration when the patient is SUPINE

19
Q

Upper border of the liver?
What does it indicate if there is resonant percussion note below this level?

A

5th rib, right MCL.
Resonant percussion below this level indicates hyperinflation

20
Q

What is HPOA?
What causes it?

A

Periostitis, digital clubbing and painful arthropathy of the distal joints

Associated clubbing + tenderness

Causes:

  1. Primary lung carcinoma
  2. Mesothelioma
21
Q

Causes of bronchiectasis

A
  1. Acquired
    - childhood infection (TB, pertussis, pneumonia)
    - RA, sjogrens
    - recurrent aspiration
    - localized obstruction
    - ABPA
  2. Congenital
    - CF
    - primary ciliary dyskinesia
    - hypogammaglobulinemia (may also be acquired)
22
Q

4 causes of lung collapse

Features on exam?

A

Malignancy
Mucus plugs
Tuberculosis
Hilar lymphadenopathy (i.e. sarcoid)

Ipsilateral tracheal deviation, dull percussion note, reduced chest expansion, reduced breath sounds, reduced percussion note

23
Q

Indications for home O2

A

PaO2 <55
SpO2 <88%

On room air

24
Q

obstructive severity

A

mild (>70%)
moderate (60–69%)
moderately severe (50–59%)
severe (35–49%)
very severe (<35%)

25
Q

differential diagnosis for homogenous opacity on chest x-ray

A

consolidation (i.e. pneumonia)
pleural effusion (look for presence of a meniscus and tracheal deviation away from the effusion)
lung collapse

26
Q

differential diagnosis for a non-homogenous opacity on chest x-ray

A

pneumonia
pulmonary infarction
carcinoma
TB

27
Q

differential diagnosis for diffuse miliary opacities on chest x-ray

A

Infective

  • TB
  • pneumonia (viral fungal)

Neoplastic

  • metastatases
  • lymphoma
  • carcinoma lymphangitis

Infiltrative

  • sarcoidoses

Exposures

  • pneumocoiosis (coal workers, silicosis)

Other

  • vasculitis
  • pulmonary haemmorhage
28
Q

differntial diagnosis for nodular opacification on chest xray

A

pneumonia

pneumoconiosis

TB

pulmonary metastases

sarcoidosis (look for widened mediastinum)

29
Q

differential diagnosis for calcified pulmonary nodules

A

Diffuse:

  • post varicella pneumonia
  • histoplasmosis
  • ectopic calcification due to hypercalcemia (renal failure, hyperparathyroidism)

Localized:

  • tuberculosis
  • pneumoconiosis
  • post varicella pneumonia
30
Q

Describe this chest xray

A
  • hyperinflated (air below heart, flattened hemidiaphragm)
  • dilated airways with thickened bronchial walls (arrow)
  • reticular opacifications and mucoid impaction

Consistent with bronchiectasis

31
Q

Describe this chest xray

A
  • bilateral hilar lymphadenopathy with widned mediastinum*
  • bilateral upper zone predominant reticulonodular opacification
  • splaying of the carina

Sarcoidosis with upper zone predominant fibrosis

*widened mediastinum = >1/3 transthoracic distance at level of aortic knuckle

32
Q

Describe this CT chest

Pattern and possible etiologies?

A
  • peripheral predominant wide spread reticular opacifaction
  • honey combing
  • traction bronchiectasis
  • interlobular septal thickening

Pattern: UIP

Causes: IPF, RA, anca-vasculitis, hypersensitivity pneumonitis, asbestosis

33
Q

Describe this CT chest

Pattern and possible etiologies

A
  • wide spread symmetric ground glass and reticular opacities
  • traction bronchiectasis

Pattern: NSIP

Possible etiologies: systemic sclerosis, SLE, HIV, drug induced, infection, also hypersensitivity pneumonitis and idiopathic

34
Q

Additonal manifestations of CF

A

GI - distal intestinal obstruction, malabsoprtion (cachexia), pancreatic insufficiency, reflux, liver cirrhosis + portal hypertension

Respiratory - sinusitis, bronchiectasis, pneumothorax, hemoptysis

Peripheries - clubbing

Endo - CF realted DM, hypogonadism

MSK - Arthropathy, fractures (kyphotic posture?

Renal -failure, stones

Clinical exam (15 decks)

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