Resp Vivas Flashcards
pulmonary fibrosis o/e
oxygen dry cough tachypnoea reduced expansion fine end insp creps
pulmonary fibrosis signs of cause
hand deformity (if RA) clubbing (if idiopathic PF) sclerodactyly/telengiectasia/microstomia (systemic sclerosis) butterfly rash (SLE) kyphosis (ank spond) lots of drugs cause too
complications - cushingoid + bruising (steroid use), RVH (pulmHTN)
COPD o/e
inhalers/nebs accessory muscles used tar stained tachypnoeic lip pursing reduced cricosternal distance <3cm tracheal tug indrawing of IC muscles hyperresonance (lost cardiac and hep dullness) quiet breath sounds wheeze prolonged expiratory phase
pneumonectomy o/e
unilateral chest flattening thoracotomy scar tracheal deviation towards reduced expansion dull percussion reduced breath sounds bronchial breathing upper zones
lobectomy o/e
thoractomy scar
possibly no other signs as other lobes can expand
possibly some reduced expansion, some dullness, some reduced a/entry
pleural effusion o/e
reduced expansion
stony dull percussion
reduced breath sounds
reduced vocal resonance
signs of cause of pleural effusion o/e
hands deformed (RA) clubbing (lung ca) butterfly rash (SLE) chronic liver disease signs heart failure signs
bronchiectasis o/e
productive cough
insp clicks
clubbing
coarse, late expiratory creps
signs of causes of bronchiectasis
young+thin = CF
rasied LNs - malignancy
dextrocardia - Kartagener’s
curved yellow nails + lymphoedema = yellow nail syndrome
signs of lung cancer o/e
cachexia clubbing tar stained fingers hard irregular raised LNs radiation marks / tattoo
signs of lung ca complications
pain and swelling of wrists = hypertophic pulmonary arthropathy
ptosis/miosis/anhydrosis = HOrner’s
lung transplant o/e
mid sternotomy or bilat thoractomy scar
may have signs of COPD, clubbing etc (indication)
copd again
signs (flap, bounding pulse, hyper-expanded/res, exp wheeze), CP, CXR may show pneumothorax, ABG – T2RF FBC – low alb if severe spiro – low FEV1, ratio FEV/FVC <0.7 GOLD classification. Cons – stop smoking, physio Med – salbutamol +/- tiotropium +/- ICS, vaccs, carbocisteine mucolytic. LTOT if palliative + non smoker + <7 O2. Can consider lung transplant.
classify COPD severity
– mild FEV 80%+, mod 50-80, sev 30-50, v bad <30%. CXR – hyperinflated 8+ ant ribs seen,flat hemidiaphragm, dec lung markings, bullae. 1. SABA or SAMA 2. Add LABA or LAMA 3. Add ICS 4. LABA, LAMA, ICS.
ICS + LABA inhalers
– Seretide, Symbicort, Fostair
pulmonary fibrosis full summary
lung scarring, progressive hypoxia. Upper zone – coal, ank spond, radiation, TB, EAA Lower zone – more common – conn tissue, asbestos, idiopathic PF, drugs (amiodarone, methotrexate, sulphasalazine). Chronic worsening SOB with dry cough. Reduced expansion, fine creps. Clubbing if idiopathic. Inv – CXR, CT, bloods for cause, PFTs, lung biopsy. Reticulonodular shadowing. HRCT – honeycombing, ground glass. Restrictive spirometry. Steroids, antifibrotics, rehab, stop smoking, LTOT
pneumonectomy
– trachea displaced towards removal site, reduced expansion, dull percussion, absent breath sounds CXR organ displacement into cavity.
lobectomy
may have no signs, could have signs above. Indications for both incl: lung ca, local bronchiectasis, aspergilloma, large bullectomy. FEV good for op.
lung lesion workup
- CT CAP + PET scan, biopsy of lung, PFTs
thoracic scars
median sternotomy (open heart surgery – CABG, valve), pacemaker scar (ICD or pacemaker), posterolateral thoracotomy (pneumonecto or lobectomy, oesophageal surg), mini thoracotomy (MVR), axillary (Pthroax), anterolateral thoracotomy (open chest massage)
causes of bronchiectasis
genetic CF, syndromes, A1AT def mech malignancy, FB childhood pertussis, measles, TB, pneumonia immune HIV, leukaemia, allergic
signs of bronchiectasis
Signs = chronic productive cough, haemoptysis, recurrent inf, clubbing, insp clicks, coarse insp creps, ronchi (gurgling wheeze).
imaging signs bronchiectasis
CXR tramlines, ring shadows. HRCT – signet ring sign bronchial wall thickening.
investigating bronchiectasis and managing
. Screen cause – Ig, aspergillus IgE, CF sweat test/genetics, HIV, rheum Igs, A1AT, sputum culture
Manage – chest physio, prophylaxis if recurrent inf, trial bronchodil/neb hypertonic saline, vaccines, lung resection if localised disease with poor response.
