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2021 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Causes of Upper Zone pulmonary fibrosis

A

SCHART

Silicosis/Sarcoidosis
Coal workers pneumoconiosis
Histiocytosis X
Ank Spond/ABPA
Radiation
TB
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2
Q

Causes of Lower Zone pulmonary fibrosis

A

RASID

RA
Asbestosis
Scleroderma
Idiopathic
Drugs: Bleomycin, MTx, Nitrofurantoin, Amiodarone, Hydralazine
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3
Q

Resp Schpiel:

A

Today I examined ___ respiratory system.

Salient features include ___ crepitations/wheeze/dullness/reduced breath sounds in the ____.

This was associated with percussion/vocal resonance/expansion findings of ___ and peripheral findings of ____.

This is consistent with a diagnosis of ____ but tehre are other differentials.

My findings in more detail _____.

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4
Q

Causes of clubbing

A

Lung cancer
Bronchiectasis
IPF
CF

Infective endocarditis
Cyanotic congenital heart disease
CLD

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5
Q

DDx of non CF bronchiectasis

A

Recurrent chest infections –> bronchiectasis
Primary ciliary dyskinesia
CVID - recurrent sinopulmonary infections
Bronchial narrowing/obstruction

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6
Q

Pleural effusion -

Transudate causes

A 
Cardiac failure
Liver failure
Nephrotic syndrome
Hypothyroidism
Meig's syndrome (Ovarian fibroma and pleural effusion)
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7
Q

Pleural effusion -

Exudate causes

A 
Pneumonia (para-pneumonic)
Neoplastic (lung mets/mesothilioma)
TB, sarcoidosis
Pulmonary infarction
RA/SLE
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8
Q

Light’s criteria for exudative effusion

A

Pleural fluid protein : serum protein > 0.5

Pleural fluid LDH : serum LDH > 0.6

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9
Q

Bronchial breath sounds

A

Pneumonia
Localised fibrosis/collapse
Above a pleural effusion

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10
Q

Decreased breath sounds

A 
Emphysema
Large lung mass
Collapse/fibrosis/pneumonia
Effusion
Pneumothorax
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11
Q

ILD Causes:

A

Occupational/Environmental (upper zones) - silicosis, asbestosis, extrinsic allergic alveolitis, stone mason/dusts, Birds, Farming
Drugs (lower zones) - bleomycin, MTx, amiodarone
Radiation

CTD/Granulomatous

  • RA
  • SLE
  • Scleroderma
  • Sjogren’s syndrome
  • Crohn’s disease/UC
  • Dermatomyositis/polymyositis
  • Sarcoidosis

Idiopathic

  • IPF - expect clubbing
  • NSIP - extensive ground glass
  • UIP
  • COP
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12
Q

Fine crackles causes

A
  • Pulmonary fibrosis

- Heart failure (usually coarse)

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13
Q

Coarse crackles causes

A
  • Pneumonia
  • Heart failure
  • Bronchiectasis
  • Atelectasis
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14
Q

Usual Interstitial Pneumonia Findings

A
  • Honeycombing
  • Subpleural & Basal Predominance
  • Traction bronchiectasis

Rx:

  • Pifendidone
  • Nintendanib
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15
Q

NSIP Findings

A
  • Ground glass changes
  • Subpleural sparing
  • Traction bronchiectasis

Rx:

  • Steroids
  • Mycophenolate/Azathioprine
  • Lung Transplant
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16
Q

UIP Causes

A
  • IPF
  • Asbestosis
  • CTD-related ILD (e.g., RA)
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17
Q

NSIP Causes

A
  • More associated with CTD
  • HIV
  • Drugs (Amiodarone, MTX, Nitrofurantoin)
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18
Q

Resp additional tests:

A
  • Temperature chart
  • Oxygen Saturation
  • PEF/FET >3-5 seconds = prolonged/COPD
  • Breast examination
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19
Q

Resp Likely cases:

A
  • ILD +/- CREST (39%)
  • Bronchiectasis (16%)
  • Pneumonectomy/Lobectomy (9%)
  • Pleural effusion (7%)
  • Lung cancer (4%)
  • COPD (4%)
  • Lung Tx!
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20
Q

Respiratory causes of clubbing:

A
  • ILD
  • Carcinoma of the lung
  • Mesothelioma
  • Bronchiectasis
  • Cystic fibrosis
  • Lung abscess
  • Empyema
  • TB
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21
Q

Complications of ILD:

A
  • Respiratory failure
  • Chest infection
  • Pulmonary HTN
  • Cor pulmonale
  • Carcinoma of the lung
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22
Q

Pleural effusion signs:

A
  • reduced chest expansion
  • stony dull percussion
  • reduced vocal resonance
  • reduced breath sounds with area of bronchial breathing above the effusion
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23
Q

Causes of pleural effusion:

A
  • Carcinoma of the lung - nicotine staining, clubbing, lymph nodes, radiation burns, hepatosplenomegaly.
  • Lymphoma - LNs, radiation burns, hepatosplenomegaly.
  • Carcinoma of the breast - breast lump, nipple changes, lymphadenopathy, previous mastectomy/lumpectomy.
  • RA - symmetrical deforming polyarthropathy of the hands, rheumatoid nodules
  • SLE - petechial rash, livedo reticularis, purpura, arthopathy, malar rash
  • CLD - jaundice, ascites, peripheral oedema, and other stigmata of CLD
  • Hypoalmuniamemia - cachexia, poor nutritional status, peripheral oedema
  • CCF - raised venous pressure, S3, S4, peripheral oedema.
24
Q

Exudate (protein >30g/L) causes:

A
  • Neoplasia
  • CTD (RA, SLE)
  • Infection - CAP, TB
  • Pulmonary infarction
  • Sub-diaphragmatic: pancreatitis, sub-phrenic abscess, hepatic abscess
  • Drugs: MTx, Nitrofurantoin, Bromocriptine

Others: asbestosis, sarcoidosis, Dressler’s syndrome, Trauma, Chylothorax

25
Q

Transudate (protein <30g/L) causes:

A
  • CCF
  • Constrictive pericarditis
  • Hypoalbuminaemia
  • Nephrotic syndrome
  • Cirrhosis
  • Peritoneal dialysis
  • Uraemia
  • Hypothyroidism
26
Q

Light’s criteria?

A

Pleural fluid protein : serum protein >0.5
Pleural fluid LDH : serum LDH >0.6
Pleural fluid LDH > 2/3 of the upper limit of normal serum value.

27
Q

Dullness to percussion of lung base ddx:

A
  • Pleural effusion
  • Pleural thickening
  • Collapse
  • Consolidation
  • Raised hemi-diaphragm
  • Lower lobe lobectomy (in the presence of thoracotomy scar).
28
Q

Indications for lobectomy:

A
  • Bronchiectasis (uncontrolled symptoms, i.e., recurrent haemoptysis)
  • Malignancy (NSCLC)
  • Solitary pulmonary nodule (unknown cause)
  • Cystic fibrosis
  • TB
  • Lung abscess
29
Q

Indications for pneumonectomy:

A
  • Bronchiectasis
  • Malignancy
  • TB
30
Q

Productive cough, clubbing, and coarse crackles ddx:

A
  • Bronchiectasis
  • Carcinoma of the lung (nicotine staining, lymphadenopathy)
  • Lung abscess
  • Pulmonary fibrosis
31
Q

Causes of bronchiectasis:

A

1) Respiratory childhood infection - pertussis, measles, TB
2) Bronchial obstruction - foreign body, chronic aspiration, endobronchial tumour, LN (TB, sarcoidosis and malignancy) and granulomata.
3) Fibrosis - long-standing pulmonary fibrosis, TB/sarcoidosis, unresolved or suppurative pneumonia
4) Muco-ciliary clearance defects - CF, immotile cilia syndrome, Kartagener’s syndrome, Young syndrome
5) Immunodeficiency - CVID, AIDS
6) ABPA
7) AI - RA, Sjogren syndrome, IBD (UC > CD)
8) Congenital anatomical defects: Bronchopulmonary sequestration
9) Idiopathic

32
Q

Cx of bronchiectasis

A
  • Pneumonia
  • Pneumothorax
  • Empyema
  • Collapse
  • Metastatic cerebral abscess
  • Respiratory failure
  • Pulmonary HTN
  • Amyloidosis
33
Q

Consolidation ddx

A
  • pneumonia (pyrexia, purulent sputum, haemoptysis)
  • malignancy (cachexia, clubbing, nicotine staining, lymphadenopathy, productive cough)
  • infarction (signs of pulmonary HTN, DVT, bruising-suggesting anti-coagulation).
34
Q

Percussion stony dull (2)

A
  • Fluid/effusion
35
Q

Percussion resonant (2)

A
  • PTx
  • COPD
36
Q

Vocal resonance increased (clearly audible)

A
  • Consolidation
  • Tumour
  • Lobar collapse
37
Q

Vocal resonance decreased (muffled)

A
  • Fluid/effusion
  • PTx (air outside lung)
38
Q

Other (7)

A
  • Pemberton’s - 30 second-1minute
  • Legs (oedema)
  • Temperature
  • Saturations
  • Forced expiratory time - 3 seconds or less
  • Peak expiratory flow - decreased in COPD (>9 = COPD)
  • Spirometry
39
Q

DECAF

A
  • Extended MRC Dyspnea Scale (2 if can’t leave the house)
  • Eosinophils <0.05×10⁹/L (1)
  • Consolidation on chest x-ray (1)
  • Acidemia, pH <7.30 (1)
  • AF (1)
40
Q

BODE

A
  • BMI - > 21 (1)
  • Obstruction - FEV1 <35% (+3)
  • Dyspnoea - mMRC Dyspnea Scale (3 if can’t leave the house)
  • E - ET: Oxygen - 6MWT
41
Q

Bronchiectasis management (7)

A
  • Sputum clearance
  • Postural drainage
  • Chest Physio
  • Flu, pneumococcal, covid vax
  • Smoking cessation
  • Low dose macrolide - MAC/AFB
  • IVIG
42
Q

Daytime sleepiness ddx (6)

A
  • Not enough sleep
  • Poor adjustment to shift work
  • Use of sedative + stimulant drugs
  • Depression w/without early morning waking
  • Idiopathic hypersomnolence
  • Narcolepsy
43
Q

Pulmonary Rehab (3)

A
  • Exercise training
  • Nutrition
  • Counselling

*2x/week, 2hrs at a time, 8 weeks/yr - needs to be done annually

44
Q

Lung transplant indications (5)

A
  • ILD - IPF and non-IPF
  • COPD
  • CF
  • Pulmonary vascular disease
  • Re-Tx for chronic lung allograft dysfunction
45
Q

Asthma discussion (6)

A
  • Confirm Dx
  • Control - previous ICU/ETT
  • Inhaler technique/adherence to Rx
  • Action plan
  • Triggers
    *Impact on life/time off work
46
Q

Asthma biologics (2)

A
  • Allergic - Omalizumab (IgE)
  • Eosinophlic - Mepoluzimab - Anti-IL5

*Decreases smooth muscle mass in A, increases QOL, decreases exacerbations

47
Q

ILD Rx (6)

A
  • Pul rehab
  • LTOTx
  • Vaccination
  • Lung tx
  • Anti-fibrotic meds - decrease rate of decline - Nintenadnib - BD, SE GI upset/dLFTs, Pirfinidone - 9-12 tabs/day!, SE photosensitivity rash
  • ACP/Pal care
48
Q

OSA driving:

A
  • CPAP 4-5hrs per night
  • AHI <5
49
Q

OSA management (5)

A
  • LOW
  • No ETOH
  • CPAP
  • Splint
  • Surgery
50
Q

COPD management (7)

A
  • Inhaler, technique
  • Vaccination
  • Smoking cessation
  • Action plan
  • Long term Oxygen
  • Anxiety Rx
  • Pulmonary Rehab
51
Q

Improve asthma control (3)

A
  1. Check inhaler technique and minimise triggers
  2. R/v previous asthma phenotype and Ax candidacy for biologic Rx
  3. Ensure non-asthma causes of breathlessness are exluded

In more detail…

52
Q

COPD general (7)

A
  • Baseline Sx and reliever use
  • Lung fn (FEV1 proportional to Sx and prognosis), previous chest imaging
  • Exacerbation freq, hospitalisation, ICU admission
  • Smoking cessation
  • Inhaler technique
  • Cx of Rx - Pred
  • Preventative measures - vaccination, exercise, pul rehab
53
Q

COPD basics (5)

A
  • Avoidance of RFs - smoking
  • Infection: vaccination, masks, hand hygiene
  • Regular physical activity
  • Inhalers - LAMA, adherence, technique
  • Pul Rehab 8/52 per year

*ICS decreases exacerbations by 25% but SE: CAP

54
Q

COPD Adv Rx (5)

A
  • Frequent exacerbations, high sputum: ICS, LT Abx - macrolide, doxycycline
  • Chronic hypoxia - ABG - home O2 if pO2 <55 or <60 w pul HTN
  • Vent failure - ABG is hypercapnic, may be candidate for home NIV
  • Hyperinflated? LVRS or bronchoscopic LVR, endobronch valve to shrink lung
  • If young, consider LTx
55
Q

Refractory SOB (3)

A
  • O2
  • Opioids, anxiolytics
  • Rehab - recondition - pul rehab, breathing techniques to avoid gas trapping

2021 (34 decks)

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