Respiratory Flashcards
Signs or cardiomegaly/cardiac tamponade
“Pericardial silhouette enlarged” if more than half of lung width
Better than cardiomegaly cos it may be enlarged due to pericardial effusion/tamponade
Types of pneumothorax
Primary spontaneous pneumothorax/PSP:no underlying lung issues
Vs secondary spontaneous pneumothorax(secondary to lung disease eg asthma,COPD)
Traumatic
-iatrogenic(eg from ventilator,central line too far from SCA,biopsy,thorascopy)
-non iatrogenic(eg from stab wounds)
Objective ways to identify a pneumothorax on XR
ACCP:distance from apex to cupola >3cm(threshold higher cos of gravity)A for Apex
BTS:interpleural distance at level of hilum> 2cm
How does the lung USUALLY collapse in a pneumothorax
The lung usually collapses towards the hilum:unless scarring causee it to collapse un-uniformly(eg scarring in the upper lobe caused by chronic smoking causes it not to collapse towards hilum)
Risk factors for a nodule being benign vs malignant
-Size >20mm 50% chance of malignancy
-Borders(spiculations): poorly circumscribed borders more likely to be malignant
-Growth rate(too fast or too slow unlikely)except Small cell carcinoma and lymphoma
-attenuation:solid vs non solid(solid more common but non solid more likely to be malignant)
-calcifications:eccentric most dangerous(tumour grows out from the calcification) vs popcorn central etc
-Location:apex tends to collect more smoke in lung,higher chance of malignant lesions
Signs of Pulmonary Embolism on CXR
-Hamptons Hump(wedge shaped infarct)
-Westermark sign(oligaemia:a clarified area distal to a large vessel occluded by a pulmonary embolism,caused by reflex vasoconstriction and impaired vascular is still bc obstruction
-Pallas’s sign:enlarged descending pulmonary artery
-Fleischner sign: Dilated central pulmonary artery
-Meniscus sign: blunting of costophrenic angle
Criteria for differentiating transudative and exudative pleural effusion
Lights criteria
Exudative if:
Effusion protein/Serum protein >0.5
OR Effusion LDH/Serum LDH >0.6
OR Effusion LDH > 2/3 laboratory upper limit of serum LDH reference range
Causes of transudative effusion
1)Congestive Heart Failure
2)Nephrotic syndrome
3)Chronic Liver disease
Causes of exudative effusion
1)Infections
2)Neoplasm
Increased inflammation causes more protein to leak out of pulmonary vessels
Types of interstitial lung disease(restrictive)
1.Idiopathic Pulmonary Fibrosis:diagnosis of exclusion
2.Hypersensitivity pneumonitis(chronic)
3.Pneunoconiosis
4.Sarcoidosis
5.Asbestosis:caused by asbestos fibres
6.SLE
7. Rheumatoid arthritis associated ILD
8.Silicosis
9. Drug fibrosis:AMIODARONE BROMOCRIPTINE CYCLOPHOSPHAMIDE METHOTREXATE NITROFURANTOIN
4 Ts of anterior mediastinal masses
- Thyroid
- Thymus
- Teratoma
- Terrible lymphoma
Medial mediastinal masses
- Esophageal
- Bronchial cysts
- Hernia(hiatus?)
- Lymph nodes
Posterior Mediastinal masses
- Aortic Aneurysm
- Germ Cell Tumors
Which main bronchus do foreign bodies usually enter and why
Right main bronchus as it is oriented more vertically, has a larger diameter and is shorter
Impt qns to ask in any suspected asthma case
Interval Symptoms, personal and family history of Atopy, past HD/ICU admissions or invasive intubation
Complications of pneumonia
Parapneumonic effusion
Sepsis
Spread to other sites eg meningitis,osteomyelitis
Hemolytic Uremic Syndrome with strep pneumo
Necrotising pneumonia
Long term:
Lung fibrosis
Bronchiectasis
Pathogens in atypical pneumonia
Mycoplasma and chlamydia pneumoniae
Causes s of bronchiectasis
Focal
1.Post infectious
2. Mechanical
3. Aspiration
4. Tumor
5. Lymph nodes
Systemic
Immunodeficiency acquired and congenital
Cystic fibrosis
Ciliary abnormalities eg kartegener
Congenital lobar emphysema
Idiopathic
Coryzal symptoms
Fever, rhinorrhea, cough, sore throat
Croup triad
- Loss of voice/laryngitis
- Barking cough
- Strider
Ideal method for administering high flow O2 in acute respiratory distress
Non rebreather mask> venturi and nasal prongs
Causes of ILD
Idiopathic
Rheumatological
Drug related
Pneumoconiosis
Function of incentive spirometer
Patient to breathe in as deeply and as slowly aa possible-> helps expand the lungs and prevent atelactasis
How to ddx between pleural effusion and fibrothorax
Tracheal deviation in pleural effusion?
Causes of upper lobe lung fibrosis
STAR
Sarcoidosis
TB
ABPA
Radiation
Causes of lower lobe lung fibrosis
RADIO
Rheum(RA, scleroderma, Dermatomyositis, systemic sclerosis)
Asbestosis
Drugs
Idiopathic
Others
Treatment of interstitial lung disease
Non pharm
-pt education
-smoking cessation
- vaccinations
Pharm
-Fibrinolytics eg perfenidone, nintedanib
Non pharm
-Lung transplant
Key invx in case of interstitial lung disease
- CXR
- HRCT
- ABG
- Lung function test
3 common pathogens causing COPD exacerbation
- Strep pneumo
- HIB
- Moraxella Catarrhalis
eosinophilia count cutoff for starting ICS in COPD exacerbation
> 300
GOLD grade vs ABE
Grade is for prognosis
ABE is for management
2 causes of white out lung
Pleural effusion(trachea pushed contralateral) and lung collapse(trachea pushed ipsilateral)
Paraneoplastic syndromes a/w small cell lung ca
SIADH, Lambert Eaton, Cushings
Common sites of lung mets
Liver, adrenals, bone and brain
Malignancy most associated with asbestosis
Malignant Mesothelioma
Things to send for pleural fluid studies
Cytology - cancer cells
Cell counts - neutrophilic or lymphocytic
ADA - local context can be TB or some tumours
Culture & sensitivity
Protein
LDH
pH, glucose
pH <7.2, glucose > 2.2 means complicated parapneumonic effusion → need chest tube insertion
Ddx of massive pleural effusion
1) Malignancy
2) Parapneumonic
3) Tuberculous
4) Transudate eg hepatoc hydrothorax
Definitive treatment of massive hemoptysis
Bronchial Artery Embolization
cutoff for complicated pleural effusion
pH <7.2
ai
n invx for suspected pulmonary embolism depending on suspicion
CTPA(high sus)
D Dimer(low sus)
US Lower Limbs
Diagnosis of pulmonary arterial hypertension(PAH)
Via Swan Ganz catheter
> 25mm at rest
35mm during exercise
mx of asthma exacerbation
nebs in 1:2:1 ratio(salb NS ipratropium)
PO or IV corticosteroids
Magnesium sulphate
Common cause of hypoK in asthma patients
Iatrogenic due to beta agonist
pulmonary hypertension treatment
ambrisentan and sildenafil
Oxygen therapy
Rheumatological causes of ILD at bases
RA, Systemic sclerosis, dermatomyositis
Causes of upper Lobe ILD: STAR
Sarcoidosis
Tuberculosis
ABPA/Ankylosing Spondylitis
Radiation
Causes of lower lobe ILD: RAID
Rheumatological( RA, Scleroderma, Dermatomyositis)
Asbestosis
Idiopathic Pulmonary Fibrosis
Drugs( Methotrexate, Cyclophosphamide, Azathioprine)
