Respiratory Flashcards
What are the signs of the various lobar pneumonias?
Right side has 3 lobes and the left lobe has 2 lobes.
Right upper lobe pneumonia -> consolidation stops at the horizontal fissure
Right middle lobe:
Right heart border is lost ( silhouette sign)
Right hemidiaphragm is visible
Right lower lobe pneumonia:
Right heart border is visible
May lose the right hemidiaphragm
Describe how lung collapse looks?
In all collapse should be able to see visible vascular markings
Right UL:
Horizontal fissure goes up
Middle:
Lost right heart border
How does a pneumothorax look?
Loss of vascular markings.
What are the causes of clubbing
C - cyanotic heart disease, CF
L - Lung cancer, Lung abscess
U - UC
B - bronchiectasis
B - benign mesothelioma
I - infective endocarditis, idiopathic pulmonary fibrosis
N - neurogenic tumours
G - gastrointestinal dis
What is extrinsic allergic alveolitis?
Also known as hypersensitivity pneumonitis
- Inflammation of alveoli and bronchioles due to an immune response to inhaled allergens.
-Non-igE mediated
- caused by repeated inhalation of non-human protein such as bird fanciers lung, farmers lung
Acute exposure -> reversible
Chronic low-grade exposure -> can be irreversible -> fibrosis
How do you diagnose COPD>
Spirometry
what is commonly tested when a person is started on ethambutol?
Visual acuity/Visual fields and colour vision
Can COPD cause weight loss?
YES!
A small amount of weight is normal
What are some special features you see in pneumonia
You may see **air bronchograms **
- i.e the bronchi is visible becuase the alveoli are filled with debri and gunk
**Air space opacification **
- i.e. the air spaces are filled with debri and white stuff
What are the auscultation findings with pneumonia
reduced breath sounds
bronchial breathing ( on expiration).
Percussion is dull
What is the CURB-65
Assessing how to manage CAP and score of 4 high 30 day mortality
C = AMTS <=8/10
U= >7mmol (only in hospital)
R= >=30/min
B= Systolic <= 90 and Diastolic <=60
65
How do you manage pneumonia
CURB SCORE:
CRP < 20 mg/L - do not routinely offer antibiotic therapy
CRP 20 - 100 mg/L - consider a delayed antibiotic prescription
CRP > 100 mg/L - offer antibiotic therapy
0 - home with oral amox for 5 days
2 or more - Hospital admission.
Give dual abx (amox and a macrolide) for 7-10 days
what follow up is required for patients with pneumonia
repeat chest-xray at 6 weeks ( ensure no other abnormalitis such as lung tumour)
only in :
With symptoms and signs that persist despite treatment.
Who are at higher risk of underlying malignancy (particularly smokers and people aged more than 50 years).
what is the difference between bronchitis and pneumonia on x-ray
Bronchitis - x ray normal
pneumonia- infiltrates
Sign of pneumothorax on C-XRAY?
Visible visceral pleural edge ( i.e. the white line showing the part that has collapsed)
No lung markings peripheral to this.
Lung may collapse
What features are present in tension pneumothorax?
ipsilateral increased intercostal space
contralateral shift of the mediastinum
depression of the hemidiaphragm
what is pneumothorax?
presence of gas in the pleural space
What are the signs on auscultation?
It may cause chest pain : often pleuritic because affects pleura.
Signs:
Hyper-resonant lung percussion
reduced breath sounds
reduced lung expansion
tachypnoea
tachycardia
Management for pneumothorax?
**Primary **
- < 2 cm:
–Discharge, repeat CXR - > 2 cm/SOB:
–Aspiration
–If unsuccessful: chest drain
**Secondary **: pre-existing comorbities, if a bullae ruptures.
*< 2 cm:
–Aspiration
*> 2 cm:
–Chest drain
What is the follow up for pneumothoax?
Conservative:
- primary cause -> reviewed every 2-4 days as an outpatient
- secondary -> monitor as an inpatient
if stable -> follow up in outpt department in 2-4 weeks
Needle aspiration:
outpatients department in 2-4 weeks
Chest drain:
daily review as an inpatient
remove drain when resolved
discharge and follow-up in the outpatients department in 2-4 weeks
what do you do for recurrent pneumothorax?
Video-assisted thoracoscopic surgery (VATS) should be considered to allow for mechanical/chemical pleurodesis +/- bullectomy.
How to treat tension pneumothorax?
Tension pneumothorax (one-way air leak into pleural space):
1. Give high flow o2 via a non-rebreather mask
2. Mx with chest decompression
- use open thoracostomy followed by a chest drain if expertise is available.
- Otherwise a needle decompression can be used with a 16-gauge cannula, which is inserted at the second intercostal space, mid-clavicular line, on the affected side. The needle should be inserted just above the third rib, to avoid damaging the neurovascular bundle.
NB: If the cause of the pneumothorax is trauma, ATLS guidelines advise the 5th intercostal space mid-axillary line due to ease of access).
Needle decompression acts as a bridge before insertion of an intercostal chest drain
What are the features of pulmonary oedema on x-ray?
Acute pulomonary oedema (secondary to HF):
A -> air space opacificaion
B -> batwing
C -> cardiomegaly ratio >0.5
D -> diversion
E -> Pleural effusion
What is COPD
Spectrum of obstructive airway disease.
Includes two key components:
- chronic bronchitis + emphysema
What are the radiographic features of COPD?
- increased bronchovascular markings
- lung hyperinflation with flattened hemidiaphragms
What are the fissures of the lungs?
Horizontal fissure - right lung
Oblique fissure - Left lung
What typically causes upper lobe consolidation
Tuberculosis.
What do you see in pneumoperitoneum?
Gas within the peritoneal cavity like a perforated duodenal ulcer
Erect chest x ray – subdiaphragmatic free gas
What are the signs of pleural effusion
Signs — reduced chest wall movements on the affected side, stony dull percussion note, diminished or absent breath sounds, and (in people with heart or renal failure) signs of fluid overload.
What are the signs of lung collapse?
Signs — reduced chest wall movement on the affected side, dull percussion note with bronchial breathing, reduced or diminished breath sounds.
How is pleural effusion mx?
as above, ultrasound is recommended to reduce the complication rate
a 21G needle and 50ml syringe should be used
What should the fluid be sent for?
pH, protein, lactate dehydrogenase (LDH), cytology and microbiology
what determines exudate and trasnduate
exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
