Respiratory Flashcards
What are 4 causes of a restrictive lung defect on spirometry? Mixed?
Obesity, interstitial lung disease, pulmonary fibrosis, pleural disease. Cystic fibrosis
What are 4 atypical symptoms of OSA? What are 6 physical exam features to check?
Poor focus, depression, low libido, nocturia. BMI, neck circumference, BP, nasal patency, mallampatti score, CV - apex beat, ECG.
What are 7 measures to address in OSA? When is a sleep physician referred?
Weight reduction, smoking cessation, alcohol reduction, positional therapy (bed head, alarms), intranasal steroids for polyps, sleep hygiene, review driving. Refer for severe OSA 15+ AHI.
What are 7 differentials for haemoptysis?
URTI/bronchitis; vascular - PE, CCF; lobar infection: pneumonia/TB/abscess; bronchogenic carcinoma; bleeding disorder; bronchiectasis; vasculitis - good pastures syndrome.
What are 3 systemic features of lung ca? How do small cell and secondary mets appear on CXR?
High ALP from bony mets, SIADH, hypercalcaemia. SCLC: central w mediastinal widening, aggressive. Secondary mets: canon ball lesions.
Features of mycoplasma and chlamydophila pneumoniae? Legionella? Psittacosis - test.
Young, dry cough, bilateral lower zone infiltrate. L: related to cooling systems, dry cough, fever, diarrhoea, low sodium. Treat w azith. P: fever, headache, dry cough, diarrhoea. Throat swab PCR.
1st line treatments for CAP. 6 indicators of severe pneumonia.
Amoxy 1g TDS. For atypical: doxy BD, azith or clarithro. 5-7 days. RR > 22, HR > 100, BP < 90, confusion, O2 sats < 92%, multilobar involvement on CXR.
Bronchiectasis - risk factors, associations, bugs.
Asthma/COPD and CF. Socioeconomic disadvantage: smoke exposure, recurrent RTI from overcrowding, lack of access to healthcare, lack of access to early treatment. Bugs: aspergillus, pseudomonas, e.coli, klebs.
What are exam and radiological features of bronchiectasis?
Coarse crackles, clubbing, chronic productive cough. CXR: thick airways and linear atelectasis - tram tracks. HRCT gold standard: dilated bronchus makes signet ring w pulmonary artery.
Mx of bronchiectasis - acute exacerbation, 7 fx of long term and 4 indications to refer
Base abx on prev sputum, always get sputum, modify if colonised by pseudomonas. Pulmonary rehab, airway clearance, minimise infectious exposures, action plan, immunisation, smoking cessation, nutrition. Refer if >3 exac in a year, hospitalised, resistant organisms, rapid progression.
4 hx/ex features of interstitial lung disease. 5 possible causes
Exertional dyspnoea, dry cough, fine insp crackles, clubbing. Idiopathic, sarcoid, drugs (amiodarone, nitrofurantoin), hypersensitivity pneumonitis or any connective tissue disease.
Sarcoidosis - sx, ex and ix findings, mx.
Cough, fatigue, weightloss, dyspnoea. Erythema nodosum, bilateral hilar lymphdaenopathy and reticular opacities. Aim to exclude other diseases - can do biopsy. No treatment, may do steroids.
When/how does radiation pneumonitis present? How is it managed?
1-3mo post radiotherapy, cough + fatigue. CT shows ground glass opacity or consolidation. Tx w steroids 8 weeks.
Pneumothorax - what is large? Risk of recurrence of a primary Ptx? How is a tension pneumothorax managed?
> 3cm apex, 2cm lateral. Primary recur in 30-50% (consider pleurodiesis). Tension: no CXR, urgent needle decompression 2nd intercostal space midclavicular line. Give oxygen and analgesia (morphine)
What are 6 differentials for a cavitating lung lesion?
Cancer (bronchogenic carcinoma), autoimmune granuloma - rheumatoid nodule, PE or septic PE, TB, pulmonary abscess, bronchogenic cyst.
