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Respiratory Flashcards

1
Q

Asymmetrical chest expansion
No scar

A

Tracheal central

Lung consolidation

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2
Q

Assymetrical lung expansion
No scar
Tracheal pulled towards side of lesion

A

Lung collapse
Lung atelectasis
Traction bronchiectasis
Traction fibrosis

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3
Q

Assymetrical lung expansion
No scar
Tracheal away from lesion

A

Massive pleural effusion
Tension pneumothorax

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4
Q

Assymetrical chest expansion
Scar
Tracheal central

A

Lobectomy

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5
Q

Assymetrical chest expansion
Scar
Tracheal towards side of lesion

A

Pneumonectomy

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6
Q

Assymetrical chest expansion
Scar
Tracheal towards side of lesion

A

Pneumonectomy

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7
Q

Bronchiectasis

A

Clubbing
Chesty copious sputum
Reduced chest expansion bilaterally
Normal percussion
Normal vocal resonance
Central Tracheal
Late Coarse crepitation
Crepitation dampen towards end inspiration
Cough altered crepitation and different amplitude
Right sided heart failure (raised jvp, loud p2, pedal oedema)

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8
Q

Respiratory causes of clubbing

A

Chronic suppurative lung disease
- bronchiectasis
- lung abscess
- empyema
- cf
Lung carcinoma
Pleural and mediastinal tumour
Pulmonary fibrosis
Cryptogenic organising pneumonia

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9
Q

Assymetrical chest expansion
Dull to percussion - ppr - ccc

A

Pleural effusion
Pleural thickening
Raised hemi diaphragm (phrenic nerve crush scar)
Consolidation
Collapse
Cancer

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10
Q

Lung cancer signs

A

Nicotine stain
Clubbing
Wasting of small muscle (wash)
Horner syndrome
Svco
Lymphadenopathy
Radiotherapy burn mark
Radiotherapy tattoo marks

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11
Q

Co2 retention

A

Palmar erythema
Warm hands
Bounding pulses
Co2 flaps

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12
Q

Etiology of bronchiectasis

A

INFECTION:
Post infection TB, ABPA, measles
AUTOIIMUNE:
(SLE, RA, Sjogren, IBD)
SYNDROMIC :
Yellow nail syndrome (yellow nail, bronchiectasis, sinusitis, recurrent pleural effusion)
Cystic fibrosis
Primary cilliary dyskinesia
Cystic fibrosis
IMMUNODEFICIENCY:
Hiv
HypoigG
CVID
OBSTRUCTION:
Lung cancer
Compression of mediastinal Lymphadenopathy

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13
Q

How to investigate bronchiectasis

A

Lung function test - obstructive lung disease
Hrct - to look for tree in bud appearance
Sputum culture - look for infection
Blood test (autoimmune screening, apba - eosinophilia, RAST, raised IgE)
Echo - look for pulmonary htn

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14
Q

Management of bronchiectasis

A

MDT
Identify cause of bronchiectasis
Refer to chest physician
Pulmonary rehabilitation
Chest physiotherapy
Targeted antibiotic for infection
Prophylatic antibiotics
Mucolytics
Stop smoking
Vaccination - pneumococcus, influenza
Dietitian

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15
Q

Complications of bronchiectasis

A

Hemopytsis
Respiratory failure
Pulmonary hypertension (loup P2, raised jvp, parasternal heave, ll odema)
Lung abcess/ recurrent pneumonia/ empyema
Pneumothorax /lung collapse
Metastatic cerebral abcesses
Amyloidosis

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16
Q

Pulmonary fibrosis

A

Clubbing
Tracheal central
Reduced chest expansion
Dull to percussion
Fine crepitation (no change with cough)

17
Q

Respiratory causes of clubbing

A

Chronic suppurative disease
- lung empyema
- bronchiectasis
- abcess
- cystic fibrosis
Mesothelioma
Pulmonary fibrosis
Cryptogenic organising pneumonia
Squamous cell carcinoma of lung cancer

Cardiovascular
Infective endocarditis

18
Q

Apical lung fibrosis
(Charts)

A

C - coal worker pneumoconiosis
H - histoplasmosis
A - Ankylosing spondylitis
R - radiation
T - tb
S - silicosis, sarcoidosis

19
Q

Basal lung fibrosis
Rasid

A

R - rheumatoid arthritis
A - asbestosis, acute eosinophilic pneumonitis
S - sle, ssc, Sjogren
I - idiopathic lung fibrosis, ild
D - drugs (Mtx, Amiodarone, nitrofurantoin

20
Q

Lobectomy

A

Thoracotomy scar
Tracheal deviation towards lesion site
Normal examination
Reason : secondary hyperinflation of other lobes

21
Q

Consolidation

A

No mediastinal shift
Reduced chest wall expansion
Dull on percussion
Increase vocal resonance
Bronchial breath sound
Coarse inspiration crackles

22
Q

Pleural effusion

A

Tracheal deviated away from lesion (massive pleural effusion)
Reduced chest expansion on affected site
Stony dull to percussion
Reduce breath sound
Bronchial breathing at level of effusion
Reduce vocal resonance to level of effusion

23
Q

Light criteria
( for protein between 25 to 30)

A

Pleural protein to serum protein > 0.5
Pleural ldh to serum ldh > 0.6
Pleural ldh > 2/3 normal serum value

24
Q

Clubbing + crepitation

A

Bronchiectasis
Pulmonary fibrosis
Lung abcess
Mitotic lung lesion

25
Collapse consolidation
No scar Ipsilateral reduce chest expansion Dullness on percussion Tracheal deviated towards side of lesion (Ipsilateral) - upper zone collapse Prominent Bronchial breathing Increase vocal resonance in consolidation Reduce vocal resonance in collapse region
26
Ddx of thoracotomy scar
Pneumonectomy Lobectomy Lung volume reduction surgery Bullectomy Thoracopasty
27
Ddx of pneumonectomy
T tuberculosis B bronchiectasis M malignancy
28
Ddx of lobectomy
T tuberculosis B bronchiectasis M malignancy Cystic fibrosis Solitary lung nodules Bullectomy
29
Pre op evaluation of pneumonectomy
Pre op FEV1 > 2L (low risk) Pre op FEV1 <2L (high risk) (need for predicted post op fev1 and gas transfer + lung ventilation/perfusion scan)
30
Indication of lung transplant
Obstructive (copd, alpha 1 anti trypsin deficiency) Restrictive (lung fibrosis) Suppurative (cystic fibrosis, bronchiectasis) Vascular (pul htn)
31
Post lobectomy complications
Bronchopleural fistula Pleural effusion Pneumonia at remaining lung tissues Tumour recurrence Chronic atelectasis
32
Investigation post pneumonectomy
Cxr Ct thorax Sputum c n s Tumour markers
33
Increase vocal resonance
Consolidation Bronchiectasis Cavitation Mass Lung collapse with mediastinal shift to the side of lesion
34
Reduced vocal resonance
Pleural effusion Pneumothorax Lung fibrosis Lobectomy Pneumonectomy
35
Lateral thoracotomy scar
Pneumonectomy Lobectomy Single lung transplant
36
Lung Collapse
Trachea deviated to affected site Reduce chest expansion over affected site Dullness on percussion Reduce air entry at affected site Reduced vocal resonance

Short case (4 decks)

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