Respiratory Flashcards
What does inspiratory noise imply?
Upper airway obstruction, common in kids with croup, not good if you hear it in an adult.
What does wasting in the hands indicate?
May be an apical lung tumour affecting the brachial plexus.
Where should you look for clubbing?
Hands and feet- sometimes it only shows up in the feet.
What does peripheral cyanosis indicate?
Circulatory insufficiency- poor perfusion
What does central cyanosis indicate?
Respiratory insufficiency- hypoxia
What does a deviated trachea indicate?
Upper lobe pathology on the side it deviates to.
What muscle wasting do you see in advanced lung disease?
Shoulder girdle
What does an increased percussion note indicate?
Pneumothorax, hyperinflation, lung cyst
What do decreased lung sounds indicate? (At least 5)
Consolidation, collapse, dense fibrosis, pleural fluid, thickening, elevated hemidiaphragm.
What is atelectasis, what are 3 common causes, and who is the most at risk?
Atelectasis is; collapsed lung resulting in reduced or absent gas exchange.
Common causes: post-op, surfactant insufficiency, blocking of bronchioles via sputum plug, foreign body, tumour.
At risk: elderly, smokers
When do you get wheeze?
Asthma, bronchitis, pulmonary oedema.
Are wheezes usually inspiratory or expiratory?
Expiratory
List 5 causes of crackles
Pulmonary oedema, pulmonary fibrosis, pneumonia, bronchiectasis, atelectasis
How many seconds indicate significant airflow obstruction for FEV1?
6 seconds. It is normally less than 3.
What is tripodding?
Using arms to help accessory muscles
Does pulmonary hypertension cause cheek flushing?
Yes
What signs would you find in examination of somebody with pulmonary hypertension?
Palpable RV grave and 2nd heart sound
Loud H2
4th heart sound
Pulmonary flow murmur.
What signs would you find in examination of somebody with right heart failure?
Elevated JVP
3rd heart sound
Peripheral oedema, ascites, pleural effusions.
Is the cough from diffuse lung disease usually productive or dry?
Usually dry
What distinguishes diffuse lung disease from other lung disease patterns?
Diffuse disease usually involves either or both the alveoli or the interstitium, including the pulmonary vasculature.
What acute processes cause a diffuse lung pattern?
Water- pulmonary oedema from altered Starling forces.
Inflammation- acute inhalation injury from toxic fumes, acute drug toxicity or infection.
Blood-diffuse leakage from inflamed vessels in vasculitis
What are the physiological effects of acute alveolar and interstitial filling or inflammation?
Loss of elastic recoil- stiff lungs Tachynoea Cough Increased WOB Usually severe dyspnoea Severe hypoxia due to serious V/Q impairment.
What is sarcoidosis and with what 3 abnormalities can it typically present?
Sarcoidosis is a multi system (non caseating) granulomatous disorder which typically affects the lungs, skin and lymph nodes.
Typically presents with; bilateral hilar adenopathy, pulmonary reticular opacities, skin, joint, and/or eye lesions.
Name the 2 most common interstitial lung diseases
Idiopathic pulmonary fibrosis and sarcoidosis.
Name some causes of interstitial lung disease.
Asbestos
Occupational exposure to birds, chemicals etc.
Drugs- chemotherapy and antibiotics eg. Methotrexate, amiodarone, bleomycin, nitrofurantoin- Ola but still used for recurrent UTIs
Radiotherapy
Connective tissue disease
Vasculitis
Name 4 signs of inflammatory pain and 3 connective tissue diseases that they would be associated with which lead to pulmonary fibrosis.
Fever, joint pain, morning stiffness, rash. Systemic sclerosis Rheumatoid arthritis SLE Polymyositis
What test do you perform if you’re looking for lung cancer?
Chest CT
What test do you perform if looking for PE?
CT Pulmonary angiogram
What test would you perform if someone presented with significant haemoptysis?
CT bronchial angiogram.
Which test is especially relevant in connective tissue disorders?
ECG- may identify LV dysfunction. Assess for presence of pulmonary hypertension.
What do Kerley B lines indicate?
Pulmonary oedema.
What does honeycomb lung indicate?
Idiopathic pulmonary fibrosis. It is a marker of severity.
