respiratory Flashcards
what is stertor?
hot potato speech due to nasopharyngeal or orophrarangeal blockage
cause of biphasic stridor?
tracheal narrowing
cause of inspiratory stridor?
narrowing at vocal cords
what does wheeze on waking indicate?
COPD
what is wheeze?
high pitched whistling from upper airways
why is sputum green?
dead neutrophils release veroperoxidase
what colour sputum will a patient with COPD and infection produce?
in the morning-green from dead stagnated neutrophils, it will become yellow throughout the day as more live ones are coughed up
what is red sputum an indicator of
pneumococcal pneumonia
causes of clubbing
cardiac-IE -congenital cyanotic disorders
respiratory-bronchiectasis -TB -neoplasm -sarcoidosis -IPF -empyema
GI-IDB -PBC -achalasia -liver cirrhosis
familial
how might a patient describe dyspnoea?
hard to get enough air in
short of breath
tiredness
what is dyspnoea?
unecessary awareness of breathing
cardiac causes of dyspnoea
heart failure MI cardiomyopathy constrictive pericardits pericardial effusion
respiratory causes of dyspnoea
asthma COPD bronchiectasis fibrosis tumour sarcoidosis alveolitis pneumonia PE pulmonary HTN pneumothorax pleural effusion ank spond kyphoscoliosis myasthenia gravis Guillian Barre syndrome
if dyspnoea was sudden onset (minutes), what is a likely diagnosis?
PE pneumothorax pleural effusion asthma inhaled foreign body
what is orthopneoa often a sign of?
left ventricular failure and less commonly: r muscle weakness pleural eff massive ascites morbid obesity GORD
onset of dyspnoea from hours to days
asthma
pneumonia
COPD exacerbation
dyspnoea onset weeks to months
anaemia
PE
neuromuscular disorders
dyspnoea onset months to years
COPD
pulmonary fibrosis
pulmonary TB
breathlessness RELIEVED by lying down
platypnoea from R>L PFO
ASD
dyspnoea on waking is associated with?
asthma
left ventricular failure
what is breathlessness on waking associated with?
COPD-SOB that wakes is more typical of asthma
what symptoms should you ask about if someone presents with SOB?
chest pain
wheeze
cough
where does pleural pain localise
if originates above 6th rib, it’s localised
if below 6th rib-referred to upper abdo
if over the diaphragm, it’s referred to shoulder tip or neck
causes of pleuritic chest pain?
pneumonia
pleural effusion
pulmonary embolism
fractured ribs
describe the chest pain in lung cancer
dull, aching, progressive, unrelated to breathing, disrupts sleep
what is Pancoast’s tumour?
a tumour in the apex of the lung that compresses the brachial plexus and causes pain down medial side of arm
reterosternal, raw, burning pain, worse on coughing
mediastinum pain caused by irritants or infection of trachobronchial tree
central chest pain?
MI or massive PE causing increased pressure in RV
define tachypnoea
over 25 b/min
causes of tachypnoea
fever acute asthma COPD exac pneumonia pul oedema interstitial lung disease
define bradypnoea and give causes
under 10 b/min
opioid toxicity
hypothryoidism
raised ICP
causes of painless breathlessness
PE pneumonia pneumothorax metabolic acidosis hypovolaemia acute left ventricular failure
what is Cheyne-Stokes respiration?
periodic breathing, increasing in depth and rate and then there’s a 10-20s period of apnoea or hypopnea, it’s due to altered CO2 sensitivity from congestive heart failure (bad prognosis), altitude sickness, encephalitis, brainstem lesions, raised ICP
causes of Kussmaul’s breathing?
DKA AKI lactic acidosis methanol poisoning salicylate poisoning
reduced chest expansion is seen in?
lung cancer
pneumonia
IPF
pleural effusion
hyperinflation seen in?
asthma
COPD
what areas does fibrosis affect?
starts basally
what respiratory diseases may cause ankle swelling?
COPD from cor pulmone
IPF
what would cause diminished vesicular breathing?
pleural effusion pleural thickening pneumothorax hyperinflation over an area of collapse
what will speech sound like over pleural effusion?
muffled
respiratory diseases in which there will be raised eosinophil count
allergic asthma
pulmonary eosinophilia
allergic bronchopulmonary aspergillosis
churg strauss
what ion will severe pneumonia reduce?
sodium
what respiratory disease causes Ig deficiency?
bronchiectasis
what requires a high resolution CT scan?
bronchiectasis
interstitial lung disease
indications for bronchoscopy
? lung cancer
? foreign body aspiration
specimens for microbiology
causes of respiratory acidosis
acute ventilatory failure from severe acute asthma, severe pneumonia, COPD exa, skeletal abnormality or neuromuscular disorder
respiratory alkalosis causes
hyperventilation (asthma, PE, pleurisy)
CNS-stroke; subarachnoid; early salicylate poisoning
causes of metabolic acidosis
- DKA
- poisoning from alcohol, methanol, ethylene glycol, iron, salicylate
- AKI
- lactic acidosis-shock, cardiac arrest
- loss of bicarb from renal tubular acidosis, severe diarrhoea, Addison’s
metabolic alkalosis causes
- loss of acid from severe vomiting, NG suction
- loss of potassium from XS diuretic, hyperaldosteronism, Cushing’s, liquorice, XS alkali ingestion
what does haemoptysis suggest?
PE
malignancy
Which organisms are most likely to cause COPD exacerbation?
Moraxella carrhalis, S. pneumoniae, H influenzae, rhinovirus, influenza
features of bronchiectasis on CXR?
tram track bronchi
ring like shadows
thick dilated airways
what is the faulty protein in CF?
CF transmembrane conductance regulator
GI complications of CF?
DIOS, autodigestion+malabsorption+steatorrhoea, cholesterol stones, cirrhosis, PUD, GI cancer
add to the list of: SOB, haemoptysis, bronchiectasis, steatorrhoea sx of CF
meconium ileus, nasal polyps, sinusitis, liver/kidney failure, GORD
how can you prove CFTR dysfunction?
nasal PD, sweat test and small bowel ion studies
how do you treat a CF exacerbation?
o2 support, antibiotics, control hyperglycaemia, increased physio and nutrition support
is bronchitis obstructive or restrictive?
obstructive
transudate PE causes?
liver cirrhosis, kidney failure, hypothyroidism, heart failure, low protein, a haemothorax
sx of PE?
atelectasis leading to PE, pleuritic chest pain, asymptomatic, stony dull to percussion, reduced breath sounds, reduced expansion
why does systemic bp fall in PE?
decrease in cardiac output because pulmonary artery pressure has increased
what is a massive PE?
both pulmonary arteries blocked
what would you hear on auscultating a PE?
coarse crackles, possibly a pleural rub
what might a PE CXR look like?
normal or blunting of the costophrenic angles or atelectasis
management of PEs?
high flow o2
adrenaline
consider surgery if massive
LMWH until INR over 2 then warfarin
