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Clinical exam - short cases > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What characteristics are suggestive of each of the following forms of ILD?

  • COP
  • LAM
  • Connective tissue diseases (scleroderma, SLE, Sjogren’s, RA, PM, DM)
  • Churg-Strauss or SLE
A

COP
- Inisidious onset of cough, fevers, malaise and myalgias over weeks to months
- responds to steroids
LAM
- premenopausal women with Hx of pneumothorax
CTD
- weight loss, fatigue, fever, rash, arthralgia
Churg-Strauss syndrome
- Pre-existing asthma
Goodpasture’s syndrome or SLE
- Haemoptysis and renal disease

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2
Q

Which medications are typically associated with lung fibrosis?

A 
Amiodarone, hydralazine, procainamide
MTX, d-penicillamine
Bleomycin, cyclophosphamide, busulphan
Nitrofurantoin
Bromocriptine
Gold
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3
Q

What are the causes of upper lobe fibrosis?

A 
Berylliosis
Radiation
Extrinsic Allergic Alveolitis
Allergic bronchopulmonary aspergillosis
Silicosis
TB
Sarcoidosis

Cystic fibrosis / Coal worker’s pneumoconiosis
Langerhans cell histiocytosis (Eosinophilic granuloma)
Ankylosing spondylitis
Psoriasis

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4
Q

What are the causes of lower lobe fibrosis?

A 
IPF
RA, scleroderma, PM, DM, MCTD
Asbestosis
Aspiration
Drugs
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5
Q

What are the components of the respiratory exam?

A 
Position on side of bed
Expose
O2, sputum cup, inhalers, flutter valve, 4WW
State name, address, DOB
Cough
Work of breathing
Hands: nicotine, clubbing, cyanosis, wasting, finger abduction
Wrist tenderness (if clubbing present)
Pulse
BP (+ pulsus paradoxus)
Asterixis
Pemberton's
Eyes: Horner's, jaundice, anaemia
Mouth: central cyanosis
Voice: recurrent laryngeal nerve palsy
Trachea
Forced expiratory time

Posterior chest

  • Inspect: shape, scars, radiotherapy marks, prominent veins
  • Palpate: cervical lymph nodes, expansion x 2 levels, fremitus
  • Percuss: supraclavicular region, back, axillary, tidal percussion

Anterior chest

  • Inspect
  • Palpate: fremitus
  • Percuss
  • Auscultate
CVS
- JVP
- Apex beat
- PHTN
Cor pulmonale

Temp

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6
Q

What are the causes of bronchiectasis?

A
  • Obstruction (foreign body, tumour)
  • Infection (bacterial, non-TB mycobacteria, measles, pertussis, influenza, adenovirus)
  • TB
  • Immunodeficiency (hypogammaglobulinemia, HIV, bronchiolitis obliterans after lung transplant)
  • ABPA
  • COPD, bronchiolitis
  • Recurrent aspiration, toxic inhalation, radiation
  • Foreign body aspiration, tumour, LN enlargement
  • Autoimmune or rheumatological (RA, Sjogren’s, SLE, IBD, relapsing polychondritis)
  • Genetic causes (CF, A1AT deficiency, Kartagener’s syndrome/primary ciliary dyskinesia, Young’s syndrome, Marfan’s syndrome, bronchial cartilege deficiency)
  • Neuropathic disorders (Riley-Day syndrome, Chagas’ disease)
  • IBD
  • Yellow nail syndrome
  • Traction bronchiectasis from postradiation fibrosis or IPF
  • Bronchial atresia
  • Idiopathic
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7
Q

What are the components of the respiratory exam?

A

Position at side of bed
Evaluate bedside: O2, sputum cup, puffers, flutter valve, mobility aid, IVC, IV meds
Expose: body habitus, deformities, scars, cyanosis
WOB: Name, place, date
Cough
Forced expiratory time
RR and depth of breathing

Hands: clubbing, cyanosis, nicotine stains, palmar crease pallor, small muscle wasting, C8-T1 weakness
Wrist
- HPOA
- Pulse (tachycardia, paradoxus)
- Asterixis
Arms
- Steroid purpura
- BP (check paradoxus)
Eyes: Horner's, jaundice, anaemia
Mouth: central cyanosis
Neck
- Cervical, supraclavicular, axillary LN
- Trachea: deviation, tug

Posterior chest

  • Shape, scars, radiotherapy, prominent veins
  • Expansion
  • Percuss: back, axillae, tidal percussion
  • Breath sounds, vocal resonance

Anterior chest

  • Inspect
  • Expansion
  • Percuss: supraclavicular, chest
  • Breath sounds
  • Pemberton’s

CVS

  • JVP
  • Apex beat
  • PHTN
  • Cor pulmonale

Other
- Temp, Sats

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8
Q

Name 3 drug causes of pleural effusions.

A

Bromocriptine
MTX
Nitrofurantoin

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9
Q

What is the DDx for a transudative pleural effusion?

A 
CCF
Constrictive pericarditis
Mitral stenosis
Cirrhosis
Nephrotic syndrome
Uraemia
Peritoneal dialysis
Hypothyroidism
Meig's syndrome
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10
Q

What is the DDx for elevated amylase in pleural fluid?

A

Pancreatitis
Malignancy
Bacterial pneumonia
Oesophageal rupture

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11
Q

What is the DDx for low pleural fluid glucose?

A 
Empyema
TB
Malignancy
RA
SLE
Oesophageal rupture
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12
Q

What are the common distributions of bronchiectasis in various causes of it?

A

Infection: Lower lobes, RML, lingula
Malignancy: RML
TB, chronic fungal infections: Upper lobes
ABPA: Upper lobes, involves proximal bronchi

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13
Q

What are the respiratory causes of clubbing?

A 
ILD
CF
Bronchiectasis
TB
Lung cancer
Mesothelioma
Lung abscess
Empyema
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14
Q

What is the DDx for a cavitating lung lesion?

A

Infectious

  • Staph aureus
  • Klebsiella pneumoniae
  • Anaerobic infections
  • Pseudomonas aeruginosa
  • TB
  • Aspergilloma
  • Histoplasmosis
  • Coccidiomycosis

Non-infectious

  • Malignancy - usually SCC or lymphoma
  • GPA
  • Pulmonary rheumatoid nodule
  • Caplan’s syndrome (RA + pneumoconiosis)
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15
Q

What is the difference between inspiratory and expiratory stridor?

A

Inspiratory stridor - extrathoracic obstruction

Expiratory stridor - intrathoracic obstruction

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16
Q

What is the DDx for chilous pleural effusion?

A 
Tumour (usually lymphoma)
Thoracic duct trauma
Lymphatic disorders (eg. LAM)
TB
Cirrhosis
Tuberous sclerosis
17
Q

What are DDx for different pulmonary distributions of bronchiectasis?

A

Upper zones - CF, TB, ABPA
Middle zones - LN enlargement, atypical mycobacteria
Lower zones - aspiration, hypogammaglobulinaemia, ciliary dyskinesia, childhood infection

18
Q

What are the most commonly isolated pathogens in bronchiectasis?

A 
Haemophilus influenza
Strep pneumoniae
Staph aureus
Moraxella catarrhalis
Atypical mycobacteria
19
Q

What comprises the FACED score used in bronchiectasis?

A 
FEV1
Age
Colonisation with Pseudomonas
Extent of radiological involvement (number of lobes involved)
Dyspnoea

Predicts 5 year mortality

20
Q

What are the treatment options in bronchiectasis?

A
  • Bronchodilators if airway reversibility exists. Also helps with mucolysis.
  • Mucoactive therapies in CF (normal saline, hypertonic saline, mannitol, acetylcysteine, bromhexine)
  • Bubble PEP
  • Macrolides improve QoL and exacerbation frequency in CF bronchiolitis
  • Exercise improves QoL
21
Q

What are the features of yellow nail syndrome?

A

Yellow nails
Bronchiectasis
Pleural effusions
Lymphoedema

22
Q

What should be tested for in pleural fluid if TB is suspected?

A

Adenosine deaminase

23
Q

What are the causes of pleural flud lymphocytosis?

A

Long standing pleural effusions: malignancy, TB, CCF, lymphoma, collagen vascular diseases, sarcoidosis

24
Q

What are the causes of an exudative pleural effusion?

A 
Malignancy - primary, secondary, mesothelioma
Pneumonia
TB, sarcoidosis
Pulmonary infarction
MTX, nitrofurantoin, bromocriptine
RA, SLE
Pancreatitis
Radiation
Subphrenic abscess
25
Q

Lung metastases are most commonly which malignancies?

A 
Breast
Colorectal cancer
RCC
Uterine leiomyosarcoma
Head and neck SCC

Clinical exam - short cases (11 decks)

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