Respiratory Flashcards
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
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
Which medications are typically associated with lung fibrosis?
Amiodarone, hydralazine, procainamide MTX, d-penicillamine Bleomycin, cyclophosphamide, busulphan Nitrofurantoin Bromocriptine Gold
What are the causes of upper lobe fibrosis?
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
What are the causes of lower lobe fibrosis?
IPF RA, scleroderma, PM, DM, MCTD Asbestosis Aspiration Drugs
What are the components of the respiratory exam?
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
What are the causes of bronchiectasis?
- 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
What are the components of the respiratory exam?
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
Name 3 drug causes of pleural effusions.
Bromocriptine
MTX
Nitrofurantoin
What is the DDx for a transudative pleural effusion?
CCF Constrictive pericarditis Mitral stenosis Cirrhosis Nephrotic syndrome Uraemia Peritoneal dialysis Hypothyroidism Meig's syndrome
What is the DDx for elevated amylase in pleural fluid?
Pancreatitis
Malignancy
Bacterial pneumonia
Oesophageal rupture
What is the DDx for low pleural fluid glucose?
Empyema TB Malignancy RA SLE Oesophageal rupture
What are the common distributions of bronchiectasis in various causes of it?
Infection: Lower lobes, RML, lingula
Malignancy: RML
TB, chronic fungal infections: Upper lobes
ABPA: Upper lobes, involves proximal bronchi
What are the respiratory causes of clubbing?
ILD CF Bronchiectasis TB Lung cancer Mesothelioma Lung abscess Empyema
What is the DDx for a cavitating lung lesion?
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)
What is the difference between inspiratory and expiratory stridor?
Inspiratory stridor - extrathoracic obstruction
Expiratory stridor - intrathoracic obstruction
What is the DDx for chilous pleural effusion?
Tumour (usually lymphoma) Thoracic duct trauma Lymphatic disorders (eg. LAM) TB Cirrhosis Tuberous sclerosis
What are DDx for different pulmonary distributions of bronchiectasis?
Upper zones - CF, TB, ABPA
Middle zones - LN enlargement, atypical mycobacteria
Lower zones - aspiration, hypogammaglobulinaemia, ciliary dyskinesia, childhood infection
What are the most commonly isolated pathogens in bronchiectasis?
Haemophilus influenza Strep pneumoniae Staph aureus Moraxella catarrhalis Atypical mycobacteria
What comprises the FACED score used in bronchiectasis?
FEV1 Age Colonisation with Pseudomonas Extent of radiological involvement (number of lobes involved) Dyspnoea
Predicts 5 year mortality
What are the treatment options in bronchiectasis?
- 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
What are the features of yellow nail syndrome?
Yellow nails
Bronchiectasis
Pleural effusions
Lymphoedema
What should be tested for in pleural fluid if TB is suspected?
Adenosine deaminase
What are the causes of pleural flud lymphocytosis?
Long standing pleural effusions: malignancy, TB, CCF, lymphoma, collagen vascular diseases, sarcoidosis
What are the causes of an exudative pleural effusion?
Malignancy - primary, secondary, mesothelioma Pneumonia TB, sarcoidosis Pulmonary infarction MTX, nitrofurantoin, bromocriptine RA, SLE Pancreatitis Radiation Subphrenic abscess
Lung metastases are most commonly which malignancies?
Breast Colorectal cancer RCC Uterine leiomyosarcoma Head and neck SCC
