Respiratory Flashcards
Clubbing: causes
RESP: lung carcinoma (usually not NSLC), chronic pulmonary suppuration (e.g. bronchiectasis, lung abscess, empyema), idiopathic pulmonary fibrosis, asbestosis, cystic fibrosis, pleural fibroma or mesothelioma, mediastinal disease (e.g. thymoma, lymphoma, carcinoma).
CVS: IE, cyanotic congenital heart disease
OTHER: IBD, cirrhosis, coeliac disease, thyrotoxicosis, brachial AV aneurysm or arterial graft sepsis (unilateral), neurogenic diaphragmatic tumours, familial or idiopathic, hemiplegic stroke (unilateral).
Pleural effusion: transudate vs exudate
Transudate =
Pleural:serum protein <0.5
Pleural LDH <2/3 upper limit of normal
Pleural:serum LDH <0.6
Exudate=
Pleural:serum protein >0.5
Pleural LDH >2/3 upper limit of normal
Pleural:serum LDH >0.6
Pleural effusion: causes of transudate
Cardiac failure Nephrotic syndrome Liver failure Meigs' syndrome (ovarian fibroma and pleural effusion) Hypothyroidism (classically exudate)
Pleural effusion: causes of exudate
Pneumonia Neoplasm- lung Ca, metastatic carcinoma, mesothelioma Tuberculosis, sarcoidosis Pulmonary infarction Subphrenic abscess Pancreatitis (raised amylase) CTD- RA, SLE (decreased complement) Drugs- nitrofurantoin (acute), methysergide (chronic), drugs causing lupus, chemotherapeutic agents, bromocriptine Radiation
If pH <7.2 = empyema, TB, neoplasm, RA, oesophageal rupture
Breath sounds: vesicular
normal, rustling leaves
Breath sounds: bronchial
Expiratory phase prolonged and has blowing quality
Causes: lobar pneumonia, localised fibrosis or collapse, above a pleural effusion, large lung cavity
Breath sounds: reduced
Causes: emphysema, large lung mass, collapse / fibrosis / pneumonia, effusion, pneumothorax
Added sounds: wheeze (rhonchi)
Inspiratory wheeze = asthma or upper airway extrathoracic obstruction
Expiratory wheeze = asthma and COPD
Fixed inspiratory wheeze = monophonic and does not change with respiration; usually fixed bronchial obstruction (e.g. carcinoma)
Added sounds: crackles (crepitations)
Late or pan inspiration: - Fine = fibrosis - Medium = LVF - Coarse = bronchiectasis or retained secretions Early inspiratory: - Coarse = COPD
Causes of haemoptysis
RESP: bronchitis, bronchial carcinoma, bronchiectasis, penumonia, pulmonary infarction, cystic fibrosis, lung abscess, TB, foreign body, goodpasture’s syndrome, rupture of a mucosal blood vessel after vigorous coughing.
CVS: MS (severe), acute LV failure
Bleeding diatheses
Tracheal displacement: causes
- TOWARDS side of lesion: upper lobe collapse, upper lobe fibrosis, pneumonectomy
- AWAY from the side of the lung lesion (uncommon): massive pleural effusion, tension pneumothorax
Upper mediastinal masses such as goitre
Chest wall deformity types
Pectus carinatum: pigeon chest (outward bowing of the sternum and costal cartilages)
Pectus excavatum: funnel chest (localised epression of the lower edge of the sternum)
Kyphoscoliosis: exaggerated forward curvature. Idiopathic (80%), secondary to poliomyelitis, Marfan’s.
Consolidation: CFx
- Reduced expansion on affected side
- Vocal fremitus: increased on affected side
- Percussion: dull
- Breath sounds: bronchial; can have medium, late or pan-inspiratory crackles as the pneumonia resolves
- Vocal rub: increased
- Pleural rub: may be present
Collapse: CFx
TRACHEA: displaced towards collapsed side
EXPANSION: reduced on the affected side with flattening of the chest wall on the same side
PERCUSSION: dull over the collapsed area
BREATH SOUNDS: reduced, with or without bronchial breathing above the area of collapse
Collapse: causes
INTRALUMINAL: mucus (e.g post op, asthma, CF), foreign body, aspiration
MURAL: bronchial carcinoma
EXTRA MURAL: peribronchial lymphadenopathy, aortic aneursym
Pleural effusion: CFx
TRACHEA: displaced away if massive EXPANSION: reduced on the affected side PERCUSSION: stony dullness BREATH SOUNDS: reduced or absent. May have bronchial breathing over effusion due to compression of overlying lung. VOCAL RESONANCE: reduced
Pleural effusion: causes
TRANSUDATE: cardiac failure, hypoalbuminaemia (nephrotic syndrome, CLD), hypothyroidism, Meigs syndrome
EXUDATE: pneumonia, neoplasm (bronchial carcinoma, metastatic carcinoma, mesothelioma), TB, pulmonary infarction, subphrenic abscess, acute pancreatitis, CTD, drugs (cytotoxics), irradiation, trauma
HAEMOTHORAX: severe trauma, rupture of a pleural adhesion containing a blood vessel
CHYLOTHORAX: trauma or surgery to the thoracic duct, carcinoma or lymphoma involving the thoracic duct
EMPYEMA: pneumonia, lung abscess, bronchiectasis, TB, penetrating chest wound
Pneumothorax: CFx
EXPANSION: reduced on the affected side
PERCUSSION: hyperresonance
BREATH SOUNDS: reduced or absent
Subcut emphysema
Pneumothorax: causes
SPONTANEOUS: bullae rupture, emphysema with rupture of bullae, iatrogenic. Rarely asthma, lung abscess, bronchial carcinoma, eosinophilic granuloma, ILD, Marfan’s.
TRAUMATIC
Bronchiectasis: CFx
SYSTEMIC: fever, cachexia, sinusitis (70%), clubbing, cyanosis (if severe)
SPUTUM: voluminous, purulent, blood stained
ASCULT: coarse pan-inspiratory or late inspiratory crackles over the affected lobe
If severe: copious sputum, clubbing, widespread crackles, signs of airway obstruction, signs of respiratory failure and cor pulmonale.
Bronchiectasis: causes
CONGENITAL: primary ciliary dyskinesia, cystic fibrosis, congenital hypogammaglobulinaemia
ACQUIRED: infections in childhood, localised disease such as foreign body / bronchial adenoma / TB, allergic bronchopulmonary aspergillosis (proximal bronchiectasis)
COPD: CFx
GENERAL: pursed lip breathing, barrel shaped chest, use of accessory muscles.
PALPATION: reduced chest expansion (<5cm), hyperinflated chest
PERCUSSION: hyperresonant
BREATH SOUNDS: decreased, early inspiratory crackles
Signs of RV failure in severe disease
Pulmonary fibrosis: CFx
GENERAL: dyspnoea, cyanosis, clubbing
PALP: slightly reduced expansion
ASCULT: fine late inspiratory or pan-inspiratory crackles
Signs of associated CTD
Pulmonary fibrosis: causes
UPPER LOBE: (SCHART)
- Silosis, sarcoidosis
- Coal workers pnuemoconiosis
- Histiocytosis
- Anklyosing spondylitis, allergic bronchopulmonary aspergillosis
- Radiation
- Tuberculosis
LOWER LOBE: (RASCO)
- RA
- Abestosis
- Scleroderma
- Cryptogenic fibrosing alevolitis
- Drugs (busulphan, bleomycin, nitrofurantoin, hydralazine, MTX, amiodarone)
