Respiratory Flashcards
Stony dull to percuss
Pleural Effusion
Right sided pleuritic chest pain
most likely pneumonia
• Alveolar bat’s wings, Kerley B lines, Cardiomegaly, Dilated prominent upper lobe vessels Pleural Effusion
Pulmonary oedema
Ground-glass appearance on X-ray
Pulmonary fibrosis or Respiratory Distress Syndrome of the newborn
Ziehl-Neelsen stain positive for acid fast
TB
Caseous necrosis
TB
Obstructive Respiratory Problem
Reduced FEV1
FVC is normal
Ratio of FEV1 to FVC is reduced
PEF reduced
Miliary Tuberculous
spread of organism into bloodstream. If organism spread via pulmonary artery, miliary dissemination into the lung occurs. If organism spread via pulmonary vein, there is systemic dissemination to the liver, spleen, and kidneys.
Positive anti-glomerular basement membrane antibodies
Goodpasture’s syndrome
Chest infection with a parrot/pigeon as pet
caused by chlamydophilapsittaci
Dry cough and diarrhoea after holiday abroad, some indication of water
Legionella pneumophila (test urine for antigens) - hyponatraemia
“Tall, thin young man who indulges in marijuana”
probably pneumothorax (Marfan’s)
Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis and weight loss
Sarcoidosis
Bronchiole wider than neighbouring arteriole (on CT) (signet ring sign)
Bronchiectasis
“D sign on X ray”
Empyema
“Steeple” sign on X ray
laryngotracheobronchitis/croup
Child with barking cough
Croup
Pneumocystis pneumonia
HIV (treat with Co-trimoxazole [± prednisolone if severe])SS
Asthma + Nasal Polyps + Salicylate sensitivity
Samter’s Triad
Alcoholic (danger of aspiration pneumonia)
Klebsiella pneumoniae
Red Jelly sputum
Klebsiella Pneumoniae
Mucoid sputum
Chlamydia psittaci
Rusty sputum
Pneumococcal pneumonia
Cannonball metastases (also weight loss and haematuria)
classically from primary renal cell carcinoma
Morning headache
hypercapnia or Side effects of organic nitrates
ACTH secreting lung tumour
Small cell carcinoma of the lung
PTH secreting lung tumour
Squamous cell ca. of lung
Small-cell carcinoma
neuroendocrine, highly malignant, and may be associated with ectopic endocrine syndromes.
Coxiellaburnetti
sheep/farm infection
Increased serum ACE and Ca2+
Sarcoid
Causes of Pulmonary Fibrosis
BREAST CA Bleomycin/ berrylium, Radiation, Extrinsic allergic alveolitis, Ankylosing Spondylitis, Sarcoidosis, Tuberculosis, Cryptogenic fibrosingalveolitis( idiopathic pulmonary fibrosis), Asbestosis.
Eggshell calcification at hilar region
Silicosis
Heart-failure cells’ seen in alveolar spaces
Macrophages that have absorbed haemosiderin - found in chronic pulmonary oedema, and associated (severe) left-ventricular heart failure. Also, seen in long-standing pulmonary hypertension
Ghon Focus
An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in tuberculosis infection. Note: Ghon Focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy.
Drugs to Treat TB
2 RIPE 4 RI - 2 months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, 4 months Rifampicin, Isoniazid
Assmann Focus
Apical lesion of secondary tuberculous infection
‘Coin lesion’ found on chest radiographs
Apical lesion of secondary tuberculous infection
• ‘Coin lesion’ found on chest radiographs → a rounded solitary lesion. The common lesions are: Primary bronchial or lung carcinoma, Metastatic tumour (esp. of kidney), Bronchial hamartoma, Carcinoid tumour, Granulomatous inflammation, Lung abscess.
Horner’s Syndrome
Can occur when there is a local spread of cancer to the intrathoracic nodes or a Pancoast’s tumour. Signs include: ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil), and lack of sweating on the ipsilateral (same side as invasion) side of the face. This is due to invasion, of the cervical sympathetic chain.
Acute management of Asthma
OSHIT MAN: o Oxygen 100% through a non-rebreather mask o Salbutamol Nebulised back-to-back. o Hydrocortisone IV or Prednisolone PO o Ipratropium Bromide Nebulised hourly o Theophylline IV or aminophylline IV o Magnesium and call an o Anaesthetist
Thumbprint sign on head x
epiglottitis
Snow storm appearance on x ray
baritosis, silicosis
Management of infective exacerbation of COPD
iSOAP o i - ipratropium o S - Salbutamol o O- Oxygen o A - amoxicillin o P - prednisolone
Non-smoker + lung cancer
(peripheral) adenocarcinoma
Squamous + Small-cell Lung cancers
CENTRAL
High d-dimers
suspect (but not diagnose) Pulmonary Embolism (send for CTPA or V/Q scan)
Low d-dimers
exclude Pulmonary Embolism
Large PE
thrombolysis
Small PE
Low Molecular Weight Heparin
Honeycomb lung
fibrosingalveolitis
What is an apical lesion called?
Assmann Focus
What is a key indicator of Goodpasture’s Syndrome
+ anti-GBM antibodies
Inspiratory whoop/barking cough
pertussis
Hyperexpanded chest
COPD
Positive sweat test >60mmol/L NaCl
CF
fever, night sweats, anorexia, hemoptysis
TB
Swinging fever, copious foul smelling sputum
Lung abcess
4 Types of Autoimmune reactions
ABCD – allergic, blood, clumps, delayed
TB drug side effects
o TB DRUG - Orange coloured tears / urine Rifampicin
o TB DRUG - Peripheral neuropathy / hepatitis Isoniazid
o TB DRUG - Colour Blindness Ethambutol
o TB DRUG - Gout Pyrazinamide
o TB DRUG - Hearing Problems Streptomycin