Respiratory Buzzwords 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 and Respiratory Distress
Syndrome of the newborn
Ziehl-Neelsen stain positive for acid fast bacilli
TB
Caseous necrosis
TB
Apical disease
Most likely (secondary) TB; apical lesion is called an Assmann focus!
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 chlamydophila psittaci
Dry cough and diarrhoea after holiday abroad, some indication of water spread
Legionella pneumophila (test urine for antigens)
“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-tramoxazole [± prednisolone if
severe])
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. Small-cell carcinoma
are neuroendocrine, highly malignant, and may be associated with ectopic endocrine
syndromes.
PTH secreting lung tumour
Squamous cell ca. of lung
Increased serum ACE and Ca2+
Sarcoid
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.
Assmann Focus
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:
O SHIT MAN:
a. Oxygen 100% through a non-rebreather mask
b. Salbutamol Nebulised back-to-back.
c. Hydrocortisone IV or Prednisolone PO
d. Ipratropium Bromide Nebulised hourly
e. Theophylline IV or aminophylline IV
f. Magnesium and call an
g. Anaesthetist
Thumbprint sign on head x ray
epiglottitis
Inspiratory whoop/barking cough
pertussis
Snow storm appearance on x ray
baritosis, silicosis
Management of infective exacerbation of COPD
iSOAP
i - ipratropium
S - Salbutamol
O - Oxygen
A - amoxicillin
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
Respiratory alkalosis
panic attack
Frank pus on aspiration
empyema
obstructive lung disease, raised eosinophils
asthma
obstructive lung disease, raised neutrophils
COPD
Pickwickian disease (a.k.a Obesity hypoventilation syndrome)
obese people whose
body fat preventing air getting in. Causes sleep apnoea and hypercapnia (high levels
of carbon dioxide in the blood).
overnight nasal ventilation
Pickwickian disease (a.k.a Obesity hypoventilation syndrome)
Guillian-Barre disease
disease which causes paralysis. Normally preceded by a
strep. throat/infection of respiratory or GI tract. A.K.A polyneuritis (meaning rapidly
progressive, ascending motor neurone paralysis, beginning in the feet and ascending
to the other muscles)
Coal workers pneumoconiosis
two types Simple coal worker’s pneumoconiosis
(the disease in its early form) and progressive massive fibrosis (the disease in its later
form).Problems found at the apex of the lung
Adult respiratory distress syndrome
occurs when non-cardiogenic pulmonary
oedema leads to acute respiratory failure. CXR shows bilateral alveolar shadowing.
Pulmonary oedema
– CXR showing bats wings(perihilar shadowing), upper lobe
venous diversion, fluid in horizontal fissue, kerley B lines (small horizontal lines in the
periphery due to fluid in the interlobular septae and pleural effusions)
Treatment of a pneumothorax
options are observation, needle, chest tube
insertion, surgery
TLCO
how well oxygen can diffuse into the blood
Asbestosis
problems found at the base of the lung
Treatment of P.E.
if not immediately life threatening then anticoagulation therapy
(IV warfarin and heparin). Check other treatment.
Type 1 diabetic presents with vomiting and not taking her insulin. Dehydrated and
deep labored breathing
metabolic acidosis (diabetic ketoacidosis).
APx ray
Anterior Posterior usually A Portable
22 year old woman, weight loss, sputum, night sweats, tender well defined nodules
on shins bilaterally
erythema nodosum
Extrinsic allergic alveolitis
granulomatous inflammation of the lungs. Acute and subacute
cause pneumonitis. Chronic cause fibrosis, emphysema. Treated with steroids and antigen
avoidance. Can show bilateral reticulonodular shadows on a CXR. Several types;
major antigen is Saccharopolyspora rectivirgula. Buzzwords; farmer,
lymphocyte, “positive test”
Farmer’s lung;
due to exposure to avian proteins. Buzzwords; pigeons, parrots
Bird-fancier’s lung;
‘Blood tests reveal cANCA positive result, joint pain, nasal congestion and recurrent
nosebleeds’
granulomatosis with polyangiitis (GPA)
Type of lung cancer….
most common type in smokers. Secrete parathyroid hormone and
causes hypercalcemia (can cause bones, stones, groans and moans - info below). Common
places for metastasises include lymph nodes, liver, bones, adrenal glands and the brain.
Buzzwords: smoker, cavitating, hilar tumours.
Squamous cell
Type of lung cancer…
poorly differentiated. Sex hormone releasing. Can cause gyneocomastia.
Large cell
Type of lung cancer…
most common type in non-smokers. Derived from gram cells;
mucus stains blue. Often leads to peripheral tumours. Causes hypertrophic pulmonary
osteoarthropy i.e. finger clubbing, periosteal inflammation (like ankle pain)
Adenocarcinoma
Type of lung cancer…
has the worse prognosis. Is the only lung cancer that is chemo sensitive.
Cancer likely to be derived from endocrine cells. Secretes ADH causing SIADH
(syndrome of inappropriate antidiuretic hormone). Also secretes ACTH (adrenocorticotropic)
causing moon face”, acne, high BP.
Small cell
Vague presentation of lung cancer:
chest pain, finger clubbing, pancoast tumour
(apex of lung), hoarseness.
Brachial plexus lesions: causes…
finger tingling, arm pain
Horner’s syndrome: sympathetic chain interrupted causes…
droopy eye lid, small
pupils, unilateral loss of sweating on one side.
Hypercalcemia - problems arising from this:
Moans (GI conditions); constipation, nausea, decreased appetite, abdominal pain,
peptic ulcer disease
Stones (kidney related conditions); kidney stones, frequent urination
Groans (psychological conditions); confusion, dementia, memory loss, depression
Bones (bone pain and bone-related conditions); bone aches and pains, fractures,
curving of the spine and loss of height.
Asthma Spirometry:
- FVC normal
- FEV1 reduced
- FEV1/FVC ratio reduced (due to half of ratio being reduced)
COPD Spirometry
- FVC reduced
- FEV1 reduced
- FEV1/FVC ratio normal (as both parts of the ratio have been reduced making it
normal)
Restrictive airway disease Spirometry:
- FVC reduced
- FEV1 reduced
- FEV1/FVC ratio normal (as both parts of the ratio have been reduced making it normal)
Restrictive airway disease Spirometry:
- FVC reduced
- FEV1 reduced
- FEV1/FVC ratio normal (as both parts of the ratio have been reduced making it normal)
Respiratory Failure types…
Type 1 - low oxygen levels (hypoxemia)
Type 2 - low oxygen levels, high carbon dioxide levels (COPD)
TB drugs
2 RIPE 4 RI - 2months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, 4months
Rifampicin, Isoniazid
middle aged Asian presents with weight loss, night sweats and productive cough. CXR
shows multiple small discrete nodules throughout both lung fields
TB
Rifampin side effects
red-orange discoloration of urine and tears, rashes and
hepatotoxicity.
Isoniazid side effects
tingling, parasthesiae of the extremities
Pyrazinamide side effects
joint pain, rash, allergic reaction, yellow skin or eyes, worsening gout
Ethambutol side effects
change in vision, optic neuritis and red-green colour blindness.
Type of TB…
immune activation, killing organism – small focus (Ghon
focus)(large hilar nodes – granulomatous) – military TB invades blood
Primary TB
Type of TB…
reinfection/reactivation – fibrosing, cavitating apical lesion –
associated with immunosuppressed
Secondary TB
PE risk factors
Hereditary eg factor V Leiden
History - previous DVT or PE
Hypomobility eg fracture or long trip
Hypovolaemia eg dehydration
Hypercoagulability eg smoking
Hormones eg oestrogen
Hyperhomocysteinemia
Hyperviscosity states eg malignancy, post-surgery
Causes of Pulmonary Fibrosis
Bleomycin
Radiation
Extrinsic allergic alveolitis
Ankylosing Spondylitis
Sarcoidosis
Tuberculosis
Cryptogenic fibrosing alveolitis (idiopathic pulmonary fibrosis)
Asbestosis
NODOSUM spelt backwards reveals some causes of erythema nodosum, the more
common appear first…
Mycobacteria (TB) -
Ulcerative colitis/Crohns disease
Sarcoidosis
Other infections (streptococcus, mycoplasma, EBV)
Drugs including sulphonamides and oral contraceptive pill
Occult malignancy
No cause found/nurturing (pregnancy)
What symptoms does chlamydophila psittaci (birds) cause?
headache, mucoid sputum
What does coxiella burnetti (sheep/farm) cause?
Qfever
What does Legionella (water foreign holiday) cause? What testing should be done?
GI upset – ‘urine antigen testing’
What does Mycoplasma cause? What type of person is it common in?
dry cough/young people
What does Klebsiella pneumonia cause? What type of person is it common in?
red currant jelly sputum + COPD/alcoholics/elderly
What does Pneumocystis carinii pneumonia cause? What type of person is it common in?
HIV, AIDS, immunosuppressed
What does Streptococcus pneumonia cause?
rusty sputum – usually lobar pneumonia
Common cause in CF patients
staph aureus/pseudomonas aeruginosa
Who is at risk of Haemophilus influenzae?
COPD/alcoholics/elderly
What does Bordetella pertussis cause?
whooping cough/bronchopneumonia
What is Pseudomonas aeruginosa associated with? What type of bacteria is it?
– CF – UTI, GI, burns, scars – gram neg bacillus
