Respiratory Buzzwords Flashcards
On respiratory examination: Hyperexpanded chest
COPD, Chronic asthma
On respiratory examination: Postural flapping tremor
Acute CO2 retention
On respiratory examination: Stony dull percussion
Pleural effusion
On respiratory examination: Fine crepitations
Pulmonary oedema
On respiratory examination: Pleuritic chest pain
Pulmonary embolism, pneumonia, pneumothorax
On respiratory examination: Stridor
Upper airway obstruction, e.g. foreign body, croup
ABCDEF: Respiratory causes of Clubbing
Abcess (lung), Bronchiectasis (including CF), Cancer (lung), Decreased oxygen (hypoxia, NOT COPD), Empyema, Fibrosing alveolitis
Resp Radiological change: Kerley B lines
Pulmonary oedema, perhaps caused by congestive heart failure
Resp Radiological change: Bat-wing shadowing
Pulmonary oedema, perhaps caused by congestive heart failure
Resp Radiological change: Tram-line shadowing
Bronchiectasis
Resp Radiological change: Miliary shadowing
Miliary TB
Resp Radiological change: Wedge-shaped infarct
Pulmonary embolus
Resp Radiological change: ‘Ground-glass’ appearance
Fibrosis
Resp Radiological change: ‘Honeycomb’ appearance
Fibrosis (late)
Resp Radiological change: Pleural mass with lobulated margin
Mesothelioma
Respiratory condition: Early-onset emphysema plus liver disease. Fever, cough, shortness of breath hours after exposure to antigen (usually farmer after hay exposure). Positive serum precipitins
alpha1-Antitrypsin deficiency, Extrinsic allergic alveolitis
Respiratory condition: Asymptomatic with bilateral hilar lymphadenopathy (BHL)/progressive shortness of breath/dry cough. Non-pulmonary manifestations, e.g. erythema nodosum ↑ serum ACE (angiotensin-converting enzyme) or hypercalcaemia may be mentioned
Sarcoidosis
Respiratory condition: History of recurrent chest infections, failure to thrive. May mention steatorrhoea (pancreatic insufficiency). Positive sweat test (sodium, chloride > 60 mmol/L)
Cystic fibrosis
Respiratory condition: Progressive dyspnoea and cyanosis. Gross clubbing, fine end-inspiratory crackles. Chest x-ray: ground-glass → honeycomb lung
Idiopathic pulmonary fibrosis
Respiratory condition: Non-specific, e.g. fever, nightsweats, anorexia, haemoptysis. Ziehl–Neelsen staining shows acid-fast bacilli (AFBs)
TB
Respiratory condition: Swinging fever, copious foul-smelling sputum. Usually patient has persistent, worsening pneumonia
Lung abscess
Pneumonia Cause: Positive cold agglutinins
Mycoplasma pneumoniae
Cause of Cavitating lung
Squamous Cell Carcinoma, Autoimmune (Wegener’s granulomatosis), Vascular (PE), Infection (Klebsiella, TB, Staph aureus)
Resp drug side effect: Peripheral neuropathy, hepatitis
Isoniazid
Resp drug side effect: Tremor, tachycardia
Salbutamol
Resp drug side effect: Orange-coloured tears/urine. Deranged liver function tests (LFTs), hepatitis
Rifampicin
Resp drug side effect: Retrobulbar/Optic neuritis (pain, loss of vision)
Ethambutol
Resp drug side effect: Gout
Pyrazinamide
D sign on CXR
Empyema
Steeple sign on CXR
Croup (Laryngotracheobronchitis)
Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis and weight loss
Sarcoidosis
Child with barking cough
Croup (Laryngotracheobronchitis)
ACTH secreting lung tumour
Small cell carcinoma
PTH secreting lung tumour
Squamous cell carcinoma
Increased serum ACE and Ca2+, afro-carribean
Sarcoidosis
Lung cancer: Sensitive to chemotherapy, highly malignant with worse prognosis
small cell carcinoma
Lung cancer: Not sensitive to chemotherapy, better prognosis
Non small-cell carcinoma
TB vs Sarcoidosis
TB has caeseous necrosis, tuberculin positive. Sarcoid does not
Isolated area of infection and caseous necrosis at the periphery of the lung, beneath the pleura
Ghon focus
Apical lesion of secondary tuberculous infection
Assman focus
Ptosis (drooping of the eyelid), Enophthalmos (sunken eye), Miosis (small pupil), and lack of sweating on the Ipsilateral side of the face
Horner’s Syndrome, possible spread of a pancoast tumour
Non-smoker with lung cancer
likely adenocarcinoma
Paraneoplastic syndromes: Cushings & inappropriate ADH
Small cell lung cancer (ACTH & ADH respectively)
Also Lambert–Eaton myasthenic syndrome
Paraneoplastic syndromes: Hypercalcaemia
Non-small cell lung cancer (PTH)
Sore throat, wide-spread rash after antibiotics
Infective Mononucleosis
Easily mistaken as allergy to said antibiotics
Conditions where elevated ANCA (Anti neutrophil cytoplasmic antibody) is found
Wegener’s granulomatosis
Churg-strauss syndrome
Microscopic polyangiitis
autoimmune haemolytic anaemia + cold agglutins +ve
Mycoplasma pneumoniae
pneumonia + lymphopenia + haematuria
Legionella pneumonia
Anti glomerular basement membrane antibody
Goodpasture’s syndrome
Wegener’s granulomatosis vs Goodpasture’s syndrome
Both are associated with pulmonary-renal syndrome
Wegener’s granulomatosis is differentiated by positive cANCA, Goodpasture’s involves anti-glomerular basement membrane antibody & linear staining on direct immunofluorescence of kidneys
Occupational relations of pneumonoconiosis: silicosis, berryliosis, asbestosis, coal workers’ pneumoconiosis
Silicosis: Mining, quarry, sand-blasting, ceramics (silicon oxide = sand)
Berryliosis: Aerospace manufacturing/engineering, berylium mining, making fluorescent light bulbs
Asbestosis: Shipyard, building houses, asbestos exposure
Coal workers’: coal mining
Air bronchogram in area of consolidation suggests
Pneumonia most likely
Indicates patent bronchus and not occluded, hence pneumonia most likely
TLCO vs KCO
TLCO: transfer factor for Carbon Monoxide, used to measure the ability for gaseous exchange (or surface area)
Reduced TLCO = reduced area of transfer/reduced ability for gas exchange (such as COPD, fibrosis, emphysema, PE, cardiac insufficiency)
Raised TLCO = raised ability for gas exchange (Increased blood volume due to exercise, left to right shunting, alveolar haemorrhage)
KCO: transfer factor PER UNIT of alveolar volume. High KCO indicates good gas exchange and any SOB should be attributed to extrapulmonary origin. Low KCO indicates alveolar damage
Intrapulmonary nodules + Rheumatoid arthritis
Caplan’s Syndrome (Aka Rheumatoid Pneumoconiosis)
Often present with Rheumatoid arthritis on top of respiratory symptoms. Chest CT/CXR reveals round, well defined nodules
Eggshell calcification of mediastinal nodes
Silicosis
Pulmonary Renal syndrome causes
Goodpasture’s (Anti glomerular basement membrane antibodies)
Wegener’s granulomatosis (cANCA)
Churg-Strauss (pANCA, asthma)
Microscopic Polyangiitis (don’t think will come up)
Pneumothorax + subcutaneous emphysema in the neck after episode of vomitting
Likely oesophageal rupture (Boeerhaave syndrome)
Primary ciliary dyskinesia + bronchiectasis, situs inversus, chronic sinusitis
Kartagener’s syndrome
Morning headache + daytime somnolence that improves with overnight nasal ventilation
Obstructive Sleep Apnea, Pickwikian syndrome (obesity hypoventilation syndrome + sleep apnea)
ARDS definition (ROAR)
R: Reduced lung compliance
O: Oedema, non-cardiogenic
A: Acute onset (
ARDS causes
A: Aspiration/ Acute Pancreatitis/ Amniotic Fluid embolus
R: Raised Intracranial pressure/ Resp tract infection (pneumonia)
D: Diabetic Ketoacidosis/ Drugs
S: Sepsis/ Surgery/ Severe burns/ Smoke Inhalation
