Respiratory (CXRs + interpretation) Flashcards
Increased tactile vocal fremitus
Increased tissue density (e.g. consolidation, tumour, lobar collapse)
Decreased tactile vocal fremitus
Presence of fluid or air outside of the lung (e.g. pleural effusion, pneumothorax)
Dullness on percussion
Cardiac dullness, consolidation, tumour, lobar collapse
Hyper-resonance on percussion
Pneumothorax
Symmetrical reduced chest expansion
Pulmonary fibrosis
Asymmetrical reduced chest expansion
Pneumothorax, pneumonia and pleural effusion
Wheeze
Asthma, COPD and bronchiectasis.
Stridor
Foreign body inhalation (acute) and subglottic stenosis (chronic)
Coarse crackles
Pneumonia, bronchiectasis and pulmonary oedema
Fine end-inspiratory crackles
Pulmonary fibrosis
Respiratory causes of lymphadenopathy
Lung cancer with metastases
Tuberculosis
Sarcoidosis
The trachea deviates away from..
Tension pneumothorax and large pleural effusions.
The trachea deviates towards..
Lobar collapse and pneumonectomy.
Interpret the following x-ray
Confi rms the patient’s name and date of birth
Checks the date and time the CXR was performed
Assesses image quality (rotation, inspiration, projection, exposure) ~ PA lm. Slight malrotation. Adequate inspiration and exposure
Inspects trachea for deviation ~ none
Identi es carina ~ visible and unremarkable
Assesses for hilar enlargement or displacement ~ unremarkable
Inspects lung fields for abnormalities ~ subtle absence of lung markings at the left apex
Inspects pleura for abnormalities ~ visible rim between the lung margin and chest wall at the left apex
Assesses heart size ~ unremarkable
Assesses heart borders ~ unremarkable
Assesses diaphragm ~ unremarkable
Assesses costophrenic angles ~ unremarkable
Assesses mediastinal contours ~ unremarkable
Assesses bones ~ unremarkable
Assesses soft tissues ~ unremarkable
Assesses for tubes, valves and pacemakers ~ unremarkable
Diagnosis: Spontaneous pneumothorax
Interpret the following x-ray
Confi rms the patient’s name and date of birth
Checks the date and time the CXR was performed
Assesses image quality (rotation, inspiration, projection, exposure) ~ AP mobile lm with adequate rotation, inspiration and exposure
Inspects trachea for deviation ~ none
Identifi es carina ~ subtly visible and unremarkable
Assesses for hilar enlargement or displacement ~ unremarkable
Inspects lung fields for abnormalities ~ bilateral, di ffuse alveolar oedema appearing as poorly-de nsed nodular opacities; interstitial oedema appearing as peripheral septal lines (Kerley B lines)
Inspects pleura for abnormalities ~ unremarkable
Assesses heart size ~ unable to assess due to AP lm
Assesses heart borders ~ unremarkable
Assesses diaphragm ~ unremarkable
Assesses costophrenic angles ~ bilateral blunting of the costophrenic angles
Assesses mediastinal contours ~ unremarkable
Assesses bones ~ unremarkable
Assesses soft tissues ~ unremarkable
Assesses for tubes, valves and pacemakers ~ telemetry/ECG leads
Diagnosis: Pulmonary oedema
Interpret the following ECG
Confi rms the patient’s name and date of birth
Checks the date and time the CXR was performed
Assesses image quality (rotation, inspiration, projection, exposure) ~ PA lm. Adequate rotation and inspiration. Slightly underexposed
Inspects trachea for deviation ~ deviated to the right
Identi es carina ~ visible but deviated to the right
Assesses for hilar enlargement or displacement ~ unable to adequately assess
Inspects lung elds for abnormalities ~ opaci cation of the left hemithorax, with a meniscus.
Right hemithorax unremarkable
Inspects pleura for abnormalities ~ unable to adequately assess the left hemithorax. Right hemithorax unremarkable
Assesses heart size ~ unable to adequately assess
Assesses heart borders ~ unable to adequately assess
Assesses diaphragm ~ left hemidiaphragm obscured. Right hemidiaphragm unremarkable
Assesses costophrenic angles ~ left hemidiaphragm obscured with a visible meniscus. Right costophrenic angle unremarkable
Assesses mediastinal contours ~ mediastinal shift to the right Assesses bones ~ unremarkable
Assesses soft tissues ~ unremarkable
Assesses for tubes, valves and pacemakers ~ unremarkable
Diagnosis: Left-sided pleural e ffusion
Interpret the following x-ray
Con firms the patient’s name and date of birth
Checks the date and time the CXR was performed
Assesses image quality (rotation, inspiration, projection, exposure) ~ PA lm. Adequate rotation, inspiration and exposure.
Inspects trachea for deviation ~ none
Identi es carina ~ visible and unremarkable
Assesses for hilar enlargement or displacement ~ unremarkable
Inspects lung elds for abnormalities ~ consolidation with air bronchograms in the right upper lobe, con ned inferiorly by the horizontal fi ssure
Inspects pleura for abnormalities ~ unremarkable
Assesses heart size ~ unremarkable
Assesses heart borders ~ unremarkable
Assesses diaphragm ~ unremarkable
Assesses costophrenic angles ~ unremarkable
Assesses mediastinal contours ~ unremarkable
Assesses bones ~ unremarkable
Assesses soft tissues ~ unremarkable
Assesses for tubes, valves and pacemakers ~ unremarkable
Diagnosis: Pneumonia (right upper lobe)
Interpret the following the spirometry results
Confi rms the patient’s name, date of birth & unique patient identifi er
Con firms the date and time of the spirometry test
FEV1 Reduced ~ seen in both obstructive and restrictive disease, more so in obstructive disease
FVC Reduced ~ seen in both obstructive and restrictive disease, more so in restrictive disease
FEV1/FVC ratio Reduced ~ suggestive of obstructive disease
Diagnosis: COPD (obstructive pattern)
Interpret the following the spirometry results
Confirms the patient’s name, date of birth & unique patient identifier
Confirms the date and time of the spirometry test
FEV1 Reduced ~ seen in both obstructive and restrictive disease, more so in obstructive disease
FVC Reduced ~ seen in both obstructive and restrictive disease, more so in restrictive disease
FEV1/FVC ratio increased ~ suggestive of restrictive disease
Diagnosis: Interstitial lung disease (restrictive pattern)
Differentiate between obstructive and restrictive FEV1 and FVC values
Interpret the following volume-time graph
Normal – rapid increase in volume of air expired initially, then curve forms a plateau
Obstructive – prolonged increase (because air cannot be expired as quickly due to airway resistance) but ends at the same point because the FVC is normal
Restrictive – rapid increase as normal, but curve forms a plateau much sooner (because total air volume in lungs is smaller)
Interpret the following flow-volume curve
Normal: rapid increase in flow rate, then gradual decrease until the end of expiration
Obstructive: decreased peak expiratory flow rate with steeper reduction in flow rate after it peaks creating a characteristic dip in the curve (worst in emphysema, due to small airway collapse)
Restrictive: curve is normal in shape but smaller due to proportionally reduced flow rates (total volume of lungs is restricted)
Interpret the following ABG
Resp acidosis - infective exacerbation of COPD
Interpret the following ABG
Resp alkalosis - secondary to an anxiety-induced panic attack
Interpret the following ABG
Resp acidosis with metabolic compensation - secondary to type 2 resp failure caused by COPD
Outline management of asthma
Step 1: short-acting inhaled B2-agonist (eg. Salbutamol)
Step 2: add low-dose inhaled corticosteroid steroid (ICS)
Step 3: add long-acting B2-agonist (eg. Salmeterol). If no benefit, stop this and increase ICS dose; if benefit but inadequate control, continue and increase ICS dose.
Step 4: Trial oral leukotriene receptor antagonist, high-dose steroid, oral B2-agonist
Outline management of COPD
