Respiratory for PACEs Flashcards
What p02 to be centrally cyanosed?
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Resp causes of clubbing
Infection
Fibrosis
Cancer
Obstructive breathing pattern
fastest exhalation lasts 6 seconds
What chest deformity in long term T2 resp failure
Kyphosis
How to discuss percussion>
Symmetrical or asymmetrical
then resonant/hyperresonant
dull/stony dull
Breathing on auscultation - spectrum of findings
decreased resonance - consolidation (less air due to pus)
no resonance - pleural effusion (acts as dampener)
What does increased vocal resonance mean?
More solid pathology
When auscultating - what is bronchial breathing
Seen in collapsed or consolidated lung
Timing of ins and exp similar with a gap in the middle
Causes of monophonic wheeze
mucus or narrowing
or listening over the trachea
What types of crackles are there?
Coarse or fine
Coarse
bubbles sound
bronchiectasis or pulm oedema
Fine crackles
Like velcro
opening of fibrosed alveoli
Why check the ankles and sacrum
Look for complications
pHT and RHF
Shins for Erythema Nodosum
reduced air entry
Dull percussion
reduced VR
Effusion
Effusion - signs
reduced air entry
Dull percussion
reduced VR
Bronchial breathing
dull percussion
increased VR
Collapse or consolidation
Collapse or consolidation
Bronchial breathing
dull percussion
increased VR
Fine crackles, clubbed, sputum
Bronchiectasis
What are the common resp investigations?
Bloods Sputum culture CXR Spirometry Echo - pHT and cardiac failure CT - difference between HRCT and Volime CT
Lung function: Gas Transfer - what does it measure
Uptake of CO
Lower lung surface area and decreased transfer factor
Volume CT
3mm slices for nodules and cancer
HRCT
10-15mm slices
lower amount of radiation
interstitial lung disease
Resp MDT
SMOKING CESSATION
Dietician Physio NIV Surgery Psych Palliative
Asthma on resp examination
If well controlled can be completely normal
Invesitigations in Asthma
Spirometry (obstructive with reversibility)
Exhaled NO - if increased then asthmatic and should be on steroids
Histamine challenge
Peak flow diary for variability
Skin tests/ IgE / Eosinophils
Asthma Rx
INhaled steroids + Montelukast + LABA
Writeen asthma plan involving the nursing team
Bronchiectasis complications
Pulm HTN Cachexia Lobar collapse Massive haemoptysis T2 RF / asterixis Situs inversus / Kartaageners (Swapped liver and heart on wrong side)
Causes of Bronchiectesis
Idiopathic Post infective (measles, pertussis, TB) Immunodeficency (hypogammaglobulinaemia / CVID (low IgG) / Spec polysaccharide ad deficiency CF PCD, Youngs, Kartageners ABPA Obstruction / foreign body / tumour RheumA, IBD
ix in bronchiectasis
Volume CT / HRCT - shows ring shadows and tram lines Immunoglobulins CF testing Spirometry Cultures
Management for bronchiectasis
Airway Clearance through PHYSIO Smoking cessation Abx more than 3 infection/year Rx any cause Pulm Rehab Bronchodilaters
Complications of lung cancer
SVCO, Horners
Example of non-small cell
adenocarcino,ma and squamous
Lung cancer Ix
Volume CT
Lung function for rx ability and resectability
PET CT
Biopsy lymph and liver
Rx of small cell lung cancer
Rarely resection mostly chemo and radiation
Non-small cell cancer
Resection
Radiotherapy
Chemo
Palliative
Sign of COPD
Airflow obstruction - prolonged exp phase
pursed lip breathing
wheeze/inhalers
Hyperexpansion - reduced cricosternal distance
Loss of cardiac dullness
Displaced liver
Causes signs - Tar staining!
Cx of COPD
Bruising/steroid therapy
pHT
Co2 retention
Hyperinflation - loss of cardiac dullness and displaced liver edge. Reduced cricosternal distance)
Ix in COPD
FBC - polycythaemia A1AT Lung function ABG CT Echo for pHT
What is the modified MRC for breathlessness
0 - hard exercise 1 - moderate exercise 2 - slow 3 - rest after minuetes 4- on dressing
Mx of COPD
Bronchodilaters Pulm Rehab Dietician SMOKING CESSATION Steroids/Abx oxygen if pO2 is less than 7.8
Signs in Effusion
Decreased expansion
decreased air entry
decreased Vocal resonance
Ax conditions to effusion
Transudative - liver and cardiac pathology
Exudative - malignancy, infection TB, RA, yellow nail
use lights criteria
Ix in effusion
CXR
CT later on
US guided drain
send to lab
Chemistry
Micriscopy
Immunology
Ax conditions to Fibrosis
RA
Sign of fibrosis
fine late inspiratory crackles
causes of fibrosis
idiopathic
connective tissue associated - scleroderma, RA, SLE
Sarcoid
increased sensitivity pneumonitis
drugs - amioderone, nitrofurantoin, bleomycin, methatrexate
Ix in Fibrosis
FBC, complement, autoimmune screen, preceptins CXR, HRCT Lung function Echo BAL ABG
Mx of Fibrosis
Physio/rehab
nurse specialist
anti-tussive
smokingcessation
Profenidone?
Lung surgery normally for?
Cancer
TB
Bronchiectasis
Signs of penumonectomy
Scar Chest wall deformity shifted trachea decreased expansion no breath sounds (in lobectomy will be decreased)
Signs in penuomonia/collapse
decreased expansion
dull
reduced or no air entry
increased vocal resonance
