Respiratory Medicine Flashcards
1
Q
What is asthma ?
A
Asthma is a chronic inflammatory disease of the airways. It causes reversible airway obstruction during an exacerbation.
2
Q
Differentials for a wheeze
A
Acute asthma exacerbation
Bronchitis
Pulmonary oedema
PE
GORD
Allergy
Vocal cord dysfunction
3
Q
What is the pathophysiology of asthma ?
A
There is airway epithelial damage - shedding and sub-epithelial fibrosis, basement membrane thickening.
There is an inflammatory response with eosinophils, T cells and mast cells.
The cytokines amplify the inflammatory response.
There is increased numbers of goblet cells secreting mucus.
4
Q
Triggers for asthma
A
Smoking
URTI
Allergens such as pollen
Exercise ( + cold air )
Drugs ( aspirin and beta blockers )
Certain foods and drinks
5
Q
Mild exacerbation of Asthma management
A
ABCDE
Aim for 94-98% with oxygen if needed
ABG if sats below 92%
5 mg nebulised salbutamol
40 mg PO prednisolone or ( IV hydrocortisone if PO not possible )
6
Q
What extra steps in the management plan are there for a severe exacerbation of asthma ?
A
500 mg Nebulised Ipratropium bromide
Consider back to back salbutamol
7
Q
How does asthma present ( history ) ?
A
Cough - dry , nocturnal
Wheeze
Breathlessness
Chest tightness
Atopy - genetic susceptibility to develop allergies
8
Q
How does asthma present ( on examination ) ?
A
Raised RR
Raised pulse
Low oxygen sats
Bilateral wheeze
9
Q
How is asthma diagnosed ?
A
Peak expiratory flow
Spirometry - reversible obstructive pattern
10
Q
What are the steps in the stepwise management of asthma ?
A
Step 1 - SABA + low dose ICS
Step 2 - Add inhaled LABA to low dose ICS
Step 3 - increase ICS or add LTRA
Step 4 - specialists therapy
11
Q
What is COPD ?
A
COPD is characterised by airflow obstruction. The airflow obstruction is usually progressive and not fully reversible. The disease is predominately caused by smoking.
12
Q
Pathophysiology of COPD ?
A
COPD is an umbrella term which encompasses emphysema and chronic bronchitis. There is mucous gland hyperplasia and loss of cilial function.
There is also alveolar wall destruction causing irreversible enlargement of air spaces distal to the terminal bronchiole
There is also chronic inflammation and fibrosis of small airways.
13
Q
What are the causes of COPD ?
A
Smoking
Inherited alpha - 1 antitrypsin deficiency
Industrial exposure such as soot
14
Q
What is the outpatient COPD management ?
A
Smoking cessation
Pulmonary rehabilitation
Bronchodilators
Anti Muscarinics
Steriods
Mucolytics
Diet
LTOT if appropriate
15
Q
What are the types of exacerbations of COPD ?
A
Infective - change in sputum volume and colour
- fever
- raised WCC +/- raised CRP
Non infective
16
Q
Management of COPD exacerbation ?
A
ABCDE approach
Give oxygen and aim for 88-92%
Nebulised salbutamol and Ipratropium
Steriods - prednisolone 30 mg
Antibiotics if purulent sputum or raised WCC
CXR
Consider IV aminophylline
17
Q
What are the common organisms for community acquired pneumonia ?
A
Streptococcus pneumoniae
Haemophilus Influenzae
Moraxella catarrhalis
18
Q
What are the common organisms for hospital acquired pneumonia ?
A
E. coli
MRSA
Pseudomonas
19
Q
What are the common organisms for an atypical pneumonia ?
A
Legionella pneumophila
Chlamydia pneumoniae
Mycoplasma pneumoniae
20
Q
Common differentials for CXR consolidation ?
A
Pneumonia
TB - usually upper lobe
Lung cancer
Lobar collapse
Haemorrhage
21
Q
Investigations for pneumonia ?
A
Prompt CXR
FBC, U&E, CRP and sputum culture
ABG if sats are low
If there is a high CURB-65 score perform an Atypical pneumonia screen - serology and urine legionella test
22
Q
How do you assess the severity of pneumonia ?
A
CURB-65
Confusion
Urea above 7 mmol/L
RR above 30
BP lower than 90 systolic and 60 diastolic
Above 65 years
23
Q
Management of Pneumonia ?
A
ABCDE approach
Assess if any features of sepsis
Mild - moderate = 5-7 days of amoxicillin ( doxycycline if penicillin allergy )
Moderate - severe = co-amoxiclav and clarithromycin / doxycycline
24
Q
Symptoms for a PE ?
A
Chest pain
SOB
Haemoptysis
25
Risk factors for a PE ?
Surgery
Pregnancy
Fracture or varicose vein
Malignancy
Reduced mobility
Previous DVT
26
If there is an unprovoked PE what should be considered ?
Malignancy
Thrombophilia
27
Management for a PE ?
ABCDE
Oxygen if hypoxic
Analgesia if there is pain
Subcut LMWH
Should be fully anti coagulated once confirmed on CTPA
28
What extra steps are given if there is a massive PE ?
Thrombolysis with IV Alteplase
29
What are contraindications for thrombolysis ?
ABSOLUTE
Haemorrhagic or ischaemic stroke in last 6 months
CNS neoplasia
Recent trauma or surgery
GI bleed in the last month
Bleeding disorder
Aortic dissection
RELATIVE
Warfarin / DOAC
Pregnancy
Advanced liver disease
Infective endocarditis
30
What are some clinical features of TB ?
Fever
Nocturnal sweats
Weight loss
Malaise
Cough +/- purulent sputum / haemoptysis
+/- pleural effusion
31
Differential diagnosis for haemoptysis
Infection -
- pneumonia
- TB
- bronchiectasis / CF
Malignancy -
- lung cancer
- mets
Others -
- PE
32
Risk factors for TB ?
Past history
Known contact with someone with TB
Born in country with high TB incidence
Foreign travel to a country with high incidence
Evidence of Immunosuppression
33
Management of respiratory TB ?
ABCDE + aim to culture whenever possible
If productive cough - x3 sputum samples
Consider bronchoscopy if no productive cough
Routine bloods + HIV test and vitamin D levels
Consider CT chest
Start empirical antibodies if waiting for diagnosis ( if suspecting pneumonia or TB )
Start anti-TB therapy if severely unwell after sending cultures.
(Treatment usually started before diagnosis confirmed ).
Notify public health
34
What is given in anti-TB therapy ?
2 months of 4 antibiotics - rifampicin, isoniazid, Pyrazinamide and ethambutol
Then 4 ,months of 2 antibiotics - rifampicin and isoniazid
35
What monitoring is needed when taking anti-TB therapy ?
LFT’s
Compliance so direct observed therapy is sometimes used
TB treatment has side effects
36
What are some major side effects of TB medications ?
Rifampicin - Hepatitis, Rashes, orange secretions
Isoniazid - hepatitis, rashes, peripheral neuropathy and psychosis
Pyrazinamide - hepatitis, rashes, Arthralgia and vomiting
Ethambutol - retrobulbar neuritis
37
What is bronchiectasis ?
Chronic dilatation of one or more bronchi. The
bronchi exhibit poor mucus clearance and there is predisposition to recurrent or chronic bacterial infection
38
What is the gold standard diagnostic test for bronchiectasis ?
High resolution CT
39
Causes of bronchiectasis ?
Post-infective - whooping cough or TB
Immune deficiency - hypogammaglobinaemia
Genetics - CF,
Obstruction - foreign body
40
What blood tests can be performed to assess the cause of the bronchiectasis ?
Immunoglobulin levels
CF genotype
HIV test
Rheumatoid factor
Auto antibodies
41
What is seen on CT in bronchiectasis ?
Signet rings
42
What are some of the common organisms causing bronchiectasis ?
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
43
Management of bronchiectasis ?
Treat underlying cause
Physiotherapy - mucus and airway clearance
10-14 days antibiotics
Haemophilus influenzae - amoxicillin ( doxycycline )
Pseudomonas aeruginosa - Ciprofloxacin
Long term prophylactic antibiotics can be given - azithromycin
Pulmonary rehabilitation if MRC dyspnoea scare is higher than 3
44
what is a rare side effect of Ciprofloxacin that the patient should be made aware of ?
Achilles tendinitis
45
What is cystic fibrosis ?
CF is an autosomal recessive disease leading to mutations in the CFTR. This can lead to a multisystem disease characterised by thickened secretions
46
How is CF diagnosed ?
- One or more of the characteristic phenotypic features
- or a history of CF in a sibling
- or a positive newborn screening test result
AND
- An increased sweat chloride concentration
- or identification of 2 CF mutations
47
What are some features of CF ?
Chronic sinusitis
Repeated LTRI
Bronchiectasis
Liver disease
Portal hypertension
Gallstones
Steatorrhea
Nasal polyps
Pancreatic insufficiency
Diabetes
Oestoporosis
Arthralgia
Finger clubbing
48
What are some common complications of CF ?
Respiratory infections
Low body weight
Distal intestinal obstruction syndrome
CF related diabetes
49
What are some CF related advice ?
No smoking
Avoid other CF patients
Avoid friends / relatives with colds
Avoid jacuzzi’s
Clean and dry nebulisers thoroughly
Avoid stables, rotting vegetation and compost
Annual influenza vaccine
50
Management of CF ?
Physiotherapy for airway clearance
Exercise
Mucolytic treatment
Pancreatic enzyme replacement ( creon if there is pancreatic fibrosis )
Nutritional supplementation
Long term antibiotics
51
Symptoms of bronchiectasis ?
shortness of breath.
wheezing
Productive cough +/- haemoptysis
chest pain
52
What is interstitial lung disease ?
An umbrella term describing a number of conditions that affect the lung parenchyma in a a diffuse manner.
53
What are the common interstitial lung diseases ?
Usual interstitial pneumonia
Non-specific interstitial pneumonia
Extrinsic allergic alveolitis
Sarcoidosis
54
What is seen on pulmonary function tests in interstitial lung disease ?
Restrictive pattern
55
What are the classical findings in usual interstitial pneumonia ?
Finger clubbing
Reduced chest expansion
Fine inspiratory crepitations
( May show features of pulmonary hypertension )
56
What is the commonest type of pulmonary fibrosis ?
Usual interstitial pneumonia
57
What is extrinsic allergic alveolitis ?
It is a non-IgE hypersensitivity reaction due to inhalation of organic antigens to which the body has been sensitised causing an inflammatory response.
( also known as hypersensitivity Pneumonitis )
58
How soon after exposure does a reaction occur in extrinsic allergic alveolitis ?
How long does it take to settle after the repsonse ?
Short period 4-8 hours
1-3 days
59
What is the difference between acute and chronic extrinsic allergic alveolitis ?
Acute is usually reversible while chronic is less reversible
60
What are the common drug causes of extrinsic allergic alveolitis ?
Amiodarone
Bleomycin
Methotrexate
Nitrofurantion
Penicillamine
61
What is sarcoidosis ?
A multisystem inflammatory condition of unknown cause.
Forms caseating granulomas
Commonly affects the resp system but can affect any organ
62
What investigations should be done if suspecting sarcoidosis ?
PFT’s
CXR
Bloods - FBC, U&E, calcium
Urinalysis - calcium
ECG, ECHO & cardio MRI
CT/ MRI ( if headaches and suspecting neuro sarcoidosis
63
Symptoms of extrinsic allergic alveolitis ?
Acute ( hours after exposure ) - non-productive cough, SOB, fever, malaise
Subacute ( weeks after exposure ) - productive cough, SOB
Chronic ( months to years after exposure ) - SOB, productive cough, weight loss, clubbing
64
Investigations for extrinsic allergic alveolitis ?
CXR -
High resolution CT
Bloods - FBC ( low Hb ), raised CRP
PFT’s
65
General Interstitial lung disease management ?
Depends on underlying pathology
Remove exposure ( pet birds, drugs )
Stop smoking
Treat infective exacerbation
Oxygen is resp failure
Palliative care
66
Symptoms of sarcoidosis ?
SOB
Dry cough
Wheeze
Fatigue
Arthralgia
67
Treatment for sarcoidosis ?
Systemic steroids for symptomatic lung disease
( IV if acutely unwell )
Bisphosphonates for osteoporosis protection
If severe consider lung transplant
68
Most common cause of lung cancer ?
Smoking
69
What is the 5 year survival rate in lung cancer ?
16 %
70
What are the common types of lung cancer ?
Non-small cell lung cancers
- squamous
- adenocarcinoma ( arising from mucous producing cells )
- large cell ( poorly differentiated so can’t be classified as squamous or adenocarcinoma )
Small cell carcinoma ( grows and spreads rapidly )
Secondary lung cancer ( mets from breast, renal or thyroid )
71
Symptoms of lung cancer ?
Peristaltic cough - haemoptysis
SOB
Chest pain
Weight loss
Dysphagia
Hoarse voice
72
Signs of lung cancer ?
Clubbing
Lymphadenopathy
Hepatomegaly
Pleural effusion
Tender chest wall
73
What are some paraneoplastic syndromes from squamous cell lung cancer ?
Hypercalcaemia due to production of PTH-like peptide causing a rise in calcium.
74
What are some paraneoplastic syndromes from small cell lung cancer ?
SIADH ( due to production of ADH from the cells )
Cushing’s disease ( due to ACTH production from the cells )
75
Risk factors for lung cancer ?
Smoking
Passive smoking
Asbestos
Radon gas exposure
Family history
Air flow obstruction
76
Investigations for lung cancer ?
Bloods
CXR
Staging CT
Bronchoscopy with biopsy
Thoracocentesis if there is a pleural effusion
PET scan
77
Stage 1 / 2 Lung cancer treatment ?
Curative surgery if fit for surgery
Radiotherapy if not fit
78
Stage 3a lung cancer treatment ?
Surgery and adjuvant chemotherapy clinical trial
79
Stage 4 lung cancer treatment ?
Chemotherapy
Radiotherapy
Palliative care
80
What is a pancoast tumour and what signs and symptoms can it cause ?
An apical lung cancer ( usually squamous )
Pain in dermatomes C8-T2, small muscle wasting in hands
Horner’s syndrome - ptosis, Miosis, anhydrosis
SVC obstruction
81
What is obstructive sleep apnoea ?
An upper airway obstruction during sleep causing sufficient sleep fragmentation resulting in significant daytime symptoms usually excessive tiredness.
82
Who is the most likely to get sleep apnoea ?
Male
Upper body obesity
83
What is the pathophysiology of sleep apnoea ?
Upper airway potency depends on dilator muscle activity which relax during sleep ( some narrowing is normal ).
Excessive narrowing can be due to either an already small pharyngeal size when awake or an excessive narrowing during sleep
84
What can cause a small pharyngeal size ?
- Fatty infiltration of pharyngeal tissues and external pressure from increased neck fat or muscle bulk
- large tonsils
- craniofacial abnormalities
- extra submucosal tissue
85
What are some causes of excessive narrowing of the airway during sleep ?
- Obesity
- Neuromuscular disease with pharyngeal involvement ( stroke, MND )
- muscle relaxants
- Increasing age
86
What is used to diagnose obstructive sleep apnoea ?
- Overnight oximetry
- Limited sleep study - oximetry, snoring, body movements, HR, oronasal flow, chest and abnormal movements and leg movements
- full polysomnography ( limited study + ECG and EMG
87
Management for obstructive sleep apnoea ?
Weight loss
Avoid evening alcohol
If significant - Nasal CPAP
If severe may require a period of NIV prior to CPAP
88
What is CPAP ?
CPAP (continuous positive airway pressure) is a machine that uses mild air pressure to keep the airways open while you sleep.
The upper airways are splinted open with approx 10 cm H20 pressure to prevent airway collapse and improve daytime fatigue.
89
What are some examples of sympathomimetics ?
Salbutamol
Formeterol
Salmeterol
90
What is the main indication of sympathomimetics ?
Bronchospasms
91
What is the action of sympathomimetics ?
Beta 2 selective adrenergic agonists - increase cAMP in smooth muscle cells resulting in relaxation and thus bronchodilation.
92
Side effects of sympathomimetics ?
Tremor
Headache
GI upset
Palpitations
Tachycardia
Hypokalaemia
93
Examples of anti - Muscarinics ?
Ipratropium
Tiotropium
94
What is the main indication for anti - Muscarinics ?
Bronchospasms usually in COPD
95
What is the action of anti - Muscarinics ?
Muscarinic antagonist which decreases cGMP which affects intracellular calcium resulting in decraesed smooth muscle cell contractility.
96
Common side effects of anti - Muscarinics ?
Dry mouth
Constipation
Cough
Headache
97
What are some examples of Xanthines ?
Aminophylline
Theophylline
98
Main indications of xanthines ?
Asthma
COPD
99
What is the action of xanthines ?
Blocks Phosphodiesterase resulting in decreased cAMP breakdown causing bronchodilation.
Has positive chronotropic and ionotropic effects
100
What are the common side effects of xanthines ?
Headache
GI upset
Reflux
Palpitations
Dizziness
101
Examples of inhaled steroids ?
Beclomethasone
Budesonide
102
Main indications of inhaled steriods ?
Asthma
COPD
103
What is the action of inhaled steroids ?
Increase airway calibre by decreasing bronchial inflammation +/- modifying allergic reactions
104
Common side effects of inhaled steroids ?
Cough
Oral thrush
Unpleasant taste
Hoarseness
105
Examples of corticosteroids ?
Prednisolone PO
Hydrocortisone IV/IM
Dexamethasone PO/IV
106
What are the main indications of corticosteroids ?
COPD
Asthma
Inflammation
Allergic and immune responses
107
Common side effects of of corticosteroids ?
Adrenal suppression
Hyperglycaemia
Psychosis
Insomnia
Indigestion
Mood swings
108
What is some important factors to take into account when prescribing corticosteroids ?
May need PPI to reduce GORD
Bisphosphonates for bone protection
109
What is a pleural effusion ?
Excessive production of pleural fluid
110
What are causes of transudative pleural effusions ?
Left ventricular failure
Cirrhosis
Nephrotic syndrome
111
What are causes of exudative pleural effusions ?
Infection - pneumonia TB
Cancer - lung, breast, lymphoma
Infarction - PE, MI
Inflammation - RA, SLE
112
Symptoms of pleural effusions ?
SOB
Cough
Pleuritic chest pain
113
Clinical signs seen on examination in pleural effusions ?
Dull percussion
Decreased breath sounds
Decreased expansion
Mediastinal shift If large
114
Investigations for pleural effusions ?
CXR
Pleural aspiration
Bloods
115
Management of pleural effusions ?
Treat underlying cause
Chest drain should be placed if there are signs of pleural infection
116
What is a pneumothorax ?
A defect in the pleura causing air to enter the pleural space. The pleural seal is broken and the elasticity of the lungs causes them to collapse.
117
Symptoms of a pneumothorax ?
Acute onset SOB
Pleuritic chest pain
Respiratory distress (Tension)
118
Signs in a simple pneumothorax ?
Decreased chest expansion
Hyper-resonant on percussion
Decreased breath sounds
119
Extra signs seen in a tension pneumothorax ?
Trachea deviated away from affected side
120
Investigations for a pneumothorax ?
Erect CXR
CT only if diagnosis uncertain
USS can be used in supine patients
121
Management for a primary pneumothorax ?
If symptomatic and rim of air is more than 2cm on CXR give O2 and aspirate.
If unsuccessful consider re-aspiration or intercostal drain.
122
What is different in the management of a pneumothorax if it is secondary compared to primary ?
Lower threshold for an intercostal drain
123
Management for a tension pneumothorax ?
100% oxygen and immediate needle decompression for instant relief then proceed to chest drain.
124
What are some risk factors for a pneumothorax ?
Pre-existing lung condition
Height
Smoking
Diving
Trauma / chest procedure
125
What are some causes of non-resolving pneumonia ?
Complication - empyema, lung abscess
Host - immunocompromised
Antibiotics - inadequate dose, poor oral absorption
Organism - resistant or unexpected organism not covered by empirical antibiotics
Second diagnosis - PE, cancer, organising pneumonia
126
What is coronavirus ?
Coronaviruses are a large family of viruses that cause illness ranging from the common cold to more serious diseases such as severe acute respiratory distress.
127
Symptoms of COVID-19 ?
High temperature
New and continuous cough
Loss or change to taste and smell
SOB
Fatigue
Headache
Sore throat
Loss of appetite
Diarrhoea
128
Management of COVID-19 ?
Unwell - oxygen supplementation ( may need CPAP or invasive ventilation )
Dexamethasone ( and consider Toculilizumab and +/- remdesivir )
129
Investigations for COVID-19 ?
PCR tests
Antigen tests - rapid lateral flow
130
What are the types of respiratory failure ?
Type 1 - low pO2, normal or low pCO2
Type 2 - low pO2 and high pCO2
131
Signs and symptoms of respiratory failure ?
SOB
Fatigue
Tachycardia
Dyspnoea
Cyanosis
Headache
132
Investigations for respiratory failure ?
FBC, LFT, U&E,
ABG
Pulse oximetry
CXR
133
Management for type 1 respiratory failure ?
Treat underlying cause
Give oxygen to correct hypoxia
Assisted ventilation if PaO2 is lower than 8 kPa
134
Causes of type 1 respiratory failure ?
Pulmonary oedema
Pneumonia
ARDS
Asthma
Emphysema
PE
135
Causes of type 2 respiratory failure ?
COPD
Opiate overdose
Respiratory muscle failure
Severe asthma
Severe COPD
136
What is hypoxia ?
Inadequate tissue perfusion
137
What is hypoxaemia ?
Low arterial oxygen levels
138
Management for type 2 respiratory failure ?
Treat underlying cause
Controlled oxygen therapy
Recheck ABG after 20 mins
If no improvement consider assisted ventilation
If this fails consider intubation
139
What is cor pulmonale ?
Right sided heart failure caused by chronic pulmonary arterial hypertension
140
Causes of cor pulmonale ?
COPD
Bronchiectasis
Severe chronic asthma
PE
Kyphosis
Scoliosis
Sickle cell anaemia
141
Clinical features of cor pulmonale ?
Dyspnoea
Fatigue
Syncope
Cyanosis
Tachycardia
Raised JVP
Hepatomegaly
Murmurs
142
Investigations for cor pulmonale ?
FBC
ABG
CXR
ECG
143
Management of cor pulmonale ?
Treat underlying cause
Respiratory - give O2, monitor ABG, assess for LTOT
Cardiac - diuretics - furosemide, monitor U&E, give Amiloride or potassium replacements
Consider venesection if haematocrit is over 55%
144
What is pulmonary rehabilitation ?
Many people with chronic lung disease avoid exercise and physical activity because of breathlessness.
This leads to a vicious cycle of increasing social isolation and inactivity leading to worsening of symptoms.
Pulmonary rehabilitation aims to break this cycle - an MDT 6-12 week programme of supervised exercise, unsupervised home exercise, nutritional advice and disease eduction.
145
What is long term oxygen therapy ( LTOT )?
LTOT is a small machine that filters oxygen from air and tunnels it into your nostrils.
The oxygen therapy aims to increase oxygen in your blood.
146
What is dyspnoea ?
It is the sensation that one has to use an abnormal amount of effort in breathing.
147
Causes of dyspnoea by onset ?
- Abrupt
- days / week
- months
- years
Abrupt - PE, pneumothorax, acute exacerbation of asthma
Days / weeks - asthma, pneumonia, congestive heart failure
Months - pulmonary fibrosis
Years - COPD
148
What is a chronic cough and common causes ?
It is a long lasting cough ( longer than 8 weeks ).
Common causes : viral infection, asthma, post-nasal drip, GORD and medications.
149
what is sputum and what questions should be asked if a patient has it ?
Excess respiratory secretions that are coughed up.
How often ?
How much ?
Colour ?
Consistency and smell ?
150
What do the colours of sputum suggest about the cause ?
White - COPD
Grey - cigarette smokers
Yellow / green - infection
Yellow - eosinophils in the sputum of asthma patients
151
What is haemoptysis and what should be established about it ?
The coughing up of blood can vary from streaks to massive, life-threatening bleeds.
Amount, colour, frequency, nature
152
Causes of haemoptysis ?
Infection
Bronchiectasis
Carcinoma
PE
153
What is a wheeze ?
A whistling ‘musical’ sound emanating from narrow smaller airways. It occurs in inspiration and expiration but more prominent during expiration.
154
causes of a wheeze ?
Asthma
COPD
HF
Bronchiectasis
155
What is pleuritic chest pain ?
Pain arising from respiratory disease and usually from the parietal pleura.
Sharp, severe pain at the height of inspiration or on coughing.
156
What is lung parenchymal pain ?
Pain from the lung tissue and is usually dull and constant.
It usually is due to malignancy spreading to the chest wall.
157
What is Diaphragmatic pain ?
May be felt at the ipsilateral shoulder tip and pain from the costal parts of the diaphragm may be referred to the abdomen.
158
What is a common cause of MSK pain in the chest ?
Costochondritis
159
What are 4 causes of low PaO2 ?
Hypoventilation
Diffusion impairment
Shunt
V/Q mismatch
160
What is asbestosis ?
Asbestosis is a chronic lung disease caused by inhaling asbestos fibres. Prolonged exposure to these fibres can cause lung tissue scarring and fibrosis. This causes your lungs to become stiff and they can’t e expand as much.
161
Symptoms and signs of asbestosis ?
SOB
Dry cough
Chest tightness and pain
Crackles in the lungs
Clubbing
162
What risk factors are there for asbestosis ?
People who worked in mining, milling, manufacturing, and installation or removal of asbestos products before the late 1970s are at highest risk of asbestosis.
163
What are the complications of asbestosis ?
Lung cancer
Rarely - malignant mesothelioma can occur years after exposure
164
Other than asbestosis what are some other lung diseases associated with an occupation ?
Coal worker’s pneumoconiosis - inhaling coal dust ( also known as black lung ) and causing scarring.
Silicosis - inhaling free crystalline silica, a dust found in the air of mines as well as in stone, clay and glass manufacturing. It can increase the risk of TB and causes scarring.
165
Other than medications what can cause extrinsic allergic alveolitis ?
Inhalation of fungal spores from moldy hay, bird droppings and other organic dust.
166
What may a patient present with in a respiratory history ?
Dyspnoea
Chest pain
Wheeze
Cough
Sputum
Haemoptysis
167
If someone presents with chest pain what should you ask about ?
Site
Severity
Radiation
Triggers
Relieving factors
Diurnal variation
Associated symptoms
168
During a respiratory history what should be asked about during the social history ?
Smoking - current or ex
Any pets - cats, birds in particular
Recent foreign travel
Any immobility recently ?
Alcohol ?
Housing and daily activities ?
169
In a respiratory examination what should be assessed in a general inspection ?
Any discomfort or pain ?
Breathlessness ?
The colour ( cyanosis )
Purse lip breathing
Accessory muscles in use ?
Any audible sounds
RR ?
Tremors ?
Any bedside items ?
170
During a respiratory examination what should be assessed for in the hands ?
Clubbing
Peripheral cynaosis
Tar staining
CO2 retention flap
171
During a respiratory examination what should be assessed for in the face ?
Eyes for Horner’s syndrome
Mouth for central cyanosis pale conjunctiva
172
During a respiratory examination what should be assessed for in the neck ?
Trachea
JVP
Lymph nodes
