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Respiratory - Short Case > Respiratory - Short Case > Flashcards

Respiratory - Short Case Flashcards

1
Q

CXR: calcified lesions in the lung fields

A

TB

pneumoconiosis

post-chickenpox pneumonia

tularaemia

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2
Q

What is histoplasmosis?

A

Fungal lung infection

Assoc with immunocompromise

Histoplasma capsulatum is found in soil, often associated with decaying bat guano or bird droppings.

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3
Q

Wheezes/Rhonchi

a. inspiratory wheeze is characteristic of?
b. expiratory wheeze is characteristic of?
c. fixed inspiratory wheeze (monophonic - does not change with respiration) is a sign of?

A

a. asthma, or upper airway extrathoracic obstruction
b. asthma and COPD
c. carcinoma

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4
Q

ddx Bronchial breath sounds

A

lobar pneumonia (common)

localised fibrosis or collapse

above a pleural effusion

large lung cavity

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5
Q

Pleural fluid analysis: pH <7.2

A

Empyema, tuberculosis, neoplasm, RA, oesophageal rupture

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6
Q

CXR: reticular (linear opacities)

A

fibrosis, brochiectasis

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7
Q

What are the causes of chronic ILD?

A
  • Idiopathic pulmonary fibrosis
  • Rheumatological disease
    • RA
    • Systemic sclerosis
    • SLE
    • Polymyositis
    • Dermatomyositis
    • Sjogren’s syndrome
    • MCTD
    • Ankylosing spondylitis
    • Psoriasis
  • Eosinophilic lung disease
    • Drugs (nitrofurantoin, sulphasazine)
    • Aspergillosis
  • Other respiratory disease
    • Sarcoidosis
    • Tuberculosis
  • Vasculitis
    • Polyarteritis nodosa
    • Wegner’s granulomatosis
    • Churg-strauss syndrome
    • Goodpasture’s syndrome
  • Inhaled agents
    • Extrinsic allergic alveolitis
    • Asbestosis
    • Silicosis
    • Beryliosis
  • Drugs
    • Amiodarone
    • Nitrofurantoin
    • Bleomycin
    • Gold
    • Methotrexate
  • Radiation fibrosis
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8
Q

How do you define an exudate and what are some causes?

A

Light’s criteria

Pleural fluid protein : serum protein >0.5

LDH >2/3 ULN

Pleural LDH : serum LDH >0.6

Causes

Pneumonia

Neoplasm - lung carcinoma, metastatic carcinoma, mesothelioma

Tuberculosis, sarcoidosis

Pulmonary infarction

Subphrenic abscess

Pancreatitis

CTD - RA, SLE

Drugs - nitrofurantoin (acute), drugs causing lupus, chemotherapeutic agents, bromocriptine

Radiation

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9
Q

CXR: coin lesion ddx

A

carcinoma

tuberculoma

harmatoma

granuloma

AVF

rheumatoid nodule

lung abscess

hydatid cyst

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10
Q

Stony dullness, bronchial breathing on top, needle marks from previous aspirations

A

pleural effusion

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11
Q

CXR: miliary calcification ddx

A

post-chickenpox pneumonia

histoplasmosis

coccidioidomycosis

ectopic calcification in renal failure, hyperparathyroidism

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12
Q
A
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13
Q

Loose cough, full sputum mug, coarse crackles and wheezes, clubbing

A

Bronchiectasis

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14
Q
A
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15
Q

CXR: localised non-homogenous opacity ddx

A

pneumonia

pulmonary infarct

carcinoma

tuberculosis

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16
Q

Causes of clubbing?

A
  1. Respiratory
  • lung ca
  • chronic pulmonary suppuration (ie. bronchiectasis, lung abscess, empyema)
  • IPF, asbestosis
  • cystic fibrosis
  • pleura fibroma or mesothelioma
  • mediastinal disease (thymoma, lymphoma, carcinoma)
  1. Cardiovascular
  • IE
  • cyanotic congenital heart disease
  1. Other
  • Inflammatory bowel disease
  • Cirrhosis
  • Coeliac disease
  • thyrotoxicosis
  • hemiplegic stroke

**Clubbing does NOT occur with COPD, sarcoidosis, coal worker’s pneumoconiosis, silicosis

17
Q

Dry cough, crackles, clubbing

A

ILD

18
Q

How would you investigate someone with ILD?

A

Blood tests

  • FBC (anaemia in vasculitis or polycythemia in longstanding hypoxia)
  • Inflammatory markers
  • Immunoglobulins
  • Autoimmune profile (ANA, ENA, ANCA, anti-GBM)
  • CK (polymyositis, dermatomyositis)
  • RF
  • ACE

ABG

  • T1RF

CXR

  • Bilateral basal reticulonodular infiltrates, honeycombing.
  • Bilateral hilar lymphadenopathy - sarcoidosis
  • Calcified pleural plaques in asbestosis

Lung function tests

  • Reduction in lung volumes (TLC, FRC)
  • Restrictive pattern of defect
  • Reduced gas transfer factor and gas transfer coefficient

HRCT

MRI

Broncho-alveolar lavage

Lung biopsy

6 minute walk test

19
Q

How do you define a transudate?

What are causes of transudates?

A

Light’s criteria

  • Pleural protein : serum protein = <0.6
  • pleural LDH <2/3 ULN
  • pleural : serum LDH <0.6

Causes

Cardiac failure

Nephrotic failure

Liver failure

Meig’s syndrome - ovarian fibroma and pleural effusion

Hypothyroidism

20
Q

Please present someone with advanced ILD secondary to systemic sclerosis with evidence of pulmonary HTN and on steroid therapy.

A

This patient is/isn’t breathless at rest. There is evidence of peripheral and central cyanosis. The fingers are clubbed. The skin over the fingers and face is smooth, shiny and tight. There is sclerodactyly, atrophic nails, and evidence of Raynaud’s phenomenon. There is no evidence of nicotine staining. There is steroid purpura peripherally. There are no palpable lymph nodes. On examination of the chest, there are no scars. The trachea is central and the cricoid-notch distance is not reduced. Chest expansion is equal but reduced bilaterally. The percussion note is dull and vocal fremitus is reduced at both bases. On auscultation, there are fine end-inspiratory crackles at both bases. There are no audible squawks and there is no wheeze.

In addition, the venous pressure is elevated. There is a prominent parasternal heave, and a loud pulmonary component to the second heart sound. There is peripheral edema.

21
Q

Overinflated chest, possible cyanosis, pursed lipped breathing, reduced breath sounds and wheezes, Hoover’s sign

A

COPD

22
Q

CXR: diffuse opacities ddx

A

miliary <2mm: miliary TB, miliary metastases, sarcoidosis, pneumoconiosis, lymphoma, lymphagitis, pneumonia, vasculitis, pulmonary haemorrhage

nodular 3-10mm: pneumonia, pneumoconiosis, TB, met carcinoma, sarcoidosis

23
Q

CXR: cavitated lesion ddx

A

lung abscess

carcinoma (usually squamous cell) or Hodgkin’s

TB

fungi

24
Q

Causes of upper lobe lung fibrosis?

A

SCHART

  • Sarcoidosis/silicosis
  • Coal-worker’s pneumoconiosis
  • Histiocytosis
  • Ankylosing spondylitis/allergic bronchopulmonary aspergillosis
  • Radiation
  • Tuberculosis
25
Q

often young patient with signs of bronchiectasis and cachexia

A

cystic fibrosis

26
Q

CXR: homogenous opacity ddx

A

Pneumonia - lobar or segmental

Collapse

Effusion

27
Q

What is the treatment for pulmonary fibrosis?

A
  • Treatment generally ineffective
  • Anti-fibrotic agents Nintedanib or Pirferidone
  • Consider Sildenafil if pHTN
  • Lung rehabilitation, consider lung transplant
28
Q

sometimes clubbing, scar, radiotherapy marks, signs of effusion or collapse, lymph nodes

A

treated carcinoma

29
Q

Pleural fluid analysis: chylous

A

Tumour (usually lymphoma), thoracic duct trauma, tuberculosis, tuberous sclerosis

30
Q

gross unilateral chest deformity, big scar

A

thoracoplasty

31
Q

What are the causes of lower lobe fibrosis?

A

Lower lobes (RASCO)

  • rheumatoid arthritis
  • asbestosis
  • scleroderma
  • cryptogenic fibrosing alveolitis
  • other (drugs, e.g. busulphan, bleomycin, nitrofurantoin, hydralazine, methotrexate, amiodarone)
32
Q

ddx Reduced breath sounds

A

emphysema

large lung mass

collapse, fibrosis, or pneumonia

effusion

pneumothorax

33
Q

Crackles/crepitations

  1. Late or pan inspiratory crackles
  • Fine ddx
  • Medium ddx
  • Coarse ddx
  1. Early inspiratory crackles
    * Coarse
A

Fine late inspiratory crackles: fibrosis - dry

Medium late inspiratory crackles: caused by LVF

Coarse late inspiratory crackles: bronchiectasis or retained secretions

Early inspiratory crackles: coarse - caused by COPD

Respiratory - Short Case (1 decks)

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