Respirology

Question 1

Pneumonia

Answer 1

S+S

• Pleuritic chest pain, fever, chills, cough, purulent sputum, dyspnea
• Wheezing, crackles, consolidation (dullness to percussion, egophony, bronchophony)

Question 2

Pneumothorax

Answer 2

S+S

• Sudden pleuritic chest pain, dyspnea
• Dec breath sounds
• Tension pneumo: hypotension, tracheal deviation away from affected side, high JVP

Investigations

• CXR: lack of lung markings, mediastinum shifted away
• U/S

Question 3

Chronic Obstructive Pulmonary Disease (COPD)

Answer 3

• Defn: airflow limitation, usually progressive + associated with enhanced chronic inflam response in the airways + lung to noxious particles or gases
• Sub-types: emphysema, chronic bronchitis, chronic obstructive asthma (but often combo) (separate cards)
• Usually has to be > 10-15 PYs

S+S

• Triad: sob, chronic cough, sputum production (initially in the morning)
• Earliest sx = soboe. Other = wheezing, chest tightness

P/E

• Early stg: normal or prolonged expiration or wheezes on forced exhalation
• Inspection: inc AP diameter/ barrel chest, tripod, accessory muscles, pursed lip expiration, inc JVP
• Percussion: hyper-resonance, dec diaphragmatic excursion
• Ausc: dec breath sounds, wheezes, crackles at the lung bases
• Palpation: enlarged/ tender liver (RHF)

Investigations

• PFTs - esp spirometry*: pre and post bronchodilator administration to assess for obstruction and irreversibility
• Exclude anemia, HF (BNP), Cr, etc
• Check alpha-1 anti-trypsin (AAT) if young pt with no/ low smoke exposure
• Imaging: not required to dx but CXR +/- CT during acute exacerbations to exclude complicating factors or if the cause of dyspnea or sputum production is unclear.

Tx

1. Salbutamol/ ventolin
2. Atrovent
3. Steroids (prednisone - dec length in hospital + frequency of exacerbation)
4. Abx (ie doxy, levo, azithro)

Question 4

COPD - Chronic Bronchitis

Answer 4

• Defn: chronic productive cough for 3 mos in each of 2 successive years, and other causes of chronic cough are excluded.

Question 5

COPD - Emphysema

Answer 5

• Defn: abnormal + permanent airspace enlargement distal to the terminal bronchioles + destruction of the airspace walls, W/O visible fibrosis.

Question 6

Pulmonary Edema

Answer 6

• CXR: Kerley B lines

Question 7

Clubbing

Answer 7

• Inc distal finger tip mass, lovibond angle >180°
• Most common cause = lung cancer
• Bilateral: pulmonary (ie bronchiectasis, CF, emphysema, pneumonia, pulmonary lymphoma), cardio (ie CHF, congenital heart disease, infectious endocarditis). Sometimes extra-thoracic (ie IBD, cirrhosis, GI neoplasms)
• Unilateral: nearby vascular lesions (ie peripheral shunt, AV fistula, aneurysm. Also Pancoast tumors, lymphadenitis, erythromelalgia)