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Short Case differentials - Respiratory Flashcards

1
Q

Causes of stridor - sudden onset

A

Anaphylaxis

Inhaled foreign body

Acute epiglottitis

Toxic gas inhalation

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2
Q

Causes of stridor - gradual onset

A

Laryngeal or pharyngeal tumours

Cricocarytenoid rheumatoid arthritis

Bilateral vocal cord palsy

Tracheal carcinoma

Paratracheal lymph node compression

Post-tracheostomy or intubation granulomata

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3
Q

Causes of tracheal displacement - Toward side of lung lesion

A

Pneumonectomy

Upper lobe collapse

Upper lobe fibrosis

Upper mediastinal masses

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4
Q

Causes of tracheal displacement - Away from the side of lung lesion

A

Massive pleural effusion

Tension pneumothorax

Upper mediastinal masses

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5
Q

Scars - long diagonal posterior scar

A

Pneumonectomy

Lobectomy

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6
Q

Scars - 2-3cm scars

A

VATS procdure for - pleurodesis or lung reduction surgery

Wedge resection

Biopsy

Decortication

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7
Q

Hoover’s sign

A

Movement of two thumbs at the xiphisterum inward during inspiration rather than outward (COPD hyperinflation)

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8
Q

Causes of bronchial breath sounds

A

Lung consolidation

Pleural effusion above the fluid

Collapsed lung

Localised pulmonary fibrosis

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9
Q

Early inspiratory crackles

A

COPD

Late pulmonary fibrosis

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10
Q

Late or pan inspiratory crackles

A

Left ventricular failure

Pneumonia (coarse)

Bronchiectasis (coarse)

Pulmonary fibrosis (fine)

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11
Q

Unilateral loss of chest wall movement

A

Consolidation

Collapse

Pleural effusion

Pneumothorax

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12
Q

Bilateral loss of chest wall movement

A

COPD

Bronchial asthma

Interstitial pulmonary fibrosis

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13
Q

Dull percussion note

A

Consolidation

Collapse

Pleural effusion

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14
Q

Causes of atelectasis

A

Intraluminal - mucus (post op, asthma, CF), foreign body, aspiration

Mural - bronchial carcinoma

Extramural - peribronchial lymphadenopathy, aortic aneurysm

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15
Q

Causes of transudative effusion

A

Cardiac failure

Hypoalbuminaemia from nephrotic syndrome or CLD

Hypothyroidism

Meig’s syndrome

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16
Q

Causes of exudative effusion

A

Pneumonia (parapneumonic effusion)

Neoplasm - bronchial carcinoma, metastatic carcinoma, mesothelioma

Trauma

Tuberculosis

Pulmonary infarction

Subphrenic abscess

Connective tissue disease - RA, SLE

Irradiation

Drugs - methysergide, cytotoxics

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17
Q

Causes of haemothorax

A

Trauma

Rupture of blood vessel

Pleural adhesion containing vessel

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18
Q

Chylothorax

A

Trauma or surgery to thoracic duct

Carcinoma or lymphoma involving thoracic duct

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19
Q

Empyema

A

Pneumonia

Lung abscess

Bronchiectasis

Tuberculosis

Penetrating chest wound

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20
Q

Causes of pneumothorax

A

Spontaneous

Traumatic

Iatrogenic

Emphysema with bullae rupture

Asthma

End stage fibrosis

Lung abscess

Bronchial carcinoma

Marfan’s syndrome

Eosinophilic granuloma

Lymphangioleiomyomatosis

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21
Q

Causes of tension pneumothorax

A

Trauma

Mechanical ventilation at high pressure

Spontaneous

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22
Q

Causes of congenital bronchiectasis

A

Primary ciliary dyskinesia

Cystic fibrosis

Congenital hypogammaglobulinaemia

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23
Q

Causes of acquired bronchiectasis

A

Childhood infections - whooping cough, pneumonia, measles

Localised disease- foreign body, bronchial mass, tuberculosis

Allergic bronchopulmonary aspergillosis (proximal brochiectasis)

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24
Q

Causes of upper lobe predomininat ILD

A

Silicosis

Sarcoidosis

Coal worker’s pneumoconiosis (progressive massive fibrosis)

Ankylosing spondylitis

Allergic bronchopulmonary aspergillosis

Radiation therapy

Tuberculosis

Cystic fibrosis

Alveolar haemorrhagic syndromes

Chronic eosinophilic pneumonitis

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25
Lower lobe predominant ILD
Rheumatoid arthritis Asbestosis Scleroderma Idiopathic interstitial fibrosis Drugs Acute allergic alveolitis Acute eosinophilic pneumonitis
26
Drugs that cause ILD
bleomycin busulfan nitrofurantoin hydralazine methotrexate amiodarone
27
Interstitial lung disease secondary to alveolitis
Idiopathic pulmonary fibrosis Connective tissue disease Pulmonary haemorrhagic syndromes - Goodpasture's Graft versus host disease Asbestos Radiation Aspiration pneumonia Drugs Toxic gas or fume exposure
28
Interstitial lung disease due to granulomatous disease
Sarcoidosis Wegener's disease Churg Strauss disease Hypersensitivity pneumonitis to organic or inorganic dusts
29
Pneumonia examination features
Reduced expansion on affected side Increased vocal fremitus and vocal resonance Dull percussion on affected side Bronchial breath sounds Medium, late or pan inspiratory crackles Pleural rub
30
Atelectasis examination features
Displaced trachea towards affected side Reduced expansion and chest wall flattening on the affected side Dull percussion over affected side Reduced breath sounds (no bronchial breathing when mass obstructs medium airways)
31
Pleural effusion examination features
Displacement of tracheal and apex beat away from effusion Reduced expansion on effected side Stony dullness to percussion on affected side Breath sounds reduced or absent Reduced vocal resonance
32
Pneumothorax examination features
Reduced expansion on affected side Hyperresonance if large effusion Breath sounds reduced or absent Subcutaneous emphyesma
33
Tension pneumothorax examination features
Tachypnoeic, cyanosed Trachea and apex displaced away from affected side Expansion reduced or absent on affected side Percussion hyperresonant over affected side Absent breath sounds and hyperresonance Elevated JVP with Kausmal's sign
34
Bronchiectasis examination features
Purulent, voluminous sputum Clubbing Cachexia Sinusitis Fever Coarse pan-inspiratory crackles over affected lobe Signs of cor pulmonale and respiratory failure Signs of secondary amyloidosis
35
Signs of cor pulmonale
Loud and palpable P2 Parasternal heave Soft early diastolic murmur at LUSE Raised JVP Pitting oedema
36
Signs of secondary amyloidosis
Peripheral oedema Proteinuria Cardiac failure Hepatomegaly Splenomegaly Carpal tunnel syndrome
37
Bronchial asthma examination features
Inspiratory and expiratory wheeze Dry or productive cough Tachypnoea Tachycardia Prolonged expiration Prolonged forced expiratory time Use of accessory muscles of respiration Hyperinflated chest
38
Signs of severe asthma
Exhaustion and fear Inability to speak Cyanosis Tachycardia Pulsus paradoxus Reduced or absent breath sounds
39
COPD examination features
Barrel shaped chest with increased anterio-posterior diameter Pursed lip breathing Use of accessory muscles of breathing Reduced chest expansion Hyperinflated chest Hoover's sign Tracheal tug Hyperresonant decreased breath sounds Early inspiratory creps Signs of cor pulmonale
40
Signs of hyperinflated chest
Increased antero-posterior diameter High shoulders Hyper resonant percussion throughout lung fields Decreased liver percussion dullness
41
Signs of superior vena caval obstruction
Plethoric facies Periorbital oedema Conjunctival injection Exophthalmos Venous dilatation on fundoscopy Raised non pulsatile JVP Positive Pemberton's sign Supraclavicular lymphadenopathy
42
Signs of tracheal compression
Stridor Respiratory distress
43
Phrenic nerve paralysis exam features
Dullness to percussion at affected base unaffected by deep inspiration absent breath sounds
44
Mediastinal compression exam features
Superior vena caval compression Tracheal compression Horner's syndrome Hoarseness Phrenic nerve paralysis
45
Horner's syndrome
Unilateral ptosis of eye Small reactive pupil (meiosis) Unilateral dry forehead (anhydrosis)
46
Possible features of lung carcinoma
Cachexia Haemoptysis Clubbing Hypertrophic pulmonary osteoarthropathy Lobar collapse or volume loss Pneumonia Pleural effusion Fixed respiratory wheeze Tender ribs Mediastinal compression Supraclavicular and axillary lymphadenopathy
47
Apical lung carcinoma
Horner's syndrome Recurrent laryngeal palsy C8/T1 nerve root lesion
48
Neoplastic features small cell carcinoma
SIADH Ectopic ACTH syndrome Carcinoid syndrome Lambert-Eaton syndrome Retinal blindness
49
Neoplastic endocrine features squamous cell carcinoma
Hypercalcaemia Gynaecomastia Hypoglycaemia from IGF secretion
50
Neurological neoplastic syndromes
Lambert Eaton syndrome Retinal blindness Peripheral neuropathy Sub-acute cerebellar degeneration Dermatomyositis/polymyositis Cortical degeneration
51
Haematological neoplastic syndromes
Migrating venous thrombophlebitis DIC Anaemia
52
Dermatological neoplastic syndromes
Acanthosis nigricans Dermatomyositis
53
Renal neoplastic syndromes
Membranous glomerulonephritis
54
Sarcoidosis exam features - skin and face
Lupus pernio Granulomata Erythema nodosum Parotidomegaly
55
Sarcoidosis exam features - eyes
Ciliary injection Anterior uveitis
56
Sarcoidosis exam features - Cardiorespiratory
Fine end inspiratory crepitations Cor pulmonale Second and third degree heart block
57
Sarcoidosis exam features - abdominal
Generalised lymphadenopathy Hepatosplenomegaly
58
Sarcoidosis exam features - CNS
Cranial nerve lesions Peripheral neuropathy
59
Sarcoidosis - Musculoskeletal
arthralgia Swollen fingers Bone cysts
60
Pulmonary embolism features
Tachycardia, tachypnoea Fever Pleural friction rub Elevated JVP w/ large v waves right ventricular heave Palpable and loud P2 S3 or S4 Hepatic impulse Tricuspid murmur Unilateral leg swelling
61

Short case clinical skills (5 decks)

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