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Short case clinical skills > Short Case differentials - Respiratory > Flashcards

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
Q

Lower lobe predominant ILD

A

Rheumatoid arthritis

Asbestosis

Scleroderma

Idiopathic interstitial fibrosis

Drugs

Acute allergic alveolitis

Acute eosinophilic pneumonitis

26
Q

Drugs that cause ILD

A

bleomycin

busulfan

nitrofurantoin

hydralazine

methotrexate

amiodarone

27
Q

Interstitial lung disease secondary to alveolitis

A

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
Q

Interstitial lung disease due to granulomatous disease

A

Sarcoidosis

Wegener’s disease

Churg Strauss disease

Hypersensitivity pneumonitis to organic or inorganic dusts

29
Q

Pneumonia examination features

A

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
Q

Atelectasis examination features

A

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
Q

Pleural effusion examination features

A

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
Q

Pneumothorax examination features

A

Reduced expansion on affected side

Hyperresonance if large effusion

Breath sounds reduced or absent

Subcutaneous emphyesma

33
Q

Tension pneumothorax examination features

A

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
Q

Bronchiectasis examination features

A

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
Q

Signs of cor pulmonale

A

Loud and palpable P2

Parasternal heave

Soft early diastolic murmur at LUSE

Raised JVP Pitting oedema

36
Q

Signs of secondary amyloidosis

A

Peripheral oedema

Proteinuria

Cardiac failure

Hepatomegaly

Splenomegaly

Carpal tunnel syndrome

37
Q

Bronchial asthma examination features

A

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
Q

Signs of severe asthma

A

Exhaustion and fear Inability to speak

Cyanosis

Tachycardia

Pulsus paradoxus

Reduced or absent breath sounds

39
Q

COPD examination features

A

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
Q

Signs of hyperinflated chest

A

Increased antero-posterior diameter

High shoulders

Hyper resonant percussion throughout lung fields

Decreased liver percussion dullness

41
Q

Signs of superior vena caval obstruction

A

Plethoric facies

Periorbital oedema

Conjunctival injection

Exophthalmos

Venous dilatation on fundoscopy

Raised non pulsatile JVP Positive

Pemberton’s sign

Supraclavicular lymphadenopathy

42
Q

Signs of tracheal compression

A

Stridor

Respiratory distress

43
Q

Phrenic nerve paralysis exam features

A

Dullness to percussion at affected base unaffected by deep inspiration

absent breath sounds

44
Q

Mediastinal compression exam features

A

Superior vena caval compression

Tracheal compression

Horner’s syndrome

Hoarseness

Phrenic nerve paralysis

45
Q

Horner’s syndrome

A

Unilateral ptosis of eye

Small reactive pupil (meiosis)

Unilateral dry forehead (anhydrosis)

46
Q

Possible features of lung carcinoma

A

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
Q

Apical lung carcinoma

A

Horner’s syndrome

Recurrent laryngeal palsy C8/T1 nerve root lesion

48
Q

Neoplastic features small cell carcinoma

A

SIADH

Ectopic

ACTH syndrome

Carcinoid syndrome

Lambert-Eaton syndrome

Retinal blindness

49
Q

Neoplastic endocrine features squamous cell carcinoma

A

Hypercalcaemia

Gynaecomastia

Hypoglycaemia from IGF secretion

50
Q

Neurological neoplastic syndromes

A

Lambert Eaton syndrome

Retinal blindness

Peripheral neuropathy

Sub-acute cerebellar degeneration

Dermatomyositis/polymyositis

Cortical degeneration

51
Q

Haematological neoplastic syndromes

A

Migrating venous thrombophlebitis

DIC

Anaemia

52
Q

Dermatological neoplastic syndromes

A

Acanthosis nigricans

Dermatomyositis

53
Q

Renal neoplastic syndromes

A

Membranous glomerulonephritis

54
Q

Sarcoidosis exam features - skin and face

A

Lupus pernio

Granulomata

Erythema nodosum

Parotidomegaly

55
Q

Sarcoidosis exam features - eyes

A

Ciliary injection

Anterior uveitis

56
Q

Sarcoidosis exam features - Cardiorespiratory

A

Fine end inspiratory crepitations

Cor pulmonale

Second and third degree heart block

57
Q

Sarcoidosis exam features - abdominal

A

Generalised lymphadenopathy

Hepatosplenomegaly

58
Q

Sarcoidosis exam features - CNS

A

Cranial nerve lesions

Peripheral neuropathy

59
Q

Sarcoidosis - Musculoskeletal

A

arthralgia

Swollen fingers

Bone cysts

60
Q

Pulmonary embolism features

A

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
Q
A

Short case clinical skills (5 decks)

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