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Medicine > Short Case Respiratory Xpress > Flashcards

Short Case Respiratory Xpress Flashcards

1
Q

State the causes of lung collapse

A
  • Bronchogenic CA
  • TB
  • Bronchial adenoma
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2
Q

State the causes of lung consolidation

A
  • Bacterial pneumonia
  • Bronchogenic CA
  • Pulmonary infarct
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3
Q

State (2) causes of bibasal crackles with finger clubbing

A
  • Bronchiectasis
  • Interstitial lung disease
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4
Q

State (2) causes of bibasal crackles without finger clubbing

A
  • Left ventricular failure
  • Bronchopneumonia
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5
Q

Define asthma

A
  • Chronic inflammatory disorder of the airway characterized by bronchial hyper-responsiveness of the airway to various stimuli, leading to widespread bronchocontriction
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6
Q

How would you diagnose bronchial asthma?

A
  • Typical symptoms/signs
  • Lung function test
  1. > 20% of diurnal variation in PEF on >3 days in a week for 2 weeks
  2. FEV1 >15% increase after bronchodilator or oral steroid
  3. FEV1 >15% decrease after 6 minutes of exercise (running)
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7
Q

What are the indicators of severe asthma?

A
  • Inability to complete 1 sentence in 1 breath
  • RR >25/min
  • Pulse rate >110/min
  • PEF <50% of predicted or best value
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8
Q

What are the indicators of life-threatening asthma?

A
  • Exhaustion, confusion, coma
  • Bradycardia, hypotension
  • Silent chest, cyanosis
  • PEF <33% of predicted or best value
  • Normal or increased PCO2
  • PO2 <60mmHg
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9
Q

How do you manage a case of acute asthma?

A
  • ABG
  • CXR (to exclude pneumothorax)
  • O2, nebuliser - Beta-agonist
  • High dose steroid (IV hydrocortisone, prednisolone)
  • For severe attack -> IV aminophylline, consider ventilation
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10
Q

Define COAD

A

A disease state characterized by AIRFLOW LIMITATION that is not fully reversible

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11
Q

How do you diagnose a case of COAD?

A

Key indicators:
- Chronic cough with sputum production
- Progressive or persistent dyspnea
- History of smoking
- Exposure to occupational dusts or chemicals

Spirometry (To confirm the diagnosis of COAD)
- Airflow limitation (FEV1/FVC <70%) that is not fully reversible (post-bronchodilator FEV1 <80% of predicted value)

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12
Q

What does finger clubbing in COAD superimposed?

A

Superimposed BRONCHOGENIC CA, chronic infection

Finger clubbing is NOT a feature of COAD

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13
Q

State (2) differentials for COAD

A
  • Left ventricular failure
  • Chronic asthma
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14
Q

What are the additional investigations of COAD?

A
  • Bronchodilator reversibility test (Largely irreversible in COAD)
  • Glucocorticoid reversibility test (>15% increase in FEV1 after a course of steroid therapy)
  • Chest X-ray (Hyper-inflation, bullous changes, pulmonary hypertension)
  • ECG (Cor pulmonale -> Peaked P wave at L2, 3 and AVF)
  • ABG
  • Alpha-1-antitrypsin deficiency (indicated in young patients <45Y or those with strong family history of COAD)
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15
Q

How would you manage a case of acute exacerbation of COAD?

A
  • Nebulized bronchodilator, oxygen
  • CXR -> to exclude pneumothorax
  • Antibiotics (H. influenza, Strep pneumonia)
  • Steroids (Oral or IV)
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16
Q

What are the possible findings on PE in a patient with COAD?

  1. Face
  2. Chest
  3. Abdomen
A

Face
- Central cyanosis
- Polycythemia
- Pursed lips

Chest
- Barrel chest
- Hyper-resonance
- Downward displacement of upper border of liver
- Rhonchi
- Loud S2 (Pulmonary hypertension)

Abdomen
- Palpable liver
Possible cause:
1. Hyper-inflated lungs
2. Bronchogenic CA with liver metastasis
3. Cor-pulmonale

17
Q

State the clinical features of bronchogenic CA

A
  • Primary tumor - Pancoast syndrome
  • Mediastinal spread - hoarseness (recurrent laryngeal nerve palsy), superior vena cava obstruction
  • Metastasis - pleura, liver, brain, adrenal
  • Paraneoplastic syndrome (PNS)
    1. Endocrine - ectopic ACTH secretion (scc), gynecomastia (adc), syndrome of inappropriate ADH secretion/SIADH (scc), hypercalcemia (sqcc)
    2. Neurological - cerebellar syndrome, poly-/dermatomyositis, LEMS
    3. Others - hypertrophic pulmonary osteoarthropathy, clubbing
18
Q

What are the investigations to be done for a case of bronchogenic CA?

A
  • Serum sodium, calcium
  • CXR - hilar mass or coin lesion, rib erosions, raised hemidiaphragm (phrenic nerve paralysis), lymphangitis carcinomatosis
  • Pleural fluid cytology
  • Bronchoscopy (+ washing and brushing) - endobronchial tumor
  • CT scan thorax/abdomen, bone scan - staging
  • Lung function test - FEV1
19
Q

Define Pancoast syndrome

A

Apical lung tumor with
- Invasion of lower trunk (C8 - T1) of brachial plexus -> WASTING OF SMALL MUSCLES OF THE HAND
- Sympathetic chain -> HORNER’S SYNDROME
- 2nd-3rd ribs

20
Q

Define interstitial lung disease

A
  • A.k.a diffuse parenchymal lung disease
  • Group of disorders that involve the space between epithelial and endothelial basement membrane
21
Q

State the causes of ILD

A
  • Known cause
    1. Drugs
    2. Connective tissue disease
    3. Occupational exposure - asbestos, silica
  • Idiopathic pulmonary fibrosis
  • Granulomatous DPLD - Sarcoidosis
  • Other forms of DPLD
22
Q

What are the investigations of ILD?

A
  • CXR
  • Lung function test
  • CTD screen
  • High-resolution CT (HRCT)
  • Bronchial lavage
  • Lung biopsy
23
Q

What is the possible treatment for ILD?

A
  • Steroid/cyclophosphamide
  • Treat underlying cause
24
Q

Define bronchiectasis

A

Chronic suppurative inflammation of the bronchi that results in permanent dilatation of the airways

25
Q

State the etiologies of bronchiectasis

A
  • Post-infectious (Measles, Pertussis, TB, aspergillosis)
  • Endobronchial obstruction (Bronchial adenoma/carcinoma)
  • Congenital - Kartagener’s syndrome, hypogammaglobulinemia (extremely rare)
26
Q

What are the complications of bronchiectasis?

A
  • Pneumonia
  • Hemoptysis
  • Cerebral abscess
  • Amyloidosis
27
Q

What investigations to be done to diagnose a case of bronchiectasis?

A
  • Sputum AFB/fungal culture
  • Sputum culture - H influenza, P aeruginosa, Strep pneumonia
  • CXR - ring-like shadows , tram lines, focal opacities
  • Aspergillus precipitin test
  • High-resolution CT
    1. BEST tool to diagnose
    2. Detects airway changes that are not visible on X-ray
28
Q

List the specific treatment of bronchiectasis

A
  • Bronchopulmonary hygiene
  • Antibiotics
  • Surgical resection of damaged segments/lobes that are nidus for infection
29
Q

In diagnostic approach to pleural effusion, what are the (2) important questions?

A
  • Is the fluid a transudate or exudate?
  • If the fluid is an exudate, what is the etiology?
30
Q

What are the investigations to be done for pleural effusion and the possible findings?

A

CXR/US/CT scan
- Helps in finding the best site for pleural tap

Pleural tap and fluid analysis
- Protein
- Glucose (Decrease in infection and malignancy)
- Gram stain, Ziehl-Neelson stain
- Culture/cytology
- Adenosine deaminase (Increase in tuberculous effusion)

Percutaneous pleural biopsy
- Indicated in undiagnosed pleural exudates with non-diagnostic cytology and clinical suspicion of TB or malignancy

31
Q

State the laboratory findings of a transudate and its possible cause

A
  • Protein <30g/l
  • LDH <200IU/L
  • Pleural : serum LDH ratio <0.6

Possible cause
- Cardiac failure
- Nephrotic syndrome
- Chronic liver disease

32
Q

State the laboratory findings of an exudate and its possible cause

A
  • Protein >30g/l
  • LDH >200IU/L
  • Pleural : serum LDH ratio > 0.6

Possible cause
- Malignancy
- Pneumonia
- TB
- Pulmonary infection
- Connective tissue disease

33
Q

State the laboratory findings of an empyema and its possible cause

A
  • Turbid, foul-smelling
  • Centrifuged pleural fluid - clear supernatant

Possible cause
- Lung infection
- Chest trauma
- Thoracic surgery
- Subdiaphragmatic abscess

34
Q
A

Medicine (8 decks)

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