Station 1: Respiratory Flashcards
Causes of clubbing
ABDOMINAL: liver cirrhosis, primary biliary cirrhosis, inflammatory bowel disease
RESP: CF, bronchiectasis, lung cancer, fibrosis, abscess, empyema
CARDIO: infective endocarditis, congenital heart disease (cyanotic), atrial myxoma
OTHER: idiopathic, thyroid acropachy
Light’s criteria
An effusion is an exudate when one of the following is met:
- Pleural fluid LDH >200 (2/3 x the upper limit of normal)
- Pleural fluid protein / serum protein is >0.6
- Pleural fluid LDH / serum LDH is >0.5
(nb. protein is longer than LDH)
Causes of apical fibrosis
Berylliosis Radiation Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoidosis Tuberculosis Silicosis
Causes of basal fibrosis
UIP Connective tissue diseases Aspiration Asbestosis SLE Scleroderma
Differentiating between a lobectomy and pneumonectomy
- pneumonectomy expect deviated trachea and dullness to percucssion
- lobectomy of the upper lobe may cause increased percussion note
- lobectomy of the lower lobe will cause dullness to percussion and absent breath sounds
Causes of pulmonary hypertension
Primary pulmonary hypertension
Thromboembolic diseases
Secondary to pulmonary disease due to chronic hypoxia e.g. COPD, fibrosis
Secondary to cardiac disease due to pulmonary venous hypertension e.g. congestive cardiac failure
Causes of bronchiectasis
Idiopathic
Post infective e.g. pneumonia, tuberculosis, pertussis, measles
Congenital e.g. cystic fibrosis, Kartagener’s and Young’s syndrome, primary ciliary dyskinesia, hypogammaglobulinaemia
Autoimmune e.g. sarcoid
Other e.g. HIV/AIDs, ABPA, fibrosis
Investigations in suspected pulmonary fibrosis
Full history and examination
Bedside tests including O2 sats, peak flow
CXR
Bloods inc. ESR, ANA, rheumatoid factor and anti-CCP
HRCT to confirm diagnosis and pattern of disease
Spirometry, lung volumes and transfer factors
Investigations in suspected bronchiectasis
Full history and examination
Bedside tests including O2 sats, peak flow
CXR
Bloods: immunoglobulins, apergillus serology and skin prick testing
HRCT to confirm structural damage
Sputum culture to determine colonising organisms
Spirometry
Infection screen / genetic screen / sweat testing if appropriate
Investigations in suspected COPD
Full history and examination Bedside tests including O2 sats, peak flow CXR Bloods including a1AT in young patients ABG Spirometry and gas transfer Consider CT chest to exclude malignancy
Causes of pulmonary fibrosis
Autoimmune: SLE, sarcoid. connective tissue diseases, rheumatoid arthritis, ankylosing spondylitis
Iatrogenic: e.g. drugs: bleomycin, methotrexate, radiation
Infection: tuberculosis
Other: industrial lung diseases coal workers lung, EAA, berylliosis, silicosis
Indications for single lung transplantation
Dry lung conditions e.g. fibrosis, COPD
Indications for double lung transplantation
Wet lung conditions e.g. cystic fibrosis, bronchiectasis, pulmonary hypertension
Management of COPD
Conservative
- smoking cessation advice
- pneumococcal and flu vaccination
- pulmonary rehabilitation
- LTOT if pO2 <7.3 or <8 with sx of cor pulmonale
- nutrition
- exercise
Medical
- inhalers e.g. short and long acting beta 2 agonists, long acting muscarinic antagonists, inhaled corticosteroids
FEV1 >80% pred = SABA
FEV1 <60% pred = LABA + LAMA
FEV1 <40% pred = LABA + LAMA + ICS (nb. avoid if previous pneumonia - TORCH trial)
Surgery
- bullectomy
- lung volume reduction surgery
- endobronchial valve replacement
- single lung transplant
Differential diagnosis for wheeze
Cardiac wheeze/pulmonary oedema
Bronchiolitis e.g.RA, eGPA, chronic rejection following lung transplantaton
