Top of Disease Table - Hx Flashcards
What is important in the respiratory Hx
Chest pain SOB - QUANTIFY Cough Exercise tolerance and how it changed Wheeze Haemoptysis Recurrent infections Systemic Sx Sleep
PMH - Resp support / pre-term at birth - Childhood illness DH and allergy FH
What do you want to know about cough
Productive Colour and volume in cups Any blood Is it positional - Worse flat / early morning = GORD
What causes wheeze
Bronchial inflammation leading to constriction
What do you ask about sleep
Do you sleep through night
Do you wake up feeling SOB
Does your parter notice stop breathing
What in SH
Occupation Exposure Pets Travel Smoking Alcohol
What do you look for on inspection
Sputum pot - look inside O2 Breathlessness Pursed lip - severe emphysema Cyanosis
What do you look for in hands
Red palms, flap, bounding pulse = CO2 retnetion
Tar staining NOT nicotine
Clubbing
What are other important aspect
Chest
JVP
LN - ALWAYS offer
Signs of RHF
What do you look in chest
Hyperinflation - Increased AP diameter - Cricosternal - Use of accessory - Prolonged expiratory Signs of surgery or thoracoscopy
RHF
Raised JVP
Loud P2
RV heave
TR
What causes haemoptysis
Lung cancer Pulmonary oedema TB PE LRTI Bronchiectasis Mitral stenosis Aspergilloma Macroscopic polyangiitis Good-pasture
Why does MS cause
Rupture of bronchial veins due to increase in LA pressure
How does it present
SOB
AF
Malar flush
What causes acute SOB
Pulmonary oedema MI Pneumonia Endocarditis PE Pneumothorax Arrythmia
What type of crackles in pulmonary oedema
Fine crackles
What type of crackles in fibrosis
Coarse crackles
What causes chronic SOB
Heart failure Asthma / COPD Aortic stenosis Lung cancer Pulmonary fibrosis Bronchiectasis Anaemia Obesity
How does HF present
Hx IHD / HTN
Orthopnoea and PND
Bibasal crackle
3rd HS
What causes cough
URTI / LRTI TB Drugs Asthma / COPD Lung cancer Reflux Oesophagtiis HF Post-jnasal drip A1-antitrypsin deficeincy
What drugs cause cough
ACEI
Ticagrelor
What is important to ask in lung ca
B symptoms
Hoarseness
What are red flags of cough suggesting TB / lymphoma / cancer
Fever / night sweat / weight loss
Haeomptysis
Dyspnoea
If chronic cough + sputum
COPD / bronchiectasis
What are bed sites test
Sputum PEFR Pulse oximetry ABG Spirometry PFT
What do you send sputum for
MC+S
PCR + ZN if infected
What does colour
Clear = bronchitis
Yellow / green = infection
Red = blood
Black = smoke / coal
When is PEFR useful
Asthma
What gives you poor result in oximetry
CO Nail varnish Skin colour Poor perfusion Moving
If sats <92%
Do ABG
What does spirometry measure
Lung volume
FEV1 and FVC
What is obstructive pattern
FEV1 <80%
FVC NORMAL OR LOW
RATIO <70%
Can’t get air out fast but with prolonged expiration will get it all out
What causes
Asthma
COPD
Bronchiectasis
CF
What is restrictive pattern
FEV1 <80%
FVC <80%
Ratio >70%
Due to reduced lung volume and shallow breaths
What causes restrictive
Fibrosis Interstitial pneumonia Connective tissue Sarcoid Pleural effusion Neuromuscular Obesity
What are PF
TLC
Residual volume
Gas transfer (KCO)
What is TLC
Increased in obsruction
Reduced in restrictive due to reduced gas exchange
What is KCO
Reduced in emphysema and interstitial lung
What are radiological tests
CXR USS for drainage X/Q PET CT CTPA Pulmonary angiography
What is bronchoscopy
Tube via nose or mouth under LA to look through bronchioles
When do you do
Suspect cancer
Pneumonia not resolving
Intersitial lung disease
What can be done during
BAL and sent to lab
When do you do BAL
Malignancy Pneumonia Bronchiectasis Suspected TB with -ve sputum ILD
What is needed pre-procedure
FBC Coaulation CXR CT Spiroemtrry ABG
What are complications
Hypoxia
Bleeding
Pneumothorax
How do you do lung biopsy
Percutaneous
Transbronchial at bronchoscopy
Open
When do you do mediastinoscopy/ / thoracoscopy
Pleural lesion
Drain effusion
Pleurodesis
Require GA
What causes clubbing
CLUBBING Cyanotic HD Lung disease UC and Chrons Birth defect - congenital Biliary cirrhoiss IE Neoplasia GI malabsorption (coeliac)
What are the lung disease causes
ABCDEF Abscess Bronchiectasis CF DONT say COPD Empyema Fibrosis
Ix SOB
A-E Hx + exam - Quantify SOB - worse in morn / even / position CXR ECG ABG or VBG Bloods \+- CT
ABG or VBG
ABG if severe hypoxic/ suspecting type II
Resp causes SOB
Obstruction Anaphylaxis PE Pneumothorax COPD / asthma Pneumonia Pleural effusion Neoplasm Fibrosis
Cardiac
ACS Oedema Arrythmia Tamponade Myocarditis Cardiomyopathy
Infectious
Pneumonia
Epiglottitis
Traumati
Pneumothorax Haemothorx Tamponade Flail chest Rib fracture
Abdominal
Ascites
Obesity
Pregnancy
Psychogenic
Panic attack
Metabolic
Acidosis
POisoning
Renal failure
Haematological
CO poison
Anaemia
Neuromuscular
CVA
GBS
