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Year 5 Respiratory > Toronto Notes Approach to Resp Patient > Flashcards

Toronto Notes Approach to Resp Patient Flashcards

1
Q

Most Common Causes of Chronic
Cough in the Non-smoking Patient
(cough >3 mo with normal CXR)

A
  • GORD
  • Asthma
  • Post-nasal drip
  • ACEI

Consider Parenchymal disease e.g. pneumonia and abscess and CHF.

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2
Q

Most common cause of Haemoptysis

A

Chronic Bronchitis

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3
Q

Differentials for hemoptysis

A 
• Airway Disease
Acute or chronic bronchitis
Bronchiectasis
Bronchogenic CA
Bronchial carcinoid tumor
• Parenchymal Disease
Pneumonia
TB
Lung abscess
• Vascular Disease
PE
Elevated pulmonary venous pressure: LVF, Mitral stenosis
Vascular malformation
Vasculitis e.g. Goodpasture's syndrome
• Miscellaneous
Impaired coagulation
Pulmonary endometriosis
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4
Q

Causes of acute dyspnoea

A

• Cardiac causes
Ischemic heart disease
CHF exacerbation
Cardiac tamponade

• Pulmonary causes
Upper airway obstruction (anaphylaxis, foreign body)
Airway disease (asthma, COPD exacerbation, bronchitis)
Parenchymal lung disease (ARDS, pneumonia)
Pulmonary vascular disease (PE, vasculitis)
Pleural disease (pneumothorax, tension pneumothorax)
Respiratory control (metabolic acidosis, ASA toxicity)

• Psychiatric
Anxiety/psychosomatic

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5
Q

Causes of chronic dyspnoea

A

• Cardiac causes
Valvular heart disease
Decreased CO

• Respiratory causes
Parenchymal lung disease (interstitial disease)
Pulmonary vascular disease (pulmonary HTN, vasculitis)
Pleural disease (effusion)
Airway disease – asthma, COPD

• Metabolic causes
Severe anemia
Hyperthyroidism

• Neuromuscular and chest wall disorders
Deconditioning, obesity, pregnancy, neuromuscular
disease

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6
Q

What are the two main categories of chest pain?

A

Pleuritic and non-pleuritic

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7
Q

Causes of non-pleuritic chest pain:

A

• Pulmonary
Pneumonia
PE
Neoplastic

• Cardiac
MI
Myocarditis/pericarditis

• Esophageal
GERD
Spasm
Esophagitis
Ulceration
Achalasia

• Mediastinal
Lymphoma
Thymoma

• Subdiaphragmatic
PUD
Gastritis
Biliary colic
Pancreatitis

Vascular
• Dissecting aortic aneurysm

• MSK
Costochondritis
Skin
Breast
Ribs
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8
Q

Pleuritic Chest Pain

A 
• Pulmonary
Pneumonia
PE
Pneumothorax
Hemothorax
Neoplasm
TB
Empyema

• Cardiac
Pericarditis
Dressler’ssyndrome

• GI
Subphrenic abscess
Pancreatitis

• MSK
Costochondritis
Fractured rib
Myositis
Herpes zoster
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9
Q

Signs of respiratory distress

A 
Nasal Falre
Tracheal tug
Intercostal drawing
Accessory muscles
Tripoding 
↑ RR
Central & Peripheral cyanosis 
Inability to speak
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10
Q

Why are pulmonary function tests useful?

A

Differentiate patterns of lung disease (restrictive vs obstructive)
Lung volume, flow rates and diffusion capacity

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11
Q

What is a normal FEV1? How is it calculated?

A

Based on age, height, weight = predicted

Normal = +/- 20%

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12
Q

Describe Obstructive Lung disease

Give examples

A
  • ↓ Flow rate - worst in expiration
  • Air trapping (Increased RV/TLC)
  • Hyperinflation (↑FRC, TLC)
  • FEV1/FVC raion ↓

COPD, asthma, bronchiolitis, bronchiectasis (can be mixed picture)

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13
Q

Describe restrictive patterns

Examples

A

↓ Lung compliance
↓ Lung volumes
FEV1/FVC ratio ↑ or normal

ILD, pleural disease, neuromuscular disease, chest wall disease.

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14
Q

How to differentiate between asthma/COPD

A

Reversibility after bronchodilator - rise in FEV1 >12% = asthma

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15
Q

What is bronchoscopy, what is it used for?

A

A flexible or rigid bronchoscope is used for visualization of a patient’s airways
Allows for:
• Tissue washings for culture and cytology
• Endobronchial or transbronchial tissue biopsies
• Removal of secretions/foreign bodies/blood
• Laser resections
• Airway stenting
• Mediastinal lymph nodes can also be sampled using a special bronchoscope equipped
with an U/S probe (EBUS)

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16
Q

CXR: What signs of consolidation can you see on CXR

A

Consolidation ‘airspace disease’
Air bronchogram
Silhouette sign
Less visible blood vessels

17
Q

Acute causes of consolidation

A

water (pulmonary edema), pus (pneumonia), blood (hemorrhage)

18
Q

Chronic causes of consolidation

A

neoplasm (lymphoma), inflammatory (eosinophilic

pneumonia), chronic infection (TB, fungal)

19
Q

Sings of reticular lung disease

A

Reticular: “interstitial disease
Increased pulmonary markings
Honeycombing (IPF)

20
Q

Nodular - what must you specify?

A

Cavitary vs non-cavitary

21
Q

Causes of nodules

A

Cavitary
• neoplasm (primary vs. metastatic lung cancer),
• infectious(anaerobic or Gram negative, TB, fungal), inflammatory (RA,Granulomatosis with Polyangiitis [GPA])
Non-cavitary: above + sarcoid, Kaposi’s sarcoma (in HIV), silicosis and other pneumoconiosis

22
Q

Causes of respiratory acidosis

A 
• Respiratory Center Depression (Decreased RR)
Drugs (anesthesia, sedatives, narcotics)
Trauma
Increased ICP
Encephalitis
Stroke
Central apnea
Supplemental O2 in chronic CO2 retainers (e.g. COPD)

• Neuromuscular Disorders (Decreased Vital Capacity)
Myasthenia gravis
Guillain-Barré syndrome
Chest wall disease (obesity, kyphoscoliosis)

• Airway Obstruction (Asthma, COPD)

• Parenchymal Disease
COPD
Pulmonary edema
Pneumothorax
Pneumonia
ILD (late stage)
ARDS

Mechanical hypoventilation

23
Q

Causes of respiratory alkalosis

A 
• Hypoxemia
Pulmonary disease (pneumonia, edema, PE, interstitial
fibrosis)
Severe anemia
Heart failure
High altitude
• Respiratory Center Stimulation
CNS disorders
Hepatic failure
Gram-negative sepsis
Drugs (ASA, progesterone, theophylline, catecholamines,
psychotropics)
Pregnancy
Anxiety
Pain

• Mechanical Hyperventilation (Excessive Mechanical
Ventilation)

24
Q

Causes of airway obstruction ↓ FEV1

A 
Airway Obstruction (decreased FEV1)
• Asthma
• COPD (chronic bronchitis, emphysema)
• Bronchiectasis
• Cystic fibrosis
25
Q

What Factors that Shift the Oxygen-Hb Dissociation Curve to the Right (Hb released O2)

A 
"CADET, face right!"
CO2
Acid
2,3-DPG
Exercise
Temperature
26
Q

What is a pulmonary shunt?

A 
Occurs when the capillary networks of
the alveoli are perfused, yet there is a
lack of adequate ventilation (and thus
oxygenation) in that alveolus or group
of alveoli. Thus this blood enters the
pulmonary venous system without being
oxygenated.

Giving Oxygen - does not improve P02 until shunt is removed

Year 5 Respiratory (1 decks)

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