Uni finals course Flashcards
Aspects of respiratory history
PC HPC PMH DH SH FH Smoking and alcohol
What might anaemia indicate?
GI bleed Steroids B12 deficiency Alcohol abuse Chronic disease Iron deficiency
What does asterixis indicate
Decompensated T2RF also decompensated liver disease
Causes of clubbing
CLUBBING
Cystic fibrosis Lung cancer UC Bronchiectasis idiopathic pulmoary fibrosis Neurogenic tumours Gastrointestinal distrubance
What is respiratory splinting?
Reduced inspiratory effort as a result of pleuritic chest pain
They may be leaning forward to avoid the irritation
When is a thoracotomy done and where is the scar
To remove lung cancer
Around the scapula on the back/side!
Chest deformities
Kyphoscoliosis
Pectus excavatum
Pectus carinatum
Type of NIV for COPD
BiPAP to help remove CO2!
NIV for sleep apnoea
CPAP to keep alveoli open!
Whats important to check when prescribing an inhaler?
Check technique
What colour is a SABA?
Blue
Reduced resonance on percussion could indicate…
Pus (empyema)
Consolidation
Characteristic bronchial breathing
Inspiration and expiration equally loud and equal in duration.
Normally, expiration should be shorter than inpiration.
Sounds like they are scuba diving
What does bronchial breathing (peripherally, because centrally is reasonably normal) indicate?
Pneumonia
Pleural effusions
Atelecatasis
Characteristic wheeze
You’ve had it yourself after a big run
Whisteling as you breath in
Kind of musical
What can a wheeze indicate?
Obstruction
Asthma
May be mucus, ask them to cough!
Characteristics of fine crackles
Like breathing into a radio
Or wood burning in a fireplace
Early inspiratory crackles indicate
Chronic bronchitis
Late inspiratory crackles indicate
like wood burning on a fireplace
Pneumonia
Atelectasis
Chronic heart failure
Cause of rhonchi sounds on auscultation
Widened airways (e.g. emphysema) with thick secretions Turbulent flow
Coarse crackles indicate
Mucus
Cause of increased vocal resonance
Pneumothorax
Causes of reduced vocal resonance
Consolidation
Effusion
Collapse
Mediastinal shift can indicate
Pneumothorax
Lobar collapse
Signs of RHF
Peripheral oedema Syncope Pulmonary oedema Fatigue Exertional dyspnoea Dizziness
Reduced air entry
Stony dull percussion
Reduced vocal fremitus
Effusion
Bronchial breathing/crackles, dull percussion, reduced VF
Consolidation
Fine crackles, clubeed
Fibrosis
Coarse crackles, clubbed, purulent sputum
Bronchiectasis
When would you use a high resolution CT?
Bronchiectasis
Idiopathic pulmonary fibrosis
Causes of raised calcium
Parathyroid cancer
Vitamin D overdose
Primary hyperparathyoidism
Secondary hyperparathyoidism
Ix for pulmonary HTN
Echo (looking for reduced ejection fraction from RHS)
Spirometry (thinking about COPD)
FEV1/FVC <70% indicates
Obstruction
FVC <80% predicted indicates
Restriction
Causes of restrictive lung disease
Fibrosis
Interstitial lung disease
Causes of obstructive lung disease (FEV1 reduced)
COPD
Asthma
Bronchiectasis
What do you want to measure in GBS and myasthenia gravis (respiratory wise)
FVC
What is volumetric CT used for?
Cancer staging
Lymph nodes
How much radiation is CT
2-4 years background radiation!
What do you want to check in asthma
Peak flow
Complications of oral steroid use
Oral thrush
Complications of bronchiectiasis
Haemoptysis
Pulmonary HTN
Lobar collapse (mucus balls)
Type 2 respiratory failure (may see asterixis)
Causes of bronchiectasis
Idiopathic Post TB Immunodeficiency PCD Tumour
Ix for bronchiectasis
Spirometry
Sputum cultures
Aspergillis markers
Mx of bronchiectasis
MDT Physiotherapy; airway clearnace, drainage Smoking cessation Prophylactic antibiotics Correct underlying causes
Complications of lung cancer
Horner’s
SVCO
Endocrine issues (from SIADH, ACTH, ACE)
Lung cancer Ix
PET-CT
Volumetric CT
Biopsy
Bronchoscopy
Mx of non-small cell lung cancer
Surgical resection (lobectomy)
Radiotherapy
Chemotherapy
Palliative
Mx of small cell cancer
Chemo +/ radiation
Cause of reduced cricosternal distance
COPD (because hyperexpanded lungs!)
What may you see on COPD FBC
Polycythaemia (trying to increase O2)
What scoring system can you use for COPD dyspnoea?
mMRC grading
4 = too breathless to get dressed
Mx of COPD
Bronchodilators (SABA/LABA) ICS (low dose) Pulmonary rehabilitation Dietician Smoking cessation
Classic inhaler for COPD and what does it have in it
Symbicort
Budenoside
Eformoterol
Features of pleural effusion
Stony dull
Reduced expansion unilaterally
Reduced air entry
Decreased vocal fremitus
Causes of pleural effusion
Transudate = liver disease, cardiac, hypothyroidism Exudative = malignancy, infective
Ix for pleural effusion
X-ray
Other imaging if necessary
Aspiration (diagnostic/therapeutic) = chest drain
Treat underlying cause
Features of interstitial lung disease
Clubbing
Rheumatoid hands? (associated disease)
Fine inspiratory crackles
Erythema nodosum (sarcoid)
Causes of interstitial lung disease
Idiopathic Systemic sclerosis Rheumatoid arthritis Methotrexate Amiodarone Sarcoidosis Bird-fanciers lung
Ix for ILD
Anti-CCP
Serum ACE levels
DH
SH (birds)
CXR
ABG
Mx of ILD
MDT approach
Pulmonary rehabilitation
Drug treatment for idiopathic pulmonary fibrosis
Ninetabinib
Signs of a pneumonectomy
Reduced expansion and no breath sounds on one side
Rheumatoid arthritis, breathless and peripheral oedema =>
Interstitial lung disease causing RHF causing peripheral oedema
FVC < FEV1 implies …
Restrictive lung disease
Soap bubble osteolysis =>
Fibrous dysplasia
Normal tissue is being replaced with fibrous tissue
Pain in ribs and hips
Associated with McCune albright syndrome (cafe au lait and hyperthyroidism)
Pain in shin of young child
Onion skinning of the periosteum seen on X-ray
What Chromosomal abnormality is often seen and what is the diagnosis?
11;22
Ewing’s sarcoma
15yo with painful swelling in knee
Lytic lesion on X-ray with a raised periosteum (Codmans triangle)
Dx
Osteosarcoma
50yo with urinary frequency
Pelvic X-ray shows fluffy calcification
Chondrosarcoma
Cartilage cancer of the bone
Which time of bone disease is cartilage forming in bone
Enchondroma
Benign
