1. Loss of voice/laryngitis 2. Barking cough 3. Strider

Respiratory Flashcards by Ang Qing Kang Dominic

Signs or cardiomegaly/cardiac tamponade

“Pericardial silhouette enlarged” if more than half of lung width

Better than cardiomegaly cos it may be enlarged due to pericardial effusion/tamponade

How well did you know this?

Not at all

Perfectly

Types of pneumothorax

Primary spontaneous pneumothorax/PSP:no underlying lung issues

Vs secondary spontaneous pneumothorax(secondary to lung disease eg asthma,COPD)

Traumatic
-iatrogenic(eg from ventilator,central line too far from SCA,biopsy,thorascopy)
-non iatrogenic(eg from stab wounds)

How well did you know this?

Not at all

Perfectly

Objective ways to identify a pneumothorax on XR

ACCP:distance from apex to cupola >3cm(threshold higher cos of gravity)A for Apex

BTS:interpleural distance at level of hilum> 2cm

How well did you know this?

Not at all

Perfectly

How does the lung USUALLY collapse in a pneumothorax

The lung usually collapses towards the hilum:unless scarring causee it to collapse un-uniformly(eg scarring in the upper lobe caused by chronic smoking causes it not to collapse towards hilum)

How well did you know this?

Not at all

Perfectly

Risk factors for a nodule being benign vs malignant

-Size >20mm 50% chance of malignancy

-Borders(spiculations): poorly circumscribed borders more likely to be malignant

-Growth rate(too fast or too slow unlikely)except Small cell carcinoma and lymphoma

-attenuation:solid vs non solid(solid more common but non solid more likely to be malignant)

-calcifications:eccentric most dangerous(tumour grows out from the calcification) vs popcorn central etc

-Location:apex tends to collect more smoke in lung,higher chance of malignant lesions

How well did you know this?

Not at all

Perfectly

Signs of Pulmonary Embolism on CXR

-Hamptons Hump(wedge shaped infarct)

-Westermark sign(oligaemia:a clarified area distal to a large vessel occluded by a pulmonary embolism,caused by reflex vasoconstriction and impaired vascular is still bc obstruction
-Pallas’s sign:enlarged descending pulmonary artery

-Fleischner sign: Dilated central pulmonary artery

-Meniscus sign: blunting of costophrenic angle

How well did you know this?

Not at all

Perfectly

Criteria for differentiating transudative and exudative pleural effusion

Lights criteria

Exudative if:
Effusion protein/Serum protein >0.5
OR Effusion LDH/Serum LDH >0.6
OR Effusion LDH > 2/3 laboratory upper limit of serum LDH reference range

How well did you know this?

Not at all

Perfectly

Causes of transudative effusion

1)Congestive Heart Failure
2)Nephrotic syndrome
3)Chronic Liver disease

How well did you know this?

Not at all

Perfectly

Causes of exudative effusion

1)Infections
2)Neoplasm

Increased inflammation causes more protein to leak out of pulmonary vessels

How well did you know this?

Not at all

Perfectly

Types of interstitial lung disease(restrictive)

1.Idiopathic Pulmonary Fibrosis:diagnosis of exclusion
2.Hypersensitivity pneumonitis(chronic)
3.Pneunoconiosis
4.Sarcoidosis
5.Asbestosis:caused by asbestos fibres
6.SLE
7. Rheumatoid arthritis associated ILD
8.Silicosis
9. Drug fibrosis:AMIODARONE BROMOCRIPTINE CYCLOPHOSPHAMIDE METHOTREXATE NITROFURANTOIN

How well did you know this?

Not at all

Perfectly

4 Ts of anterior mediastinal masses

Thyroid
Thymus
Teratoma
Terrible lymphoma

How well did you know this?

Not at all

Perfectly

Medial mediastinal masses

Esophageal
Bronchial cysts
Hernia(hiatus?)
Lymph nodes

How well did you know this?

Not at all

Perfectly

Posterior Mediastinal masses

Aortic Aneurysm
Germ Cell Tumors

How well did you know this?

Not at all

Perfectly

Which main bronchus do foreign bodies usually enter and why

Right main bronchus as it is oriented more vertically, has a larger diameter and is shorter

How well did you know this?

Not at all

Perfectly

Impt qns to ask in any suspected asthma case

Interval Symptoms, personal and family history of Atopy, past HD/ICU admissions or invasive intubation

How well did you know this?

Not at all

Perfectly

Complications of pneumonia

Parapneumonic effusion
Sepsis
Spread to other sites eg meningitis,osteomyelitis
Hemolytic Uremic Syndrome with strep pneumo
Necrotising pneumonia

Long term:
Lung fibrosis
Bronchiectasis

How well did you know this?

Not at all

Perfectly

Pathogens in atypical pneumonia

Mycoplasma and chlamydia pneumoniae

How well did you know this?

Not at all

Perfectly

Causes s of bronchiectasis

Focal
1.Post infectious
2. Mechanical
3. Aspiration
4. Tumor
5. Lymph nodes

Systemic
Immunodeficiency acquired and congenital
Cystic fibrosis
Ciliary abnormalities eg kartegener
Congenital lobar emphysema
Idiopathic

How well did you know this?

Not at all

Perfectly

Coryzal symptoms

Fever, rhinorrhea, cough, sore throat

How well did you know this?

Not at all

Perfectly

Croup triad

Loss of voice/laryngitis
Barking cough
Strider

How well did you know this?

Not at all

Perfectly

Ideal method for administering high flow O2 in acute respiratory distress

Study These Flashcards

Non rebreather mask> venturi and nasal prongs

Causes of ILD

Study These Flashcards

Idiopathic
Rheumatological
Drug related
Pneumoconiosis

Function of incentive spirometer

Study These Flashcards

Patient to breathe in as deeply and as slowly aa possible-> helps expand the lungs and prevent atelactasis

How to ddx between pleural effusion and fibrothorax

Study These Flashcards

Tracheal deviation in pleural effusion?

Causes of upper lobe lung fibrosis

STAR Sarcoidosis TB ABPA Radiation

Causes of lower lobe lung fibrosis

RADIO Rheum(RA, scleroderma, Dermatomyositis, systemic sclerosis) Asbestosis Drugs Idiopathic Others

Treatment of interstitial lung disease

Non pharm -pt education -smoking cessation - vaccinations Pharm -Fibrinolytics eg perfenidone, nintedanib Non pharm -Lung transplant

Key invx in case of interstitial lung disease

1. CXR 2. HRCT 3. ABG 4. Lung function test

3 common pathogens causing COPD exacerbation

1. Strep pneumo 2. HIB 3. Moraxella Catarrhalis

eosinophilia count cutoff for starting ICS in COPD exacerbation

>300

GOLD grade vs ABE

Grade is for prognosis ABE is for management

2 causes of white out lung

Pleural effusion(trachea pushed contralateral) and lung collapse(trachea pushed ipsilateral)

Paraneoplastic syndromes a/w small cell lung ca

SIADH, Lambert Eaton, Cushings

Common sites of lung mets

Liver, adrenals, bone and brain

Malignancy most associated with asbestosis

Malignant Mesothelioma

Things to send for pleural fluid studies

Cytology - cancer cells Cell counts - neutrophilic or lymphocytic ADA - local context can be TB or some tumours Culture & sensitivity Protein LDH pH, glucose pH <7.2, glucose > 2.2 means complicated parapneumonic effusion → need chest tube insertion

Ddx of massive pleural effusion

1) Malignancy 2) Parapneumonic 3) Tuberculous 4) Transudate eg hepatoc hydrothorax

Definitive treatment of massive hemoptysis

Bronchial Artery Embolization

cutoff for complicated pleural effusion

pH <7.2

n invx for suspected pulmonary embolism depending on suspicion

CTPA(high sus) D Dimer(low sus) US Lower Limbs

Diagnosis of pulmonary arterial hypertension(PAH)

Via Swan Ganz catheter >25mm at rest >35mm during exercise

mx of asthma exacerbation

nebs in 1:2:1 ratio(salb NS ipratropium) PO or IV corticosteroids Magnesium sulphate

Common cause of hypoK in asthma patients

Iatrogenic due to beta agonist

pulmonary hypertension treatment

ambrisentan and sildenafil Oxygen therapy

Rheumatological causes of ILD at bases

RA, Systemic sclerosis, dermatomyositis

Causes of upper Lobe ILD: STAR

Sarcoidosis Tuberculosis ABPA/Ankylosing Spondylitis Radiation

Causes of lower lobe ILD: RAID

Rheumatological( RA, Scleroderma, Dermatomyositis) Asbestosis Idiopathic Pulmonary Fibrosis Drugs( Methotrexate, Cyclophosphamide, Azathioprine)

Respiratory Flashcards

(51 cards)