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PACES > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What do thoracotomy scars indicate

A

Pneumectomy for lobectomy for lung cancer or in older patients TB
Small right sided thoracotomy scars- minimally invasive mitral valve surgery

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2
Q

What are 3 thoracotomy scars

A

Posterolateral- most common
Anterolateral
Axillary

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3
Q

What looking for in hands resp exam

A

Clubbing- fibrosis, TB, bronchiectasis, cancer, mesothelioma, asbestos
Thenar wasting
Yellow nails
Sclerodactyly
Calcinosis
RA hand signs
Tar staining
Cyanosis
Tremor

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4
Q

Pulses to feel for in resp exam

A

Bounding- CO2 retention
Pulsus paradoxus- COPD and asthma exacerbation

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5
Q

Causes of bradypnoea

A

OSA
CO poisoning
Opioids

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6
Q

What looking for in face resp exam

A

Ptosis- horners syndrome
Conjunctival pallor
Candida from steroid inhalers
Central cyanosis

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7
Q

Normal cricothyroid distance and what causes

A

Under 5cm
Reduced if hyperexapanded lung

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8
Q

What looking for in inspection of chest

A

Scars
Chest deformities
- kyphoscoliosis can cause restrictive lung pattern
- pectus excavatum (scoliosis and marfans)
- pectus carinatum (bulging sternum from childhood resp disease)
- barrel chest from increase in anterior-posterior diameter ( COPD, CF)

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9
Q

What scars looking for in resp exam

A

Chest drain- 1 scar in axilla
Midline sternotomy- CABG, lung transplant
Posterolateral scar- transplant, pneumectomy, lobectomy
2 small scars, 1 in axilla and 1 posterolaterally indicates video assisted thoracoscopy

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10
Q

Indications for VATS scars

A

Effusion
Pneumothorax
Biopsy for cancer or mesothelioma
Pleuroidesis

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11
Q

Bronchial breath sounds cause

A

Pneumonia

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12
Q

Reduced breath sounds causes

A

Pleural effusion
Pneumothorax

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13
Q

Coarse crackles causes

A

Oedema
Pneumonia
Bronchiectasis

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14
Q

Increased vocal fremitus causes

A

Pneumonia
Lobar collapse

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15
Q

CREST management

A

Mainly focussing on symptom control
Raynauds- CCB, conservative, prostacyclin
Oesophageal dysmobility- metoclopramide, PPI if associated GORD
Renal disease- ACEi
Immunosuppressive therapy with steroids, methotrexate, cyclophosphamide or mycophenolate particularly helpful for interstitial lung diseases

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16
Q

Investigating CREST

A

Bloods- auto-antibodies anti-centromere for limited, anti-topoisomerase for diffuse
HRCT
Skin biopsy may show collagen deposition and fibrosis

17
Q

COPD management

A

Conservative- stop smoking, pulmonary rehab, vaccinations- influenza and pneumococcal
Medical- 1st SABA or SAMA then depends on steroid responsive, if so ICS and LABA, if not LABA and LAMA. 3rd line is all options. If inhalers not tolerated or working then oral theophylline. If frequent exacerbations- prophylactic azithromycin. If meet certain criteria based off ABGs then LTOT
Surgical- lung reduction

18
Q

Steroid responsive features

A

Atopy/asthma
Eosinophilia
Diurnal variation of over 20%
FEV1 variation of over 400ml over time

19
Q

How can RA cause fibrosis

A

Interstitial lung
Methotrexate

20
Q

Causes of lung fibrosis

A

Upper zones
- berryliosis
- radiation
- EAA
- ank spond
- sarcoidosis
- TB
Lower zone
- ank spond
- RA, SLE
- idiopathic
- drugs- cyclophosphamide, bleomycin, nitrofurantoin, amiodarone

21
Q

How investigate pulmonary fibrosis

A

Simple imaging- CXR
HRCT diagnostic
BAL- help identify if inflammatory component and steroid responsive

22
Q

Management of pulmonary fibrosis

A

Conservative- stop smoking, if drug cause, occupational or organic precipitant then avoid exposure
Manage cause- immunosuppressant for sarcoid, connective tissue diseases, if BAL reveals lymphocytosis then steroids
Anti-fibrotic agents- pirfenidone, nintenanib
LTOT
Lung transplant may be required

23
Q

Indications for thoracotomy

A

Pneumectomy
Lobectomy- cancer, TB
Oesophageal surgery

24
Q

Advantage of axillary thoracotomy

A

Muscle sparing

25
Q

Clamshell scar

A

Double lung transplant

PACES (11 decks)

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