What is the cut off for deoxygenated haemoglobin for cyanosis to be present?
Describe pleural pain
Worse on inspiration and coughing
Radiates from front to back or up to shoulder (if pathology is at the diaphragm)
What are some DDx of SOB
Pneumonia with significant effusion
What are the three physiological mechanisms for the sensation of dyspnoea?
Increased drive to breath
Increased load (work of breathing)
Decrease muscle strength
A force expiratory time over what time is significant?
What is ARDS? What does it commonly follow?
Acute respiratory distress syndrome
What are some clinical signs of COPD?
Signs of pulmonary HTN
Prolonged force expiratory time
A decreased percussion note can reflect what?
Rhonchi or wheeze implies the pathology is in which section of the lung?
What is bronchiectasis?
Permenant widening of bronchi which are flabby and scarred
How do you tell the difference between obstructive and restrictive lung disease from spirometry?
The forced expiratory ratio (FEV1/FEC) while be reduced in obstructive lung disease
The FER will be maintained in restrictive lung disease but the FVC will be reduced
How do you calculate the A-a gradient?
A-a gradient = (150 - (1.25 x PaCO2)) - PaO2
What are two possible prequels to empyema?
Direct spread from the diaphragm
An increased percussion note generally reflects what?
When is stridor usually heard?
What is a normal A-a gradient?
What is Hoover's sign?
Lower intercostal muscle retract due to flattening of diaphragm caused by lung hyperinflation
How can you tell the difference between the two types of crepitations?
Bubbling through fluid will be heard througout inspiration and expiration
The popping open of alveoli will only be heard at late inspiration
How can you differentiate pleural effusion and consolidation on clinical exam?
Both will be dull to percussion but pleural effusion will have reduced breath sounds while consolidation will have increased
What is ABPA?
Allergic Bronchopulmonary Aspillergosis
What are some signs of pulmonary hypertension?
RV heave and palpable S2
4th Heart slow
Pulmonary flow murmur
What are the three main respiratory causes of clubbing?
Suppurative lung disease (eg bronchiectasis, TB)
Chronic lung fibrosis - idiopathic and asbestosis but not sarcoidosis
What is the difference between cyanosis and pallor?
Cyanosis occurs when there is significant amounts of deoxygenated haemoglobin
Pallor occurs when there is reduced Hb concentration in blood (anaemia)
Does COPD classically cause crepitations?
When measuring chest expansion with a tape measure, what is the normal measurement for expansion and what is reduced?
~4cm is normal
Outline a systematic approach to the causes of dyspnoea?
Why might you get a loud P2 in PCP infection?
Widespread pulmonary infection > V-Q mismatch > A-V shunting > Pulmonary HTN (reduced capillary bed) > Loud P2