Flashcards in Respiratory Deck (124)
Which serum electrolyte is likely to be raised in a patient with active TB?
Increased serum calcium due to activated macrophages which produce calcitriol (active form of vit D)
What are causes of shortness of breath?
What is an expiratory wheeze?
Musical / whistling sound
Narrowing / obstruction of small airways
Causes: Inflammation - asthma, COPD, allergic reaction
Secretions blocking lumen - infection
Physical blockage - tumour, foreign body
What is stridor?
High-pitched, harsh, vibrating noise
Turbulent airflow in large airways
What are your differential diagnoses for SOB?
Bronchial Inflammation: Infection / Pneumonia, Asthma, COPD, Bronchiectasis
Fluid in Airways: Pulmonary Oedema (heart failure)
Non-inflammatory Narrowing / Obstruction: Lung cancer, Pulmonary embolism, Inhaled foreign body
What are common pathogens which cause pneumonia?
What are symptoms of pneumonia?
Dyspnoea (acute / sub-acute)
What are pathological features of asthma?
Reversible airway obstruction
Bronchial muscle contraction
Mucosal swelling / inflammation
Increased mucus production
What are symptoms and features that would make you suspect asthma?
Usually episodic, diurnal variation
Non-productive nocturnal cough
What are features of COPD?
Progressive disorder of airway obstruction
Little / no reversibility or diurnal variation
Chronic bronchitis - clinical
Emphysema - histological
SMOKERS, Chronic cough, dyspnoea, wheeze and sputum, Age >35yrs
What is bronchiectasis?
Chronic infection of airways
Destroys muscular tissue so held dilated by lung parenchyma
Filled with purulent sputum
What are some causes of bronchiectasis?
Congenital: cystic fibrosis
Post-infection: measles, pertussis, TB
Airway obstruction: tumours
How can heart failure be a cause of SOB?
Impaired left ventricular function –blood backs up in pulmonary
circulation so Pulmonary Oedema
What are causes of heart failure?
Ischaemic heart disease
What are non cardiac causes of fluid overload which could result in pulmonary oedema?
Excessive IV fluids
What questions in the history would you want to ask about someone's cough?
When did it first start?
Is it present all the time?
Does it wake you up at night?
Worse at any time of day?
Does anything trigger it?
Work? Exercise? Medication?
Do you cough anything up? What colour? Any blood?
What questions in the history would you want to ask about someone's SOB?
When did it first start? How quickly has it come on?
Is it present all the time? Is it only present when you exert yourself?
Before this started, how far could you walk on flat before getting breathless? And now?
Is it worse in certain positions? How many pillows do you use?
Does anything else trigger it?
What associated symptoms would you want to ask about in a patient who you suspect has asthma?
What associated symptoms would you want to ask about in a patient who you suspect has bronchiectasis?
Progressive illness (or acute-on-chronic)
What past medical history questions are important in a patient who you suspect has bronchiectasis?
Chest infections? Especially as a child
What past medical history questions are important in a patient you suspect has heart failure?
Which drugs might be particularly relevant to ask about in a patient presenting with SOB?
On home nebulisers or oxygen?
Multiple allergies / atopy?
What social history questions are important in a patient presenting with SOB?
Change of job?
SMOKING!! Pack years?
Time spent living abroad?
What family history questions are important in a patient presenting with SOB?
Bronchitis? Emphysema? Especially at an early age
What end of the bed signs might you look for in a patient with SOB?
Accessory muscle use
Inhalers / nebulisers
What examination findings might you see in a patient with SOB?
CO2 retention flap
What are respiratory causes for clubbing?
A – abscess
B – bronchiectasis (incl CF)
C – cancer (bronchial + mesothelioma)
D – decreased oxygen (hypoxia)
E – empyema
F – fibrosing alveolitis
What is cor pulmonale? What are symptoms of this?
Right sided heart failure due to long term pulmonary hypertension or chronic low oxygen conditions - COPD, CF
Symptoms: SOB during activity, tachycardia, palpitations, chest pain, syncope, cyanosis, raised JVP
What are the descriptors for abnormal percussion of a lung?
Pleural Effusion: stony dull
Pneumothorax: hyper resonant