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1
Q

Atelectasis Causes

A

Post-Surgery
TB
Blockage of a bronchus (tumour - most common is non-small cell lung Ca)

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2
Q

Hilar-Mediastinal Lymphadenopathy differentials

A

Tumour - Lung Ca, Lymphoma, Mets

Sarcoidosis

Active TB

Scleroderma

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3
Q

Subcutaneous Emphysema Causes

A

Trauma
Infectious
Spontaneous

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4
Q

Subcutaneous Emphysema - Trauma causes

A 
Broken rib from blunt trauma
Chest drain 
Dental extraction 
Endotracheal tube
Postive pressure ventilation (BiPAP)

Valsava
Boeerhave Syndrome (spontaneous oesophageal perforation)
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5
Q

Subcutaneous Emphysema -

Infectious causes

A

Anaerobic bacteria e.g. Clostridium

Associated with cellulitis, fasciitis

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6
Q

Subcutaneous Emphysema -

Spontaneous presentation

A

Young men

Benign, resolves on its own

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7
Q

Booerhaave Syndrome

A

Rupture of oesophagus due to vomiting.

  1. Vomiting
  2. Chest pain
  3. Subcutaneous emphysema
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8
Q

Ground Glass Shadowing

A

Hazy GREY diffuse opacification (do not obscure airways/blood vessels)

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9
Q

Ground Glass Shadowing Differential Dx

A

COVID 19

Atypical pneumonias 
Pulmonary aspiration 
Lung cancer 
Inflammatory lung disease
Wegener's
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10
Q

Consolidation

A

White out

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11
Q

COVID 19 CXR

A

CT is needed to confirm dx.

Bilateral peripheral ground glass shadowing which progresses to consolidation.

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12
Q

COVID 19 CT

A

Ground Glass Shadowing
Consolidation
Crazy Paving Pattern

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13
Q

Non-Cardiogenic Pulmonary Oedema - Most common cause

A

ARDs

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14
Q

ARDs

A

Non-cardiogenic pulmonary oedema caused by:

Underlying sepsis
Pneumonia (COVID)
Gastric aspiration
Blood transfusion
Pancreatitis
Trauma 
Drug overdose
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15
Q

Non-Cardiogenic Pulmonary Oedema - other causes

A

High Altitude Pulmonary Oedema

Opioid Overdose

Salicylate Toxicity

Neurogenic Pulmonary Oedema

PE

Reexpansion Pulmonary Oedema

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16
Q

Lobar Pneumonia CXR Findings

A

Lobar consolidation with bronchograms

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17
Q

Lobar Pneumonia - Causative Organism

A

Community Acquired infection by Streptococcus Pneumonia (Gram +ve)

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18
Q

Lobar Pneumonia - Other Causative Organism

A

Legionalla Pneumonia

Dx supported by non-respiratory signs:

  • Diarrhoea
  • Raised LFTs
  • Neurological dysfunction
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19
Q

Bronchopneumonia

A

Infection which originates in the airways and spreads to air spaces

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20
Q

Bronchopneumonia CXR Findings

A

Patchy consolidation

No bronchograms

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21
Q

Bronchopneumonia - Causative Organisms (HAP)

A 
E. Coli 
Pseudomonas Aeruginosa (Gram -ve)
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22
Q

Bronchopneumonia - Causative Organism (CAP)

A

Staphylococcus Aureus (Gram +ve)

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23
Q

Nodular Opacification

A

Seen in

Varicella Zoster
Mycoplasma Pneumoniae
TB (in upper zones)

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24
Q

Interstitial Consolidation

A

Seen in immunocompromised patients

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25
Pneumonia Complications
``` Pleural Effusion (Parapneumonic) Empyema Abscess Formation Pneumatocele Pneumothorax ```
26
Abscess Formation Organisms
TB S. Aureus Klebsiella Penumoniae
27
Limited clinical improvement in pneumonia patient
?Cancer ?Alternative Organisms ?Non-infectious causes
28
Pneumatocele
Air filled cyst, associated with Staph A
29
Pneumatocele v Abscess
Abscess has air:fluid level, pneumatocele doesn't
30
Pleural Effusion = Exudative
Fluid leaks OUT of the lungs due to inflammation/cancer
31
Exudative Pleural Effusion causes
Lung Cancer Rheumatoid Arthritis Pneumonia TB
32
Pleural Effusion = Transudative
Fluid moves ACROSS the membrane
33
Transudative Pleural Effusion causes
``` Hypoalbuminaemia Hypothyroidism Renal failure Heart Failure Meig's Syndrome ```
34
Meig's Syndrome
Right Pleural Effusion Ovarian Ca Ascites
35
Parapneumonic Effusion
Pleural Effusion due to pneumonia (most common cause of exudative effusion) pH is normal
36
Empyema
Parapneumonic effusion progresses and enough neutrophils gather to form frank pus, Low pH, low glucose, low neutrophils High LDH
37
Asthma Chronic Management
1. SABA 2. SABA + Low ICS 3. SABA + Low ICS + LTRA 4. SABA + Low ICS + LABA 5. SABA + Low MART (Low ICS + Fast LABA) 6a) SABA + Mod MART (Mod ICS + Fast LABA) 6b) SABA + Mod ICS + LABA Reductions 25-50% every 3 months Uncontrolled = 3 episodes/week or nightwaking
38
Acute Asthma Management
OSHITME O2 15L via Non-Rebreather Salbutamol 2.5-5mg NEB every 10 minutes (O2 driven) Hydrocortisone IV 100mg every 6 hours OR 40-50mg Prednisolone OD 5 days Ipatropium Bromide 500mcg every 6 hours NEB Theophylline (Aminophylline) Magnesium Sulphate Escalate
39
Chronic COPD Management
1. SABA or SAMA 2. Asthmatic Features - LABA + ICS No Asthmatic Features - LABA + LAMA 3. LABA + LAMA + ICS
40
COPD Grading
80, 50, 30 FEV1
41
COPD Organisms
HSM Haemophilus Influenza Streptococcus Pneumoniae Moraxella Catarrhlis
42
Acute COPD Management
OSIP O2 24-48% Venturi Nebulised Salbutamol Nebulised Ipatropium Bromide 30-40mg Prednisolone
43
Asthma Drugs
SABA = Salbutamol, Terbutaline LABA = Salmeterol Fast Acting LABA = Formetorol ICS = Budenosine, Beclomethasone (<400mcg, 400-800mcg, >800mcg) LTRA = Montelukast Anti-muscarinic Antagonist = Ipatropium Bromide
44
PEFR Procedure
Sit/stand Best of three tries Baseline PEFR needed
45
Spirometry Procedure
Sit Do three times, take the best two (within 100ml of eachother) Reversibility: Salbutamol with spacer 4 x 100mcg OR Salbutamol 2.5-5mg with nebuliser
46
CLUBBING Causes
``` Cyanotic Heart Disease Lung Disease (ABCDEF) UC + Chron's Biliary Cirrhosis - PBC Birth defect Infective Endocarditis Neoplasm GI malabsorption - Coeliac ```
47
CLUBBING - Lung Disease (ABCDEF)
``` Abscess Bronchiecstasis Cystic Fibrosis Don't say COPD Empyema Fibrosis ```
48
Lung Disease - Obstructive
Asthma COPD Bronchiectasis
49
Lung Disease - Restrictive
ILD (CHARTS, DIAL) Scoliosis NMD Obesity
50
Interstitial Lung Disease - CHARTs, DIAL
CHARTS - Upper Zone ``` Coal Miners Pneumoconiosis Hypersensitivity (EAA) Ankylosing Spondylitis Radiation TB Sarcoidosis/Silicosis ``` ``` DIAL - Lower Zone Drugs (Pulmonary Fibrosis) Idiopathic Pulmonary Fibrosis Asbestosis Lupus ```
51
Bronchiectasis
Chronic inflammation causes irreversible airway dilation with mucus plugs
52
Bronchiectasis Causes
Can be due to: Chronic infection Chronic Inflammation/destruction Impaired mucociliary clearance
53
Bronchiectasis Causes - Infection
Immunodeficient state (HIV) allowing recurrent infection Pertussis, measles TB Pneumonia Allergic Bronchopulmonary Aspergillosis (ABPA) Granulomatous disease
54
Bronchiectasis Causes - Impaired Mucociliary Clearance
Cystic Fibrosis Primary Ciliary Dyskinesia (Kartagener's Syndrome) Muscular Dystrophy Lung Cancer
55
Kartagener's Syndrome
Situs Invernus Chronic Sinusitis Bronchiectasis Sub fertility
56
Bronchiectasis Causes - Chronic inflammation/destruction
Chron's UC SLE Marfans
57
Bronchiectasis Clinical Presentation
Chronic daily cough with sputum with episodic exacerbations Haemoptysis Fatigue due to low FEV1 (later in disease) Cyanosis (in children)
58
Bronchiectasis Episodic Exacerbations
Increased cough Increased sputum SOB Fever, chest pain
59
Bronchiectasis Physical Examination
Crackles Wheeze Clubbing (<2%)
60
Bronchiectasis CXR
Tram track sign due to thickened airway walls Cystic dilations
61
Bronchiectasis CT
Signet Ring sign | Tram Track sign
62
Bronchiectasis Bloods
FBC - to see if current infection Sputum culture IG Screen - immunodeficiency is a cause CFTR Mutation
63
Bronchiectasis Treatment
``` Physical training Postural drainage Abx for exacerbations/maintenance Bronchodilators Immunisation (pneumococcal) Surgery ```
64
Bronchiectasis - Organisms isolated from Patients
Haemophilus influenzae (most common) Pseudomonas aeruginosa Klebsiella spp. Streptococcus pneumoniae
65
Allergic bronchopulmonary aspergillosis
History of bronchiectasis and eosinophilia Manage with steroids

Respiratory (9 decks)

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