Uni finals course Flashcards by Joseph Rose

Aspects of respiratory history

PC
HPC
PMH
DH
SH
FH
Smoking and alcohol

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What might anaemia indicate?

GI bleed 
Steroids 
B12 deficiency
Alcohol abuse 
Chronic disease
Iron deficiency

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What does asterixis indicate

Decompensated T2RF also decompensated liver disease

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Causes of clubbing

CLUBBING

Cystic fibrosis
Lung cancer 
UC
Bronchiectasis 
idiopathic pulmoary fibrosis
Neurogenic tumours
Gastrointestinal distrubance

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What is respiratory splinting?

Reduced inspiratory effort as a result of pleuritic chest pain
They may be leaning forward to avoid the irritation

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When is a thoracotomy done and where is the scar

To remove lung cancer

Around the scapula on the back/side!

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Chest deformities

Kyphoscoliosis
Pectus excavatum
Pectus carinatum

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Type of NIV for COPD

BiPAP to help remove CO2!

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NIV for sleep apnoea

CPAP to keep alveoli open!

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Whats important to check when prescribing an inhaler?

Check technique

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What colour is a SABA?

Blue

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Reduced resonance on percussion could indicate…

Pus (empyema)

Consolidation

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Characteristic bronchial breathing

Inspiration and expiration equally loud and equal in duration.
Normally, expiration should be shorter than inpiration.
Sounds like they are scuba diving

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What does bronchial breathing (peripherally, because centrally is reasonably normal) indicate?

Pneumonia
Pleural effusions
Atelecatasis

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Characteristic wheeze

You’ve had it yourself after a big run
Whisteling as you breath in
Kind of musical

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What can a wheeze indicate?

Obstruction
Asthma
May be mucus, ask them to cough!

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Characteristics of fine crackles

Like breathing into a radio

Or wood burning in a fireplace

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Early inspiratory crackles indicate

Chronic bronchitis

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Late inspiratory crackles indicate

like wood burning on a fireplace

Pneumonia
Atelectasis
Chronic heart failure

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Cause of rhonchi sounds on auscultation

Widened airways (e.g. emphysema) with thick secretions
Turbulent flow

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Coarse crackles indicate

Mucus

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Cause of increased vocal resonance

Pneumothorax

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Causes of reduced vocal resonance

Consolidation
Effusion
Collapse

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Mediastinal shift can indicate

Pneumothorax

Lobar collapse

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Signs of RHF

``` Peripheral oedema Syncope Pulmonary oedema Fatigue Exertional dyspnoea Dizziness ```

Reduced air entry Stony dull percussion Reduced vocal fremitus

Effusion

Bronchial breathing/crackles, dull percussion, reduced VF

Consolidation

Fine crackles, clubeed

Fibrosis

Coarse crackles, clubbed, purulent sputum

Bronchiectasis

When would you use a high resolution CT?

Bronchiectasis | Idiopathic pulmonary fibrosis

Causes of raised calcium

Parathyroid cancer Vitamin D overdose Primary hyperparathyoidism Secondary hyperparathyoidism

Ix for pulmonary HTN

Echo (looking for reduced ejection fraction from RHS) | Spirometry (thinking about COPD)

FEV1/FVC <70% indicates

Obstruction

FVC <80% predicted indicates

Restriction

Causes of restrictive lung disease

Fibrosis | Interstitial lung disease

Causes of obstructive lung disease (FEV1 reduced)

COPD Asthma Bronchiectasis

What do you want to measure in GBS and myasthenia gravis (respiratory wise)

FVC

What is volumetric CT used for?

Cancer staging | Lymph nodes

How much radiation is CT

2-4 years background radiation!

What do you want to check in asthma

Peak flow

Complications of oral steroid use

Oral thrush

Complications of bronchiectiasis

Haemoptysis Pulmonary HTN Lobar collapse (mucus balls) Type 2 respiratory failure (may see asterixis)

Causes of bronchiectasis

``` Idiopathic Post TB Immunodeficiency PCD Tumour ```

Ix for bronchiectasis

Spirometry Sputum cultures Aspergillis markers

Mx of bronchiectasis

``` MDT Physiotherapy; airway clearnace, drainage Smoking cessation Prophylactic antibiotics Correct underlying causes ```

Complications of lung cancer

Horner's SVCO Endocrine issues (from SIADH, ACTH, ACE)

Lung cancer Ix

PET-CT Volumetric CT Biopsy Bronchoscopy

Mx of non-small cell lung cancer

Surgical resection (lobectomy) Radiotherapy Chemotherapy Palliative

Mx of small cell cancer

Chemo +/ radiation

Cause of reduced cricosternal distance

COPD (because hyperexpanded lungs!)

What may you see on COPD FBC

Polycythaemia (trying to increase O2)

What scoring system can you use for COPD dyspnoea?

mMRC grading | 4 = too breathless to get dressed

Mx of COPD

``` Bronchodilators (SABA/LABA) ICS (low dose) Pulmonary rehabilitation Dietician Smoking cessation ```

Classic inhaler for COPD and what does it have in it

Symbicort Budenoside Eformoterol

Features of pleural effusion

Stony dull Reduced expansion unilaterally Reduced air entry Decreased vocal fremitus

Causes of pleural effusion

``` Transudate = liver disease, cardiac, hypothyroidism Exudative = malignancy, infective ```

Ix for pleural effusion

X-ray Other imaging if necessary Aspiration (diagnostic/therapeutic) = chest drain Treat underlying cause

Features of interstitial lung disease

Clubbing Rheumatoid hands? (associated disease) Fine inspiratory crackles Erythema nodosum (sarcoid)

Causes of interstitial lung disease

``` Idiopathic Systemic sclerosis Rheumatoid arthritis Methotrexate Amiodarone Sarcoidosis Bird-fanciers lung ```

Ix for ILD

Anti-CCP Serum ACE levels DH SH (birds) CXR ABG

Mx of ILD

MDT approach | Pulmonary rehabilitation

Drug treatment for idiopathic pulmonary fibrosis

Ninetabinib

Signs of a pneumonectomy

Reduced expansion and no breath sounds on one side

Rheumatoid arthritis, breathless and peripheral oedema =>

Interstitial lung disease causing RHF causing peripheral oedema

FVC < FEV1 implies ...

Restrictive lung disease

Soap bubble osteolysis =>

Fibrous dysplasia Normal tissue is being replaced with fibrous tissue Pain in ribs and hips Associated with McCune albright syndrome (cafe au lait and hyperthyroidism)

Pain in shin of young child Onion skinning of the periosteum seen on X-ray What Chromosomal abnormality is often seen and what is the diagnosis?

11;22 | Ewing’s sarcoma

15yo with painful swelling in knee Lytic lesion on X-ray with a raised periosteum (Codmans triangle) Dx

Osteosarcoma

50yo with urinary frequency | Pelvic X-ray shows fluffy calcification

Chondrosarcoma | Cartilage cancer of the bone

Which time of bone disease is cartilage forming in bone

Enchondroma | Benign

Uni finals course Flashcards

(70 cards)