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Respiratory Medicine > Day 01 (480-489) > Flashcards

Day 01 (480-489) Flashcards

1
Q

Cause of Blood-stained sputum are

A
  1. Cancer
  2. Tuberculosis
  3. Bronchiectasis
  4. Pulmonary embolism
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2
Q

Cause of Serous/frothy/pink sputum

A

Pulmonary oedema

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3
Q

Feature of COPD except

a) Reduced expansion
b) Inward movement of lower ribs on inspiration (low flat diaphragm)
c) Prolonged expiration
d) Hyperinflated ‘barrel’ chest
e) Reduced breath sounds

A

Answer: A
Explanation: Reduced expansion is cause of Pulmonary Fibrosis

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4
Q

T/F Feature of COPD
a) raised jugular venous pressure (JVP)
b) peripheral oedema
c) Increased cricosternal distance
d) cor pulmonale
e) Intercostal indrawing during expiration

A

Answer: T T F T F
Explanation: c) Reduced cricosternal distance
e) Intercostal indrawing during inspiration

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5
Q

In COPD Heart sounds ( loudest / soft ) in epigastrium

A

Loudest

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6
Q

In COPD cardiac apex is ( palpable / not palpable )

A

Answer: Not palpable

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7
Q

T/F – COPD causes loss of cardiac dullness on percussion

A

Answer: T

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8
Q

Feature of Pulmonary Fibrosis (T/F)
a) Low diaphragm
b) Clubbing
c) Central cyanosis
d) Fine expiratory crackles at bases
e) Reduced JVP

A

Answer: F T T F F
Explanation:
a) high diaphragm
d) Fine inspiratory crackles at bases
e) Raised JVP

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9
Q

T/F Finger clubbing common in idiopathic pulmonary fibrosis.

A

Answer: T

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10
Q

Cause of dull percussion at bases in Pulmonary fibrosis

A

High diaphragm

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11
Q

Breath sound in pneumonia

A

Bronchial

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12
Q

T/F Vocal resonance increase over consolidation

A

Ans: T

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13
Q

(T/F) - Whispering pectoriloquy present in pneumonia.

A

Ans: T

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14
Q

T/F – In lung collapse there is reduced breath sounds with central obstruction.

A

Asn: T

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15
Q

Percussion note in both Pneumonia & Lung collapse is

A

Ans: Dull

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16
Q

T/F In both Pneumonia & Lung collapse there is increased expansion on the affected side.

A

Ans: F

Explanation: In both Pneumonia & Lung collapse there is decreased expansion on the affected side.

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17
Q

Percussion note in pneumothorax _

A

Ans: Resonant or hyper-resonant

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18
Q

Breath Sound absent in_

A

a) Pneumothorax
b) Pleural effusion

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19
Q

Feature of Tension pneumothorax (T/F)
a) Deviation of trachea to opposite side
b) Tachycardia
c) Hypotension
d) Stony dull on Percussion
e) Bronchial breath sounds

A

Ans: T T T F F

Eplanation : d) Stony dull on Percussion - Pleural effusion
e) Bronchial breath sounds - Pneumonia/ Consolidation

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20
Q

T/F - In large pleural effusion Trachea and apex may be moved to opposite side.

A

Ans: T

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21
Q

Reduced expansion on the affected side in _

A
  1. Pneumonia
  2. lobe collapse
  3. pneumothorax
  4. pleural effusion
  5. Pulmonary fibrosis
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22
Q

Nerves involve in Inspiration_

A
  1. Phrenic nerves originating from C3, 4 and 5.
  2. Intercostal nerves originating from the thoracic spinal cord.
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23
Q

T/F - Expiration is largely passive & driven by elastic recoil of the lungs.

A

Ans: T

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24
Q

Gas exchange unit of lung_

A

Ans: Acinus

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25
Q

Acinus comprises_

A
  1. Respiratory bronchioles
  2. Alveoli
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26
Q

Alveoli contains_

A
  1. Flattened type I pneumocytes
  2. Cuboidal, type II pneumocytes
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27
Q

Surfactant, a phospholipid mixture that reduces surface tension is produced by (type I pneumocytes / type II pneumocytes)

A

Ans : Type II pneumocytes

28
Q

Function of type II pneumocytes_

A
  1. Counteracts the tendency of alveoli to collapse
  2. Divide to type I pneumocytes after lung injury
29
Q

Alveolar walls contain _ fibers.

A
  1. Elastin
  2. Collagen
30
Q

T/F - Elastin fibres allow the lung to be easily distended at physiological lung volumes.

A

Ans: T

31
Q

T/F - Collagen fibres cause increasing stiffness as full inflation is approached.

A

Ans: T

32
Q

T/F - Maximum inspiratory volume is limited by the chest wall.

A

Ans: F
Explanation: Maximum inspiratory volume is limited by the lung

33
Q

(Elastin / Collagen) fibres in alveolar walls maintain small airway patency by radial traction on the airway walls.

A

Ans: Elastin

34
Q

In emphysema, alveolar walls collapse on (expiration/ Inspiration)?

A

Ans: Expiration

Explanation:
In emphysema, loss of alveolar walls leaves the small airways unsupportedand cause air trapping and limits expiration at a high end-expiratory volume.

35
Q

Origin of the respiratory cycle_

A

Posterior medulla oblongata.

36
Q

Breathing is controlled by_

A
  1. Central chemoreceptors sense the pH of the cerebrospinal fluid (CSF)
  2. Carotid bodies sense hypoxaemia but are mainly activated by arterial PO2 values below 8 kPa (60 mmHg).
  3. Muscle spindles sense changes in mechanical load.
  4. Vagal sensory fibres stimulated by stretch.
  5. Cortical (volitional) and limbic (emotional) influences can override the automatic control of breathing.
37
Q

(T/F) – Hypoxia constricts pulmonary arterioles and airway & CO2 dilates bronchi.

A

Ans: T

Explanation:
The pulmonary circulation in health operates at low pressure (approx- imately 24/9 mmHg) and can accommodate large increases in flow with minimal rise in pressure, e.g. during exercise. Pulmonary hypertension occurs when vessels are destroyed by emphysema, obstructed by thrombus, involved in interstitial inflammation or thickened by pulmonary vascular disease. The right ventricle responds by hypertrophy, with right axis deviation and P pulmonale (tall, peaked p waves) on the electrocar- diogram (ECG), and clinical features of right heart failure; the term ‘cor pulmonale’ is often used for these findings.

38
Q

Component of Upper airway defences_

A
  1. Nasal hairs
  2. Columnar ciliated epithelium
  3. Cough
39
Q

Component of Lower airway defences_

A
  1. Innate and adaptive immune responses
  2. Mucociliary escalator
  3. Airway secretions
40
Q

(T/F) - Repeated sino-pulmonary infections and bronchiectasis are characters of Defective mucociliary transport

A

Ans: T

41
Q

Feature of Defective mucociliary transport are_

A
  1. Cystic fibrosis
  2. Primary ciliary dyskinesia
  3. Young syndrome
42
Q

Airway secretion contains_

A
  1. Antimicrobial peptides (AMPs, such as defensins and lysozyme)
  2. Immunoglobulin A (IgA)
  3. Antiproteinases
  4. Antioxidants
43
Q

α -antitrypsin regulates neutrophil elastase, and deficiency of this may be associated with (mature emphysema / premature emphysema)

A

Ans: Premature emphysema

44
Q

CT provides detailed images of lungs of

A
  1. Pulmonary parenchyma
  2. Mediastinum
  3. Pleura
  4. Bony structures
45
Q

(T/F) – In cases of suspected lung cancer, CT is central to both diagnosis and staging.

A

Ans: T

46
Q

Investigation of choice in diagnosis of pulmonary thromboembolism _

A

CT pulmonary angiography (CTPA)

47
Q

HRCT used in_

A
  1. Diffuse parenchymal lung disease
  2. Airway thickening
  3. Bronchiectasis
  4. Emphysema
48
Q

In PET 18F-fluorodeoxyglucose (FDG) quantifies the rate of glucose metabolism. ). FDG-PET is useful in _

A
  1. Staging of mediastinal lymph nodes
  2. Distal metastatic disease in lung cancer
  3. Investigation of pulmonary nodules
  4. Extrapulmonary disease in sarcoidosis
49
Q

Increased translucency in CXR_

A
  1. Bullae
  2. Pneumothorax
  3. Oligaemia
50
Q

Both unilateral & bilateral hilar enlargement can be seen in CXR _

A
  1. TB
  2. Lymphoma

Explanation:

Unilateral hilar enlargement:
1. Tb
2. Lymphoma
3. Lung cancer
Bilateral hilar enlargement:
1. TB
2. Lymphoma
3. Sarcoidosis
4. Silicosis

51
Q

Pulmonary and pleural shadowing in CXR _

A
  1. Consolidation: infection, infarction, inflammation and, rarely, bronchoalveolar cell carcinoma
  2. Lobar collapse: mucus plugging, tumour, compression by lymph nodes
  3. Solitary nodule
  4. Multiple nodules: miliary tuberculosis (TB), dust inhalation, metastatic malignancy, healed varicella pneumonia, rheumatoid disease
  5. Ring shadows, tramlines and tubular shadows: bronchiectasis
  6. Cavitating lesions: tumour, abscess, infarct, pneumonia (Staphylococcus/ Klebsiella), granulomatosis with polyangiitis (GPA)
  7. Reticular, nodular and reticulonodular shadows: diffuse parenchymal lung disease, infection
  8. Pleural abnormalities: fluid, plaques, tumour
52
Q

(T/F) - Pleural space can be assessed by Transthoracic ultrasound

A

Ans: T

53
Q

(T/F) - Right-sided lung tumours may involve the left recurrent laryngeal nerve, paralysing the left vocal cord and leading to a hoarse voice and a ‘bovine’ cough.

A

Ans: F ( Left-sided )

54
Q

In case of bronchoscopy (T/F)

  1. Trachea & first 3–4 generations of bronchi can be inspected.
  2. Flexible fibreoptic bronchoscope performed under general anaesthesia.
  3. Indication of rigid bronchoscopy are massive haemoptysis, removal of a foreign body, endobronchial laser therapy and stenting.
  4. Flexible fibreoptic bronchoscope used in sarcoidosis and diffuse malignancy.
  5. Transbronchial biopsies can be taken by flexible bronchoscopy .
A

Ans: TFTTT

Explanation:
Flexible fibreoptic bronchoscope performed under local anaesthesia.
Rigid bronchoscopy performed under general anaesthesia.

55
Q

_ is the gold standard for the evaluation of the pleural surfaces.

A

Ans: Thoracoscopy

56
Q

_ antigen in sputum, blood or urine may be of diagnostic importance in pneumonia.

A

Ans: Pneumococcal

57
Q

(T/F) - Legionella antigen can be detected by immunofluorescence in Urine

A

Ans: T

58
Q

Airway narrowing occurs in

A
  1. Asthma
  2. Bronchitis
  3. Emphysema
59
Q

(T/F) - Interstitial inflammation and/or fibrosis lead to progressive loss of lung volume (‘restrictive’ defect) with normal expiratory flow rates.

A

Ans: T

60
Q

(T/F) - Airflow obstruction is defined as a FEV1/FVC ratio of more than 70%.

A

Ans: F ( Less than 70%)

Explanation:
The forced expired volume in 1 second (FEV1) is the volume exhaled in the first second, and the forced vital capacity (FVC) is the total volume exhaled. Airflow obstruction is defined as a FEV1/FVC ratio of less than 70%. In this situation, spirometry should be repeated following inhaled short- acting β2-adrenoceptor agonists (e.g. salbutamol); an increase of > 12% and > 200 mL in FEV1 or FVC indicates significant reversibility. A large improvement in FEV1 (> 400 mL) and variability in peak flow over time are features of asthma.

61
Q

(T/F) - All the gas in the lungs can be measured by rebreathing an inert non-absorbed gas (usually helium)

A

Ans: T

  • lung volume may be measured by body plethysmography.
62
Q

(T/F) - 0.3% Carbon monoxide is used to measure the capacity of the lungs to exchange gas.

A

Ans: T

63
Q

_ is the most frequent symptom of respiratory disease.

A

Ans: Cough

64
Q

(T/F) - Coexistence of an expiratory noise (stridor) indicates partial obstruction of a major airway (e.g. laryngeal oedema, tracheal tumour, scarring, compression or inhaled foreign body) and requires urgent investigation and treatment.

A

Ans: F ( Inspiratory )

65
Q

Extra-thoracic causes of cough_

A
  1. Nasal or sinus disease
  2. Gastro-oesophageal reflux disease
  3. Cough hypersensitivity
66
Q

(T/F) - Bordetella pertussis infection in adults can result in cough lasting up to 3 months.

A

Ans: T

67
Q

Respiratory diseases can stimulate breathing and dyspnoea by:

A
  1. Stimulating intrapulmonary sensory nerves (e.g. Pneumothorax, interstitial inflammation and pulmonary embolus)
  2. Increasing the mechanical load on the respiratory muscles (e.g. Airflow obstruction or pulmonary fibrosis)
  3. Causing hypoxia, hypercapnia or acidosis, which stimulate chemoreceptors

Respiratory Medicine (8 decks)

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