Disorders of Breathing, Respiration or Circulation

Question 1

Superficial venous thrombosis

Answer 1

palpable as linear, indurated cord

variable pain, tenderness, erythema, warmth

Question 2

Why would we do a chest x-ray?

Answer 2

• Disorders of: —Heart, Lungs, Pleural and pericardial cavities, Great vessels, Skeletal structures, Lymph nodes in mediastinum
• Usually done PA (postero-anterior) and lateral
• Maybe followed by CT, MRI

Question 3

Describe a sputum test?

Answer 3

• by expectoration, bronchoscopy, endotracheal, transtracheal aspirations
• Sputum Culture and Sensitivity: microscope, culture of preparation, antibiotic sensitivity test
• Sputum Cytology: microscope, for malignancy

Question 4

What causes White sputum?

Answer 4

allergies or viral

or non-pus forming bacterium

Question 5

What causes Yellow-green sputum?

Answer 5

pus-forming bacterium

Question 6

What causes scattered expiratory wheezes?

Answer 6

narrowing of LRT in both lungs and all over

Question 7

What are the reasons for a change in chronic cough?

Answer 7

1) Worsening of previous condition
2) Superimposed infection
3) New pathology (malignancy)

Question 8

What is the pathophysiology of wheeze and sputum in smokers?

Answer 8

smoking -> metaplasia (- ciliary cells, + goblet cells, + mucus) -> narrows lumen

Question 9

What investigations would you use to confirm a suspected pneumonia?

Answer 9

• Microscopy, Culture, Sensitivity test

- Chest x-ray

Question 10

What causes night coughing in kids?

Answer 10

• asthma
• post-nasal drip
• GORD

Question 11

What questions do you ask when you suspect asthma?

Answer 11

• what months is it during?
• family history of allergies?
• any changes in home recently? (new detergent, new pet, new room with carpet)
• other allergies?

Question 12

What is the pathophysiology of wheeze in asthma?

Answer 12

-stimulus (eg. pollen) -> inflammation of epithelium -> thickens + smooth muscle contraction + inflammatory exudate

Question 13

What causes runny eyes?

Answer 13

likely allergies

Question 14

What does a dry cough mean?

Answer 14

• URT issue

- inhaled irritants

Question 15

Define coryza

Answer 15

stuffy nose

Question 16

What is the likely cause of acute rhinorrhea, sore throat, runny eyes, dry cough?

Answer 16

Allergic pharyngitis

Question 17

What other disorders is “acute rhinorrhea, sore throat, runny eyes, dry cough” a prodrome to?

Answer 17

-Influenza
-LRT infection
-glandular fever
-HIV becoming positive AIDS
-meningitis
Hodgkins lymphoma

Question 18

What are the 3 top causes of dyspnoea?

Answer 18

• respiratory tract pathology
• L side heart failure with pulmonary oedema
• anaemia

Question 19

What colour sputum would croup make?

Answer 19

white (it is viral, not bacterial)

Question 20

What questions do you ask for a 3yr old with cough with sputum?

Answer 20

• immunization history?

- daycare? other sick kids?

Question 21

What investigations do can you do for asthma?

Answer 21

• allergy patch test
• blood test for eosinophils (high), IGE (high)
• spirometry

Question 22

What causes crackles at both lung bases?

Answer 22

pulmonary oedema

Question 23

What causes crackles at one lung base?

Answer 23

TB

lobar pneumonia

Question 24

What causes scattered crackles on both lungs?

Answer 24

bronchopneumonia

Question 25

What do you ask a 26 year old female with occasional palpitations and fatigue?

Answer 25

- last period? - diet? - family history of anaemia?

Question 26

What is the DDx for palpitations and fatigue in a 26 yr old woman?

Answer 26

- anaemia | - pregnancy

Question 27

What could be the cause of a 14 year old's mild dyspnoea and wheeze with dry cough, precipitated by strong emotions and exercise?

Answer 27

Asthma | Allergies

Question 28

What is the DDx of 42yr old heavy smoker male with 10yr history of increasing dyspnoea, morning cough with white sputum, increasing fatigues ?

Answer 28

- emphysema - chronic bronchitis - bronchus carcinoma

Question 29

What investigations can confirm emphysema?

Answer 29

- chest X-ray | - lung function test

Question 30

What causes a pink frothy sputum?

Answer 30

pulmonary oedema

Question 31

What are the causes of pleuritic pain?

Answer 31

- pulmonary embolism with infarction - pericarditis - pneumonia - myocardial infarction - pneumothorax

Question 32

Which is the only disorder of impulse conduction?

Answer 32

Heart block

Question 33

What are some causes of arrhythmias?

Answer 33

- electrolyte imbalance (hypercalcaemia) - high catecholamines (hyperthyroid) - drugs (B-blockers, antidepressants) - hypoxia (MI) - vagal hyperactivity - acidosis - ischaemia - aging - fever

Question 34

What is the definition of a cough?

Answer 34

- forceful expiratory action, preceded by preliminary inspiration - protects lung from accumulation of secretions and entry of irritating destructive substances

Question 35

What are the categories for the common causes of a cough?

Answer 35

``` inflammatory stimuli (laryngitis) mechanical stimuli (choking) chemical stimuli (noxious gas) thermal stimuli (cold air) ```

Question 36

What are the common causes of haemoptysis?

Answer 36

- lung oedema - bleeding tendency - trauma - TB - pneumonia - bronchus carcinoma - pulmonary embolus with infarction

Question 37

What causes a blood-streaked sputum?

Answer 37

- bleeding tendency - lung carcinoma - pulmonary embolism + infarction - trauma - TB - bronchiectasis

Question 38

What causes a rusty sputum?

Answer 38

-pneumococcal pneumonia

Question 39

What causes morning cough?

Answer 39

- chronic bronchitis - bronchiectasis - postnasal drip - chronic sinusitis

Question 40

What causes night cough?

Answer 40

- asthma - postnasal drip - CROUP

Question 41

What causes cough worse lying down, better with sitting up ?

Answer 41

left hear failure

Question 42

What causes cough worse with exercise ?

Answer 42

- asthma - chronic bronchitis - many

Question 43

What causes cough with fever and sweats ?

Answer 43

- respiratory infections | - Lymphoma

Question 44

What causes cough plus sore throat and rhinorrhoea ?

Answer 44

URT infection

Question 45

What are the top 3 things to ask a patient which hypertension?

Answer 45

- dyspnoea (L H failure) - ishcaemic heart disease - signs of stroke / brain bleed / cerebellar lesions

Question 46

What are the causes of hypertension?

Answer 46

90% primary idiopathic 10% secondary to: - endocrine (hyperthyroid) - renal (glomerulonephritis) - pregnancy - neurogenic (cranial, lesions) - medications

Question 47

What are causes of systolic pressure increase?

Answer 47

- exercise - stress - pain - cafeine - recent smoke

Question 48

What causes increase of diastolic blood pressure?

Answer 48

increase in total peripheral resistance

Question 49

What are the causes of bilateral ankle oedema?

Answer 49

* R heart failure * renal failure * metabolic (starvation, malabsorption) * pregnancy, PMS * bilateral venous congestion

Question 50

What are the causes of unilateral ankle oedema?

Answer 50

* venous congestion | * lymphatic obstruction -> filariasis, irradiation

Question 51

What is CROUP?

Answer 51

* acute laryngotracheobronchitis * follows URT * parainfluenza type 1 * bark like cough * hoarseness, dyspnoea, cyanosis * inspiratory stridor, accessory insp. muscles

Question 52

What is pernicious anaemia?

Answer 52

* macrocytic * low intrinsic factor -> B12 deficiency * presents with GIT discomfort and sensory changes

Question 53

What is aplastic anaemia?

Answer 53

* low all blood formed elements due to bone marrow failure | * presents with features of anaemia plus bleeding tendency and low immunity

Question 54

What is thalassaemia?

Answer 54

* haemolytic anaemia | * abnormal structure and function of RBC

Question 55

What is mesothelioma?

Answer 55

* pleural carcinoma | * from exposure to asbestos