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ESA3 revision decks > ESA3 revision session 2 > Flashcards

ESA3 revision session 2 Flashcards

1
Q

What can cause a lump in the neck?

A

Vascular

Inflammatory

Traumatic

Autoimmune

Metabolic

Infection

Neoplastic

Degenerative

Idiopathic

Congenital

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2
Q

vascular cause of neck lump

A

carotid artery aneurysm

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3
Q

infection

A

cervical lymphadenopathy

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4
Q

congenital

A
  • Thyroglossal cyst- midline
  • Branchial cyst- SCM
  • Cervical rib
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5
Q
  • Neoplastic cause
A

Apical lung cancer- Pancoast tumour (left)

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6
Q

Thryoglossal duct cyst

A

- midline lump

  • thyroid gland dvewlops int he floor of the pharnx, in the foramen cecum
  • it descends down necks as it develops
  • remains connected to tongue by thyroglossal duct
  • if patency not resolved, a cyst develops
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7
Q

branchial cysts

A

lump on SCM

  • incomplete fusion of the second arch over the other clefts
  • fluid can fill in this space leading to a soft non-tender mass ont he anterior border of SCM
  • can arise after infection/trauma causing cyst to swell and become apparent
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8
Q

A non-tender left supraclavicular node is a associated with what type of malignancy?

A
  • GI metastases- gastric malignancy
  • Virchow node
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9
Q

what does this chest x ray confirm

A

pancoast tumour

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10
Q

pancoast tumours can cause disruption of the

A

brachial pleuxs- lower routes C8/T1 (Klumpke)

  • apex of lung in close proximity to lower nerve root of the rbachial plexus*
  • pancoast tumour causes it to impingle on C8 and T1 roots*
  • sensory innervation of medial hand and forearm
  • intrinsic muscles of the hand
  • muscles of the forearm
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11
Q

klumpkes palsy

A

C8-T1- upper brachial plexus injury

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12
Q

Erbs palsy-

A

C5 C6—shoulder dystocia (lower brachial plexus injury)

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13
Q

what other structures can be affecred by a pancoast tumour

A
  • Recurrent laryngeal nerve
    • Reduced ability to cough
    • hoarseness
  • Sympathetic trunk/chain
    • Horners syndrome
  • Subclavian artery and vein
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14
Q

horners syndrome

A

impingment of sympathetic chain by pancoast tumour

Symptoms:

  • partial ptosis
  • miosis- constircted pupil as dilatore pupillae not innervated
  • anhydrosis- lack of sweating due to denervated sweat glands
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15
Q

What does the sympathetic nervous system do in the eye

A
  • eyelid- helps raise it
  • pipil- dilates it
  • sweat glands- stimulated production
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16
Q

Eyelid muscle innervation

A
  • Levator palpebrae superioris (CN III- oculomotor)
  • Superior tarsal plate (sympathetic innervation)
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17
Q

partial psosis

A
  • sympathetic innervation to the taral muscle of the eyelid is lost
    • leads to drooping of eyelid
  • innervation to levator palpebrae suprioris (LPS) is still in tact
    • can partially raise eyelid
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18
Q

complete ptosis

A
  • paralysis of levatoe palpebrae superioris (LPS) due to CN III lesion (compression of parasympathetic fibres)
  • tarsal muscle inenrvation is intact (however too weak to riase eyelid alone)
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19
Q

parasympathetic fibres which hitch-hike on the ocuclomotor nerve run on the

A

periphery

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20
Q

parasympathetic fibres which hitch-hike on the ocuclomotor nerve innervates the

A

sphincrer pupillae muscle to constrict the pupil

21
Q

pathology of CN III will causes a

A

dilated pupil (SNS domiantes)

22
Q

Compressive vs vascular CN III lesion: Compressive

A

Compressive –e.g. aneurysm/tumour will compress the outside of the nerve= loss of Parasympathetic fibres first- lose pupil innervation first (pupil dilation)- motor signs will be later

23
Q

Compressive vs vascular CN III lesion: Vascular

A

Vascular- loss of blood supply= loss of motor function CN III first (full ptosis)

  • Parasympathetic is peripheral therefore can get blood supply from close structures- pupils spared
24
Q

Effect of CN III lesion on eye movent?

A
  • oculomotor (CN III) supplies 4 out of 6 muscles
  • trochlear (lateral rectus) and abducens nerve (superior oblique) preserved
  • unopposed action of LR and SO = down and out position
25
Q

why can facial oedema and venous distention occur in patients with pancoast tumours

A
  • pancoast tumours can compress the superior vena cava
  • svc responsible for draining the upper limb, head and neck of blood
  • compressur ewill cause back log of blood icnreased venous pressur
  • eincreased hydrostatic pressure can cuase fluid to move out of the facial veins and into the tissue causing oedema
26
Q

horners vs CN III palsy

A
27
Q

how is venous jugular pressure

A
  • place at 45 degrees
  • turn the head towards the left
  • measure the height from the sternal angle + 5cm
  • >5 cm indicates raised JVP
28
Q

What lung conditions can cause heart failure?

A

What lung conditions can cause heart failure?

  • Cor pulmonale (right heart failure on its own because of lung condition)
    • Pulmonary hypertension increases the afterload of the right heart
    • RV hypertrophies to accommodate then dilatation
    • Reduced RV cardiac output- reduced LV filling
    • CO unable to meet demand of the body
  • Causes of Cor pulmonale
    • PE
    • COPD
      hypoxia pulmonary vasoconstriction
29
Q

30 cigs a day for 24 year. what is the pack year history

A

1 pack = 20 cigarettes

30 cigarettes= 1.5 packs

1.5 x 24= 36

36 pack-years

30
Q

describe 2 appaoraches a health promotion campaign cna take to reduce smoking incidence

A

medical prevention- encourage smokers to opt into early detection to prevent smoking related disease

  • behaviour change- psychological health behaviorus theories in campagins
  • educational- dissemintate info
31
Q
A
32
Q

Sepsis six

*

A
  • B- blood cultures
  • U- urine outputs
  • F0- fluids
  • A- Ax
  • L- lactate
  • O- oxygen

Give 3

Take 3

33
Q
  • Septic shock is
A
    • Sepsis in combination with either a lactate >2 mmol/l despite adequate fluid resus or the patient is requiring vasopressors to maintain MAP >65 mmHg
      • Basically sustained low BP
34
Q

How to look at acid-base balances?

A
  • pH- are they normal, acidotic or alkalotic
  • pCO2- is the change in keep with pH
    • yes- resp cause
    • no - change or opposite
  • HCO3- abnormal? Change in keeping with pH?
    • if yes- metabolic cause
    • if no- compensatory cause
35
Q

acid base

A
  • Low pH- acidic
  • pCO2 low
  • HCO3- low

What is this ? partially compensated metabolic acidosis

  • resp is trying to compensate for low HCO3
36
Q

The anion gap

A

An elevated anion gap means there are unmeasured cations in the blood-these unmeasured cations are acids. Hence, a high anion gap suggest a metabolic acidosis

37
Q

interpret this CXR

A
  • Emphysema- lots of ribs can be seen due to hyperinflation
    • Flattened hemi diaphragm
    • Very dark lung fields- lots of air
38
Q

summary of how to review a CXR

A
39
Q

What do we need to think about with COPD patients and oxygen?

*

A
  • CO2 retainers – blue bloater (chronic bronchitis)
    • Need to aim sats for 88-92%
  • If they are not retainers- pinker puffer (emphysema)
    • 94%
40
Q

COPD and oxygen

A
  • need controlled oxyegn therapy i.e. you know exactly how much oxygen you are giving threm
  • if they are in CO2 retention, aim sat 88-92%
  • regular ABGs

if we give oxygen, redue hypoxic drive, patient will hypoventilate, hypoventilation decreases CO2 removal therefore pts will end up hypercapnic

41
Q

Type 1 – low pO2 <8kPa

A
  • pCO2 normal or low
  • ventilation perfusion mismatch
    • solubility of O2 and CO2 (CO2 is much more soluble)
      • CO2 not as badly affected as O2
42
Q
  • Type 2- low PO2 <8kPa
A
  • pCO2 higher- retaining CO2 >6.7 kPa
  • hypoventilation problem
43
Q

respiratory acidosis can call

A

hyperkalaemia

44
Q

hyperkalemia on ECG

A
  • tall tended T wave
  • flattened or absent P-waves
  • PR interval prolongation
  • prolonged QRS
  • can become brady cardic
45
Q

how to red an ECG

A
46
Q

Why does acidosis cause hyperkalaemia?

A

H+ moves into cells

K+ moves out of cells

47
Q

What drugs might you give to the pt to reverse the hyperkalaemia?

A
  • IV insulin (drives K+ into cells)
  • IV dextrose to avoid hypoglycaemia

what would you give to stabilise the cardiac membrane?

  • calcium gluconates
  • later give furosemid to removed K+ from body
48
Q
A
49
Q

calcium gluconates

A

to stabilise cardiac membrane

ESA3 revision decks (12 decks)

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