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respiratory > history and examination > Flashcards

history and examination Flashcards

1
Q

what is cough lying down in the evening characteristic of?

A

GORD

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2
Q

what is cough disrupting sleep typical of?

A

asthma

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3
Q

what is cough on rising in the morning typical of?

A

rhino sinusitis

post-nasal drip

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4
Q

why does a Fx of asthma, eczema and hay fever increase the chance of asthma?

A

predisposition to form excess IgE in response to allergen

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5
Q

what conditions are associated with birds?

A

hypersensitivity pneumonitis

psittacosis

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6
Q

what is farmers lung otherwise known as ?

A

ILD

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7
Q

causes of pulmonary fibrosis

A

asbestos (shipyard/construction workers)
quartz/silica (miners, quarry workers)
coal

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8
Q

what is used to predict mortality in community acquired pneumonia

A

CURB 65

c: confusion
u: >7mmol/L
r: >30/min
b: bp <60

age 65 or over

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9
Q

use of accessory muscles is characteristic of what condition?

A

severe COPD

acute severe asthma

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10
Q

what is cyanosis

A

blue colour caused by an absolute concentration of deoxygenated Hb of >50g/L

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11
Q

what does does central cyanosis reflect?

A

arterial hypoxaemia

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12
Q

what does peripheral cyanosis reflect?

A

circulatory disorders or cold

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13
Q

what is pulsus pardoxus

A

exaggeration of the normal variability of pulse volume with the respiratory cycle

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14
Q

what is erythema nodosum a feature of

A

acute sarcoidosis

Tb

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15
Q

what is clubbing associate d with?

A 
thoracic disease (lung cancer, bronchiectasis, ILD)
GI disorders
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16
Q

what is a fine finger tremor caused by?

A

excessive use of beta agonist or theophylline bronchodilator drugs

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17
Q

what is a coarse flapping tremor (asterixis) seen in

A

severe ventilatory failure and CO2 retention

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18
Q

what kind of heart failure is the JVP raised in

A

right sided heart failure

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19
Q

what does chronic hypoxia in COPD lead to

A

pulmonary arterial vasoconstriction
pulmonary hypertension
right heart dilatation
peripheral oedema

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20
Q

features of superior vena caval obstruction

A

raised and non pulsatile JVP

abdominojugular reflex absent

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21
Q

causes of superior vena caval obstruction

A

lung cancer compressing the vena cava
lymphoma
thymoma
mediastinal fibrosis

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22
Q

what is a barrel shaped chest defined as

A

the anteroposterior diameter being greater than the lateral diameter

23
Q

what is a barrel shaped chest associated with

A

lung hyperinflation in patients with severe COPD

24
Q

why do patients with kyphosis or scoliosis develop ventilatory failure?

A

reduced ventilatory capacity and increased work of breathing.

these patients develop progressive ventilatory failure with CO2 retention and cor pulmonale at a young age

25
Q

what is pectus carinatum (pigeon chest)

A

localised prominence of the sternum and adjacent costal cartilages

26
Q

what is pectus excavatum

A

developmental deformity with a localised depression of the lower end of the sternum

27
Q

causes of tracheal deviation towards the side of the lung lesion

A

lung collapse
fibrosis
pneumonectomy

28
Q

causes of tracheal deviation away from the side of the lung lesion

A

tension pneumothorax

massive pleural effusion

29
Q

causes of unilateral reduced lung expansion

A

pleural effusion
lung/lobar collapse
pneumothorax
unilateral fibrosis

30
Q

causes of bilateral reduced lung expansion

A

severe COPD

diffuse pulmonary fibrosis

31
Q

resonant percussion note detected over….

A

normal lung

32
Q

hyperresonant percussion note detected over…

A

pneumothorax

33
Q

dull percussion note detected over…

A

pulmonary consolidation
pulmonary collapse
severe pulmonary fibrosis

34
Q

stony dull percussion note detected over…

A

pleural effusion

haemothorax

35
Q

reduced conduction causes of diminished vesicular breathing

A
  • obesity/thick chest wall
  • pleural effusion or thickening
  • pneumothorax
36
Q

if the breath sounds appear reduced, what should you ask the patient to do?

A

ask the patient to cough

37
Q

if the reduced breath sounds are due to bronchial obstructions, what happens after the patient coughs?

A

likely to become more audible

38
Q

what is aegophony

A

a bleating or nasal sound heard over the consolidated lung (pneumonia) or at the upper level of a pleural effusion

39
Q

reduced airflow causes of diminished vesicular breathing?

A

generalised (e.g. COPD)

localised (collapsed lung)

40
Q

Wells score for PE?

A 
PE/DVT
immobilisation
cancer
haemoptysis
heart rate >100bpm
signs of DVT
41
Q

major risk factors for pulmonary thromboembolism?

A
  • fracture of the hip, pelvis or leg
  • hip or knee replacement
  • major abode or pelvic surgery
  • major trauma
  • spinal cord injury
  • malignancy
42
Q

what produced crackles?

A

abrupt opening of distal airways on inspiration after they have collapsed on expiration

43
Q

causes of early inspiration crackles?

A

small airways disease (bronchiolitis)

44
Q

causes of middle inspiration crackles?

A

pulmonary oedema

45
Q

causes of fine late inspiratory crackles (sound similar to hair rubbing)?

A

pulmonary fibrosis

46
Q

causes of coarse late inspiratory crackles?

A

bronchial secretions in COPD, pneumonia, lung abscess,

47
Q

causes of biphasic crackles?

A

bronchiectasis

48
Q

what is a wheeze caused by?

A

continuous oscillation of opposing airway walls occurring during airway narrowing

49
Q

why would a wheeze be loud on expiration?

A

because airways normally dilate during inspiration and narrow on expiration

50
Q

where do high pitched wheezes arise from?

A

smaller airways (have a whistling quality)

51
Q

where do low pitched wheezes arise from?

A

larger bronchi

52
Q

what is a wheeze characteristic of?

A

asthma

COPD

53
Q

cause of a pleural friction rub?

A

produced when inflamed parietal and visceral pleurae move over one another

54
Q

cause of a pleural rub

A

pulmonary infarction (due to PE)
pneumonia
pulmonary vasculitis

respiratory (16 decks)

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