RESP Flashcards
What structure connects the middle ear with the nasopharynx?
Eustachian tube
what does the eustacian tube do?
enabling pressure equalisation of the middle ear
pain, associated hearing loss and fever is cause by what? (with a bulging tympanic membrane and fluid level)
otitis media
what is a red flag referral for ENT ?
unexplained persistent hoarseness in a person over the age of 45
or
An unexplained lump in the neck
causes of voice hoarseness?
voice overuse smoking viral illness hypothyroidism gastro-oesophageal reflux laryngeal cancer lung cancer
which organisms which may colonise CF patients?
Staphylococcus aureus
Pseudomonas aeruginosa
Burkholderia cepacia*
Aspergillus
Hypothyroidism cause what kinda of voice change?
Hypothyroidism is a known cause of hoarseness
The voice change is due to a thickening of vocal cords from mucopolysaccharide. Mucopolysaccharide, also known as glycosaminoglycans, is sugar molecules found throughout the body in mucus and in the fluid surrounding the joints. This buildup lowers the note produced by the voice box. The thyroid hormone helps prevent this build up.
what is the likely consequence of a wrongly inseted NG tube?
The end of the tube ishould be below the diaphragm in the stomach.
serious consequences for a patient including aspiration pneumonia and death.
Where does control and regulation of the respiratory centres occur
brain stem
upper/lower pon and medulla
The respiratory centres control the respiratory rate and the depth of respiration.
what is the role of the thalamus?
The thalamus is involved in sensory, motor and cognitive functions, its axons connect with the cerebral cortex.
what is the role of cerebellum?
The cerebellum coordinates voluntary movements and helps maintain balance and posture.
what is the role of parietal lobe?
The parietal lobe processes information about sensory input, sensory discrimination and body orientation.
what is the role of occipital lobe?
The occipital lobe contains the primary visual cortex.
Lung cancer: paraneoplastic features of
Small cell?
ADH
ACTH - not typical, hypertension, hyperglycaemia (blurred vision), hypokalaemia (muscle weakness), alkalosis and muscle weakness are more common than buffalo hump etc
cushings syndrome
Lambert-Eaton syndrome
Lung cancer: paraneoplastic features of squamous cell?
parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
clubbing
hypertrophic pulmonary osteoarthropathy (HPOA)
hyperthyroidism due to ectopic TSH
Lung cancer: paraneoplastic features of Adenocarcinoma?
gynaecomastia
hypertrophic pulmonary osteoarthropathy (HPOA)
Legionella pneumophila
Another one of the atypical pneumonias
Hyponatraemia and lymphopenia common
Classically seen secondary to infected air conditioning units
Streptococcus pneumoniae
Accounts for 80% of cases
Particularly associated with high fever, rapid onset and herpes labialis
A vaccine to pneumococcus is available
Haemophilus influenzae
Particularly common in patients with COPD
Staphylococcus aureus
Often occurs in patient following influenza infection
Pneumocystis jiroveci
typically only seen in HIV positive patients and presents with a dry cough and exercise-induced desaturation.
Klebsiella pneumoniae
pneumonia Classically seen in alcoholics
also has a red currant jelly sputum
Idiopathic interstitial pneumonia
a group of non-infective causes of pneumonia. Examples include cryptogenic organizing pneumonia which describes a form of bronchiolitis which may develop as a complication of rheumatoid arthritis or amiodarone therapy.
pneumonia signs?
signs of systemic inflammatory response: fever, tachycardia
reduced oxygen saturations
ausculatation: reduced breath sounds, bronchial breathing
pneumonia symtpoms?
cough sputum dyspnoea chest pain: may be pleuritic fever
pneumonia xray?
the classical x-ray finding in pneumonia is consolidation
pneumonia blood results?
full blood count: would usually show a neutrophilia in bacterial infections
urea and electrolytes: check for dehydration (remember the ‘U’ for urea in CURB-65, see below) and also other changes seen with some atypical pneumonias
CRP: raised in response to infection
what is CURB-65?
The management of patients with community-acquired pneumonia
C Confusion (abbreviated mental test score <= 8/10)
U Urea >7 mmol/L
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years
Patients with a CURB-65 score of 0 should be managed in the community.
Patients with a CURB-65 score of 1 should have their Sa02 assessed which should be >92% to be safely managed in the community and a CXR performed. If the CXR shows bilateral/multilobar shadowing hospital admission is advised.
Patients with a CURB-65 score of 2 or more should be managed in hospital as this represents a severe community acquired pneumonia.
The CURB-65 score also correlates with an increased risk of mortality at 30 days with patients with a CURB-65 score of 4 approaching a 30% mortality rate at 30 days.
what is the action of Alpha-1 antitrypsin (A1AT) in COPD?
A1AT inhibits neutrophil elastase, so no elastase to cause destruction of aveolar walls (emphasema)
Alpha-1 antitrypsin (A1AT) deficiency is a common inherited condition caused by a lack of a protease inhibitor (Pi) normally produced by the liver.
What is a adverse consequence as a result of chest drain insertion?
winged scapula as a result of the long thoracic nerve being damaged. (paralysis of the serratus anterior muscle can also occur)
Failure to use aseptic technique during the procedure can result in hospital-acquired pleural infection as the drain is being inserted into this space,
Chest drain indications?
Chylothorax is a type of pleural effusion where lymphatic fluid accumulates in the pleural cavity, and pyothorax is a type of pleural effusion where pus accumulates in the pleural cavity. Chylothorax, pneumothorax and pyothorax are all indications for chest drain insertion and not known complications of the procedure.
which nerve is anterior to the lung root and which nerve is posterior to the lung root?
The vagus nerve is the most posteriorly located structure at the lung root. The phrenic nerve lies most anteriorly.
the difference between cushings disease and symdrome?
Cushing’s disease (a pituitary adenoma) and Cushing’s syndrome (the symptoms associated with a high cortisol level, of any cause).
what is aminophlline?
Aminophylline is a shorter acting theophylline
what is the mechanism of action of aminophlline?
Aminophylline binds to adenosine receptors and blocks adenosine-mediated bronchoconstriction
what are xanthines?
theophylline or aminophylline
used in the management of acute asthma and chronic obstructive pulmonary disease (COPD).
what are COPD xray findings?
hyperinflation
bullae: if large, may sometimes mimic a pneumothorax
flat hemidiaphragm
also important to exclude lung cancer
what is the normal intracranial pressure?
The normal intracranial pressure is between 7 and 15 mm Hg.
The brain can accommodate increases up to 24 mm Hg, thereafter clinical features will become evident.
what is monre-kelly doctrine?
Pressure within the cranium is governed by the Monroe-Kelly doctrine. This considers the skull as a closed box. Increases in mass can be accommodated by loss of CSF.
Once a critical point is reached (usually 100- 120ml of CSF lost) there can be no further compensation and ICP rises sharply. The next step is that pressure will begin to equate with MAP and neuronal death will occur.
Other metabolic factors such as hypercapnia will also cause vasodilation, which is of importance in ventilating head injured patients.
The brain can only metabolise glucose, when glucose levels fall, consciousness will be impaired.
Webber and rennie hearing test?
Webbers test:
sensorineurial–> lound in good ear (no hearing in sensorineurial hearing loss ear)
conductive–> lound in bad ear
Rennie rest:
conductive hearing loss, better on the bone
sensorineural loss, the sound is heard better on air conduction, as in healthy individuals.
Which nerves pass through middle ear
chorda tympani, a branch of the facial nerve (CN7)
Chorda Tympani
chorda tympani is a branch of the facial nerve, the seventh cranial nerve. It arises from the mastoid segment of the facial nerve and carries parasympathetic fibres (destined for the submandibular and sublingual gland) and taste fibres (destined for the anterior two-thirds of the tongue). After it branches off the facial nerve, it passes through the middle ear before exiting via the petrotympanic fissure. It meets and joins with the lingual nerve (a branch of the mandibular nerve) to reach the tongue and two salivary glands.
vestibulochlear nerve
vestibulocochlear nerve is the eighth cranial nerve. It consists of a vestibular component that carries balance information from the labyrinths of the inner ear, and a cochlear component that carries hearing information from the cochlea of the inner ear.
maxillary nerve
maxillary nerve is the second division of the trigeminal nerve, the fifth cranial nerve. It carries sensation from the upper teeth and gingivae, the nasal cavity and skin across the lower eyelids and cheeks.
mandibular nerve
mandibular nerve is the third division of the trigeminal nerve, the fifth cranial nerve. It carries sensation from the lower teeth and gingivae, the anterior two-thirds of the tongue, the mandible, the skin across the chin and mandible. It also carries motor fibres to the muscles of mastication, mylohyoid, tensor veli palatini, tensor tympani and the anterior belly of digastric.
glossopharyngeal nerve
glossopharyngeal nerve is the ninth cranial nerve. It carries taste and sensation from the posterior one-third of the tongue, as well as sensation from the pharyngeal wall, tonsils, pharyngotympanic tube, middle ear, tympanic membrane, external auditory canal and auricle. It also carries motor fibres to stylopharyngeus and parasympathetic fibres to the parotid gland. Information from the baroreceptors and chemoreceptors of the carotid sinus are carried via this nerve.
what si Trotters’ triad?
Trotter’s triad (diagnosis of nasopharyngeal carcinoma)
Unilateral conductive hearing loss
Ipsilateral facial & ear pain
Ipsilateral paralysis of soft palate
An association with previous Epstein Barr Virus is well established
what is Nasopharyngeal carcinoma?
Nasopharyngeal carcinoma
Basics
Squamous cell carcinoma of the nasopharynx
Rare in most parts of the world, apart from individuals from Southern China
Associated with Epstein Barr virus infection
Cervical lymphadenopathy
Tx: radiotherapy
what us Meniere’s disease?
a disorder of the inner ear of unknown cause.
It is characterised by excessive pressure and progressive dilation of the endolymphatic system.
It is more common in middle-aged adults but may be seen at any age. Meniere’s disease has a similar prevalence in both men and women.
“Vertigo, tinnitus, fluctuating sensorineural hearing loss - suspect Meniere’s disease”
diseases of hearing loss causes? name 3
Meniere’s disease: Vertigo, tinnitus, fluctuating sensorineural hearing loss. Painless rash?
Acoustic neuroma (vestibular schwannoma): unilateral sensorineural hearing loss, tinnitus, vertigo, facial numbness, loss of corneal reflex. a benign tumour of the 8th cranial nerve, also known as the vestibulocochlear nerve
Herpes Zoster Oticus (Ramsey Hunt syndrome) is a rare type of shingles: painful rash, vertigo, sensorineural hearing loss, facial palsy. sometimes a painful rash.
vestibular neuronitis: Long episodes of vertigo last for hours, it usually occurs after a recent viral illness, there is nausea and vomiting and hearing is not affected.
benign paroxysmal positional vertigo, vertigo occurs for seconds after sudden movement of the head.
parainfluenza causes what?
Parainfluenza virus is the most common cause of croup.
What is the normal function of the cystic fibrosis transmembrane regulator?
Chloride channel
What is mesothelioma risk factors?
f asbestos exposure through his occupation as a builder. As there a is latent period of 30 years and a complicated effusion,
what are the features of mesothelioma?
dyspnoea, weight loss, chest pain
clubbing
painless pleural effusion
investigation findings of mesothelioma?
suspicion is normally raised by a chest x-ray showing either a pleural effusion or pleural thickening
the next step is normally a pleural CT
fluid from pleural effusion should be sent to microscopy, culture and sensitivity (MC&S)
Malignant otitis externa causative agents?
pseudomonas aeruginosa (95%)
Staph Aureus, S epidermidis, aspergillus fumigatus
risk factors for malignant otitis externa?
old age
diabetes mellitus
immuno-compromised status
features of malignant otitis externa?
long standing otalgia
otorrhea
hearing loss
hallmarks:
granulation tissue in ear
canal
cranial nerve palsy
headache, neck stiffness
what is lung compliance?
Lung compliance is defined as change in lung volume per unit change in airway pressure.
compliance is inversely proportional to elastic recoil.
A high degree of compliance indicates a loss of elastic recoil of the lungs, as in old age or emphysema.
what are the causes of increased lung compliance?
old age
emphysema
what are the causes of low lung compliance?
pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis
atelectasis
pneumonia
lack of surfactant
a greater change in pressure is needed for a given change in volume
what histological findings are present in tuberculosis?
Epithelioid histiocytes is a histological finding in patients with granulomas resulting from a TB infection
a macrophage that has become an eoithelial cell.
what is Kartagener’s syndrome?
Kartagener’s syndrome (also known as primary ciliary dyskinesia)
defective dynein motor protein in cilia
Features dextrocardia or complete situs inversus bronchiectasis recurrent sinusitis subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)
