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Resp Combanium Flashcards

1
Q

Markers of TB

A

Emaciation
Phlycten
Erythema nodosum
Lupus vulgaris
Scrofuloderma
Iritis

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2
Q

Horners syndrome

A

Ptosis
Miosis
Anhydrosis
Enophthalmos
Absent cilio spinal reflex

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3
Q

Pancoast tumour

A

Wasting of hand muscles
Weakness of hand muscles
Shoulder pain

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4
Q

Dyspnea and causes

A

Undue awareness of one’s own breathing
. Physiological(exercise,fever,anemia)
. Respiratory (asthma, COPD,pneumonia,myasthenia gravis,Gillian Barre ,ankylosingnspondilitis,kyphoscoliosis,obesity,pleural effusion, pneumothorax,pulm edema,pulm embolism,obstruction)
. Cardiac(left vent failure,valvular heart disease, congenital cyanotic,acute MI)
. Mechanical(rib fracture)
. Metabolic(met acidosis,diabetic ketoacidosis,uremia,hypokalemia)

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5
Q

Grades of dyspnea

A

1- on strenuous exercise
2- hurrying on level ground or walking up a hill
3- slower than peers,stops after 15 mins
4- rests after 100 yards
5- on rest

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6
Q

Cardinal symptoms of rs

A

Dyspnea
Cough
Haemoptysis
Chest pain
Fever
Wheeze

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7
Q

Cough and causes

A

Reflex act of forceful expiration against a closed glottis that helps in clearing the airways
Causes
Resp: tracheobronchitis
Bronchial asthma
Bronchiectasis
Foreign body
Cardiac: left vent failure
Ms
Aortic aneurysm
Post Nas drip
GE reflux
Drugs (ace inhibitors)

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8
Q

Types of cough

A

Brassy cough- compression over trachea
Bovine cough- recurrent laryngeal nerve palsy
Nocturnal cough - asthma,lvf,post nasal drip
Drug induced-ace inhibitors
Cough syncope-

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9
Q

Copous sputum seen in

A

Bronchiectasis
Lung abscess
Empyema rupturing into bronchus
Necrotizing pneumonia
Alveloar cell ca

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10
Q

Diff color of sputum

A

Green or yellow- bact,due to myeloperoxidase
Black- coal worker pneumoconiosis
Rusty- pneumococcal pneumonia
Red currant jelly- klebsiella pneumonia
Pink frothy- pulm edema
Blood stained- tb,malignancy,bronchiectasis
Anchovy sauce- ruptured amoebic liver abscess

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11
Q

Causes of blood in sputum

A

Infection:
TB
Lung abscess
Bronchiectasis
Pneumonia
Fungal infection
Neoplasms:
Bronchogenic ca
Metastasis
Cvs :
Ms
Pah
Av malformations
Pulm embolism
Congenital: bronchial cyst
Collagen vasular diseases:
Chrug Strauss
Wegeners granulomatosis

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12
Q

Diff BTW hemoptysis and hemetemesis

A

Hemoptysis. Haematemesis
Cough present
Nausea vomiting
Frothing present
Alkaline pH. Acidic pH
Food particles
Bright red. Dark brown
Bronchoscopy. Gastroscopy

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13
Q

Causes of chest pain

A

Cardiac:
Angina
Mi
Pericarditis
Acute dissection of aorta
Resp:
Pleurisy
Chest wall:
Musculoskeletal pain
Neuropathi pain
Gi :
Reflux esophagitis
Hiatus hernia
Esophageal spasm

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14
Q

Pack years

A

Duration of smoking in years × numb of packets smoked a day
Each pack is 20 cigs
More than 40 is high risk malignancy

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15
Q

Smoking index

A

Numb of cigs per day × duration in yrs
More than 300 high risk

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16
Q

Occupational diseases

A

Bagassosis- sugarcane
Farmers lung- mouldy hay
Malt workers lung- barley
Coal workers pneumoconiosis- coal workers
Silicosis- sand blasting
Asbestosis- mining
Byssinosis- cotton mills
Beryllosis: aerospace industries

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17
Q

Bifurcation of trachea at

A

Anteriorly sternal angle
Posteriorly t4-t5 intervertebral disc

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18
Q

Lymphatic drainage of lung

A

Parietal pleura- axillary lymph nodes
Right lung and left lower lobe - right supraclavicular node
Left upper lobe- left supraclavicular node

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19
Q

Shape of chest

A

Pectus carinatum
Pectus excavatum
Barrel shaped(emphysema)
Flat chest
Bulging chest( pleural effusion,tumour,pneumothorax)
Depression of chest- fibrosis,collapse,pleural adhesions

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20
Q

Normal resp rate

A

12-20 b/min
1:4 ratio with pulse

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21
Q

Causes of tachypnea

A

Exertion
Fever
Acidosis
Anoxia
Anemia
Hysteria

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22
Q

Causes of bradypnea

A

Narcotic poisoning
Alkalosis
Hypothyroidism
Raised ict

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23
Q

Causes of cheynes stokes breathing

A

Cardiac failure
Renal failure
Narcotic poisoning
Raised ict

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24
Q

Pathophysiology of cheynes stoke breathing

A

Anoxmic conditions- abolishment of spontaneous rythmic activity - apnea- increased pCo2- respiratory centre stimulation - hyperventilation - decreased pCo2- depressed resp centre- anoxmic condition

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25
Causes of kussmals breathing
Diabetic ketoacidosis Starvation Alcoholic keto acidosis Uremia Pontine lesion
26
Causes of biots rep
Meningitis
27
Causes of pursed lipped resp
Copd
28
Accessory muscles
Inspiration Sternocleidomastoid Scalene Trapezius Pectoralis Expiration Abdominal muscles Lattisimisus dorsi
29
Trailes sign
Undue prominence of clavicular head of sternocleidomastoid on the side of which trachea is deviated Investing later of deep fascia encloses both heads
30
Tactile vocal fremitus seen in
Increased- consolidation Decreased- plerual effusion, pneumothorax
31
Supraclavicular area also called
Kronigs isthmus
32
Different percussion notes
Normal- resonant Hyper resonant- pneumothorax Tympanic- stomach air bubble Impaired dull- fibrosis, consolidation,collapse Stony dullness- pleural effusion
33
Borders of kronigs isthmus
Medially scalenus muscle Laterally acromion process of scapula Anteriorly clavicle Posteriorly trapezius
34
Traubes space
6th superiorly Left mid ax laterally Left costal margin inf Boundaries Left side spleen Above left lung resonance Below left costal margin
35
Content of traubes space
Fundus of stomach
36
Causes of dullness in traubes space
Left sided pleural effusion Splenomegaly Fundal growth Enlarged left love of liver Massive pericardial effusion
37
Traube space shifted upwards in
Left diaphragmatic paralysis Left lower lobe collapse Fibrosis
38
Tidal percussion absent in
Diaphragmatic paralysis Right side pleural effusion Empyema Subdiaphragmatic abscess
39
Percussion tenderness seen in
Empyema
40
Straight line dullness seen in
Hydropneumothorax
41
S shaped curve of ellis
In moderate pleural effusion Uppermost dull in axilla Reason: capillary suction between two layers of pleura
42
Diff between vesicular and bronchial breath sounds
Ves. Bronchial Low pitch. High pitch Insp > exp. Insp=exp No pause. Pause Due to consolidation Due to Filtering effect of lung paranchyma
43
Types of bronchial breath sounds
Tubular: high pitched,consolidation,collapsed lung with patent bronchus above level of pleural effusion Cavernous: low pitched,thick walled cavity with communicating bronchus Amohoric: low pitch with high tone,superficial smooth walled cavity,bronchopleural fistula,tension pneumothorax
44
Types of vocal resonance
Bronchophony- consolidation,cavity comm with bronchus above level of pleural eff Egophony- nasal quality to tone of E to A sign, consolidation,cavity above pleural eff Whispering pectriliquoy- whispered voice heard loud and clear,pneumonic consolidation
45
What are rales
Short explosive sounds often described as bubbling or clicking Fine- from alveoli Coarse- from bronchioles and bronchus
46
Types of rales
Early insp- COPD Late insp- ild (pulm fibrosis, asbestosis-pulm edema) Mid insp- bronchiectasis Exp- chronic bronchitis
47
Reason for rales
Sudden changes in gas pressure related to sudden opening of previously closed small airways
48
Wheeze and types
Musical sounds associated with airway narrowing Exp polyphonic wheeze- asthma,COPD Fixed monophonic- localised narrowing,tumor or foreign body Insp - pulm fibrosis,fibrosinh alveolitis,asbestosis
49
Diff between pleural rub and crackles
Rub. Crcakles Superficial. Not superficial Continuous. Discontinuous Localised. Heard over large area Unaffected by cough. Affected Ass with pain. Not ass.
50
Post tussive suction seen in
Thin walled cavity comm with bronchus
51
Post tussive rales seen in
Cavity filled with thick material due to clearing of secretions
52
Succession splash seen in
Hydropneumothorax Diaphragmatic hernia Large cavity with air and fluid
53
De espines sign
Presence of high pitched tubular breath sounds and whispering pectriliquoy-below t3 spine in adults and t4 in children Due to mass in middle or posterior mediastinum
54
Gamma mediastinal crunch, hammans sign
Clicking rythmical sound synchronous with cardiac cycle Due to mediastinal emphysema
55
Campbell's sign
Inspiratory tracheal descent Seen in copd
56
Oliver's sign
Tracheal tug In aortic arch aneurysm False positive is mediastinal tumour attached to arch Fals negative is non pulsatile thrombosed aortic aneurysm
57
Diff between fibrosis and collapse
Fibrosis. Collapse Chronic. Sudden Clubbing. No clubbing Breath sounds dec. Absent Crackles. No added sounds Wasting. No wasting
58
Causes of lung collapse
Pneumothorax Neoplasm Pleural eff Foreign body Mucus plugs Enlarged lymph nodes
59
What is pneumonic consolidation
Exudative solidification of lung tissue
60
Classification of pneumonia
Primary Secondary. Bronchopneumonia Hap Aspiration pneumonia
61
Pathological stages of pneumonia
Congestion- fine crackles Red hepatization- bronchial breath sounds Grey hepatization-bronchial breath sounds Resolution- coarse crackles
62
What is bronchiectasis
Chronic necrotizing infection of the bronchi and bronchioles leading to or associated with abnormal dilatation of airways
63
Mounler Kuhn syndrome
Tracheobronchomegaly
64
William Campbell syndrome
Bronchomalacia
65
Kartageners syndrome
Bronchiectasis Sinusistis Situa inversus
66
Young's syndrome
Idiopathic obstructive azoospermia Kartageners
67
Yellow nail syndrome
Lymphedema Yellow nails Pleural effusion
68
Chandra kheterpal syndrome
Levocardia Sinusitis Bronchiectasis but no ciliary abnormality
69
Types of bronchiectasis
Cylindrical Saccular Varicose Fusiform
70
Pathology of bronchiectasis
Infection- inflammatory damage to bronchial wall- dilatation- collapse - collection of secretion- infection- inflammatory change to bronchial wall- dilatation
71
Bronchiectasis sicca
Only hemoptysis No sputum In tb Upper lobe
72
Brocks syndrome
Middle live bronchiectasis Obstruction of right middle lobe bronchus by lymph node Seen as sequelae of primary tb
73
Why s right middle lobe bronchus involved in brocks syndrome
Narrow Surrounded by group of lymph nodes Longer coarse Collateral ventilation
74
Pseudo bronchiectasis seen in
Pneumonic consolidation Tracheobronchitis Lung collapse
75
Traction tracheobronchitis seen in
ILD
76
Causes of pleural effusion
Transudate( CCF, cirrhosis, nephrotic syndrome,myxedema,pulm embolism) Exudate( infection,collagen vascular disease( wegeners granulomatosis,rheumatoid arthritis sle) uremia
77
Drug induced pleural effusion
Bromocriptine Amlodarone Nitrofurantoin Dantrolene
78
Groccos triangle
Triangle area of dullness at the base of opp lung due to passive collapse
79
Normal pleural fluid
25 ml
80
Pleural fluid detectable amount
300 ml
81
Pleural fluid glucose level less than 60 mg/dl
Bact infection Rheumatoid pleural eff Malignancy Tb
82
Pleural fluid increased amylase level
Pancreatic pleural eff Esophageal rupture Malignancy
83
Pleural fluid total white cell count > 10,000
Empyema Para pneumonic eff Pancreatitis Pulm EMB Malignancy Tb
84
Pleural fluid increased neutrophils
Pulm inf Pulm abscess Intra abd abscess
85
Pleural fluid increased lymphocytes
Tb Malignancy
86
Pleural fluid increased eosinophils
Hodgkins disease Fungal inf Parasitic Drugs- dantrolene,nitrofurantoin Trauma Pulm infarction
87
Pleural fluid pH<7
Systemic acidosis Esophageal rupture Rheumatoid pleurisy Tb Malignancy pleura Hemothorax
88
Needle for pleural biopsy
Abrams needle/ trucut needle
89
Classification of parapneuminic effusion
Class 1- non significant pleural effusion 2- typical parapneuminic effusion 3- borderline complicated parapneumonic eff 4- simple complicated parapneumonic eff 5- complex complicated parapneumonic eff 6- empyema 7- complex empyema
90
Indications for tube thoracostomy
Presence of gross pus in pleural space Culture positive Glucose<40g/dl pH<7 Loculations
91
Causes of chylothorax
Trauma Tb Congenital absence of thoracic duct Yellow nail syndrome Filariasis
92
Pseudochylothorax
Tb due to cholestrol crystals Rheumatoid arthritis
93
Causes of acute plueral eff
Acute pancreatitis Trauma Pulm EMB Esophageal rupture
94
DD of pleural eff
Thickened pleura Empyema Consolidation Massive collapse Bronchial ca Subphrenic abscess Liver abscess Hydatid cyst
95
Diff between thick pleural and pleural eff
Thick. Eff Long standing. Short Intcost space depressed. Bulging Impaired resonance. Stony dull No position change. Changes Ellis curve absent. Present No egophony-. Egophony- Rib crowding. No
96
Causes of empyema
Bronchiectasis Lung abscess Pneumonia Subphrenic abscess Liver abscess Trauma
97
Classification of ca lung
Benign Coin lesion on xray Malignant Primary Bronchogenic ca Bronchial ca Adenoid cystic ca Mucoepidermoid ca Fibrosarcoma ca Leiomyoma Lymphoma Carcinoid Secondary
98
Tnm staging of lung ca
T T1- <=3 cm T2- >3 or involves main bronchus >=2 cm distal to carina T3- involves main bronchus less than 2 cm from carina or involves chest wall or diaphragm T4- minimal pleural eff or invades mediastinum,heart,trachea,eoohagus,great vessels N N0- no nodal inv N1- ipsilateral hilar node N2- ipsilateral mediastinal and or subcarinal node N3- contralateral mediastinal,hilar or supraclavicular M M0- no distant metastasis M1- distant metastasis
99
Gohns focus
Subpleural focus of infection usually at lower border of upper lobe or upper border of lower lobe
100
Gohns complex
Gohns focus plus draining lymphatics plus hilar draining lymph nodes
101
Gohns lesion
Calcified gohns focus
102
Ranke complex
Calcified gohns complex
103
Assmans focus
Reactivated primary focus
104
Simon's focus
Focus of tb lesion formed at apices through hematogenous spread from assmans focus
105
Rich focus
Caseous subcortical focus in brain
106
Puhls lesion
Isolated lesion of chronic pulm tb in Apex of lung
107
Types of miliary tb
Pulmonary Septicemic Meningitic
108
Tuberculin test
Intradermal administration of tuberculin induces development of delayed hypersensitivity wich reaches maximum at 72 hrs Checked at 48 hrs Positive more than 10 mm Negative less than 5 mm In immuno comp,more than 5 is positive
109
False negative tuberculin test
Aids Hodgkins lymphoma Malnutrition Miliary tb Tb meningitis Immunosupp drugs Live viral vaccinations
110
Case definition of tb
New case- who has never had treatment for tb Relapse- declared cured in the past but became smear postive Treatment failure- smear positive while on treatment Return after default- smear postive after interupting treatment for 2 months Chronic case- smear positive after treatment Cured- neg smear after treatment
111
First line drugs for tb
Isoniazid Rifampicin Pyrazinamide Ethambutol Streptomycin
112
Side effects of isoniazid
Hepatitis Peripheral neuropathy Drowsiness
113
Side effects of rifampicin
Orange urine Thrombopenia Nausea vomiting
114
Side effects of ethambutol
Optic neuritis
115
Side effects of streptomycin
Hearing loss Ataxia Nystagmus Proteniuria
116
Second line drugs of tb
Amikacin Kanamycin Ethionamide Ofloxacin
117
ATT not used in pregnancy
Fluoroquinolones Ethionamide

General Med (10 decks)

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