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General Med > Resp Combanium > Flashcards

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
Q

Causes of kussmals breathing

A

Diabetic ketoacidosis
Starvation
Alcoholic keto acidosis
Uremia
Pontine lesion

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26
Q

Causes of biots rep

A

Meningitis

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27
Q

Causes of pursed lipped resp

A

Copd

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28
Q

Accessory muscles

A

Inspiration
Sternocleidomastoid
Scalene
Trapezius
Pectoralis
Expiration
Abdominal muscles
Lattisimisus dorsi

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29
Q

Trailes sign

A

Undue prominence of clavicular head of sternocleidomastoid on the side of which trachea is deviated
Investing later of deep fascia encloses both heads

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30
Q

Tactile vocal fremitus seen in

A

Increased- consolidation
Decreased- plerual effusion, pneumothorax

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31
Q

Supraclavicular area also called

A

Kronigs isthmus

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32
Q

Different percussion notes

A

Normal- resonant
Hyper resonant- pneumothorax
Tympanic- stomach air bubble
Impaired dull- fibrosis, consolidation,collapse
Stony dullness- pleural effusion

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33
Q

Borders of kronigs isthmus

A

Medially scalenus muscle
Laterally acromion process of scapula
Anteriorly clavicle
Posteriorly trapezius

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34
Q

Traubes space

A

6th superiorly
Left mid ax laterally
Left costal margin inf

Boundaries
Left side spleen
Above left lung resonance
Below left costal margin

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35
Q

Content of traubes space

A

Fundus of stomach

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36
Q

Causes of dullness in traubes space

A

Left sided pleural effusion
Splenomegaly
Fundal growth
Enlarged left love of liver
Massive pericardial effusion

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37
Q

Traube space shifted upwards in

A

Left diaphragmatic paralysis
Left lower lobe collapse
Fibrosis

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38
Q

Tidal percussion absent in

A

Diaphragmatic paralysis
Right side pleural effusion
Empyema
Subdiaphragmatic abscess

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39
Q

Percussion tenderness seen in

A

Empyema

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40
Q

Straight line dullness seen in

A

Hydropneumothorax

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41
Q

S shaped curve of ellis

A

In moderate pleural effusion
Uppermost dull in axilla
Reason: capillary suction between two layers of pleura

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42
Q

Diff between vesicular and bronchial breath sounds

A

Ves. Bronchial
Low pitch. High pitch
Insp > exp. Insp=exp
No pause. Pause
Due to consolidation
Due to
Filtering effect of lung paranchyma

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43
Q

Types of bronchial breath sounds

A

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

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44
Q

Types of vocal resonance

A

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

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45
Q

What are rales

A

Short explosive sounds often described as bubbling or clicking
Fine- from alveoli
Coarse- from bronchioles and bronchus

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46
Q

Types of rales

A

Early insp- COPD
Late insp- ild (pulm fibrosis, asbestosis-pulm edema)
Mid insp- bronchiectasis
Exp- chronic bronchitis

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47
Q

Reason for rales

A

Sudden changes in gas pressure related to sudden opening of previously closed small airways

48
Q

Wheeze and types

A

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
Q

Diff between pleural rub and crackles

A

Rub. Crcakles

Superficial. Not superficial
Continuous. Discontinuous
Localised. Heard over large area
Unaffected by cough. Affected
Ass with pain. Not ass.

50
Q

Post tussive suction seen in

A

Thin walled cavity comm with bronchus

51
Q

Post tussive rales seen in

A

Cavity filled with thick material due to clearing of secretions

52
Q

Succession splash seen in

A

Hydropneumothorax
Diaphragmatic hernia
Large cavity with air and fluid

53
Q

De espines sign

A

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
Q

Gamma mediastinal crunch, hammans sign

A

Clicking rythmical sound synchronous with cardiac cycle
Due to mediastinal emphysema

55
Q

Campbell’s sign

A

Inspiratory tracheal descent
Seen in copd

56
Q

Oliver’s sign

A

Tracheal tug
In aortic arch aneurysm
False positive is mediastinal tumour attached to arch
Fals negative is non pulsatile thrombosed aortic aneurysm

57
Q

Diff between fibrosis and collapse

A

Fibrosis. Collapse

Chronic. Sudden
Clubbing. No clubbing
Breath sounds dec. Absent
Crackles. No added sounds
Wasting. No wasting

58
Q

Causes of lung collapse

A

Pneumothorax
Neoplasm
Pleural eff
Foreign body
Mucus plugs
Enlarged lymph nodes

59
Q

What is pneumonic consolidation

A

Exudative solidification of lung tissue

60
Q

Classification of pneumonia

A

Primary
Secondary.
Bronchopneumonia
Hap
Aspiration pneumonia

61
Q

Pathological stages of pneumonia

A

Congestion- fine crackles
Red hepatization- bronchial breath sounds
Grey hepatization-bronchial breath sounds
Resolution- coarse crackles

62
Q

What is bronchiectasis

A

Chronic necrotizing infection of the bronchi and bronchioles leading to or associated with abnormal dilatation of airways

63
Q

Mounler Kuhn syndrome

A

Tracheobronchomegaly

64
Q

William Campbell syndrome

A

Bronchomalacia

65
Q

Kartageners syndrome

A

Bronchiectasis
Sinusistis
Situa inversus

66
Q

Young’s syndrome

A

Idiopathic obstructive azoospermia
Kartageners

67
Q

Yellow nail syndrome

A

Lymphedema
Yellow nails
Pleural effusion

68
Q

Chandra kheterpal syndrome

A

Levocardia
Sinusitis
Bronchiectasis but no ciliary abnormality

69
Q

Types of bronchiectasis

A

Cylindrical
Saccular
Varicose
Fusiform

70
Q

Pathology of bronchiectasis

A

Infection- inflammatory damage to bronchial wall- dilatation- collapse - collection of secretion- infection- inflammatory change to bronchial wall- dilatation

71
Q

Bronchiectasis sicca

A

Only hemoptysis
No sputum
In tb
Upper lobe

72
Q

Brocks syndrome

A

Middle live bronchiectasis
Obstruction of right middle lobe bronchus by lymph node
Seen as sequelae of primary tb

73
Q

Why s right middle lobe bronchus involved in brocks syndrome

A

Narrow
Surrounded by group of lymph nodes
Longer coarse
Collateral ventilation

74
Q

Pseudo bronchiectasis seen in

A

Pneumonic consolidation
Tracheobronchitis
Lung collapse

75
Q

Traction tracheobronchitis seen in

A

ILD

76
Q

Causes of pleural effusion

A

Transudate( CCF, cirrhosis, nephrotic syndrome,myxedema,pulm embolism)
Exudate( infection,collagen vascular disease( wegeners granulomatosis,rheumatoid arthritis sle) uremia

77
Q

Drug induced pleural effusion

A

Bromocriptine
Amlodarone
Nitrofurantoin
Dantrolene

78
Q

Groccos triangle

A

Triangle area of dullness at the base of opp lung due to passive collapse

79
Q

Normal pleural fluid

A

25 ml

80
Q

Pleural fluid detectable amount

A

300 ml

81
Q

Pleural fluid glucose level less than 60 mg/dl

A

Bact infection
Rheumatoid pleural eff
Malignancy
Tb

82
Q

Pleural fluid increased amylase level

A

Pancreatic pleural eff
Esophageal rupture
Malignancy

83
Q

Pleural fluid total white cell count > 10,000

A

Empyema
Para pneumonic eff
Pancreatitis
Pulm EMB
Malignancy
Tb

84
Q

Pleural fluid increased neutrophils

A

Pulm inf
Pulm abscess
Intra abd abscess

85
Q

Pleural fluid increased lymphocytes

A

Tb
Malignancy

86
Q

Pleural fluid increased eosinophils

A

Hodgkins disease
Fungal inf
Parasitic
Drugs- dantrolene,nitrofurantoin
Trauma
Pulm infarction

87
Q

Pleural fluid pH<7

A

Systemic acidosis
Esophageal rupture
Rheumatoid pleurisy
Tb
Malignancy pleura
Hemothorax

88
Q

Needle for pleural biopsy

A

Abrams needle/ trucut needle

89
Q

Classification of parapneuminic effusion

A

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
Q

Indications for tube thoracostomy

A

Presence of gross pus in pleural space
Culture positive
Glucose<40g/dl
pH<7
Loculations

91
Q

Causes of chylothorax

A

Trauma
Tb
Congenital absence of thoracic duct
Yellow nail syndrome
Filariasis

92
Q

Pseudochylothorax

A

Tb due to cholestrol crystals
Rheumatoid arthritis

93
Q

Causes of acute plueral eff

A

Acute pancreatitis
Trauma
Pulm EMB
Esophageal rupture

94
Q

DD of pleural eff

A

Thickened pleura
Empyema
Consolidation
Massive collapse
Bronchial ca
Subphrenic abscess
Liver abscess
Hydatid cyst

95
Q

Diff between thick pleural and pleural eff

A

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
Q

Causes of empyema

A

Bronchiectasis
Lung abscess
Pneumonia
Subphrenic abscess
Liver abscess
Trauma

97
Q

Classification of ca lung

A

Benign
Coin lesion on xray
Malignant
Primary
Bronchogenic ca
Bronchial ca
Adenoid cystic ca
Mucoepidermoid ca
Fibrosarcoma ca
Leiomyoma
Lymphoma
Carcinoid
Secondary

98
Q

Tnm staging of lung ca

A

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
Q

Gohns focus

A

Subpleural focus of infection usually at lower border of upper lobe or upper border of lower lobe

100
Q

Gohns complex

A

Gohns focus plus draining lymphatics plus hilar draining lymph nodes

101
Q

Gohns lesion

A

Calcified gohns focus

102
Q

Ranke complex

A

Calcified gohns complex

103
Q

Assmans focus

A

Reactivated primary focus

104
Q

Simon’s focus

A

Focus of tb lesion formed at apices through hematogenous spread from assmans focus

105
Q

Rich focus

A

Caseous subcortical focus in brain

106
Q

Puhls lesion

A

Isolated lesion of chronic pulm tb in Apex of lung

107
Q

Types of miliary tb

A

Pulmonary
Septicemic
Meningitic

108
Q

Tuberculin test

A

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
Q

False negative tuberculin test

A

Aids
Hodgkins lymphoma
Malnutrition
Miliary tb
Tb meningitis
Immunosupp drugs
Live viral vaccinations

110
Q

Case definition of tb

A

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
Q

First line drugs for tb

A

Isoniazid
Rifampicin
Pyrazinamide
Ethambutol
Streptomycin

112
Q

Side effects of isoniazid

A

Hepatitis
Peripheral neuropathy
Drowsiness

113
Q

Side effects of rifampicin

A

Orange urine
Thrombopenia
Nausea vomiting

114
Q

Side effects of ethambutol

A

Optic neuritis

115
Q

Side effects of streptomycin

A

Hearing loss
Ataxia
Nystagmus
Proteniuria

116
Q

Second line drugs of tb

A

Amikacin
Kanamycin
Ethionamide
Ofloxacin

117
Q

ATT not used in pregnancy

A

Fluoroquinolones
Ethionamide

General Med (10 decks)

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