Resp Corrections Flashcards
1
Q
What is a palpable reference point that can be used in BEC?
a) Right 4th rib
b) Rib 2
c) Rib 6
d) Superior to the clavicle
e) Between right ribs 4 and 6
f) 2nd intercostal space
g) T11 vertebra
h) Xiphoid process
i) T3 vertebra
j) 5th intercostal space
A
Xiphoid process
2
Q
What site is used in decompressing a tension pneumothorax?
A
2nd intercostal space
3
Q
Whta increase pulmonary ventilation more resp rate or tidal volume?
A
tidal volume
4
Q
What is an anatomical landmark for cardiopulmonary resusitation?
A
xiphoid process
5
Q
What respiratory pathogen, if present in a patient with CF, is a contraindication for a lung transplant?
A
Burkholderia cenocepacia
6
Q
what is a common pulmonary manifestation of aspergillus infection?
A
allergic asthma
7
Q
what is normally seen in the emergency department for CF pneumothorax/PE?
A
pneumothorax
8
Q
what is a test where pilocarpine is administered aka?
A
sweat test
9
Q
what type of respiratory failure are you at risk for with OSA?
A
respiratory failure 2
10
Q
what antibiotic is a contraindication for theophylline?
A
ciprofloxacin
11
Q
what is the mechanism of action for aminophylline?
A
binds to adenosine receptors and blocks the action of adenosine mediated bronchoconstriction
12
Q
what arterial blood gas finding would you find for maple syrup disease?
A
metabolic acidosis
13
Q
On the rigjht side of the patients chest, which one of the following surface landmarks would most likely mark the boundary between the middle and lower lobes?
a) fourth costal cartilage
b) horizontal line at level of sternal angle
c) horizontal line at the level of the nipple
d) ninth costal cartilage
e) sixth rib
A
e) sixth rib
14
Q
Name the respiratory causes of clubbing
A
empyema bronchiectasis pulmonary edema carcinomas (except small cell) CF fibrosis
15
Q
what is the +ve value in sweat test for CF?
A
chloride > 60mmol/L
16
Q
which asthma drug has an association with HYPOkalaemia?
A
salbutamol
17
Q
what organism is an individual likely to develop pneumonia from after recovering from influenza?
A
staph aureus
18
Q
where should a chest drain be inserted?
A
2nd intercostal space mid clavicular line
19
Q
what does a wedge shape on CXR indicate?
A
pulmonary infarction
ie a pulmonary embolism
20
Q
what pneumonia causative organism is likely found in student accomodation/ living spaces?
A
mycoplasma pneumoniae
21
Q
what is the most common lung cancer in patients who dont smoke?
A
adenocarcinoma
22
Q
what is miosis a symptom of?
A
horner’s syndrome
23
Q
name some transudates?
A
heart failure pericarditis cirrhosis malabsoprtion hypo thyroidism
24
Q
name some exudates?
A
infection, inflammation and malignancy
25
what is the ABG result for pnuemothorax in patients with chronic lung disease?
resp acidosis
26
where are pancoast tumours found and what do they invade?
apex of the lung
| bronchial plexus
27
what are the paraneoplastic syndromes for adenocarcinoma?
thromboplebitis
| fingerclubbing
28
what type of lung cancer is keratinising?
squamous cell carcinoma
29
what are the paraneoplastic syndromes of squamous cell carcinoma?
parathyroid hormone secretion
| hypercalcaemia
30
who are small cell carcinomas common in?
smokers
31
which lung cancer type has the worst prognosis?
small cell
32
what lung cancers have finger clubbing as a side effect?
adenocarcinoma
| mesothelioma
33
paraneoplastic syndromes of small cell cancer?
ACTH secretion -cushings syndrome
| ADH secretion- hypotraemia, increased fluid retention
34
What cancers get HPOA?
non small cell and mesothelioma
35
what nerve is affected if a hoarse voice is present?
recurrent laryngeal
36
symptoms of cushings?
fat deposits
muscle weakness
headache
glucose intolerance
37
what stages of cancer can get surgfery?
stage 0-3a
38
what is the score used for fitness for treatment in lung cancer?
ECOG
39
what disease has tramline and ring shadows on CXR and cystic shadowing?
bronchiectasis
40
is you see an orange shaped sign on CXR/CT what is it?
lung abscess
41
if you see a D sign on CXR what is the disease?
empyema
42
if you see a banana sign on CT what is it?
empyema
43
if a patient recovering from pneumonia still has a recuurant fever what should you expect the cause is?
a pleural effusion
44
if a patient is found to have haemolytic anaemia, what type of pneumonia?
mycoplasma
45
if someone has a bird what type of pneumonia?
chlamydia psittaci
46
what type of pneumonia for sheep workers or farmers?
coxiella burnetti
47
what type of pneumonia for alcoholics?
kleibsiella pneumonae
48
red jelly sputum indicates what?
kleibsiella pneumonia
49
rusty suptum indicates what?
pneumoccoal pneumonae
50
if the agar test comes back chocolatey for pneumonia what is it?
h. influenzae
51
what organism causes COPD exacerbation pneumonia?
h influenzae
52
if someone has pneumonia, dry cough and diahorrea what pneumonia is it?
legionella
53
what curb score is needed for hospitalisation?
2
54
what pneumonias do you need a urine test for?
LEGIONELLA AND PNEUMOCCOAL
55
what type of pneumonia for HIV?
pnemocyctis pneumonia
56
what type of pneumonia IV drug users?
endocarditis
57
what causes LRTI of CF?
pseudonomas aeroguinosa
58
antibiotics for severe HAP?
AGM
| amoxicillin gentamycin and metronizadole
59
d:diaphoresis
sweaty
60
name the 4 antibiotics used to treat TB and the management plan
```
rifampicin
isoniazid
pyrazinamide
ethambutol
2M all 4M RI
```
61
se of rimfampicin
orange pee
62
SE of isoniazid
neuropathy
63
SE pyrazanamide
joint pain
64
SE of ethambutol
colour blindness
65
what patients do you need to be wary of with rimfampicin?
warfarin and liver
66
what are the causative agents in TB/
```
mycobacterium:
tuberculosis
bovis
africans
microti
```
67
what is a gohn focus?
TB encapsulated by a granuloma made up of epitheliod and langerhans cells
68
what is a gohn complex?
ghon focus + lymph nodes
69
what lymph nodes are commonly affected in TB?
hilar
70
what type of hypersensitivity reaction is TB?
IV
71
what type of necrosis is present in TB?
caseous
72
what test do you do on sputum and what is result for TB?
zheil neelson and yellow/red/orange
73
what is auramine used to test for?
TB
74
if there was bilateral lymphadenopathy, scar tissue/granulomas on CXR what disease?
TB
75
what is are millet seed infiltrates on CXR indicative of?
miliary TB
76
when does TB become miliary?
when it has been reactivited the second time and spreads around lungs
77
type I resp failure is what?
hypoxia +/- low/normal CO2
78
what is hypoxia?
PaO2<8kPa
79
type II resp failure is what?
hypoxia + hypercapnia
80
common resp failure 1 diseases?
asthma, pulmonary odema, pneumonia, PE
81
common resp 2 failures?
myasthenia gravis, gullain barre syndrome, COPD exaceration, acute asthma, neuro problems
82
what tyoe of lung cancer most commonly cavitates?
squamous cell
83
what is the most common organism isolated from patients with bronchiectasis?
haemophilus influenza
84
what is the protein thats mutated in CF?
CFTR
85
what are the two mutations of CFTR in CF?
F508 del or G115D
86
Name the ILD for which you use the four C's?
IPF
87
What is a the pathology of IPF?
honeycombing
88
4c's of IPF?
progressive dry COUGH
CLUBBING
CYANOSIS
bilateral fine end CREPITATIONS
89
CXR results for IPF?
bilateral/lowerzone reticulonodular shadows
90
what happens to the lung volume in IPF?
decreases
91
what is the test everyone must get if IPF is suspected?
HRCT
92
ground glass appearance on HRCT?
early IPF
93
Honeycombing on HRCT?
late IPF
94
what lobes is IPF commonly found in?
lower lobes
95
PFTs for IPF?
restrictive
96
if the pathology result says Usual INterstital pneumonia- what is it?
IPF
97
is there is a antibody titre> 1:160 what is the cause of IPF?
collagen vascular disease
98
outline treatment for IPF?
antifibrotic drugs
O2
Lung transplant
Steroids/immunosupressant but not that useful
99
name 2 antifibrotic drugs?
pirfenidone and nintedanib
100
what type of resp failure do you get after IPF?
type 2
101
what type of hypersensitivity reaction is extrinisc allergic alveolitis?
type 3
102
what type of Ig complex is involved in pathology of EAA?
IgG
103
what causes bird fanciers lung/ pigeons?
avian/bird droppings (proteins found in here)
104
cause of farmers/mushroom/sugarcanes lung?
thermophilic actinomyocytes
105
what is the cause of malt/cheese workers lung?
fungus (aspergillus)
106
if the pathology report says hypersensitivity pneumonitis- what is it?
EAA
107
how many hours after exposure does a flu-like illness occur for EAA?
6-18hrs
108
is there wheeze in EAA?
no
109
what is acute CXR EAA?
patchy infiltrates
110
what is the chronic CXR EAA?
pulmonary fibrosis, commonly in UPPER ZONES
111
how do you tell difference between EAA chronic and IPF on CXR?
IPF is lower lobes
| EAA is Upper lobes
112
what do PFTs show for chronic EAA?
restrictive, but reversible and decreased TLCO
113
what would a lung biopsy show of EAA?
non-caseating granulomas
114
treatment for EAA?
remove antigen exposure
steroids
O2 poss antifibrotic drugs
115
what inhaled dust disease if mining/construction worker?
silica
116
what inhaled dust disease if underground mining?
coal
117
what inhaled dust disease if ore processing, workinh, nuclear bombs?
beryllium
118
what inhaled dust disease if shipyeard, roof, textiles?
asbestosis
119
what is UL round opacities on CXR if underground miner?
coal workers pneumoconiosis
120
what happens to DLCO in coal workers?
decreases
121
what is caplans syndrome?
rheumatoid arthritis and pneumoconiosis( especially coal workers)
122
CXR shows egg shell calcification of hilar lymph nodes?
silicosis
123
which is a more dangerous asbestos serpentine or amphibole?
amphibole
124
if someone has chest pain and pleural effusion with asbestos exposure what is it?
mesothelioma
125
clubbing is seen in asbestosis true/false
true
126
CXR and HRCT for asbestosis?
linera interstilial fibrosis
| bilateral plueral thickening and pleural plaques
127
PFTs for asbestosis?
restrictive or obstructive if patient has COPD
128
treatments plan for asbestosis?
stop smoking
supportive care- bronchodilators and antibiotics
pulmonary rehab
129
what type of hypersensitivity reaction is sarcoidosis?
type IV hypersensitvity
130
if the patient is black, has erythmateous nodular rash what is it?
sarcoidosis
131
what is it if bilateral hilar lymphadenopathy?
sarcoidosis
132
what may you see in a FBC for sarcoid?
increased ACE and raised Ca2+ levels
133
do small cell lung cancers cavitate?
nay
134
where is the trachea palpated?
suprasternal/jugular notch
135
where is the sternal angle/ angle of louis clinically palpable?
rib 2
136
where does larynx become trachea and pharynx become oeophageus?
C6
137
where does trachea bifurcate and what is it aka?
t5-7 and carina
138
give the 3 characteristics of horners syndrome?
MAP
Miosis
anhydrosis
ptosis
139
what antigen is present in squamous cell carcinoma?
p63
140
what is the narrowest part of the larynx where foreign bodies tend to block?
rima glottidis
141
asian man with night sweats, fever and weight loss?
TB
142
- T1DM with vomiting and not taking their insulin – dehydrated and deep labored breathing what is it?
metabolic acidosis, DKA, diabetatic keratosis
143
what is a thumprint sign on HEAD xr?
epiglottitis
144
what causes epiglottidis?
h influenze
145
what should epiglottidis be treated with?
ceftriaxone
146
what should you deffo not do in epglottidis?
toch with tongue depressor
147
where is resp rhythm established?
medulla
148
what does apneustic area do in pons?
prolong inspiration
149
what does pneumotaxic area do in pons?
inhibits inspiration
150
What is henrys law?
volume of the gas is proportional to the partial pressure of gas in equilibrium with liquid
151
what is coryza?
common cold
152
what do positive cold agglutinins indicate?
mycoplasma infection
153
what test would you do to look for bone mets?
99M Tc radionuclide bone scanning
154
what is samters triad?
asthma, salicylate sensitivity (aspirin) and nasal polyps
155
what causes centriacinar emphysema?
smoking
156
what causes panacinar emphysema?
A1AT
157
where is horizontal fissure?
rib 4
158
where is oblique fissure?
rib 6
159
what vein and artery supplies the anterior intercostal muscles?
internal thoracic artery/ vein
160
what vein and artery supplies the posterioir intercostal spaces?
throacic aorta ad azygous vein
161
what bone scan is used to diagnose osetoprosis?
DEXA
162
is bronchopneumonia neutrophilic or eosinophilic?
neutrophilic
163
how to differentiate between direct and indirect hernias?
on occlusion and cough, direct lump will reappear, indirect will not reappear
164
what disease is this the pathological descriptiojn for?
| Idiopathic inflammation of alveoli with thickening of alveolar walls
IPF
165
what disease is this the pathological description for?
| Reversible airway obstruction and bronchospasm
acute asthma
166
what disease is this the pathological description for?
| Non-caseating granuloma formation
sarcoid
167
what disease is this the pathological description for?
| Uncontrolled proliferation of epithelial cells in large airways of lung
cancerrrr
168
where are the peripheral chemoreceptors?
carotid and aortic arches
169
what do peripheral chemoreceptors respond to?
decrease O2, pH or an increase in CO2 and H+
170
what does serum tryptase mark?
mast cell degranulation ie immune response to allergen
171
what nerve travels infront of hilum?
phrenic
172
what nerve travels behind of hilum?
vagus
173
what muscles attach to ribs?
scalenes
174
what direction of external intercostal muscles run in?
direction of hand into pockets
175
where is the visceral pleura?
stuck to the lungs
176
if you cant see the R heart border which lobe is consolidated?
middle
177
if the lower lobe is consolidated what isn't seen on CXR?
hemidiaphragm
178
when looking at the hilum what is the most posterior bit?
bronchus
179
when looking at the hilum what is the most superior bit?
arteries
180
when looking at the hilum what is the most anterioir and inferioir bit?
pulmonary vein
181
in oxygen haemoglobin dissociation curve what isthe shape?
sigmoid
182
what does the steep bit indicate in oxygen dissociation curve?
when haemoglobin has a high affinity for O2
183
what does bohr effect do to oxygen haemoglobin dissociation curve?
shifts to right as increased CO2 so decreased affinity of haemoglobin for O2
184
if the oxygen haemoglobin curc=ve shifts to the left what does it indicate?
high affinity for O2 binding to haemoglobin
185
which ribs are true ribs?
1-7
186
which ribs are false ribs?
8-10
187
which ribs float?`
11 +12
188
where is sternal angle?
level of rib 2
189
hiw do you remember the openings of the diagphragm?
I 8 10 Eggs At 12
190
what type of muscle is the diagphragm?
skeletal
191
what nerve supllies the serratus anterior?
long throacic
192
paralysis of what nerve results in a winged scapula?
long throacic
193
what groove is the cephalic ein located in?
deltopectoral groove
194
what happens at the sternal angle?
trachea bifurcates
195
where do inguinal ligaments attach between?
ASIS and pubic tubercle
196
where do the anterior intercostal arteries come from?
branch of thoracic artery
197
where do posterior intercostal arteries come from?
branch of thoracic aorta
198
where do anterior intercostal veins drain into?
internal thoracic veins
199
where do posterior intercostal veins drain into?
azygous vein
200
how do you tell wether pulmonary artery/vein on CT?
arteries run beside bronchus
201
what is the first line treatment for acute respiratory distress?
CPAPA
202
what is step 2 in COPD treatment?
SABA and LAMA/LABA
203
what is step 2 asthma treatment?
ICS alone
204
what is treatment for bronchiolitisin baby?
supportive and bronchodialtor
205
what is antibiotic for klebsiella?
cefotaxime
206
what is the best test to screen for CF?
faecal elastase
207
what 2 drugs can cause pulmonary fibrosis?
azathoprine and bleomycin
208
pathophysiology of transudates?
increased hydrostatic pressure or low plasma oncotic pressure
209
pathophysiology of exudates
inflammation and increased capillary permeability
210
swinging fever?
abscess
211
apical disease?
most likely secondary Tb
212
Positive anti-glomerular basement membrane antibodies ?
goodpastures syndrome
213
steeple sign on CXR?
laryngotracheobronchitis/croup
214
mucoid sputum?
chlamydia pstattci
215
cannonball mets?
renal cell carcinma mets
216
morning headache?
hypercapnia or SE of organic nitrates
217
coin lesion on CXR could be what?
Primary bronchial or lung carcinoma, Metastatic tumour (esp. of kidney), Bronchial hamartoma, Carcinoid tumour, Granulomatous inflammation, Lung abscess.
218
snow storm appearance on CXR?
baritosis/ silicosis
219
1st line treatment for pertussis?
erythromycin
220
1st line treatment for croup?
steroids
221
1st line investigation for epigglotitids?
larynscope
222
treatment for epiglottidis?
intubation
223
aetiology for croup?
RNA virus eg RSV
224
aetiology for epiglottidis?
bacteria gm -ve eg haempphilus influenzae
225
goodpasters syndrome is what?
automimmune condition causing buildup of autoimmune proteins in the kidneys and lungs that leads to damage of these organs.
