Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

BPT Clinical Exam Prep > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What does a bovine cough suggest?

A

Vocal cord palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

At what SaO2 does central cyanosis start to become visible?

A

SaO2 <90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does COPD result in clubbing?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the cardiovascular causes of clubbing?

A

Cyanotic/congential heart disease and infective endocarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the respiratory causes of clubbing?

A

MOST COMMON: Lung cancer (but not usually small cell as it develops too quickly). Chronic pulmonary suppuration: bronchiactasis, lung abscess, empyema. Also idiopathic pulmonary fibrosis (and a lesser extent, other interstitial lung disease).
LESS COMMON: asbestosis, cystic fibrosis, pleural mesothelioma or pleural fibroma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the GI causes of clubbing?

A

cirrhosis, IBD, coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the name of the process that leads to clubbing that also can cause detectble arthropathy at the wrist?

A

Hypertrophic pulmonary oestoarthropathy. Presents as periosteal inflammation at the distal ends of long bones and can be detected by palpating the distal ends of the radial and ulnar bones, but also the ankles and metacarpal/metatarsal bones.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Other than asterixis, what might be found in the hypercapnoeaic patient?

A

Confusion, warm peripheries and bounding pulse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the triad of signs that comprises a Horner’s syndrome?

A

Ptosis, miosis (pupil constriction) and anhidrosis of the affected side.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the cause of a Horner’s syndrome?

A

Hypothalamus lesion
Lateral medullary syndrome
C-spine disease
Lung malignancy
Lower brachial plexopathy
Carotid aneurysm
Thyroid lesions
Neck lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What muscle closes the upper and lower lids and what innervates this muscle?

A

Orbicularis oculi. Innervated by the seventh (facial) nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What muscle opens the upper eye lid and what innervates this muscle?

A

The levator palpedbrae superioris. Innervated by the third (occulomotor) cranial nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Mullers muscle?

A

It’s the little muscle that opens the eye really wide when someone looks shocked. It’s innervated by the sympathetic nervous system, and becomes paralysed when the sympathetic chain is paralysed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Horner’s syndrome is caused by what?

A

Unilateral defect of the sympathetic innervation of the head and neck. This can occur as a result of a lesion anywhere along this tract from the hypothalmus, into the brainstem, down the spine to the T1 level, then up through the sympathetic chain, via the neck along the carotid and jugular veins or in the face.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the differential cranial nerve deficit for a unilateral ptosis if not Horner’s syndrome?

A

CNIII nerve palsy, however this would also cause issues with extraocular muscles leading to a down and out appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pathologies lead to tracheal deviation towards the lesion?

A

Upper lobe collapse, upper lobe fibrosis, pneumonectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What pathologies lead to tracheal displacement away from the side of a lung lesion?

A

Massive pleural effusion or tension pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the types of added breath sounds?

A

Wheezes (continuous),crackles (interrupted), and rubs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the significance of polyphonic vs monophonic wheeze?

A

Polyphonic wheezes are the result of multiple foci of airway narrowing in say COPD or asthma. A monophonic wheeze suggests a single narrowing of an airway producing a single note - e.g. with a intrabronchial malignancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the significance of early, vs mid-late vs pan inspiratory crackles?

A

Early only crackles are heard in small airways, rather than alveolar, disease such as COPD and cease by mid inspiration. Mid-late or pansystolic crackles suggest disease isolated to the alveoli. These mid-late or pansystolic crackles can then be further characterised as fine, medium or coarse. Numerous fine crackles are classic of interstitial lung disease. Medium crackles are usually due to pulmonary oedema. Coarse crackles suggest signifcant intra-airway secretions impacting on normal alveolar function seen in diseases such as bronchiectasis or pneumonia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the differentials for a pleural friction rub?

A

Pneumonia, pulmonary infarction. Rarely, malignancy, spontaneous pneumothorax.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What does increased vocal resonance indicate?

A

Increased tissue density that is able to transmit higher pitch sounds. This usually indicates consolidation secondary to infection or other cause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What components of the cardiac exam should be included routinely as part of respiratory exam?

A

JVP, palpate for right heart dysfunction (heaves and thrills), auscultate for P2, look at the legs for pulmonary oedema or evidence of DVT, examine the liver the displacement inferiorly due to COPD and tendorness or pulsatility due to right heart failure with TR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which way does the trachea go in unilateral atelechtasis?

A

Deviation towards the atelectasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is Light's criteria?
Exudate criteria requires ONE of the following: 1. pleural fluid/serum protein >0.5, OR 2. pleural fluid/serum LDH >0.6, OR 3. pleural fluid LDH >2/3 normal upper limit for serum LDH.
26
Differentials for transudate pleural effusion?
Cardiac failre Hypoalbuminaemia (e.g. secondary to nephrotic syndrome, liver disease or malignancy) Hypothyroidism Meig's syndrome
27
Differentials for exudative pleural effusion?
Pneumonia Malignancy TB Pulmonary infarction Pancreatitis Connective tissue disease including RA and SLE Some cytotoxic medications Radiotherapy Trauma Meig's syndrome Pseudo Pseudo Meig's - raised CA125, ascites and pleural effusion in a pt with SLE.
28
What is Meig's syndrome?
Benign ovarian tumour accompanied by exudative pleural effusion and ascites. The ascites and effusion resolve when the tumour is removed. Why ascites and pleural effusion accompany a benign ovarian tumour is not understood. Theories unclud thoraci ductal obstruction, tumour production of excess VEGF and other random things. It is a diagnosis of exclusion and can only be diagnosed after the tumour is removed and the third spaced fluid collections resolve.
29
Differentials for chylothorax?
Thoracic duct injury from trauma Thoracic duct injury from malignancy
30
Empyema differentials
Pneumonia Lung abscess Bronchiectasis TB Penetrating chest wound
31
What is Yellow Nail Syndrome?
Rare condition caused by lymphatic system hypoplasia. It's associated with pleural effusion, bronchiectasis and lower limb lymphoedema.
32
Causes of secondary pneumothorax?
Medical intervention Emphysema bullae rupture - older pts Asthma - when severe Lung abscess Eosinophilic granuloma Lymphangioleimyomatosis - pre-menopausal women Marfan's syndrome End stage pulmonary fibrosis
33
What the congential causes of bronchiectasis?
Cystic fibrosis Primary ciliary dyskinesia Congential hypogammaglobulinaemia
34
What are the acquired causes of bronchiectasis?
Recurrent childood infections (esp whoping cough, pneumonia or measles) Localised disease such as foregin body aspiration, bronchial adenoma or TB Allergic bronchopulmonary aspergillosis (ABPA - causes proximal bronchiectasis).
35
What is Hoover's sign?
Paradoxical coming together of the thumbs over the sternum during inspiration. Sensitive and specific for COPD.
36
What diseases typically lead to upper lobe predominant pulmonary fibrosis?
SCART S- silicosis and sarcoidosis C - coal workers pneumoconiosis, cystic fibrosis, chronic allergic alveolitis, chronic eosinophilic pneumonitis A - ankylosing spondylitis, alleric bronchopulmonary aspergillosis, alveolar haemorrhage syndromes R - radiation T - tuberculosis
37
What diseases typically lead to lower lobe predominant pulmonary fibrosis?
RASIO R - rheumatoid arthritis A - asbestosis, acute allergic alveolitis, acute eosinophilic pneumonitis S - scleroderma I - idiopathic intersitital fibrosis O - other including drugs - amiodarone, nitrofuantoin, hydralazine, methotrexate, bleomycin, busulfan
38
What are the most likley endocrine phenomena associated with lung malignany?
Hypercalcaemia secondary to PTH like protein (most common in squamous cell carcinomas), hyponatraemia secondary to ADH release (most common in small cell carcinoma), ectopic ACTH secretion (small cell carcinoma), carinoid syndrome secondary to 5-HT secretion from NET tumours, gynaecomastia secondary to gonadotrophin secretion from squamous cell carcinomas, and rarely hypoglycaemia from insulin-like peptide secretion from squamous cell carcinomas.
39
What is Eaton-Lambert syndrome? How does it relate to cancer?
Progessive muscle weakness that improves on repeititve movements due to an antibody targeting pre synaptic voltage gated calcium at the neuromuscular junction - causes reduced ACh release and muscle weakness. Associated with small cell carcinoma or thymoma.
40
What paraneoplastic neurological syndromes or muscular diseases are associated with small cell lung cancer?
Lambert-Eaton syndrome, retinal blindness, peripheral neuropathy, subactue cerebellar degeneration, polymyositis.
41
What haematoligcal paraneoplastic phenomona are associated with lung cancer?
Migrating venous thrombophlebitis DIC Anaemia
42
What are the pulmonary features of sarcoidosis?
80% have pulmonary disease Hilar lymphadenopathy ILD - upper lobe predominant Non-caseating granulomas
43
What the extrapulmonary signs of sarcoidosis?
Skin - lupus pernio (violaceous patches on the face, nose fingers or toes), pink nodules and plaques in old scars, erythema nodosum on the shins. Eyes: anterior uveitis Lymp nodes: generalised adenopathy Liver and spleen: enlarged Parotids: enlarged CNS - cranial nerve lesions. The most commonly affected is nerve VII. MSK - arthralgia, dactylitis Heart - heart block, cor pulmonale Endocrine - hypercalcaemia
44
Name this flow volume loop
Normal flow volume loop
45
Describe this - what could cause it?
Variable extrathoracic obstruction leading to normal expiratory FEV1 and FVC with flat with slow inspiratory flow with normal inspiratory volume. Causes include vocal cord paralysis, tracheomalacia of the extrathoracic trachea, large airway neoplasm.
46
Describe this - what could cause it?
Variable intrathoracic obstruction. Occurs with tracheal or large airway masses that collapse with forced expiration. Can also be the behavious of tracheomalacia.
47
Describe this - what could cause it?
Fixed upper airway obstrction (can be intrathoracic or extrathoracic). Flow limitation throughout inspiration and expiration.
48
Describe this - what could cause it?
Peripheral or lower airways obstruction - the 'scooped out' pattern. Typical of uncontrolled asthma or COPD.
49
What are the features on spirometry of restrictive lung disease?
Preserved FEV1/FVC ratio (>0.7) with reduced total FEV1 and reduced FVC. Reduced total lung capacity.
50
What effect does being a current smoker have on the DLCO in PFTs?
Substantially lowers it.
51
What does DLCO do in obstructive airways disease?
Typically, a low DLCO in a patient with obstructive flow volume loops has emphysema. In COPD, the DLCO reduction usually followed the FEV1 reduction.
52
How is DLCO helpful in patients with restrictive PFT FEV/FVC values?
Reduced DLCO suggests that the restriction is due to intrapulmonary disease such as ILD or pneumonitis. A normal DLCO with a restrictive lung pattern sugests an extrapulmonary cause of restriction such as kyphoscoliosis or neuromuscular weakness.
53
What is the differential for low DLCO with normal other spirometry values?
Pulmonary vascular disease such as pulmonary embolus, pulmonary hypertension, and vasculitis. Early ILD Anaemia Hepatmopulmonary syndrome Increase circulating carboxyhaemoglobin Pneumonectomy
54
What is the differential for increased DLCO?
Obesity Asthma High altitude Polycythaemia Pulmonary haemorrhage Left to right intracardiac shunt Mild heart failure Exercise
55
What is the differential for pleural fluid with pH < 7.2?
Empyema, tubuculosis, neoplasm, rheumatoid arthritis, oesophageal rupture
56
What is a differential for pleural fluid Glucose <3.33?
Infection, carcinoma, mesothelioma, rheumatoid arthritis
57
Red blood cells > 5000 / mL in pleural fluid suggests what?
Pulmonary infarction, neoplasm, trauma, asbestosis, tuberculosis, pancreatitis
58
Amylase > 2000 U/L in pleural fluid analysis suggests what?
Pancreatits, abdominal viscera rupture, oesophageal rupture
59
Complement levels decreased in pleural fluid indicate what as the cause of an effusion?
Rheumatoid arthritis, SLE
60
What is the differential diagnosis for bronchial breath sounds?
Lobar pneumonia Localised fibrosis or collapse Above a pleural effusion A large lung cavity
61
What is the differential for reduced breath sounds?
Emphysema Large lung mass Collapse (fibrosis or pneumonia) Effusion Pneumothorax
62
What are the differentials for an inspiratory wheeze?
Asthma Upper airway extrathoracic obstruction
63
What the differentials for an expiratory wheeze?
Asthma COPD
64
On CXR, what is the differential for a homogenous opacity?
Pneumonia Collapse Effusion
65
On CXR, what is th differential fo a localised non-homogenous opacity?
Pneumonia Pulmonary infarct Carcinoma Tuberculosis
66
On CXR, what are the differentials for miliary (<2mm) diffuse opacites?
Miliary TB Miliary metastesis (esp breast, thyroid, melanoma, pancreas) Sarcoidosis Pneumoconiosis Lymphoma Lymphangitis Viral pneumonia Vasculitis Pulmonary haemorrhage
67
On CXR, what are the differentials for nodular 3-10mm diffuse opacities?
Pneumonia Pneumoconiosis Tuberculosis Metastatic carcinoma Sarcoidosis
68
On CXR, what are the differential diagnoses for reticular opacities?
Fibrosis Bronchiectasis
69
On CXR, what is the differential diagnosis for a cavitated lesion?
Lung abscess Carcinoma (usuall SCC) Hodgkin lymphoma TB Fungal infections
70
On CXR, what is the differential for calcified lesions in lung fields?
Tuberculosis Pneumoconiosis Post-chickenpox pneumonia Tularaemia (infection from gram negative Francisella tularensis - in Australia ringtail possums are an important reservior. It is also transmitted by ticks and biting flies)
71
On CXR what is the differential for miliary (<2mm) calcifications?
Post-chickenpox pneumonia Histoplasmosis (Histoplasma capsulatum - fungus - bird and bat droppings or soil) Coccidioidomycosis (fungal infection from soil, not endemic in Australia, normally from california) Ectopic calcification in CKD or hyperparathyroidism (caclinosis)
72
On CXR, what is the differential diagnosis for a coin lesion?
Carcinoma (primary or metastatic) Tuberculoma Hamartoma Granuloma Arteriovenous fistula Rheumaotid nodule Lung abscess Hydatid cyst
73
Decribe this imaging
a) Right middle lobe bronchiectasis. Note the increased lung markings and the thickened bronchial walls (arrow). (b) CT scan of the chest of a patient with bronchiectasis. Note the thickened bronchial walls (arrow).
74
Describe this imaging
Right upper lobe fibrosis. Note the loss of volume and increased lung markings (arrow)
75
Describe this imaging
CT scan of chest showing pulmonary haemorrhage in a patient with Goodpasture’s syndrome.
76
Describe the finding in this imaging
Retrosternal goitre
77
Describe the findings in this imaging
Retrosternal mass thoracic aortic aneurysm (1) and pulmonary metastases (2).
78
Describe the imaging findings
(a) Chest X-ray showing granulomatosis with polyangiitis (GPA, or Wegener’s granulomatosis). Note infiltrates and destructive changes. (b) Lateral view. Note infiltrates and destructive changes.
79
Describe the imaging
Large left pleural effusion (arrow). Note previous left mastectomy.
80
Describe the imaging
(a) Sarcoidosis basal infiltrate (arrows). (b) Hilar lymphadenopathy (arrow)
81
What is the normal distance for chest expansion posteriorly?
>2.5cm
82
What amount of pleural fluid can be detected on a PA cxr?
180mls
83
How can you tell a PA from an AP XR?
AP scapulae are in the lung fields more than PA (this is the most reliable finding) AP ribs more parallel to the ground than PA AP heart is larger than would be expected AP the vertebrae are more easily visible through the heart.
84
What is the normal pH of pleural fluid?
7.6-7.64
85
What is the differential for a dull percussion note at the lower zone posteriorly?
Effusion Pleural thickening Collapse Consolidation Raised hemidiphragm Lower lobe lobectomy
86
What are the diagnostic criteria for a chylothroax?
White milky appearance Cholesterol > 4g/L
87
Differential for a chylothorax?
Lymphatic obsrtuction Lymphatic damage Nephrotic syndrome Cirrhosis
88
What special test is done on pleural fluid to detect tuberculosis?
Adenosine deaminase activity (>43units/mL 78% sensitive for TB)
89
What is 'traction' bronchiectasis?
Dilation and distortion of the airways due to surrounding fibrosis within the lung parenchyma. Seen in ILD.
90
Does COPD cause bronchiectasis?
Yes it can
91
What is the most common PFT finding in patients with bronchiectasis without fibrosis?
Obstructive when mild to moderate - can become restrictive once disease is severe.
92
What organism typically causes ABPA?
Aspergillus fumigatus
93
What is Kartagener's syndrome?
Primary ciliary disorder. Leads to respiratory infections (especiailly sinusitis) and bronchiectasis, infertility, and dextrocardia. Full sinus invertus in 50% of cases.
94
Which types of lung cancer have the greatest association with smoking?
Small cell lung cancer Squamous cell non-small cell lung cancer Note that the most likley lung cancer in non-smokers is adenocarcinoma
95
What is the typical makeup of malignant pleural effusion?
pH <7.3 Low glucose High protein Raised amylase Positive cytology Usually some red cells
96
What FEV1is a relative contraindication to surgical resecetion?
<1.5L
97
What paraneoplastic syndromes have been associated with lung cancer?
SIADH Cushing syndrome Hypercalcaemia Hyperthyroisdism Hypoglycaemia Lambert Eaten (pre-synaptic voltage gated calcium channel abs) Sensory neuropathy (anti-hu) Subacute cerebellar degeneration (anti-yo, antipurkinje cell antibody) Limbic encephalopathy (anti-hu, and anti-yo abs) Dermatomyositis Acanthosis nigracans Gynaecomastia (ectopic b-hcg)
98
What are the indications for a lobectomy?
Bronchiectasis with uncontrolled haemoptysis Malignancy Solitary pulmonary nodule of unknown cause Cystic fibrosis Tuberculosis Lung abscess
99
What are the indications for a pneumonectomy?
Malignancy Bronchiectasis with uncontrolled symptoms Tuberculosis
100
What are the complications of chronic tuberculosis?
Pulmonary fibrosis Bronchiectasis Cor pulmonale Aspergilloma Reactivation
101
When is a tuberculin skin testing most valuable?
For screening asymptomatic contacts of active patients AND who are not BCG vaccinated AND whoe have not previously had a mycobacterial infection
102
What is the aetiology of primary pneumothoracies?
Rupture of apical pleural blebs under the visceral pleura. Usually, young, tall men who smoke.
103
What types of lung disease can result from rheumatoid arthritis?
Bronchiolitis obliterans Bronchiectasis Fibrosis Pleural effusion Pulmonary nodules
104
Is it sensitive to sample pleural fluid for TB?
No, need to culture pleural biopsy.
104
Is it sensitive to sample pleural fluid for TB?
No, need to culture pleural biopsy.
105
What does vocal resonance over a pleural effusion?
Reduces, becomes more muffled
106
What does vocal resonance do over a pneumothorax?
Reduces
107
At what thoracic level is the carina?
T4/T5
108
At what thoracic level does the oblique fissure start?
T4/T5 posteriorly
109
At what point does the oblique fissure intersect the horizontal fissure of the right lungs? (surface anatomy)
The intersection between the 5th rib the mid-axillary line. The oblique fissure continues in the same line, and the horizontal fissure goes directly towards the sternum parallel to the ground and meets the sterum at the 4th costochondrosternal joint.
110
What's this?
Pleural effusion. Note the steep meniscus.
111
What's this?
Hydropneumothorax. Note the loss of meniscus - flat line on top of the pleural effusion.

BPT Clinical Exam Prep (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions