Respiratory

Question 1

What does inspiratory noise imply?

Answer 1

Upper airway obstruction, common in kids with croup, not good if you hear it in an adult.

Question 2

What does wasting in the hands indicate?

Answer 2

May be an apical lung tumour affecting the brachial plexus.

Question 3

Where should you look for clubbing?

Answer 3

Hands and feet- sometimes it only shows up in the feet.

Question 4

What does peripheral cyanosis indicate?

Answer 4

Circulatory insufficiency- poor perfusion

Question 5

What does central cyanosis indicate?

Answer 5

Respiratory insufficiency- hypoxia

Question 6

What does a deviated trachea indicate?

Answer 6

Upper lobe pathology on the side it deviates to.

Question 7

What muscle wasting do you see in advanced lung disease?

Answer 7

Shoulder girdle

Question 8

What does an increased percussion note indicate?

Answer 8

Pneumothorax, hyperinflation, lung cyst

Question 9

What do decreased lung sounds indicate? (At least 5)

Answer 9

Consolidation, collapse, dense fibrosis, pleural fluid, thickening, elevated hemidiaphragm.

Question 10

What is atelectasis, what are 3 common causes, and who is the most at risk?

Answer 10

Atelectasis is; collapsed lung resulting in reduced or absent gas exchange.
Common causes: post-op, surfactant insufficiency, blocking of bronchioles via sputum plug, foreign body, tumour.
At risk: elderly, smokers

Question 11

When do you get wheeze?

Answer 11

Asthma, bronchitis, pulmonary oedema.

Question 12

Are wheezes usually inspiratory or expiratory?

Answer 12

Expiratory

Question 13

List 5 causes of crackles

Answer 13

Pulmonary oedema, pulmonary fibrosis, pneumonia, bronchiectasis, atelectasis

Question 14

How many seconds indicate significant airflow obstruction for FEV1?

Answer 14

6 seconds. It is normally less than 3.

Question 15

What is tripodding?

Answer 15

Using arms to help accessory muscles

Question 16

Does pulmonary hypertension cause cheek flushing?

Answer 16

Yes

Question 17

What signs would you find in examination of somebody with pulmonary hypertension?

Answer 17

Palpable RV grave and 2nd heart sound
Loud H2
4th heart sound
Pulmonary flow murmur.

Question 18

What signs would you find in examination of somebody with right heart failure?

Answer 18

Elevated JVP
3rd heart sound
Peripheral oedema, ascites, pleural effusions.

Question 19

Is the cough from diffuse lung disease usually productive or dry?

Answer 19

Usually dry

Question 20

What distinguishes diffuse lung disease from other lung disease patterns?

Answer 20

Diffuse disease usually involves either or both the alveoli or the interstitium, including the pulmonary vasculature.

Question 21

What acute processes cause a diffuse lung pattern?

Answer 21

Water- pulmonary oedema from altered Starling forces.
Inflammation- acute inhalation injury from toxic fumes, acute drug toxicity or infection.
Blood-diffuse leakage from inflamed vessels in vasculitis

Question 22

What are the physiological effects of acute alveolar and interstitial filling or inflammation?

Answer 22

Loss of elastic recoil- stiff lungs
Tachynoea
Cough
Increased WOB
Usually severe dyspnoea
Severe hypoxia due to serious V/Q impairment.

Question 23

What is sarcoidosis and with what 3 abnormalities can it typically present?

Answer 23

Sarcoidosis is a multi system (non caseating) granulomatous disorder which typically affects the lungs, skin and lymph nodes.
Typically presents with; bilateral hilar adenopathy, pulmonary reticular opacities, skin, joint, and/or eye lesions.

Question 24

Name the 2 most common interstitial lung diseases

Answer 24

Idiopathic pulmonary fibrosis and sarcoidosis.

Question 25

Name some causes of interstitial lung disease.

Answer 25

Asbestos
Occupational exposure to birds, chemicals etc.
Drugs- chemotherapy and antibiotics eg. Methotrexate, amiodarone, bleomycin, nitrofurantoin- Ola but still used for recurrent UTIs
Radiotherapy
Connective tissue disease
Vasculitis

Question 26

Name 4 signs of inflammatory pain and 3 connective tissue diseases that they would be associated with which lead to pulmonary fibrosis.

Answer 26

Fever, joint pain, morning stiffness, rash. 
Systemic sclerosis
Rheumatoid arthritis
SLE
Polymyositis

Question 27

What test do you perform if you’re looking for lung cancer?

Answer 27

Chest CT

Question 28

What test do you perform if looking for PE?

Answer 28

CT Pulmonary angiogram

Question 29

What test would you perform if someone presented with significant haemoptysis?

Answer 29

CT bronchial angiogram.

Question 30

Which test is especially relevant in connective tissue disorders?

Answer 30

ECG- may identify LV dysfunction. Assess for presence of pulmonary hypertension.

Question 31

What do Kerley B lines indicate?

Answer 31

Pulmonary oedema.

Question 32

What does honeycomb lung indicate?

Answer 32

Idiopathic pulmonary fibrosis. It is a marker of severity.