Respiratory Flashcards
What is a common respiratory cause of Horner’s syndrome?
Lung carcinoma
What is ‘Pigeon chest’?
Congenital deformity of the anterior chest wall. Known as Pectus Carinatum
What can cause an apex beat?
RVH, Pleural effusion, tension pneumothorax
When will chest expansion be asymmetrical?
Pneumothorax, pneumonia, pleural effusion
When will chest expansion be reduced?
Pulmonary fibrosis.
What is the opposite of dull?
Hyperresonant
What could a hyperresonant sound signify?
Air within the pleural spaces e.g. pneumothorax
When would you hear a dull sound (hyporesonance)?
Tumours, pleural effusion.
What do we call a normal breath sound?
A vesicular sound
When can we see wheeze?
COPD,
Where are fine crackles heard compared with coarse crackles?
Coarse crackles = bass
Fine crackles =
In which patients may you see mesothelioma?
Asbestos exposure
Which respiratory conditions may you be looking for in inspection?
Kyphosis/ scoliosis.
What is the order of lung examination?
Lymph nodes, Inspection, palpation, percussion, auscultation.
Give causes of enlarged lymph nodes (lymphadenopathy)
Infection (Pneumonia, TB). Malignancy (Lung cancer).
Sarcoidosis
Which respiratory medication could tremor in the hand be caused by?
Salbutamol - beta 2 agonist
Name two respiratory issues that would cause us to want to inspect the mouth.
Central cyanosis
Oral candidiasis
Give a feature of Horner’s which could get an extra mark
Sunken eye - enopthalmos
Give x3 differences between carotid and JVP.
JVP is non palpable and biphasic.
JVP is readily occludable.
What might cause pleural thickening?
Asbestos.
What is the difference in tracheal shift in pneumothorax Vs. lobar collapse
Pneumothorax = opposite side
Lobar collapse = towards affected side.
What do you have to remember to ask the patient when auscultating their chest?
Breathe GENTLY in and out through MOUTH.
Are fine crackles usually heard on inspiration or expiration?
Inspiration.
What are the two types of normal respiratory sounds?
Bronchial and vesicular.
Bronchical heard on expiration.
Vesicular heard on inspiration.
What is the one condition where vocal fremitus is increased?
Consolidation (pneumonia)
- reduced in the rest; blocked.
What is a main sign to see when inspecting the posterior chest?
Sacral oedema
What do fine crackles indicate?
Fibrosis
What do coarse crackles indicate?
Pneumonia
Someone with HIV is predisposed to which other disease?
TB
Which test do we do for TB?
The acid-fast bacillus (AFB) test.
What might be a specific condition in a room for TB patients?
Negative pressure = prevents spread of airborne microbes.
What does an apical opacity on the X-ray indicate?
Mycetoma
Which microorganism causes mycetoma?
Aspergilloma
What is a mycetoma?
A fungus ball in the lung cavity caused by a pleural mass.
What does mesothelioma cause that may be seen on the X-ray?
Pleural mass
Asthma is which type sensitivity reaction?
Type I.
Aspergillosis is which type hypersensitivity reaction?
Type I, III and IV.
Give three respiratory dysfunctions aspergillosis causes
Recurrent asthma
Bronchial damage
Bronchiectasis
Which markers will be higher in aspergillosis?
IgE, serum precipitins.
The S1Q3T3 pattern on the ECG is associated with which respiratory condition?
Pulmonary embolism
Which is a key diagnostic test to investigate whether someone has a pulmonary embolism?
CTPA.
The CURB-65 score is used for which pathology?
Pneumonia
Which is more serious - low urea or high CRP?
Low urea
Erythema nodosum is associated with which diseases?
Sarcoidosis, streptococcal, Crohn’s disease
Which X-ray sign is associated with Sarcoidosis, lymphoma and TB?
Bilateral hilar lymphadenopathy
Bilateral hilar lymphadenopathy is associated with which 3 conditions?
Sarcoidosis
Lymphoma
TB
Which non-specific markers are raised in Sarcoidosis?
ACE Inhibitors, calcium
What is sarcoidosis?
A multi-system disorder where there is an accumulation of T cells.
Which type of erythema is seen in a typical rash?
Erythema Chronicum migrans - seen in Lyme disease for example.
What affect do emphysema and asthma have on lung size?
Hyperinflation of lungs
rather than reduced lung volume
Which question must we ask when suspecting mesothelioma and why?
Occupation; mesothelioma can be caused by inhaled asbestos.
Which X-ray changes do we see in TB?
Miliary nodular lung densities
Patchy consolidation
What is the difference in x-ray signs between tension and apical pneumothorax?
Tension pneumothorax = will see mediastinal shift, whereas will not see this in apical pneumothorax.
Is the mediastinal shift seen going toward or away from the pneumothorax?
Mediastinal shift will be AWAY from the pneumothorax.
What is a main medication used to treat sarcoidosis?
Steroids.
Pancoast tumours involve which nerves?
The brachial plexus (think pancoast tumours are seen at the apices of the lung)
Which medications do we use to treat more serious pneumonia?
Co-amoxiclav and Clarithromycin
What is the value of Urea for it to be considered ‘high risk’?
> 10mmol/L.
How do we treat CAP?
Amoxicillin.
Which diagnostic tool do we use to investigate PEs?
CTPA - Computed tomography pulmonary angiogram
What is pleurisy/ pleuritic chest pain?
Intense sudden stabbing chest pain during inhaling and exhaling. Can be felt in the shoulder.
Where is Erythema nodosum seen?
Sarcoidosis
Streptococcal infection
TB
UC/Crohn’s
Pneumocystitis (PCP) is associated with which other disease?
HIV.
Compare x-ray changes in pneumonia Vs. pneumocystitis.
Pneumonia = lobar consolidation. PCP = more than one lobe affected.
Rare case: signs of haemoptysis and blood in urine point toward which diagnosis?
Good pasture syndrome.
What is Good Pasture syndrome?
Autoimmune disease affecting the kidney and lungs.
What test do we use to investigate multiple myeloma?
Serum protein electrophoresis
Cold agglutins are associated with which respiratory condition?
Pneumonia
What is the first mode of treatment in a pulmonary embolism?
Low molecular weight heparin (e.g. dalteparin)
Which class does Dalteparin fall under?
LMWH.
What is the good thing about D dimer?
Sensitive = if it is negative, can rule out PE.
How do we treat pulmonary oedema?
Furosemide
What is the first step in anaphylaxis?
Stop antibiotics/ any drugs
Give two differentials of respiratory conditions that occur within a matter of seconds/ minutes as onset.
Pneumothorax
Pulmonary embolism.
How do we treat a pneumothorax?
For more than 2cm, Firstly aspiration
THEN if not successful, chest drain.
A patient keeps pigeons and shows consolidation on his X-ray. What is the likely diagnosis?
Extrinsic allergic alveolitis.
Name the different types of shadowing on the chest x ray.
Interstitial/ alveolar shadowing
Reticulo-nodular shadowing
Homogeneous shadowing
How does pulmonary oedema look different to fibrosing alveolitis?
Pulmonary oedema = more general shadowing. Fibrosing alveolitis = spiky, scratchy shadows
If you see a large space of white fluid on the x-ray, what should we think?
Pleural effusion.
White = fluid.
What will a pericardial effusion look like on the x ray?
Enlarged cardiac silhouette, white.
Name one condition in which we will see bihilar lymphoadenopathy on CXR.
Sarcoidosis.
How do we manage a pneumothorax?
Less than 2cm = aspiration
More than 2cm = chest drain
What is a sign specific to a pleural effusion?
Meniscus on x ray.
Protein <20/L is indicative of what on aspiration?
Transudate. Exudate will be>30/L.
What are ‘Cannonball metastases’ indicative of?
Secondary Lung Cancer
In which valvular condition could you see malar flush?
Mitral stenosis
Which medications are stroke patients on for life?
Clopidogrel
How will pneumonia present on auscultation?
Coarse crackles.
How do we treat pneumonia?
Antibiotics: Metronidazole + amoxicillin
How do we treat a tension pneumothorax?
Immediate = Needle aspiration (thoracocentesis)
More chronic = Chest drain
Where do we needle aspirate?
2nd ICS, MCL.
