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Respiratory Flashcards

1
Q

What is a common respiratory cause of Horner’s syndrome?

A

Lung carcinoma

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2
Q

What is ‘Pigeon chest’?

A

Congenital deformity of the anterior chest wall. Known as Pectus Carinatum

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3
Q

What can cause an apex beat?

A

RVH, Pleural effusion, tension pneumothorax

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4
Q

When will chest expansion be asymmetrical?

A

Pneumothorax, pneumonia, pleural effusion

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5
Q

When will chest expansion be reduced?

A

Pulmonary fibrosis.

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6
Q

What is the opposite of dull?

A

Hyperresonant

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7
Q

What could a hyperresonant sound signify?

A

Air within the pleural spaces e.g. pneumothorax

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8
Q

When would you hear a dull sound (hyporesonance)?

A

Tumours, pleural effusion.

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9
Q

What do we call a normal breath sound?

A

A vesicular sound

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10
Q

When can we see wheeze?

A

COPD,

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11
Q

Where are fine crackles heard compared with coarse crackles?

A

Coarse crackles = bass

Fine crackles =

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12
Q

In which patients may you see mesothelioma?

A

Asbestos exposure

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13
Q

Which respiratory conditions may you be looking for in inspection?

A

Kyphosis/ scoliosis.

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14
Q

What is the order of lung examination?

A

Lymph nodes, Inspection, palpation, percussion, auscultation.

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15
Q

Give causes of enlarged lymph nodes (lymphadenopathy)

A

Infection (Pneumonia, TB). Malignancy (Lung cancer).

Sarcoidosis

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16
Q

Which respiratory medication could tremor in the hand be caused by?

A

Salbutamol - beta 2 agonist

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17
Q

Name two respiratory issues that would cause us to want to inspect the mouth.

A

Central cyanosis

Oral candidiasis

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18
Q

Give a feature of Horner’s which could get an extra mark

A

Sunken eye - enopthalmos

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19
Q

Give x3 differences between carotid and JVP.

A

JVP is non palpable and biphasic.

JVP is readily occludable.

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20
Q

What might cause pleural thickening?

A

Asbestos.

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21
Q

What is the difference in tracheal shift in pneumothorax Vs. lobar collapse

A

Pneumothorax = opposite side

Lobar collapse = towards affected side.

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22
Q

What do you have to remember to ask the patient when auscultating their chest?

A

Breathe GENTLY in and out through MOUTH.

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23
Q

Are fine crackles usually heard on inspiration or expiration?

A

Inspiration.

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24
Q

What are the two types of normal respiratory sounds?

A

Bronchial and vesicular.
Bronchical heard on expiration.
Vesicular heard on inspiration.

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25
What is the one condition where vocal fremitus is increased?
Consolidation (pneumonia) | - reduced in the rest; blocked.
26
What is a main sign to see when inspecting the posterior chest?
Sacral oedema
27
What do fine crackles indicate?
Fibrosis
28
What do coarse crackles indicate?
Pneumonia
29
Someone with HIV is predisposed to which other disease?
TB
30
Which test do we do for TB?
The acid-fast bacillus (AFB) test.
31
What might be a specific condition in a room for TB patients?
Negative pressure = prevents spread of airborne microbes.
32
What does an apical opacity on the X-ray indicate?
Mycetoma
33
Which microorganism causes mycetoma?
Aspergilloma
34
What is a mycetoma?
A fungus ball in the lung cavity caused by a pleural mass.
35
What does mesothelioma cause that may be seen on the X-ray?
Pleural mass
36
Asthma is which type sensitivity reaction?
Type I.
37
Aspergillosis is which type hypersensitivity reaction?
Type I, III and IV.
38
Give three respiratory dysfunctions aspergillosis causes
Recurrent asthma Bronchial damage Bronchiectasis
39
Which markers will be higher in aspergillosis?
IgE, serum precipitins.
40
The S1Q3T3 pattern on the ECG is associated with which respiratory condition?
Pulmonary embolism
41
Which is a key diagnostic test to investigate whether someone has a pulmonary embolism?
CTPA.
42
The CURB-65 score is used for which pathology?
Pneumonia
43
Which is more serious - low urea or high CRP?
Low urea
44
Erythema nodosum is associated with which diseases?
Sarcoidosis, streptococcal, Crohn's disease
45
Which X-ray sign is associated with Sarcoidosis, lymphoma and TB?
Bilateral hilar lymphadenopathy
46
Bilateral hilar lymphadenopathy is associated with which 3 conditions?
Sarcoidosis Lymphoma TB
47
Which non-specific markers are raised in Sarcoidosis?
ACE Inhibitors, calcium
48
What is sarcoidosis?
A multi-system disorder where there is an accumulation of T cells.
49
Which type of erythema is seen in a typical rash?
Erythema Chronicum migrans - seen in Lyme disease for example.
50
What affect do emphysema and asthma have on lung size?
Hyperinflation of lungs | rather than reduced lung volume
51
Which question must we ask when suspecting mesothelioma and why?
Occupation; mesothelioma can be caused by inhaled asbestos.
52
Which X-ray changes do we see in TB?
Miliary nodular lung densities | Patchy consolidation
53
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.
54
Is the mediastinal shift seen going toward or away from the pneumothorax?
Mediastinal shift will be AWAY from the pneumothorax.
55
What is a main medication used to treat sarcoidosis?
Steroids.
56
Pancoast tumours involve which nerves?
The brachial plexus (think pancoast tumours are seen at the apices of the lung)
57
Which medications do we use to treat more serious pneumonia?
Co-amoxiclav and Clarithromycin
58
What is the value of Urea for it to be considered 'high risk'?
>10mmol/L.
59
How do we treat CAP?
Amoxicillin.
60
Which diagnostic tool do we use to investigate PEs?
CTPA - Computed tomography pulmonary angiogram
61
What is pleurisy/ pleuritic chest pain?
Intense sudden stabbing chest pain during inhaling and exhaling. Can be felt in the shoulder.
62
Where is Erythema nodosum seen?
Sarcoidosis Streptococcal infection TB UC/Crohn's
63
Pneumocystitis (PCP) is associated with which other disease?
HIV.
64
Compare x-ray changes in pneumonia Vs. pneumocystitis.
``` Pneumonia = lobar consolidation. PCP = more than one lobe affected. ```
65
Rare case: signs of haemoptysis and blood in urine point toward which diagnosis?
Good pasture syndrome.
66
What is Good Pasture syndrome?
Autoimmune disease affecting the kidney and lungs.
67
What test do we use to investigate multiple myeloma?
Serum protein electrophoresis
68
Cold agglutins are associated with which respiratory condition?
Pneumonia
69
What is the first mode of treatment in a pulmonary embolism?
Low molecular weight heparin (e.g. dalteparin)
70
Which class does Dalteparin fall under?
LMWH.
71
What is the good thing about D dimer?
Sensitive = if it is negative, can rule out PE.
72
How do we treat pulmonary oedema?
Furosemide
73
What is the first step in anaphylaxis?
Stop antibiotics/ any drugs
74
Give two differentials of respiratory conditions that occur within a matter of seconds/ minutes as onset.
Pneumothorax | Pulmonary embolism.
75
How do we treat a pneumothorax?
For more than 2cm, Firstly aspiration | THEN if not successful, chest drain.
76
A patient keeps pigeons and shows consolidation on his X-ray. What is the likely diagnosis?
Extrinsic allergic alveolitis.
77
Name the different types of shadowing on the chest x ray.
Interstitial/ alveolar shadowing Reticulo-nodular shadowing Homogeneous shadowing
78
How does pulmonary oedema look different to fibrosing alveolitis?
Pulmonary oedema = more general shadowing. Fibrosing alveolitis = spiky, scratchy shadows
79
If you see a large space of white fluid on the x-ray, what should we think?
Pleural effusion. | White = fluid.
80
What will a pericardial effusion look like on the x ray?
Enlarged cardiac silhouette, white.
81
Name one condition in which we will see bihilar lymphoadenopathy on CXR.
Sarcoidosis.
82
How do we manage a pneumothorax?
Less than 2cm = aspiration | More than 2cm = chest drain
83
What is a sign specific to a pleural effusion?
Meniscus on x ray.
84
Protein <20/L is indicative of what on aspiration?
Transudate. Exudate will be>30/L.
85
What are 'Cannonball metastases' indicative of?
Secondary Lung Cancer
86
In which valvular condition could you see malar flush?
Mitral stenosis
87
Which medications are stroke patients on for life?
Clopidogrel
88
How will pneumonia present on auscultation?
Coarse crackles.
89
How do we treat pneumonia?
Antibiotics: Metronidazole + amoxicillin
90
How do we treat a tension pneumothorax?
Immediate = Needle aspiration (thoracocentesis) | More chronic = Chest drain
91
Where do we needle aspirate?
2nd ICS, MCL.

Year 3 (13 decks)

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