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Internal Medicine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Decreased tactile fremitus

A

Liquid or air between lungs and chest wall

Pleural effusion
Pneumothorax
Empyema
Pleural thickening

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2
Q

Increased tactile fremitus

A

Solid between lung and chest wall. Increased conduction.

Consolidation
Mass
Fibrosis

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3
Q

Normal TF

A

Asthma

ILD??

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4
Q

Asymmetrical chest expansion

A 
Pneumothorax 
Hemothorax
Chylothorax 
Massive effusion
Unilateral diaphragmatic paralysis
Pleuritis 
Atelectasis (lung collapse)
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5
Q

Tracheael deviation

A

Towards: fibrosis, atelectasis

Away: massive effusion, pneumothorax, mass, hyper infiltration, mediastinal mass

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6
Q

Normal percussion (resonant)

A

Asthma

ILD

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7
Q

Hyper-resonance

A

Pneumothorax
COPD
Emphysema

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8
Q

Dull percussion note

A

Stony: Due to fluid or blood in the pleural cavity. Pleural effusion, hemothorax

Relative: consolidation, lung fibrosis, lung collapse, pleural thickening

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9
Q

Decreased air entry

A

Obstruction

Pneumonia

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10
Q

Bronchial breath sound

A

Normally heard over 2 ICS, around manubrium

Gap between inspiration and expiration

Inspiration and expiration equal

Higher pitch, louder

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11
Q

Bronchial breath sounds confirmatory tests

A

Egophony (‘e’ heard as ‘a’)
Bronchophony (sounds heard clearly)
Whispered pectoriloquy (increased loudness of whisper)

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12
Q

Bronchial breath sound ddx

A

Consolidation
Fibrosis
Cavitation
Upper border of pleural effusion

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13
Q

Vesicular breath sound

A

Inspiration longer and louder than expiration

No gap between inspiration and expiration

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14
Q

Adventitious (added breath sounds)

A 
Wheezing 
Crackles/rales/crepitation 
Rhonci 
Stridor 
Pleural friction rub
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15
Q

Wheezing

A

Lower airway obstruction

High pitched and continuous

Mostly in expiration

Ddx: asthma, TB, COPD, bronchiecstasis

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16
Q

Crackles/rales

A

At the level of the alveoli. Due to fluid accumulation

Bilateral:
ILD
CHF
Pneumonia 
Pulmonary edema
PCP

Unilateral:
Pneumonia
Bronchiecstasis

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17
Q

Stridor

A

Upper airway obstruction

Heard more on inspiration

Croup, foreign bodies, aspiration, vocal cord dysfunction, epiglottitis

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18
Q

Rhonci

A

Fluid accumulation

Fine crackles

Al the level of the bronchi

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19
Q

Lung parenchyma vs. Interstitium

A

Lung parenchyma: portion of the lung involved in gas exchange (alveoli, alveolar ducts and respiratory bronchioles)

Interstitium: the tissue and space around the alveoli. Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. The

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20
Q

Pulmonary fibrosis

A

Y

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21
Q

Pulmonary edema

A

Fluid accumulation in the tissue and air spaces of the lungs. Either due to failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation (cardiogenic pulmonary edema), or an injury to the lung parenchyma or vasculature of the lung (non-cardiogenic pulmonary edema).

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22
Q

Pulmonary consolidation

A

A region of normally compressible lung tissue that has filled with liquid instead of air.
The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung.
It is considered a radiologic sign.
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts.
The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood.

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23
Q

Pleural effusion

A

Excess fluid that accumulates in the pleural cavity.

Hydrothorax 
Hemothorax 
Chylothorax 
Pyothorax (Pleural empyema)
Urinothorax
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24
Q

Atelectasis

A

Collapse or closure of a lung resulting in reduced or absent gas exchange.

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25
Q

Pleural tap (thoracentesis)

A

Below inferior angle of scapula in the 7th ICS, above 8th rib

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26
Q

Light’s criteria

A

Pleural fluid protein: serum fluid protein
>0.5 exudate

Pleural fluid LDH: serum fluid LDH
>0.6 exudate

Pleural fluid LDH> 2/3 of upper limit of serum LDH

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27
Q

Exudative

A 
Bacterial infection 
TB
Fungal
Viral
Parasitic 
Neoplastic
Collagen: vascular disease, SLE, RA
Pulmonary embolism
Hemothorax
Chylothorax 
Drug induced pleural disease 
Asbestosis
Sarcoidosis
Post-coronary artery by-pass surgery
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28
Q

Transudative

A 
CHF
Cirrhosis 
Nephrotic syndrome 
Myxedema 
Superior vena cava obstruction
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29
Q

Chest tube

A

Pleural fluid pH <7.2
Pleural fluid glucose <60mg/dL
Positive gram stain or culture of PF
Presence of gross pus in the pleural space

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30
Q

Clubbing of fingers is due to

A

Long standing lack of oxygen to the peripheral tissues.
Leads to increase in the vascularity of the distal fingers and consequently an increased spin giantess of the nail beds (compensation)

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31
Q

Clubbing ddx

A 
Respiratory:
Bronchial ca
Lung ca
Pulmonary TB
CF
Chronic suppurations lung diseases (empyema, lung abscess, bronshiecstasis)

Cardiac: cyanotic CHD, IE

GI:
IBD (Crohn’s, UC)
Malabsorption (Celiac)
GI lymphoma 
Liver cirrhosis
32
Q

Not a cause of clubbing

A

Chronic bronchitis

33
Q

Chest expansion

A

Around the level of 4th ICS, the nipple

5-8 cm

34
Q

Diaphragmatic excursion

A

3-5 cm

35
Q

Tracheael deviation

A

Towards: fibrosis, atelectasis

Away: massive effusion, pneumothorax, mass, hyper infiltration, mediastinal mass

36
Q

Normal percussion (resonant)

A

Asthma

ILD

37
Q

Hyper-resonance

A

Pneumothorax
COPD
Emphysema

38
Q

Dull percussion note

A

Stony: Pleural effusion, hemothorax

Relative: Consolidation, fibrosis, lung collapse

39
Q

Decreased air entry

A 
Obstruction 
Pneumonia
Pleura also effusion
Pneumothorax 
Hemothorax 
Emphysema
40
Q

Bronchial breath sound

A

Normally heard over 2 ICS, around manubrium

Gap between inspiration and expiration

Inspiration and expiration equal

Higher pitch, louder

41
Q

Bronchial breath sounds confirmatory tests

A

Egophony (‘e’ heard as ‘a’)
Bronchophony (sounds heard clearly)
Whispered pectoriloquy (increased loudness of whisper)

42
Q

Bronchial breath sound ddx

A

Consolidation

Cavitation

43
Q

Vesicular breath sound

A

Inspiration longer and louder than expiration

No gap between inspiration and expiration

44
Q

Adventitious (added breath sounds)

A 
Wheezing 
Crackles/rales/crepitation 
Rhonci 
Stridor 
Pleural friction rub
45
Q

Wheezing

A

Lower airway obstruction

High pitched and continuous

Mostly in expiration

Ddx: asthma, TB, COPD, bronchiecstasis

46
Q

Crackles/rales ddx

A

At the level of the alveoli, due to fluid accumulation

Bilateral: Pneumonia, pulmonary edema, CHF, ILD, PCP
Unilateral: Pneumonia, bronchiecstasis

47
Q

Stridor

A

Upper airway obstruction

Heard more on inspiration

Croup, foreign bodies, aspiration, vocal cord dysfunction, epiglottitis

48
Q

Rhonci

A

Fluid accumulation

Fine crackles

Al the level of the bronchi

49
Q

Lung parenchyma vs. Interstitium

A

Lung parenchyma: portion of the lung involved in gas exchange (alveoli, alveolar ducts and respiratory bronchioles)

Interstitium: the tissue and space around the alveoli. Alveolar epithelium, pulmonary capillary endothelium, basement membrane, perivascular and perilymphatic tissues. The

50
Q

Pulmonary edema

A

Fluid accumulation in the tissue and air spaces of the lungs. Either due to failure of the left ventricle of the heart to remove blood adequately from the pulmonary circulation (cardiogenic pulmonary edema), or an injury to the lung parenchyma or vasculature of the lung (non-cardiogenic pulmonary edema).

51
Q

Pulmonary consolidation

A

A region of normally compressible lung tissue that has filled with liquid instead of air.
The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung.
It is considered a radiologic sign.
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts.
The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood.

52
Q

Pleural effusion

A

Excess fluid that accumulates in the pleural cavity.

Hydrothorax 
Hemothorax 
Chylothorax 
Pyothorax (Pleural empyema)
Urinothorax
53
Q

Extrapulmonary TB

A

Lymph nodes (painless)
Pleura
Genitourinary tract

54
Q

Asymmetrical chest expansion

A 
Pneumothorax 
Hemothorax
Chylothorax 
Massive effusion
Unilateral diaphragmatic paralysis
Pleuritis 
Atelectasis (lung collapse)
55
Q

Respiratory cause of chest pain

A

Pleuritic pain:
TB pleurisy
Para-pneumonic effusion
Pulmonary embolism

55
Q

Respiratory causes of SOB

A 
Asthma
COPD
Pneumonia
Pulmonary embolism
Pneumothorax 
Diffuse ILD
55
Q

Cheyne-Stokes breathing

A

Occurrence of periodic apnea in HF

55
Q

Kussmaul breathing

A

DKA

55
Q

No air entry

A

Effusion

Pneumothorax

55
Q

Vesicular breath sound in

A

Asthma

ILD

56
Q

Pleural friction rub

A

Pleuritis
Pleural fibrosis
Mass (pleural??)

57
Q

Hemorrhagic pleural fluid

A

TB
Malignancy
Trauma
Pulmonary embolism

58
Q

Turbid pleural fluid

A

Anaerobic

59
Q

Pyogenic pleural fluid

A

TB
Bacterial
Amoeba (chocolate color)

60
Q

Opaque/milky color pleural fluid

A

Thoracic duct trauma

Lymphatic obstruction

61
Q

Ddx of peripheral cyanosis

A

Cold weather
Low CO (shock)
Arterial occlusion
Venous occlusion.

62
Q

Central cyanosis ddx

A

Respiratory failure
Cyanotic HD
Abnormal Hb pigment
PDA with reversal of shunt

63
Q

Pleural fluid normal amount

A

10-20ml

64
Q

Decreased diaphragmatic excursion occurs in

A

COPS

Paralysis of diaphragm

65
Q

Chest X-ray consolidation

A

Pneumonia
Cancer
Fungal infections
Aspergillosis

66
Q

Pleural effusion chest X-ray

A

Homogeneous
Blunting of costophrenic angle
Meniscus

67
Q

Diaphragm of the stethoscope

A

High-pitched sounds

S1, S2, pan systolic murmurs

68
Q

Bell of the stethoscope

A

S3, S4, diastolic murmurs at the apex

69
Q

S3 gallop

A 
Left/right ventricular heart failure
Mitral regurgitation 
Constrictive pericarditis 
Anemia
Pregnancy 
Fever
Thyrotoxicosis
70
Q

S4 gallop

A

Hypertension
Aortic stenosis
Hypertrophic cardiomathy

71
Q

Opening snap

A

Mitral stenosis

Tricuspid stenosis

72
Q

Gallaveredin phenomenon

A

Dissociation between the noisy, harsh and musical components of aortic stenosis murmur. Noisy heard at the neck and musical at the apex.

Internal Medicine (10 decks)

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