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Internal medicoine > Respiratory System > Flashcards

Respiratory System Flashcards

1
Q

Tar stains on the thumb, 2nd and 3rd digits (3)

A

It is an indicator of smoking history
DDx
- chronic obstructive pulmonary disease: emphysema, bronchitis
- lung cancer

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2
Q 
Digital clubbing (10)
1-5
A 
Others
- interstitial Lung disease
- fibrosing alveolitis
- cavitating pulmonary tuberculosis
Suppurative: 
- cystic fibrosis
- empyema
- lung abscess
- bronchiectasis
- tuberculosis
Non suppurative:
- small cell ca
- mesothelioma
- bronchial ca
- sarcoidosis 
- asbestosis 
- pleural fibrosis
- idiopathic pulmonary fibrosis
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3
Q

Wasting 10

A

Localized
Median nerve lesion- carpal tunnel syndrome
Brachial plexus lesion
Generalized wasting
Malnutrition: poor diet, malabsorption, cancer
Muscular disorders: muscular dystrophies, inflammatory Myositis
Chronic disease: cancer, heart failure, COPD, infection, cirrhosis, kidney disease

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4
Q

Bilateral Asterexis 8

A
  • hepatic encephalopathy
  • uremia due to renal failure
  • hypercabia
  • severe congestive heart failure
  • medications: clozapine, carbamazepine, valproate, levodopa
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5
Q

Unilateral Asterexis

A

CNS lesions

  • thalamus lesion
  • midbrain lesion
  • basal ganglia lesion
  • frontal lobe lesion
  • subdural haematoma
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6
Q

Bradycardia less than 60

6

A 
Physiological: high cardiac fitness in athletes
Beta blockers
Hypothyroidism 
Raised intracranial pressure 
Heart block
Sick sinus syndrome
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7
Q

Tachycardia greater than 100

7

A

Sinus tachycardia: physical exertion, infection, anxiety, thyrotoxicosis, stimulant drug, cardiogenic shock
Atrial fibrillation: aberrant conduction, parenchymal damage

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8
Q

Tachypnea greater than 20

9

A 
Physiologic: during exercise
 at high altitudes
Anxiety
Metabolic acidosis
Sepsis
Pulmonary embolism 
Pneumonia 
Asthma
Thyrotoxicosis
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9
Q

Bradypnea less than 12 breaths per minute

5

A
  • respiratory suppression
  • drugs : opioids or
  • hypothyroidism
  • raised intracranial pressure
  • respiratory failure
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10
Q 
Hornerā€™s syndrome
Made up of 3:
-  ptosis: dropping of the eye lid
- miosis: constriction of pupil of the eye
- anhidrosis: lack of sweating
A

Causes:

  • Pancoast tumor in the apex of the lung
  • brachial plexus lesions
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11
Q

Tracheal deviation
Volume loss: significant atelectosis, lobectomy, pneumonectomy
Volume expansion: tension pneumothorax, large pleural effusion

A

Tracheal deviation toward affect side: volume loss

Tracheal deviation away from affected side: tracheal expansion

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12
Q

Tracheal tug

A

Ask patient to breath in and look for downward movement of trachea
Suggestive of airway obstruction, thoracic aortic carcinoma, copd

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13
Q

Oliverā€™s sign

A

Also known as tracheal tug

Refers to the downward movement of the trachea on systole and is indicative of a thoracic aortic aneurysms

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14
Q

Cervical lymphadenopathy

5

A
  • lung cancer
  • head or neck cancer
  • lymphoma
  • glandular fever
  • TB
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15
Q

Decreased chest expansion bilaterally

3

A
  • Asthma
  • COPD
  • Musculoskeletal rib fracture
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16
Q

UnilaterL chest expansion

5

A
  • pneumothorax
  • pulmonary effusion
  • consolidation
  • fibrosis
  • atelectasis
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17
Q

Pain in respiration in a RS patient

5

A 
Pneumonia
Pneumothorax: pain + distress
Asthma
COPD : pursed lips + tripod stand
Pulmonary embolism
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18
Q

Hypertrophic pulmonary osteoarthropathy

A

Indicative of malignancy (bronchial carcinoma)

Wrist is tender and swollen

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19
Q

Causes of hornerā€™s syndrome 9

A
  • Pancoast tumor: Horner syndrome in the presence of axial, shoulder, scapula, arm, or hand pain may be indicative of compression by an apical lung tumor.
  • carotid artery dissection
  • Adie pupil
  • Holmes-Adie pupil (contralateral)
  • Iris sphincter muscle damage
  • Senile miosis
  • Third nerve palsy
  • migraine
  • trauma to brachial plexus
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20
Q

Pancoast tumor

A
  • sharp shoulde pain radiating to the axilla, shoulder blade and bone of scapula
  • radiates to the arms to the ulnar nerve
  • can cause Hornerā€™s diseases
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21
Q

Flapping tremors

A

Increased Co2 retention

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22
Q

Pulse

A

Rate:
Tachypnea: infection, pulmonary embolism
Bradypnea: drugs, athletes
Rhythm:
Irregularly irregular: atrial fibrillation and multiple ectopic bear
Atrial fibrillation seen in pneumonia and pulmonary embolism, copd, empyesema, obstructive sleep apnea
Patient with atherosclerosis indicative of smoking

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23
Q

Lung problems occurring in systemic lupus erythematous

A
  • pleuritis
  • Acute lupus pneumonitis
  • chronic lupus pneumonitis
  • pulmonary hypertension
  • shrinking lung syndrome
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24
Q

Dehydration

5

A
  • dry mucous membranes
  • enopthalmus
  • increased capillary refill time
  • decreased skin tugor
  • weak radial pulse

Causes

  • seizures
  • renal failure
  • hypovolumeric shock
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25
Q

Upon auscultating the anterior and posterior

7

A
  • chest expansion
  • tactile fremitus
  • percussion note
  • air way entry
  • breath sounds
  • added sounds
  • vocal resonance
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26
Q

Wasting signs

A
  • prominent clavicles
  • prominent ribs
  • prominent zygomatic bone
  • wasting of the therna and hypotherna eminences
  • wasting of the dorsal interrossei or dorsal guttering
  • wasting of temporalis muscle
  • prominent mandibular and maxilla bones
  • sunken eyes
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27
Q

Types of breathing

4

A
  • Normal breathing
  • Kussmaul seen in diabetes ketoacidosis
  • biotes
  • chainstokeā€™s breathing
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28
Q

Epitrochlear lymph nodes

8

A
  • rheumatic arthritis
  • sarcoidosis
  • secondary syphyllis
  • leprosy
  • tuberculosis
  • hiv
  • melanoma
  • lymphoma
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29
Q

Bilateral pedal swelling

12

A
  • deep vein thrombosis
  • right heart failure
  • cellulitis
  • chronic kidney disease
  • filariasis
  • lymphoedema
  • gravity
  • venous insufficiency
  • hypoalbunemia
  • oral contraceptive
  • steroids
  • NSAIDs
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30
Q

Unilateral pedal oedema 11

A
  • pulmonary embolism
  • deep venous thrombosis
  • gravity
  • pregnancy
  • venous insufficiency
  • filariasis
  • lymphoedema
  • hypoalbunemia
  • NSAIDs
  • steroids
  • birth control
31
Q

Unilateral gynecomastia

A
  • lack of testosterone
  • raised estrogen levels
  • hiv
  • hemodialysis
  • anabolic steroids
  • cimetidine
  • spironolactone
  • digoxin
  • merhyldopa
  • gonadotropins
32
Q

Barrel chest shape 5

A
  • emphysema
  • chronic bronchitis
  • chronic asthma
  • cystic fibrosis
  • osteoarthritis
33
Q

Pectus carinatum : pigeon shaped chest 6

A
  • Down syndrome
  • Marfan syndrome
  • Homocysturia
  • Edward syndrome
  • Morquio syndrome
  • osteogenesis imperfects
34
Q

Pectus excavating: funnel shaped

A

Associated with

  • Marfan syndrome
  • scoliosis
  • Ehlerā€™s Daniloā€™s syndrome
35
Q

Superior vena cava obstruction
Distended veins on the chest
Have non pulsatile JVP

A 
lung cancer (90%)
retrosternal tumours e.g. lymphoma, thymoma, dermoid
retrosternal goitre
massive mediastinal lymphadenopathy
 aortic aneurysm
36
Q

DDx of costochondritis 9

A
  • Acute coronary syndrome
  • pulmonary embolism
  • pneumonia
  • anxiety
  • myocardial infarction
  • herpes zoster
  • pericarditis
  • polychondritis
  • fibromyalgia
37
Q

DDx of raised JVP 7

A
  • superior vena cava obstruction but JVP is not pulsatile
  • right heart failure with pulmonary HtN or cor pulmonale and JVP is pulsatile
  • constrictive pericarditis raises JVP in Kussmaul sign: Kussmaulā€™s sign, which is an increase in the jugular venous pressure during inspiration, is also a characteristic finding in constrictive pericarditis.
    -Cardiac tamponade
  • restrictive cardiomyopathy
  • tricuspid stenosis
  • ## tricuspid regurgitation
38
Q

Investigations done in respiratory disease

8

A
  • chest x-ray
  • chest CT scan
  • blood test ( full blood count)
  • pulmonary function test
  • needle biopsy through the chest wall
  • bronchoscopy
  • electrocardiograph
  • echocardiogram

CT - computed tomography

39
Q

Lung diseases that cause central cyanosis

A
  • lung cancer
  • pulmonary oedema
  • pulmonary embolism
  • pleural effusion
  • pneumothorax
  • severe asthma
  • copd
40
Q

Red tongue

A

CO poisoning

41
Q

Displacement of cardiac impulse without trachea shift

A
  • enlarged left ventricule
  • scoliosis
  • Pectus excavating
42
Q

Airway entry is decreased

A
  • asthmatics
  • copd
    Due to narrowing of tubes
43
Q

Bronchial sounds

A
  • consolidation
  • pulmonary fibrosis
  • above pleural effusion
  • atelectasis
44
Q

For a normal person bronchial sounds are heard

A

When you auscultation the trachea and surfaces where the main bronchi is close to the chest wall (right apical region and between the scapulae)

45
Q

Airway entry is decreased

A
  • asthmatics
  • copd
    Due to narrowing of tubes
46
Q

Bronchial sounds

A
  • consolidation
  • pulmonary fibrosis
  • above pleural effusion
  • atelectasis
47
Q

For a normal person bronchial sounds are heard

A

When you auscultation the trachea and surfaces where the main bronchi is close to the chest wall

48
Q

Diminished breath sounds 8

A
  • thick chest wall
    -collapse of lung tissue
  • reduced chest movement due to pleuritic pain
  • copd
  • asthma
  • pneumothorax
  • pleural effusion
  • pleural thickening
49
Q

Increased breath sounds

A
  • if the chest wall is thin

- hyperventilation

50
Q

Rhonchi

A

Rhonchi is what you hear with a sthetoscope and wheeze is what you hear with your ears
Wheezes have a longer expiration than inspiration
Wheezes are normally heard in the expiration stage
Heard due to obstruction by mucus causing narrowing of the tube (asthmatic and copd), aspiration (by foreign body) or congestion(severe pulmonary oedema)

51
Q

Crackles

Heard predominately at the end of inspiration

A

Coarse crackles: are heard in both inspiration and expiration
Causes: pneumonia, bronchiectasis, fibrosising alveolitis

Fine crackles: are heard at the end of inspiration usually at the lung bases
Causes: pulmonary oedema and CHF and pulmonary fibrosis

52
Q

Pleural friction rub

A

Best heard at the posterior and lateral region of the lungs
Heard in both inspiration and expiration
Pneumonia and pulmonary embolism

53
Q

If a patient is in distress

A
  • tachypnea
  • nasal flaring
  • paradoxical breathing
  • use of accessory muscle: sternocleidomastoid muscle, anterior:middle and posterior scalene muscle
  • tracheal tugging
  • use of oxygen mask, Ventori mask, nasal prongs
  • subcostal or intercostal recessions
54
Q

To confirm consolidation

A 
Decreased chest expansion
Increased tactile fremitus 
Dull percussion note
Decreased airway entry 
Bronchial sounds with or without coarse crackles
Increased vocal resonance 
Presence of whispering pectoriloquy
Presence of aegophony
55
Q

Stridor

A

Harsh musical sound heard at the mouth marked on inspiration and denotes major airway obstruction

56
Q

Pulmonary chest pain

A
  • Pleurisy: sharp pleuritic chest pain, worse lying, better when sitting, pleural rub on exam, lasts hours or days, often with cough or respiratory infection
  • pulmonary embolism: sudden severe chest pain with SOB, pleuritic in nature, predisposition to venous clotting, hypoxia and tachycardia
57
Q

Paradoxical pulse

A

Respiratory distress

58
Q

Bounding pulse

A

CO2 retention

59
Q

Trachea tug

A

Severe airflow limitation

60
Q

JVP raised

A

Cor pulmonale

61
Q

Apex beat impalpable

A

COPD
pleural effusion
Dextrocardia

62
Q

Dull percussion

A
  • lung collapse
  • consolidation
  • fibrosis
  • pleural thickening
  • tuberculosis
63
Q

Stony dull percussion

A

Pleural effusion

64
Q

Hyperresonant percussion

A
  • pneumothorax
  • hyperexpansion such as asthma or copd
65
Q

Ewart sign

A

Refers to bronchial breath sounds heard above pleural effusion or pericardial effusion

66
Q

Diminished breath sounds

A

Difficult to hear

Pleural effusion, pleural thickening, pneumothorax, bronchial obstruction, copd, asthma

67
Q

Silent chest

A

Inaudible breath sounds

Life threatening asthma

68
Q

Crackles

A

Reopening of small airways during inspiration

Fine and late in inspiration ā€¢ Coarse and mid inspiratory
ā€¢ Early inspiratory
ā€¢ Pulmonary oedema ā€¢
Bronchiectasis ā€¢ Small airway disease
ā€¢ Late/pan inspiratory ā€¢ Disappear post cough
ā€¢ Alveolar disease ā€¢ Insignificant

69
Q

Kussmaul respiration

A

Kussmaul respiration is deep, sighing breaths in severe metabolic acidosis (blowing off CO2), eg diabetic or alcoholic ketoacidosis, renal impairment.

70
Q

Cheyene- stokes breathing pattern

A

Cheyneā€“Stokes breathing: Breaths get deeper and deeper, then shallower (Ā±epi- sodic apnoea) in cycles. Causesā€”brainstem lesions or compression (stroke, ī€€ICP). If the cycle is long (eg 3min), the cause may be a long lung-to-brain circulation time (eg in chronic pulmonary oedema or ī€cardiac output). It is enhanced by opioids.

71
Q

Sputum analysis

A

Further examinationā€”sputum, temperature charts, O2 sats, PEFR: Inspect spu- tum and send suspicious sputum for microscopy (Gram stain and auramine/ZN stain, if indicated), culture, and cytology.
ā€¢ Black carbon specks suggests smoking: commonest cause of increased sputum. ā€¢ Yellow/green sputum suggests infection, eg bronchiectasis, pneumonia.
ā€¢ Pink frothy sputum suggests pulmonary oedema.
ā€¢ Bloody sputum (haemoptysis) may be due to malignancy, TB, infection, or trau-
ma, and requires investigation for these causes. See p49. ā€¢ Clear sputum is probably saliva.

clear and colourless (chronic bronchitis), yellow-green or brown (pulmonary infection), red (haemoptysis), black (smoke, coal dust), or frothy white-pink (pulmonary oedema).
Send the sample to the laboratory for microscopy, culture/sensitivity. If indicated, ask for ZN stain, and PCR.

72
Q

Chest deformity

A

Barrel chest: ī€€AP diameter, tracheal descent and chest expansion ī€, seen in chronic hyperinflation (eg asthma/COPD).
ā€¢ Pigeon chest (pectus carinatum): chronic childhood asthma, Harrisonā€™s sulcus
ā€¢ Funnel chest (pectus excavatum): Developmental defect involving local sternum depression (lower end). Causes displacement of the heart to the left. Adsociations: scoliosis, Marfan, Ehlerā€™s Danlos syndrome
ā€¢ Kyphosis: ā€˜Humpbackā€™ from increased AP thoracic spine curvature.
ā€¢ Scoliosis: Lateral curvature (OHCS p674); all of these may cause a restrictive ventilatory defect.

73
Q

Differential diagnosis of dyspnea

A

Heart failure
Acute chest syndrome
Pulmonary embolism
Pneumonia
Copd/asthma
High altitudes
Acute respiratory distress sundrome

Internal medicoine (10 decks)

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