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
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
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
4
Q
Bilateral Asterexis 8
A
- hepatic encephalopathy
- uremia due to renal failure
- hypercabia
- severe congestive heart failure
- medications: clozapine, carbamazepine, valproate, levodopa
5
Q
Unilateral Asterexis
A
CNS lesions
- thalamus lesion
- midbrain lesion
- basal ganglia lesion
- frontal lobe lesion
- subdural haematoma
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
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
8
Q
Tachypnea greater than 20
9
A
Physiologic: during exercise at high altitudes Anxiety Metabolic acidosis Sepsis Pulmonary embolism Pneumonia Asthma Thyrotoxicosis
9
Q
Bradypnea less than 12 breaths per minute
5
A
- respiratory suppression
- drugs : opioids or
- hypothyroidism
- raised intracranial pressure
- respiratory failure
10
Q
Hornerās 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
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
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
13
Q
Oliverās 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
14
Q
Cervical lymphadenopathy
5
A
- lung cancer
- head or neck cancer
- lymphoma
- glandular fever
- TB
15
Q
Decreased chest expansion bilaterally
3
A
- Asthma
- COPD
- Musculoskeletal rib fracture
16
Q
UnilaterL chest expansion
5
A
- pneumothorax
- pulmonary effusion
- consolidation
- fibrosis
- atelectasis
17
Q
Pain in respiration in a RS patient
5
A
Pneumonia Pneumothorax: pain + distress Asthma COPD : pursed lips + tripod stand Pulmonary embolism
18
Q
Hypertrophic pulmonary osteoarthropathy
A
Indicative of malignancy (bronchial carcinoma)
Wrist is tender and swollen
19
Q
Causes of hornerās 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
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 Hornerās diseases
21
Q
Flapping tremors
A
Increased Co2 retention
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
23
Q
Lung problems occurring in systemic lupus erythematous
A
- pleuritis
- Acute lupus pneumonitis
- chronic lupus pneumonitis
- pulmonary hypertension
- shrinking lung syndrome
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
25
Upon auscultating the anterior and posterior
| 7
- chest expansion
- tactile fremitus
- percussion note
- air way entry
- breath sounds
- added sounds
- vocal resonance
26
Wasting signs
- 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
27
Types of breathing
| 4
- Normal breathing
- Kussmaul seen in diabetes ketoacidosis
- biotes
- chainstokeās breathing
28
Epitrochlear lymph nodes
| 8
- rheumatic arthritis
- sarcoidosis
- secondary syphyllis
- leprosy
- tuberculosis
- hiv
- melanoma
- lymphoma
29
Bilateral pedal swelling
| 12
- deep vein thrombosis
- right heart failure
- cellulitis
- chronic kidney disease
- filariasis
- lymphoedema
- gravity
- venous insufficiency
- hypoalbunemia
- oral contraceptive
- steroids
- NSAIDs
30
Unilateral pedal oedema 11
- pulmonary embolism
- deep venous thrombosis
- gravity
- pregnancy
- venous insufficiency
- filariasis
- lymphoedema
- hypoalbunemia
- NSAIDs
- steroids
- birth control
31
Unilateral gynecomastia
- lack of testosterone
- raised estrogen levels
- hiv
- hemodialysis
- anabolic steroids
- cimetidine
- spironolactone
- digoxin
- merhyldopa
- gonadotropins
32
Barrel chest shape 5
- emphysema
- chronic bronchitis
- chronic asthma
- cystic fibrosis
- osteoarthritis
33
Pectus carinatum : pigeon shaped chest 6
- Down syndrome
- Marfan syndrome
- Homocysturia
- Edward syndrome
- Morquio syndrome
- osteogenesis imperfects
34
Pectus excavating: funnel shaped
Associated with
- Marfan syndrome
- scoliosis
- Ehlerās Daniloās syndrome
35
Superior vena cava obstruction
Distended veins on the chest
Have non pulsatile JVP
```
lung cancer (90%)
retrosternal tumours e.g. lymphoma, thymoma, dermoid
retrosternal goitre
massive mediastinal lymphadenopathy
aortic aneurysm
```
36
DDx of costochondritis 9
- Acute coronary syndrome
- pulmonary embolism
- pneumonia
- anxiety
- myocardial infarction
- herpes zoster
- pericarditis
- polychondritis
- fibromyalgia
37
DDx of raised JVP 7
- 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: Kussmaul'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
Investigations done in respiratory disease
| 8
- 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
Lung diseases that cause central cyanosis
- lung cancer
- pulmonary oedema
- pulmonary embolism
- pleural effusion
- pneumothorax
- severe asthma
- copd
40
Red tongue
CO poisoning
41
Displacement of cardiac impulse without trachea shift
- enlarged left ventricule
- scoliosis
- Pectus excavating
42
Airway entry is decreased
- asthmatics
- copd
Due to narrowing of tubes
43
Bronchial sounds
- consolidation
- pulmonary fibrosis
- above pleural effusion
- atelectasis
44
For a normal person bronchial sounds are heard
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
Airway entry is decreased
- asthmatics
- copd
Due to narrowing of tubes
46
Bronchial sounds
- consolidation
- pulmonary fibrosis
- above pleural effusion
- atelectasis
47
For a normal person bronchial sounds are heard
When you auscultation the trachea and surfaces where the main bronchi is close to the chest wall
48
Diminished breath sounds 8
- thick chest wall
-collapse of lung tissue
- reduced chest movement due to pleuritic pain
- copd
- asthma
- pneumothorax
- pleural effusion
- pleural thickening
49
Increased breath sounds
- if the chest wall is thin
| - hyperventilation
50
Rhonchi
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
Crackles
| Heard predominately at the end of inspiration
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
Pleural friction rub
Best heard at the posterior and lateral region of the lungs
Heard in both inspiration and expiration
Pneumonia and pulmonary embolism
53
If a patient is in distress
- 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
To confirm consolidation
```
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
Stridor
Harsh musical sound heard at the mouth marked on inspiration and denotes major airway obstruction
56
Pulmonary chest pain
- 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
Paradoxical pulse
Respiratory distress
58
Bounding pulse
CO2 retention
59
Trachea tug
Severe airflow limitation
60
JVP raised
Cor pulmonale
61
Apex beat impalpable
COPD
pleural effusion
Dextrocardia
62
Dull percussion
- lung collapse
- consolidation
- fibrosis
- pleural thickening
- tuberculosis
63
Stony dull percussion
Pleural effusion
64
Hyperresonant percussion
- pneumothorax
- hyperexpansion such as asthma or copd
65
Ewart sign
Refers to bronchial breath sounds heard above pleural effusion or pericardial effusion
66
Diminished breath sounds
Difficult to hear
Pleural effusion, pleural thickening, pneumothorax, bronchial obstruction, copd, asthma
67
Silent chest
Inaudible breath sounds
Life threatening asthma
68
Crackles
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
Kussmaul respiration
Kussmaul respiration is deep, sighing breaths in severe metabolic acidosis (blowing off CO2), eg diabetic or alcoholic ketoacidosis, renal impairment.
70
Cheyene- stokes breathing pattern
CheyneāStokes breathing: Breaths get deeper and deeper, then shallower (Ā±epi- sodic apnoea) in cycles. Causesābrainstem lesions or compression (stroke, īICP). If the cycle is long (eg 3min), the cause may be a long lung-to-brain circulation time (eg in chronic pulmonary oedema or īcardiac output). It is enhanced by opioids.
71
Sputum analysis
Further examinationāsputum, 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
Chest deformity
Barrel chest: īAP diameter, tracheal descent and chest expansion ī, seen in chronic hyperinflation (eg asthma/COPD).
ā¢ Pigeon chest (pectus carinatum): chronic childhood asthma, Harrisonās 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, Ehlerās Danlos syndrome
ā¢ Kyphosis: āHumpbackā from increased AP thoracic spine curvature.
ā¢ Scoliosis: Lateral curvature (OHCS p674); all of these may cause a restrictive ventilatory defect.
73
Differential diagnosis of dyspnea
Heart failure
Acute chest syndrome
Pulmonary embolism
Pneumonia
Copd/asthma
High altitudes
Acute respiratory distress sundrome
