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Rs Practical Flashcards

1
Q

What is cough?

A

A sudden and variable expiratory thrust of air from lungs through air passages associated with phonation, and momentarily interrupts the physiology of breathing.

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2
Q

Events of cough

A

•deep inspiration
•tight closure of glottis, supraglottic structure
•quick forceful contraction of expiratory muscles
•the opening of glottis

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3
Q

Classification of cough

A

Acute - less than 3weeks
Subacute - 3-8weeks
Chronic > 8weeks

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4
Q

Causes of acute cough

A

Viral pneumonia, tracheobronchitis, asthma, foreign body

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5
Q

Causes of Subacute cough

A

Tb, pneumonia, Bronchiectasis

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6
Q

Causes of Chronic cough

A

COPD, ILD, Tb, lung cancer

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7
Q

Types of cough

A

• Productive - suppurative lung disease
• Brassy cough- metallic sound due to aortic aneurysm
•Bovine cough- compression of recurrent laryngeal nerve
•Dry cough- pleural disorder, ild
• Paroxysmal cough- whooping cough
• Barking cough- croup, epiglottis
• spluttering - tracheosophageal fistula
• Hacking - heavy smokers
•Otogenic - arnold ‘s nerve stimulation

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8
Q

What is Bronchorrhea?

A

Normal sputum- 10-15ml/24
Bronchorrhea -100ml/hr

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9
Q

Rust coloured sputum

A

Pneumococcal pneumonia

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10
Q

3 layer sputum is seen in ?

A

Bronchiectasis:
• upper- foamy layer
• middle - mucous
• bottom - purulent

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11
Q

3 layer sputum is seen in ?

A

Bronchiectasis:
• upper- foamy layer
• middle - mucous
• bottom - purulent

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12
Q

What is haemoptysis?

A

It is defined as coughing of blood originating below the vocal cords.

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13
Q

True vs false haemoptysis

A

Above - below vc
Persists - does not persist
X-ray abnormal- normal

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14
Q

What is PND

A

Sudden onset dysnea 2-2.5 hrs after sleep

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15
Q

Why is PND caused?

A

Patient usually wakes up during REM sleep.
Cf- sits up with legs hanging down, air hunger, self ventilates.
Mechanism - sympathetic overactivity during REM- increased Hr - increased diastolic phase and ventricular filling - interstitial pulmonary congestion - respiratory system lags - perceived as dyspnea

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16
Q

What is orthopnea and its causes?

A

Dyspnea in recumbent position. Occurs after lying down, hence the patient sleeps propped up or upright
Mechanism - it is caused by shifting of venous blood into pulmonary circulation - V/Q mismatch, compression of diaphragm, postural diastolic dysfunction. Slow sustained rise of PCWP.

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17
Q

What is trepopnea

A

Dyspnea when lying on oneside and disappears on the other side.
Causes- unilateral lung pathology or heart failure

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18
Q

What is platypnea?

A

Dyspnea on sitting or standing and relieved by lying supine.
Causes - Av shunt, ARDS

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19
Q

What is Bendopnea?

A

Dyspnea on bending

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20
Q

What are the grading of mMRC?

A

Modified Medical Research Council
• grade 1- breathless on strenuous exercise
• grade 2- shortness of breath when hurrying on level ground or walking slightly uphill
• grade 3- stop for breath after walking about 100yards or few minutes
• grade 4- too breathless to leave the house or when getting dressed

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21
Q

What are the classes of NYHA?

A

•Class 1- p/o with hd but with no limitations
•Class 2 - slight limitation of physical activities
• Class 3 - marked limitation of physical activity
•Class 4- dyspnic even at rest

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22
Q

What are the different noisy breathing?

A

Laryngeal - Stridor
Oropharyngeal - stertor
Tracheal- Rattling
Bronchial- Wheezing

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23
Q

Name the external features of TB?

A

Matted lymph nodes
Erythema nodosum
Phlyctenular conjunctivitis
Choroid tubercles
Discharging sinus
Scrofuloderma
Lupus vulgaris
Uveitis

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24
Q

External markers of malignancy

A

Cachexia
Grade 4 clubbing
Acanthosis nigricans
Horner’s syndrome
SVC obstruction

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25
Kartageners syndrome
Recurrent sinusitis with ciliary dyskinesia Bronchiectasis Situs invertus Male infertility
26
Samter's triad
Aspirin insensitivity Bronchial asthma Ethmoidal polyp
27
Harrison sulcus
Horizontal groove where diaphragm attaches to the ribs. Prominent in rickets, copd.
28
Trail's sign
In the presence of tracheal deviation , there is prominence of claviclular head of strenocleidomastoid muscle on the same side.
29
Name abnormal signs of respiration
•Sitting and catching the edge: cope - to use latissimus dorsi muscle •Tripod position - to improve function of pectoralis major and minor • Hoover sign - paradoxical indrawing of the lateral ribcage - chronic airflow obstruction • pursed lip breathing - seen in COPD to increase intra alveolar pressure
30
Suzman's sign
Coarctation of aorta- visible pulsation around scapula
31
Oliver 's sign
Tracheal-tug sign Hold the cricoid cartilage and give slight upward thrust Postive: downward pull with each heartbeat -aortic aneurysm
32
Campbell sign
Tracheal descent on inspiration- due to depressed diaphragm in long standing hyperinflation of lung
33
Movements of chest
• pump handle movement - in upper anterior chest, place palms in infra claviclular region • Bucket 🪣 handle movement - lower ant.chest , approximate thumbs in the mammary region
34
Diameters of chest
AP : T - 5:7 Chest expansion- normal 5-8 cm
35
What is Vocal fremitus?
The sounds produced by vocal cord and transmitted along the tracheobronchial tree and heard along the chest wall. Increased in • consolidation •cavity •bronchopleural fistula Decreases in • pleural effusion • pneumothorax •fibrosis •collapse •asthma and copd
36
Teitze syndrome
Costochondritis
37
Rib crowding
Fibrosis, atelectasis, collapse
38
Intercoastal widening
Pneumothorax, pleural effusion, emphysema
39
Types of percussion souds
1. Tympanic - normally in abdomen, subcutaneous emphysema 2. Hyper resonant - emphysema, pneumothorax, large bullae 3. Impaired - Fibrosis, collapse 4. Dull - consolidation 5.stony dull - pleural effusion 6. Cracked pot- in children, act of crying, pathological lung cavity in connection with bronchus 7. Amphoric - pneumothorax with cavity 8. Straight line dullness - hydropneumothorax 9. straight line of ellis- pleural effusion
40
Kronig's isthmus
It is a band of resonance in supraclavicular region, bounded by Ant- posterior border of clavicle Med- muscles of neck Post- anterior border of trapezius Lat- acromioclavicular joint If dull - apical tb , pancoast tumor
41
Kronig's isthmus
It is a band of resonance in supraclavicular region, bounded by Ant- posterior border of clavicle Med- muscles of neck Post- anterior border of trapezius Lat- acromioclavicular joint If dull - apical tb , pancoast tumor
42
Traube's space
Above 6th rib Below left costal margin Lateral by mid axillary line
43
Obliteration of traube's space is seen in
Left side pleural effusion Pericardial effusion Massive splenomegaly Enlarged left lobe of liver
44
Shifting dullness absent in
Loculated pleural effusion
45
Grocco's triangle 📐
Paravertebral triangle of dullness
46
Types of normal breathing
• vesicular •tracheal/bronchial breathing •Bronchovesicular
47
Characteristics and production of vesicular breath sounds
Rustling or breezy I:E - 4:1 No pause Louder in infra claviclular, axillary and infra scapular •Produced- due to seperation of alveolar walls by rushing of air
48
Characteristics and production of tracheal breath sounds
Character is gutteral or aspirate Expiration is longer I:E- 1:1 There is a pause , no alveolar phase
49
Types of Tracheal breathing
1.Tubular - high pitched at brochioles conducted to the chest wall. Eg: consolidation, massive pleural effusion 2.Amphoric- low pitched with metallic overtone Eg: open pneumothorax due to bronchopleural fistula 3. Cavernous - low pitched with peculiar hollow Eg. Cavity
50
Characteristics and production of bronchovesicular breath sounds
Intermediate in character E longer and louder Heard at upper sternum, between scapula
51
Types of Adventitious sounds
Continuous - high pitched (wheeze), low pitched (ronchi) Discontinuous- crepitations and pleural rub
52
Continuous Adventitious sounds
Musical in quality Mechanism - airflow limitation, narrowing of airways along with inc intrathoracic pressure - wheeze Air moves through tracheo- bronchial passage in presence of mucus or respiratory secretions TYPES - Monophonic or polyphonic E or I Monophonic causes- tumor , fb, mucous plug Polyphonic - copd , bronchial asthma
53
Discontinuous-Adventitious sounds
Crepitations, rales and pleural rub • mech of crep: fine- snapping open of successive small airways ,eg: asbestosis, ild, pe Coarse- bubbling of air through accumulated secretions . eg: Bronchiectasis, lung abscess, bronchitis Pleural rub: harsh , discontinuous, non-musical, cause - consolidation, infarction
54
Where are the following crepitations seen 1. Coarse leathery 2. Velcrocrepts 3.posture induced crackles 4.post-tussive crepi
Bronchiectasis, ILD, HF, pneumonia tb
55
Conditions where vocal resonance is increased
Consolidation, large cavity, bronchopleural fistula
56
Conditions in which vocal resonance is decreased
Pleural effusion, pneumothorax, fibrosis and collapse
57
What is hippocrates succussion splash?
Seen in hydropneumothorax
58
What is Coin test?
High pitched metallic or tympanic note Seen in hydropneumothorax
59
What is Hamman's mediastinal crunch?
Loud crackling sound heard 3-5th intercoastal space near the left sternal border synchronous with heartbeat
60
What is Hamman's mediastinal crunch?
Loud crackling sound heard 3-5th intercoastal space near the left sternal border synchronous with heartbeat
61
Abnormal apical impulse
1. Absent - pericardial effusion, dextrocardia, lft pleural effusion 2. Tapping - Mitral stenosis 3. Hyperdynamic (volume overload)-AR,MR,VSD,PDA 4. Heaving ( pressure overload)- AS, HCM 5. Double apical impulse- HOCM, LV aneurysm 6. Triple impulse - HOCM 7. Retractile - severe TR 8. See saw- Lv aneurysm

Medicine Practicals (5 decks)

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