Approach to evaluation of respiratory symptoms, URTI and suppurative lung diseases

Question 1

Dyspnea

– Timing
• acute eg _______,________,_________,________
• Chronic eg _________,_________,__________,___________

Answer 1

asthma, pneumonia, embolism, pneumothorax

COPD, interstitial lung disease, Neuromuscular disease, heart failure

Question 2

Cough : Acute versus chronic

• Acute
– ————
–___________
– __________

• Chronic
– Post nasal drip
– ______
– _________
–______________
–_______________

Answer 2

URTI; COPD exacerbation; Allergy

Asthma and COPD

GERD; Tuberculosis; Interstitial lung disease

Question 3

Accessory muscles of ventilation include the scalene, ____________,___________,_________,_______________

Answer 3

the sternocleidomastoid, the pectoralis major, the trapezius, and the external intercostals.

Question 4

Disease states with mucoid sputum?

Disease states with mucopurulent sputum?

Disease states with purulent sputum?

Answer 4

Chronic bronchitis; bronchial asthma

Acute bronchitis, chronic bronchitis, cystic fibrosis

Lung abscess, acute bronchitis, pneumonia, bromchiectasis, aspiration pneumonia

Question 5

Barrel chest is a deformity in which the chest becomes ______________. Lung diseases that cause the chest to repeatedly over-expand or to remain in that position can lead to barrel chest, such as __________,___________, and __________

Answer 5

expanded in size

emphysema, cystic fibrosis, and asthma.

Question 6

Pectus excavatum

Also called: ________ chest, _______ chest, _________ chest, Cobbler’s chest

A condition in which the _______________________

Answer 6

funnel chest, sunken chest, hollowed chest, Cobbler’s chest

A condition in which the breastbone sinks into the chest.

Question 7

What is pectus carinatum?

Pectus carinatum is a deformity of the chest wall in which the ________________________________ . Pectus carinatum is sometimes called “ ______________ ”

Answer 7

breastbone and ribs are pushed outward

pigeon breast

Question 8

Scoliosis

A _______________ of the ________

Answer 8

sideways curvature of the spine.

Question 9

Signs of scoliosis

_______ shoulders

________ in spine

________ hips

Answer 9

Uneven

Curve

Uneven

Question 10

Kyphosis
Also called: ________,________

A ________________ of the back.

Answer 10

hunchback, round back

forward rounding

Question 11

Cheyne-Stokes breathing involves a period of _____,_______ breathing followed by ______,_______ breathing and moments ___________________________

Answer 11

fast, shallow

slow, heavier

without any breath at all (apneas).

Question 12

The most common causes of Cheyne-Stokes respirations are __________ and ___________.

Answer 12

heart failure and stroke

Question 13

Kussmaul breathing is an abnormal breathing pattern characterized by ____,________ breathing at a consistent pace. It’s a sign of a medical emergency — usually _________________________

Answer 13

rapid, deep

diabetes-related ketoacidosis (DKA),

Question 14

Tracheal Alignment Abnormalities
• Pneumothorax – shifts to ___________ side
• Pleural Effusion – shifts to ___________ side
• Fibrosis or Atelectasis – shifts towards _________ side
• Pulmonary consolidation – _______ shift

Answer 14

unaffected; unaffected

affected; no

Question 15

Causes of abnormal chest excursion
• Bilaterally decreased in both _______ and _________ lung diseases

• Reduced on the affected side in _________, lobar __________, __________ , large ____________ , and __________

Answer 15

restrictive and obstructive

consolidation; atelectasis; pneumothorax

pleural effusion and fractured ribs

Question 16

Tactile/vocal fremitus

• Increased with __________,________,_______, or __________
• Decreased with ___________________, as seen in __________,____________,___________

Answer 16

alveolar consolidation, atelectasis, pulmonary edema or fibrosis

increased distance between lung and chest wall

Pneumothorax,Pleural effusion, COPD

Question 17

Percussion Notes

• Dullness – ______eased density
– __________,_________,_________,________

• Hyperresonance – _____eased density
– Hyperinflation (_______), —————-

Answer 17

incr

Atelectasis, alveolar filling/consolidation, pleural effusion/thickening, fibrosis

decr; COPD; Pneumothorax

Question 18

Auscultation in consolidation vs obstruction

Answer 18

Bronchial breath sound

Wheeze

Question 19

Investigation
• Chest _______
• Chest _____________
• ______________ tests
• _________ tests
• ___________
• _____________

Answer 19

x-ray

Computed tomography scan

Pulmonary function; Sputum

Arterial blood gas

Bronchoscopy

Question 20

Aetiology Of URTIs

• Often _______ in aetiology, only about 15% caused by ___________

• Diagnosis is based on symptoms: __________,________,__________ , malaise, ____ grade fever.

Answer 20

viral; streptococcus pyogenes.

cough, nasal, sore throat (voice), headache

low

Question 21

Sputum colour is important in URTIs!

T/F

Answer 21

F

Sputum colour not important here!

Question 22

In streptococcal sore throat, URT symptoms are usually _________. Often limited to _________ and ________

Answer 22

absent

high grade fever and sore throat.

Question 23

Important differential diagnosis for URTI is ____________________

Answer 23

allergic rhino sinusitis.

Question 24

For step sore throat, antibiotics are indicated.

T/F

Answer 24

T

Question 25

Indication for immediate prescribing of antibiotics in URTI
›
Children younger than _____ years with bilateral _____________
› Children with __________ who have ____________

› Patients with acute sore throat/acute pharyngitis/acute tonsillitis when __________________ are present

Answer 25

2; acute otitis media

otorrhoea; acute otitis media

three or more Centor criteria

Question 26

Centor criteria for strep pharyngitis. Score of ≥3
›
_________ or _______ on __________ (+1)
› Tender/swollen _____________(+1)
›_______>_______(+1)
› Absence of _______ (+1)

Answer 26

Exudate or swelling on tonsils

anterior cervical lymph nodes

Fever >38C

cough

Question 27

Antibiotics choice for URTI where indicated
§ The Sinus and Allergy Health Partnership (SAHP) guidelines 1
Recommend any of the following as initial therapy in adults with mild disease who have not received antibiotics in the previous 4 to 6 weeks:

• ____________
• ____________
• ____________ axetil or other first and second generation cephalorsporins.

Answer 27

amoxicillin-clavulanate
• Amoxicillin
• cefuroxime

Question 28

Bronchiectasis
• Abnormal (temporary or permanent?) ___________ of the _________ or ________ due to destruction of the _________ and ___________ component of the ___________.

Answer 28

permanent; dilatation

bronchi or bronchioles

muscular and elastic

bronchial wall.

Question 29

Bronchiectasis

Presents as recurrent, (acute or chronic?) refractory infections of the airways.

Answer 29

Chronic

Question 30

In 50% of cases in adults, _________ cause of bronchiectasis is found

Answer 30

No

Question 31

Clinical presentation of bronchiectasis

Symptoms
• (Acute or Chronic?) cough with ______ volume sputum
• __________
• (Wheezing or Stridor?)
• __________
• Fever
• Weight loss
• Exacerbations characterized by increased sputum quantity, viscidity and odour

Answer 31

Chronic; large

Dyspnoea; wheezing

Haemoptysis

Question 32

Physical findings of bronchiectasis

•____________
• Weight loss
•__________ and rhonchi
• Chest examination may be normal in ______ bronchiectasis
•_____________

Answer 32

Digital clubbing

Crepitation; dry

Cor-pulmonale

Question 33

High resolution _________________ is the gold standard for diagnosis of bronchiectasis.

Answer 33

chest Computed tomography scan

Question 34

Lung abscess
• _________ containing _________ lesions of the lung that often appears as a _________ _________ with an _________

• A similar process with _________ _________ cavities ____cm is referred to as necrotizing pneumonia

Answer 34

Pus ; necrotic

rounded ; opacity

air-fluid ;multiple

small ; <2cm

Question 35

Diagnosis of lung abscess: Clinical features

Symptoms
• Risk factor
• Sudden expectoration of _______ volume sputum initially
• __________ sputum
• Fever and weight loss

Physical

•______________
• __________ breath sound and ___________

Answer 35

large; Foul smelling

Digital clubbing

Bronchial; crepitation

Question 36

Empyema
• _________ in the pleural space or _________ pleural fluid

Answer 36

Pus ;infected

Question 37

Types of empyema
– Acute or chronic (>__________)
–___________ or ________ in the pleural space
–_______ or _______ (eg _______ or ————)

Answer 37

3 months

Loculated or free

Closed or open

broncho-pleural fistula or sinus track

Question 38

primary infective empyema without pneumonia is often due to _______

Answer 38

TB

Question 39

Clinical features of empyema
• Depends on the underlying cause
•_______ following aerobic infections
• More _______ in anaerobic and mycobacterial infections
•_____________ following pneumonia
• _________ with ______ amounts of sputum suggests broncho-pleural fistula
• Digital clubbing

Answer 39

Acute; indolent

Prolonged fever

Postural cough; large

Question 40

Empyema necessitans is a ____________________ of an empyema that has ______________________________,
usually into the ___________ , to form a
_________________ that eventually
may _________________

Answer 40

spontaneous discharge

burrowed through the parietal pleura

chest wall

subcutaneous abscess ; rupture through skin