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Flashcards in BIBLE Respiratory Deck (126)
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1
Q

Where is the trachea palpated?

A

Suprasternal angle/jugular notch

2
Q

What is the palpable area to locate rib 2 called?

A

Sternal angle

3
Q

Where does the larynx become trachea and pharynx become oesophagus?

A

C6

4
Q

At what vertebral level does the trachea bifurcate?

A

T5-7 (Carina)

5
Q

Where is the lingula found?

A

Left lung (superior lobe)

6
Q

Where is the horizontal fissure found?

A

Right lung (separates upper lobe from the middle lobe)

7
Q

What separates the superior and inferior lobes of both lungs?

A

Oblique fissure

8
Q

Where can the middle lobe be auscultated?

A

Between ribs 4 and 6

9
Q

At what rib can the horizontal fissure be found?

A

Follows right of rib 4

10
Q

Where can the oblique fissures be found?

A

Rib 6 bilaterally rising to T3 posteriorly

11
Q

At what vertebral level can the lung base be auscultated?

A

T11

12
Q

Nerve that supplies the diaphragm

A

Phrenic (C3,4,5 keeps the diaphragm alive)

13
Q

When a lung cancer invades the sympathetic chain causing ptosis (drooping of the eyelid), miosis (constriction of the pupil of the eye) and anhidrosis (inability to sweat normally)

A

Horners syndrome

14
Q

What lung cancer is most commonly associated with non-smokers?

A

Adenocarcinoma

15
Q

What antigen is contained in a squamous cell carcinoma of the lung?

A

P63

16
Q

What is the rima glottidis?

A

Narrowest part of the larynx where foreign bodies tend to block

17
Q

What is associated with a raised eosinophil count?

A

Asthma (obstructive lung disease)

18
Q

What is associated with a raised neutrophil count?

A

COPD

19
Q

What is the urine antigen test used for?

A

Legionella Pneumonia

20
Q

What can be seen in pulmonary oedema? (ABCDE)

A
Alveolar bat's wings 
Kerley B lines 
Cardiomegaly 
Dilated prominent upper lobe vessels 
Pleural Effusion
21
Q

Ziehl Nelson Stain posiive for acid fast bacilli

A

TB

22
Q

What are the features of Idiopathic pulmonary fibrosis? (4 C’s of Fibrosis)

A

Clubbing
Cough
Cyanosis
Crackles

23
Q

What is a D sign on an X-Ray indicative of?

A

Empyema

24
Q

What is respiratory failure defined as?

A

Inadequate gas exchange defined by an oxygen of <8kPa

25
Q

What is type 1 respiratory failure?

A

Hypoxia

Low oxygen, normal or low carbon dioxide

26
Q

What causes type 1 respiratory failure?

A

Ventilation perfusion mismatches

27
Q

How is type 1 respiratory failure treated?

A

Treat underlying cause

Target sats 94-98%

28
Q

What is type 2 respiratory failure?

A

Hypoxia and hypercapnia

Low oxygen with high carbon dioxide (PaCO2 >6kPa)

29
Q

What causes type 2 respiratory failure?

A

Alveolar hypo perfusion with or without V/Q mismatches

30
Q

What is the treatment for type 2 respiratory failure?

A

Treat underlying cause

Target sats 88-92%

31
Q

What are the categories of pleural effusion and how are they split up?

A

Transudate (<30 g/l protein)

Exudate (>30 g/l protein)

32
Q

What are the causes of transudate?

A

HF
Liver cirrhosis
Nephrotic Syndrome
Meigs Syndrome

33
Q

What are the causes of Exudate?

A

Infection
Malignancy
PE
Autoimmune - Rheumatoid, SLE

34
Q

What is a thumbprint sign on heard X-Ray indicative of?

A

Epiglottitis

35
Q

What is increased ACE and Calcium indicative of?

A

Sarcoidosis

36
Q

Where is respiratory rhythm established in the brain?

A

Medulla

37
Q

What groups of neurones control inspiration and expiration? (DIVE)

A

Dorsal firing is Inspiratory

Ventral firing is Expiratory

38
Q

What prolongs inspiration?

A

Apneustic Centre

39
Q

What inhibits inspiration?

A

Pneumotaxic Centre

40
Q

What is respiratory epithelium?

A

Pseudostratified ciliated columnar epithelium with goblet cells

41
Q

Which virus causes coryza? (common cold)

A

Rhinovirus

42
Q

Which pneumonia is associated with birds?

A

Chlamydiophilia psittaci

43
Q

What pneumonia is acquired from sheep/farms and what does is cause?

A

Coxiella burnetti

Q fever

44
Q

WHich pneumonia is acquired from foreign water on holiday and how is it tested for?

A

Legionella
Urine antigen Testing
Causes GI Upset

45
Q

Which pneumonia is associated with a dry cough and young people?

A

Mycoplasma

46
Q

Which pneumonia causes red purulent jelly sputum and occurs in COPD/alcoholics/ elderly patients?

A

Klebsiella pneumonia

47
Q

Which pneumonia occurs in patients that are immunocompromised or have HIV/AIDS?

A

Pneumocystis Carinii

48
Q

Which pneumonia causes rusty sputum?

A

Streptococcus pneumonia

49
Q

Which pneumonia commonly affects CF patients?

A

Staph aureus

Pseudomonas aeruginosa

50
Q

Which pneumonia occurs in COPD/alcoholics/elderly patients?

A

Haemophilus influenzae

51
Q

Which pneumonia causes whooping cough/bronchopneumonia?

A

Bordetella pertussis

52
Q

Which pneumonia is associated with CF, UTI’s, GI, burns, scars and is a gram negative bacillus?

A

Pseudomonas aeruginosa

53
Q

Differential diagnosis for a hyperexpanded chest

A

COPD

Chronic Asthma

54
Q

Postural flapping tremor

A

Acute CO2 retention

55
Q

Stony dull percussion

A

Pleural effusion

56
Q

Fine crepitation’s can be associated with

A

Pulmonary oedema

Pulmonary fibrosis

57
Q

What causes pleuritic chest pain?

A

PE
Pneumonia
Pneumothorax

58
Q

What can be associated with stridor?

A

Upper airway obstruction (foreign body, croup)

59
Q

What can be associated with Kerley B lines and bat wing shadowing on a CXR?

A

Heart failure

60
Q

What can be associated with Tram-line shadowing on a CXR?

A

Bronchiectasis

61
Q

What is associated with miliary shadowing on a CXR?

A

Miliary TB

62
Q

What is associated with a wedge shaped infarct on a CXR?

A

PE

63
Q

What is associated with a ‘ground glass appearance’ on a CXR?

A

Fibrosis

64
Q

What is associated with a honeycomb appearance on a CXR?

A

Fibrosis (late)

65
Q

What is associated with a pleural mass with a lobulated margin on CXR?

A

Mesothelioma

66
Q

What condition is associated with early onset emphysema plus liver disease?

A

Alpha1 antitrypsin deficiency

67
Q

What condition is associated with Fever, cough and SOB hours after exposure to antigen (farmer after hay exposure)?

A

Extrinsic allergic alveolitis

68
Q

Asymptomatic with bilateral hilar lymphadenopathy / progressive SOB / dry cough
Erythema nodosum
Increased serum ACE or hypercalcaemia

A

Sarcoidosis

69
Q

History of recurrent chest infections, failure to thrive
May mention steatorrhea
Positive sweat test

A

CF

70
Q

Progressive dyspnoea and cyanosis
Gross clubbing, fine end-respiratory crackles
CXR - Ground glass -> honeycomb lung

A

Fibrosing alveolitis

71
Q

Non-specific (fever, night sweats, anorexia, haemoptysis

Zeihl-Neelson staining showing acid-fast bacilli

A

TB

72
Q

Swinging fever, copious foul smelling sputum

Patient usually has persistent worsening pneumonia

A

Lung Abscess

73
Q

What organism is associated with positive cold agglutinins?

A

Mycoplasma infection

74
Q

What organism is associated with an occupation involving water systems?

A

Legionella infection

75
Q

What organism is associated with cavitating lung(s)?

A

Staphylococcal/klebsiella infection

76
Q

What organism is associated with contact with birds?

A

Chlamydia psittaci infection

77
Q

What organism is associated with HIV +ve patients with bilateral hilar shadowing?

A

Pneumocystis carinii pneumonia

78
Q

What drug causes peripheral neuropathy, hepatitis?

A

Isoniazid

79
Q

What drug causes oRange coloured tears/urine, deranged LFT’s, hepatitis?

A

Rifampicin

80
Q

What drug causes retrobulbar neuritis (pain, loss of vision)? EYE problems

A

Ethambutol

81
Q

What drug causes gout?

A

Pyrazinamide

82
Q

What drug causes tremors and tachycardia?

A

Salbutamol

83
Q

What drug causes candidiasis in the mouth/pharynx?

A

High dose ICS

84
Q

What type of cancer is mucin producing?

A

Adenocarcinoma

85
Q

What type of cancer produced PTH (parathyroid hormone)?

A

Squamous cell carcinoma

86
Q

What type of cancer produces ACTH (adrenocorticotrophic hormone)?

A

Small cell cancer

87
Q

Which investigation would you do to look for bone metastasis?

A

Radionuclide bone scan

99M Tc molecule injected

88
Q

If D-Dimers are high

A

Suspect (but not diagnose) PE

89
Q

What is used to diagnose PE?

A

CTPA (1st line) or V/Q scan

90
Q

If D-Dimers are low

A

Exclude PE

91
Q

What is the treatment for a large PE?

A

Thrombolysis (1st line management for massive PE)

92
Q

What is the treatment for a small PE?

A

Low Molecular Weight Heparin

93
Q

What is the management for PE?

A

LMWH - After PE is diagnosed
Vitamin K antagonist (Warfarin) given within 24hrs of diagnosis
Thrombolysis - 1st line management for massive PE

94
Q

What is the management of an infective exacerbation of COPD? (iSOAP)

A
Ipratropium 
Salbutamol 
Oxygen 
Amoxicillin
Prednisolone
95
Q

What can be seen in a young non-smoker with potential liver damage?

A

Alpha1 antitrypsin deficiency

96
Q

What syndrome is a combination of rheumatoid arthritis and pneumoconiosis?

A

Caplans Syndrome

97
Q

What is Samters Triad and what does it indicate?

A

Asthma
Salicylate sensitivity (Aspirin)
Nasal Polyps
Indicates Aspirin induced asthma

98
Q

Pink puffer, pursed lips and prolonged expiration are indicative of what?

A

Emphysema

99
Q

What are the classification of Emphysema?

A

Centri-acinar

Pan-acinar

100
Q

Where is centri-acinar emphysema located?

A

Distension and damage of lung tissue concentrated around respiratory bronchioles
Distal alveolar ducts and alveoli tend to be well preserved

101
Q

What causes Centri-acinar emphysema?

A

Smoking and related to coal dust

102
Q

Where is pan-acinar emphysema located?

A

Distension and destruction involve whole acinus

103
Q

What causes pan-acinar emphysema?

A

Alpha 1 antitrypsin deficiency

104
Q

Which type of emphysema is more common?

A

Centri-acinar

105
Q

What is the commonest cause of bronchiolitis and how is it diagnosed?

A

RSV

Diagnosed by PCR

106
Q

What is Boyles Law?

A

Pressure exerted by gas varies inversely with the volume of gas (as volume increases, pressure decreases)

107
Q

What supplies the Anterior intercostal spaces?

A

Internal Thoracic Artery/vein

108
Q

What supplies the posterior intercostal spaces?

A

Thoracic aorta/azygous vein

109
Q

What mediates Type 1 sensitivity?

A
IgE mediated (Fc Receptors)
Mast cell degradation
110
Q

What is the test for anaphylaxis?

A

Serum Tryptase - Only in anaphylaxis and not in local reactions

111
Q

List some examples of a type 1 hypersensitivity reaction

A
Allergic asthma 
Allergic conjunctivitis 
Allergic rhinitis
Anaphylaxis 
Pen allergy 
Food allergy
112
Q

What hypersensitivity reaction is mediated by IgG and IgM?

A

Type 2

113
Q

Give some examples of a type 2 hypersensitivity reaction

A

Autoimmune haemolytic anaemia
Goodpasture syndrome
Graves disease
Immune thrombocytopenia

114
Q

Which type of hypersensitivity reaction is NOT antibody mediated?

A

Type 4

115
Q

Give some examples of type 4 hypersensitivity reactions

A

SLE
MS
Rheumatoid arthritis

116
Q

What is the most common cause of community acquired pneumonia and pneumonia seen typically in HIV patients?

A

Pneumocystis pneumonia

117
Q

What is the treatment for TB?

A

RIPE for 2 months

RI for 4 months

118
Q

What is used to diagnose osteoporosis?

A

DEXA bone scan

119
Q

Is bronchopneumonia neutrophilic or eosinophilic?

A

Neutrophilic

120
Q

How is community acquired pneumonia assessed?

A

CURB 65 score

121
Q

What is contained within CURB65?

A
Confusion 
Urea >7
RR >30
BP <90 or <60
Age >65
122
Q

What score is mild CAP and how is it treated?

A

0-2

Amoxicillin (doxycycline is pen allergic)

123
Q

What score is severe CAP and how is it treated?

A

IV co-amoxiclav + IV Clarithromycin

Then step down to oral doxycycline

124
Q

How is hospital acquired pneumonia/aspiration pneumonia treated?

A

IV Amoxicillin + Metronidazole + Gentamicin (AMG)

Step down to co-trimoxazole + metronidazole orally

125
Q

What is the first line treatment for an acute COPD exacerbation?

A

Amoxicillin

126
Q

What is the second line treatment for an acute COPD exacerbation?

A

Doxycycline