BIBLE Respiratory Flashcards
(126 cards)
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
What is type 1 respiratory failure?
Hypoxia
| Low oxygen, normal or low carbon dioxide
26
What causes type 1 respiratory failure?
Ventilation perfusion mismatches
27
How is type 1 respiratory failure treated?
Treat underlying cause
| Target sats 94-98%
28
What is type 2 respiratory failure?
Hypoxia and hypercapnia
| Low oxygen with high carbon dioxide (PaCO2 >6kPa)
29
What causes type 2 respiratory failure?
Alveolar hypo perfusion with or without V/Q mismatches
30
What is the treatment for type 2 respiratory failure?
Treat underlying cause
| Target sats 88-92%
31
What are the categories of pleural effusion and how are they split up?
Transudate (<30 g/l protein)
| Exudate (>30 g/l protein)
32
What are the causes of transudate?
HF
Liver cirrhosis
Nephrotic Syndrome
Meigs Syndrome
33
What are the causes of Exudate?
Infection
Malignancy
PE
Autoimmune - Rheumatoid, SLE
34
What is a thumbprint sign on heard X-Ray indicative of?
Epiglottitis
35
What is increased ACE and Calcium indicative of?
Sarcoidosis
36
Where is respiratory rhythm established in the brain?
Medulla
37
What groups of neurones control inspiration and expiration? (DIVE)
Dorsal firing is Inspiratory
| Ventral firing is Expiratory
38
What prolongs inspiration?
Apneustic Centre
39
What inhibits inspiration?
Pneumotaxic Centre
40
What is respiratory epithelium?
Pseudostratified ciliated columnar epithelium with goblet cells
41
Which virus causes coryza? (common cold)
Rhinovirus
42
Which pneumonia is associated with birds?
Chlamydiophilia psittaci
43
What pneumonia is acquired from sheep/farms and what does is cause?
Coxiella burnetti
| Q fever
44
WHich pneumonia is acquired from foreign water on holiday and how is it tested for?
Legionella
Urine antigen Testing
Causes GI Upset
45
Which pneumonia is associated with a dry cough and young people?
Mycoplasma
46
Which pneumonia causes red purulent jelly sputum and occurs in COPD/alcoholics/ elderly patients?
Klebsiella pneumonia
47
Which pneumonia occurs in patients that are immunocompromised or have HIV/AIDS?
Pneumocystis Carinii
48
Which pneumonia causes rusty sputum?
Streptococcus pneumonia
49
Which pneumonia commonly affects CF patients?
Staph aureus
| Pseudomonas aeruginosa
50
Which pneumonia occurs in COPD/alcoholics/elderly patients?
Haemophilus influenzae
51
Which pneumonia causes whooping cough/bronchopneumonia?
Bordetella pertussis
52
Which pneumonia is associated with CF, UTI's, GI, burns, scars and is a gram negative bacillus?
Pseudomonas aeruginosa
53
Differential diagnosis for a hyperexpanded chest
COPD
| Chronic Asthma
54
Postural flapping tremor
Acute CO2 retention
55
Stony dull percussion
Pleural effusion
56
Fine crepitation's can be associated with
Pulmonary oedema
| Pulmonary fibrosis
57
What causes pleuritic chest pain?
PE
Pneumonia
Pneumothorax
58
What can be associated with stridor?
Upper airway obstruction (foreign body, croup)
59
What can be associated with Kerley B lines and bat wing shadowing on a CXR?
Heart failure
60
What can be associated with Tram-line shadowing on a CXR?
Bronchiectasis
61
What is associated with miliary shadowing on a CXR?
Miliary TB
62
What is associated with a wedge shaped infarct on a CXR?
PE
63
What is associated with a 'ground glass appearance' on a CXR?
Fibrosis
64
What is associated with a honeycomb appearance on a CXR?
Fibrosis (late)
65
What is associated with a pleural mass with a lobulated margin on CXR?
Mesothelioma
66
What condition is associated with early onset emphysema plus liver disease?
Alpha1 antitrypsin deficiency
67
What condition is associated with Fever, cough and SOB hours after exposure to antigen (farmer after hay exposure)?
Extrinsic allergic alveolitis
68
Asymptomatic with bilateral hilar lymphadenopathy / progressive SOB / dry cough
Erythema nodosum
Increased serum ACE or hypercalcaemia
Sarcoidosis
69
History of recurrent chest infections, failure to thrive
May mention steatorrhea
Positive sweat test
CF
70
Progressive dyspnoea and cyanosis
Gross clubbing, fine end-respiratory crackles
CXR - Ground glass -> honeycomb lung
Fibrosing alveolitis
71
Non-specific (fever, night sweats, anorexia, haemoptysis
| Zeihl-Neelson staining showing acid-fast bacilli
TB
72
Swinging fever, copious foul smelling sputum
| Patient usually has persistent worsening pneumonia
Lung Abscess
73
What organism is associated with positive cold agglutinins?
Mycoplasma infection
74
What organism is associated with an occupation involving water systems?
Legionella infection
75
What organism is associated with cavitating lung(s)?
Staphylococcal/klebsiella infection
76
What organism is associated with contact with birds?
Chlamydia psittaci infection
77
What organism is associated with HIV +ve patients with bilateral hilar shadowing?
Pneumocystis carinii pneumonia
78
What drug causes peripheral neuropathy, hepatitis?
Isoniazid
79
What drug causes oRange coloured tears/urine, deranged LFT's, hepatitis?
Rifampicin
80
What drug causes retrobulbar neuritis (pain, loss of vision)? EYE problems
Ethambutol
81
What drug causes gout?
Pyrazinamide
82
What drug causes tremors and tachycardia?
Salbutamol
83
What drug causes candidiasis in the mouth/pharynx?
High dose ICS
84
What type of cancer is mucin producing?
Adenocarcinoma
85
What type of cancer produced PTH (parathyroid hormone)?
Squamous cell carcinoma
86
What type of cancer produces ACTH (adrenocorticotrophic hormone)?
Small cell cancer
87
Which investigation would you do to look for bone metastasis?
Radionuclide bone scan
| 99M Tc molecule injected
88
If D-Dimers are high
Suspect (but not diagnose) PE
89
What is used to diagnose PE?
CTPA (1st line) or V/Q scan
90
If D-Dimers are low
Exclude PE
91
What is the treatment for a large PE?
Thrombolysis (1st line management for massive PE)
92
What is the treatment for a small PE?
Low Molecular Weight Heparin
93
What is the management for PE?
LMWH - After PE is diagnosed
Vitamin K antagonist (Warfarin) given within 24hrs of diagnosis
Thrombolysis - 1st line management for massive PE
94
What is the management of an infective exacerbation of COPD? (iSOAP)
```
Ipratropium
Salbutamol
Oxygen
Amoxicillin
Prednisolone
```
95
What can be seen in a young non-smoker with potential liver damage?
Alpha1 antitrypsin deficiency
96
What syndrome is a combination of rheumatoid arthritis and pneumoconiosis?
Caplans Syndrome
97
What is Samters Triad and what does it indicate?
Asthma
Salicylate sensitivity (Aspirin)
Nasal Polyps
Indicates Aspirin induced asthma
98
Pink puffer, pursed lips and prolonged expiration are indicative of what?
Emphysema
99
What are the classification of Emphysema?
Centri-acinar
| Pan-acinar
100
Where is centri-acinar emphysema located?
Distension and damage of lung tissue concentrated around respiratory bronchioles
Distal alveolar ducts and alveoli tend to be well preserved
101
What causes Centri-acinar emphysema?
Smoking and related to coal dust
102
Where is pan-acinar emphysema located?
Distension and destruction involve whole acinus
103
What causes pan-acinar emphysema?
Alpha 1 antitrypsin deficiency
104
Which type of emphysema is more common?
Centri-acinar
105
What is the commonest cause of bronchiolitis and how is it diagnosed?
RSV
| Diagnosed by PCR
106
What is Boyles Law?
Pressure exerted by gas varies inversely with the volume of gas (as volume increases, pressure decreases)
107
What supplies the Anterior intercostal spaces?
Internal Thoracic Artery/vein
108
What supplies the posterior intercostal spaces?
Thoracic aorta/azygous vein
109
What mediates Type 1 sensitivity?
```
IgE mediated (Fc Receptors)
Mast cell degradation
```
110
What is the test for anaphylaxis?
Serum Tryptase - Only in anaphylaxis and not in local reactions
111
List some examples of a type 1 hypersensitivity reaction
```
Allergic asthma
Allergic conjunctivitis
Allergic rhinitis
Anaphylaxis
Pen allergy
Food allergy
```
112
What hypersensitivity reaction is mediated by IgG and IgM?
Type 2
113
Give some examples of a type 2 hypersensitivity reaction
Autoimmune haemolytic anaemia
Goodpasture syndrome
Graves disease
Immune thrombocytopenia
114
Which type of hypersensitivity reaction is NOT antibody mediated?
Type 4
115
Give some examples of type 4 hypersensitivity reactions
SLE
MS
Rheumatoid arthritis
116
What is the most common cause of community acquired pneumonia and pneumonia seen typically in HIV patients?
Pneumocystis pneumonia
117
What is the treatment for TB?
RIPE for 2 months
| RI for 4 months
118
What is used to diagnose osteoporosis?
DEXA bone scan
119
Is bronchopneumonia neutrophilic or eosinophilic?
Neutrophilic
120
How is community acquired pneumonia assessed?
CURB 65 score
121
What is contained within CURB65?
```
Confusion
Urea >7
RR >30
BP <90 or <60
Age >65
```
122
What score is mild CAP and how is it treated?
0-2
| Amoxicillin (doxycycline is pen allergic)
123
What score is severe CAP and how is it treated?
IV co-amoxiclav + IV Clarithromycin
| Then step down to oral doxycycline
124
How is hospital acquired pneumonia/aspiration pneumonia treated?
IV Amoxicillin + Metronidazole + Gentamicin (AMG)
| Step down to co-trimoxazole + metronidazole orally
125
What is the first line treatment for an acute COPD exacerbation?
Amoxicillin
126
What is the second line treatment for an acute COPD exacerbation?
Doxycycline
