Where is the trachea palpated?
Suprasternal angle/jugular notch
What is the palpable area to locate rib 2 called?
Where does the larynx become trachea and pharynx become oesophagus?
At what vertebral level does the trachea bifurcate?
Where is the lingula found?
Left lung (superior lobe)
Where is the horizontal fissure found?
Right lung (separates upper lobe from the middle lobe)
What separates the superior and inferior lobes of both lungs?
Where can the middle lobe be auscultated?
Between ribs 4 and 6
At what rib can the horizontal fissure be found?
Follows right of rib 4
Where can the oblique fissures be found?
Rib 6 bilaterally rising to T3 posteriorly
At what vertebral level can the lung base be auscultated?
Nerve that supplies the diaphragm
Phrenic (C3,4,5 keeps the diaphragm alive)
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)
What lung cancer is most commonly associated with non-smokers?
What antigen is contained in a squamous cell carcinoma of the lung?
What is the rima glottidis?
Narrowest part of the larynx where foreign bodies tend to block
What is associated with a raised eosinophil count?
Asthma (obstructive lung disease)
What is associated with a raised neutrophil count?
What is the urine antigen test used for?
What can be seen in pulmonary oedema? (ABCDE)
Alveolar bat's wings Kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Pleural Effusion
Ziehl Nelson Stain posiive for acid fast bacilli
What are the features of Idiopathic pulmonary fibrosis? (4 C’s of Fibrosis)
What is a D sign on an X-Ray indicative of?
What is respiratory failure defined as?
Inadequate gas exchange defined by an oxygen of <8kPa
What is type 1 respiratory failure?
Low oxygen, normal or low carbon dioxide
What causes type 1 respiratory failure?
Ventilation perfusion mismatches
How is type 1 respiratory failure treated?
Treat underlying cause
Target sats 94-98%
What is type 2 respiratory failure?
Hypoxia and hypercapnia
Low oxygen with high carbon dioxide (PaCO2 >6kPa)
What causes type 2 respiratory failure?
Alveolar hypo perfusion with or without V/Q mismatches
What is the treatment for type 2 respiratory failure?
Treat underlying cause
Target sats 88-92%
What are the categories of pleural effusion and how are they split up?
Transudate (<30 g/l protein)
Exudate (>30 g/l protein)
What are the causes of transudate?
What are the causes of Exudate?
Autoimmune - Rheumatoid, SLE
What is a thumbprint sign on heard X-Ray indicative of?
What is increased ACE and Calcium indicative of?
Where is respiratory rhythm established in the brain?
What groups of neurones control inspiration and expiration? (DIVE)
Dorsal firing is Inspiratory
Ventral firing is Expiratory
What prolongs inspiration?
What inhibits inspiration?
What is respiratory epithelium?
Pseudostratified ciliated columnar epithelium with goblet cells
Which virus causes coryza? (common cold)
Which pneumonia is associated with birds?
What pneumonia is acquired from sheep/farms and what does is cause?
WHich pneumonia is acquired from foreign water on holiday and how is it tested for?
Urine antigen Testing
Causes GI Upset
Which pneumonia is associated with a dry cough and young people?
Which pneumonia causes red purulent jelly sputum and occurs in COPD/alcoholics/ elderly patients?
Which pneumonia occurs in patients that are immunocompromised or have HIV/AIDS?
Which pneumonia causes rusty sputum?
Which pneumonia commonly affects CF patients?
Which pneumonia occurs in COPD/alcoholics/elderly patients?
Which pneumonia causes whooping cough/bronchopneumonia?
Which pneumonia is associated with CF, UTI’s, GI, burns, scars and is a gram negative bacillus?
Differential diagnosis for a hyperexpanded chest
Postural flapping tremor
Acute CO2 retention
Stony dull percussion
Fine crepitation’s can be associated with
What causes pleuritic chest pain?
What can be associated with stridor?
Upper airway obstruction (foreign body, croup)
What can be associated with Kerley B lines and bat wing shadowing on a CXR?
What can be associated with Tram-line shadowing on a CXR?
What is associated with miliary shadowing on a CXR?
What is associated with a wedge shaped infarct on a CXR?
What is associated with a ‘ground glass appearance’ on a CXR?
What is associated with a honeycomb appearance on a CXR?
What is associated with a pleural mass with a lobulated margin on CXR?
What condition is associated with early onset emphysema plus liver disease?
Alpha1 antitrypsin deficiency
What condition is associated with Fever, cough and SOB hours after exposure to antigen (farmer after hay exposure)?
Extrinsic allergic alveolitis
Asymptomatic with bilateral hilar lymphadenopathy / progressive SOB / dry cough
Increased serum ACE or hypercalcaemia
History of recurrent chest infections, failure to thrive
May mention steatorrhea
Positive sweat test
Progressive dyspnoea and cyanosis
Gross clubbing, fine end-respiratory crackles
CXR - Ground glass -> honeycomb lung
Non-specific (fever, night sweats, anorexia, haemoptysis
Zeihl-Neelson staining showing acid-fast bacilli
Swinging fever, copious foul smelling sputum
Patient usually has persistent worsening pneumonia
What organism is associated with positive cold agglutinins?
What organism is associated with an occupation involving water systems?
What organism is associated with cavitating lung(s)?
What organism is associated with contact with birds?
Chlamydia psittaci infection
What organism is associated with HIV +ve patients with bilateral hilar shadowing?
Pneumocystis carinii pneumonia
What drug causes peripheral neuropathy, hepatitis?
What drug causes oRange coloured tears/urine, deranged LFT’s, hepatitis?
What drug causes retrobulbar neuritis (pain, loss of vision)? EYE problems
What drug causes gout?
What drug causes tremors and tachycardia?
What drug causes candidiasis in the mouth/pharynx?
High dose ICS
What type of cancer is mucin producing?
What type of cancer produced PTH (parathyroid hormone)?
Squamous cell carcinoma
What type of cancer produces ACTH (adrenocorticotrophic hormone)?
Small cell cancer
Which investigation would you do to look for bone metastasis?
Radionuclide bone scan
99M Tc molecule injected
If D-Dimers are high
Suspect (but not diagnose) PE
What is used to diagnose PE?
CTPA (1st line) or V/Q scan
If D-Dimers are low
What is the treatment for a large PE?
Thrombolysis (1st line management for massive PE)
What is the treatment for a small PE?
Low Molecular Weight Heparin
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
What is the management of an infective exacerbation of COPD? (iSOAP)
Ipratropium Salbutamol Oxygen Amoxicillin Prednisolone
What can be seen in a young non-smoker with potential liver damage?
Alpha1 antitrypsin deficiency
What syndrome is a combination of rheumatoid arthritis and pneumoconiosis?
What is Samters Triad and what does it indicate?
Salicylate sensitivity (Aspirin)
Indicates Aspirin induced asthma
Pink puffer, pursed lips and prolonged expiration are indicative of what?
What are the classification of Emphysema?
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
What causes Centri-acinar emphysema?
Smoking and related to coal dust
Where is pan-acinar emphysema located?
Distension and destruction involve whole acinus
What causes pan-acinar emphysema?
Alpha 1 antitrypsin deficiency
Which type of emphysema is more common?
What is the commonest cause of bronchiolitis and how is it diagnosed?
Diagnosed by PCR
What is Boyles Law?
Pressure exerted by gas varies inversely with the volume of gas (as volume increases, pressure decreases)
What supplies the Anterior intercostal spaces?
Internal Thoracic Artery/vein
What supplies the posterior intercostal spaces?
Thoracic aorta/azygous vein
What mediates Type 1 sensitivity?
IgE mediated (Fc Receptors) Mast cell degradation
What is the test for anaphylaxis?
Serum Tryptase - Only in anaphylaxis and not in local reactions
List some examples of a type 1 hypersensitivity reaction
Allergic asthma Allergic conjunctivitis Allergic rhinitis Anaphylaxis Pen allergy Food allergy
What hypersensitivity reaction is mediated by IgG and IgM?
Give some examples of a type 2 hypersensitivity reaction
Autoimmune haemolytic anaemia
Which type of hypersensitivity reaction is NOT antibody mediated?
Give some examples of type 4 hypersensitivity reactions
What is the most common cause of community acquired pneumonia and pneumonia seen typically in HIV patients?
What is the treatment for TB?
RIPE for 2 months
RI for 4 months
What is used to diagnose osteoporosis?
DEXA bone scan
Is bronchopneumonia neutrophilic or eosinophilic?
How is community acquired pneumonia assessed?
CURB 65 score
What is contained within CURB65?
Confusion Urea >7 RR >30 BP <90 or <60 Age >65
What score is mild CAP and how is it treated?
Amoxicillin (doxycycline is pen allergic)
What score is severe CAP and how is it treated?
IV co-amoxiclav + IV Clarithromycin
Then step down to oral doxycycline
How is hospital acquired pneumonia/aspiration pneumonia treated?
IV Amoxicillin + Metronidazole + Gentamicin (AMG)
Step down to co-trimoxazole + metronidazole orally
What is the first line treatment for an acute COPD exacerbation?
What is the second line treatment for an acute COPD exacerbation?