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Flashcards in Cardio/Respiratory Deck (109)
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1

How should you go about assessing circulation on a CXR?

Is the heart in the correct position? (2/3rds left, 1/3rd right)

Is the heart the correct size? (< 50% cardiothoracic ratio)

Is the mediastinum a normal width? Can you see the vessels on either side?

2

A fine physiological tremor can be caused by what medication commonly used in respiratory medicine?

Salbutamol (beta 2 agonist)

3

What rate should the oxygen flow be set to when using a nebuliser?

6-8L/min

4

How should you go about assessing the lungs and pleural space on a CXR?

Do both lungs look the same size?

Assess the apices and upper/mid/lower zones for any asymmetry

Are the borders of the costophrenic angles, hemidiaphragms and heart clear?

 

5

Describe the abnormality seen on this CXR?

There is a rounded opacity in the left middle zone near to the left hilum. The most likely diagnosis here is a lung malignancy (could be primary or metastases) or potentially an infection (bacterial/fungal)

6

What is a collapsing pulse a sign of?

Aortic regurgitation

7

How would you describe these breath sounds?

Reduced breath sounds

8

During a respiratory history exam it can be useful to ask if the patient has any pain where, to assess for referred pain from the diaphragm?

Shoulder tip

9

Describe Buerger's test, used to assess for peripheral arterial disease?

Hold patient's legs at 45 degrees for 1-2 minutes then ask them to swing their legs round to the side of the bed- if the legs become red and flushed this is indicative of arterial disease

10

Describe the abnormality seen on this CXR?

Prominent bilateral hila- likely to be bilateral lymphadenopathy, which could be caused by TB or sarcoidosis or lymphoma

11

How often should you repeat a peak flow test?

Three times (use the best of the three)

12

Where on the chest should you listen for the mitral valve?

5th left intercostal space, mid-clavicular line

13

What are some specific things to look for on the 'anything else' assessment of a CXR?

Any free air under the diaphragm?

Any subcutaneous emphysema?

14

A slow rising pulse is a sign of what pathology?

Aortic stenosis

15

In which pathology will breath sounds always be absent?

Pneumonectomy

16

What flow rate of oxygen should be used with a simple face mask?

What FiO2 does this provide?

5-10L/min

40-60%

17

What should be considered when assessing the airways on a CXR?

Is the trachea in the midline and is it straight?

Are the main bronchi narrowed or cut off?

Is there any inhaled foreign body?

18

In which pathologies may the trachea be deviated towards the affected side?

Lung collapse, pneumonectomy

19

Which cardiovascular pathologies can result in finger clubbing?

Infective endocarditis, cyanotic congenital heart disease, atrial myxoma

20

What line/tube can be seen in this CXR?

PICC line

21

How would you describe these breath sounds?

Inspiratory wheeze (stridor)

22

Describe the abnormality seen on this CXR?

There is a rounded opacification in the right lower zone near the periphery. This opacification has an air-fluid level. Differentials for this include a lung abscess (empyema) or potentially a malignancy. 

23

Describe the murmur of mitral stenosis?

A low-pitched (rumbling) mid-diastolic murmur, (GRADE), heard loudest at the apex (exacerbated by lying on LHS)

24

What murmur is this?

Aortic regurgitation (early diastolic, decrescendo)

25

What are the main risk factors for cardiovascular pathology that should be asked about early on in the history?

Smoking, diabetes, hypertension, hypercholesterolaemia

26

Asking the patient to roll onto their left side and hold their breath with the bell of your stethoscope at the apex tends to amplify which murmur?

Mitral stenosis

27

What % of average/best peak flow corresponds with moderate asthma?

50-75%

28

Describe the abnormality seen on this CXR?

Prominent upper lobe vessel dilation and enlarged hilum with blunting of the costophrenic angles, overall consistent with pulmonary oedema

29

What are the 3 main symptoms of aortic stenosis?

Shortness of breath, exertional syncope/pre-syncope, angina

30

How long should you advise patients to wait between two doses of an inhaled medication?

30 seconds