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OSCE > Cardio/Respiratory > Flashcards

Cardio/Respiratory Flashcards

1
Q

How should you go about assessing circulation on a CXR?

A

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?

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2
Q

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

A

Salbutamol (beta 2 agonist)

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3
Q

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

A

6-8L/min

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4
Q

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

A

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?

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5
Q

Describe the abnormality seen on this CXR?

A

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)

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6
Q

What is a collapsing pulse a sign of?

A

Aortic regurgitation

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7
Q

How would you describe these breath sounds?

A

Reduced breath sounds

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8
Q

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?

A

Shoulder tip

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9
Q

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

A

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

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10
Q

Describe the abnormality seen on this CXR?

A

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

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11
Q

How often should you repeat a peak flow test?

A

Three times (use the best of the three)

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12
Q

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

A

5th left intercostal space, mid-clavicular line

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13
Q

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

A

Any free air under the diaphragm?

Any subcutaneous emphysema?

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14
Q

A slow rising pulse is a sign of what pathology?

A

Aortic stenosis

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15
Q

In which pathology will breath sounds always be absent?

A

Pneumonectomy

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16
Q

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

What FiO2 does this provide?

A

5-10L/min

40-60%

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17
Q

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

A

Is the trachea in the midline and is it straight?

Are the main bronchi narrowed or cut off?

Is there any inhaled foreign body?

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18
Q

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

A

Lung collapse, pneumonectomy

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19
Q

Which cardiovascular pathologies can result in finger clubbing?

A

Infective endocarditis, cyanotic congenital heart disease, atrial myxoma

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20
Q

What line/tube can be seen in this CXR?

A

PICC line

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21
Q

How would you describe these breath sounds?

A

Inspiratory wheeze (stridor)

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22
Q

Describe the abnormality seen on this CXR?

A

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.

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23
Q

Describe the murmur of mitral stenosis?

A

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

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24
Q

What murmur is this?

A

Aortic regurgitation (early diastolic, decrescendo)

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25
Q

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

A

Smoking, diabetes, hypertension, hypercholesterolaemia

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26
Q

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?

A

Mitral stenosis

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27
Q

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

A

50-75%

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28
Q

Describe the abnormality seen on this CXR?

A

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

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29
Q

What are the 3 main symptoms of aortic stenosis?

A

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

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30
Q

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

A

30 seconds

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31
Q

What are some potential causes of coarse bibasal crepitations?

A

Bronchiectasis, CF, bibasal pneumonia

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32
Q

Describe the abnormality seen on this CXR?

A

‘Bat wing’ appearance with blunting of the costophrenic angles consistent with pulmonary oedema

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33
Q

What is the first step when interpreting a chest x-ray?

A

Confirm it is of the correct patient with name and DOB

Confirm what type of CXR it is (PA/AP)

Confirm when and where the CXR was taken and for what reason

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34
Q

Which pathology typically causes a hyper-resonant percussion note?

A

Pneumothorax

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35
Q

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

A

> 75%

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36
Q

Sacral and peripheral oedema are signs of what?

A

Right-sided heart failure

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37
Q

Describe the abnormality seen on this CXR?

A

Widespread round opacifications throughout both lung fields, consistent with pleural metastases

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38
Q

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

A

2nd right intercostal space, parasternal

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39
Q

What tube can be seen in this image?

How can you tell that it is correctly positioned?

A

NG tube

The tube should descend down the midline, bisect the carina, cross the diaphragm in the midline and sit just below the diaphragm

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40
Q

How would you describe this breath sound?

A

Bronchial breathing

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41
Q

Horner’s syndrome (ptosis, myosis, anhydrosis) in the context of respiratory symptoms can be a sign of what?

A

Pancoast tumour (invasion of the sympathetic chain)

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42
Q

Describe the abnormality seen on this CXR?

A

Complete white-out on the right side with tracheal deviation towards the right side consistent with a previous pneumonectomy

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43
Q

How would you describe these breath sounds?

A

Expiratory wheeze

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44
Q

What system should you use when describing the pulse?

A

Rate (tachycardia/bradycardia)

Rhythm (regular/irregular)

Volume (thready/bounding)

Character

45
Q

Describe the abnormality seen on this CXR?

A

Reticulo-nodular opacities throughout both lung fields which could be consistent with pulmonary fibrosis or miliary TB

46
Q

What three things do you assess to make sure a CXR is of adequate quality?

A

Rotation, penetration, inspiration

47
Q

Which pathologies may cause a dull percussion note?

A

Consolidation, lung collapse or pneumonectomy

48
Q

How would you describe these breath sounds?

A

Coarse crepitations

49
Q

Describe the murmur of aortic stenosis?

A

Ejection systolic murmur in a crescendo-decrescendo pattern, (GRADE), heard loudest at the aortic area, raidting to the carotids

50
Q

How can you tell that a CXR is adequately inspired?

A

You should be able to visualise 10-11 posterior ribs

51
Q

Describe the abnormality seen on this CXR?

A

Free air under both hemidiaphragms - can be caused by bowel perforation or a normal post-op occurrence

52
Q

Describe the abnormality seen on this CXR?

A

There is an opacification in the right upper zone, most likely consistent with consolidation from pneumonia

53
Q

Where should you assess for any bony pathology on a CXR?

A

Ribs, clavicles, shoulders, vertebrae

54
Q

If a patient has a sputum pot by their bedside, you should look in it and comment on what features?

A

Colour, purulence, presence/absence of blood

55
Q

A flapping tremor can be a sign of what?

A

CO2 retention or hepatic/renal failure

56
Q

Koilonychia is a sign of what?

A

Iron deficiency anaemia

57
Q

Venturi masks state on them what flow rate of oxygen is required to achieve the desired FiO2. What is the range of FiO2 that can be provided by Venturi masks?

A

24-60%

58
Q

Describe the abnormality seen on this CXR?

A

No lung markings on the right side- large right sided pneumothorax

59
Q

Describe the abnormality seen on this CXR?

A

There is opacification in the left lower-mid zone with a fluid level (meniscus). The opacification is blunting the left costophrenic angle and obscuring the lower left heart border. This picture is consistent with a diagnosis of a left sided pleural effusion.

60
Q

If a non-smoker has a dry cough, what non cardiorespiratory cause should you consider?

A

GORD

61
Q

What % of average/best peak flow corresponds with life-threatening asthma?

A

< 33%

62
Q

In which pathologies may the trachea be deviated away from the affected side?

A

Tension pneumothorax, large pleural effusions

63
Q

What murmur is this?

A

Aortic stenosis

64
Q

What are some potential causes of fine bibasal crepitations?

A

Pulmonary oedema or interstitial lung disease

65
Q

In terms of respiratory pathology, what can finger clubbing be a sign of?

A

Lung cancer, interstitial lung disease, suppurative lung disease

66
Q

Describe the abnormality seen on this CXR?

A

Aortic arch is on the wrong side, the left hemidiaphragm is higher than the right and there is dextrocardia- consistent with a diagnosis of situs invertus (can be associated with primary ciliary dyskinesia)

67
Q

Where is the tibialis posterior pulse palpated?

A

Behind the medial malleolus

68
Q

Where is the dorsalis pedis pulse palpated?

A

Lateral to the extensor hallucis longus tendon

69
Q

What specific symptoms should you ask about as part of a respiratory history?

A

Shortness of breath/difficulty breathing (+ orthopnoea and PND), cough (+ sputum production and haemoptysis), chest pain, wheeze, leg swelling, coryzal symptoms

70
Q

Which valvular pathology causes a murmur which may radiate to the carotids?

A

Aortic stenosis

71
Q

Describe the abnormality seen on this CXR?

A

Rib fractures on the right side resulting in subcutaneous emphysema and pneumomediastinum

72
Q

Which valvular pathology causes a murmur which may radiate to the axilla?

A

Mitral regurgitation

73
Q

How would you describe these breath sounds?

A

Fine crepitations

74
Q

What is the easiest way to describe a murmur?

A

Timing and pitch

Grade

Where is it heard loudest

Where does it radiate to

75
Q

How would you describe these breath sounds?

A

Normal (vestibular) breath sounds

76
Q

How can you tell that a CXR is not rotated?

A

The distance between the medial clavicles and spinous processes should be equal

77
Q

What is the cause of a 3rd heart sound?

A

Rapid ventricular filling - can be normal in young people but associated with heart failure in the elderly

78
Q

Hearing a wheeze on auscultation of the lungs is most suggestive of what pathology?

A

Small airway obstruction e.g. asthma or COPD

79
Q

Asking the patient to sit up and hold their breath with the diaphragm of your stethoscope at the left lower sternal edge tends to amplify which murmur?

A

Aortic regurgitation

80
Q

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

A

Smoking and occupation/hobbies

81
Q

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

A

4th left intercostal space, lower sternal edge

82
Q

What flow rate of oxygen should be used with a non-rebreather mask?

What FiO2 does this provide?

A

12-15L/min

60-80%

83
Q

Where is the apex beat usually located?

A

5th intercostal space, mid-clavicular line

84
Q

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

A

33-50%

85
Q

Where is the femoral pulse palpated?

A

At the mid-inguinal point, halfway between the ASIS and pubic symphysis

86
Q

Pulmonary oedema (crepitations at the lung bases) is a sign of which type of heart failure?

A

Left sided heart failure

87
Q

A normal JVP should be what height above the sternal angle?

A

< 3-4cm

88
Q

A wide pulse pressure is a sign of what pathology?

A

Aortic regurgitation

89
Q

Which pathology typically causes a stony dull percussion note?

A

Pleural effusion

90
Q

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

A

2nd left intercostal space, parasternal

91
Q

What is the cause of a 4th heart sound?

A

Hypertrophic ventricle - always abnormal (AS, hypertension, HCM)

92
Q

How would you describe this breath sound?

A

Pleural rub

93
Q

Malar flush is a sign of what cardiovascular pathology?

A

Mitral stenosis

94
Q

How can you tell that a CXR is adequately penetrated?

A

You should be able to visualise the spinous processes of the thoracic vertebrae

95
Q

Describe the murmur of aortic regurgitation?

A

A high-pitched early diastolic murmur, (GRADE), heard loudest at the left lower sternal edge (exacerbated by sitting upright)

96
Q

What murmur is this?

A

Mitral regurgitation (blowing, pansystolic)

97
Q

In which pathology will breath sounds be bronchial or reduced?

A

Consolidation

98
Q

What murmur is this?

A

Mitral stenosis (low-pitched/rumbling mid-diastolic)

99
Q

In which pathologies may the JVP be elevated?

A

Right-sided heart failure, fluid overload, PE, SVC obstruction

100
Q

A narrow pulse pressure is a sign of what pathology?

A

Aortic stenosis

101
Q

What specific symptoms should you ask about as part of a cardio history?

A

Shortness of breath/difficulty breathing (+ orthopnoea and PND), chest pain/tightness, cough, palpitations, syncope, ankle swelling

102
Q

In which pathology will breath sounds be reduced or absent?

A

Lung collapse, pneumothorax or effusion

103
Q

How can you tell if an ET tube is in the correct position on a CXR?

A

The tip should be 5cm above the carina and taking up 2/3rds of the diameter of the trachea

104
Q

What flow rate of oxygen should be used with a nasal cannula?

What percentage FiO2 does this provide?

A

2-6L/min

24-50%

105
Q

Cushingoid features (moon face, plethora, acne, hirsutism) can be caused by what medication commonly used in respiratory medicine?

A

Steroids

106
Q

How should the patient be positioned in order to palpate the popliteal pulse?

A

Legs relaxed, knees bent to 30 degrees

107
Q

What is the difference between tender and non-tender lymph nodes?

A

Tender is more suggestive of infection while non-tender is more suggestive of malignancy

108
Q

Describe the murmur of mitral regurgitation?

A

A blowing, pansystolic murmur, (GRADE), heard loudest at the apex and radiating to the left axilla

109
Q

What is the most important investigation to do for someone presenting with signs/symptoms of aortic stenosis?

If symptomatic, how is this condition managed?

A

ECHO

Valve replacement

OSCE (14 decks)

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