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ESA3 revision decks > ESA3 revision session 2 > Flashcards

ESA3 revision session 2 Flashcards

1
Q

What can cause a lump in the neck?

A

Vascular

Inflammatory

Traumatic

Autoimmune

Metabolic

Infection

Neoplastic

Degenerative

Idiopathic

Congenital

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2
Q

vascular cause of neck lump

A

carotid artery aneurysm

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3
Q

infection

A

cervical lymphadenopathy

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4
Q

congenital

A
  • Thyroglossal cyst- midline
  • Branchial cyst- SCM
  • Cervical rib
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5
Q
  • Neoplastic cause
A

Apical lung cancer- Pancoast tumour (left)

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6
Q

Thryoglossal duct cyst

A

- midline lump

  • thyroid gland dvewlops int he floor of the pharnx, in the foramen cecum
  • it descends down necks as it develops
  • remains connected to tongue by thyroglossal duct
  • if patency not resolved, a cyst develops
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7
Q

branchial cysts

A

lump on SCM

  • incomplete fusion of the second arch over the other clefts
  • fluid can fill in this space leading to a soft non-tender mass ont he anterior border of SCM
  • can arise after infection/trauma causing cyst to swell and become apparent
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8
Q

A non-tender left supraclavicular node is a associated with what type of malignancy?

A
  • GI metastases- gastric malignancy
  • Virchow node
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9
Q

what does this chest x ray confirm

A

pancoast tumour

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10
Q

pancoast tumours can cause disruption of the

A

brachial pleuxs- lower routes C8/T1 (Klumpke)

  • apex of lung in close proximity to lower nerve root of the rbachial plexus*
  • pancoast tumour causes it to impingle on C8 and T1 roots*
  • sensory innervation of medial hand and forearm
  • intrinsic muscles of the hand
  • muscles of the forearm
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11
Q

klumpkes palsy

A

C8-T1- upper brachial plexus injury

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12
Q

Erbs palsy-

A

C5 C6—shoulder dystocia (lower brachial plexus injury)

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13
Q

what other structures can be affecred by a pancoast tumour

A
  • Recurrent laryngeal nerve
    • Reduced ability to cough
    • hoarseness
  • Sympathetic trunk/chain
    • Horners syndrome
  • Subclavian artery and vein
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14
Q

horners syndrome

A

impingment of sympathetic chain by pancoast tumour

Symptoms:

  • partial ptosis
  • miosis- constircted pupil as dilatore pupillae not innervated
  • anhydrosis- lack of sweating due to denervated sweat glands
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15
Q

What does the sympathetic nervous system do in the eye

A
  • eyelid- helps raise it
  • pipil- dilates it
  • sweat glands- stimulated production
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16
Q

Eyelid muscle innervation

A
  • Levator palpebrae superioris (CN III- oculomotor)
  • Superior tarsal plate (sympathetic innervation)
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17
Q

partial psosis

A
  • sympathetic innervation to the taral muscle of the eyelid is lost
    • leads to drooping of eyelid
  • innervation to levator palpebrae suprioris (LPS) is still in tact
    • can partially raise eyelid
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18
Q

complete ptosis

A
  • paralysis of levatoe palpebrae superioris (LPS) due to CN III lesion (compression of parasympathetic fibres)
  • tarsal muscle inenrvation is intact (however too weak to riase eyelid alone)
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19
Q

parasympathetic fibres which hitch-hike on the ocuclomotor nerve run on the

A

periphery

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20
Q

parasympathetic fibres which hitch-hike on the ocuclomotor nerve innervates the

A

sphincrer pupillae muscle to constrict the pupil

21
Q

pathology of CN III will causes a

A

dilated pupil (SNS domiantes)

22
Q

Compressive vs vascular CN III lesion: Compressive

A

Compressive –e.g. aneurysm/tumour will compress the outside of the nerve= loss of Parasympathetic fibres first- lose pupil innervation first (pupil dilation)- motor signs will be later

23
Q

Compressive vs vascular CN III lesion: Vascular

A

Vascular- loss of blood supply= loss of motor function CN III first (full ptosis)

  • Parasympathetic is peripheral therefore can get blood supply from close structures- pupils spared
24
Q

Effect of CN III lesion on eye movent?

A
  • oculomotor (CN III) supplies 4 out of 6 muscles
  • trochlear (lateral rectus) and abducens nerve (superior oblique) preserved
  • unopposed action of LR and SO = down and out position
25
why can facial oedema and venous distention occur in patients with pancoast tumours
* pancoast tumours can compress the superior vena cava * svc responsible for draining the upper limb, head and neck of blood * compressur ewill cause back log of blood icnreased venous pressur * eincreased hydrostatic pressure can cuase fluid to move out of the facial veins and into the tissue causing oedema
26
horners vs CN III palsy
27
how is venous jugular pressure
* place at 45 degrees * turn the head towards the left * measure the height from the sternal angle + 5cm * \>5 cm indicates raised JVP
28
What lung conditions can cause heart failure?
What lung conditions can cause heart failure? * Cor pulmonale (right heart failure on its own because of lung condition) * Pulmonary hypertension increases the afterload of the right heart * RV hypertrophies to accommodate then dilatation * Reduced RV cardiac output- reduced LV filling * CO unable to meet demand of the body * Causes of Cor pulmonale * PE * COPD hypoxia pulmonary vasoconstriction
29
30 cigs a day for 24 year. what is the pack year history
1 pack = 20 cigarettes 30 cigarettes= 1.5 packs 1.5 x 24= 36 36 pack-years
30
describe 2 appaoraches a health promotion campaign cna take to reduce smoking incidence
medical prevention- encourage smokers to opt into early detection to prevent smoking related disease - behaviour change- psychological health behaviorus theories in campagins - educational- dissemintate info
31
32
Sepsis six *
* B- blood cultures * U- urine outputs * F0- fluids * A- Ax * L- lactate * O- oxygen Give 3 Take 3
33
* Septic shock is
* * Sepsis in combination with either a lactate \>2 mmol/l despite adequate fluid resus or the patient is requiring vasopressors to maintain MAP \>65 mmHg * Basically sustained low BP
34
How to look at acid-base balances?
* pH- are they normal, acidotic or alkalotic * pCO2- is the change in keep with pH * yes- resp cause * no - change or opposite * HCO3- abnormal? Change in keeping with pH? * if yes- metabolic cause * if no- compensatory cause
35
acid base
* Low pH- acidic * pCO2 low * HCO3- low What is this ? partially compensated metabolic acidosis - resp is trying to compensate for low HCO3
36
The anion gap
An elevated anion gap means there are unmeasured cations in the blood-these unmeasured cations are acids. Hence, a high anion gap suggest a metabolic acidosis
37
interpret this CXR
* Emphysema- lots of ribs can be seen due to hyperinflation * Flattened hemi diaphragm * Very dark lung fields- lots of air
38
summary of how to review a CXR
39
What do we need to think about with COPD patients and oxygen? *
* CO2 retainers – blue bloater (chronic bronchitis) * Need to aim sats for 88-92% * If they are not retainers- pinker puffer (emphysema) * 94%
40
COPD and oxygen
* need controlled oxyegn therapy i.e. you know exactly how much oxygen you are giving threm * if they are in CO2 retention, aim sat 88-92% * regular ABGs if we give oxygen, redue hypoxic drive, patient will hypoventilate, hypoventilation decreases CO2 removal therefore pts will end up hypercapnic
41
Type 1 – low pO2 \<8kPa
* pCO2 normal or low * ventilation perfusion mismatch * solubility of O2 and CO2 (CO2 is much more soluble) * CO2 not as badly affected as O2
42
* Type 2- low PO2 \<8kPa
* pCO2 higher- retaining CO2 \>6.7 kPa * hypoventilation problem
43
respiratory acidosis can call
hyperkalaemia
44
hyperkalemia on ECG
* tall tended T wave * flattened or absent P-waves * PR interval prolongation * prolonged QRS * can become brady cardic
45
how to red an ECG
46
Why does acidosis cause hyperkalaemia?
H+ moves into cells K+ moves out of cells
47
What drugs might you give to the pt to reverse the hyperkalaemia?
* IV insulin (drives K+ into cells) * IV dextrose to avoid hypoglycaemia what would you give to stabilise the cardiac membrane? * calcium gluconates * later give furosemid to removed K+ from body
48
49
calcium gluconates
to stabilise cardiac membrane

ESA3 revision decks (12 decks)

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