history and examination

Question 1

what is cough lying down in the evening characteristic of?

Answer 1

GORD

Question 2

what is cough disrupting sleep typical of?

Answer 2

asthma

Question 3

what is cough on rising in the morning typical of?

Answer 3

rhino sinusitis

post-nasal drip

Question 4

why does a Fx of asthma, eczema and hay fever increase the chance of asthma?

Answer 4

predisposition to form excess IgE in response to allergen

Question 5

what conditions are associated with birds?

Answer 5

hypersensitivity pneumonitis

psittacosis

Question 6

what is farmers lung otherwise known as ?

Answer 6

ILD

Question 7

causes of pulmonary fibrosis

Answer 7

asbestos (shipyard/construction workers)
quartz/silica (miners, quarry workers)
coal

Question 8

what is used to predict mortality in community acquired pneumonia

Answer 8

CURB 65

c: confusion
u: >7mmol/L
r: >30/min
b: bp <60

age 65 or over

Question 9

use of accessory muscles is characteristic of what condition?

Answer 9

severe COPD

acute severe asthma

Question 10

what is cyanosis

Answer 10

blue colour caused by an absolute concentration of deoxygenated Hb of >50g/L

Question 11

what does does central cyanosis reflect?

Answer 11

arterial hypoxaemia

Question 12

what does peripheral cyanosis reflect?

Answer 12

circulatory disorders or cold

Question 13

what is pulsus pardoxus

Answer 13

exaggeration of the normal variability of pulse volume with the respiratory cycle

Question 14

what is erythema nodosum a feature of

Answer 14

acute sarcoidosis

Tb

Question 15

what is clubbing associate d with?

Answer 15

thoracic disease (lung cancer, bronchiectasis, ILD)
GI disorders

Question 16

what is a fine finger tremor caused by?

Answer 16

excessive use of beta agonist or theophylline bronchodilator drugs

Question 17

what is a coarse flapping tremor (asterixis) seen in

Answer 17

severe ventilatory failure and CO2 retention

Question 18

what kind of heart failure is the JVP raised in

Answer 18

right sided heart failure

Question 19

what does chronic hypoxia in COPD lead to

Answer 19

pulmonary arterial vasoconstriction
pulmonary hypertension
right heart dilatation
peripheral oedema

Question 20

features of superior vena caval obstruction

Answer 20

raised and non pulsatile JVP

abdominojugular reflex absent

Question 21

causes of superior vena caval obstruction

Answer 21

lung cancer compressing the vena cava
lymphoma
thymoma
mediastinal fibrosis

Question 22

what is a barrel shaped chest defined as

Answer 22

the anteroposterior diameter being greater than the lateral diameter

Question 23

what is a barrel shaped chest associated with

Answer 23

lung hyperinflation in patients with severe COPD

Question 24

why do patients with kyphosis or scoliosis develop ventilatory failure?

Answer 24

reduced ventilatory capacity and increased work of breathing.

these patients develop progressive ventilatory failure with CO2 retention and cor pulmonale at a young age

Question 25

what is pectus carinatum (pigeon chest)

Answer 25

localised prominence of the sternum and adjacent costal cartilages

Question 26

what is pectus excavatum

Answer 26

developmental deformity with a localised depression of the lower end of the sternum

Question 27

causes of tracheal deviation towards the side of the lung lesion

Answer 27

lung collapse fibrosis pneumonectomy

Question 28

causes of tracheal deviation away from the side of the lung lesion

Answer 28

tension pneumothorax | massive pleural effusion

Question 29

causes of unilateral reduced lung expansion

Answer 29

pleural effusion lung/lobar collapse pneumothorax unilateral fibrosis

Question 30

causes of bilateral reduced lung expansion

Answer 30

severe COPD | diffuse pulmonary fibrosis

Question 31

resonant percussion note detected over....

Answer 31

normal lung

Question 32

hyperresonant percussion note detected over...

Answer 32

pneumothorax

Question 33

dull percussion note detected over...

Answer 33

pulmonary consolidation pulmonary collapse severe pulmonary fibrosis

Question 34

stony dull percussion note detected over...

Answer 34

pleural effusion | haemothorax

Question 35

reduced conduction causes of diminished vesicular breathing

Answer 35

- obesity/thick chest wall - pleural effusion or thickening - pneumothorax

Question 36

if the breath sounds appear reduced, what should you ask the patient to do?

Answer 36

ask the patient to cough

Question 37

if the reduced breath sounds are due to bronchial obstructions, what happens after the patient coughs?

Answer 37

likely to become more audible

Question 38

what is aegophony

Answer 38

a bleating or nasal sound heard over the consolidated lung (pneumonia) or at the upper level of a pleural effusion

Question 39

reduced airflow causes of diminished vesicular breathing?

Answer 39

generalised (e.g. COPD) | localised (collapsed lung)

Question 40

Wells score for PE?

Answer 40

``` PE/DVT immobilisation cancer haemoptysis heart rate >100bpm signs of DVT ```

Question 41

major risk factors for pulmonary thromboembolism?

Answer 41

- fracture of the hip, pelvis or leg - hip or knee replacement - major abode or pelvic surgery - major trauma - spinal cord injury - malignancy

Question 42

what produced crackles?

Answer 42

abrupt opening of distal airways on inspiration after they have collapsed on expiration

Question 43

causes of early inspiration crackles?

Answer 43

small airways disease (bronchiolitis)

Question 44

causes of middle inspiration crackles?

Answer 44

pulmonary oedema

Question 45

causes of fine late inspiratory crackles (sound similar to hair rubbing)?

Answer 45

pulmonary fibrosis

Question 46

causes of coarse late inspiratory crackles?

Answer 46

bronchial secretions in COPD, pneumonia, lung abscess,

Question 47

causes of biphasic crackles?

Answer 47

bronchiectasis

Question 48

what is a wheeze caused by?

Answer 48

continuous oscillation of opposing airway walls occurring during airway narrowing

Question 49

why would a wheeze be loud on expiration?

Answer 49

because airways normally dilate during inspiration and narrow on expiration

Question 50

where do high pitched wheezes arise from?

Answer 50

smaller airways (have a whistling quality)

Question 51

where do low pitched wheezes arise from?

Answer 51

larger bronchi

Question 52

what is a wheeze characteristic of?

Answer 52

asthma | COPD

Question 53

cause of a pleural friction rub?

Answer 53

produced when inflamed parietal and visceral pleurae move over one another

Question 54

cause of a pleural rub

Answer 54

pulmonary infarction (due to PE) pneumonia pulmonary vasculitis