Case Studies- Respiratory Flashcards
A 35 year old woman complains to her GP of being unable to sleep. She coughs at night, which keeps her awake. She sometimes feels short of breath. Both the cough and the dyspnoea are worse when she has visited her parents who have a cat. She smokes 15 cigarettes per day. Her past medical history includes eczema.
Chronic asthma
A 63 year old man has a long history of cigarette smoking. He says he always feels short of breath. He coughs, producing white sputum, most days. On auscultation, he has a widespread wheeze. He was admitted to hospital with pyrexia, increasing dyspnoea, tachycardia, tachypnoea and is now coughing up green sputum.
exacerbation of COPD
A 59 year old woman complains of being short of breath when she is active. She is worried as she now struggles to climb the stairs at home. She has a non-productive cough. Her past medical history includes rheumatoid arthritis, for which she takes methotrexate and folic acid.
interstitial lung disease
A 6 year old girl who is normally well has a productive cough and is febrile. On examination she has bronchial breathing in her right lower zone, and is dull to percussion in the same area.
pneumonia
A newborn has a diaphragmatic hernia and associated dextrocardia. His repair goes well, but his pulmonary abnormality is persisting.
pulmonary hypoplasia
A 14 month old boy has a non-productive cough. He is febrile, tachypnoeic and is breathing sounds abnormal. On examination you see sternal recession and indrawing.
bronchiolitis
A 75 year old man has been admitted for treatment of an exacerbation of COPD. On examination, you notice he has a lump in his right groin. The patient tells you that this has been there for some months, but he doesn’t always notice it, and it never causes him any problems. With your finger you press firmly over the midpoint between his anterior superior iliac spine and his pubic tubercle, and ask him to cough. The lump reappears. What is your diagnosis?
Direct inguinal hernia
A 50 year old joiner visits his GP for advice about a new lump. He has found that he has a lump in his abdomen. On examination, you note there is a surgical scar above the lump, and the patient tells you he had an operation to repair a perforation in his bowel. What do you suspect is his diagnosis?
Incisional hernia
An 80 year old woman has an outpatient appointment in the haematology clinic. When the doctor asks if she has any other new problems, she describes a pear-shaped lump in her groin. The lump is present most of the time, is not painful, and can be reduced. She has no other symptoms.
Femoral hernia
A 60 year old man who works in the coal industry has had rheumatoid arthritis for a number of years. He is referred to the chest clinic due to worsening breathlessness. His chest x rays reveal multiple small nodules throughout the lung fields.
Caplan’s syndrome
A 70 year old man is referred by his GP to the chest clinic due to worsening breathlessness. He has been experiencing night sweats and has lost weight recently, but he has put this down to the weather and feeling unwell. He is retired and used to work in the shipyards. His imaging reveals extensive pleural disease with peritoneal deposits.
mesothelioma
A 29 year old woman is admitted to the emergency department acutely dyspnoeic and wheezing. She is managed appropriately, and a senior respiratory review is sought once she is more stable. When taking her history, she says she is a lifeguard and has had several episodes of wheezing and coughing whilst at work, but this is the worst episode to date.
reactive airway dysfunction syndrome
A 30 year old woman is seen in the respiratory outpatient clinic. She is short of breath on exertion. General examination reveals a rash on her lower legs. Her investigations show a raised serum ACE and she has bihilal lymphadenopathy on chest x ray.
sarcoidosis
A 55 year old male known to the gastroenterologists is referred to the chest physicians. He is short of breath. This has come on over the past few weeks, but is new restricting even minimal exertion. On general examination, he is jaundiced and his abdomen is distended. He has spider naevi on his trunk. His LFTs are deranged and he has a macrocytic anaemia.
ascites
A 29 year old woman is referred to the respiratory outpatient clinic by her GP for worsening shortness of breath. She has become gradually more breathless over the past year, and her systemic enquiry reveals other problems with her eyes, joints and skin. An autoantibody screen reveals anti-CCP antibodies at 1:640.
rheumatoid
A 28 year old female complains of shortness of breath and a dry cough as well as feeling tired. On further questioning she says she has had night sweats and weight loss and painful joints. On examination, she has red patches of skin on her legs and her left eye is inflamed. A chest X-ray shows bilateral hilar lympadenopathy. She has a raised serum ACE level.
Sarcoidosis
A 50 year old man visits his GP due to increasing breathlessness which is interfering with his work as a welder. He has a dry cough, but blames this on smoking (he smokes 15 cigarettes a day and has done for many years). On examination, his fingers are clubbed, and late inspiratory crackles can be auscultated at both lung bases. A chest X-ray seems normal, but a later HRCT shows a ground-glass appearance, with pleural thickening.
Asbestosis
A 35 year old woman is admitted to hospital with chest pain and shortness of breath. On examination, she has a red rash across her face, and has oral ulcers. She takes no medication. Her full blood count shows she is thrombocytopenic, and an auto-antibody screen shows raised ds-DNA and ANA antibodies.
Systemic lupus erythematosus
A 19 year old is admitted to A+E short of breath. He is very breathless, appears distressed, and you are unable to take a full history. Following examination, a chest x-ray is requested (see above). What urgent management would you initiate?
Insert a large bore cannula into the 2nd intercostal space, mid clavicular line on the right side
