extra Flashcards
can you peform a peak flow sat or standing
yes - so chest is expanded and not compressed by poor posture
highest reading is recorded
diagnostic level of sweat test for CF
over 60 mmol/L
foul smelling sputum , recurrent fever and histroy of stroke ( risk of aspiration) and finger clubbing
lung abcesss
what is ARDS
In ARDS, the alveolar capillaries become more permeable, leading to fluid accumulation in the alveoli. This is non-cardiogenic pulmonary oedema. There are several underlying pathophysiological mechanisms that have been suggested including pro-inflammatory cytokines and chemokines, as well as neutrophilic infiltration. The commonest finding in ARDS is hypoxaemic respiratory failure. The commonest clinical presentation is acute-onset cyanosis, dyspnoea and tachypnoea.
ARDS has a mortality rate of 30–45% and has significant morbidity in the population that does survive. The American-European consensus conference has developed a number of criteria for recognising ARDS including: <1 week onset of a known risk factor, pulmonary oedema, non-cardiogenic, and pO2/FiO2 ratio <40 (a defining feature).
culmative damage and repeated chest infection lead to distal airway dilation - bronchiectasis - sign of CT
signet ring sign
what would suggest life-threatening asthma
Normal PaCO2 (4.6 - 6.0kPa)
intially low due to hyperventilation
4 diangostic criteria for ARDS
bilateral diffuse infiltrates -alveolar
less than 7 days
P02:Fi02 undre 200
pulmonary capillary wedge pressure under 18mmHg - elevated left atrial pressure
A 28-year-old Afro-Caribbean woman presents to the emergency department with shortness of breath, painful red lesions on her shins and pain in her ankle joints.
Vitals signs show a temperature of 38.4. A chest X-ray is ordered and shows bilateral hilar lymphadenopathy.
Which of the following is the most likely diagnosis?
This lady is presenting with acute sarcoidosis, also known as Lofgren’s syndrome. This is the combination of bilateral hilar lymphadenopathy, erythema nodosum, acute polyarthritis and fever. Sarcoidosis is also more common in those of Afro-Caribbean heritage
hF mamagement
Captopril, Bisoprolol and Pneumococcal vaccination
This is the correct answer. The patient has signs, symptoms and chest x-ray are consistent with left sided heart failure. Patients with chronic heart failure are managed with angiotensin converting enzyme inhibitors (ACEi) and beta blockers as first line management. ACE-i work on the renin angiotensin aldosterone axis to dilate blood vessels and decrease blood pressure. Beta blockers reduce the heart rate and improve the ejection fraction as the heart can fill more efficiently. Additionally, the pneumococcal vaccine is given to patients with chronic heart failure and those over the age of 65 to reduce the risk of developing a streptococcus pneumoniae pneumonia
perihilar and central lesion for cancer what cancer
SCLC
cavitating lesion in lung , haeompytyss and ALARM symtpoms - Alarm symptoms are vomiting, bleeding or anemia, abdominal mass or unintended weight loss, and dysphagia VBAD
SCLC
precedding flu-like illness, dyr cough and erythema multiforme ( target shaped lesions) anaemia and SOB what is atypcial penumonia
mycoplasma pneumonia
erythema multiforme
target shaped lesions
what eye condition is associated with sarcodiosis
anterior uveitis
anxiety-panic attack
The patient is presenting with shortness of breath but is saturating well at 15.0 kPa (not hypoxic - therefore by definition not in respiratory failure). Their pH and CO2 are however quite deranged - however in-keeping with the normal physiological response to breathing more quickly (blowing off more CO2 and as a result your carbonic anhydrase equation shifts and the patient becomes more alkalotic). The normal bicarbonate indicates that the cause of this alkalosis is respiratory in origin.
are the pneumococcal and influenza vaccines live
no
marfans disease increases the risk of
pnemothorax and aortic dissection or rupture
A 43-year-old gentleman is assessed in A&E. He presents with a one week history of shortness of breath, non-productive cough and fevers. He has a past medical history of HIV and says he had stopped taking his antiretroviral medication 6 months ago due to side-effects. On initial assessment, he appears unwell, tachypneic and has oxygen saturations of 90% on air.
His chest X-ray is as follows:
This patient has become short of breath and febrile on a background of uncontrolled HIV. It is likely that he is immunocompromised. He is hypoxic and his chest X-ray shows bilateral ground glass like opacification most prominent in the lung bases. This is highly suspicious for PCP and should be treated accordingly
bronchiectasis tx
chest physio
tx for adenocarcinoma
loboectomy
This is correct. It is the definitive management of a patient with a curative adenocarcinoma (non-small cell lung cancer), patients must undergo pulmonary lung function tests prior to treatment with surgery
tx for adenocarcinoma
loboectomy
This is correct. It is the definitive management of a patient with a curative adenocarcinoma (non-small cell lung cancer), patients must undergo pulmonary lung function tests prior to treatment with surgery
symptoms of facial plethora, distended neck veins, a headache and have a positive Pemberton’s test
SVC obstruction
stent
A 30 year old woman develops a five day history of a productive cough and high fever. She also has been short of breath progressively over the past few days.
Furthermore, she complains of painful blue fingers and toes over the past two days, which occur whenever she is outdoors and the temperature has dropped. Yet when indoors she has noticed they return to their normal colour.
What additional findings would you expect to see on examination?
Multiple erythematous papules with deeply erythematous borders
This is correct. The patient has signs of cold autoimmune haemolytic anaemia and a pneumonia. The pneumonia most commonly associated with this autoimmune condition is mycoplasma pneumonia. Mycoplasma pneumonia can also present with erythema multiforme
A 30 year old woman develops a five day history of a productive cough and high fever. She also has been short of breath progressively over the past few days.
Furthermore, she complains of painful blue fingers and toes over the past two days, which occur whenever she is outdoors and the temperature has dropped. Yet when indoors she has noticed they return to their normal colour.
What additional findings would you expect to see on examination?
Multiple erythematous papules with deeply erythematous borders
This is correct. The patient has signs of cold autoimmune haemolytic anaemia and a pneumonia. The pneumonia most commonly associated with this autoimmune condition is mycoplasma pneumonia. Mycoplasma pneumonia can also present with erythema multiforme
squmaous cell carcinoma linked to what hormone
parathyroid hormone related peptide
squmaous cell carcinoma linked to what hormone
parathyroid hormone related peptide
how does sarcoidosis lead to hypercalcaemia
Sarcoidosis is associated with the formation of granulomas which causes hypercalcaemia via uncontrolled synthesis of 1,25-dihydroxyvitamin D3 by macrophages
someone has superior vena cava obstruction what is the first step management
dexamethasone - reduce swelling to secure the airway - 8mg
prominent neck veins and elevation of both arms results in facial engorgement, consistent with a diagnosis
SVCO
hypercalcaemia management - either in lung cancer from release of PTHrP or osteolytic bone lesions
IV fluids
IV bisphosphonate - 2-4 day response
hypercalcaemia management - either in lung cancer from release of PTHrP or osteolytic bone lesions
IV fluids
IV bisphosphonate - 2-4 day response
Sepsis of pulmonary origin is the most common underlying cause of ARDS which is a life-threatening non-cardiogenic pulmonary oedema. when does this occur
one week of an established risk factor and presents with new bilateral opacities on the chest X-ray
sings of high Ca
polyuria, polydipsia, constipation and confusion
squamous cell carcinoma associated with hypertrophic pulmonary osteoarthropathy HPOA - affects hands and feet
birds - pneumonia to humans
chlamydia psittaci
birds - pneumonia to humans
chlamydia psittaci
birds - pneumonia to humans
chlamydia psittaci
birds - pneumonia to humans
chlamydia psittaci
This is correct. The patient has a productive cough with haemoptysis, finger clubbing and bilateral coarse inspiratory crepitations which point towards bronchiectasis. The young patient demographics makes a congenital cause more likely. Furthermore, cystic fibrosis is a multi-system condition which can affect pancreatic function causing both exocrine and endocrine insufficiency
CF
bronchial obstruction
salbutamol
type 1 failure
liaise ICU - O2 support
history of stroke predispose to what
aspiration pneumonia
history of stroke predispose to what
aspiration pneumonia
history of stroke predispose to what
aspiration pneumonia
over 40 unexplained haemoptysis -
2ww urgent referal
3 or more exacerbations per year - optimal medical management
long term prophylactic antibiotics
non-ceasating vs ceaseating granulomas
non - sarcoidosis
ceaseating - TB
CF and complaining of steatorrhoea - pale and oily stool hard to flush away
creon - pancrelipase
CF and complaining of steatorrhoea - pale and oily stool hard to flush away
creon - pancrelipase
penumonia - myalgia , headaches, dry cough , high fevers , low sodium
legionella pneumophilia
penumonia assoicated with herpes laialis and lobar penumonia
strep
bilateral coarse crackles means
thick mucus production and reduced clearance
near fatal - elevated CO2
life threatening - back to normal CO2
near fatal - elevated CO2
life threatening - back to normal CO2
what abx for aspiration pneumonia
metronidazole
lambert eaton syndrome caused by
voltage gated calcium chaneel antibodies
methotrexate can cause
pneumonitis
COPD with asthmaitic feature need LABA and ICS
without
LABA and LAMA
brain tumour in palliative care what tx would you get- pallative
dexamethasone 8-16mg per day
opiate of choice for patients with renal impairement
oxycodone - diabetic neuropathy
oxycodone is stronger than morphine
low VQ ratio means what compared to high V/Q ratio
Low V/Q: areas that have poor ventilation with oxygen but are well perfused by blood. E.g. bronchoconstriction (Asthma), airway collapse in emphysema, mucus plug, congestive cardiac failure
High V/Q: areas of the lung with adequate ventilation but are lacking blood perfusion E.g. Pulmonary embolism.
lung cancer normally mets too
Lung cancer most commonly metastasises to the brain, bone, liver and adrenals.
pulmonary hypertension on ECG
P pulmonale is a right atrial abnormality that is seen on ECG as tall, peaked P waves. It is a feature that can be seen on ECG in patients with pulmonary hypertension, as it is a cause of right atrial enlargement.
resp alkalosis seen in what overdose
aspriin
resp patients noramlyl given 15L/minute Oxygen via a non-rebreathe mask
unless chronic CO2 retainer such as COPD what do you do for oxygen
28% oxygen via Venturi mask
This patient has severe COPD and is a chronic CO2 retainer as shown by the raised HCO3 and base excess on his arterial blood gas. His target oxygen saturations should be 88-92%. By over-oxygenating him and achieving saturations of 96%, he is losing his hypoxic drive and is hypoventilating. This is shown by his reduced work of breathing and looking calmer, which is in fact a decreasing level of consciousness due to CO2 narcosis. He should be switched onto 28% oxygen via a Venturi mask with an aim of achieving target oxygen saturations of 88-92%
RF for cholangiocarcinoma
could get excroiations over skin
This patient has three of the key risk factors for cholangiocarcinoma (a tumour arising from the bile duct epithelium): age >50, ulcerative colitis and PSC. She also has painless jaundice, weight loss and itching, all of which are commonly seen in cholangiocarcinoma.
bladder cancer 2www
patient is aged 45 years or over and has painless visible haematuria
