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Amir SAM > Interactive Cases in General Internal Medicine (2) > Flashcards

Interactive Cases in General Internal Medicine (2) Flashcards

1
Q

60 yr old man • SOB • Sudden onset • PMH: COPD • On symbicort & tiotropium • PR: 110 bpm • JVP:  •  BS, Scattered wheeze & creps (R) • Peripheral oedema • Sats: 80% (air) • FBC: Hb 85, WCC 12, plt: 300

What is the most likely diagnosis?

  1. Pneumothorax
  2. Pulmonary embolism
  3. Airway disease
  4. Pneumonia
  5. Pulmonary oedema
  6. Interstitial lung disease
  7. Pleural effusion
  8. Anaemia
  9. Thyrotoxicosis
  10. Nerve/muscle disease
A

pneumothorax

because sudden

COPD- predisposes you to pneumothorax

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2
Q

What are the different differentials of breathlesness based on onset?

A

Seconds:

  • Pneumothorax
  • PE
  • FB

Min/ Hrs

  • Airways (inflammation/obstruction)
  • Chest infection (pus)
  • Acute heart failure (fluid)

Days/ weeks

  • Above (chronic/not resolving)
  • Interstitial lung disease
  • Malignancy/ Large pleural effusion
  • Neuromuscualr
  • Anaemia/ Thyrotoxicosis
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3
Q

He is started on oxygen.

What is the most appropriate next step in his management?

A. Chest drain insertion

B. Chest ultrasound

C. CPAP

D.Observation

E. Pleural aspiration

A

A chest drain

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4
Q

What is the management of a Pneumothorax

A

Primary: (no other respiratory conditions)

< 2 cm:

– Discharge, repeat CXR

> 2 cm/SOB:

– Aspiration

– If unsuccessful: chest drain

Secondary (history of COPD)

< 2 cm:

– Aspiration

> 2 cm:

– Chest drain

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5
Q

below what number of hb are people breathless?

A

80

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6
Q

Why do you get a raised JVP in this patient

60 yr old man • SOB • Sudden onset • PMH: COPD • On symbicort & tiotropium • PR: 110 bpm • JVP:  •  BS, Scattered wheeze & creps (R) • Peripheral oedema • Sats: 80% (air) • FBC: Hb 85, WCC 12, plt: 300

A

because there right heart failure due to COPD

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7
Q

What are assoicated symptoms with breathlessness?

A

WBC

Wheeze, breathlessness, Cough

sputum, haemoptisis

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8
Q

What are risk factors for PE

A

Signs of DVT

– Previous DVT/PE

– ? immobility, surgery, malignancy

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9
Q

What is the recurrent SOB due to?

This 2 hours afterwards.

A
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10
Q

47 year old woman • Acute SOB • Pleuritic chest pain • PMHx: DVT • O2 Saturation: 78% (air) • PR: 110 bpm • BP: 120/80 mmHg •raised JVP • Vesicular BS

This is her ECG

What does her ECG show:

A. Atrial fibrillation

B. Normal axis & RBBB

C. Right Axis deviation & RBBB

D. Right Axis deviation & LBBB

E. Left Axis deviation & LBBB

A

Right Axis deviation & RBBB

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11
Q

47 year old woman • Acute SOB • Pleuritic chest pain • PMHx: DVT • O2 Saturation: 78% (air) • PR: 110 bpm • BP: 120/80 mmHg •raised JVP • Vesicular BS

This is her ECG:

What is the most appropriate next step in her management? A.LMWH

B.BiPAP

C.Warfarin

D.Thrombolysis

E.Furosemide

A
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12
Q

What does the CXR show?

A

PE (westermark sign)

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13
Q

• 50-year-old female • progressive SOB • dry cough • clubbing • FEV1/FVC ratio > 70%.
What are your differentials?

A

PULMUNARY FIRBOSIS (reticulaar nodular shadowing)

– Idiopathic fibrosing alveolitis

– Connective tissue disease, RA

– Drugs

– Asbestosis (? ship builder)

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14
Q

• 41-year-old man • Smoking history of 30 pack-years • Chronic SOB, chest pain & cough •low BS, Hyper-resonant PN L&R

What does this CXR show?

A

large bullae

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15
Q

50-year-old female Chronic SOB Sputum No clubbing FEV1/FVC ratio < 70%

What does this CXR show?

A

Hyper expanded lung

Emphysema/ COPD

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16
Q

What conditions cause bullae in the lungs?

A

COPD

17
Q

Cough • sputum • wt loss • Night sweats

What does this CXR show?

A

TB

18
Q

A 70-year-old man • SOB • Keeps pigeons

A
19
Q

CXR1

A

normal

20
Q

CXR 2

A

COPD/ Emphesema

21
Q

CX3

A

left pneumothorax

22
Q

What are different types of opacities you can have on a chest X ray and what conditions could it point towards?

A

Interstitial/alveolar shadowing: fluid (pulmonary oedema), pus (pneumonia), blood ()

Reticulo-nodular shadowing:fibrosis

Homogeneous shadowing: pleural effusion

Masses/cavitations:

23
Q

WHat does this CXR show?

A

alveolar shadowing

middle lobe pneumonia

24
Q

What does this show

A

bilateral alveolar shadowing

Pulmonary oedema

25
Q

What does this X ray show

A

reticular nodular shadowing

FIBROSIS

26
Q

What does this show

A

pleural effusion

Homogenous shadowing - with miniscus

27
Q

What does this CXR show

A

homogenous shadowing

could be effusion or collapse

LOOK at trachea

towards is collapse

away is effusion

IN THIS CASE: towards so collapse

28
Q

what does this show

A

cavitating lesion with an air fluid level

29
Q

What could this be due to ?

A

infection: klebsiella or staph or TB
inflammation: rheumatoid nodule

malignancy

30
Q

what does this CXR show

A

enlarged heart-

could be a globular heart- pericardial effusion

31
Q

what does this x ray show

A

bilateral hilar lymphadenopathy

32
Q

what does a globular heart indicate

A

pericardial effusion

33
Q

what does this x ray show?

A

pleural plaques related to asbestos

NOT asbestosis- need fibrosis for this

34
Q

what could cause hilar lymphadenopathy?

A

infection: tb
inflammation: sarcoidosis
malignancy: lymphoma

35
Q

What does this chest x ray show

A

mastectomy

36
Q

what does this chest x ray show

A

pace maker, leads

Amir SAM (7 decks)

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