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Pass Medicine notes > Resp key questions > Flashcards

Resp key questions Flashcards

1
Q

68 y/o male, 40 pack year history, breathlessness on exertion. productive cough of white sputum over last four months.
F
FEV1/FVC ratio 51%, minimal reversibility after 2 week trial of oral steroids.

likely diagnosis?

A

Chronic obstructive pulmonary disease (COPD)

FEV1/FVC indicates obstructive defect.

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2
Q

Describe what an FEV1/FVC ratio of less than 80% indicates?

A

obstructive defect

seen in COPD and asthma

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3
Q

Describe what an FEV1/FVC ratio of more than 80% indicates?

A

restrictive defect

seen in lung fibrosis

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4
Q

Type 1 respiratory failure may show

A
  1. Fluid accumulation
    - -> water —-> pulmonary oedema
    - -> pus —-> pneumonia
    - -> blood —-> haemorrhage
  2. Hypoxemia
    - -> oxygen can’t diffuse
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5
Q

Type 2 respiratory failure may show

A
  1. Obstruction
    - -> asthma, COPD
    - -> Flail chest, guillain barre
  2. CO2 collects thus hypercapnic
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6
Q

54 y/p, weight loss, loss of appetite, shortness of breath. resp rate 19, oxygen on air 94%.

On examination, there is reduced air entry and dullness to percussion on lower to mid zones of the right lung.

Reduced chest expansion on right.

what might she have?

A

Pleural effusion

  • reduced air entry
  • dullness to percussion in lower and midzones
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7
Q

Typically patients with COPD exhibit what type of respiratory failure?

A
  • type 2 resp failure
  • caused by alveolar hypoventilation
  • longstanding hypercapnia
  • resulting in respiratory acidosis
  • over time will be compensated by kidneys retaining more bicarb
  • in order to normalise pH levels
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8
Q

Bronchiectasis

A

chronic infection of bronchi and bronchioles.

leading to permanent dilation of these airways.

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9
Q

Clinical signs in patients with COPD

A
  • carbon dioxide retention tremor
  • peripheral cycanosis
  • tar staining in finger tips
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10
Q

28 y/o male, A+E, acute onset of pleuritic chest pain and shortness of breath while playing football. oxygen sats are 93% . resp rate 20, temp 37.1

decreased expansion on LHS chest. hyper-resonant to percussion and reduced air entry on left.

most likely diagnosis is:

A

LHS pneumothorax

  • pleuritic chest pain
  • acute onset
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11
Q

What are pancoast’s tumours?

A
  • defined as tumours arising from lung apex
  • as it grows can compress structures

e. g.
- —> brachiocephalic vein
- —> subclavian artery
- —> recurrent laryngeal n.
- —> vagus, phrenic
- —> Horner’s syndrome

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12
Q

compress of what may result in Horner’s syndrome?

A

Sympathetic ganglion

  1. Miosis (pupil constriction)
  2. Ptosis (drooping eye)
  3. Ipsilateral anhydrosis
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13
Q

50 y/o afro-carribean male, no PMH, 4 month history of dry cough and shortness of breath one exertion.

blood tests reveal rasied ESR and [ACE]/

CXR shows bilateral hilar lyphaedenopathy.

Indicative of…

A

Sarcoidosis

- multisystem granulomatous disorder

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14
Q

Briefly recap the pathophysiology of Sarcoidosis?

A
  • unknown antigen detected by CD4+ T Helper cells
  • cytokine release
  • non-infection noncaseating granulomas
  • macrophages in granuloma
  • release 1-a-hydroxylase
  • thus HYPERVITAMINOSIS D
  • calcium kidney stones
  • sudden severe pain
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15
Q

69 y/o male, dyspnoae, cyanosis, finger clubbing.

CXR shows bilateral lower zone reticulo-nodular shadowing.

honey combing of lung on CXR

likely diagnosis

A

Pulmonary fibrosis

In advanced fibrotic disease. honeycombing of lung may be seen.

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16
Q

25 y/o severe exacerbation of asthma. resp rate 30, 95% oxygen sats, temp 37.2. as you feel peripheral pulse, volume falls as patient inspires.

describe the pathophys between the falling volume of the pulse?

A
  • narrowing of airways
  • thus when patient inspires
  • sudden increase in negative intrathoracic pressure
  • causes dilatation of pulmonary vasculature
  • pooling of blood in lungs
  • diminished pulmonary venous return to left atrium
  • reduced stroke volume
  • BP falls , volume of pulse falls.
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17
Q

Empyema

presents with:

A

Pus in pleural space

  • transient fever
  • SoB
  • pleural effusion
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18
Q

78 y/o female, hyponatraemia, weight loss and haemoptysis.

mass lesion detected on CT chest scan.

suspicious of bronchogenic carcinoma.

what type of bronchogenic carcinoma would explain the patients above symptoms?

A

Small cell carcinomas.

May lead to ectopic hormone production.

resulting in paraneoplastic syndromes.

Likely daignosis: Syndrome of inappropriate ADH secretion (SIADH)

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19
Q

56 y/o male, three month history of productive ocugh, blood tinged sputum following return from India.

lethargy, nigh sweats, decreased appetite.

patients chest has good air entry bilaterally, no added sounds.

sputum sample reveals fast growth of bacilli.

likely diagnosis?

A

Tubercolosis.

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20
Q

The following features would indicate a diagnosis of:

  • acute onset within past day
  • on background of known risk factor (e.g. pneumonia)
  • bilateral pulmonary oedema
  • crackles, CXR changes
  • hypoxia despite oxygen therapy
A

acute respiratory distress syndrome

21
Q

acute respiratory distress syndrome caused by

A
  • increased permeability of alveolar capillaries

- leading to fluid accumulation in alveoli

22
Q

70 y/o with small cell lung cancer. weakness in limbs worse in legs, gets slightly less weak the more he moves. no pain anywhere else and no other symptoms.

most likely to have:

A

Lambert-Eaton syndrome

  • weakness in prox arms and legs
  • weakness worse in legs (unlike in myasthenia gravis)
23
Q

1 pack year defined as

A

20 cigarettes per day for 1 year.

24
Q

crackles on auscultation would indicate…

A

pulmonary fibrosis

25
Q

chronic productive cough in the absence of wheeze or breathlessness may indicate…

A
  • bronchiectasis
  • inhaled foreign body
  • obliterative bronchioitis
  • large airway stenosis
26
Q

42 y/o smoker, chronic cough and shortness of breath. brings up copious amounts of sputum.

CXR shows numerous parallel line shadows

A

Bronchiectasis

  • parallel line shadows common
  • may indicate dilated bronchi
  • due to peribronchial inflammation and fibrosis
27
Q

71 y/o recurrent collapse during exertion, presents with shortness of breath. HR and BP okay.

A

syncope from aortic stenosis

28
Q

73 y/o male SoB. smokes 20/day. Spirometry reveals restrictive picture

A

pulmonary fibrosis

29
Q

multiple rounded lesions o CXR are highly suggestive off…

A

lung metastases

30
Q

haematocrit

A

ratio of volume of red blood cells to total volume of blood

31
Q

patient with long term COPD might have increased concentration of haematocrit on their FBC. why?

A
  • increased [haematocrit] known as polycythaemia
  • due to long term hypoxia present in COPD
  • results in increased erythropoietin production
  • by kidneys
  • thus h.globin levels rise
32
Q

thrombocythaemia

A
  • raised platelet count

- can be caused by infection, malignancy or any form of inflammation

33
Q

leukopenia

A
  • reduced white cell count
34
Q

bilateral hilar lymphadenopathy seen mainly in what conditions?

A
  1. sarcoidosis

2. tuberculosis

35
Q

24 y/o female afro-carribean, facial weakness, fever, painful red eyes. LHS facial palsy, tender swelling of parotids. hypercalcaemic.

most likely diagnosis?

A

Sarcoidosis

  • multisystem
  • granulomas (abnormal collection of inflam cells)
36
Q

55 y/o male progressively worse SoB, worse when walking, dry cough. bibasal crackles. evidence of finger clubbing.

spirometry done, clearly restrictive pattern.

typical history of

A

idiopathic pulmonary fibrosis

  • progressive exertional dysponea
  • dry cough
  • finger clubbing
  • bilateral basal crackles
  • restrictive lung pattern
  • CXR interstital shadowing
  • high res CT ‘honey comb’ lungs
37
Q

panic attacks result in…

A
  • hyperventilation
  • respiratory alkalosis
  • oxygen will be normal
  • no metabolic compensation as panic attacks resolve rapidly
38
Q

Pneumonia assessment criteria

A

CRB65

C - confusion

R - resp rate (>30/min)

B - BP

65 - (>65 y/o)

39
Q

notes:

patients with asthma who are not controlled with a SABA + ICS should have a leukotriene receptor antagonist added before LABA

A

patients with asthma who are not controlled with a SABA + ICS should have a leukotriene receptor antagonist added before LABA

40
Q

67 y/o male admitted to surgical unit with acute abdominal pain. found to have RHS pneumonia.

Nursing staff give him oxygen.

after 30 mins patient is moribund, sweaty and agitated.

ABG reveals acute resp acidosis.

why?

A
  1. COPD patient who has recieved too much oxygen.
  2. patients lose hypoxic drive for respiration
  3. thus retain CO2
  4. subsequently hypoventilate
  5. leading to resp arrest
41
Q

Meig’s syndrome

A
  • benign ovarian tumour
  • ascites
  • pleural effusion
42
Q

64 y/o male Bangladeshi , bloody sputum, breathlessness, signs of malaise, fever.

sputum samples and CXR are done. what other test should be offered?

A
  • suspected TB patient
  • should also be given a HIV test
  • as latent TB often pushed into active disease by immunosuppresion
  • most common cause of immunosuppression is HIV
43
Q

COPD patients tend to retain…

A
  • CO2
  • thus chronically raised bicarb

remember!

Type 1 resp failure: low oxygen and no CO2 retention

Type 2 resp failure: low oxygen, high co2

44
Q

paraneoplastic Cushing’s syndrome

A
  • vast majority caused by small cell bronchial carcinoma
  • neuroendocrine tumour which can secrete hormones / antibodies
  • in Paraneoplastic cushing’s there is ectopic ACTH production
  • syndrome results in: muscle weakness, hypertension, hypokalaemia, oedema
45
Q

most common infective organism in exacerbations of COPD

A

Haemophillus influenza

46
Q

Kartagener’s syndrome

A
  • primary ciliary dyskinesia

- dynein arm defects results in immotile cilia

47
Q

deficiency in what protein is a risk factor for hepatocellular carcinoma

A

alpha-1-antitrypsin

48
Q

how might you distinguish between tension pneumothorax and simple pneumothorax?

A
  • hypotension will occur in tension pneumothoraces as a result of cardiac outflow obstruction
  • thus measure BP

Pass Medicine notes (34 decks)

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