Respiratory Flashcards
pneumonia
received treatment
2m later still having cough
All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution to ensure that the consolidation has resolved and there is no underlying secondary abnormalities (e.g. a lung tumour).
28 y old Pregnant - 32w - ECG sinus tachycardia
D-dimer is high
What are the 2 investigations to consider?
- Chest xray to look for an alternative diagnosis.
- If the chest xray is normal consider a compression duplex doppler of both legs to exclude a DVT. If this is positive, the patient is treated with full dose low molecular weight heparin (LMWH) (warfarin is of course teratogenic).
- If both the above investigations are normal, and there remains a strong suspicion of a PE, then clinicians should consider a CTPA or VPS. Current guidance however favours a perfusion scan as it has lower lung radiation doses than a CTPA.
ECG VT with positive concordance throughout the chest leads and similar morphology
Arrhythmogenic right ventricular cardiomyopathy
- Inherited AD pattern with variable expression
- RV myocardium is replaced by fatty and fibrofatty tissue
- ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex
- Echo changes are often subtle in the early stages but may show an enlarged, hypokinetic right ventricle with a thin free wall
- MRI is useful to show fibrofatty tissue
Management
- Drugs: sotalol is the most widely used antiarrhythmic
- Catheter ablation to prevent ventricular tachycardia
- ICD
Young age with recurrent pneumonia and chest mass
Bronchial carcinoid is the most common lung cancer in adolescents and can present with recurrent pneumonia
COPD severity
Post-bronchodilator FEV1/FVC
FEV1 (of predicted)
Severity
(30-50-80)
< 0.7 > 80% Stage 1 - Mild
< 0.7 50-79% Stage 2 - Moderate
< 0.7 30-49% Stage 3 - Severe
< 0.7 < 30% Stage 4 - Very severe
Lung cancer: paraneoplastic features
Small cell (ALA)
- ADH
- ACTH - not typical, hypertension, hyperglycaemia, hypokalaemia, alkalosis and muscle weakness are more common than buffalo hump etc
- Lambert-Eaton syndrome
Squamous cell (C PTH)
- parathyroid hormone-related protein (PTH-rp) secretion causing hypercalcaemia
- clubbing
- hypertrophic pulmonary osteoarthropathy (HPOA)
- hyperthyroidism due to ectopic TSH
Adenocarcinoma (GH)
- gynaecomastia
- hypertrophic pulmonary osteoarthropathy (HPOA)
