Respiratory Flashcards
An 80-year-old man presents with bilateral cavitating bronchopneumonia after an influenza infection.
Staph Aureus
- Not a common pathogen in CAP but can cause it in debilitated patients, including the elderly, IV drug users and those recovering from influenza
- Flucloxacillin is the treatment of choice for staphylococcal infections
A 24-year-old student presents with severe headache, fever, dry cough and arthralgia. He has recently bought several parrots and was previously fit and well.
Chlamydia psittaci
-Macrolide antibiotic
A 40-year-old man with HIV presents with fever, dry cough, weight loss and exertional dyspnoea.
Pneumocystis carinii
A 75-year-old man presents with headache, dry cough, anaemia and a skin rash. Blood tests detect cold agglutinins.
Mycoplasma pneumoniae
- A characteristic feature is the autoimmune haemolytic anaemia caused by the presence of cold agglutinins
- Macrolide treatment empirically
A 25-year-old air-conditioning technician, who suffered from flu-like symptoms a week ago, has developed a dry cough. His chest radiograph shows multilobar shadowing. Blood tests show hyponatraemia and lymphopenia. Urinalysis reveals haematuria.
Legionella pneumophila
A 65-year-old smoker presents with shortness of breath, gallop rhythm and production of pink frothy sputum.
Pulmonary oedema
-Secondary to left ventricular failure
A 24-year-old man initially complaining of cough and intermittent haemoptysis presents a few weeks later with haematuria. Biopsy confirms a crescentic glomerulonephritis. Renal biopsy shows linear pattern deposition on immunofluorescence.
Goodpasture’s syndrome
-cANCA and antiglomerular basement membrane antibodies
A 34-year-old woman originally complaining of nasal obstruction develops cough, haemoptysis and pleuritic chest pain. Her chest radiograph shows multiple nodular masses.
Wegener’s granulomatosis
A 22-year-old man presents with fever, nightsweats, weight loss and cough pro- ductive of cupfuls of blood. Ziehl–Neelsen stain is positive for acid-fast bacilli.
TB
A 35-year-old businessman returns from a trip abroad and collapses at the airport with haemoptysis and pleuritic chest pain. He has a sinus tachycardia and his ECG shows right axis deviation.
PE
-Diagnosis by VQ scan and Pulmonary angiography
Multiple bilateral nodules between 0.5 and 5 cm in a former miner with rheumatoid arthritis on CXR
Caplan’s syndrome
Kerley B lines, bat-wing shadowing, prominent upper lobe vessels, cardiomegaly on CXR
Left ventricular failure
Trachea deviated to right, horizontal fissure and right hilum displaced upwards on CXR
Right upper lobe collapse
Numerous calcified nodules sized less than 5 mm located predominantly in the lower zones of the lungs on CXR
Previous varicella pneumonitis
Double shadow right heart border, prominent left atrial appendage, left main bronchus elevation on CXR
Mitral Stenosis
Trachea deviated to right, horizontal fissure and right hilum displaced upwards on CXR
Right upper lobe collapse
- Horizontal fissure should be at the level of the 6th rib in the axillary line
- In left upper lobe collapse: hazy white appearance over a large part of the left lung field, with tracheal deviation to the side of the collapse
Numerous calcified nodules sized less than 5 mm located predominantly in the lower zones of the lungs on CXR
Previous varicella pneumonitis
-Other causes of numerous calcified nodules include TB, histoplasmosis and chronic renal failure
Double shadow right heart border, prominent left atrial appendage, left main bronchus elevation on CXR
Mitral Stenosis
-Advanced mitral stenosis
A 28-year-old African–Caribbean man presents with dry cough and progressive shortness of breath. His chest radiograph shows bilateral hilar lymphadenopathy.
Sarcoidosis
-More common in black patients
The chest radiograph of a 13-year-old boy with cystic fibrosis has tramline and ring shadows.
Bronchiectasis
-May also be clubbed with coarse inspiratory crackles
A 65-year-old dockyard worker presents with weight loss and shortness of breath. He is clubbed and cachectic. His chest radiograph shows pleural calcifi- cation and a lobulated pleural mass.
Mesothelioma
-CXR classically shows a mass with a lobulated margin
A 40-year-old woman presents with gross clubbing and progressive shortness of breath. Examination reveals fine end-inspiratory crackles. Her chest radiograph shows a ground-glass appearance of the lung.
Cryptogenic fibrosing alveolitis
-CXR may also include ground glass shadowing and as the disease progresses “honeycombing”
A 65-year-old smoker presents with shortness of breath. On the chest radiograph, eight ribs can be seen anteriorly above the diaphragm on each side of the chest in the mid-clavicular line.
COPD
-Should not seen more than 6 ribs anteriorly normally
A 7-year-old girl with slight wheeze and shortness of breath despite inhaled salbutamol.
Inhaled Sodium Cromoglycate
