Respiratory Flashcards
A patient’s chest is stony dull to percussion. What is this a sign of?
Pleural effusion
A patient presents with right sided pleuritic chest pain. What’s the most likely diagnosis?
Pneumonia
What are the common signs of pulmonary edema?
Alveolar bat’s wings Kerley B lines Cardiomegaly Dilated prominent upper lobe Pleural effusion
What is a ground-glass appearance on X-ray a sign of?
Pulmonary fibrosis
Or
Respiratory distress syndrome of a newborn
A Ziehl-Neelsen stain is positive for an acid fast bacilli. Which disease does this indicate?
TB
Caseous necrosis is indicative of which respiratory disease?
TB
What is apical disease a sign of?
Most likely secondary TB
An apical lesion is called an Assmann focus
What is miliary tuberculosis?
The spread of mycobacterium tuberculosis through the bloodstream
If the organism spreads via the pulmonary artery, military dissemination into the lung occurs
If the organism spreads via the pulmonary vein, there is systemic dissemination to the liver, spleen and kidneys
A patient has positive anti-glomerular basement membrane antibodies. What is the likely diagnosis?
Goodpasture syndrome (GPS)
A rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure.
A patient presents with a chest infection and mentions he has pet parrots/pigeons. Which organism has caused his infection?
Chlamydophilla psittaci
A patient presents with a dry cough and diarrhoea after a holiday abroad. Which organism is the most likely cause of this?
Legionella pneumophila
How do you confirm that a patient has been infected by legionella pneumophila?
Test urine for antigens
A tall, thin, young man who indulges in marijuana comes in with acute onset shortness of breath. What is the likely diagnosis?
Pneumothorax
Common in Marfan’s syndrome
What are the most common signs and symptoms of sarcoidosis?
Bilateral hilarity lymphadenopathy Erythema nodosum Granulomas Fatigue Uveitis Weight loss
A CT shows bronchioles wider than neighboring arterioles (signet ring sign). What is the diagnosis?
Bronchiectasis
There is a D sign on an X-ray. What does this indicate?
Empyema
There is a steeple sign on an X-ray. What is the likely diagnosis?
Laryngotracheocronchitis
Croup
A child comes in with a barking cough. What is the most likely diagnosis?
Croup
In which patients is pneumocystis pneumonia likely to occur?
Patients with a lowered immune system such as patients with HIV
How do you treat pneumocystis pneumonia?
Co-tramoxazole
+ prednisolone if severe
What is Samter’s triad?
Also known as aspirin exacerbated respiratory disease
Asthma
Nasal polyps
Salicylate sensitivity (such as NSAIDs or aspirin)
Klebsiella pneumoniae is common in who?
Alcoholics
A patient presents with red jelly sputum. Which organism is this patient likely to be infected by?
Klebsiella pneumoniae
What is mucous sputum a sign of?
Chlamydia psittaci
Rusty sputum is a sign of what?
Pneumococcal pneumonia
A patient comes in with haematuria, weight loss and cannonball metastases in their lungs. What is the likely source of these?
Primary renal cell carcinoma
A patient comes in with a headache since the morning. What could this be a sign of?
Hypercapnia
Side effects from organic nitrates
A patient has an ACTH secreting lung tumour. What is their diagnosis?
Small cell carcinoma of the lung
A patient has a PTH secreting lung tumour. What is their diagnosis?
Squamous cell carcinoma of the lung
Having increased serum ACE and calcium is a sign of which condition?
Sarcoidosis
A patient comes in with an eggshell calcification at the hilar region. What is their likely condition?
Silicosis
What is an Assmann focus?
An apical lesion of secondary tuberculous infection
What is a ghon focus?
An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura.
A coin lesion is found on a chest radiograph. What is this likely to be?
A rounded solitary lesion is most likely:
A primary bronchial or lung carcinoma A metastatic tumour (esp. kidney) A bronchial hamartoma A carcinoid tumour A lung abscess Granulomatous inflammation
What are some of the signs of Horner’s syndrome?
Ptosis (drooping of the eyelid)
Enopthalmos (sunken eye)
Miosis (small pupil)
Lack of sweating on the ipsilateral side of the face
When can Horner’s syndrome occur?
When there is local spread of cancer to the intrathoracic nodes
When there is a pancoast tumour
What is the acute management of asthma?
Oxygen (100% through a non rebreather mask) Salbutamol (nebulized) Hydrocortisone IV or prednisolone Ipratropium bromide Theophylline IV or aminophylline IV
There is a thumbprint sign in a head X-ray. Which structure is that?
Epiglottis
What is a whooping cough a sign of?
Pertussis
There is a snow storm appearance on an x ray. What is this a sign of?
Baritosis
Silicosis
What is the management of an infective exacerbation of COPD?
I - Ipratropium S - Salvutamol O - Oxygen A - Amoxicillin P - Prednosolone
A non smoker has lung cancer. What is this likely to be?
An adenocarcinoma
A patient comes in with shortness of breath and high d-dimers. What do you suspect?
PE
If the d-dimer is low, exclude PE
What is the treatment of PE?
Small PE - Low molecular weight heparin
Large PE - Thrombolysis
A patient comes in with shortness of breath and respiratory alkalosis. What is the likely cause?
Panic attack
Which is the obstructive lung disease with raised eosinophils?
Asthma
Which is the obstructive lung disease with raised neutrophils?
COPD
An obese patient needs overnight nasal ventilation and has hypercapnia. Which disease do they suffer from?
Pickwickian disease
Aka obesity hypoventilation syndrome
What is Guillian-Barre disease?
A disease which causes paralysis.
It is normally preceded by a strep throat/ infection of the respiratory or G.I. tract
Describe the types of coal workers pneumoconiosis.
Simple coal workers pneumoconiosis (the disease in its early form)
Progressive massive fibrosis
(The disease in its later form)
When does adult respiratory distress syndrome occur?
When non cardiogenic pulmonary oedema leads to acute respiratory failure.
A chest X-ray shows bilateral alveolar shadowing. What is this a sign of?
Adult respiratory distress syndrome
Which part of the lungs does asbestosis usually affect?
The bases
A type 1 diabetic patient presents with vomiting. She is dehydrated and has deep labored breathing. She reports not having taken her insulin. What is the likely diagnosis?
Metabolic acidosis
Diabetic ketoacidosis
A 22 year old woman presents with weight loss, sputum, night sweats and bilateral, tender and well defined modules on her shins bilaterally. What is the likely diagnosis?
Erythema nodosum
Which is the major antigen for Farmer’s lung?
Saccharopolyspora rectivirgula
A patient presents with joint pain, nasal congestion and recurrent nosebleeds. His blood tests reveal a cANCA positive result. What is the cause of this?
Granulomatosis with polyangiitis
What is exudate?
Extra protein (> 30)
What is transudate?
Less protein (< 30)
Which type of lung cancer is sensitive to chemotherapy?
Small cell lung cancer (also has the worst prognosis)
What problems arise from hypercalcemia?
Moans (GI conditions) - constipation, nausea, decreased appetite, abdominal pain
Stones (Kidney related conditions) - Kidney stones, frequent urination
Groans (psychological conditions) - confusion, dementia, memory loss, depression
Bones (bone pain and bone related conditions) - bone aches and pains, fractures
What are the spirometry readings in asthma?
FVC - normal
FEV1 - reduced
FEV1/ FVC ratio - reduced
What are the spirometry readings in COPD?
FVC - reduced
FEV1 - reduced
FEV1/ FVC ratio - normal
What are the spirometry readings in restrictive airway disease?
FVC - reduced
FEV1 - reduced
FEV1/ FVC ratio - normal
What is type 1 respiratory failure?
Low oxygen levels
What is type 2 respiratory failure?
Low oxygen levels and high CO2 levels
What is the treatment for TB?
2 RIPE 4 RI
2 months of: R - Rifampicin I - Isoniazid P - Pyrazinamide E - Ethambutol
4 months of:
R - Rifampicin
I - Isoniazid
What are some side effects of Rifampin?
Red/orange discoloration if urine and tears
Rashes
Hepatotoxicity
What are some side effects of Isoniazid?
Tingling sensation
Parasthesiae of the extremities
What are some of the side effects of pyrazinamide?
Joint pain Rash Allergic reaction Yellow skin or eyes Worsening gout
What are some side effects of ethambutol?
Change in vision
Optic neuritis
Red-green color blindness
A patient with TB has a fibrosing, cavitating apical lesion. Which type of TB is this?
Secondary TB (reactivation or reinfection)
Which organism is common in pneumonia for CF patients?
Staphylococcus aureus
Pseudomonas aeruginosa
What are some risk factors for PE?
Hereditary e.g. factor V Leiden History I.e. previous DVT or PE Hypo-mobility e.g. fracture or long trip Hypovolaemia e.g. dehydration Hormones e.g pregnancy or oral contraceptives Hypercoagulability e.g smoking
What are some causes of pulmonary fibrosis?
B - Bleomycin R - Radiation E - Extrinsic allergic alveolitis A - Ankylosing spondylitis S - Sarcoidosis T - Tuberculosis
What are some causes of erythema nodosum?
Nodosum spelt backwards
M - Mycobacterium Tuberculosis
U - Ulcerative colitis/ Crohn’s disease
S - Sarcoidosis
O - Other infections (streptococcus, mycoplasma, EBV)
D - Drugs including the oral contraceptive pill
O - Occult malignancy
N - No cause found/ nurturing (pregnancy)
