Respiratory Flashcards
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- stony dull = pleural effusion
- look for meniscus (fluid level) and at base of lungs
- fluffy opacification
- should be found where dull percussion found
- could look like COPD if patient wasnt young–> probs tall and slim
- also diaphragm isnt flat
diagnose this X-ray
- overexposed (dark)
- lung markings throguhout
- fluffy opacification
therefore pneumonia in the right middle lobe (blurred right heart border)
how many ribs should you see in an xray
7-9
Question 4
A 47 y/o man presents to his GP with a cough for the past two years that has been worsening, and increasing dyspnea on exertion. On further discussion he describes the cough as productive of white sputum.
His Pulmonary Function Test results are shown. Units for FVC and FEV1 Litres; DLCO units mL/min/mm. What type of lung disease does this patient most likely have
- FEV1/FVC ratio = <70%
- 3.2/4.65= 68%
- FEV1 is also decreased (Normal values in healthy males aged 20-60 range from 4.5 to 3.5 liters)
- therefore obstructive e.g. asthma or COPD
- small change after bronchodilator therefore irreversible
Question 5
A 56 y/o woman with kyphoscoliosis presents to her GP with several months of increasing dyspnea with even minimal exertion. On further discussion she had noted dyspnea when shopping or gardening for the past year but dismissed this as being secondary to her smoking (1 pack/day for 20 years stopped 20 years ago ). Her PFT results are shown. Units for FVC and FEV1 Litres; DLCO units mL/min/mm. What type of lung disease does this patient most likely have?
- FEV1/FVC = 2.35/2.75= 87%
- restrictive lung disease
- DLCO (tells us about the integrity of the alveoli/ capillary relationship) normal therefore must be extrinsic
- no change with bronchodilator
answer: restrictive lung disease due to extrinsic pathology
–> due to kyphoscholiosis
A 47 y/o woman presents to her GP with several months of increasing dyspnea on exertion and dry cough; on further discussion she had noted dyspnea and dry cough when she exercised for the past 6 months but dismissed this as being secondary to her past history of smoking (1 pack/day for 15 years, stopped 5 years ago). Her past medical history is significant for Non-Hodgkins lymphoma for which she received bleomycin. The Respiratory Consultant diagnoses her with interstitial lung disease secondary to bleomycin induced pulmonary fibrosis. Which Flow Volume Loop (A, B C, D or E?) would be consistent with this diagnosis?
You are an FY1 on the Acute Medical Unit and are bleeped by the nurse looking after Mr Gangarosa, a 56 year old man with COPD who was admitted with pneumonia, decompensated COPD and oxygen saturations of 82% on room air three days ago and who is now behaving “strangely”. The patient is being treated with IV antibiotics, oxygen, steroids, and nebulisers. The nurse thinks that the patient has delirium and altered mental state secondary to the unfamiliar hospital environment and steroids, and asks you to come as soon as you can to prescribe some form of sedating medication and review the steroids. The patient’s electrolytes are below:
Na 138 mmol/L (136-145 mmol/L)
K 4.9 mmol/L (3.5-5.0 mmol/L)
HCO3 32 mmol/L (22-26 mmol/L)
Cl 96 mmol/L (95-105 mmol/L)
Which of the following should be your priority?
You examine Mr Gangarosa’s (from Q7) blood work and note his white blood cell count has normalised, and on physical exam you note he is afebrile. However, he does appear somnolent and confused and keeps trying to pull out his IV cannula and oxygen mask. You then obtain Mr Gangarosa’s (from Q7)arterial blood gas, shown below:
pH = 7.24 (7.35 – 7.45)
PaO2 = 10 kPa (10.6-13.3)
PaCO2 = 11 kPa (4.7-6.0)
HCO3- = 32 mmol/L (22-26)
What is the best explanation for Mr Gangarosa’s arterial blood gas results?
Ms Felippe (from Q10) is admitted to the hospital with persistent vomiting secondary to partial small bowel obstruction at the level of the duodenum, and dehydration. What would you predict her admitting electrolytes would show, and why?
A 48 year old man, Mr Meneire, with no significant past medical history, presents to his GP with 3 days of right shoulder pain. The pain is located over the acromioclavicular joint. The pain is worse at night with lying down and associated with shortness of breath. Mr Meneire states that the pain is better during the day. He is an avid ping pong player and does not have pain or shortness of breath when playing.
Except for abdominal bloating he denies any other symptoms. The shoulder exam is normal. Physical exam is significant for temperature of 37 C, normal respiratory rate, heart rate and blood pressure, reduced breath sounds in the right lower lobe, mild abdominal distention and right upper quadrant discomfort to deep palpation without rebounding or guarding.
An X-ray of the shoulder shows mild osteoarthritis in the AC joint but is otherwise normal.
Chest X-ray carried out because of the respiratory symptoms reveals an elevated right diaphragm and otherwise unremarkable.
What clinical scenario best explains Mr Meneire’s history and findings?
