Respiratory case studeis Flashcards
Chronic cough, SOB, heavy smoker, steady weight, quiet wheeze on expiration
Low FVC, FEV1 and FEV1/FVC
What lung disease is this?
COPD
Chronic cough, SOB, heavy smoker, steady weight, quiet wheeze on expiration
Low FVC, FEV1 and FEV1/FVC
Underlying diagnosis for cough
Cough expels materials from respiratory passages, sensed by receptors in epithelium. Noxious substances in tobacco results in excess mucus, inflammation and impaired ciliary function - chronic bronchitis
SOB, fatigue, enlargement of hilarity lymph nodes, bilateral infiltrates throughout lungs, no infection
Low FVC, low FEV1, raised FEV1/FVC
What do these results show?
FVC and FEV1 reduced to similar degree and FEV1/FVC is increased slightly - restrictive lesion
SOB, fatigue, enlargement of hilarity lymph nodes, bilateral infiltrates throughout lungs, no infection
Low FVC, low FEV1, raised FEV1/FVC
Underlying diagnosis
Sarcoidosis, an uncommon chronic inflammatory condition which produces granulomata in various tissues and organs, including skin, lung, liver, brain and heart.
Fatigue and breathlessness are common features. Restrictive lung disease results from extensive deposition of inflammatory infiltrates; it also produces enlarged hilar lymph nodes.
Diagnosis often difficult and may need LN biopsy
TB doesn’t get better with steroids
Nocturnal, productive cough, SOB, tightness in chest, whistling breath, expiratory wheeze
FVC low, FEV1 low, FEV1/FVC low
What do these results show?
Moderately obstructive disease - asthma
Why is asthma bad at night?
Asthma is commonly worse at night – several factors may cause this:
- Allergens in the bedroom (e.g. house dust mite, mould)
- The air is usually coldest
- Nasal secretions can drip into the chest
- Natural cortisol levels are lower
Two drugs in asthma inhaler?
The drugs likely to be in the inhaler are:
- A steroid, such as fluticasone or budesonide, to reduce inflammation
A long-acting β2 adrenoreceptor agonist, such as salmeterol or formoterol or muscarinic antagonist
FVC, FEV1, FEV1/FVC for asthma
FVC equal
FEV1 reduced
FEV1/FVC decreased
Massively reduced FEV1, FVC, TLCO
What does this show?
Both FEV1 and FVC are substantially (and equally) reduced, indicating major restrictive lung disease. The reduced TLCO shows impaired oxygen diffusion across the alveolar-capillary basement membrane.
Why do you lose weight with lung disease?
Restrictive disease uses up energy for breathing
Which diseases can clubbing indicate?
Lung cancer Bronchiectasis Lung access Hypersensitivity Sarcoidosis Asbestosis TB NOT COPD
What is clubbing?
Softening of nail bed, loss of angle
Severe back pain of acute onset, pins and needles in legs spreading to abdomen, VC is reduced
What is the working diagnosis?
Muscle weakness secondary to neuronal failure
AIDP - acute inflammatory demyelinating neuropathy - Guillane Barre
How do you diagnose Guillon Barre?
Nerve conduction studies, lumbar puncture
What is AIDP?
autoimmune attack on myelin, LMN, destroys axon, causes weakness - lung muscle failure, loss of reflexes, sensory loss, respiratory failure
