RESPIRATORY DISEASES Flashcards
- Bronchial breath sounds are normal near the bronchus. T/F?
True
- Bronchial breath sounds in one of the lungs could suggest pneumothorax. T/F?
False. There would be absent breath sounds.
- TB would be a reasonable likely diagnosis in a baby with wet cough for two weeks and mild fever. T/F?
False.
More likely causes are protracted bacterial bronchitis or pneumonia
- TB would be a reasonable likely diagnosis in an elderly Vietnamese man who migrated 20 years ago presenting with cough for 3 months. T/f?
True.
Vietnam has 10-30 times the incidence of TB compared to Australia.
An apical lung tumour can cause Ramsay-Hunt syndrome T/F
False.
Ramsay hunt syndrome - Ear shingles leading to facial nerve palsy that involves the forehead
Apical lung tumour -
- Can invade recurrent laryngeal nerve that supplies the larynx = hoarseness
- Can invade nerves supplying face = Horner’s syndrome
-> Can cause superior venal cava obstruction = Pemberton’s sign
Lung cancer can occur in non-smokers
T
Cardiac cause of chest pain can be excluded if pain is reproducible on palpation
True
Rib fractures require surgical treatment
False
Which of the following is suggestive of severe croup?
a. coughing that disrupts sleep
b. barking cough
c. stridor at rest
d. associated fever
stridor at rest
Cystic fibrosis can be complicated by
a. infertility
b. pleural effusion
c. lung cancer
d. Obesity
infertility
How can sarcoidosis and lung cancer be differentiated?
a. significant weight loss in sarcoidosis
b. painful red lumps on the shin (erythema nodosum ) usually occur in lung cancer
c. lung cancer would not cause brain symptoms such as headache
d. bilateral vs unilateral mediastinal lymph nodes on chest xray
d.bilateral vs unilateral mediastinal lymph nodes on chest xray
It is normal in a newborn to have:
a. an air leak around the heart ( pneumopericardium)
b. nasal flaring as they are obligate nose breathers
c. respiratory rate of 60
d. weak cry at 9 minutes of life
respiratory rate of 60
Which of the following statement is true about lung investigations:
a. chest xrays can pick up small lung cancers <1cm
b. bronchoscopy is indicated to determine the underlying cause of asthma
c. spirometry can diagnose pulmonary fibrosis
d. peak flow meters can help diagnose occupational asthma
d
A patient with pneumonia would need to go to hospital if:
a. their oxygen saturation is 95% in room air
b. they have known congestive cardiac failure
c. they are elderly
d. they have high fevers after one dose of antibiotic
b
Bronchitis is a
a. moderately serious condition requiring oral antibiotics
b. serious condition requiring urgent medical attention
c. minor condition in long term smokers
d. self-limiting condition requiring supportive treatment only
d
An 80y.o. lady lives alone had a 40 pack year history of smoking and chronic obstructive pulmonary disease. She walks around with a 4 wheel frame for dyspnea on exertion. She uses her COPD puffers regularly. She has a 2 week history of wet cough and trouble sleeping at night; her symptoms are not responding to antibiotics. What are the issues in this case? What are the next steps in treatment/management required?
Issues
- Frail elderly lady living alone with risk factors for lung cancer (age, significant smoking history) who has a persistent cough despite antibiotics
- Cancer needs to be excluded
¡Whether or not cancer present, quite unwell and unable to sleep at night - ability to manage by herself at home
- Difficulty sleeping - cardiac issue (cardiac risk factors – age, smoking)
Management
- She needs medical assessment for degree of respiratory distress
- She needs a chest xray to look for pneumonia, lung abscess, signs of cancer (unilateral lymph node, large mass)
- CT chest if chest xray suggestive
- Bronchoscopy to diagnose cancer
- Oncology team and/or palliative care
- Family need to be involved
- advanced care directive
- Aged care assessment – ability to manage independent living
A 20y.o. female university student is studying for exams. She has a sore throat, fever and cough and wants antibiotics so she can improve quickly and get back to studying for exams. What are the red flags for antibiotics?
- Sore throat and fever with no cough
- One sided throat pain : quinsy/peritonsillar abscess
- Tender cervical lymphadenopathy
- Fever, vomiting
What features of cough are concerning?
Persistent without identifiable cause
- Inhaled foreign body in a child
- Lung cancer
- Post tussive vomiting (pertussis)
- Associated weight loss
- Haemoptysis
- Large volume of sputum (bronchiectasis)
- Failure to thrive in children (cystic fibrosis)
