Revision Group Work Flashcards
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
a) Calculate her smoking history in pack years
Pack-years is how many years they’ve smoked 20 cigarettes a day for a year.
30 cigarettes a day for (64-20) years = pack-year history
30/20 cigarettes x 44 years = pack-year history
3/2 cigarettes x 44 years = pack-year history
1.5 cigarettes x 44 years = pack-year history
66 pack-year history
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
b) Spirometry confirms the diagnosis of COPD. A normal flow volume loop is shown below.
Label the axes and Draw the flow volume loop you would expect to see in this patient before and after bronchodilators
x-axis: volume (L), from right to left (5 4 3 2 1 0)
y-axis: flow (L/s), from bottom to top -8 to 12 (co-ordinates at 0)
Before:
After:
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
c) Lung function testing also reveals the following results:
___ / Predicted value / Value
Total Lung Capacity (TLC) / 6.5 / 8.0
Residual volume (RV) / 2.33 / 4.2
What is the explanation for the increased total lung capacity (TLC) and residual volume (RV)?
x
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
d) What is the most likely cause for the clinical deterioration in her condition?
It’s an acute exacerbation of COPD, which is almost always infective. Therefore it is likely to be pneumonia.
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
e) What is the most likely cause for her ankle swelling?
Pulmonary hypertension (due to ineffective lungs) causing heart failure.
Right side of heart has to push harder to get blood into lungs, which causes megaly, giving heart failure, peripheral oedema, hepatomegaly etc. - known as cor pulmonale.
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
f) How is central cyanosis differentiated from peripheral cyanosis? What is the significance of central cyanosis?
x
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
The results the arterial blood gas analysis (breathing room air ) is as follows: O2 Saturation = 87% (94 – 98%) PaO2 = 7.56 kPa (9.3 – 13.3 kPa) PaCO2 = 7.0 kPa (4.7 – 6.0) HCO3- = 34 mmol/L (22 – 26) pH = 7.33 7.35 – 7.45
g) What type of respiratory failure does this patient have?
x
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
The results the arterial blood gas analysis (breathing room air ) is as follows: O2 Saturation = 87% (94 – 98%) PaO2 = 7.56 kPa (9.3 – 13.3 kPa) PaCO2 = 7.0 kPa (4.7 – 6.0) HCO3- = 34 mmol/L (22 – 26) pH = 7.33 7.35 – 7.45
h) State her acid base status
x
Question 1
A 64-year-old woman has a cough productive of white sputum and increasing breathlessness on exertion during the last year. She is now breathlessness on walking 100 yards on level ground. She has smoked 30 cigarettes a day since the age of 20. There is no childhood or family history of asthma. COPD is suspected.
A month later, she is seen in the emergency department with worsening breathlessness and a cough productive of purulent sputum. On examination the temperature is 380 C, heart rate = 112/min, BP = 130/70, Respiratory rate = 24/ minute. There is central cyanosis, bilateral ankle swelling.
The results the arterial blood gas analysis (breathing room air ) is as follows: O2 Saturation = 87% (94 – 98%) PaO2 = 7.56 kPa (9.3 – 13.3 kPa) PaCO2 = 7.0 kPa (4.7 – 6.0) HCO3- = 34 mmol/L (22 – 26) pH = 7.33 7.35 – 7.45
i) Treatment is commenced with oxygen, bronchodilators and antibiotics. Despite improvement in her oxygen saturation to 96% as measured by pulse oximetry, she becomes drowsier. The arterial blood gas analysis is repeated (while breathing 28% oxygen); the results are shown below
PaO2 = 11 kPa (9.3 – 13.3 kPa) PaCO2 = 8.0 kPa (4.7 – 6.0) HCO3- = 34 mmol/L (22 – 26) pH = 7.30 7.35 – 7.45
Why has the PaCO2 level increased to 8.0 kPa despite improvement in PaO2?
x
Question 2
A 25 year old man developed sudden onset pleuritic chest pain and increasing breathlessness
a) What abnormality is seen on the CXR?
Tension pneumothorax
Question 2
A 25 year old man developed sudden onset pleuritic chest pain and increasing breathlessness
b) Comment on the position of the trachea:
Tracheal shift to unaffected side
Question 2
A 25 year old man developed sudden onset pleuritic chest pain and increasing breathlessness
c) On Auscultation what clinical signs are likely to be heard over: the right and left sides of the chest?
Right side will be normal as no pneumothorax
Left side will have no breath sounds, which is the most distinguishing clinical feature
Question 3
A 49 year old man has a permanent pacemaker inserted. The pacing wires were placed via subclavian vein cannulation
a) What post-procedure complication is seen on the CXR?
x
Question 3
A 49 year old man has a permanent pacemaker inserted. The pacing wires were placed via subclavian vein cannulation
b) What part of the lung was involved /injured?
x
Question 4
This 59 year old man is seen in the emergency department with fever, cough and breathlessness.
a) What is the most likely diagnosis?
x
