Week 4 Flashcards
Early morning headache, no photophobia, distended external jugular vein, anastamoses visible on abdomen.
Superior vena cava obstruction
A paraneoplastic change affecting the ends of long bones, causing pain and altered shape.
hypertrophic pulmonary osteoarthropathy
A non-specific sign of respiratory disease, with loss of nail bed angle and increased fluctuation on examination.
Finger clubbing
The immunoglobulin that binds to allergen in a Type I hypersensitivity reaction.
IgE
A mast cell degradation product that can be measured during an acute episode of anaphylaxis.
Serum tryptase
Seen in high quantities with chronic Type I hypersensitivity reactions, particularly as an infiltrate. Within the lungs, may contribute to chronic yellow sputum production.
Type I hypersensitivity reaction
Causes pneumonia, or a pyrexia of unknown origin (Q fever). This infection is a zoonosis. Complicated cases can include a culture-negative endocarditis.
Coxiella burnetti
This organism causes an atypical community acquired pneumonia. It is mostly seen in older children and young adults, and spreads from person to person.
Respiratory syncytial virus
An organism that causes pneumonia, acute epliglottitis and exacerbations of COPD. It is gram negative and is cultured on chocolate agar.
Haemophilus influenzae
A 19 year old is admitted to A+E short of breath. He is very breathless, appears distressed, and you are unable to take a full history. Following examination, a chest x-ray is requested (see above). What urgent management would you initiate?
Insert a large bore cannula into the 2nd intercostal space, mid clavicular line on the right side
The treatment you choose is successful (confirming your diagnosis), but he is moved from A+E to a ward in the hospital. What management would you suggest when handing over his care to the new team?
Insert a chest drain into the 4th or 5th intercostal space in the mid axillary line
The same patient is readmitted twice more during the following few months, each time with the same problem. What definitive management would possibly prevent further recurrence?
Refer for pleurodesis
Have a major role in innate immunity. Kill pathogens by oxidative free radicals. Can test function using the NBT (nitroblue tetrazdium) test. Important in the defence against bacterial and fungal infection.
neutrophil
Respond to pathogen peptides bound to HLA class 1 molecules. Directly kill infected cells via the production of perforin, inducing apoptosis. Protect against viral infections and tumours.
CD8 T cell
Antibody producing cells. Fully differentiated.
plasma cell
A 22 year old nursery nurse visits her GP for the fourth time this year. She has had multiple chest infections and is worrying about how much time she needs to spend away from work. She says she is coughing up yellow-green phlegm most of the time and experiences chest pain. She is referred to the chest clinic. Investigations include a HRCT, which does not show widened airways. Her sputum does return abnormal growth.
Chronic bronchial sepsis
A 43 year old man who is normally fit and well fails to recover from what he thought was a winter cold. He is admitted to hospital and diagnosed with community acquired pneumonia. A repeat CXR shows a D sign, and his pleural tap is frank pus.
Empyema
A 5 year old girl is referred to hospital by her GP, primarily for failure to thrive. When taking a history with her parents, you discover she struggles to gain weight. She is small for her age. Her parents say she is intolerant to many foods, and often complains of an upset tummy and what sounds like steatorrhoea. She has had multiple chest infections that don’t respond well for antibiotics, and a HRCT shows widened airways. Genetic testing revels a recessive defect.
Cystic fibrosis
Respond to pathogen peptides bound to HLA class II molecules. Activate other lymphocytes. Produce cytokines and influence phagocyte function. Immunoregulatory cells.
CD4 T cell
Found within the bloodstream as monocytes. Phagocytic.
macrophage
A component of this pathway is vital in opsonisation of pathogens. When bound to antigen can indirectly activate phagocytes.
complement
A 57 year old woman has been in hospital in the intensive care unit following GI surgery. She has been fed via a nasogastric tube, but the aspirate is inconclusive. On CXR the NG placement is found to be incorrect, but there is a further abnormality within her right lung field which you believe is secondary to this.
Intrapulmonary abscess
A patient with slowly resolving pneumonia is found to have a new abnormality on CXR. It is unclear whether this requires drainage, surgical management or is likely to resolve. Investigations show pH 8.1, LDH 800, Glucose 3.5. Clear fluid on tap.
Simple effusion
A 35 year old man is admitted to the acute medical unit short of breath. He seems generally unwell. On examination he has a low BMI (17), and you notice multiple bruises and infected puncture wounds on his extremities. He tells you he regularly injects various street drugs. He has a cardiac murmur and his CXR shows multiple small opacities throughout both lung fields.
Right sided bacterial endocarditis
