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
Occurs when the airway is narrowed. May be distressing, can be associated with shortness of breath. Can be relieved with stents.
Stridor
An interruption in the sympathetic chain affecting the innervation of the face. Includes ptosis, anhydrosis and miosis.
Horner’s syndrome
Ptosis - Drooping eyelids
Anhydrosis - Failure of sweat glands; decreased sweating
Miosis - Decrease pupil size; excessive contraction
A lung cancer in the apex of the lung which can invade into the brachial plexus, causing wasting of the small muscles of the hand and interrupts sympathetic innervation to the head.
Pancoast tumour
A boy is referred to genetics following investigation for repeated infections. He has had multiple viral and bacterial infections, and has had recurrent oral candidiasis. Clinically he has multiple facial features suggestive of a genetic cause to his condition. His investigations to date have revealed a low T cell count and hypocalcaemia. His cardiovascular system is abnormal.
Di George syndrome
A patient with psoriatic arthritis is started on an immunological therapy for their joint disease. They had no clinical features of chest disease prior to treatment, but now they are short of breath and feel generally unwell. A new chest x ray shows a suspicious cavitating lesion in their left lung apex.
Reactivation of latent tuberculosis
A 3 month old baby boy is referred to dermatology with recurrent skin rashes and infections, and the GP was unsure if this was eczema or another underlying diagnosis. His skin is noted to be abnormal across his whole body, and the underlying diagnosis is found to be a form of SCID, though his skin condition has a specific cause.
Graft versus host disease
Infects children, with peak incidence in winter. May be secondary to another infection, and can cause mild to severe illness, which may be flu-like. Diagnosis is confirmed by PCR.
Metapneumovirus
The commonest cause of bronchiolitis. Diagnosis is by PCR on throat or pernasal swabs. Treatment is supportive.
Respiratory syncytial virus
A sexually-transmitted infection that can cause infantile pneumonia by vertical transmission.
Chlamydia trachomatis
A paraneoplastic change, also known as myasthenic syndrome, involving hyporeflexia, proximal limb weakness and reduced autonomic activity.
Eaton Lambert syndrome
The attack occurs at the connection between nerve and muscle (the neuromuscular junction) and interferes with the ability of nerve cells to send signals to muscle cells.
Local tumour spread that can cause effusion of the related anatomical cavity and atrial fibrillation.
Pericardial invasion
A feature of metastatic disease, found on examination and often affecting the neck. Cells from the primary tumour can be seen on aspiration or biopsy.
lymphadenopathy
