Extra Respiratory Questions Flashcards
You are called to see a patient 2 days post emergency laparotomy who is now complaining of ‘difficulty breathing’. Their oxygen saturations are 98% on air via nasal cannulae, heart rate is 84 beats per minute, respiratory rate 14 breaths per minute, blood pressure 115/71 mmHg and temperature 38.9 ºC. On general inspection the patient is wearing TED stocking and has a canulae in situ. On examination there were bi-basal crackles and reduced air entry, heart sounds one and two were present with no added sounds, the abdomen was tender around the surgical site but soft and bowel sounds were present.
Which of the following should be ordered next as part of further investigatory work-up?
D-dimer CXR CRP CTPA ABG
CXR
This patient is normotensive, not tachycardic or tachypnoeic and has a normal oxygen saturation as well as a temperature which is higher than would be expected with a PE. As a PE is unlikely, a CT pulmonary angiogram would not be first-line in this scenario. A D dimer and CRP would be expected to be raised postoperatively and an arterial blood gas would add no information given the normal oxygen saturation. A Chest x-ray is therefore the first investigation which should be requested here.
A 68-year-old male presents to your GP surgery complaining of a persistent cough, shortness of breath and a weight loss of 2 stone over the last 6 weeks. On further questioning, you establish he has a 20 pack-year history of smoking.
On examination, you notice he is cachexic with tar staining between his right index and middle fingers and upon his lips. You also note subtle but noticeable gynaecomastia.
Which type of lung cancer is most likely to have resulted in gynaecomastia in this case?
SCLC
Adenocarcinoma
Mesothelioma
Squamous cell carcinoma
Adenocarcinoma
Gynaecomastia - associated with adenocarcinoma of the lung
A 40-year-old man attends his GP with worsening breathlessness. The GP is especially concerned as he is a non-smoker and refers him urgently to respiratory physicians. After extensive investigations, it is determined that he is suffering from emphysema due to alpha-1-antitrypsin deficiency and that he carries the PiZZ phenotype.
In addition to monitoring his respiratory function, what else should be routinely carried out for this patient?
Renal function tests bone marrow biopsy LFTs Neuro examination Upper GI endoscopy
LFTs
Alpha-1 antitrypsin deficiency is a risk factor for cirrhosis and hepatocellular carcinoma
A 53-year-old man is undergoing investigations after experiencing shortness of breath, weight loss and persistent cough with occasional haemoptysis for the past year. A chest x-ray showed opacification in the upper lobes but was not diagnostically conclusive. A high-resolution CT scan confirms the presence of pulmonary fibrosis affecting the upper lobes.
Which of the following conditions is the most likely to have caused this patient’s CT findings?
Idiopathic pulmonary fibrosis amiodarone asbestosis TB RA
TB
Tuberculosis typically causes upper zone pulmonary fibrosis
A 69-year-old man with chronic obstructive pulmonary disease (COPD) presents to the Emergency Department with dyspnoea. Three days ago he was started on amoxicillin and prednisolone by his GP. Since arriving in the department he has been given back-to-back nebulised salbutamol and ipratropium bromide. The oxygen concentration has been titrated to 28% to achieve a saturation of 88-92%. Due to his poor response to treatment an aminophyline infusion is started. Thirty minutes later, his arterial blood gases show the following (taken on 28% oxygen):
pH 7.30
pCO2 7.6 kPa
pO2 8.1 kPa
What is the most appropriate next step in management?
IV Mg sulphate
IV hydrocortisone
NIV
Increase Oxygen
NIV
A 75-year-old man is undergoing investigations after experiencing shortness of breath and persistent cough for the past year. A chest x-ray showed opacification in the lower lobes but was not diagnostically conclusive. A high-resolution CT scan confirms the presence of pulmonary fibrosis affecting the lower lobes of both lungs.
Which of the following conditions is the most likely to have caused this patient’s CT findings?
Sarcoidosis
AS
TB
Idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis
Idiopathic pulmonary fibrosis predominately affects the lower zones
A 60-year-old smoker is brought into the emergency department with shortness of breath. His observations are as follows:
Respiratory rate 40/min Oxygen saturation 94% (Air) Blood pressure 110/90 mmHg Temperature 37ºC Heart rate 90/min
However, he quickly deteriorates and requires intubation. As the anaesthetists start the ventilate him his blood pressure drops to 80/60 mmHg and his oxygen saturation drops to 90%. What is the likely underlying cause of this mans symptoms?
COPD aspiration tension pneumothorax MI asthma
tension pneumothorax
Tension pneumothoraces may deteriorate after attempted ventilation
