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Flashcards in Case Studies- Respiratory Deck (46):
1

A 35 year old woman complains to her GP of being unable to sleep. She coughs at night, which keeps her awake. She sometimes feels short of breath. Both the cough and the dyspnoea are worse when she has visited her parents who have a cat. She smokes 15 cigarettes per day. Her past medical history includes eczema.

Chronic asthma

2

A 63 year old man has a long history of cigarette smoking. He says he always feels short of breath. He coughs, producing white sputum, most days. On auscultation, he has a widespread wheeze. He was admitted to hospital with pyrexia, increasing dyspnoea, tachycardia, tachypnoea and is now coughing up green sputum.

exacerbation of COPD

3

A 59 year old woman complains of being short of breath when she is active. She is worried as she now struggles to climb the stairs at home. She has a non-productive cough. Her past medical history includes rheumatoid arthritis, for which she takes methotrexate and folic acid.

interstitial lung disease

4

A 6 year old girl who is normally well has a productive cough and is febrile. On examination she has bronchial breathing in her right lower zone, and is dull to percussion in the same area.

pneumonia

5

A newborn has a diaphragmatic hernia and associated dextrocardia. His repair goes well, but his pulmonary abnormality is persisting.

pulmonary hypoplasia

6

A 14 month old boy has a non-productive cough. He is febrile, tachypnoeic and is breathing sounds abnormal. On examination you see sternal recession and indrawing.

bronchiolitis

7

A 75 year old man has been admitted for treatment of an exacerbation of COPD. On examination, you notice he has a lump in his right groin. The patient tells you that this has been there for some months, but he doesn’t always notice it, and it never causes him any problems. With your finger you press firmly over the midpoint between his anterior superior iliac spine and his pubic tubercle, and ask him to cough. The lump reappears. What is your diagnosis?

Direct inguinal hernia

8

A 50 year old joiner visits his GP for advice about a new lump. He has found that he has a lump in his abdomen. On examination, you note there is a surgical scar above the lump, and the patient tells you he had an operation to repair a perforation in his bowel. What do you suspect is his diagnosis?

Incisional hernia

9

An 80 year old woman has an outpatient appointment in the haematology clinic. When the doctor asks if she has any other new problems, she describes a pear-shaped lump in her groin. The lump is present most of the time, is not painful, and can be reduced. She has no other symptoms.

Femoral hernia

10

A 60 year old man who works in the coal industry has had rheumatoid arthritis for a number of years. He is referred to the chest clinic due to worsening breathlessness. His chest x rays reveal multiple small nodules throughout the lung fields.

Caplan's syndrome

11

A 70 year old man is referred by his GP to the chest clinic due to worsening breathlessness. He has been experiencing night sweats and has lost weight recently, but he has put this down to the weather and feeling unwell. He is retired and used to work in the shipyards. His imaging reveals extensive pleural disease with peritoneal deposits.

mesothelioma

12

A 29 year old woman is admitted to the emergency department acutely dyspnoeic and wheezing. She is managed appropriately, and a senior respiratory review is sought once she is more stable. When taking her history, she says she is a lifeguard and has had several episodes of wheezing and coughing whilst at work, but this is the worst episode to date.

reactive airway dysfunction syndrome

13

A 30 year old woman is seen in the respiratory outpatient clinic. She is short of breath on exertion. General examination reveals a rash on her lower legs. Her investigations show a raised serum ACE and she has bihilal lymphadenopathy on chest x ray.

sarcoidosis

14

A 55 year old male known to the gastroenterologists is referred to the chest physicians. He is short of breath. This has come on over the past few weeks, but is new restricting even minimal exertion. On general examination, he is jaundiced and his abdomen is distended. He has spider naevi on his trunk. His LFTs are deranged and he has a macrocytic anaemia.

ascites

15

A 29 year old woman is referred to the respiratory outpatient clinic by her GP for worsening shortness of breath. She has become gradually more breathless over the past year, and her systemic enquiry reveals other problems with her eyes, joints and skin. An autoantibody screen reveals anti-CCP antibodies at 1:640.

rheumatoid

16

A 28 year old female complains of shortness of breath and a dry cough as well as feeling tired. On further questioning she says she has had night sweats and weight loss and painful joints. On examination, she has red patches of skin on her legs and her left eye is inflamed. A chest X-ray shows bilateral hilar lympadenopathy. She has a raised serum ACE level.

Sarcoidosis

17

A 50 year old man visits his GP due to increasing breathlessness which is interfering with his work as a welder. He has a dry cough, but blames this on smoking (he smokes 15 cigarettes a day and has done for many years). On examination, his fingers are clubbed, and late inspiratory crackles can be auscultated at both lung bases. A chest X-ray seems normal, but a later HRCT shows a ground-glass appearance, with pleural thickening.

Asbestosis

18

A 35 year old woman is admitted to hospital with chest pain and shortness of breath. On examination, she has a red rash across her face, and has oral ulcers. She takes no medication. Her full blood count shows she is thrombocytopenic, and an auto-antibody screen shows raised ds-DNA and ANA antibodies.

Systemic lupus erythematosus

19

Is palpable within the jugular notch.

Trachea

20

Is the level at which the lower respiratory tract begins.

C6 vertebra

21

Is an anatomical landmark for cardiopulmonary resuscitation.

Xiphoid Process

22

The intracellular mechanisms and processes that consume oxygen and produce carbon dioxide.

Internal respiration

23

At a constant temperature, the pressure exerted by a gas varies inversely with the volume of the gas.

Boyle's Law

24

P=2T/r describes the relationship between alveolar radius and the tendency to collapse. A smaller alveolar radius means a higher tendency to collapse.

Law of LaPlace

25

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?

Q image thumb

Insert a large bore cannula into the 2nd intercostal space, mid clavicular line on the right side

26

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

27

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.

The goal of a pleurodesis is to eliminate the pleural space so that fluid can no longer accumulate.

 

28

An 18 year old man is admitted with sudden onset shortness of breath and is complaining of right-sided chest pain. On examination he is tachycardic, tachypnoeic and hypertensive. His right side is hyperresonant when percussed. His PA chest X-ray shows a line parallel to the right chest wall.

 Right-sided tension pneumothorax 

29

A 60 year old woman is admitted to hospital by her GP. She has been unwell for the past few days and has not responded to the GP's initial treatment. On examination she is tachycardic, tachypnoeic, pyrexial and mildly hypertensive. On percussion her right middle zone is dull. Her PA chest X-ray shows loss of the right heart border.

Right middle lobe pneumonia

30

A 20 year old male patient complains of shortness of breath. On PA chest X-ray his right horizontal fissure is displaced. There is an opacity in his upper right zone.

Right upper lobe collapse

31

Specialised cells in the nasal cavity involved in smell and taste.

Olfactory epithelial cell

32

Squamous epithelial cells found in the alveolar sac.

Type I pneumocyte

33

 The cells of the pulmonary capillaries which contribute to the blood-air barrier.

Endothelial cell

34

A patient is admitted with pyrexia, dyspnoea and a productive cough. On chest X-ray, the left heart border is obscured.

Lingular pneumonia

35

A 20 year old male patient complains of shortness of breath. On chest X-ray his left oblique fissure is displaced, and the medial left hemidiaphragm is obscured.

Left lower lobe collapse

36

A 20 year old male patient complains of shortness of breath. On lateral chest X-ray his oblique fissure seems to be very anterior, and on PA chest X-ray his left heart border is obscured and there is a veil-like opacity.

Left upper lobe collapse

37

 The stage of lung maturation that takes place between 16-28 weeks' gestation. It sees the branching of terminal bronchioles into respiratory bronchioles and finally alveolar ducts.

 Canalicular

38

The germ layer that forms the lining of the trachea and bronchial tree.

Endoderm

39

The structure that develops on the anterior foregut and is the first respiratory structure to develop.

Respiratory diverticulum

40

The initial stage in tumour development where cells gross appearance and histological findings are altered but there is no malignancy.

Squamous metaplasia

41

 tumour which produces keratin pearls, and may produce thyroid transcription factor.

Squamous carcinoma

42

A lung cancer which is only treated by chemotherapy but may become rapidly resistant to treatment.

Small cell lung cancer

43

The stage of lung maturation that takes place between 28-36 weeks' gestation. The terminal sacs form, and capillaries come into close contact with the alveoli ready for gas exchange.

Saccular

44

The structure that is seen to develop by 28 days' gestation, found inferior to the trachea.

Bronchial buds

45

The stage of lung maturation that takes place between 36 weeks' gestation and early childhood and involves further maturation of the alveoli.

Alveolar

46