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Flashcards in Diagnosis- Respiratory Deck (40)
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1
Q
  1. Which of the following conditions is described below?

A respiratory condition characterised by variable airway obstruction due to chronic inflammation, smooth muscle hyperplasia and mucus hypersecretion. It presents with an FEV1:FVC ratio of less than 0.7:1 on spirometry.

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Cystic Fibrosis (CF)
  • Asthma
  • Bronchiectasis
A

Asthma

2
Q

An 81-year-old female presents with a 2-day history of dyspnoea, a productive cough (thick green sputum), fever and confusion. She has a Chest X-ray carried out at her local hospital. Based off her history and the X-ray below, diagnose her condition

  • Left-sided pleural effusion
  • Right-lower lobe pneumonia
  • Right-sided tension pneumothorax
  • Interstitial Lung Disease
A
  • Right-lower lobe pneumonia
3
Q
  1. Which of the following is the most common bacterial pathogen in Community-Acquired Pneumonia?
  • Pneumocystis jirovecii
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Streptococcus pneumoniae
A

Streptococcus pneumoniae

4
Q
  1. A 2-year-old infant is brought into A&E at 3am by his mother who is very concerned about his breathing. She mentions he has had a very high fever of 39.5 oC for the past 24 hours, but overnight developed a high-pitched, harsh wheezing sound when he breathes in. She also noticed he is drooling excessively. What is your diagnosis?
  • Epiglottitis
  • Croup
  • COPD exacerbation
  • Rhinovirus
A

Epiglottitis

Epiglottitis is a clinical emergency. The clinical picture for epiglottitis includes a very high fever (sometimes in excess of 40 oC, sudden onset dyspnoea +/- stridor, distress and dysphagia/sialorrhoea (excessive drooling). Treatment involves maintaining airway patency and IV antibiotics. It is caused by bacterial infection by Haemophilus influenza B.

5
Q
  1. A 33-year-old male presents to primary care with a 4-week history of a non-productive cough, which has recently been accompanied by a fever (38.1 oC) and night sweats. Upon further questioning, the GP uncovers the patient was homeless for the majority of his twenties and was a previous IVDU. The GP sends the patient to A&E for a chest X-ray which can be seen below. What is your diagnosis?
  • Bilateral upper lobe pneumonia
  • Hypersensitivity pneumonitis
  • Left-sided pneumothorax
  • Tuberculosis
A

Tuberculosis

6
Q

A 64-year-old woman presents to A&E with sudden onset dyspnoea, pleuritic chest pain and haemoptysis. She has recently driven home from a holiday to the Scottish Highlands. The A&E SHO performed a D-dimer blood test which was positive. What is the most likely diagnosis in this case?

  • Pneumothorax
  • Myocardial Infarction
  • Pulmonary Embolism
  • Pneumonia
A

Pulmonary Embolism

7
Q

What is the best imaging modality to confirm your diagnosis of PE?

  • Chest X-ray
  • Full Blood Count
  • Transoesophageal Echocardiogram
  • CTPA
A

CTPA

, a positive D-dimer is not necessarily indicative of a PE. Therefore, a positive D-dimer + symptoms of a PE warrants performing a CT Pulmonary angiogram – CT which looks at the pulmonary arteries to check for occlusion.

8
Q

A 56-year-old male with Type II Diabetes Mellitus, hypercholesterolaemia and a BMI of 55 kg/m2 presents to his GP with a 3-month history of fatigue and morning headaches. He mentions during the consultation that he recently lost his job at an accountancy firm because he was caught sleeping at his desk multiple times throughout the day. What is the most likely diagnosis?

  • Microcytic anaemia
  • Obstructive Sleep Apnoea
  • Chronic sinusitis
  • Narcolepsy
A

Obstructive Sleep Apnoea

, OSA is the best fit in this example due to the patient’s weight and underlying conditions.

9
Q

A 26-year-old male, who has recently taken up smoking, is brought in by ambulance to the local A&E department. He was sat down at home watching Bridgerton on Netflix, when he suddenly developed left-sided chest pain and dyspnoea. Upon examination in A&E, the F2 doctor on call finds reduced breath sounds unilaterally and hyper-resonance upon percussion to the left chest wall. His findings were consistent with a pneumothorax. The same doctor performs some basic blood tests and finds his LFT’s (Liver Function tests) to be deranged. What is the underlying cause of his pneumothorax?

  • Wilson’s disease
  • a-1 Antitrypsin deficiency
  • Mesothelioma
  • Idiopathic Pulmonary Fibrosis
A

a-1 Antitrypsin deficiency

10
Q
  1. Please interpret the following ABG (arterial blood gas)

pH 7.26 (7.35-7.45)

PaO2 7 kPa (11-13)

PaCO2 9.4 kPa (4.7-6.0)

HCO3- 23 mEq/L (22-26)

Base excess -1 (-2 to +2)

  • Uncompensated Respiratory Acidosis
  • Uncompensated Metabolic Acidosis
  • Partially compensated Respiratory Acidosis
  • Uncompensated Respiratory Alkalosis
A

Uncompensated Respiratory Acidosis

11
Q

What is the most common mutation in Cystic Fibrosis

G551D

N1303K

ΔF508

R117H

A

ΔF508

12
Q

Pneumothorax will NOT present with:

Air trapping

Hypertension

Hypoxia

Tachycardia

A

Hypertension

13
Q

Type 1 pneumocytes produce surfactant

True

False

A

False

14
Q

What CFTR mutation class is ΔF508

Class 1

Class 2

Class 3

Class 4

A

Class 2

15
Q

Asthma will present with an increased FEV1:FVC ratio

True

False

A

False

16
Q

The intrapleural pressure in the lungs is always negative

True

False

A

True

17
Q

Which investigation is used to rule out DVT

MRI

Compression US with Doppler

D-Dimer

Venography

A

D-Dimer

18
Q

Hypoxaemia and Hypercapnia is:

Type 1 Respiratory Failure

Type 2 Respiratory Failure

A

Type 2 Respiratory Failure

19
Q

EGFR mutation is commonly seen in this type of lung cancer

Large cell carcinoma

Alveolar cell carcinoma

Mesothelioma

Adenocarcinoma

A

Adenocarcinoma

20
Q

Squamous cell carcinoma is a form of non small cell lung cancer

True

False

A

True

21
Q

Which of the following is NOT a restrictive disease

Pulmonary fibrosis

Bronchiecstasis

Kyphoscoliosis

Lung Tumour

A

Bronchiecstasis

22
Q

What does Spirometry NOT provide information on

FEV1/FVC ratio

Peak Expiratory Flow Rate (PEFR)

Total Lung Capacity

FEV1

A

Total Lung Capacity

23
Q

A patient has smoked 60 cigarettes a day for 40 years, what is their pack years?

100

120

80

240

A

120

24
Q

What type of pneumothorax is this?

Closed

Tension

Open

A

Tension

25
Q

Which Interstitial Lung Disease has a better prognosis?

UIP (Usual Interstitial Pneumonia)

NSIP (Non-Specific Interstitial Pneumonia)

IPF (Idiopathic Pulmonary Fibrosis)

A

NSIP (Non-Specific Interstitial Pneumonia)

26
Q

What is NOT TRUE about COPD

Does not respond well to therapy

Has a stable disease course

Common in smokers

Affects patients >35

A

Has a stable disease course

27
Q

What is the most common organism causing Community Acquired Pneumonia

Haemophilus Influenzae

Staphylococcus Aureus

Klebsiella Pneumoniae

Streptococcus Pneumoniae

A

Streptococcus Pneumoniae

28
Q

Which of the following is true of Neonatal Respiratory Distress Syndrome (NRDS)

Decreased surfactant WITH hyaline lining

Increased surfactant in preterm babies

Decreased surfactant with NO hyaline lining

Increased surfactant

A

Decreased surfactant WITH hyaline lining

29
Q

Which ventilation method is the most invasive

Positive pressure ventilation

Non invasive ventilation

Negative pressure ventilation

Intermittent abdominal pressure ventilator

A

Positive pressure ventilation

30
Q

Which three things are in Virchow’s Triad of Thrombosis (select 3)

Stasis

Endothelial Damage

Inflammation

Hypercoagulability

A

ENdothelial Damage

Hypercoagulability

Stasis

31
Q

Which aggressive lung cancer is associated with paraneoplastic syndromes (ie SAIDH, Cushings)

Pancoast tumours

Squamous cell carcinoma (SCC)

Adenocarcinoma

Small cell lung cancer

A

Small cell lung cancer

32
Q

What is the most common type of lung cancer in SMOKERS

Small cell carcinoma

Adenocarcinoma

Squamous cel cell carcinoma

Alveolar cell carcinoma

A

Squamous cel cell carcinoma

33
Q

Salbutamol is a Short Acting Beta-2-Antagonist (SABA)

True

False

A

False

34
Q

What is NOT a cause of Type 2 Respiratory Failure

Muscular Dystrophy

Kyphoscoliosis

Guillan Barre syndrome

Pulmonary Embolism

A

Pulmonary Embolism

35
Q

What 2 diseases fall under the definition of COPD (select 2)

Emphysema

Hypersensitivity pneumonitis

Bronchiolitis

Chronic Bronchitis

A

Emphysema

Chronic Bronchitis

36
Q

Asbestosis has a very short latency period

True

False

A

False

37
Q

The recurrent laryngeal nerve receives general sensation from which area of the larynx?

Cricothyroid muscle only

All laryngeal muscles EXCLUDING the cricothyroid muscle

All muscles of the larynx

A

All laryngeal muscles EXCLUDING the cricothyroid muscle

38
Q

What is the orientation of the muscle fibres of the internal intercostal muscle

Anteroinferior

Posteroinferior

A

Posteroinferior

39
Q

Which of the following helps in diagnosing Asthma?

CRP

Histamine Challenge test

ABGs

IgG levels

A

Histamine Challenge test

40
Q

Which of the following is often associated with pleuritic chest pain

Sarcoidosis

COPD

Pneumothorax

Idiopathic Pulmonary Fibrosis

A

Pneumothorax