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DPD > Interactive cases 2: Respiratory medicine > Flashcards

Interactive cases 2: Respiratory medicine Flashcards

1
Q 
60 yr old man
SOB, Sudden onset
PMH: COPD
On symbicort & tiotropium
PR: 110 bpm
JVP high 
decreased BS, Scattered wheeze & creps (R)
Peripheral oedema
Sats: 80% (air)
FBC: Hb 85, WCC 12, plt: 300
A

PE

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2
Q

What causes bilateral hilar lymphadenopathy

A

TB, sarcoid, lymphoma

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3
Q

Mass/cavitating lesion

A

TB, abscess, rheumatoid nodule. Air-fluid level

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4
Q

What is seen with left lower lobe pneumonia?

A

loss of L hemidiaphragm, normally seen behind the heart

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5
Q

50F, progressive SOB, dry cough, clubbing, FEV1/FVC >70%

A

Interstitial lung disease e.g. pulmonary fibrosis, reticulonodular shadowing on CXR

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6
Q

3 signs of constrictive pericarditis

A

high JVP, hepatomegaly, ascites

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7
Q

50F, no clubbing, hyper-expansion on CXR, sputum, chronic SOB, FEV1/FVC 63%

A

COPD

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8
Q

reticulonodular shadowing

A

pulmonary fibrosis (idiopathic or extrinsic allergic alveolitis)

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9
Q

homogenous shadowing

A

pleural effusion (meniscus seen)

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10
Q

Which lobe is affected if CXR consolidatoin obscures the right heart border?

A

right middle lobe, listen in axilla for pathology

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11
Q

41M SOB, cough, CP, chronic. 30y smoking history, decreased breath sounds, hyper resonant bilaterally

A

big bullae, vanishing lung syndrome. CT do NOT put achest drain in. Lung volume reduction surgery

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12
Q

What causes a globular heart?

A

pericarditis with percardial effusion

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13
Q

CXR opacities, fluffy interstial/alveolar shadowing

A

fluid, pus or blood (pneumonia, HF)

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14
Q

what is symbicort?

A

long acting beta agonist and steroid (given to COPD pts)

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15
Q

what is tiotropium

A

anti cholinergic bronchodilator (COPD pts)

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16
Q

Causes of acute breathlessness

A

pneumothorax (alveoli pop), PE (PA clot), foreign body obstruction (block airway), anxiety

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17
Q

why would there be a raised JVP in COPD pt?

A

COPD-> chronically hypoxic -> vasoconstriction -> pulmonary HT -> RHF (peripheral oedema)

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18
Q

auscultation of COPD pt

A

wheeze (airway obstruction) and crepitations

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19
Q

respiratory diseases that are RF for pneumothorax

A

COPD (bullous burst)

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20
Q

RF for PE

A

female, middle-aged, smoker, CTD (Marfan’s), immobility, Fx or PMH of DVT

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21
Q

causes of sub-acute breathlessness

A

(mins/hours) - fluid (HF), pus (pneumonia), blood (in alveoli or interstitium. fluffy air-space shadowing

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22
Q

causes of chronic breathlessness

A

chronic (infection, PEs, COPD, PF, HF). Basically anything except pneumothorax

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23
Q

Interstitial lung disease

A

pulmonary fibrosis (idiopathic or extrinsic allergic alveolitis)

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24
Q

scan used to drain fluid

A

US

25
Q

What is CPAP?

A

continuous positive airway pressure. used for Type 1 hypoxic respiratory failure -> improves oxygenation
(both insp and exp positive airway pressure)

26
Q

Distinguish between primary and secondary pneumothorax

A

primary has no history of previous lung disease. Secondary has underlying lung disease e.g. COPD

27
Q

Tx for primary pneumothorax:
<2cm
>2cm

A

<2cm - leave and observe

>2cm - aspirate (failure -> chest drain)

28
Q

Tx for secondary pneumothorax:
<2cm
>2cm

A

<2cm aspirate

>2cm - chest drain

29
Q

pulmonary oedema cause and CXR findings

A

LHF or CCF.

CXR bilateral fluffy air space shadowing

30
Q

What leads determine axis deviation on ECG?

A

Lead 1 (R or S overall more negative = axis deviation)
avL more +ve - LAD
avL more -ve RAD

31
Q

S1 Q3 T3

A

ECG feature of PE

32
Q

What is BiPAP?

A

Inspiratory positive airway pressure. Non-invasive ventilation for respiratory acidosis e.g. COPD

33
Q

What is ePAP?

A

expiratory positive airway pressure

34
Q

Why is there a raised JVP in PE pt?

A

due to clot

could also be RHF/CCF

35
Q

Mx of PE pt

A

ABC, give oxygen
LMWH (enoxapaprin, dalteparin)
do CTPA to confirm PE (if not stop LMWH)
Then warfarin when INR high

36
Q

Why is there a delay in giving warfarin to PE pt?

A

Warfarin is initially a pro-coagulant as inhibits protein C and S for first few days

37
Q

When would you thrombolyse a PE pt?

A

if haemodynamically unstable (low BP due to e..g MI)

38
Q

Mx of primary pneumonia >2cm

A

ABC
aspirate
regular analgesia (especially if chest drain inserted)

39
Q

what does FEV/FVC ratio tell you?

A

<70% obstructive lung disease (COPD/asthma) as FEV low

>70% restrictive lung disease (PF) as FVC low

40
Q

Causes of pulmonary fibrosis

A

idiopathic
CTD (SLE, scleroderma)
Drugs (Methotrexate, Nitropheratin)
Asbestos (-> asbestosis), not just asbestos plaque

41
Q

Hyperinflated lung on CXR

A

see >7 ribs anteriorly and flattened diaphragm

42
Q

upper lobe shadowing

A

pulmonary TB

43
Q

describing CXR

A

Name, DOB, date+time, PA/AP
Rotation
Inspiration
Penetration (too white=over, too black=under)

44
Q

Cause of loss of visible l hemidiaphragm (behind heart)

A

collapse or consolidation

45
Q

bilateral fluffy shadowing

A

fluid/blood/pus

most likely pulmonary oedema

46
Q

CXR total white out

A

massive effusion or collapse

47
Q

Differentiate between massive effusion and lung collapse

A

look at trachea on CXR
effusion pushes trachea away
collapse pulls trachea towards

48
Q

coin lesion, air fluid level causes

A

Infection (TB, staph aureus, Klebsiella)
Inflammation (RA or cavitation nodules)
Malignancy (squamous cell carcinoma)

49
Q

causes bilateral hilar lymphadenopathy

A

TB, sarcoidosis, lymphoma

50
Q

signs of asbestos poisoning on CXR

A

multiple pleural plaques OR

reticular nodular shadowing (asbestosis, type of pulmonary fibrosis)

51
Q 
47W Acute SOB
Pleuritic chest pain
PMHx: DVT
O2 Saturation: 78% (air)
PR: 110 bpm BP: 120/80, high JVP, Vesicular BS
Most appropriate Mx?
1. LMWH
2. BiPAP
3. Warfarin
4. Thrombolysis
5. Furosemide
A

LMWH

52
Q

Vanishing lung syndrome

A

otherwise known as idiopathic giant bullous emphysema

typically young thin male smokers

53
Q

radiographic criteria for vanishing lung syndrome

A

giant bullae in one or both upper lobes occupying at least one third of the hemithorax and compressing surrounding parenchyma
(Air–liquid levels within bullae are uncommon and raise the question of bacterial superinfection)

54
Q

Mx of vanishing lung syndrome

A

Lung-volume–reduction surgery after:
assessment of exercise capacity
pulmonary-function testing, smoking cessation

55
Q 
Cough
sputum 
wt loss
Night sweats
CXR upper lobe shadowing
A

pulmonary TB

56
Q

A 70-year-old man
SOB
Keeps pigeons

CXR bilateral reticulonodular shadowing

A

extrinsic allergic alveolitis

57
Q

75M 3 day worsening SOB, productive cough, reduced exercise tolerance. 50 pack/year smoking history. Temp 38.5. PR 110 bpm, BP 140/87 mmHg, RR 28 bpm. O2 sats 87% breathing air. He is given oxygen, aiming for 88-92% sats. Next step Mx?

a) IV aminophylline
b) IV MgSO4
c) IV steroids
d) Non invasive ventilation
e) Salbutamol nebuliser

A

Salbutamol nebuliser
(and ipratropium)
aminophylline if don’t respond to above, MgSO4 for asthmatics, steroids given but don’t work as quickly so not next step. NIV need to see resp acidosis and high CO2.

58
Q

66M w/metastatic prostate cancer. Has ongoing bony pain which taked paracetomal codeine, and morphine. Pain still not well controlled. Next step Mx?

a) Co-dydramol
b) Finasteride
c) Radiotherapy
d) Tamsulosin
e) Vit D

A

Radiotherapy

codydramol=paracetomal and codeine, dont want xs. Finasteride and Tamsulosin used for prostate symptoms

DPD (7 decks)

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