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DPD > Interactive cases 2: Respiratory medicine > Flashcards

Interactive cases 2: Respiratory medicine Flashcards

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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

25
What is CPAP?
continuous positive airway pressure. used for Type 1 hypoxic respiratory failure -> improves oxygenation (both insp and exp positive airway pressure)
26
Distinguish between primary and secondary pneumothorax
primary has no history of previous lung disease. Secondary has underlying lung disease e.g. COPD
27
Tx for primary pneumothorax: <2cm >2cm
<2cm - leave and observe | >2cm - aspirate (failure -> chest drain)
28
Tx for secondary pneumothorax: <2cm >2cm
<2cm aspirate | >2cm - chest drain
29
pulmonary oedema cause and CXR findings
LHF or CCF. | CXR bilateral fluffy air space shadowing
30
What leads determine axis deviation on ECG?
Lead 1 (R or S overall more negative = axis deviation) avL more +ve - LAD avL more -ve RAD
31
S1 Q3 T3
ECG feature of PE
32
What is BiPAP?
Inspiratory positive airway pressure. Non-invasive ventilation for respiratory acidosis e.g. COPD
33
What is ePAP?
expiratory positive airway pressure
34
Why is there a raised JVP in PE pt?
due to clot | could also be RHF/CCF
35
Mx of PE pt
ABC, give oxygen LMWH (enoxapaprin, dalteparin) do CTPA to confirm PE (if not stop LMWH) Then warfarin when INR high
36
Why is there a delay in giving warfarin to PE pt?
Warfarin is initially a pro-coagulant as inhibits protein C and S for first few days
37
When would you thrombolyse a PE pt?
if haemodynamically unstable (low BP due to e..g MI)
38
Mx of primary pneumonia >2cm
ABC aspirate regular analgesia (especially if chest drain inserted)
39
what does FEV/FVC ratio tell you?
<70% obstructive lung disease (COPD/asthma) as FEV low | >70% restrictive lung disease (PF) as FVC low
40
Causes of pulmonary fibrosis
idiopathic CTD (SLE, scleroderma) Drugs (Methotrexate, Nitropheratin) Asbestos (-> asbestosis), not just asbestos plaque
41
Hyperinflated lung on CXR
see >7 ribs anteriorly and flattened diaphragm
42
upper lobe shadowing
pulmonary TB
43
describing CXR
Name, DOB, date+time, PA/AP Rotation Inspiration Penetration (too white=over, too black=under)
44
Cause of loss of visible l hemidiaphragm (behind heart)
collapse or consolidation
45
bilateral fluffy shadowing
fluid/blood/pus | most likely pulmonary oedema
46
CXR total white out
massive effusion or collapse
47
Differentiate between massive effusion and lung collapse
look at trachea on CXR effusion pushes trachea away collapse pulls trachea towards
48
coin lesion, air fluid level causes
Infection (TB, staph aureus, Klebsiella) Inflammation (RA or cavitation nodules) Malignancy (squamous cell carcinoma)
49
causes bilateral hilar lymphadenopathy
TB, sarcoidosis, lymphoma
50
signs of asbestos poisoning on CXR
multiple pleural plaques OR | reticular nodular shadowing (asbestosis, type of pulmonary fibrosis)
51
``` 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 ```
LMWH
52
Vanishing lung syndrome
otherwise known as idiopathic giant bullous emphysema | typically young thin male smokers
53
radiographic criteria for vanishing lung syndrome
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
Mx of vanishing lung syndrome
Lung-volume–reduction surgery after: assessment of exercise capacity pulmonary-function testing, smoking cessation
55
``` Cough sputum wt loss Night sweats CXR upper lobe shadowing ```
pulmonary TB
56
A 70-year-old man SOB Keeps pigeons CXR bilateral reticulonodular shadowing
extrinsic allergic alveolitis
57
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
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
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
Radiotherapy | codydramol=paracetomal and codeine, dont want xs. Finasteride and Tamsulosin used for prostate symptoms

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