Respiratory Flashcards
Lung abscess, COPD, Emphysema, Pneumonia, Radiation effects (15 cards)
Which of the following regarding pathophysiology of lung abscess is NOT correct?
a. Gastro-oesophageal reflux would be an insignificant finding.
b. Poor dental hygiene may play a role.
c. Immunosuppression sate may play a role.
d. Patient may have hoarse voice.
Answer: a
Reason: gastro-oesophageal reflux would be a SIGNIFICANT finding
(Host: Immunosuppression, Alcohol abuse, Altered mental status, Dental diseases, Neuromuscular disease, Vocal cord paralysis, Malignant obstruction, Reflux diseases)
Which of the following is NOT regarded as a principle of management for lung abscess?
a. External drainage is indicated if there is no drainage into the tracheobronchial tree.
b. Even though response to medical treatment is generally poor it should be started so as to avoid surgery.
c. Adequate drainage into the tracheobronchial tree is desirable.
d. Causative organisms should be identified as soon as possible.
Answer: b
(Lung abscess responds well to medical treatment)
Lung abscess management principles:
* Identify organism ASAP
* 6 - 8 weeks medical therapy: 80-90% of abscesses respond to medical therapy
* Adequate drainage into tracheobronchial tree is desirable
* External drainage indicated: if there is no drainage into tracheobronchial tree
Which one of the following statements regarding the pathology of lobar pneumonia is NOT correct?
a. Oedema and congestion dominate in the first of four stages.
b. The red hepatisation phase is associated with rusty sputum due to the presence of red blood cells.
c. In the grey hepatisation phase the sputum is purulent.
d. The final phase of resolution involves the proliferation of fibroblasts.
Answer: d
Four stages:
1. Congestion (day 1): dominated by oedema and vascular congestion, alveolar capillaries are engorged, proteinaceous fluid, few neutrophils, and bacteria in alveoli.
2. Red Hepatisation (day 2-3): alveoli filled with red blood cells, neutrophils, and fibrin, lungs appear liver-like (“hepatisation”), rusty sputum due to extravasated red blood cells.
3. Grey Hepatisation (day 4-6): disintegrate of red blood cells, alveoli filled with fibrin and neutrophils, lung appears grey and firm, purulent sputum is produced due to pus (neutrophils + debris).
4. Resolution (days 7+): macrophages digest exudate - clearing fibrin and debris, no fibroblast proliferation in typical resolution.
(If fibroblasts proliferate, it suggests organisation and possible fibrosis, which is not part of normal resolution)
Which of the following is NOT a typical respiratory consequence of radiation?
a. Pneumonitis
b. Dyspnea
c. Cor pulmonale
d. Productive cough
Answer: d
Cough is dry but not productive
Clinical findings:
* Radiation pneumonitis
* Dyspnea (shortness of breath)
* Cough (dry not productive)
* Signs and symptoms of cor pulmonale: abnormal enlargement of the right side of the heart as a result of disease of the lungs or pulmonary blood vessels
Which of the following statements regarding investigations of lung abscess NOT correct?
a. CT scan may show cavitation with adjacent consolidation.
b. Bronchoscopy is helpful to rule out associated endobronchial obstruction.
c. Ultrasound is the investigation of choice because of accuracy, non invasiveness and convince.
d. On X-ray it is common to see an air fluid level within the abscess cavity.
Answer: c
(Radiology not ultrasound)
Lung abscess investigations:
* Radiology:
- CXR (chest X-ray): infiltrative process associated with an air fluid level within the abscess cavity.
- CT scan: one or more cavity lesion(s) with adjacent consolidation (consolidation = there is liquid where there should be air).
* Bronchoscopy:
- Rule out endobronchial tumour or obstruction.
- To obtain washings for bacteriology.
Which of the following statements regarding investigations for lung abscess is NOT correct?
a. Presentation is clearly clinically different from that of pneumonia.
b. The patient may give a history of night sweats.
c. There may be weight loss.
d. Sputum may be purulent.
Answer: a
(Lung abscess has a similar presentation as pneumonia)
Lung abscess clinical presentation:
(Similar presentation as pneumonia)
* Weight loss, fever, night sweats and cough.
* Production of purulent sputum (pus) and foul breath.
Which of the following is NOT correct regarding lung abscess patient management?
a. Postural drainage is a key element.
b. The physiotherapist plays a major role.
c. It is important to educate the patient about the condition.
d. Mobilisation is contraindicated because it promotes spread of infection to the lower lobes.
Answer: d
(Mobilisation is not contraindicated)
Role of allied health (lung abscess):
* Patient education
* Chest physiotherapy - postural drainage is a key element and mobilisation is encouraged
Which one of the following statements regarding chronic lung diseases is NOT correct?
a. Non-neoplastic, non-infectious diffuse disease can be categorised on the basis of lung function tests.
b. Emphysema is an example of restrictive lung disease.
c. In restrictive disease there is reduced lung expansion and decreased total lung capacity.
d. In obstructive lung disease there is an increase in resistance to airflow due to partial or complete airway obstruction at any level.
Answer: b
Emphysema is NOT an example of a restrictive lung disease.
Emphysema = example of COPD
Which of the following statements regarding COPD is NOT correct?
a. It is regarded as a preventable condition.
b. It is usually not progressive i.e. once established the condition remains static.
c. Patients may have difficulty hyperventilating to maintain O2 and may present as blue bloaters.
d. Associated with enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases (cigarette smoking).
Answer: b
COPD is characterised by persistent airflow limitation that is usually progressive.
- May present with chronic bronchitis - it includes chronic inflammation of the airways and blue blotter is seen when the patient has permanent airflow limitation.
- Blue blotter / Blue bloater: cyanosis (bluish tint to skin/lips) due to hypoxia + fluid retention and overweight appearance from right sided heart failure (cor pulmonate).
Which one of the following statements regarding airflow limitation in COPD is NOT correct?
a. Increased recoil of the airways results in collapse and gas trapping.
b. Lung parenchymal destruction results in loss of alveolar attachments.
c. Fibrosis in small airways plays a role.
d. Luminal plugs complicate the condition.
Answer: a
DECREASED elastic recoil of the airways results in collapse and gas trapping.
Mechanisms underlying airflow limitation in COPD:
* Small airways disease:
- Airway inflammation
- Airway fibrosis, luminal plugs
- Increased airway resistance
* Parenchymal destruction:
- Loss of alveolar attachments
- Decrease of elastic recoil
Which of the following statements regarding chronic complications of COPD is NOT correct?
a. Lung cancer may be associated
b. Superimposed infection is unusual
c. Cachexia/wasting syndrome may complicate the disease
d. CVS problems may arise e.g. congestive heart failure
Answer: b
Superimposed infection is common
Chronic complications of COPD:
* Chronic inflammation and epithelial damage contribute to malignant transformation (Lung cancer).
* In COPD, superimposed infections are common - infections contribute to worsening symptoms and lung function decline.
* Cachexia/wasting syndrome - seen in advanced COPD - multifactorial causes: increased work of breathing, inflammation, poor appetite.
* CVS problems - right sided heart failure (cor pulmonale) due to chronic pulmonary hypertension + COPD is also linked to increased risk of ischemic heart disease and arrhythmias.
Which one of the following is NOT a typical feature of radiation injury to the lungs?
a. In the acute phase protein rich fluid flows from capillaries into the interstitium.
b. Injury to lymphatics may impair the absorption of exudate.
c. In the chronic phase lymphocytes express fibrogenic cytokines.
d. The chronic phase is characterised by a persistent productive cough.
Answer: d
Non-productive cough (dry)
Which of the following statements regarding the clinical presentation of pneumonia is NOT correct?
a. The cough of pneumonia is often productive.
b. Haemoptysis excludes a diagnosis of pneumonia.
c. Patients may have associated myalgia.
d. Gastrointestinal symptoms may include abdominal pain and diarrhoea.
Answer: b
- Haemoptysis does not exclude the diagnosis of pneumonia
- Haemoptysis is a clinical presentation of pneumonia
(* Haemoptysis = coughing up blood)
(* Myalgia = pain in muscle or group of muscles)
Clinical presentation of pneumonia:
* Cough (productive) + haemoptysis
* Chest pain, pleurtic
* Fever, malaise, myalgia
* Confusion
* Jaundice, abdominal pain, diarrhoea
* Hypoxia
The x-ray of a patient with community acquired pneumonia may appear to be normal. Which one of the following diagnoses would NOT be associated with a ‘clear’ x-ray of lung tissue?
a. Lung infarction
b. Influenza infection
c. Whooping cough
d. Asthma with associated viral syndrome
Answer: a
Lung infarction causes visible abnormalities on a chest x-ray
Visible abnormalities on chest x-ray - Lung infarction:
* Wedge shaped opacities
* Pleural effusion
* Consolidation near the periphery of the lung
Which one of the following would probably NOT adversely affect the lung’s clearing mechanisms?
a. Corrosive gas inhalation
b. Pulmonary congestion and oedema
c. Cystic fibrosis
d. Whooping cough
Answer: d
Whooping cough = No direct damage or impairment to the lung’s clearing mechanisms
