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Year 3 Medicine > Respiratory > Flashcards

Flashcards in Respiratory Deck (23):
1

A 65 year old female with a 30 pack year history
presents with progressive SOB and a productive cough.
You hear an audible wheeze and note that she is using
her accessory muscles of respiration.

A. Alpha 1 an trypsin deficiency
B. Sarcoidosis
C. Extrinsic Allergic Alveolitis
D. Pulmonary Embolism
E. COPD
F. Idiopathic Pulmonary Fibrosis
G. Asthma
H. Bronchiectasis

65 year old
30 pack year history
progressive SOB
productive cough
wheeze


E. COPD

2

In COPD, "Blue bloaters" predominantly have...

Chronic Bronchitis

Copious sputum production
Cough
Cyanotic (blue)
Volume overload (bloater)
Wheezy on auscultation
Rhonchi

3

In COPD, "Pink Puffers" predominantly have...

Emphysema

• Severe constant dyspnoea & tachypnoea (puffing)
• Non-cyanotic (pink)
• Thin/cachectic
• Diminished breath sounds

4

A 27 year old female of Scandinavian origin
presents with SOB that has developed over the past few
months. She says she is finding it increasingly difficult to
complete her morning runs. O/E you note tender,
erythematous nodules on both her shins.

A. Alpha 1 anti-trypsin deficiency
B. Sarcoidosis
C. Extrinsic Allergic Alveolitis
D. Pulmonary Embolism
E. COPD
F. Idiopathic Pulmonary Fibrosis
G. Asthma
H. Bronchiectasis

27 year old female
Scandinavian origin
SOB developed over the past few months
Tender, erythematous nodules on both her shins

B. Sarcoidosis

5

A gentleman presents with acute breathlessness.
You are unable to take comprehensive history as he
speaks little English. O/E he has a respiratory rate of 25 breaths per minute with good air entry in all lung fields.

A. Alpha 1 anti-trypsin deficiency
B. Sarcoidosis
C. Extrinsic Allergic Alveolitis
D. Pulmonary Embolism
E. COPD
F. Idiopathic Pulmonary Fibrosis
G. Asthma
H. Bronchiectasis

Acute breathlessness
RR of 25
Good air entry in all lung fields

D. Pulmonary Embolism

6

A 52 year old male presents with an 8 month history of exertional dyspnoea and a non-productive cough. He also complains of a “lack of energy” and weight loss.

A. Alpha 1 an trypsin deficiency
B. Sarcoidosis
C. Extrinsic Allergic Alveolitis
D. Pulmonary Embolism
E. COPD
F. Idiopathic Pulmonary Fibrosis
G. Asthma
H. Bronchiectasis

52 year old
8 month history of exertional dyspnoea
Non-productive cough
Lack of energy
Weight loss

F. Idiopathic Pulmonary Fibrosis

7

A 47 year old farmer presents with a recent history of breathlessness, fever and chills. Whilst taking the history, you establish that he came into contact with mouldy hay that morning.

A. Alpha 1 an trypsin deficiency
B. Sarcoidosis
C. Extrinsic Allergic Alveolitis
D. Pulmonary Embolism
E. COPD
F. Idiopathic Pulmonary Fibrosis
G. Asthma
H. Bronchiectasis

Farmer
Recent history of breathlessness, fever and chills
Mouldy hay

C. Extrinsic Allergic Alveolitis

8

A 27 year old male, who has recently had surgery after a motorcycle accident, is brought to A&E by LAS. He is tachycardic and hypotensive.

Best investigation.

A. HRCT
B. VQ Scan
C. CTPA
D. D-dimer
E. Tissue biopsy
F. CXR
G. BAL
H. Spirometry

Recently had surgery.
Tachycardic and hypotensive.

C. CTPA

(Suspected PE. High probability (Well's score) so D-dimer should be skipped. CTPA is the first line imaging investigation?)

9

A 32 year old pregnant woman presents with sudden onset SOB and “chest pain when [she] breathes in”.

Best investigation.

A. HRCT
B. VQ Scan
C. CTPA
D. D-dimer
E. Tissue biopsy
F. CXR
G. BAL
H. Spirometry

Pregnant
Sudden onset SOB
Chest pain when she breathes in

B. VQ Scan

(PE suspected. D-dimers unreliable in pregnancy. V/Q scanning remains the test of choice.

10

A 37 year old female presenting with PUO (pyrexia of unknown origin) undergoes a full diagnostic work-up. Her CXR shows lung infiltrates.
Best investigation.

A. HRCT
B. VQ Scan
C. CTPA
D. D-dimer
E. Tissue biopsy
F. CXR
G. BAL
H. Spirometry

37 year old female
PUO
lung infiltrates

E. Tissue biopsy

(Sarcoidosis suspected. Bronchoscopy with bronchoalveolar lavage (BAL) and bronchial and tranbronchial biopsies).

11

The CXR of a 64 year old male reveals a ground-glass appearance” of the lungs.
Best investigation.

A. HRCT
B. VQ Scan
C. CTPA
D. D-dimer
E. Tissue biopsy
F. CXR
G. BAL
H. Spirometry

64 year old male
"ground-glass appearance"

A. HRCT

(Interstitial pulmonary fibrosis.
HRCT is essential for diagnosis- more sensitive than CXR)
Initially: ground-glass appearance
Later: irregular reticulonodular shadowing
Finally: honeycomb lung.

12

A 57 year old smoker with a 2 year history of productive cough and increased work of breathing.
Best investigation.

A. HRCT
B. VQ Scan
C. CTPA
D. D-dimer
E. Tissue biopsy
F. CXR
G. BAL
H. Spirometry

57 year old smoker
2 year history of productive cough
Increased work of breathing

H. Spirometry

(COPD suspected. (Chronic bronchitis, emphysema & asthma)
Spirometry to diagnose and rule out other interstitial lung diseases)

13

A 22 year old student from Ghana presents with numbness of!her fingers, which seems most noticeable at the tips.
She is being treated for TB for 2 months now and has been complaining of being
tired and sick.

Which drug is the most likely culprit?

A. Isoniazid
B. Rifampacin
C. Streptomycin
D. Ethambutol
E. Metronidazole

Numbness of her fingers
TB

A. Isoniazid

(S/Es of Isoniazid: peripheral neuropathy, raised LFTs)

Rifampicin: orange urine/tears, enzyme inducer, raised LFTs
Isoniazid: peripheral neuropathy, raised LFTs
Pyrazinamide: Arthralgia, raised LFTs
Ethambutol: Red-Green colour blindness (optic neuritis)

(Key one last)

14

A thin young patient presents with an exacerbation of his condition.
He has a history of recurrent childhood chest infections and poor digestion.
He has clubbing, a mucopurulent cough
and is short of breath.

What is his likely condition?

A. COPD
B. Tuberculosis
C. Cystic fibrosis
D. Kartagener Syndrome
E. Bordetella pertussis

Thin young patient
Exacerbation of his condition
Recurrent childhood infections
Poor digestion
Clubbing
Mucopurulent
SOB

C. Cystic Fibrosis

Pulmonary effects: recurrent chest infections (Pseudomonas aeruginosa); bronchiectasis

Non-pulmonary:
pancreatic insufficiency (steatorrhoea plus diabetes); male infertility; failure to thrive; clubbing)

15

A 57 year old ex-builder presents short of breath and chest pain on his let.
You quickly examine him and find dull percussion and reduced vocal fremitus on his affected side.

What is the most likely diagnosis?

A. Mesothelioma
B. Squamous cell carcinoma
C. SIADH
D. Horner’s syndrome
E. Pancoast’s syndrome
F. Adenocarcinoma
G. Superior vena cava obstruction
H. Metastasis
I. Cushing’s syndrome
J. Large cell carcinoma

Ex-builder
SOB
Dull percussion
Reduced vocal fremitus

A. Mesothelioma

(Signs of pleural effusion- mesothelioma)

16

A 72 year old female presents feeling odd and tired.
She complains that her vision is a bit funny and you notice that one of her eyelids is droopy.
Upon further questioning she has noticed a recent cough.

What is the most likely diagnosis?

A. Mesothelioma
B. Squamous cell carcinoma
C. SIADH
D. Horner’s syndrome
E. Pancoast’s syndrome
F. Adenocarcinoma
G. Superior vena cava obstruction
H. Metastasis
I. Cushing’s syndrome
J. Large cell carcinoma

Vision funny
One of her eyelids is droopy
Recent cough

D. Horner's syndrome

(via a Pancoast's tumour- sympathetic ganglia compression: anhidrosis, miosis and ptosis)

17

A 82 year old man, ex-smoker,
presents with 2 months of weight loss.
His face appears red and his eyelids look oedematous.

What is the most likely diagnosis?

A. Mesothelioma
B. Squamous cell carcinoma
C. SIADH
D. Horner’s syndrome
E. Pancoast’s syndrome
F. Adenocarcinoma
G. Superior vena cava obstruction
H. Metastasis
I. Cushing’s syndrome
J. Large cell carcinoma

Ex-smoker
Weight loss
Red face
Eyelids look oedematous

G. Superior vena cava obstruction

(Probably via a pancoast tumour or a centrally located tumour.
Compression of SVC: facial flushing, periorbital oedema, rasied non-pulsatile JVP, distended chest veins, Pemberton's sign positive- raise hands above head--> facial congestion, cyanosis and SOB after 1 minute.)

18

A 67 year old female, current smoker, presents with a
headache and weight loss over a period of 4 months.
She reckons the headache is worse when she bends down to tie up her shoes.

What is the most likely diagnosis?

A. Mesothelioma
B. Squamous cell carcinoma
C. SIADH
D. Horner’s syndrome
E. Pancoast’s syndrome
F. Adenocarcinoma
G. Superior vena cava obstruction
H. Metastasis
I. Cushing’s syndrome
J. Large cell carcinoma

Current smoker
Weight loss
Headache- worse when she bends down

H. Metastasis

(Brain space occupying lesion)

19

A 66 year old male, ex-smoker, presents with a chronic
cough and feeling short of breath all the time.
When you were auscultating to his chest you notice
thin red lines down his abdomen and bruises on this
shins.

A. Mesothelioma
B. Squamous cell carcinoma
C. SIADH
D. Horner’s syndrome
E. Pancoast’s syndrome
F. Adenocarcinoma
G. Superior vena cava obstruction
H. Metastasis
I. Cushing’s syndrome
J. Large cell carcinoma

Ex smoker
Thin red lines on abdomen
Bruises

I. Cushing's syndrome

(Via small cell carcinoma
Paraneoplastic syndromes-
Small cell: Cushing's via ACTH; SIADH via ADH; Eaton-Lambert syndrome via anti-neuronal autoantibodies
Squamous cell: Hypoercalcaemia of malignancy via PTHrP)

20

Organisms causing infection in COPD sufferers

Bacterial: Hemophilus influenzae
Streptococcus pneumoniae

Viral: rhinovirus, influenza, adenovirus

21

Organisms causing infection in COPD sufferers

Bacterial: Hemophilus influenzae
Streptococcus pneumoniae

Viral: rhinovirus, influenza, adenovirus

22

72 y.o. man
smoked for 40 years
history of hospital admissions for resp. complaints
Increasing dyspnoea and chest tightness
expiratory wheeze on auscultaion
Chronic cough- not productive

Non-infective exacerbation of COPD

sufferer of COPD (long smoking Hx, hospital admissions for resp)
Presents with symtpoms of acute exacerbation of COPD
Cough is not productive so is a non-infective exacerbation (pollution, fall in temp)

23

84 year old woman
dyspnoea and productive cough (large production of purulent sputum)
Has been told by her doctor that she has irreversible lung damage because she has smoked for 65 years

Infective exacerbation of COPD

sufferer of COPD (long smoking history causing irreversible lung damage)
exacerbation (dyspnoea and cough)
Cough is productive (purulent sputum)- so infective

Common organisms are H. influenzae, S. pneumoniae as well as rhinovirus, influenza, adenovirus