Respiratory Case Studies

Question 1

What are the structural and physiological abnormalities of COPD?

Answer 1

Structural: Narrowing of airways, emphysema
Physiological: Reduced rate of air flow, dynamic hyperinflation

Question 2

What prior events may have contributed to a diagnosis of COPD?

Answer 2

Smoking
Repeated chest infections
Family history
Exposure to dust
Air pollution

Question 3

What are the symptoms of COPD?

Answer 3

Dyspnoea, wheeze, phlegm and cough

Question 4

What are the signs of COPD?

Answer 4

Tachpnoea, hyperinflated chest, wheeze, decreased breath sounds, prolonged expiration

Question 5

What abnormal test results would you expect from a patient with COPD?

Answer 5

Chest X-ray
Reduced FEV1
Hypoxia
Hypercapnia

Question 6

What medical interventions would be put in place for a patient with COPD?

Answer 6

Antibiotics for existing bronchitis
Beta-2 receptor agonists
LABAs
Anticholinergic therapy
Inhaled/oral steroids
Oxygen therapy

Question 7

What secondary prevention is necessary with COPD?

Answer 7

Not smoking/vaping
Supplemental oxygen

Question 8

What structural and physiological abnormalities arise with asthma?

Answer 8

Structural: reversible airway obstruction, bronchospasm
Physiological: inflamed airways, reduction in airflow, dynamic hyperinflation, hyper-reactive smooth muscle

Question 9

What prior events may have caused asthma?

Answer 9

Exposure to allergens/irritants
Exercise or cold induced
Prior eczema or hayfever
Family history

Question 10

What are the symptoms of asthma?

Answer 10

Wheezing, coughing, chest tightness, Dyspnoea

Question 11

What are the signs of asthma?

Answer 11

Wheeze
Use of accessory muscles
Paradoxical pulse
Over-inflation of the chest

Question 12

What abnormal test results are expected with asthma?

Answer 12

Reduced FEV1
Chest X-ray

Question 13

What medical interventions are necessary for a patient with asthma?

Answer 13

Inhaled SABAs
LABAs
Inhaled corticosteroids
Oral prednisolone

Question 14

What are methods of secondary prevention of asthma?

Answer 14

Avoiding triggers
Leukotriene antagonists

Question 15

What are the structural and physiological abnormalities of lung cancer?

Answer 15

Structural: blockage of bronchi, extra-luminal compression and accumulation of pleural fluid
Physiological: limits effectiveness of the lungs, para-neoplastic symptoms

Question 16

What prior events may have caused lung cancer?

Answer 16

Smoking
Exposure to asbestos

Question 17

What are the symptoms of lung cancer?

Answer 17

Dyspnoea
Haemoptysis
Chronic coughing
Wheezing
Chest pain
Weight loss

Question 18

What are the signs of lung cancer?

Answer 18

Weight loss
Fatigue
Dysphonia
Dysphagia
Clubbing

Question 19

What abnormal test results would you expect from a patient with lung cancer?

Answer 19

Chest X-ray
CT scan
Bronchoscopy
PET
Endobronchial ultrasound
Biopsy

Question 20

What medical interventions are necessary with lung cancer?

Answer 20

Lobectomy, pneumonectomy, chemotherapy, radiotherapy

Question 21

What secondary prevention is needed for lung cancer?

Answer 21

Screening
Check the common sites of metastasis

Question 22

What are the structural and physiological abnormalities in cystic fibrosis?

Answer 22

Structural: CFTR mutation(autosomal recessive), bronchiectasis
Physiological: affects entire body, progressive disability

Question 23

What prior events are associated with cystic fibrosis?

Answer 23

Family history
Bowel obstruction
Frequent chest infections
Thick/sticky mucus

Question 24

What are the symptoms of cystic fibrosis?

Answer 24

Coughing, Dyspnoea, lung infections, chest exacerbations, abnormal bowel movements

Question 25

What are the signs of cystic fibrosis?

Answer 25

Salty skin Poor growth and weight gain Vitamin deficiencies Haemoptysis Clubbing Cyanosis

Question 26

What abnormal test results would you expect with cystic fibrosis?

Answer 26

Genetic screenings Sweat test Obstructive lung function Abnormal pancreatic function No sperm

Question 27

What medical interventions are necessary with cystic fibrosis?

Answer 27

Physiotherapy Nutrition Treat infections CFTR modulators Lung transplantation

Question 28

What are the secondary preventions of cystic fibrosis?

Answer 28

Antenatal genetic counselling Proactive treatment

Question 29

What are the structural and physiological abnormalities of bronchiectasis?

Answer 29

Structural: Irreversible dilation of part of the bronchial tree Physiological: Inflammation, easily collapsible, obstructive lung disease

Question 30

What prior events may have causes bronchiectasis?

Answer 30

Prior infections e.g. measles/pneumonia Acquired/congential causes Immunodeficiencies

Question 31

What are the symptoms of bronchiectasis?

Answer 31

Dyspnoea Green/yellow sputum Halitosis (bad breath)

Question 32

What are the signs of bronchiectasis?

Answer 32

Course crepitations Hypoxia Hypercapnia

Question 33

What abnormal test results would you expect with bronchiectasis?

Answer 33

High resolution CT Abnormal blood gases

Question 34

What medical interventions are necessary for bronchiectasis?

Answer 34

Controlling infections Relieving obstructions Potentially surgery but unlikely Nebulised antibiotics

Question 35

What secondary prevention measures are necessary for bronchiectasis?

Answer 35

Childhood immunisations Adult vaccination Stopping smoking

Question 36

What are the structural and physiological abnormalities of pneumonia?

Answer 36

Structural: alveolar filling with fluid, bronchial obstruction, inflammation, bacterial brinchopneumonia Physiological: stops oxygen reaching bloodstream

Question 37

What prior events may have caused pneumonia?

Answer 37

Viral flu Vomiting when semi conscious

Question 38

What are the symptoms of pneumonia?

Answer 38

Productive cough Fever Stabbing chest pain Dyspnoea Headache

Question 39

What are the signs of pneumonia?

Answer 39

High temperature Green/brown sputum Tachypnoea Tachycardia Hypotension Hypoxia Bronchial breathing

Question 40

What abnormal test results are expected with pneumonia?

Answer 40

Chest x-ray Blood/sputum culture

Question 41

What medical interventions are necessary with pneumonia?

Answer 41

Oxygen Fluids Antibiotics

Question 42

What secondary prevention is necessary for pneumonia?

Answer 42

Vaccinations available

Question 43

What are the structural and physiological abnormalities of pneumothorax?

Answer 43

Structural: collection of air between lung and chest wall causing lung collapse Physiological: reduction in blood oxygen, lungs less efficient

Question 44

What prior events may have caused pneumothorax?

Answer 44

Physical trauma to the chest Secondary to COPD

Question 45

What are the symptoms of pneumothorax?

Answer 45

Dyspnoea Chest pain

Question 46

What are the signs of pneumothorax?

Answer 46

Diagnosis often made on examination Deviated trachea Hypoxia In tension pneumothorax - hypotension and cardiac arrest

Question 47

What abnormal test results are expected with pneumothorax?

Answer 47

Chest X-ray CT

Question 48

What medical interventions are required with pneumothorax?

Answer 48

Often self resolves One way chest tube

Question 49

What secondary prevention is necessary with pneumothorax?

Answer 49

Avoid significant changes in atmospheric pressure Pleurodesis (sticking lung to the chest wall)

Question 50

What are the structural and physiological abnormalities of respiratory faliure?

Answer 50

Significa ant obstruction of the upper airway Damage to brain and respiratory control

Question 51

What’s the difference between type 1 and 2 respiratory faliure?

Answer 51

Type 1 has hypoxia but normal or decreased PCO2 and increased pH Type 2 has hypoxia and increased PCO2 so decreased pH

Question 52

What are the symptoms of respiratory failure?

Answer 52

Dyspnoea

Question 53

What are the signs of respiratory failure?

Answer 53

Hypoxia, tachypnoea