DUMES Respiratory Revision
Friday Q&A Session
14th August 2020
Contributors:
Olivia Allatt
Lucy Gold
Julia Manini
Nitya Nair
Ross Wilson
1. Select the correct classification for each of the following joints:
1. Select the correct classification for each of the following joints:
2. Select the correct classification for each of the following joints:
2. Select the correct classification for each of the following joints:
3. Identify the correct cell types based on the following descriptions of their function:
3. Identify the correct cell types based on the following descriptions of their function:
4. Select the correct associations for each of the following anatomical landmarks:
4. Select the correct associations for each of the following anatomical landmarks:
5. Respiratory epithelium goes by which histological name …?
5. Respiratory epithelium goes by which histological name …?
Pseudostratified columnar epithelium with Goblet cells
6. Select the nerve which serves each of the following functions in the cough reflex:
6. Select the nerve which serves each of the following functions in the cough reflex:
7. Regarding the upper and lower respiratory tracts:
7. Regarding the upper and lower respiratory tracts:
8a. Regarding the upper and lower respiratory tracts:
A patient which a known lung tumour develops a left-sided Horner’s syndrome. Where is the causative lesion most likely to be found?
8a. Regarding the upper and lower respiratory tracts:
A patient which a known lung tumour develops a left-sided Horner’s syndrome. Where is the causative lesion most likely to be found?
8b. Regarding the upper and lower respiratory tracts:
A patient on the stroke unit has a compromised swallow. They later develop aspiration pneumonia. Where is aspiratory infiltrate most likely to be found?
8b. Regarding the upper and lower respiratory tracts:
A patient on the stroke unit has a compromised swallow. They later develop aspiration pneumonia. Where is aspiratory infiltrate most likely to be found?
8c. Regarding the upper and lower respiratory tracts:
A patient is treated in the accident and emergency department following a motorcycle accident. They are acutely breathless. Chest films reveal a left-sided rib fracture. Damage to which structure MUST be excluded during the diagnostic work-up?
8c. Regarding the upper and lower respiratory tracts:
A patient is treated in the accident and emergency department following a motorcycle accident. They are acutely breathless. Chest films reveal a left-sided rib fracture. Damage to which structure MUST be excluded during the diagnostic work-up?
9. A 56-year-old man is admitted to A&E with nausea, vomiting and severe abdominal pain. The patient was noted to be hyperventilating during the ambulance journey. He has a BMI of 32 and a past medical history of hypertension and type II diabetes. During the course of his treatment, an arterial blood gas (ABG) is obtained.
What is the MOST ACCURATE description of these findings?
pH = 7.20 (7.35 – 7.45)
PaCO2 = 23 (35 – 45)
[HCO3-] = 14 (22 – 26)
What is the MOST ACCURATE description of these findings?
pH = 7.20 (7.35 – 7.45)
PaCO2 = 23 (35 – 45)
[HCO3-] = 14 (22 – 26)
What is the MOST ACCURATE description of these findings?
pH = 7.20 (7.35 – 7.45)
PaCO2 = 23 (35 – 45)
[HCO3-] = 14 (22 – 26)
10a. You are working in a humanitarian aid camp in a region of Asia recently struck by flooding. A 30-year-old woman attends clinic and appears severely dehydrated. She complains of copious watery, ‘rice-water’ stools.
Which organism is the likely cause of this woman’s symptoms?
10a. You are working in a humanitarian aid camp in a region of Asia recently struck by flooding. A 30-year-old woman attends clinic and appears severely dehydrated. She complains of copious watery, ‘rice-water’ stools.
Which organism is the likely cause of this woman’s symptoms?
10b. You are working in a humanitarian aid camp in a region of Asia recently struck by flooding. A 30-year-old woman attends clinic and appears severely dehydrated. She complains of copious watery, ‘rice-water’ stools.
If this patient were to have an ABG performed, what would be the MOST LIKELY biochemical abnormality?
10b. You are working in a humanitarian aid camp in a region of Asia recently struck by flooding. A 30-year-old woman attends clinic and appears severely dehydrated. She complains of copious watery, ‘rice-water’ stools.
If this patient were to have an ABG performed, what would be the MOST LIKELY biochemical abnormality?
11. A pulmonary embolus is suspected in a patient in the ICU. He is haemodynamically stable.
Which investigation is MOST USEFUL for the diagnosis of pulmonary embolus in this patient?
11. A pulmonary embolus is suspected in a patient in the ICU. He is haemodynamically stable.
Which investigation is MOST USEFUL for the diagnosis of pulmonary embolus in this patient?
12. A 35 year old obese female who had a surgery for breast cancer 2 weeks ago presents to the Emergency Department with severe pleuritic chest pain, shortness of breath and haemoptysis.
On examination: BP is 80/50 mmHg, heart rate is 130 bpm, she is cyanotic, respiratory rate is 30 and ABG shows Type 1 respiratory failure.
Which of the following drugs should be administered immediately?
12. A 35 year old obese female who had a surgery for breast cancer 2 weeks ago presents to the Emergency Department with severe pleuritic chest pain, shortness of breath and haemoptysis.
On examination: BP is 80/50 mmHg, heart rate is 130 bpm, she is cyanotic, respiratory rate is 30 and ABG shows Type 1 respiratory failure.
Which of the following drugs should be administered immediately?
13. A 45 year old female with acute shortness of breath, right-sided pleuritic chest pain and tachycardia is suspected of having a pulmonary embolism. Which is the MOST APPROPRIATE investigation for definitive confirmation of a PE?
13. A 45 year old female with acute shortness of breath, right-sided pleuritic chest pain and tachycardia is suspected of having a pulmonary embolism. Which is the MOST APPROPRIATE investigation for definitive confirmation of a PE?
14. A 40 year old man presents to A&E with chest pain (severity 7/10) and shortness of breath. He reports ‘tearing a muscle’ in his leg while playing football two days earlier. PMH – hypertension. No family history, no recent travel. Non-smoker. Normal BMI.
Which of these test results can EXCLUDE a diagnosis of pulmonary embolism?
14. A 40 year old man presents to A&E with chest pain (severity 7/10) and shortness of breath. He reports ‘tearing a muscle’ in his leg while playing football two days earlier. PMH – hypertension. No family history, no recent travel. Non-smoker. Normal BMI.
Which of these test results can EXCLUDE a diagnosis of pulmonary embolism?
15. A 65 year old female presents with sudden onset shortness of breath and pleuritic chest pain. She has left-sided leg swelling. She has a history of a right-sided mastectomy for breast cancer five months ago. She has a BMI of 27.
Observations: HR = 102bpm, BP = 110/75 mmHg, SaO2 = 89%, T = 37.7.
What would be the MOST APPROPRIATE management for this patient?
15. A 65 year old female presents with sudden onset shortness of breath and pleuritic chest pain. She has left-sided leg swelling. She has a history of a right-sided mastectomy for breast cancer five months ago. She has a BMI of 27.
Observations: HR = 102bpm, BP = 110/75 mmHg, SaO2 = 89%, T = 37.7.
What would be the MOST APPROPRIATE management for this patient?
16. A 53 year old man presents to his GP with breathlessness. He denies chest pain but has developed a cough over the past couple of months. He describes two episodes of haemoptysis in the last week. His wife thinks his clothes look bigger on him compared to a month ago.
PMH: 2x pneumonia this year. T2DM.
SX: 25 pack year smoking history. BMI = 35. Consumes 28 units of alcohol per week.
CXR: solitary right lung nodule, adjacent to right main bronchus
What is the MOST LIKELY finding on biopsy?
16. A 53 year old man presents to his GP with breathlessness. He denies chest pain but has developed a cough over the past couple of months. He describes two episodes of haemoptysis in the last week. His wife thinks his clothes look bigger on him compared to a month ago.
PMH: 2x pneumonia this year. T2DM.
SX: 25 pack year smoking history. BMI = 35. Consumes 28 units of alcohol per week.
CXR: solitary right lung nodule, adjacent to right main bronchus
What is the MOST LIKELY finding on biopsy?
17. A 55 year old factory worker falls at work. A CXR is performed to exclude rib fracture. Bilateral pleural thickening is seen on CXR. Further history indicates he is very active without any respiratory symptoms. He smokes 20 cigarettes per day. There is no family history of lung disease. He takes no medication.
What is the MOST LIKELY diagnosis?
17. A 55 year old factory worker falls at work. A CXR is performed to exclude rib fracture. Bilateral pleural thickening is seen on CXR. Further history indicates he is very active without any respiratory symptoms. He smokes 20 cigarettes per day. There is no family history of lung disease. He takes no medication.
What is the MOST LIKELY diagnosis?
18. A 76 year old retired steelworker has worsening exertional dyspnoea and a chronic cough. He denies chest pain. He has a 45 pack year smoking history but quit aged 50. There is no notable family history. He takes no regular medication. He has noticed that he wheezes when he has an upper respiratory tract infection, and his doctor once prescribed him an inhaler. He is bothered by joint swelling and stiffness.
What is the MOST LIKELY diagnosis?
18. A 76 year old retired steelworker has worsening exertional dyspnoea and a chronic cough. He denies chest pain. He has a 45 pack year smoking history but quit aged 50. There is no notable family history. He takes no regular medication. He has noticed that he wheezes when he has an upper respiratory tract infection, and his doctor once prescribed him an inhaler. He is bothered by joint swelling and stiffness.
What is the MOST LIKELY diagnosis?
19. A 38 year old man presents with a fever of 38.5°C, rigors, myalgia, non-productive cough and dyspnoea. On examination he is tachypnoeic, tachycardic and crackles can be heard at the lung bases. He reports that this happens almost every month after he cleans out the cages in which he keeps his racing pigeons.
Which steps should be taken in the management of this patient? (multiple correct answers)
19. A 38 year old man presents with a fever of 38.5°C, rigors, myalgia, non-productive cough and dyspnoea. On examination he is tachypnoeic, tachycardic and crackles can be heard at the lung bases. He reports that this happens almost every month after he cleans out the cages in which he keeps his racing pigeons.
Which steps should be taken in the management of this patient? (multiple correct answers)
20. A 56 year old man presents with worsening exertional dyspnoea and a dry cough. He has no other symptoms. He has no notable past medical history. He takes no regular medication and has not been exposed to allergens.
On examination, he has fine crackles audible over his lung bases bilaterally. There are no findings suggestive of fluid overload. His fingers are clubbed.
What would be the MOST LIKELY findings on HRCT?
20. A 56 year old man presents with worsening exertional dyspnoea and a dry cough. He has no other symptoms. He has no notable past medical history. He takes no regular medication and has not been exposed to allergens.
On examination, he has fine crackles audible over his lung bases bilaterally. There are no findings suggestive of fluid overload. His fingers are clubbed.
What would be the MOST LIKELY findings on HRCT?
21. A 1 year old child presents with failure to thrive. The child has more bowel movements per day than other children of the same age, and the stools often look shiny with an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent wet cough. On measurement, the child is small for age, with weight and height below the third percentile.
What is the MOST APPROPRIATE first line investigation?
21. A 1 year old child presents with failure to thrive. The child has more bowel movements per day than other children of the same age, and the stools often look shiny with an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent wet cough. On measurement, the child is small for age, with weight and height below the third percentile.
What is the MOST APPROPRIATE first line investigation?
22. A 50 year old male has recently developed a cough and malaise after returning from a resort holiday in Spain. On examination, he is febrile and has crackles in both lung bases.
What is the MOST LIKELY causative organism?
22. A 50 year old male has recently developed a cough and malaise after returning from a resort holiday in Spain. On examination, he is febrile and has crackles in both lung bases.
What is the MOST LIKELY causative organism?
23. A 73 year old woman with COPD has been admitted with a worsening cough, fever and rigors. A sputum culture was taken and microscopy revealed gram negative coccobacilli.
What is the MOST LIKELY causative organism?
23. A 73 year old woman with COPD has been admitted with a worsening cough, fever and rigors. A sputum culture was taken and microscopy revealed gram negative coccobacilli.
What is the MOST LIKELY causative organism?
25. A 72 year old male with no known drug allergies has been diagnosed with community acquired pneumonia. Examination and investigation results are as follows: HR 120bpm, RR 35/min, BP 80/50mmHg, urea 7.9mmol/L, no new onset confusion.
What is the MOST APPROPRIATE management?
25. A 72 year old male with no known drug allergies has been diagnosed with community acquired pneumonia. Examination and investigation results are as follows: HR 120bpm, RR 35/min, BP 80/50mmHg, urea 7.9mmol/L, no new onset confusion.
What is the MOST APPROPRIATE management?
26. A 24 year old male was admitted following a sudden onset of severe dyspnoea during a football game. On examination there is hyperresonance and loss of breath sounds on the right side as well as tracheal deviation to the left side.
What is the MOST APPROPRIATE first line management?
26. A 24 year old male was admitted following a sudden onset of severe dyspnoea during a football game. On examination there is hyperresonance and loss of breath sounds on the right side as well as tracheal deviation to the left side.
What is the MOST APPROPRIATE first line management?
Wrap up