You review a 67-year-old man who has chronic obstructive pulmonary disease (COPD). On examination there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 43%. During a recent hospital stay his pO2 on room air was 7.5 kPa.
Which one of the following interventions is most likely to increase survival in this patient?
Correct Answer E: After smoking cessation, long-term oxygen therapy (LTOT) is one of the few interventions that has been shown to improve survival in COPD.
LTOT should be offered to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
COPD: stable management: NICE updated it's guidelines on the management of chronic obstructive pulmonary disease (COPD) in 2010.
General management:
Bronchodilator therapy:
FEV1 > 50%:
FEV1 < 50%:
For patients with persistent exacerbations or breathlessness:
Oral theophylline:
Mucolytics:
Cor pulmonale:
Factors which may improve survival in patients with stable COPD:
A 49-year-old male with a past history of alcohol excess presents to the Emergency Department due to fever and shortness of breath. Chest x-ray reveals a cavitating lesion in the right middle zone.
What is the most likely causative organism?
Correct Answer A: Klebsiella pneumonia (Friedlander's pneumonia) typically occurs in middle-aged alcoholic men. Chest x-ray features may include abscess formation in the middle/upper lobes and empyema. The mortality approaches 30- 50%
Chest x-ray: cavitating lung lesion:
Differential:
A 55-year-old man is referred to the medical admissions unit. He recently returned from a holiday in Italy and has failed to respond to a course of co-amoxiclav for a suspected lower respiratory tract infection. Chest x-ray shows bilateral infiltrates. Bloods are as follows:
What is the likely diagnosis?
Correct Answer B:
Legionella: Legionnaire's disease is caused by the intracellular bacterium Legionella pneumophilia. It is typically colonizes water tanks and hence questions may hint at air-conditioning systems or foreign holidays. Person-to-person transmission is not seen.
Features:
Diagnosis:
Management:
Each one of the following may result in bronchiectasis, except:
Correct Answer B: Amyloidosis does not cause bronchiectasis per se, but may be seen in bronchiectasis as a consequence of chronic inflammation and infection.
Bronchiectasis: causes:
Bronchiectasis describes a permanent dilatation of the airways secondary to chronic infection or inflammation.
Causes:
Which one of the following causes of lung fibrosis predominately affect the lower zones?
Correct Answer A:
Lung fibrosis: It is important in the exam to be able to differentiate between conditions causing predominately upper or lower zone fibrosis. It should be noted that the more common causes (cryptogenic fibrosing alveolitis, drugs) tend to affect the lower zones.
Fibrosis predominately affecting the upper zones:
Fibrosis predominately affecting the lower zones:
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