Podcast
Questions and Answers
Which factor is NOT associated with reversible airway narrowing?
Which factor is NOT associated with reversible airway narrowing?
Which of the following is a strong predictor of high probability for asthma?
Which of the following is a strong predictor of high probability for asthma?
What should be done if there is no response to asthma therapy?
What should be done if there is no response to asthma therapy?
Which symptom is NOT typically associated with high probability asthma?
Which symptom is NOT typically associated with high probability asthma?
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What triggers bronchial smooth muscle contraction leading to airway narrowing?
What triggers bronchial smooth muscle contraction leading to airway narrowing?
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A normal PEFR when symptomatic suggests which of the following?
A normal PEFR when symptomatic suggests which of the following?
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Which of the following factors decreases the probability of asthma?
Which of the following factors decreases the probability of asthma?
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What commonly exacerbates asthma symptoms?
What commonly exacerbates asthma symptoms?
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What is the main protein released following cardiac injury that is involved in muscle contraction?
What is the main protein released following cardiac injury that is involved in muscle contraction?
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Which condition would most likely not be treated with beta blockers?
Which condition would most likely not be treated with beta blockers?
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In which situation would pulmonary edema be a likely diagnosis?
In which situation would pulmonary edema be a likely diagnosis?
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What would be a primary management step for a patient with pulmonary edema?
What would be a primary management step for a patient with pulmonary edema?
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Which of the following conditions is characterized by chronic inflammatory airway disease?
Which of the following conditions is characterized by chronic inflammatory airway disease?
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What is the most appropriate follow-up for a patient with a new myocardial infarction?
What is the most appropriate follow-up for a patient with a new myocardial infarction?
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What would be a common differential diagnosis for chest pain in a 55-year-old male patient?
What would be a common differential diagnosis for chest pain in a 55-year-old male patient?
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Which of the following conditions would not typically lead to a swollen leg in a patient?
Which of the following conditions would not typically lead to a swollen leg in a patient?
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Study Notes
CVS and Respiratory
- Learning Objectives (ILOS): The presenter outlines learning objectives for Cardiovascular (CVS) and Respiratory diseases in Year 1.
Cardiovascular System (CVS)
- Pathology: Includes Myocardial infarction, Atherosclerosis ( a Year 2 topic), Aortic dissection (specific types not included), Pericardial effusion, Cardiac tamponade, and Hypertension.
- ECG and Echocardiography: These are mentioned as diagnostic modalities for cardiovascular disease.
Patient Case: Barry
- Patient Profile: A 55-year-old male plumber, a former semi-professional football player for Blackburn Rovers, who smokes a pipe and drinks socially.
- Presenting Complaint: Chest pain.
- Examination: Chest clear on auscultation, tender over the chest wall to palpation, normal heart sounds, no pedal edema, right leg more swollen than left, with a metal plate in the foot from a 30-year old accident.
Investigations
- ECG: Image displayed; interpreted as needed.
- CXR (Chest X-Ray): Image shown but not elaborated.
- Troponin I Blood Test: 6 hours post-presentation: 2049 ng/L (normal range 0-58 ng/L). 6 hours later: 2846 ng/L.
Troponin
- Description: A protein found in cardiac and skeletal muscle, involved in muscle contraction, and released following cardiac injury.
Pathophysiology of Atherosclerosis
- Images: Several images of the pathophysiology, illustrating progression from Fatty streak to Ruptured plaque, illustrating the development of disease within the arterial wall. Diagram shows the role of endothelial cells, media, intima, fibrous cap, cell debris, macrophages, smooth muscle cells, T cells and ApoB-LP in the development of the pathological condition. Other diagrams display the progression from normal artery to abnormal blood flow to blocked blood flow in the coronary arteries (UA/NSTEMI and STEMI).
Blood Results (Full Blood Count)
- Details: A full blood count is shown, listing various parameters, including Hemoglobin blood (HB), White blood cells (WBC), Platelets (Plts), Red Blood Cells (RBC), Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC), Red Cell Distribution Width (RDW), and various white blood cell counts (Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils). Further analysis of some of these blood values would be necessary.
Blood Results (Other)
- Details: Other blood results including sodium, potassium, urea, creatinine, eGFR, ALT (alanine transaminase), Alkaline Phosphatase, Albumin, coagulation screen parameters (PT, INR, APTT Ratio, Fibrinogen and CRP), and TSH. Normal ranges for lab results are displayed.
Differential Diagnosis
- Possible Causes: Acute Coronary Syndrome (ACS), Aortic Dissection, Pulmonary Embolus (PE), and Myocarditis are listed as potential causes of the patient's symptoms.
ACS Treatment
- Medications: DAPT, Fondaparinux, ACE inhibitors, Beta-blockers, and Statins are listed as treatments for ACS.
Further Investigations and Decision Making
- What now?: The presenter asks what should be done next.
- Patient Considerations: Patient bradycardia is identified as a consideration to be avoided when choosing treatment plans.
- Further considerations: Potential causes of a MI include Type 1, 2, 3, 4 or 5 myocardial infarction.
Respiratory System
- Diagnosis Issues (Lawrence): Possible diagnoses include asthma, COPD, pulmonary embolism, lung cancer, pneumothorax, and pneumonia. A chest X-ray is shown, as well as a spirometry test.
- Respiratory Examination (Lawrence): Barrel chest, bilateral wheezing, clubbing of fingers, and cachexia are noted.
- Spirometry Interpretation: A flowchart is shown on how to interpret spirometry findings. This includes FEV1/FVC ratio, FEV1 and FVC percentage predicted. Diagrams outlining conditions and findings (obstructive and restrictive lung diseases) are shown.
- Respiratory Assessment: Further spirometry results and lung function testing details are given.
- Treatment: Antibiotics, steroids, nebulisers, sputum sample, urinary antigens, specialist nurse support, and aminophylline are mentioned in the treatment options for respiratory issues.
Additional Notes
- Lawrence's presentation later: Subsequent problems, including sudden-onset Shortness of Breath (SOB) and subsequent chest x-ray and CT scans are mentioned. The images are not labeled but are consistent with possible bullae.
- Further diagnoses: A more specific diagnosis is made two years after initial presentation.
Bullae
- Description: Large air sacs resulting from the loss of elasticity in the air sacs in the lungs as part of emphysema.
Further Information
- Case Progression: Information about the patient's course is described in multiple later presentations.
- Later Investigations: Blood tests and additional imaging are mentioned as part of monitoring the patient.
Summary and Conclusions
- Echocardiogram: A summary of the echocardiogram findings, including aortic stenosis, left ventricular function, and right heart pressures, and a conclusion are given.
- Follow-up: The presenter suggests follow-up with cardiology and/or the community heart failure team.
- Recommendations: Follow-up with cardiology, fluid restriction, and cardiac rehab are recommended.
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Description
This quiz focuses on the Cardiovascular System (CVS) and respiratory diseases, specifically covering learning objectives, pathology, and diagnostic modalities. It includes a patient case study of Barry, a 55-year-old male, and emphasizes the importance of ECG and echocardiography in diagnosis. Test your knowledge on these critical medical topics.
