Respiratory Quiz
During yesterday’s MRCP mock exam, Wuchereria had a tough time with one of the local examiner.
This patient has clubbing with cyanosis and bilateral fine crepitations over the bases with a scar as seen in the picture. He also has an area of consolidation over the R lower zone
Examiner : How do you correlate the scar and the findings ?
Any takers?
This patient has clubbing with cyanosis and bilateral fine crepitations over the bases with a scar as seen in the picture. He also has an area of consolidation over the R lower zone
Examiner : How do you correlate the scar and the findings ?
Any takers?
This case is contributed by Wuchereria.
Labels: Quiz series, Respiratory
posted by Dr. David Teoh @ 6/13/2007 12:57:00 PM
23 Comments:
Clubbing in CVS means mainly two things :
1. bacterial endocarditis
2. cyanotic congenital heart disease.
The midline sternotomy scar indicates a previous cardiac surgery.
He's currently cyanosed, which I would not really expect of a patient who had a surgery done to correct his congenital cyanotic heart disease.
I couldn't tie in the lung finding. Could just be a pneumonia, the reason for the worsening of his cyanosis and his admission this time.
Good try:)
Need to remind you that this is Respiratory station
NOT CVS!
Try again?!
xgcqi
Hahaha....I didn't notice the most obvious.....
Common Diff for clubbing for respi then:
1. Lung Ca
2. Idiopathic pulmonary fibrosis
3. Chronic suppurative lung disease.
Could this be idiopathic pulmonary fibrosis?
i think this person has got cystic fibrosis and the scar is from previous lung surgery.
this young lady has got cyanosis,clubbing and midline sternotomy scar,she has got bilateral lung transplant dut to cystic fibrosis and would be tachypnoeic due to left lower lobe consolidation
Good thoughts.
HINT: this patient had CABG before
Any takers?
Quick, quick....all answer so far wrong
CABG means pt previousy had coronary artery disease.
he might have an infarct which leeds to ruptured septum causing VSD after few years he dev eisenmenger syndrome due to right to left shunt causing cyanosis and finger cubbing. he is currently in failure as evidence by bibasal creps with superimposed pneumonia at right lower lobe.
heee just trying
amiodarone induce lung fibrosis------suprisingly quite common actually
Bingo!
Yes, the incidence of AF after any cardiac surgery is between 10%-50%.
Although a AV nodal blocking agent is generally preferred (class I) as the 1st line for AF after cardiac surgery, some patients might not be able to tolerate one. Hence amiodarone (class IIa) is used in these patients.
Good correlation. Keep up the good work!
ithink this pt has congenital hear disease then developed esinemenger syndrome this will explain both the finger clubing and the cyanosis for which undergone for cardiac surgey
why not broncogenic carcinoma in the rt lower zone which presents as consolidation and finger clubbing on top of bilateral lung fibrosis due to amiodarone
in respiratory station for patient with mid-thoracic sterniotomy, we have to look at leg for saphenoud or,sub-mammary scars,so as not to miss amiodarone induced lung fibrosis
amiodarone induced lung fibrosis
In resp station:
I think it may be lung transplant with bronchiolitis obliterans syndrome...
Need to look for signs of chronic steroid/cyclosporin usage...
Firstly, we have to know the age of the patient. In Respi station- young patient with clubbing, cyanosis and lung operation means CF unless proven otherwise.
CABG with amiodarone induced lung injury wont have clubbing and cyanosis.
Clubbing, cyanosis, sternotomy scar will be congenital heart disease with amiodarone induced fibrosis causing crackles.
amiodarone will not cause clubbing and moreover it will cause pigmentataion
clubbing,cyanosis in a respiratory station is either fibrosing alveolitis, suppurative lung disease or ca lung the pt has ca lung leading to consilidation and the ischaemic heart disease is coincidence.
young heavy smoker with premature coronary artey disease needing CABG had developed a lung CA possibly due to common aeitiolgy of smoking.
Since when is rythm control better than rate control for AFib? Amiodarone may be used for post-cardiac surgery for rythm control but not for long periods. It is usually taken off, specially in young patients because of its s/e profile & if AFib persists it is managed with beta-blockers & anticoagulation.
Why would a young patient have CABG surgery??? Even if he is a heavy smoker & diabetic, CAD takes time to develop. More likely, he has underlying congenital heart disease.
Otherwise this is a dumb question, reason with me & tell me why it cant be-lung transplantation/advanced lung cancer with median lobectomy/Post-CABG with severe CHF etc. What rubbish!!!
Post CABG multiple lung abcesses?
Amioderone induced cirrhosis?
people what is the big fuss!!
this is a resp station, so simply amidarone induced lung fibrosis due to cyanotic heart disease or CABG or remotley heartlung transplantation with bronchioltiis obliterans..(lower zone consolidation)
that's it!
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