Chronic SOB

Question 1

Seen invariably in smokers
Chronic productive cough is typical
Features of right heart failure may be seen

Answer 1

COPD

Question 2

A history of ischaemic heart disease or hypertension may be present
Orthopnoea and paroxysmal nocturnal dyspnoea are characteristic
Bibasal crackles and a third heart sound (S3) are the most reliable features of left-sided failure
Right heart failure causes peripheral oedema and a raised JVP

Answer 2

heart failure

Question 3

Cough, wheeze and shortness of breath are typical
Symptoms are often worse at night and may be precipitated by cold weather or exercise
Associated with hay fever and eczema

Answer 3

asthma

Question 4

Chest pain, SOB and syncope seen in symptomatic patients

An ejection systolic murmur radiating to the neck and narrow pulse pressure are found on examination

Answer 4

aortic stenosis

Question 5

There may be a history of predisposing factors e.g. Malignancy
Pleuritic chest pain and haemoptysis may be seen but symptoms are often vague
Tachycardia and tachypnoea are common in the acute situation
Symptoms of right heart failure may develop in severe cases

Answer 5

recurrent pulmonary emboli

Question 6

Normally seen in smokers
Haemoptysis, chronic cough or unresolving infection are common presentations
Systemic symptoms e.g. Weight loss and anorexia

Answer 6

lung cancer

Question 7

Progressive shortness of breath may be the only symptom
Fine bibasal crackles are typical
Spirometry shows a restrictive pattern

Answer 7

Pulmonary fibrosis

Question 8

Affected patients may produce large amounts of purulent sputum
Patients may have a history of previous infections (e.g. Tuberculosis, measles), bronchial obstruction or ciliary dyskinetic syndromes e.g. Kartagener’s syndrome

Answer 8

Bronchiectasis