Classic Presentations - Respiratory

Question 1

Patient presents with frontal headache, facial pain, purulent rhinorrhoea and fever

Answer 1

Sinusitis

Question 2

Patient presents with sneezing attacks, nasal blockage/discharge occurring >1hr on most days +/- itchy eyes and ears

Answer 2

Rhinitis - either allergic or non-allergic

Question 3

Patient presents with sore throat +/- tonsillar lymph node enlargement but not inflammation of the tonsils

Answer 3

Pharyngitis

Question 4

Child < 3 presents with hoarseness, a barking cough, stridor and progressive airway obstruction

Answer 4

Acute laryngotracheobronchitis

Question 5

Child aged 2-7 presents with severe airflow obstruction/stridor, high fever, drooling and a severe sore throat

Answer 5

Acute epiglottitis

Question 6

Patient presents with fever, chills and aches, severe headache and sore throat + dry cough

Answer 6

Influenza

Question 7

Patient presents with an dry cough that has become productive and a wheeze, breathlessness and mild fever

Answer 7

Acute bronchitis

Question 8

Patient presents with fever and rigors, breathlessness, pleuritic chest pain, a cough and a loss of apetite

Answer 8

Pneumonia

Question 9

A patient with a 20 pack year smoking history reports a productive cough, wheeze, breathlessness and frequent chest infections

Answer 9

COPD

Question 10

Young patient reports sporadic chest tightness, wheeze, dry cough and breathlessness that is worse at night

Answer 10

Asthma

Question 11

Middle aged patient presents with loud snoring, headache and daytime sleepiness

Answer 11

Obstructive sleep apnoea

Question 12

A patient with CF reports a productive cough +/- haemoptysis, halitosis, clubbing, coarse crackles and recurrent pneumonic episodes

Answer 12

Bronchiectasis

Question 13

A patient with a history of aspiration presents with persisting pneumonia, foul sputum, malaise, weight loss and raised infection markers

Answer 13

Lung abscess

Question 14

A child presents with:

• Recurrent infections - Sinusitis
• Nasal polyps
• Breathlessness
• Haemoptysis
• Steatorrhoea
• Meconium ileus (SI obstruction)
• Malabsorption

Answer 14

Cystic fibrosis

Question 15

A patient recently returning from living abroad presents with a persistent cough +/- haemoptysis, weight loss, night sweats, fever, fatigue, hoarseness and pleuritic pain

Answer 15

TB

Question 16

An Afro-Caribbean woman presents with tender red nodules on the anterior shins (erythema nodosum), fatigue, weight loss, uveitis and peripheral lymphadenopathy

Answer 16

Sarcoidosis

Question 17

A middle-aged patient presents with severe rhinorrhoea and nasal mucosa ulcer, a cough, haemoptysis and pleuritic pain

Answer 17

Granulomatosis with polyangiitis (GPA)

[Wegener’s granulomatosis]

Question 18

A 40 year old man presents initially with allergic rhinitis, late-onset asthma, breathlessness, cough and a wheeze. This progresses to a fever, sweats, fatigue, weight loss, joint and muscle pain, difficulty passing urine, cold peripheries etc

Answer 18

Eosinophilic granulomatosis with polyangiitis (EGPA)

[Churg-Strauss syndrome]

Question 19

A young asian woman presents with joint pain, fatigue, a malar rash on the face, pleurisy +/- small bilateral effusions etc

Answer 19

SLE

Question 20

A farmer/coal worker/bird owner/miller etc develops fever, malaise, cough, breathlessness, wheeze, coarse end-inspiratory crackles, weight loss and idiopathic pulmonary fibrosis features

Answer 20

Extrinsic Allergic Alveolitis (Hypersensitivity Pneumonitis)

Question 21

A recently retired builder presents with progressive breathlessness, cough, wheeze, fatigue, finger clubbing and bilateral basal end-inspiratory crackles

Answer 21

Asbestosis

Question 22

A tall, thin man presents with sudden onset pleuritic pain, increasing breathlessness and tachycardia

Answer 22

Spontaneous pneumothorax

Question 23

A patient with pneumonia/pulmonary oedema/PE/asthma/ARDS has a PaO2 of <8kPa (hypoxic) with normal or low PaCO2

Answer 23

Type 1 respiratory failure

Question 24

A patient with COPD/asthma/pneumonia/sedative drugs in their system/CNS trauma etc has a PaO2 of <8kPa (hypoxic) and a PaCO2 of >6.0kPa (hypercapnic)

Answer 24

Type 2 respiratory failure

Question 25

A very ill patient presents with breathlessness, tachypnoea, increasing hypoxaemia, central cyanosis and fine bilateral crackles

Answer 25

Acute Respiratory Distress Syndrome (acute lung injury)

Question 26

A patient with advanced COPD ( or any other cause of pulmonary hypertension) experiences progressive breathlessness, ankle oedema, RV hypertrophy, elevated JVP, ascites, parasternal heave and tricuspid regurgitation (high pitched, holosystolic murmur -begins at the first heart sound and continue to the second heart sound)

Answer 26

Cor pulmonale

Question 27

A patient presents with sudden breathlessness, tachypnoea and chest pain +/- haemoptysis, fever, pleural rub & raised JVP

Answer 27

Pulmonary embolism

Question 28

A patient presents with breathlessness, orthopnoea, cough +/- haemoptysis, leg/abdominal swelling and pale skin

Answer 28

Pulmonary oedema/congestive heart failure

Question 29

A patient presents with a 3 week history of cough +/-breathlessness, haemoptysis, chest pain, wheeze, hoarseness and dysphagia

Answer 29

Lung cancer - most commonly bronchial carcinoma