Lung findings

Question 1

Asthma/COPD

Answer 1

decreased expansion but hyperexpanded (air trapping)
hyperresonant percussion (air trapping)
decreased breath sounds, WHEEZE
COPD may have coarse early crackles (secretions)

cough, episodic, SOB, wheeze, tight chest

Question 2

Bronchiectasis

Answer 2

coarse pan-inspiratory crackles +/- shift with cough
clubbing

copius productive purulent sputum, halitosis, infections, constitutional (inflam/rpt infections)
*CF: GI, arthro, and infertility too

Question 3

Consolidation

Answer 3

decreased expansion
dull percussion
bronchial breath sounds, may have crackles, increased fremitus

infective symptoms, may have haemoptysis
TB, pneumonia
*CURB65

Question 4

Effusion

Answer 4

decreased expansion/normal
stony dull percussion
decreased breath sounds and resonance, may have bronchial
trachea away if large

• transudate vs. exudate
• empyema: swinging fever, rigor, night sweat, foul-sputum

Question 5

PTx/tension

Answer 5

normal/decreased expansion +/- trachea (tension away)
hyperresonant percussion
decreased breath sounds and resonance

pleuritic chest pain, lung disease, HD instability (Tension)

Question 6

Collapse

Answer 6

decreased expansion, trachea towards
dull percussion (squashed down)
decreased breath sounds +/- bronchial

blocked airway e.g. cancer, pneumonia, oedema
external pressure e.g. PTX, effusion

Question 7

Fibrosis

Answer 7

decreased expansion
dull percussion
bronchial breathing + fine crackles (end/pan) +/- vocal res
RHF/cor pulmonale

clubbing, exposure/PMH, SOB and cough, restrictive
*CHULT: CXR, HR-CT, UA (?PRS), Lung Fx, Tissue Bx

Question 8

Pulmonary Oedema

Answer 8

mid-inspiratory crackles; JVP, oedema, hepatomegaly

‘ABCDE’ chest xray

Question 9

Tracheal Deviation

Answer 9

towards: pneumonectomy, total collapse
normal: consolidation, mesothelioma, pulmonary oedema
away: effusion, tension PTx, large mass/cancer

Question 10

White Out (CXR)

Answer 10

Effusion: trachea away, meniscus
Collapse: trachea towards, sail sign
Pneumonectomy: missing ribs, trachea towards

Question 11

SPN (CXR)

Answer 11

cancer: primary or secondary
infection: TB, local (e.g. abscess)

check for cavitation, calcification, growth (compare)

Question 12

MPN (CXR)

Answer 12

metastases
abscess
RhA
GPA
AVM

Question 13

Consolidation/Opacity

Answer 13

pneumonia: air bronchograms
TB
fibrosis: reticulonodular
pulmonary oedema: airspace and interstitial shadowing
ARDS: 'fluffy' throughout

Question 14

PFTs

Answer 14

decreased TLCO: restricted expansion (pulm/extrapulm)
increased TLCO: haemorrhage, asthma

decreased KCO: parenchymal damage, decreased perfusion, fluid/oedema
increased KCO: haemorrhage, asthma

Question 15

Lower Zone Fibrosis DDx

Answer 15

IPF
Bronchiectasis
Asbestosis
drugs

*CHULT: CXR, HR-CT, UA (?PRS), Lung Fx, Tissue Bx

Question 16

Upper Zone Fibrosis DDx

Answer 16

TB
EAA
Ankylosing Spondylitis
Silicosis
Sarcoid
Radiation

*CHULT: CXR, HR-CT, UA (?PRS), Lung Fx, Tissue Bx

Question 17

Localised fibrosis DDx

Answer 17

EAA
TB
Systemic sclerosis, sarcoid
Berylliosis, asbestosis

Question 18

Diffuse fibrosis DDx

Answer 18

IPF, PMF
PRS
Rheumatoid lung
tuberous sclerosis, neurofibromatosis

Question 19

Sarcoid

Answer 19

chronic multisystemic non-caseating granuloma; ‘CLS NEM-H’
constitutional Sx, lung (fibrosis), skin (nodosum), nerves, eyes (ant. uve), MSK (arth/myalgia), heart arry

CXR: bilateral hilar LA
Obstructive PFTs
tissue biopsy