RES

Question 1

PLEURAL EFFUSION

• FEATURES
• DDX

Answer 1

reduced chest expansion w dullness on percussion, absent BS + reduced vocal/tactile resonance
also look for rheumatoid hands / SLE, lung CA
PLEURAL THICKENING (BS present) ; COLLAPSE (ipsilateral tracheal deviation) ; CONSOLIDATION (bronchial BS + increased vocal/tactile resonance)
parapneumonic effusion / empyema: pH<7.2, glucose <2.3, LDH>1000 +/- positive Gram stain (empyema: pus)

Question 2

BRONCHIECTASIS

• ETIOLOGY
• INX
• TX

Answer 2

• infective ; inflammatory (RA, IBD) ; malignancy ; immunodeficiency / ABPA (proximal); syndromes (young syndrome - a/w azoospermia 2’ Hg intoxication)
• sputum gm stain / cs ; CXR ; HRCT - bronchio-arteriolar ratio >1.5, lack of airway tapering, mucus plug, cystic/cylindrical/varicose bronchiectasis
• immunisation, abx, postural drainage, treat hemoptysis, surgery if localized

Question 3

ILD

• ETIOLOGY
• INX
• TX

Answer 3

• IDIOPATHIC ; CTD ; OCCUPATIONAL ; DRUGS
• HRCT > bibasal subpleural honeycombing (IPF) vs GGO (NSIP) ; pulmonary function tests
• steroids, aza/MMF (NSIP) ; ninfetanib / pirfenidone (IPF)

Question 4

NO SOUNDS
OVER LEFT UPPER / LOWER / RIGHT UPPER /LOWER CHEST
TRACHEA / MEDIASTINUM
W ___ CHEST EXPANSION / PERCUSSION NOTE / VOCAL RESONANCE
PERIPHERIES ___
COMPLICATIONS ___

Answer 4

COLLAPSE

PLEURAL EFFUSION

Question 5

EXTRA SOUNDS

Answer 5

END INSP FINE CREPS - ILD
CAUSES: idiopathic, occupational, CTD
PAN-INSP COARSE CREPS - bronchiec
CAUSES: post-infectious , post-obstructive, congenital (hypogammaglobulinemia)

Question 6

SCARS

Answer 6

pneumonectomy vs lobectomy
FOCUS ON TRACHEA + PERCUSSION NOTE
trachea : shifted to ipsilateral -> RUL lobec or pneumonect
percussion: dull throughout -> pneumonect VS dull RU chest -> RUL lobec
trachea: central -> can’t be pneumonect or RUL lobec
percussion: dull over RL chest -> RLL lobec

causes of lobect - CA, mycetoma, localized bronchiec w recurrent hemoptysis, abscess refractory to medical tx
causes of pneumonect - CA, trauma / RTA