Resp presentations Flashcards
A 66-year-old man with a smoking history of one pack per day for the past 47 years presents with progressive shortness of breath and chronic cough, productive of yellowish sputum, for the past 2 years. On examination he appears cachectic and in moderate respiratory distress, especially after walking to the examination room, and has pursed-lip breathing. His neck veins are mildly distended. Lung examination reveals a barrel chest and poor air entry bilaterally, with moderate inspiratory and expiratory wheezing. Heart and abdominal examination are within normal limits. Lower extremities exhibit scant pitting oedema.
COPD
A 56-year-old woman with a history of smoking presents to her primary care physician with shortness of breath and cough for several days. Her symptoms began 3 days ago with rhinorrhoea. She reports a chronic morning cough productive of white sputum, which has increased over the past 2 days. She has had similar episodes each winter for the past 4 years. She has smoked 1 to 2 packs of cigarettes per day for 40 years and continues to smoke. She denies haemoptysis, chills, or weight loss and has not received any relief from over-the-counter cough preparations.
COPD
-SOB
- Cough
- 4 years = chronic
- Productive cough with white sputum
Not asthma because
- No chest tightness
- Wheezing
- No specific allergens or irritants
- Asthma would be more acute
(Lack of response to OTC)
A 25-year-old woman presents with shortness of breath. She reported that in secondary school, she occasionally had shortness of breath and would wheeze after running. She experiences the same symptoms when she visits her friend who has a cat. Her symptoms have progressively worsened over the past year and are now a constant occurrence. She also finds herself wheezing when waking from sleep approximately twice a week.
Asthma
A 34-year-old man presents to his primary care physician with a 7-week history of cough that he describes as non-productive. He has had a poor appetite during this time and notes that his clothes are loose on him. He has felt febrile at times, but has not measured his temperature. He denies dyspnoea. He is originally from the Philippines. Physical examination reveals a thin, tired-appearing man but is otherwise unremarkable.
Pulmonary Tuberculosis
- Weight loss
- Fatigued (bit of malaise)
- Philippines and South Africa have prevalent rates of TB
A 55-year-old man with a history of peripheral vascular disease, who presents with a complaint of a left foot ulcer and pain when walking short distances, is found to have a popliteal stenosis and admitted for re-vascularisation. Four days after admission, on postoperative day 3, he develops shortness of breath, hypoxia, and a productive cough. Auscultation of his chest reveals decreased breath sounds at the lower aspect of the right side of his chest. His morning leukocyte count is slightly higher than the day before at 11,000 cells/mL3. An anterior-posterior bedside chest x-ray reveals right lower lobe opacity.
Hospital acquired pneumonia
A 54-year-old smoker with multiple comorbidities (diabetes, hypertension, coronary artery disease) presents with a 2-day history of a productive cough with yellow sputum, chest tightness, and fever. Physical examination reveals a temperature of 38.3°C (101°F), BP of 150/95 mmHg, heart rate of 85 bpm, and a respiratory rate of 20 breaths per minute. His oxygen saturation is 95% at rest; lung sounds are distant but clear, with crackles at the left base.
Community acquired pneumonia
A 1-year-old child presents with failure to thrive. The child was born at the 50th percentile for weight, but has crossed multiple percentile lines despite a ravenous appetite. The child has more bowel movements per day than other children of the same age, and the stools often look shiny and have an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent, wet cough. The child is small for age, with weight and length below the third percentile.
Cystic fibrosis
- Failure to thrive
- Recurrent respiratory infections
Cystic fibrosis also leads to pancreatic insufficiency –> impairs the digestion and absorption of nutrients. (leads to poor growth)
A 55-year-old woman presents for evaluation of a chronic cough, productive of thick, yellow sputum that sometimes becomes blood-tinged. She has experienced recurrent episodes of fever associated with pleuritic chest pain. She states that she is embarrassed by the persistent, intractable nature of her cough and has been prescribed multiple courses of antibiotics. Over the last 5 years, she has developed shortness of breath with exertion. Her past medical history is significant for pneumonia as a child.
Bronchiectasis
A 7-year-old boy is brought for review by his parents who are concerned about a persistent, wet cough that is affecting his sleep. His teachers report that he is tired during the school day. Since starting childcare aged 1 year old, he has experienced recurrent lower respiratory tract infections, which have resulted in several hospital admissions. His history is notable for preterm birth at 34 weeks. On examination a wheeze is present.
Bronchiectasis
- Persistent wet cough
- Recurrent lower respiratory tract infections
- Pre term birth? - could indicate underdeveloped lungs
A 70-year-old woman presents with slowly increasing dyspnoea. She cannot lie flat without feeling more short of breath. She has a history of hypertension and osteoarthritis, and she has been taking non-steroidal anti-inflammatory drugs with increasing frequency over the previous few months. On physical examination, she appears dyspnoeic at rest, her blood pressure is 140/90 mmHg, and pulse is 90 bpm. Her jugular venous pressure is elevated to the angle of the jaw. The left lung field is dull to percussion with quiet breath sounds basally. Crackles are heard in the right lung field and above the line of dullness on the left.
Pleural effusion
- Dyspnoea
- Quiet breath sounds
- Dullness to percussion
A 20-year-old man presents to the emergency department with complaints of left-sided chest pain and shortness of breath. He states that these symptoms began suddenly 4 days ago while he was working at his computer. He initially thought that he might have strained a chest wall muscle, but because the pain and dyspnoea had not resolved, he decided to seek medical attention. He has no significant past medical history but has smoked cigarettes since the age of 16 years. The patient’s vital signs are normal. He appears in mild discomfort. Examination of his chest reveals that the left hemithorax is mildly hyperexpanded with decreased chest excursion. His left hemithorax is hyper-resonant on percussion, and breath sounds are diminished when compared with the right hemithorax. His cardiovascular examination is normal.
Pneumothorax
- SOB
- Chest pain
- Hyper resonant percussion - ipsilateral
- Decreased breathing sound
A 65-year-old patient with COPD presents to the emergency department with complaints of worsening shortness of breath and right-sided chest discomfort. He states that these symptoms occurred suddenly 1 hour prior to presentation. He denies fevers and chills. He also denies increased sputum production and a change in the colour or character of his sputum. He continues to smoke cigarettes against medical advice. The patient’s blood pressure is 136/92 mmHg, heart rate is 110 beats per minute, and respiratory rate is 24 breaths per minute. Chest excursion is decreased on the right more than the left. His right hemithorax is more hyperinflated than the left. His right hemithorax is hyper-resonant on percussion. Breath sounds are distant bilaterally but more diminished on the right.
Pneumothorax
A 65-year-old man re-presents to his physician, following treatment for pneumonia, with fever, increasing breathlessness, and right-sided chest pain. He feels lethargic and has lost 4 kg in weight. He initially presented 3 weeks earlier with a productive cough and breathlessness. At that time, he was diagnosed with community-acquired pneumonia and treated with a course of oral antibiotics. He has a past medical history of poorly controlled type 2 diabetes mellitus. On examination, he is septic, with a temperature of 101.3°F (38.5°C), BP 90/60 mmHg, pulse rate 110 beats/minute, and respiratory rate 28 breaths/minute. He has dullness to percussion and decreased breath sounds at the right lung base.
Laboratory examination reveals WBC count 20 × 10⁹/L. He undergoes ultrasound-guided thoracentesis (pleural aspiration) that shows a septated pleural effusion, and frank pus is aspirated.
Empyema
A 65-year-old man presents with gradually progressive dyspnoea on exertion and a non-productive cough. He has no history of underlying lung disease and no features that would suggest an alternative aetiology for his cough and dyspnoea. He has no history of joint inflammation, skin rashes, or other features of a systemic inflammatory disease such as lupus or rheumatoid arthritis. He takes no medications and has no environmental exposures to organic allergens such as mould. On examination, he has fine crackles audible over his lung bases bilaterally; however, he has no lower-extremity oedema, elevations in jugular venous pressure, or any other findings to suggest volume overload. He has clubbing of his fingers.
Pulmonary fibrosis
A 50-year-old woman presents with shortness of breath, cough, and painful red skin lesions on the anterior surface of the lower part of both legs. Chest x-ray reveals bilateral hilar lymphadenopathy with pulmonary infiltrates.
Sarcoidosis
