Respiratory

Question 1

Causes of solitary nodule

Answer 1

Common:

1. Primary lung cancer
2. Old tuberculous nodule
3. Secondary Metastasis

Rare:

• Infection (abscess)
• Benign tumour (adenoma or harmatoma)
• AVM
• Active granulamatous disease (TB, sarcoid, Wegner’s granulomatosis, rheumatoid nodule)

RACP Medical Masterclass (2010)

Question 2

Causes of slow-onset new breathlessness

Answer 2

Common:

1. Airways disease
2. Cardiac disease
3. Pleural effusion/disease
4. Lobar/lung collapse (caused by obstructing tumour)

Must consider:

1. Thromboembolic disease
2. Anaemia

Others:

• Pulmonary arterial hypertension
• ILD
• Neuromuscular disease
• Chest wall disease

RACP Medical Masterclass (2010)

Question 3

Causes of orthopnoea

Answer 3

heart failure
central obesity

Rare:
diaphragm paralysis (i.e. inspiratory muscle weakness)

RACP Medical Masterclass (2010), UpToDate

Question 4

Cause of dyspnoea worse with lying on one side

Answer 4

unilateral lung disease, e.g. right lung collapse patients prefer lying on right side

RACP Medical Masterclass (2010)

Question 5

Value of blood tests in investigating new dyspnoea

Answer 5

Limited

Hb: exclude anaemia, polycythaemia if there is long standing hypoxia
LFTs: for possible malignancy
Serum ACE and calcium: sarcoidosis

Question 6

What lung function test findings would increase suspicion of respiratory muscle weakness?

Answer 6

• restrictive defect with a normal or supernormal gas transfer in presence of normal CXR.
• good screening test: compare erect and supine vital capacity, when a drop of > 20% suggests bilateral diaphragm paralysis

RACP Medical Masterclass (2010)

Question 7

Symptoms of superior sulcus/pancoast tumour

Answer 7

chest wall pain
brachial plexus symptoms (numbness, tingling or weakness in hand muscles)

RACP Medical Masterclass (2010)

Question 8

Systems that might arise from systemic manifestations of cancer and paraneoplastic syndromes

Answer 8

• Loss of balance, dizziness (paraneoplastic cerebellar)
• Bone pain from hypercalcaemia or metastases
• Weakness from Eaton-Lambert Syndrome (proximal more than distal)

RACP Medical Masterclass (2010)

Question 9

How can blood tests help differentiate small cell lung cancer from non small cell lung cancer?

Answer 9

SCLC:

• Hyponatraemia (SIADH)
• Hypokalaemia, hyperglycaemia and alkalosis (ectopic adrenocorticotropic hormone production)

NSCLC:
- hypercalcaemia

RACP Medical Masterclass (2010)

Question 10

What other history would support diagnosis of Wegner’s granulomatosis in a patient with solitary pulmonary nodule?

Answer 10

sinusitis
red eyes
hearing loss
renal problems

RACP Medical Masterclass (2010)

Question 11

Blood tests to request for invetigation of solitary pulmonary nodule

Answer 11

FBP, Coag profile, CRP, ESR, UEC, LFTs, metabolic bone stufy , serum ACE

RACP Medical Masterclass (2010)