Respiratory

Question 1

Signs of ILD

Answer 1

cyanosis
clubbing
reduced expansion (restrictive)
late inspiratory or pan-inspiratory, velcro-like crackles

associated signs related to CT disorders:
RA, SLE, Scleroderma, Sjogrens, poly and dermatomyositis (anti-synthestase syndrome - mechanics hands)

Question 2

Radiological signs of bronchiectasis

Answer 2

CXR:
linear atelectasis
dilated and thickened airways
- tram-tracking, ring shadows

HRCT:
airway dilatation
- tram-tracking, ring shadows
Lack of tapering of bronchi
bronchial wall thickening
tree-in-bud
muco-purulent plugs
traction bronchiectasis
signet rings

if cause is CF then also see cysts

Question 3

Signs of cystic fibrosis

Answer 3

Physique - low BMI, low muscle bulk, malnourished
Cough - purulent, haemoptysis
Clubbing, HPOA
Cynaosis, tachypnoea
Sites of glucose testing
Kyphoscoliosis, barrel chest, increased AP diameter
Prolonged expiratory time, crackles, wheeze, reduced breath sounds
Abdo distention, hepatosplenomegaly, faecal loading

Complications:

• pulmonary hypertension: RV heave, loud P2
• pneumothorax

Question 4

Signs of sarcoidosis

Answer 4

• skin: lupus pernio (bulbous violaceous nose), macular papular plaques, erythema nodosum
• eyes: uveitis, sicca symptoms
• lymphadenopathy, parotiditis
• heptosplenomegaly
• cardiac: conduction disease (AV block), cardiomyopathy, look for defibrillator/pacemaker
• neurological: peripheral neuropathy, facial nerve palsy
• arthritis/tenosynovitis/dactilitis

Pulmonary

• hilar lymphadenopathy
• upper lobe to midzone pulmonary infiltrates
• findings of interstital fibrosis
• usually normal chest exam

Question 5

Signs of lung cancer

Answer 5

HPOA (hypertrophic pulmonary osteoarthropathy - clubbing and rest tenderness)
Muscle wasting of hands (most commonly hypothenar - lower brachial plexus)
Horners syndrome
Signs of SVCO (distended neck veins, facial plethora and swelling, pembertons sign)
Lymphadenopathy
Hoarse voice
Pleural effusion
Collapse/consolidation distal to tumor
Hepatomegaly
Bone tenderness

Question 6

Differential for Crepitations

Answer 6

Pneumonia, atelectasis, pulmonary fibrosis, acute bronchitis, bronchiectasis, interstitial lung disease, post thoracotomy, metastasis ablation, pulmonary oedema.

Question 7

Signs of COPD

Answer 7

Tachypnoea, respiratory distress, accessory muscle use, Hoover’s sign (paradoxical movement of intercostals), cyanosis, elevated JVP, peripheral oedema, hyperinflation, wheeze, reduced breath sounds, hyper-resonance, prolonged expiratory phase, coarse crepitations at beginning of inspiration.