Respiratory

Question 1

Pulmonary fibrosis

Answer 1

O2 therapy

Dry cough

Tachypnoea

Reduced expansion

Fine, end-expiratory crackles

SIgns of aetiology:

Hand deformity - RA

Clubbing - idiopathic

Sclerodactyly, microstomia, telangectasia - SSc

Malar rash - SLE

Lupus pernio - Sarcoidosis

Radiation burns - RTx

Kyphosis - ankspond

Signs of complications:

Cushingoid
Pulmonary HTN

Question 2

COPD

Answer 2

Bedside inhalor/nebs

Accessory muscle use / pursed lip breathing

Nicotine stains

Tachypnoea

Tracheal tug, reduced cricosternal distance

Hyperresonance, with obliterated hepatic/cardiac dullness

Quiet breathsounds, wheeze, prolonged expiratory phase

Signs of complications:

Cushingoid - moon, bruising, thin skin, striae, proiximal weakness

Pulm HTN - RV heave, loud P2

Cor pulmonale - elevated JVP, pulsitile liver, oedema

Signs of severity: BMI, walk pt, FEV1,

Question 3

BODE Index

Answer 3

BMI - <21
Obstruction FEV1
Dyspnoea - 1-4
Exercise - 6MWT

Question 4

Pneumonectomy

Answer 4

Unilateral chest flattening

Thoracotomy scar

Tracheal deviation towards the side

Reduced expansion

Dull percussion note

Reduced or absent breath sounds

Bronchial beathing in upper zone due to deviated trachea

Signs of aetiology:

Lung cancer - nicotine staining, clubbed, cachexia

Bronchiectasis - wet cough, clubbed, coarse creps

COPD - signs of COPD (bullectomy)

Question 5

Lobectomy

Answer 5

Thoracotomy scar

without

tracheal deviation, unilateral chest flattening, reduced expansion, reduced breath sounds

Signs of aetiology:

Lung cancer - nicotine staining, clubbed, cachexia

Bronchiectasis - wet cough, clubbed, coarse creps

COPD - signs of COPD (bullectomy)

Question 6

Pleaural effusion

Answer 6

Reduced expansion

Stony dull to percussion

Reduced breath sounds with bronchial breathing above

Rediced vocal fremitus

Signs of aetiology:

Malar rash - SLE
Hand deformity - RA
Clubbing - bronchogenic ca or mesothelioma
LA, cachexia, mastectomy scar - malignancy
signs of CLD
sign of heart failure

Question 7

Bronchiectasis

Answer 7

Productive cough

Clubbing

Inspiratory clicks

Coarse, late expiratory crackles

Signs of aetiology:
Young thin - CF
Curved yellow nails - yellow nail syndrome
LA - Malignancy
Dextrocardia - Kartagener’s syndrome