Respiratory Flashcards
The patient is a 60 year old man, previous heavy smoker admitted with haemoptysis and two stone weight loss. He is clubbed, looks cachexic and has an enlarged liver. There is no evidence of a pleural effusion
Which additional features are they most likely to demonstrate?
- Clubbing
- Vocal resonance greater on right than left
- Left lung base duller than the right
- Bronchial breath sounds at the right lung base
- Widespread crackles throughout both lungs especially at the bases
- Lymphadenopathy in the neck
- Trachea deviated to the left
- Right lung base duller than the left
- Trachea deviated to the right
- Vocal resonance greater on left than right
- Bronchial breath sounds at the left lung base
- A pleural rub
-Lymphadenopathy in the neck
This story is highly suggestive of advanced lung cancer. This is likely to have spread to the nodes of the neck
You see a 20 year old man in the emergency department complaining of severe, sudden-onset breathlessness and left-sided pleuritic chest pain. The trachea is not deviated. The right lung is duller to percussion than the left. Breath sounds are greatly reduced on the left.
Which additional features are they most likely to demonstrate?
- Clubbing
- Vocal resonance greater on right than left
- Left lung base duller than the right
- Bronchial breath sounds at the right lung base
- Widespread crackles throughout both lungs especially at the bases
- Lymphadenopathy in the neck
- Trachea deviated to the left
- Right lung base duller than the left
- Trachea deviated to the right
- Vocal resonance greater on left than right
- Bronchial breath sounds at the left lung base
- A pleural rub
-Vocal resonance greater on right than left
These features suggest left-sided pneumothorax. Normally, the pathology is on the side of the lung which is duller - pneumothorax is the exception. Pleuritic chest pain is often accompanied by a rub but not usually if the cause is a pneumothorax. Vocal resonance will be reduced in the abnormal left lung
You see an 80 year old lady in clinic complaining of breathlessness. On examination, the left lung is dull all over with virtually absent breath sounds and greatly reduced vocal resonance.
Which additional features are they most likely to demonstrate?
- Clubbing
- Vocal resonance greater on right than left
- Left lung base duller than the right
- Bronchial breath sounds at the right lung base
- Widespread crackles throughout both lungs especially at the bases
- Lymphadenopathy in the neck
- Trachea deviated to the left
- Right lung base duller than the left
- Trachea deviated to the right
- Vocal resonance greater on left than right
- Bronchial breath sounds at the left lung base
- A pleural rub
-Trachea deviated to the right
These features suggest a massive left-sided pleural effusion. It is likely that this will push the trachea away to the right. You could argue that such a pleural effusion may be due to lung cancer making options a and f reasonable answers.
You visit a 55 year old woman at home. She has been chesty for a few days and now become feverish and weak. There is no chest pain. On examination, you find her left base is dull with increased vocal resonance
Which additional features are they most likely to demonstrate?
- Clubbing
- Vocal resonance greater on right than left
- Left lung base duller than the right
- Bronchial breath sounds at the right lung base
- Widespread crackles throughout both lungs especially at the bases
- Lymphadenopathy in the neck
- Trachea deviated to the left
- Right lung base duller than the left
- Trachea deviated to the right
- Vocal resonance greater on left than right
- Bronchial breath sounds at the left lung base
- A pleural rub
-Bronchial breath sounds at the right lung base
The symptoms are suggestive of lung infection. The dull left base suggests this is the area affected and the increased vocal resonance suggests there is consolidation. Bronchial breathing is another feature of consolidation
You see a 70 year old man in clinic. He has never smoked or been prone to chest infections but in the last year has become increasingly breathless. Otherwise he feels well. On examination he is severely
clubbed
Which additional features are they most likely to demonstrate?
- Clubbing
- Vocal resonance greater on right than left
- Left lung base duller than the right
- Bronchial breath sounds at the right lung base
- Widespread crackles throughout both lungs especially at the bases
- Lymphadenopathy in the neck
- Trachea deviated to the left
- Right lung base duller than the left
- Trachea deviated to the right
- Vocal resonance greater on left than right
- Bronchial breath sounds at the left lung base
- A pleural rub
Widespread crackles throughout both lungs especially at the bases
This sounds like pulmonary fibrosis which commonly causes clubbing as well as widespread crackles. The commonest cause of clubbing is lung cancer but the patient would be likely to be more unwell, chesty and / or a smoker.
