Respiratory Short Case

Question 1

Causes of Tracheal Displacement

Answer 1

1. Towards the side of the lung lesion
   a. Upper lobe collapse
   b. Upper lobe fibrosis
   c. Pneumonectomy
2. Away from the side of the lung lesion (uncommon)
   a. Massive pleural effusion
   b. Tension pneumothorax
3. Upper mediastinal masses, such as retrosternal goitre

Question 2

Signs of consolidation

Answer 2

1. Towards the side of the lung lesion
   a. Upper lobe collapse
   b. Upper lobe fibrosis
   c. Pneumonectomy
2. Away from the side of the lung lesion (uncommon)
   a. Massive pleural effusion
   b. Tension pneumothorax
3. Upper mediastinal masses, such as retrosternal goitre

Question 3

Signs of atelectasis

Answer 3

• Trachea: displaced towards the affected side
• Expansion: reduced on the affected side with flattening of the chest wall on the same side
• Percussion: dull over the collapsed area
• Breath sounds: reduced, nil added sounds

Question 4

Signs of pleural effusion

Answer 4

• Trachea and apex beat: displaced away from a massive effusion
• Expansion: reduced on the affected side
• Percussion: stony dullness over the fluid
• Breath sounds: reduced or absent. May be an area of bronchial breathing audible above the effusion due to compression of overlying lung
• Vocal resonance: reduced

Question 5

Causes of transudative effusion

Answer 5

• Transudate
o Cardiac failure
o Hypoalbuminaemia from nephrotic syndrome or chronic liver disease
o Hypothyroidism
o Meigs syndrome (ovarian fibroma causing pleural effusion and ascites)

Question 6

Causes of exudative effusions

Answer 6

o	Pneumonia
o	Neoplasm – bronchial carcinoma, metastatic carcinoma, mesothelioma
o	Tuberculosis 
o	Pulmonary infarction 
o	Subphrenic abcess 
o	Acute pancreatitis 
o	Connective tissue disease (e.g. rheumatoid arthritis, SLE)
o	Drugs such as methysergide, cytotoxics
o	Irradiation
o	Trauma