Signs

Question 1

Asthma

Answer 1

Variability of symptoms
Hyper-expanded chest
Breathless on exertion
Different triggers

Question 2

COPD

Answer 2

40+
Smoker (20+ pack year)
Breathless walking into clinic
Cyanosis
CO2 flap
Accessory breathing muscle use
Asbestos exposure
PMH childhood asthma

Question 3

ARDS

Answer 3

Abnormal CXR (fluid accumilation)
History of trauma, sepsis or pneumonia
Hypoxaemia
Fine crackles in both lungs

Question 4

Hypersensitivity pneumonitis

Answer 4

Abnormal CXR (Opacities, honycombing)
Tachypnoea
Coarse crackles at end of inspiration
Cyanosis

Severe weight loss
Idiopathic pulmonary fibrosis

Question 5

Sarcoidosis

Answer 5

Abnormal CXR (bilateral hilar lymphadebopathy)
Multisystem disorder

Question 6

Idiopathic pulmonary fibrosis

Answer 6

Cyanosis
Respiratory failure
Pulmonary hypertension
Fine bilateral inspiratory crackles
50+ years

Question 7

Pleural effusion

Answer 7

Chest exam on affected side:
-Reduced chest expansion
-Breath sounds
-Vocal Resonance
-Stony dull percussion
Clubbing
Cervical lymphadenopathy
Raised JVP
Tracheal deviation
Peripheral oedema

Question 8

Pneumothorax

Answer 8

Reduced chest exapnsion, hyper-resonance and diminished breath sounds on affected side
In a tension pneumothorax the trachea moves away from affected site
In a non-tension pneumothorax the trachea moves towards the affected side

Question 9

Pulmonary embolism

Answer 9

Cyanosis
Tachypnoea
Tachycardia
Reduced BP
Oedema
Signs of RH failure
Pyrexia

Question 10

DVT

Answer 10

Fever

Question 11

Pulmonary hypertension

Answer 11

Left parasternal heave
Loud S2
Soft pan systolic murmur with tricuspid regurgitation
RH failure
Ascites
Hepatomegaly

Question 12

Tonsilitis/Pharyngitis

Answer 12

Painful cervical lymphadenopathy
Fever
White plaques in oral candidiasis
Erythema nodosum

Question 13

Otitis Media

Answer 13

Erythema

Bulging eardrum

Question 14

Glandular Fever

Answer 14

Palatal petachiae in throat

Question 15

Acute bronchitis

Answer 15

Smoker or COPD
Cough develops to produce yellow/green sputum
Mild Fever
Neutrophil Leukocytosis

Question 16

Pneumonia

Answer 16

Pyrexia
Tachypnoea
Central Cyanosis
Dullness on percussion of affected lobe
Bronchial breath sounds
Inspiratory crepitations
Increased vocal resonance

Question 17

Bronchiectasis

Answer 17

Finger clubbing

Course inspiratory crepitations

Question 18

Lung abscess

Answer 18

Persisting or worsening pneumonia
May be finger clubbing
Raised inflammatory markers
May see abscesses on CXR or CT

Question 19

Empyema

Answer 19

Rising/elevated inflammatory markers

Exudative fluid w/ pH >7.2

Question 20

Small cell carcinoma

Answer 20

Finger clubbing
Decreased breath sounds, wheeze and crackles on auscultation
Dullness to percussion
History of smoking or asbestos exposure

Question 21

Non-small cell lung cancer

Answer 21

Finger clubbing
Decreased breath sounds, wheeze and and crackles on auscultation
Dullness to percussion
History of smoking and asbestos exposure

Question 22

Cystic Fibrosis

Answer 22

Finger clubbing 
Presents in early childhood
Worse at apices
Low BMI
Extensive crepitations
Pancreatic insufficiency
Diabetes
Positive Guthrie test

Question 23

TB

Answer 23

Patches of crepitations
Shadowing on CXR
Positive Mantoux test

Question 24

Sleep apnoea

Answer 24

Obese
Middle aged
Male
Pulmonary hypertension
Type 2 respiratory failure