interactive cases ii

Question 1

What associated sx in resp should you ask?

Answer 1

Think WBC:
Wheeze
Breathlessness
Cough => sputum => haemoptysis => weight loss (FLAWS)

Question 2

What are ddx of breathlessness occurring within seconds (sudden)?

Answer 2

Pneumothorax
PE
Foreign body

Question 3

What are ddx of breathlessness occurring within mins/days (acute)?

Answer 3

Airways (inflammation/obstruction)
Chest infection (pus)
Acute heart failure (fluid)

Question 4

What are ddx of breathlessness occurring within days/weeks (chronic)?

Answer 4

Unresolved/chronic cases of acute ddx (chest infection, heart failure, airway pathology)
Interstitial lung disease
Malignancy/large pleural effusion
Neuromuscular
Anaemia/thyrotoxicosis

Question 5

What is the management of a primary pneumothorax?

Answer 5

<2cm:
- discharge, repeat CXR
>2cm/SOB:
- aspiration
- unsuccessful: chest drain

Question 6

What is the management of a secondary pneumothorax?

Answer 6

<2cm:
- aspiration
>2cm:
- chest drain

Question 7

What is a potential complication of inserting a chest drain for a pneumothorax?

Answer 7

Pulmonary oedema

Question 8

How do you assess for axis deviation from an ECG?

Answer 8

1) Look at I + II
- if they are both overall -ve there is deviation
2) Look at VL
- if it is overall +ve => left axis deviation
- if it is overal -ve => right axis deviation

Question 9

Rx for suspected PE

Answer 9

start on LMWH

Question 10

What would an ECG of RBBB show?

Answer 10

MaRRoW

• V1 => M
• V6 => W

Question 11

What would an ECG of LBBB show?

Answer 11

WiLLiaM

• V1 => W
• V6 => M

Question 12

What do you see in vanishing lung disease?

Answer 12

Rare, occurs in young males smokers
Lungs ‘disappear’ on x-ray
Emphysematous bullae, typically in upper lobers

Question 13

What are possible ddx if you see reticulo-nodular shadowing on a CXR?

Answer 13

Idiopathic fibrosing alveolitis
Connective tissue disease, i.e. RA
Drugs (iatrogenic)
Asbestosis (?ship builder)

Question 14

What would you expect to see in a CXR of a COPD pt?

Answer 14

Hyperexpansion, flat diaphragm

Question 15

How should you start interpreting a CXR?

Answer 15

Whether PA/AP CXR of
- pt name + DOB
- date taken
- time taken 
and quality of CXR:
- R otation
- I nspiration
- P enetration

Question 16

What are the possible opacities you may see on a CXR?

Answer 16

Interstitial/alveolar shadowing (fluffy)
Reticulo-nodular shadowing
Homogenous shadowing
Masses/cavitations

=> compare L vs R upper/mid/lower zones for these

Question 17

One possible ddx of a globular heart on CXR

Answer 17

Pericardial effusion

Question 18

Possible ddx of bilateral hilar lymphadenopathy on CXR

Answer 18

Infection - TB
Inflammation - sarcoidosis
Malignancy - lymphoma

Question 19

What periphery should you not forget to look for/see in a CXR?

Answer 19

Pneumothorax
Pleural thickness
Costophrenic angles
Diaphragm
Heart
Mediastinum