Respiratory

Question 1

Pleural effusion causes

Answer 1

1. Transudate
   a. Heart failure
   b. Hypoalbuminaemia from nephrotic syndrome or chronic liver disease
   c. Hypothyroidism
   
   2. Exudate
      a. Pneumonia
      b. Neoplasm – lung, metastatic, pleural
      c. Tuberculosis
      d. Pulmonary infarction
      e. Subphrenic abscess
      f. Acute pancreatitis
      g. Connective tissue disease – rheumatoid arthritis, SLE
      h. Drugs – cytotoxics
      i. Irradiation
      j. Trauma
      k. Meig’s syndrome (ovarian fibroma causing pleural effusion and ascites)
   3. Haemothorax
      a. Trauma
      b. Rupture of pleural adhesion with blood vessel
   4. Chylothorax
      a. Trauma or surgery to thoracic duct
      b. Carcinoma or lymphoma involving thoracic duct
   5. Empyema
      a. Pneumonia
      b. Lung abscess
      c. Bronchiectasis
      d. Tuberculosis
      e. Penetrating chest wound

Question 2

Interstitial lung disease

Answer 2

1. Upper lobe predominant (SCART)
   a. Silicosis
   b. Coal worker’s pneumoconoisis, cystic fibrosis, chronic allergic alveolitis, chronic eosinophillic pneumonitis
   c. Ankylosing spondylitis, allergic bronchopulmonary aspergillosis, alveolar haemorrhage syndromes
   d. Radiation
   e. Tuberculosis
   
   2. Lower lobe predominant (RASIO)
      a. Rheumatoid arthritis, collagen vascular diseases
      b. Asbestosis, acute allergic alveolitis, acute eosinophilic pneumonitis
      c. Scleroderma
      d. Idiopathic interstitial fibrosis
      e. Others (drugs – busulfan, nitrofurantoin, hydralazine, methotrexate, amiodarone)

Question 3

Causes of dyspnoea

Answer 3

1. Respiratory
   a. Airways disease
   b. Parenchymal disease
   c. Pulmonary circulation
   d. Chest wall and pleura
   
   2. Cardiac
   3. Anaemia
   4. Non cardiorespiratory

Question 4

Causes of tracheal displacement

Answer 4

1. Towards lung lesion
   a. Upper lobe collapse
   b. Upper lobe fibrosis
   c. Pneumonectomy
   
   2. Away from side of lesion
      a. Massive pleural effusion
      b. Tension pneumothorax
   3. Upper mediastinal masses
      a. Retrosternal goitre

Question 5

Bronchial breathsound

Answer 5

• Lung consolidation
  
  • Uncommon
    ○ Localised pulmonary fibrosis
    ○ Pleural effusion (above fluid)
    ○ Collapsed lung (adjacent to pleural effusion)

Question 6

Consolidation

Answer 6

• No mediastinal displacement
  
  • Reduced chest expansion over affected area
  • Dull percussion
  • Bronchial breathsounds
  • Added crackles

Question 7

Collapse

Answer 7

• Mediastinal shift towards collapse
  
  • Reduced chest expansion over affected area
  • Dull percussion
  • Absent or reduced breathsound
  • No added sounds

Question 8

Pleural effusion

Answer 8

• Displaced away if massive only
  
  • Reduced expansion over affected area
  • Stony dull percussion
  • Absent over fluid, bronchial above
  • Pleural rub above fluid otherwise no added

Question 9

Pneumothorax

Answer 9

• Trachea displaced towards lesion or away of tension
  
  • Decreased movement over affected area
  • Resonant percussion
  • Absent breathsound
  • No added sounds

Question 10

Interstitial pulmonary fibrosis

Answer 10

• No shift
  
  • Decreased expansion symmetrically
  • Normal percussion
  • Normal breathsounds
  • Fine, late or pan-inspiratory crackles