Ultimate Finals List - Respiratory Stations

Respiratory

• Suppurative lung disease. I was asked about possible differentials. // Hyperexpanded chest, clubbing (I missed this). Empty sputum pot by bed. Coarse crackles. Bronchiectasis (I said COPD, but examiner guided me, asked for causes e.g. obstruction of bronchi, severe childhood infection like pertussis, secondary infection of tuberculosis lung, cystic fibrosis, Ix // The blindness and madness continued here. The patient had the most obvious clubbing I'd ever seen, proper drumsticks!!! He had COPD which was apparently unrelated to his clubbing I swear the left lung base was dull to percussion but again I had a moment of complete madness and said resonance was normal throughout. Afterwards the examiner made me go back and look at a plaster mark on the patient's back that revealed a needle sized hole!!! The examiner then asked me what this patient had had done, I said pleural aspiration. I was then asked why, I said pleural effusion. He then asked me if percussion was resonant and for some crazy reason I still said YES! (?!?!?!?!?!?!).

• Middle aged gentleman – ulnar deviation at MCP joints, rheumatoid nodules, hyperexpanded chest, no shortness of breath, fine inspiratory crackles more on left than right also heard at apices of lungs. Peculiar pulse. Examiner was grilling me for causes which although I said obviously secondary to rheumatoid or possibly methotrexate. he was looking for something to cause unilateral fibrosis. Only thing I could come up with was radiotherapy but with hindsight perhaps recurrent pericarditis and reactive effusions? //Peak flow at the side so use it to test peak flow // Gentleman with bilateral inspiratory crackles, decreased expansion - ?fibrosis. Asked about causes of fibrosis and then if there were any signs of any drugs patient had been on; I only noticed steroid induced "buffalo hump" when examiner pointed it out! A man with mixed connective tissue disease and lung fibrosis (I got him to do a prayer sign) // RESP- very obvious fibrosis of the lungs, I was asked about a differential but started giving causes of fibrosis..oops! she asked again about the differential, I was a little stuck, I said it may be consolidation but I would expect to hear coarse crepitations, she agreed and then said what else can we rule out, I felt a little silly saying the trachea was central so there no pneumothorax or collapse of the lung, the percussion not is resonant throughout so again rule out pneumothorax or consolidation and so on, but it what she wanted, we spent the last few minutes discussing how tired the patient must be getting, I saw her give me an A on the mark sheet

• Questions ask on different between obstructive and restrictive

• RS - Asthma - normal Examination poss! // my patient had low PEFR but normal Examination so just gave differentials - forgot to mention sputum pot I saw next to bed though!!

• Resp - lateral thoracotomy scar-lobectomy for bronchial carcinoma

• Actress with pleuritic chest pain – asked to examine her chest from behind as young female actress- 1st give 02 and reassure // followed by discussion re Diff Dx. Pneumothorax, PE, Pneumonia etc and how would treat a pneumothorax, Obs Chart with questions

• Respiratory - cryptogenic fibrosing alveolitis - questions on differentials, investigations, treatment options and criteria for home oxygen

• Respiratory: Nothing obvious on examination. Possibly hyperressonance on percussion. Peak flow was very low. When asked for differential I said COPD (hyperexpanded chest??). That was my last station, so the consultant asked the patient to stand up and made me comment on inspection. She had a marked Kyphosis and a bit of a scoliosis which was the causing a restrictive airway pattern.

• Migratory crackles in a woman with mild clubbing, no other signs, apart from dowagers hump (elderly lady with osteoporosis), I think diagnosis was bronchiectasis but I also mentioned pulmonary fibrosis.

• Resp: palmar erythema, Dupuytren’s but chest signs were not clear, end inspiratory crackles=fibrosis??, I wasn’t sure so I said its unlikely to be COPD as there was no wheeze etc, other students all came out with different differentials but the examiners was just interested in the reasoning.