Presenting Signs and Symptoms in Respiratory Disease
A. Cystic Fibrosis
B. Idiopathic Pulmonary Fibrosis
F. Extrinsic Allergic Alveolitis
From the list below, please select the most appropriate diagnosis for each set of presenting symptoms
1. A 30 year old non-smoking man presents with a dry cough, worse at night. Skin prick testing shows that he is allergic to house dust mite.
2. A 75 year old Indian, non-smoking man who has recently moved to the UK, presents with haemoptysis, night sweats and some weight loss.
We do not, however, have the power to force patients to take their anti-TB chemotherapy. Once kept in a negative pressure room, with no access to or from the outside world, the patients usually decide to take therapy quite quickly.
3. A 50 year old man who races pigeons presents with increasing blreathlessness, and a dry cough.
If the pigeons are not removed, the stimulus continues, and EAA occurs. EAA is typical of a type 4 hypersensitivity response mediated disease. T cells are activated at the site of the antigen, these T cells return to the lymph node tissue. The result is a release of monocytes which move to the area of antigen deposition, activating macrophages, forming giant cells, and ultimately granulomata. If the stimulus is removed, the disease usually halts progress, but irreversible pulmonary fibrosis has usually occurred by this point. We treat with steroids, and steroid sparing immunosupressive agents, with varying degrees of success.
Multiple Choice Questions
1. Which of the following signs would you expect to find in a patient with a pleural effusion? (Click the answer to see further info)
Trachea deviated towards the effusion
2. Your patient has dullness to percussion in the right apex, crepitations in the right apex with bronchial breathing and a right sided Horner’s syndrome. Which of the following diagnoses are likely? (Click for the answer and more information)
Right sided pleural effusion
Pancoast’s tumour of the lung
3. Your patient has the following positive signs: respiratory rate of 35, sinus tachycardia, central cyanosis, right basal pleural rub. The differential diagnosis includes (Click the answer to get more information)
Idiopathic pulmonary fibrosis
4. Clubbing is a common finding in (select all that apply)