EMQs in Clinical Medicine.pdf - Peshawar Medical College

Respiratory medicine – revision boxes 49
Box 3 Chest radiograph [14, 15]
Radiological change
• Kerley B lines
Bat-wing shadowing
• Tram-line shadowing
• Miliary shadowing
• Wedge-shaped infarct
• ‘Ground-glass’ appearance
‘Honeycomb’ appearance
• Pleural mass with lobulated margin
Pathology
Heart failure
Bronchiectasis
Miliary TB
Pulmonary embolus
Fibrosis
Fibrosis (late)
Mesothelioma
Box 4 summarizes some details to look out for in an EMQ which suggest a
particular respiratory condition.
Box 4 Respiratory conditions
Factor indicating diagnosis
Condition
• Early-onset emphysema plus liver disease 1 -Antitrypsin deficiency [57]
Fever, cough, shortness of breath hours Extrinsic allergic alveolitis [11]
after exposure to antigen (usually farmer
after hay exposure)
Positive serum precipitins
• Asymptomatic with bilateral hilar Sarcoidosis [5, 15]
lymphadenopathy (BHL)/progressive
shortness of breath/dry cough
Non-pulmonary manifestations,
e.g. erythema nodosum
↑ serum ACE (angiotensin-converting
enzyme) or hypercalcaemia may be
mentioned
• History of recurrent chest infections, Cystic fibrosis [11, 15, 74]
failure to thrive
May mention steatorrhoea (pancreatic
insufficiency)
Positive sweat test (sodium,
chloride 60 mmol/l)
• Progressive dyspnoea and cyanosis Fibrosing alveolitis [15]
Gross clubbing, fine end-inspiratory
crackles
Chest radiograph: ground-glass →
honeycomb lung
continued overleaf