Читать книгу Respiratory Medicine - Stephen J. Bourke - Страница 73

1 2.1 BBilateral crackles and clubbing are characteristic features of pulmonary fibrosis. Pulmonary oedema may exhibit fine crackles but is not associated with clubbing.

2 2.2 CThe abnormal side always moves less so the abnormality must be on the left. Consolidation increases breath sounds, collapse diminishes conduction of breath sounds.

3 2.3 BPneumonic consolidation is characterised by dullness to percussion, bronchial breathing and crackles. Pneumonia is sometimes associated with inflammation of the overlying pleura, causing pleuritic pain.

4 2.4 EPneumothorax typically causes acute pleuritic pain and is characterised by reduced breath sounds and hyperresonance on the side of the pneumothorax. Pulmonary embolism and rib fracture would not be associated with hyperresonance. There would be tenderness associated with a rib fracture.

5 2.5 AHe has been a smoker and shows features of airways obstruction with paradoxical inward movement of the costal margins on inspiration (in a normal person they move outwards), with a hyperinflated chest (reduced cricosternal distance and increased A–P diameter ‘barrel shaped’). The reduced breath sounds and absence of wheeze are more characteristic of COPD than asthma. The presence of cyanosis indicates hypoxia and respiratory failure.

6 2.6 DSuggesting involvement of the recurrent laryngeal nerve.

7 2.7 BAirway obstruction leads to hyperinflation which (if severe enough) might be associated with a hyperresonant percussion note.

8 2.8 A, E

9 2.9 A, B, EWhatever the abnormality, the abnormal side moves less.

10 2.10 A, C, D, E