1. 4 cases of chest pain

2. Man of 34 Just returned form 2 weeks in Turkey Flu like symptoms Cough
Coughed up blood
Pain right lower chest

3. On examination Temperature 38.4 Pulse 90 regular
Chest Dullness to percussion right base
BS present but added crackles and one area of coarse breathing
Scratching sound too

4. What are the possible diagnoses?
How might you distinguish between possible causes?
What tests might help?
What are the treatment options?

5. Pneumonia

6. Man of 22 Long standing asthma
Develops sharp right sided chest pain whilst out walking the dog
Becomes short of breath on exertion

7. On examination Thin Chest expansion reduced right side
Percussion note resonant and possible more so right side
Decreased air entry right apex of lung over clavicles

8. What are the possible diagnoses?
What would explain this story and chest signs?
Which factors might contribute to this problem?
How might you confirm the diagnosis?
Treatment options?
He suddenly becomes much more short of breath – why?

9. Pneumothorax

10. Tension pneumothorax

11. Needle decompression

12. Chest drain

13. Man of 63 Smoker for many years History of dyspnoea on exertion
Develops pain in left side of chest
Cough

14. ON EXAMINATION Thin Clubbed Nicotine stains
Percussion note dull left base
Decreased breath sounds left base

15. How can you explain these signs
What sort of pathology will cause dullness to percussion
What might cause reduced air entry?
What might you see on CXR?

16. Pleural effusion

17. Collapsed lung vs. effusion Where is trachea?

18. 61 YEAR OLD MAN
Just returned from 2 weeks in Turkey visiting his daughter
Developed slight chest pain whilst there went to chemist and got antibiotics
Coughed up blood
No better

19. ON EXAMINATION Apyrexial Not clubbed P 110 regular RR 28
Chest – percussion note normal
Normal air entry
Loud second heart sound especially pulmonary area

20. What might explain his signs?
Why is he tachycardic and tachypnoeic?
What can cause someone to cough up blood?
Why did the antibiotics not help?
What are the risk factors for this man?

21. Pulmonary embolism

22. CT Pulmonary embolism

23. Perfusion Ventilation mismatch

24. Pulmonary angiogram

25. ECG Tachycardia S1 Q3 T3

26. Questions