Respiratory Medicine: Clinical Cases Uncovered

271 Pages·2008·1.97 MB·English

by  Emma Baker

Respiratory
Medicine
CLINICAL CASES UNCOVERED
This book is dedicated to Belinda Brewer and her thirst for lifelong learning
Respiratory
Medicine
CLINICAL CASES UNCOVERED
Emma H. Baker
PhD, FRCP
Reader in Clinical Pharmacology and Consultant Physician
St George’s, University of London
London, UK
Dilys Lai
MD, MRCP
Consultant in Respiratory and General Medicine
Chelsea and Westminster Hospital
London, UK
A John Wiley & Sons, Ltd., Publication
This edition fi rst published 2008, © 2008 by E. H. Baker and D. Lai
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Library of Congress Cataloguing-in-Publication Data
Baker, Emma.
Respiratory medicine : clinical cases uncovered / Emma Baker, Dilys Lai.
p. ; cm.
Includes index.
ISBN 978-1-4051-5895-4 (alk. paper)
1. Respiratory organs–Diseases–Case studies. 2. Respiratory organs–Diseases–
Examinations, questions, etc. I. Lai, Dilys. II. Title.
[DNLM: 1. Respiratory Tract Diseases–Case Reports. 2. Respiratory Tract
Diseases–Problems and Exercise. 3. Signs and Symptoms, Respiratory–Case
Reports. 4. Signs and Symptoms, Respiratory–Problems and Exercises.
WF 18.2 B167r 2008]
RC732.B34 2008
616.2–dc22
2007050635
ISBN: 978-1-4051-5895-4
A catalogue record for this book is available from the British Library
Set in 9/12pt Minion by SNP Best-set Typesetter Ltd., Hong Kong
Printed in Singapore by COS Printers Pte Ltd
1 2008
Contents
Preface, vii
Acknowledgements, viii
How to use this book, ix
Part 1 Basics, 1
Basic science, 1
Approach to the patient, 17
Part 2 Cases, 41
Case 1 A 64-year-old man with respiratory arrest, 41
Case 2 A 19-year-old man with chest tightness, 46
Case 3 A 31-year-old woman with poorly-controlled asthma, 51
Case 4 A 22-year-old man with life-threatening shortness of breath, 60
Case 5 A 65-year-old man with worsening shortness of breath, 68
Case 6 A worried 56-year-old man, 75
Case 7 An 81-year-old man with acute shortness of breath, 80
Case 8 A 73-year-old woman with confusion, 87
Case 9 A 78-year-old man with ankle swelling, 92
Case 10 A 72-year-old man with a hoarse voice, 98
Case 11 A 56-year-old woman with an abnormal chest X-ray, 106
Case 12 A 68-year-old man with shortness of breath and chest pain, 112
Case 13 A 16-year-old boy with right-sided chest pain, 117
Case 14 A 62-year-old woman with breathlessness, 124
Case 15 A 24-year-old woman with pleuritic chest pain, 129
Case 16 An elderly woman who collapsed suddenly, 139
Case 17 A 45-year-old man with chest pain and breathlessness, 148
v
vi Contents
Case 18 A 72-year-old man who becomes breathless during inpatient stay on a medical
ward, 156
Case 19 A 58-year-old woman with breathlessness following surgery, 162
Case 20 A 16-year-old boy with a sore throat, 169
Case 21 A 45-year-old woman with a chronic cough, 174
Case 22 A 17-year-old girl with cystic fi brosis, 179
Case 23 A 25-year-old woman with cough and weight loss, 186
Case 24 A 44-year-old man commencing treatment for tuberculosis, 196
Case 25 A 32-year-old man who absconds from directly observed therapy for
tuberculosis, 201
Case 26 A 32-year-old woman with a skin rash and abnormal chest X-ray, 207
Case 27 A 68-year-old woman with worsening breathlessness on exertion, 213
Case 28 A 35-year-old man with chronic shortness of breath, 220
Case 29 An overweight 52-year-old man who snores, 226
Part 3 Self-assessment, 232
MCQs, 232
EMQs, 237
SAQs, 243
Answers, 245
Index of cases by diagnosis, 251
Index, 253
Preface
Medicine is a mass of facts and complex science, which used to explore the cases are real questions posed by
can be dull and indigestible. It is brought to life by students during our teaching sessions and the answers are
patients with their individual stories, clinical mysteries the end product of many attempts to answer these ques-
and their need for help. Medicine is probably best learnt tions satisfactorily. As experienced examiners we have
through clinical experience backed up by information ensured that material covered in this book is suffi cient
and refl ection. However in modern medical practice for students to pass respiratory sections of undergraduate
there is often too much to do and too little time for or general postgraduate exams. This book will also be
consideration. a useful aid to practice for junior doctors and allied
This book is one of the fi rst in a novel series that allows health professionals looking after patients with respira-
the reader to experience a virtual clinical attachment tory disease and as basic revision for doctors entering
with enough time for refl ection and teaching. Patients are specialist respiratory training.
described as they really present to hospital or general We have written the text book that we would have liked
practice. The clinical reasoning required to explain symp- to use to learn respiratory medicine. If we were starting
toms and signs, order and interpret investigations and again we would begin with the patients, attempting to
start management is demonstrated as the case develops. answer the questions posed throughout the cases alone
Relevant science is described in context to support under- or in groups before reading the written answers and rel-
standing and patients are managed according to current evant science. During relevant clinical attachments we
guidelines. This format will allow the reader to develop would use the book to update clinical skills and practice
knowledge and skills that are immediately useful for OSCE checklists. In preparation for exams we would
patient management, rather than to accumulate facts that revise case summaries and key points and practice the self
need a lot more work to translate them into practice. assessment questions. We hope you will enjoy using it and
Twenty nine patients with respiratory disease are pre- that it will help you understand respiratory medicine for
sented in the book, providing experience of the full the benefi t of patients.
breadth of adult respiratory medicine. We have chosen
these cases as they are common problems that will be Emma H. Baker
encountered at some point by all doctors in clinical prac- Dilys Lai
tice, no matter what fi eld they end up in. Many questions 2008
vii
Acknowledgements
The authors gratefully acknowledge the help of the versity of London for endless production of fantastic
following: illustrations; Sue Adie for tireless administrative support;
Dr Belinda Brewer for invaluable comments on the man- and Dr Adrian Draper, Dr Yee Ean Ong, Dr Deirdre
uscript; Dr Cathy Corbishley for generous donation of McGrath, Dr Laurie Hanna, Dr Sisa Grubnic, Dr Claire
pathology slides from her personal collection; Mr Harry Wells, Dr Stephen Thomas, nursing staff on Marnham
Young for his wonderful contribution to student educa- ward, Reg Ramai and Paula Mclean for provision of clin-
tion as a patient and for modelling for this book; Mark ical material and other assistance.
Evenden and staff of media services at St George’s, Uni-
viii
How to use this book
Clinical Cases Uncovered (CCU) books are carefully test your learning with several question styles (MCQs,
designed to help supplement your clinical experience and EMQs and SAQs), each with a strong clinical focus.
assist with refreshing your memory when revising. Each Whether reading individually or working as part of a
book is divided into three sections: Part 1, Basics; Part 2, group, we hope you will enjoy using your CCU book. If
Cases; and Part 3, Self-Assessment. you have any recommendations on how we could improve
Part 1 gives a quick reminder of the basic science, the series, please do let us know by contacting us at:
history and examination, and key diagnoses in the area. [email protected].
Part 2 contains many of the clinical presentations you
would expect to see on the wards or crop up in exams, Disclaimer
with questions and answers leading you through each CCU patients are designed to refl ect real life, with their
case. New information, such as test results, is revealed as own reports of symptoms and concerns. Please note that
events unfold and each case concludes with a handy case all names used are entirely fi ctitious and any similarity to
summary explaining the key points. Part 3 allows you to patients, alive or dead, is coincidental.
ix