[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]”This patient has presented to A&E with non-specific chest pain. Please examine their respiratory system to identify why then tell the examiners what signs you find and discuss your proposed management”[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191690″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station Time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][/vc_column][/vc_row]
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This patient has absent breath sounds at the left base.
The arterial blood gas analysis shows hypoxia and hypercapnoea which indicates respiratory failure. This patient has had an injury of spinal at the level of C5-C6 which can cause paralysis of both abdominal and intercostal muscles.
The most common causes of bilateral diaphragmatic paralysis are the motor neuron and the generalized muscle diseases. Post-viral neuropathy can cause potentially reversible diaphragm paralysis. Thyroid disease appears to cause reversible respiratory muscle weakness through both neuropathy and myopathy. Involvement of cervical spinal with large tumors or spinal cord transaction may result in permanent diaphragmatic paralysis.
Diaphragmatic electromyography (EMG) is technically difficult and as a result, the results are difficult to interpret. It is however, useful to help differentiate between a myopathy and a jueropthay as the cause. The gold standard for the diagnosis of diaphragmatic paralysis is the objective measurement of transdiaphragmatic pressure.
Other investigations include ultrasound which is exceedingly useful and fluoroscopy of the diaphragm, the latter is better for unilteral compared to bilateral diaphragmatic paralysis.
Unilateral diahpragmatic paralysis is often asymptomatic and hence the true incidence is not known. The most common causes are again traumatic, primary muscle disorders and any lung pathology that causes hyperinflation of the lung, such as COPD, as well as mediastinal masses. In unilateral diaphragmatic paralysis, symptoms often only develop when recumbant or during attempts of intense activity.
When clinically attempting to differentiate between a pleural effusion and a unilateral diaphragmatic paralysis, the expansion of the chest is key, as there can be dull ercussion at the base of the affected lung, with reduced breath sounds. However, in a pleural effusion, there is reduced chest expansion, whereas in an unilateral diaphragmatic paralysis there tends not to be.
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Question 1 of 3
What clinical signs can be heard in the patient’s chest?CorrectIncorrect
Question 2 of 3
A 36-year old male was admitted to the intensive care unit after fall from a height of 15 metres. He complains of pain at the back of his neck. A CT scan of his cervical spine revealed a non-displaced fracture at the level of C5-C6. About 10 hours later, his oxygen saturation dropped down to 88%, on air. An arterial blood gas analysis revealed PaO2 of 9.2kPa and PaCO2 of 7kPa. Which of the following statements are correct about the condition of this patient? More than one answer may be correct.CorrectIncorrect
Question 3 of 3
The clinical features of unilateral diaphragmatic paralysis can be differentiated from a unilateral pleural effusion by the following:CorrectIncorrect