Each station in the PACES has cases that occur more commonly than others. This is due to a number of factors that include the number of patients with the conditions, being able to elicit decent clinical signs and create a ‘story’ out of very little history or background information.
For the respiratory station there are only a limited number of conditions that can come up, and the most common really do occur commonly. This is due to the fact that there are not many different lung sounds that exist that can be used to differentiate conditions. You will find most conditions are either diagnosed before you listen to the chest, or only through listening to the chest, with little or no clue prior to auscultating.
The most common condition in the respiratory station is interstitial lung disease which has been found by various surveys to make up at least one-third of the patients, and is primarily diagnosed through listening to the lungs. This is not hard to determine why – there are characteristic clinical auscultatory features and it is a very common condition in respiratory medicine.
Other common cases include dullness at the lung base – see how I have not said pleural effusion. There are a number of causes of dullness at the lung base. While the most common is a pleural effusion, be careful not to ignore the other causes and get caught out. However, I remember during my preparation listening to dullness at the lung base of the patient and assuming it was a diaphragmatic paralysis, as I had learnt so much about the weird and wonderful that I lost sight of the most obvious! So do not forget about the most obvious causes either.
Other common cases include chronic obstructive pulmonary disease, bronchiectasis, pneumonectomy or lobectomy, rheumatoid lung, pneumonia, and kyphoscoliosis.
Old tuberculosis is another commonly appearing case in the UK. If, however, you are taking the exam in a country that has a far greater prevalence of tuberculosis, such as the Indian-Subcontinent or the Middle East then current active tuberculosis will appear more commonly.