[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 the acute medical unit on account of shortness of breath.  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/138191701″][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_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has atrial fibrillation and pulmonary fibrosis.

The clinical signs exhibited in this video include:

  1. An irregularly irregular pulse;
  2. An obvious tan line at the shirt sleeves;
  3. Normal chest expansion;
  4. Fibrotic sounding crackles at the lung bases and in the lower mid-axillary lines.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]Pulmonary fibrosis may arise for a number of reasons, and in this case it is not possible to determine what might have caused the patient’s condition.  However, a candidate could choose to speculate that amiodarone may be one possible cause on account of the patient’s arrhythmia and the fact that they have a tan line.  If making this argument, a candidate should recognise that AF is common, as are sun tans, and that other diagnoses may well also account for the pulmonary fibrosis.

Common drug causes of pulmonary fibrosis include:

  • Amiodarone;
  • Bleomycin;
  • Methotrexate;
  • Nitrofurantoin.

However, more than 600 drugs have been at one time or another associated with pulmonary fibrosis with varying degrees of certainty.  For this reason it is important to establish a temporal association with a potential offending agent and also ensure exclusion of other causes of pulmonary fibrosis.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient is in atrial fibrillation and has fine basal crackles in keeping with lower zone pulmonary fibrosis.  I would like to take a full history from the patient and investigate further with a chest x-ray, venous bloods and spirometry.  I would also consider a high resolution CT scan of the patient’s chest.  It is possible the pulmonary fibrosis is caused by medication, such as amiodarone, given the patient’s arrhythmia and tan.  However, I would also like to exclude other causes such as usual interstitial pneumonitis or non-specific pneumonitis.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]