[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 been referred in to the acute medical take on account of breathlessness.  Please examine their respiratory system and present your findings to the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191710″][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 pneumonia.

The clinical signs exhibited in this video include:

  • Reduced tactile vocal fremitus over the right lower zone;
  • Whispering pectoriloquy on the right;
  • Crepitations in the right lower lung field.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]Pneumonia is defined as an acute infection of lung parenchyma with recently developed segmental, lobar or multi-lobar radiological shadowing. This acute respiratory illness causes air sacs or alveoli to be inflamed and filled with fluid or pus leading to breathing difficulties.

One of the top ten causes of death, pneumonia doesn’t necessarily need a particular pre-disposing condition, yet some conditions do pre-dispose to this infection, which include:

  • Alcoholism
  • Diabetes mellitus
  • Smoking
  • Malnutrition
  • Bronchial obstruction
  • Immunosupression

Pneumonia occurring during a hospital stay is hospital-acquired pneumonia, commonly caused by;

  • E-coli
  • Enterobacteria
  • Pseudomonas

Most cases however are community-acquired pneumonia, and are caused by;

  • Streptococcus pneumoniae (most common)
  • Viruses (in children below 5)

Clinical signs of bacterial pneumonia include;

  • Fever >38C
  • Tachypnea >18/min
  • Tachycardia >100/min
  • Dyspnea
  • Central cyanosis
  • Altered mental state
  • Crepitations and / or bronchial breathing in the affected lung field.

Physical examination may also reveal specific findings including decreased intensity of breath sounds, additional sounds like crackles/rales and ronchi, egophony, tracheal deviation evident on palpation, dullness on percussion, pleural friction rub and lymphadenopathy.

Single most important initial investigation to diagnose any type of pneumonia is chest X-ray, which shows homogenous opacity localized to the affected lobe. Other investigations include;

  • FBC
  • Pathogenic specific tests (urine assays and immune serologic tests)
  • Blood culture
  • Arterial blood gases
  • Serum electrolytes and urea
  • Liver function tests
  • CRP

Severity of disease and risk of death can be very well assessed by PSI (pulmonary severity index) and Curb-65 , a score indicating the need of hospitalization. One point is given for each of these features;

  • Age >65
  • Confusion
  • Urea
  • Respiratory distress
  • Blood pressure low

While antibiotic treatment forms the mainstay of the management of pneumonia, a number of supportive measures are also taken, including;

  • Analgesics
  • Anti-pyretics
  • Chest physiotherapy
  • Iv fluids
  • Oxygen supplementation
  • Pulse oximetry with cardiac monitoring
  • Propped up position reducing the risk of aspiration
  • Respiration therapy (including bronchodilators)
  • Suctioning
  • Proper hydration
  • Nutrition
  • Mobilization

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has clinical signs in keeping with consolidation in the right lower zone.  They have reduced tactile vocal fremitus, whispering pectoriloquy and crepitations all localising to the same area.  I would like to confirm my findings with a chest x-ray.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]