[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left”][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 some non-specific chest pain.  Please examine their respiratory system and discuss your findings with the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191702″][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”][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 a left upper lobectomy (or thoracotomy) scar.

The clinical signs exhibited in this video include:

  1. A left /lobectomythoracotomy scar;
  2. Reduced expansion on the left hemithorax;
  3. Hyper-resonant percussion of the left upper zones;
  4. Absent breath sounds throughout theleft upper zone.

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]A lobectomy gives rise to subtle clinical signs. It can be difficult clinically, through physical examination alone to differentiate between a pneumonectomy and lobectomy as the scar is often the same.

To help differentiate between a pneumonectomy and a lobectomy, remember the following:

  • in a lobectomy, the clinical signs will be confirmed in the area of the lobe directly
  • in a pneumoectony, the entire lung is involved and mimics the signs of a ling collapse (which you could also get in the exam, but would not be associated with a scar)
  • the trachea placement, a contentious area of respiratory examination (due to its dubious clinical value) would be normal in a lobectomy and deviated towards the side of the pneumonectomy in the latter

By far the most common indication for a lobectomy is lung cancer (preferred over pneumonectomy if possible due to reduced complications and surgical difficulty). Other causes include:

  • Infections:
    • pulmonary abscesses
    • tuberculosis
    • fungal infections
  • Chronic conditions:
    • emphysema and benign tumours (carcinoid for example)

Complications of the procedure in order of commonality include:

  • prolonged air leak (most common)
  • atelectasis
  • pneumonia
  • pulmonary haemorrhage
  • death
  • empyema
  • acute respiratory distress syndrome
  • bronchopleural fistula(e)

You should also be aware of the development of atrial fibrillation, so when examining the patient ensure that you note whether the pulse regular, regularly irregular or irregularly irregular.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has had a previous left pneumonectomy.  They have a left thoracotomy scar and have reduced breath sounds throughout the left hemithorax.  I also note that they have nicotine-stained fingers.  It is possible that the pneumonectomy was conducted on account of lung cancer.  I would like to investigate with routine venous bloods, a chest x-ray and depending on the clinical presentation a CT scan of the chest.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]