Clinical cases
22 cases. Listen to the patient from the back and the front, compare symmetrical points, ask for a manoeuvre when needed and answer the questions.
Airway diseases
A 24-year-old woman has had episodes of breathlessness and night-time cough since childhood. Her symptoms have worsened over the past two days, after a cold.
A 68-year-old man with COPD has had increasing breathlessness for three days. His sputum has increased and become thicker.
A 46-year-old woman has had a daily cough with copious sputum since a severe pneumonia in childhood. She has several lower respiratory tract infections each year.
A 63-year-old man has had cough and wheezing for three months. He smokes and has a 45 pack-year history.
A 3-year-old boy had a sudden coughing and choking episode two days ago while eating peanuts. He settled once it passed.
Parenchyma and interstitium
A 58-year-old man has had fever and a cough with purulent sputum for three days. He also has right lower chest pain that worsens when he breathes in.
A 34-year-old woman has had fever, a productive cough and right anterior chest pain for four days. The pain worsens when she breathes in.
A 67-year-old man has had a dry cough and breathlessness that worsens on exertion for 18 months. He smoked 30 pack-years and stopped 10 years ago.
A 46-year-old woman has had colour changes in her fingers in the cold for three years. Over the past year the skin of her fingers has become thickened.
A 52-year-old man has kept pigeons for 20 years. He has had gradually increasing breathlessness and a dry cough for six months.
A 35-year-old woman has had a dry cough, breathlessness on exertion and fatigue for two months. Her chest X-ray shows bilateral hilar lymphadenopathy and reticulonodular opacities in the upper and mid zones.
Heart, circulation and pulmonary oedema
A 74-year-old man has hypertension and had a myocardial infarction five years ago. Tonight he woke from sleep with a feeling of suffocation.
A 71-year-old woman with known COPD has had increasing breathlessness for a week. She has orthopnoea and ankle oedema, and she has gained 3 kg.
A 79-year-old woman is followed up for chronic heart failure (EF 30%). She has taken her medicines irregularly for two weeks.
A 62-year-old woman had a knee replacement ten days ago and has spent most of the time since in bed. Yesterday she developed sharp right lower lateral chest pain that worsens when she breathes in, and she coughed up blood-stained sputum once.
Pleura
A 70-year-old woman has had gradually increasing breathlessness and a feeling of heaviness on the right side for three weeks. She has no fever.
A 61-year-old man was started on oral antibiotics a week ago for left lower lobe pneumonia, but his fever has not settled. Over the past two days his left-sided pain and breathlessness have been increasing.
A tall, thin 27-year-old man developed sudden left-sided chest pain and breathlessness while at rest. He smokes.
A 38-year-old woman with systemic lupus erythematosus has had sharp pain in the left lower lateral chest for two days. The pain worsens when she breathes in.
Upper airway and intensive care
A 64-year-old man was extubated two hours ago after five days of mechanical ventilation. His breathlessness and noisy breathing are getting worse.
A 63-year-old man has been intubated and mechanically ventilated for four days with pneumonia. Yesterday's X-ray showed his infiltrates regressing.
Examination technique
Switch between the "Back" and "Front" views of the diagram. In the back view, your left is the patient's left. In the front view, your left is the patient's right. Each point plays a different sound. "T" is the trachea in the neck. The manoeuvre button (cough, deep breath, bronchodilator) changes the sound at some points. No change is also a finding.