Pulmonary Vascular Diseases and Pleural Disorders — WACS Viva & Clinical Scenarios (Respiratory Medicine)

Exam-style pulmonary vascular diseases and pleural disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 42-year-old woman presents to the emergency department with sudden-onset severe dyspnoea, pleuritic chest pain, and lightheadedness 10 days following an uncomplicated total abdominal hysterectomy. On examination, she is in marked respiratory distress, blood pressure is 80/50 mmHg, heart rate is 128 beats per minute, respiratory rate is 32 breaths per minute, and oxygen saturation is 86% on ambient air. Jugular venous pressure is elevated with prominent v waves. Outline the immediate diagnostic risk stratification, bedside investigations, and emergency resuscitation and reperfusion strategy f
• SCENARIO 2: A 35-year-old male with poorly controlled type 2 diabetes presents with a 1-week history of right-sided pleuritic chest pain, high-grade fever, productive cough with purulent sputum, and progressive breathlessness. Chest radiography reveals a moderate right-sided pleural effusion with underlying consolidation. Diagnostic thoracentesis yields cloudy, purulent pleural fluid. Detail the clinical, biochemical, and microbiological criteria used to differentiate an uncomplicated parapneumonic effusion from a complicated effusion and thoracic empyema, and outline the comprehensive management plan inc
• SCENARIO 3: A 28-year-old woman presents with progressive exertional dyspnoea (New York Heart Association Functional Class III), fatigue, and presyncope over the past 8 months. Physical examination demonstrates an accentuated second heart sound with a loud pulmonic component, a parasternal heave, and an early systolic murmur at the left upper sternal border. Transthoracic echocardiography reveals right ventricular hypertrophy, right atrial dilatation, and estimated pulmonary artery systolic pressure of 68 mmHg without left heart structural abnormalities. Describe the systematic diagnostic algorithm to cla
• SCENARIO 4: A 50-year-old man presents with a 4-week history of dry cough, low-grade evening fevers, night sweats, anorexia, significant weight loss, and dull right-sided chest ache. Diagnostic thoracentesis yields straw-coloured exudative fluid with high lymphocyte predominance. Discuss the diagnostic strategy to confirm tuberculous pleurisy, the specific laboratory biomarkers and microbiological assays used on pleural fluid, the indications and technique for closed pleural biopsy, and the differentiation of this condition from malignant pleural effusion.
• SCENARIO 5: A 22-year-old tall, slender male with no prior medical history presents to the emergency unit with acute-onset sharp left-sided chest pain and rapidly worsening dyspnoea that began while at rest. Examination reveals tachypnoea, cyanosis, tracheal deviation to the right, hyper-resonance to percussion over the left hemithorax, absent breath sounds on the left, and a blood pressure of 82/54 mmHg. State the immediate life-saving intervention, the anatomical landmark for needle decompression, the subsequent definitive management using tube thoracostomy, and the physiological principles of the under