Question 2 from the second paper of 2010 is a question about the differential diagnosis of wheeze. There can be a myriad answers.
UpToDate even has a page about this sort of thing.
Causes of widespread wheeze
- Extrathoracic causes
- Anaphylaxis
- Vocal cord paralysis
- Laryngeal stenosis
- Goiter with thoracic inlet obstruction
- Anxiety with hyperventilation
- Intrathoracic central airway causes
- Tracheal stenosis
- Mediastinal tumours
- Hyperdynamic airway collapse due to tracehomalacia
- Mucus plugs
- Thoracic aortic aneurysm
- Foreign body inhalation
- Intrathoracic lower airway causes
- Bronchitis or bronchiolitis
- COPD
- Pulmonary oedema - "cardiac asthma"
- Airway distortion due to mechanical causes, eg. bronchial mass, bronchiectasis, pneumothorax
- Exposure to inhaled irritant or corrosive agent, and this includes the aspiration of gastric contents
Causes of unilateral wheeze
The differential diagnosis of a unilateral wheeze really comes down to how many different ways of obstructing a main bronchus you can think of.
- ETT malposition
- foreign body
- blood clot
- Sputum secretions
- Tumour
- Bronchogenic carcinoma
- Thymus carcinoma
- Retrosternal goitre
- compression by lymph nodes
- compression by aortic aneurysm
- traumatic dissection
- Bronchial stenosis post infection
- Bronchiectasis
- Bronchial compression by enlarged left side of heart