Buzzwords

Question 0

Right sided pleuritic chest pain

Answer 0

Most likely pneumonia

Question 1

Stony dull to percuss

Answer 1

Pleural effusion

Question 2

Alveolar bat’s wings, Kerley B lines, Cardiomegaly, Dilated Prominent upper lobe vessels, pleural Effusion (A, B, C, D, E)

Answer 2

Pulmonary oedema

Question 3

Ground-glass appearance on X-ray

Answer 3

Pulmonary fibrosis and respiratory distress syndrome of the newborn

Question 4

Ziehl-Neelson stain positive for acid fast bacilli

Answer 4

TB

Question 5

Caseous necrosis

Answer 5

TB

Question 6

Apical disease

Answer 6

Most likely (secondary) TB; apical lesions is called an Assmann focus!

Question 7

Miliary Tuberculosis

Answer 7

Spread of organism into the bloodstream. If organism spread via pulmonary artery, miliary dessemination into the lung occurs. If organims spread via pulmonary vein, there is systemic dissemination to the liver, spleen and kidneys

Question 8

Positive anti-glomerular basement membrane antibodies

Answer 8

Goodpasture’s syndrome

Question 9

Chest infection with a parrot/pigeon as pet

Answer 9

Caused by chlamydophila psittaci

Question 10

Dry cough and diarrhoea after holiday abroad, some indication of water spread

Answer 10

Legionella pneumophila (test urine for antigens)

Question 11

Tall, thin young man who indulges in marijuana

Answer 11

Probably pneumothorax (Marfan’s)

Question 12

Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis and weight loss

Answer 12

Sarcoidosis

Question 13

Bronchiole wider than neighbouring arteriole (on CT) (signet ring sign)

Answer 13

Bronchiectasis

Question 14

D sign on X-ray

Answer 14

Empyema

Question 15

Steeple sign on X-ray

Answer 15

Laryngotracheobronchitis/croup

Question 16

Child with barking cough

Answer 16

Croup

Question 17

Pneumocystis pneumonia

Answer 17

HIV (treat with co-tramoxazole [+/- prednisolone if severe])

Question 18

Asthma + nasal polyps + salicylate sensitivity

Answer 18

Samter’s triad

Question 19

Alcoholic (danger of aspiration pneumonia)

Answer 19

Klebsiella pneumoniae

Question 20

Red jelly sputum

Answer 20

Klebsiella pneumoniae

Question 21

Mucoid sputum

Answer 21

Chlamydia psittaci

Question 22

Rusty sputum

Answer 22

Pneumococcal pneumonia

Question 23

Cannonball metastases (also weight loss and haematuria)

Answer 23

Classically from primary renal cell carcinoma

Question 24

Morning headache

Answer 24

Hypercapnia or side effects of organic nitrates

Question 25

ACTH secreting lung tumour

Answer 25

Small cell carcinoma of the lung

Question 26

PTH secreting lung tumour

Answer 26

Squamous cell carcinoma of lung

Question 27

Small-cell carcinoma

Answer 27

Neuroendocrine, highly malignant and may be associated with ectopic endocrine syndromes

Question 28

Increased serum ACE and Ca2+

Answer 28

Sarcoid

Question 29

Eggshell calcification at hilar regions

Answer 29

Silicosis

Question 30

Heart-failure cells seen in alveolar spaces

Answer 30

Macrophages that have absorbed haemosiderin - found in chronic pulmonary oedema and associated (severe) left-ventricular heart failure. Also seen in long-standing pulmonary hypertension

Question 31

Ghon focus

Answer 31

An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in tuberculosis infection. Note: Ghon focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculosis pleurisy.

Question 32

Assmann focus

Answer 32

Apical lesion of secondary tuberculosis infection

Question 33

Coin lesion found on chest radiographs

Answer 33

A rounded solitary lesion. The common lesions are: primary bronchial or lung carcinoma, metastatic tumour (especially of kidney), bronchial hamartoma, carcinoid tumour, granulomatous inflammation, lung abscess.

Question 34

Horner's syndrome

Answer 34

Can occur when there is a local spread of cancer to the intrathoracic nodes or a Pancoast's tumour. Signs include: ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil), and lack of sweating on the ipsilateral (same side as invasion) side of face. This is due to invasion of the cervical sympathetic chain.

Question 35

Acute management of asthma: OSHIT MAN

Answer 35

``` Oxygen 100% through a non-rebreather mask Salbutamol nebulised back-to-back Hydrocortisone IV or prednisolone PO Ipratropium Bromide nebulised hourly Theophylline IV or aminiophylline IV Magnesium and call an Anaesthetist ```

Question 36

Thumbprint sign on head x-ray

Answer 36

Epiglottitis

Question 37

Inspiratory whoop/barking cough

Answer 37

Pertussis

Question 38

Snow storm appearance on x-ray

Answer 38

Baritosis, silicosis

Question 39

Management of infective exacerbation of COPD: iSOAP

Answer 39

``` i - ipratropium S - Salbutamol O - Oxygen A - Amoxicillin P - Prednisolone ```

Question 40

Non-smoker and lung cancer =

Answer 40

Peripheral adenocarcinoma

Question 41

Squamous and small-cell lung cancers =

Answer 41

CENTRAL

Question 42

High d-dimers

Answer 42

Suspect (but not diagnose) pulmonary embolism (send for CTPA or V/Q scan)

Question 43

Low d-dimers

Answer 43

Exclude pulmonary embolism

Question 44

Large PE

Answer 44

Thrombolysis

Question 45

Small PE

Answer 45

Low molecular weight heparin

Question 46

PE risk factors (8 H's)

Answer 46

``` Hereditary e.g. factor V Leiden History - previous DVT or PE Hypomobility e.g. fracture or long trip Hypovolaemia e.g. dehydration Hypercoaguability e.g. smoking Hormones e.g. Oestrogen Hyperhomocysteinemia Hyperviscosity states e.g. malignancy , post surgery ```