CardioResp

Question 1

List the cardiac questions

Answer 1

Chest pain
SOB
Palpitations
Dizziness/syncope
Orthopnoea/PND
Peripheral oedema

Question 2

List modifiable and non modifiable risk factors for IHD

Answer 2

Modifiable:
Hypertension
Diabetes
Obesity
Hypercholesterolaemia 
Smoking
Non modifiable:
Age
Gender
Family history

Question 3

List cardiac differentials for breathlessness

Answer 3

Acute - severe pulmonary oedema, MI, arrhythmia, pericardial disease with effusion
Chronic - LV dysfunction, valvular disease, arrhythmia, pericardial disease with effusion, coronary artery disease

Question 4

Describe the NYHA classification of chronic heart failure

Answer 4

I - no limitation of physical activity, fatigue, breathlessness, palpitation
II - slight limitation of physical activity + angina
III - marked limitation of physical activity, moderate HF
IV - inability to carry out any physical activity without discomfort, severe HF

Question 5

List differentials for chest pain

Answer 5

Cardiac - MI, angina, pericarditis
Aortic dissection
Lung/pleura - pneumothorax
MSK - inflammation
Oesophagus - GORD, gastritis

Question 6

Explain ECG axis

Answer 6

aVL - -30
I - 0
II - +60
aVF - +90
III - +120
aVR - -150

Question 7

How is an ECG calibrated?

Answer 7

Paper runs at 25 mm/s
One large square - 5mm = 0.2s
Five large squares = 1s (300/min)
Rate = 300/R-R

Question 8

Describe the protocol for interpreting an ECG

Answer 8

1. Machine in working order? 25mm/a
2. Check correct person “12 lead ECG of…”
3. Rate - regular (300/RR) or irregular (QRSs x 6)
4. Rhythm - P wave preceded by QRS = sinus. AF = absent P waves, irregular. Atrial flutter = saw tooth P waves, block. VT = 120-180, broad QRS. VF/asystole = capture or fusion beats, concordance.
5. Axis
6. Intervals - PR, QRS complex, QT
7. ST segment/T wave changes
8. R wave progression

Question 9

List the possible locations of ischaemia according to ECG changes

Answer 9

V1-V4 - anteroseptal, LAD
V1-V6 - anteroapical, LAD
V4-V6 - anterolateral, LAD
V5-V6, I, aVL - lateral, circumflex
II, III, aVF - inferior, circumflex, RCA
V7-V9 - posterior, circumflex

Question 10

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of aortic stenosis

Answer 10

Pale, sweaty, elderly
Sinus rhythm, tachycardia, low BP
Low volume, slow rising pulse
Normal JVP
Apex non displaced, pressure loaded
Thrill
Ejection systolic, crescendo decrescendo, radiates to carotid (LUB SH DUB)

Question 11

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of aortic regurgitation

Answer 11

Corrigan’s, de Musset’s, quincke’s, pistol shot femoral
Normal pulse, wide pulse pressure
High volume, collapsing pulse
Normal JVP
Displaced, volume loaded thrill
No thrill
High pitched diastolic murmur, heard best at left sternal edge in expiration with patient leaning forward (LUB DUB SH)

Question 12

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of tricuspid regurgitation

Answer 12

COPD/lung disease, elephant ears, pulsatile liver
Normal pulse and BP
JVP - giant V waves, sharp Y descent
Normal apex beat
Right ventricular heave
Pansystolic murmur at lower sternal edge, heard best in inspiration (LUB ZZZ DUB)

Question 13

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of mitral stenosis

Answer 13

Mitral facies (malar flush)
AF
Normal or low volume pulse
Raised JVP
Non displaced, tapping (open snap) apex beat
Right ventricular heave
Rumbling, mid diastolic murmur, heard best with bell in expiration with patient rolled to left (LUB DUB RRR)

Question 14

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of mitral regurgitation

Answer 14

Normal general appearance, connective tissue disorder, pulse (maybe AF), blood pressure and JVP
Displaced, volume loaded apex beat
Right ventricular heave, thrill (rare)
Pansystolic murmur radiates to axilla (LUB ZZZ DUB)

Question 15

Describe the general appearance, pulse rate and rhythm, volume and character, internal jugular, apex beat, palpation and auscultation findings of a small VSD

Answer 15

Normal appearance, pulse, block pressure, JVP and apex beat
Thrill at lower left sternal edge
Loud, harsh pansystolic murmur (LUB ZZZ DUB)

Question 16

List differentials of bradycardia on ECG

Answer 16

Sinus node disease, sinus bradycardia

AV block

Question 17

Describe the different types of heart block

Answer 17

1st degree - widened PR
2nd degree:
Mobitz I/Wenkebach) - progressive lengthening until a dropped QRS = longer longer longer drop
Mobitz II - intermittent failure of AVN = Ps don’t get through
3rd degree/complete - no synchronisation between Ps and QRS
*escape rhythm will be regular

Question 18

Define trifascicular block

Answer 18

Bundle branch block
Left axis deviation
Widened PR interval

Question 19

List differentials of tachycardia on ECG

Answer 19

Narrow complex, regular - sinus tachycardia, SVT, AVRT, AVNRT, atrial flutter, atrial tachycardia
Narrow complex, irregular - AF

Broad complex, regular - antidromic AVRT, VT/BBB
Broad complex, irregular - AF, atrial flutter, pre excited AF, toursades de points

Question 20

List management of tachycardia

Answer 20

Narrow complex - ABC, O2, IV access, fatal manouvres, adenosine 6mg, antiarrhythmic, DC cardioversion (if haemodynamically unstable)
Broad complex - ABC, arrest call if pulseless, amiodarone/lidocaine, K+/Mg2+ if needed, sedation, DC cardioversion

Question 21

Define atrial fibrillation

Answer 21

Abnormal heart rhythm, irregular beating of atria

Absent P waves, irregularly irregular on ECG

Question 22

List some risk factors for AF

Answer 22

Hypertension, valvular heart disease, coronary artery disease, cardiomyopathy
COPD, sleep apnoea, obesity
Excess alcohol, diabetes, thyrotoxicosis

Question 23

Describe the types of AF

Answer 23

Paroxysmal - spontaneously back to normal <7 days
Persistent - back to normal with assistance/>7 days
Long standing persistent/permanent

Question 24

List some signs and symptoms of AF

Answer 24

Asymptomatic, palpitations, angina, SOB, tachycardia, irregularly irregular pulse

Question 25

Describe the management of AF

Answer 25

1. Rhythm control - cardioversion (DC/amiodarone/procainamide) 2. Rate control - B blockers (bisoprolol, metoprolol), CCB (diltiazem, verapamil), digoxin, amiodarone 3. Thromboembolic prophylaxis - warfarin/NOAC

Question 26

List contraindications of flecainide

Answer 26

Structural heart disease | IHD

Question 27

What is the CHA2DS2VASC score and when is it used?

Answer 27

``` To determine if anticoagulation is necessary in AF Congestive heart failure = 1 Hypertension = 1 Age >75 = 2 Diabetes = 1 Stroke/TIA/thromboembolism history = 2 Vascular disease (peripheral artery disease, MI, plaque) = 1 Age 65-74 = 1 Sex female = 1 ``` >1 consider anticoagulation therapy >2 anticoagulation is recommended

Question 28

Explain HASBLED score

Answer 28

``` HTN = 1 Abnormal liver or renal function = 1 Stroke = 1 Bleeding = 2 Labile INR = 1 Elderly = 1 Drugs - NSAIDS, alcohol = 1 ```

Question 29

What anticoagulation is used for thromboembolic prophylaxis in patients with AF

Answer 29

Warfarin - inhibits vitamin K dependent synthesis of clotting factors *INR monitoring, mechanical valve, moderate/severe mitral stenosis Dabigatran - thrombin inhibitor Rivaroxaban - factor Xa inhibitor Apixaban - factor Xa inhibitor

Question 30

List scoring systems used in a patient with AF

Answer 30

CHA2DS2VASC HASBLED* HEMORR2HAGES* *bleeding risk

Question 31

Define the Sokolow-Lyon voltage criteria for LVH

Answer 31

S wave in V1 + R wave in V5/6 = >35 mm or 3.5 large squares

Question 32

Describe ECG changes of an MI

Answer 32

Acute - ST elevation Recent - T wave inversion, pathological Q waves Old - pathological Q waves remain New onset LBBB

Question 33

Describe ECG changes of a PE

Answer 33

s1, q3, t3 Large S wave in lead I Q wave inversion in lead III T wave inversion in lead III

Question 34

Describe ECG changes in hyperkalaemia

Answer 34

Low flat P waves Broad bizarre QRS Slurring into ST segment Tall tented T waves

Question 35

List some causes of heart failure

Answer 35

``` IHD Non ischaemic dilated cardiomyopathy Hypertension Valvular disease Congenital heart disease Arrhythmias Anaemia Thyrotoxicosis Paget's Pericardial disease Right HF Alcohol/drugs e.g. chemotherapy ```

Question 36

List pathophysiological changes in heart failure

Answer 36

``` Ventricular dilatation Myocyte hypertrophy ANP secretion Salt/water retention Sympathetic stimulation Peripheral vasoconstriction RAS/adrenergic activation ```

Question 37

List signs and symptoms of heart failure

Answer 37

Left HF: Fatigue, exertional dyspnoea, orthopnoea/PND, displaced apex beat, gallop rhythm, mitral regurgitation, lung crackles, pitting oedema Right HF: Fatigue, dyspnoea, anorexia/nausea, raised JVP (+/- V waves of tricuspid regurgitation), cardiomegaly, hepatic enlargement, ascites, pitting oedema

Question 38

Explain the Framingham classification for diagnosis of heart failure

Answer 38

2 major OR 1 major + 2 minor Major - PND, crepitations, S3 gallop, cardiomegaly, raised CVP, weight loss >4.5kg in 5 days in response to treatment, neck vein distension, acute pulmonary oedema, hepatojugular reflex Minor - bilateral ankle oedema, dyspnoea on exertion, tachycardia, decreases in vital capacity by half, nocturnal cough, hepatomegaly, pleural effusion

Question 39

Describe the management of heart failure

Answer 39

General - exercise, low salt diet, stop smoking Medical - diuretics (furosemide, bumetinide, thiazides), ACEi/ARB, B blockers, spironolactone, inotropic agents (dopamine, dobutamine, digoxin), nitrates, anticoagulation Non pharmacological - revascularisation, biventricular pacemaker/implantable cardioverter defibrillator, cardiac transplantation, left ventricular assist device/artificial heart

Question 40

List signs of heart failure on CXR

Answer 40

``` Alveolar oedema (bat's wings) Kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Pleural effusions ```

Question 41

Describe the pathophysiology of atherosclerosis and how that leads to ACS

Answer 41

Injury --> lipoproteins oxidise and combine with macrophages --> foam cells --> cytokines --> fat/smooth muscle proliferation --> plaque --> rupture --> platelet aggregation/adhesion --> localised thrombus, vasoconstriction --> MI

Question 42

List the initial management of a patient having an MI

Answer 42

Morphine 2.5-10mg IV + antiemetic (metoclopramide 10mg) Oxygen Nitrates (GTN 2 puffs sublingual) Aspirin 300mg or prasugrel 60mg/ticagrelor 180mg Further management - PCI/thrombolysis

Question 43

List complications of a STEMI

Answer 43

``` Sudden death Pump failure/pericarditis Ruptured papillary muscles/septum Embolism Aneurysm/arrhythmias Dressler's syndrome ```

Question 44

What medication and further advice should an ACS patient be discharged with

Answer 44

``` Aspirin ACEi B blockers (bisoprolol) Clopidogrel/prasugrel Statin (simvastatin) Address modifiable risk factors 1 month off work 4 weeks no driving (inform DVLA) ```

Question 45

Describe the pathophysiology of infective endocarditis

Answer 45

Endothelial damage/damaged valve --> platelet/fibrin deposit (vegetation) --> bacteraemia --> adherence/colonisation = mitral/aortic regurgitation

Question 46

Describe the clinical presentation of infective endocarditis

Answer 46

``` Heart murmur + fever Systemic infection Valvular/cardiac damage (murmur) Embolisation Immune vasculitis (Roth spots, splinter haemorrhages, janeway lesions, oslers nodes) ```

Question 47

Explain the Duke's criteria for infective endocarditis

Answer 47

2 major OR 1 major + 3 minor OR 5 minor Major - positive blood culture (typical organism in 2 separate cultures/persistently +ve blood cultures), endocardium involved (positive echo/new valvular regurgitation) Minor - predisposition, fever >38C, vascular/immunological signs, positive blood culture, positive echo

Question 48

Describe the pathophysiology and causes of pericarditis

Answer 48

Inflamed pericardium --> leukocytes--> vascularisation --> constructive/effusion (tamponade) Causes - viral, TB, idiopathic, bacteria, MI/dressler's, renal failure, RA/sarcoid/SLE

Question 49

List signs, symptoms and treatment of pericarditis

Answer 49

``` Sharp, central chest pain Worse on inspiration Radiates to left shoulder Eased by sitting forward +/- dyspnoea +/- fever Increased heart rate, respiratory rate Pericardial friction rub/knock Kussmaul's sogn Pulsus paradoxus Treatment - treat cause, bed rest, oral NSAIDs/corticosteroid, pericardial window, pericardiectomy ```

Question 50

What are Kussmaul's sign, pulsus paradoxus and beck's triad

Answer 50

Kussmaul's sign - JVP raises paradoxically with inspiration Pulsus paradoxus - systolic pressure weakens in inspiration by >10mmHg Beck's triad - raised JVP, low BP, muffled heart sounds

Question 51

Describe the management of pericardial effusion/cardiac tamponade

Answer 51

*medical emergency* ABC, IV access, ECG, bloods Pericardiocentesis --> drain (Insert needle at level of xiphisternum, aim for tip of left scapula, aspirate continuously)

Question 52

Describe ECG changes of pericarditis

Answer 52

Saddle ST elevation --> T wave flattening --> T wave inversion

Question 53

Describe different types of oxygen devices that provide supplemental oxygen

Answer 53

Nasal cannulae: Non acute situations or mild hypoxia Deliver 24-40% Flow rate 1-4L/min Simple face mask: Step up from nasal cannulae but not fixed FiO2 Delivers 30-40% Flow rate 5-10L/min Venturi mask: Delivers 24-60% (24 blue 2-4L, 28 white 4-6L, 35 yellow 8-10L, 40 red 10-12L, 60 green 12-15L) Non rebreather (reservoir) mask: Acutely unwell patients Delivers 85-90% Flow rate 15L/min NIV (CPAP/BiPAP): CPAP for sleep apnoea, HF, acute PE BiPAP for COPD, atelectasis, ARDS Invasive ventilation: Used in intensive care, theatre Delivers 100%

Question 54

Describe different severities of asthma in an acute setting

Answer 54

Mild - no features of severe, PEFR >75% Moderate - no features of severe, PEFR 50-75% Severe - PEFR 33-50%, cannot complete sentences in one breath, HR >110, RR >25 Life threatening - PEFR <33%, sats <92% or ABG pO2 <8kPa, cyanosis, poor respiratory effort, near or full silent chest, exhaustion, confusion, low BP, arrhythmia, normal pCO2 Near fatal - high pCO2

Question 55

Describe the management of asthma

Answer 55

Chronic: BTS guidelines - SABA --> ICS --> +LABA --> increase dose ICS /+LTRA or theophylline --> increase dose ICS /+LTRA or LAMA --> oral steroid Emergency: ABCDE, O2, ABG if sats <92% 5mg neb. salbutamol 40mg oral prednisolone STAT or IV hydrocortisone 500 micrograms neb. ipratropium bromide (severe) ITU/anaesthetist, IV aminophylline or salbutamol (life threatening/near fatal)

Question 56

Describe the pathophysiology of COPD

Answer 56

Mucous gland hyperplasia Loss of cilia function Emphysema Chronic inflammation Fibrosis of small airways Chronic bronchitis = cough/sputum production on most days for 3 months of 2 consecutive years Emphysema = enlarged air spaces distal to terminal bronchioles with destruction of alveolar walls

Question 57

Describe the management of COPD

Answer 57

Stable: Smoking cessation, pulmonary rehabilitation, diet, vaccinations, antimuscarinic/B2 agonist, steroids (Infective) exacerbation: ABCDE, O2 via Venturi mask, salbutamol nebs/ipratropium bromide, steroid 30 mg STAT then OD, antibiotics, CXR, consider NIV or ITU referral

Question 58

What are the requirements for LTOT?

Answer 58

Non smoker PaO2 <7.3kPa or <8kPa if cor pulmonale 16 hours/day

Question 59

Describe different severities of COPD

Answer 59

``` All FVC <0.7 Stage 1 Mild - FEV1 >80% predicted Stage 2 Moderate - FEV1 50-79% predicted Stage 3 Severe - FEV1 30-49% predicted Stage 4 Very Severe - FEV1 <30% predicted ```

Question 60

List likely organisms for different types of pneumonia

Answer 60

CAP - streptococcus pneumoniae, haemophilis influenza, mycoplasma pneumoniae, staph. aureus, legionella, moraxella catarrhalis, chlamydia HAP - G-be enterobacteria, staph. aureus, pseudomonas, klebsiella, bacteroides Aspiration - orophangeal anaerobes Immunocompromised - pneumocystis jiroveci, strep. pneumoniae, h. influenzae, s. aureus, m. catarrhalis, m. pneumoniae

Question 61

Explain a scoring system used to determine severity of pneumonia

Answer 61

``` CURB-65 Confusion <8 in abbreviated mental test Urea >7 mmol/L RR >30/min BP <90 systolic +/- 60 diastolic >65 years old ``` ``` 0-1 = home treatment 2 = hospital therapy 3 = Severe, consider ITU ```

Question 62

Describe management of pneumonia

Answer 62

ABC - pO2 >8.0 +/- sats >94%, IV fluids, VTE prophylaxis, analgesia Antibiotics according to local guidelines Mild - oral amox (500mg/8h) Moderate - oral amox (500mg/8h) + clarithromycin (500mg/12h) Severe - IV co-amox (1.2g/8h) + clarithromycin (500mg/12h) HAP - aminoglycoside + 3rd gen cephalosporin IV Aspiration - cephalosporin + metronidazole IV

Question 63

List some causes of non resolving pneumonia and some other complications

Answer 63

``` Complications - respiratory failure, hypotension, AF, pleural effusion, empyema, lung abscess, septicaemia, pericarditis, myocarditis, jaundice Host immunocompromised Antibiotic - dose too low Organism - resistance Second diagnosis - PE, cancer ```

Question 64

List some clinical features of TB

Answer 64

Fever, night sweats, malaise, weight loss Respiratory - cough, sputum, haemoptysis, pleural effusion Non respiratory - erythema nodosum, lymphadenopathy, arthralgia, pericardial effusion, meningitis

Question 65

Describe treatment for TB including monitoring required and important ADRs

Answer 65

Check patient's weight Rifampicin, isoniazid, pyrazinamide, ethambutol - 2 months Rifampicin, isoniazid - 4 months Monitor LFTs, visual acuity, counsel re contraception ADRs: Rifampicin - hepatitis, orange secretions, no OCP Isoniazid - hepatitis, peripheral neuropathy, psychosis Pyrazinamide - hepatitis, optic neuritis, vomiting, arthralgia Ethambutol - retrobulbar neuritis

Question 66

List clinical features of pleural effusion and investigations done on pleural aspirate

Answer 66

Dyspnoea, pleuritic chest pain, decreased lung expansion, decreased breath sounds, stony dull to percussion, bronchial breathing, tracheal deviation away USS guided pleural aspiration - protein, pH, LDH, glucose, amylase

Question 67

List some causes of pleural effusion

Answer 67

Transudate - HF, cirrhosis, hypoalbuminaemia (nephrotic syndrome, peritoneal dialysis), hypothyroidism, mitral stenosis, PE, constrictive pericarditis, SCV obstruction Exudate - malignancy, infection (TB, HIV), inflammatory (RA, pancreatitis, dressler's), yellow nail syndrome, fungal infections, drugs

Question 68

What is Light's criteria?

Answer 68

Used if pleural fluid protein is 25-35g/L Fluid is an exudate if: Pleural fluid/serum protein >0.5 Pleural fluid/serum LDH >0.6 Pleural fluid LDH is 2/3 upper limit of normal

Question 69

List signs, symptoms and management of a pneumothorax

Answer 69

Asymptomatic, sudden onset dyspnoea, pleuritic chest pain Decreased lung expansion, hyperresonance to percussion, decreased breath sounds, trachea deviated away (tension) Management: BTS guidelines - O2, aspirate, chest drain If tension (medical emergency) - large bore needle with saline syringe in 2nd intercostal space MCL, chest drain

Question 70

List risk factors for a PE

Answer 70

``` Recent surgery (abdo, pelvic, hip, knee) Thrombophilia e.g. antiphospholipid syndrome Leg fracture Prolonged bed rest, decreased mobility Malignancy (breast, prostate, pelvis) Pregnancy/post partum/OCP/HRT Previous PE ```

Question 71

List clinical features, treatment and prevention of PE

Answer 71

Clinical features - acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, syncope, pyrexia, cyanosis, high RR/HR, low BP, raised JVP, pleural rub, pleural effusion, DVT signs Treatment - anticoagulation (LMWH) until INR >2, start warfarin (for 3 months), thrombolysis Prevention - compression stockings, heparin, early mobilisation, stop OCP/HRT pre-op

Question 72

List some risk factors, clinical features and complications of lung cancer

Answer 72

Risk factors - high smoking pack years, increased age (>40), FH of lung history, carcinogen exposure Clinical features - cough, haemoptysis, dyspnoea, chest pain, anorexia, weight loss, cachexia, anaemia, clubbing, lymphadenopathy, consolidation, collapse, pleural effusion, bone tenderness, hepatomegaly (mets) Complications - SVC obstruction, Horner's syndrome, paraneoplastic syndrome (high Ca, SIADH, Cushing's/Addison's)

Question 73

Describe the TNM staging for NSCLC

Answer 73

Primary tumour (T) Tx malignant cells in bronchial secretions, no other evidence of tumour TIS - carcinoma in situ T0 - none evident T1 - <3cm, in lobar or more distal airway T2 - >3cm and >2cm distal to carina or any size if pleural involvement or obstructive pneumonitis extending to hilum but not all the lung T3 - involves chest wall, diaphragm, mediastinal pleura, pericardium, or <2cm from but not at carina. T >7cm diameter and nodules in same lobe T4 - involves mediastinum, heart, great vessels, trachea, oesophagus, vertebral body, carina, malignant effusion or nodules in another lobe Regional nodes (N) N0 - none involved (after mediastinoscopy) N1 - peribronchial and/or ipsilateral hilum N2 - ipsilateral mediastinum or subcarinal N3 - contralateral mediastinum or hilum, scalene or supraclavicular Distant metastasis (M) M0 - none M1a - nodule in other lung, pleural lesions or malignant effusions M1b - distant metastases present

Question 74

What is obstructive sleep apnoea? How is it diagnosed and managed?

Answer 74

Intermittent closure/collapse of pharyngeal airway --> apnoeic episodes terminated by partial arousal >15 episodes in 1 hour Epworth Sleepiness Scale score >9 Polysomnography Treatment - weight loss, no evening alcohol, mandibular advancement devices, pharyngeal surgery, CPAP, gastroplasty, tracheostomy

Question 75

When should an ABG measurement be considered

Answer 75

Unexpected deterioration in an ill patient Acute exacerbation of a chronic chest condition Impaired consciousness or impaired respiratory effort Signs of CO2 retention (bounding pulse, drowsy, tremor, headache) Cyanosis, confusion, visual hallucinations Validate measurements from pulse oximetry

Question 76

List causes of bilateral hilar lymphadenopathy on CXR

Answer 76

Sarcoidosis Infection (TB, mycoplasma) Malignancy (lymphoma, carcinoma, mediastinal tumours) Organic dust disease (silicosis, berylliosis) Extrinsic allergic alveolitis

Question 77

List differentials of granulomatous disease

Answer 77

Infections - TB, leprosy, syphillis, cat scratch fever, schistosomiasis Autoimmune - primary biliary cirrhosis, granulomatous orchitis Vasculitis - GCA, polyarteritis nodosa, takayasu's arteritis, Wegener's granulomatosis Idiopathic - Crohn's disease, de Quervain's thyroiditis, sarcoidosis

Question 78

List differentials for a nodule in the lung on a CXR

Answer 78

``` Malignancy (primary/secondary) Abscesses Granuloma Carcinoid tumour Arterio-venous malformation Encysted effusion (fluid, blood, pus) Cyst Foreign body Skin tumour (seborrhoeic wart) ```

Question 79

List some causes of an upper lobe infection

Answer 79

Aspergillosis TB Klebsiella Staph. aureus