Resp

Question 1

Positive Ziehl-Neelsen stain for acid fast bacilli

Answer 1

TB

Question 2

Caseous Necrosis

Answer 2

TB

Question 3

Apical disease is most likely:

Answer 3

(Secondary) TB

Question 4

Miliary Tuberculosus

Answer 4

Spread of organisms into the bloodstream

Question 5

If miliary tuberculous organisms spread by pulmonary artery…

Answer 5

Miliary dissemination into the lung occurs

Question 6

If Miliary tuberculosis organisms spread via pulmonary vein…

Answer 6

Systemic dissemination to the liver, spleen and kidneys

Question 7

Positive anti-glomerular basement membrane antibodies

Answer 7

Goodpastures syndrome

Question 8

Chest infection with a parrot/pigeon as a pet

Answer 8

Chlamydophila psittaci

Question 9

Dry cough + diarrhoea after holiday abroad (Spain), some indication of water spread

Answer 9

Legionella Pneumopila

Question 10

How to test for Legionella Pneumophila

Answer 10

Test urine for antigens

Question 11

Tall thin young man (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)

Answer 13

Bronchiectasis

Question 14

Signet ring sign

Answer 14

Bronchiectasis

Question 15

D sign on x-ray

Answer 15

Empyema

Question 16

“Steeple” sign on x-ray

Answer 16

Laryngotrachebronchitis/croup

Question 17

Child with barking cough

Answer 17

Croup

Question 18

Pneumocystis pneumonia

Answer 18

HIV (treat with co-tramoxazole [+prednisalone if severe]

Question 19

Asthma + nasal polyps + salicylate sensitivity

Answer 19

Samters triad

Question 20

Alcoholic (danger of aspiration pneumonia)

Answer 20

Klesbiella pneumoniae

Question 21

Red jelly sputum

Answer 21

Klebsiella Pneumoniae

Question 22

Mucous sputum

Answer 22

Chlamydia psittaci

Question 23

Rusty Sputum

Answer 23

Pneumococcal pneumonia

Question 24

Cannonball metastases (also weight loss and haematuria)

Answer 24

Classically from primary renal cell carcinoma

Question 25

Morning headache

Answer 25

Hypercapnia or side effects of organic nitrates

Question 26

ACTH secreting lung tumour

Answer 26

Small cell carcinoma of lung

Question 27

PTH secreting lung tumour

Answer 27

Squamous cell carcinoma of lung

Question 28

Increasing serum ACE and Ca2+

Answer 28

Sarcoid

Question 29

Egg shell calcification at hilar region

Answer 29

Silicosis

Question 30

Heart failure cells seen in alveolar spaces

Answer 30

(Macrophages that have absorbed haemosiderin) Found in; -chronic pulmonary oedema -associated (severe) left-ventricular heart failure -long-standing pulmonary hypertension

Question 31

Ghon Focus

Answer 31

Area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in TB infection

Question 32

Ghon Focus rupture

Answer 32

(Rare) Rupture through the visceral pleura into the pleural cavity will produce tuberculous pleurisy

Question 33

Assman focus

Answer 33

Apical lesions of secondary tuberculosis infection

Question 34

‘Coin lesion’ found on chest radiographs

Answer 34

Rounded solitary lesion Common lesions are; -primary bronchial or lung carcinoma -carcinoid tumour -metastatic tumour -bronchial hamartoma -granulomatous inflammation -lung abscess

Question 35

When does horners syndrome occur?

Answer 35

When there is a local spread of cancer to the intrathoracic nodes or a Pancoasts tumour

Question 36

Signs of Horners syndrome

Answer 36

-ptosis (drooping of the eyelid) -enophthalmos (sunken eye) -Miosis (small pupil) -lack of sweating on the ipsilateral side of the face

Question 37

Why do the signs of Horners syndrome occur

Answer 37

Due to invasion of the cervical sympathetic chain

Question 38

Thumbprint sign on head x-ray

Answer 38

Epiglottitis

Question 39

Inspiratory whoop/barking cough

Answer 39

Pertussis

Question 40

Snow storm appearance on x ray

Answer 40

Baritosis / silicosis

Question 41

Non-smoker + lung cancer

Answer 41

(Peripheral) adenocarcinoma

Question 42

Where are squamous + small cell lung cancers located

Answer 42

Central

Question 43

High d-dimers

Answer 43

Suspect (but not diagnose) pulmonary embolism

Question 44

Action to take if high d-dimers found

Answer 44

Send for CTPA or V/Q scan

Question 45

Low d-dimers

Answer 45

Exclude pulmonary embolism

Question 46

Large PE

Answer 46

Thrombolysis

Question 47

Small PE

Answer 47

DOAC

Question 48

Respiratory alkalosis

Answer 48

Panic attack

Question 49

Frank pus on aspiration

Answer 49

Empyema

Question 50

Raised eosinophils on obstructive lung disease

Answer 50

Asthma

Question 51

Raised neutrophils in obstructive lung disease

Answer 51

COPD

Question 52

Pickwickian disease

Answer 52

(Obesity hypoventilation syndrome) Obese people whose body fat prevents air getting in -causes sleep apnoea and hypercapnia

Question 53

Guillian-Barre disease

Answer 53

Causes paralysis Normally preceded by a strep. Throat / infection of respiratory or GI tract. A.K.A polyneuritis (meaning rapidly progressive, ascending motor neurone paralysis, beginning in the feet and ascending to the other muscles)

Question 54

Types of coal workers pneumoconiosis

Answer 54

Simple (early form) Progressive massive fibrosis (later form)

Question 55

Where are problems found in coal workers pneumoconiosis?

Answer 55

Apex of lung

Question 56

When does adult respiratory distress syndrome occur?

Answer 56

When non-cardiogenic pulmonary oedema leads to acute respiratory failure

Question 57

What does CXR show in adult respiratory distress syndrome?

Answer 57

Bilateral alveolar shadowing

Question 58

TLCO

Answer 58

How well oxygen can diffuse into the blood

Question 59

Asbestosis problems are found…

Answer 59

At the base of the lung

Question 60

Treatment of PE if not immediately life threatening

Answer 60

Anticoagulation therapy (Apixaban / rivaroxaban)

Question 61

Type 1 diabetic presents with vomiting and not taking her insulin. Dehydrated and deep laboured breathing

Answer 61

Metabolic acidosis (diabetic ketoacidosis)

Question 62

22 year old woman, weight loss, sputum, night sweats, tender well defined nodules on shins bilaterally

Answer 62

Erythema nodosum

Question 63

Hypercalcemia

Answer 63

Moans - GI conditions (constipation/nausea/decreased appetite/ abdominal pain/ peptic ulcer disease Bones - (bone aches/ fractures/ loss of height) Stones - kidney conditions (kidney stones/ frequent urination) Groans - psychological conditions (confusion, dementia, memory loss, depression)

Question 64

Brachial plexus lesion

Answer 64

Finger tingling, arm pain

Question 65

Farmers lung antigen

Answer 65

Saccharopolyspora rectivirgula