Resp

Question 1

stony, dull to percuss

Answer 1

pleural effusion

Question 2

right sided pleuritic chest pain

Answer 2

most likely pneumonia

Question 3

alveolar bats wings, Kerley B lines, cardiomegaly, prominent, dilated upper lobe vessels, pleural effusion

Answer 3

pulmonary oedema

Question 4

ground glass appearance on X-ray

Answer 4

Pulmonary fibrosis and Respiratory Distress Syndrome of newborn

Question 5

Ziehl-Neelsen stain positive for acid fast bacilli

Answer 5

TB

Question 6

caseous necrosis

Answer 6

TB

Question 7

apical disease

Answer 7

most likely (secondary) TB; apical lesion = Assmann focus

Question 8

miliary tuberculosis

Answer 8

spread of organism into bloodstream. If organism spread via pulmonary artery, miliary dissemination into lung occurs. if organism spread via pulmonary vein, systemic dissemination into liver, spleen, kidneys

Question 9

positive anti-glomelular basement membrane antibodies

Answer 9

Goodpasture’s syndrome

Question 10

chest infection + parrot/pigeon as pet

Answer 10

caused by chlamydophila psittaci

Question 11

dry cough + diarrhoea after holiday abroad, some indication of water spread

Answer 11

legionella pneumophila (test urine for antigens)

Question 12

‘tall, thin young man who indulges in marijuana’

Answer 12

pneumothorax (Marfan’s)

Question 13

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

Answer 13

sarcoidosis

Question 14

bronchiole wider than neighbouring arteriole on CT (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

laryngotracheobronchitis (croup)

Question 17

child with barking cough

Answer 17

croup

Question 18

pneumocystis pneumonia

Answer 18

HIV (treat with co-tramox [+ prednis if severe])

Question 19

asthma + nasal polyps + salicylate sensitivity

Answer 19

Samter’s triad

Question 20

alcoholic (danger of aspiration pneumonia)

Answer 20

Klebsellia pneumoniae

Question 21

red jelly sputum

Answer 21

Klebsellia pneumoniae

Question 22

mucoid sputum

Answer 22

chlamydophila psittaci

Question 23

rusty sputum

Answer 23

pneumococcal pneumonia

Question 24

cannonball metastases (+ weight loss and haematuria)

Answer 24

primary renal cell carcinoma

Question 25

morning headache

Answer 25

hypercapnia or side effects from organic nitrates

Question 26

ACTH secreting lung tumour

Answer 26

small cell carcinoma of the lung

Question 27

PTH secreting lung tumour

Answer 27

squamous cell carcinoma of the lung

Question 28

neuroendocrine, highly-malignant, and may be associated with ectopic endocrine syndromes

Answer 28

small-cell carcinoma

Question 29

increased serum ACE and Ca2+

Answer 29

sarcoid

Question 30

eggshell calcification at hilar region

Answer 30

silicosis

Question 31

heart-failure cells seen in alveolar spaces

Answer 31

macrophages that have absorbed haemosederin. Often seen in chronic pulmonary oedema and assoc. LV heart failure. Can also be seen in chronic pulmonary hypertension

Question 32

Ghon focus

Answer 32

area of infection and caseous necrosis found in periphery of lung beneath pleura - found in TB infection.

Question 33

assmann lesion

Answer 33

apical lesion of secondary TB infection

Question 34

coin lesion found on chest radiographs

Answer 34

primary bronchial/lung carcinoma, metastatic tumour (esp of kidneys), bronchial hamartoma, carcinoid tumour, granulomatous infection, lung abscess

Question 35

local spread of cancer to intrathoracic nodes or Pancoast tumour.

Answer 35

Horner's syndrome

Question 36

acute management: 'O SHIT MA'

Answer 36

oxygen 100% through non-rebreather, salbutamol (nebulised), hydrocortisone (IV), ipratropium (nebulised), Theophylline (IV), Magnesium sulphate, Anaesthetist

Question 37

thumbprint sign on head x-ray

Answer 37

epiglottitis

Question 38

inspiratory whoop/barking cough

Answer 38

pertussis

Question 39

snow-storm appearance on CXR

Answer 39

baritosis/silicosis

Question 40

management of infective exacerbation of COPD: iSOAP

Answer 40

ipratropium, salbutamol, oxygen, amoxicillin, prednisolone

Question 41

non-smoker + lung cancer

Answer 41

(peripheral) adenocarcinoma

Question 42

squamous + small-cell lung cancer placement:

Answer 42

central

Question 43

high D-dimers

Answer 43

suspect (but not diagnose) PE (send for CTPA or V/Q scan)

Question 44

low D-dimers

Answer 44

exclude PE

Question 45

treatment for large PE vs small PE

Answer 45

large PE = thrombolysis, small PE = low molecular weight heparin (LMWH)