Respiratory

Question 1

Dry, non productive cough, type 1 respiratory failure, mild renal impairment, hypoatraemia

Answer 1

Atypical pneumonia (legionella)

Question 2

fine inspiratory crepitations, type 1 respiratory failure, restrictive spirometry and finger clubbing

Answer 2

Idiopathic Pulmonary Fibrosis

Question 3

Acute severe bilateral pulmonary oedema due to acute capillary leak in response to trauma or illness, persistent hypoxia despite given oxygen

Answer 3

Acute Respiratory Distress Syndrome

Question 4

Respiratory alkalosis with no metabolic compensation

Answer 4

Acute Panic Attack

Question 5

Young Afro Caribbean woman, pulmonary fibrosis in upper lobes, restrictive lung pattern, raised serum ACE, hypercalemia, bilateral hillier lymphadenopathy

Answer 5

Sarcoidosis

Question 6

Sudden causes of reduction in lung function

Answer 6

asthma, pneumothorax, PE, pulmonary haemorrhage, removal or lung collapse

Question 7

High KCO

Answer 7

Pulmonary Haemorrhage (acute) and Pneumonectomy (later)

Question 8

Cavitating tumour

Answer 8

Squamous cell carcinoma

Question 9

BREAST CA

Answer 9

Bleomycin Radiation Extrinsic allergic alveolitis Ankylosing spondylitis Sarcoidosis TB Cryptogenic Fibrosing alveolitis Asbestosis

Question 10

Progressive massive fibrosis

Answer 10

Associated with emphysema, upper lobes are affected first, opacities > 10mm in diameter

Question 11

Causes of transudate effusion

Answer 11

organ failure- heart, kidney, lung

Question 12

Causes of exudate effusion

Answer 12

Maligancy, infection, pulmonary infarct, TB

Question 13

What to do with tension pneumothorax, spontaneous+collapse, emergency, trauma

Answer 13

Emergency: immediate needle thoracocentesis
Spontaneous + lung collapse: needle aspiration
Trauma: 5th intercostal space, mid axillary line

Question 14

deletion of chromosome 22q11, hypocalaemia, recurrent viral, bacterial and frequent fungal infections, absent or decreased T cells, normal/raised B cells. Developmental defect…

Answer 14

Di George Syndrome

Question 15

Mutation of IL-2 receptor, very low or absent T cells, persistent diarrhoea, failure to thrive, graft host skin disease

Answer 15

SCID

Question 16

Failure to produce mature B cells, selective IgA deficiency

Answer 16

Bruton’s hypogammaglobulinaemia

Question 17

Low IgG, IgA and IgE, recurrent bacterial infections, autoimmune disease, granulomatous

Answer 17

CVID

Question 18

Bronchiolitis in children

Answer 18

Respiratory Synctial Virus RSV

Question 19

Rare autoimmune disease, muscle weakness, paraneoplastic syndrome

Answer 19

Eaton Lambert Syndrome

Question 20

Failure to produce neutrophils

Answer 20

Reticular dysgenesis

Question 21

autosomal recessive disorder with severe chronic neutropenia, recurrent bacterial infections after first 2 weeks of birth, failure to thrive, irritability, oral ulceration

Answer 21

Kostmann syndrome

Question 22

Failure of neutrophil adhesion and migration

Answer 22

genetic defect in CD18 or defect in CD18

Question 23

Failure of oxidative killing mechanism, deficient of p47 in NADPH oxidase, excessive inflammation and granuloma formation, NBT testing

Answer 23

Chronic Granulomatous Disease

Question 24

Gel and Coombs IDID

Answer 24

Immediate hypersensitivity
Direct Cell Killing
Immune complex mediated
Delayed type hypersensitivity

Question 25

Type 2 hypersensitivity, muscle weakness

Answer 25

Guillan Barre Syndrome

Question 26

Type 2 hypersensitivity, overactive Thyroid and Bulging eyes

Answer 26

Grave's disease

Question 27

Immune complexes deposited in walks of alveoli and bronchioles, examination often normal but may have dry cough, pyrexia, wheeze and malaise

Answer 27

acute hypersensitivity pneumonitis

Question 28

antibodies form against a person's own protein

Answer 28

Systemic Lupus Erythematosus

Question 29

Drug addict in type 1 respiratory distress, treatment and why?

Answer 29

Treat with IV antibiotics to prevent HIV

Question 30

Pulmonary oedema with no cardiomegaly

Answer 30

acute left ventricular heart failure

Question 31

level of right hilar

Answer 31

6th rib

Question 32

Causes of numerous calcified nodules

Answer 32

TB, Histaplomosis, chronic renal failure, Varicella pneumonitis

Question 33

double shadow heart border, prominent left atrial apendage, left main bronchus elevation

Answer 33

Advanced mitral stenosis

Question 34

Ring shadows and tram lines on CXR

Answer 34

Bronchiectasis

Question 35

Ground glass appearance on CXR

Answer 35

Cryptogenic fibrosing alveolitis and ARDS

Question 36

A patient in type 2 respiratory failure who has responded poorly to medication should be given what next?

Answer 36

NIPPV so long as he is conscious and cooperative, next proceed to intubation

Question 37

A mucus secreting cell found in respiratory epithelium

Answer 37

Goblet cell

Question 38

A non ciliated cell found in terminal bronchioles. Acts as an immune modulator and stem cell and is able to produce surfactant

Answer 38

Clara cell

Question 39

A polygonal cell that is able to release surfactant from lamellar bodies within cytoplasm

Answer 39

Type 2 pneumocyte

Question 40

Non keratinised stratified squamous epithelium

Answer 40

Oropharynx

Question 41

Keratinised stratified squamous epithelium

Answer 41

Nasal cavity

Question 42

Olfactory

Answer 42

roof of nasal cavity

Question 43

Side effects of RIPE

Answer 43

Rimfampicin: hepatitis, discolouration of the urine/tears, orange/red Isoniazide: Neuropathy, agranulocytosis, allergic reaction Pyrazinamide: Hepatic toxicity (rare), reduced excretion of rate, gout, Ethambutol: colour blindness, developing into blindness

Question 44

Positive result for cANCA

Answer 44

Granulomatous with positive for polyangitis

Question 45

Bacterial causes of epiglottitis

Answer 45

Haemophilus Influenza B, Streptococcol or Staphylcoccal

Question 46

Complication of Cystic Fibrosis

Answer 46

Pancreatic insufficiency

Question 47

Chronic sinusitis, dextrocardia and infertility

Answer 47

Kartanger's syndrome

Question 48

Cannon ball metastases

Answer 48

Renal cell carcinoma

Question 49

What organism is likely to cause infection excerbations of COPD and what antibiotics should be given?

Answer 49

Haemophillus Influenza and treated with amoxicillin or trimethoprim

Question 50

When should an IV bronchodilator be given to a patient which an acute exacerbation of asthma?

Answer 50

Only if the patient has failed to respond to REPEATED nebulised treatment

Question 51

Small cell carcinoma

Answer 51

oat cell- arises from endocrine cells which secrete polypeptide hormones. Highly malignant and rapid growing but response well to chemotherapy.

Question 52

Squamous cell carcinoma

Answer 52

40% of lung carcinomas, cavitates, metastases late

Question 53

Large cell carcinoma

Answer 53

25% of all tumours, metastases early

Question 54

Adenocarinoma

Answer 54

10% of all tumours. Arises in scar tissue and is associated with asbestos. More common in non smokers, women and elderly

Question 55

Alveolar cell carcinoma

Answer 55

1-2% of patients. The patients produce large amounts of mucoid sputum.

Question 56

In COPD patients, non smokers with baseline O2 <7.3kPa consider...

Answer 56

Long term oxygen therapy for more than 15hrs a day to increase survival

Question 57

Egg shell calcification of hilar nodes

Answer 57

Silicosis

Question 58

Rheumatoid arthritis and rounded fibrotic nodules 0.5-5cm

Answer 58

Caplan's Syndrome

Question 59

double shadow heart border, prominent left atrial apendage, left main bronchus elevation, widening of carina

Answer 59

Advanced mitral stenosis