Respiratory

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 bat’s wings, Kerley B lines, cardiomegaly, dilated prominent 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 the new born

Question 5

Zeil-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

Question 8

Miliary Tuberculosis

Answer 8

Spread of organism into bloodstream

Question 9

Positive anti-glomerular basement membrane antibodies

Answer 9

Goodpasture’s syndrome

Question 10

Chest infection with a parrot/pigeon as pet

Answer 10

Caused by chlamydophila psittaci

Question 11

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

Answer 11

Legionella pneumophila (test urine for antigens)

Question 12

“tall thin man who indulges in marijuana” (Mr. Snoop Dogg)

Answer 12

Probable pneumothorax

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 CXR”

Answer 15

Empyema

Question 16

“Steeple” sign on CXR

Answer 16

laryngotracheobronchitis/croup

Question 17

Child with barking cough

Answer 17

Croup

Question 18

Pneumocystis pneumonia

Answer 18

HIV (treat with Co-trimoxazole [± prednisolone if severe])

Question 19

Asthma + Nasal polyps + Salicylate sensitivity

Answer 19

Samter’s Triad

Question 20

Alcoholic (danger of aspiration pneumonia)

Answer 20

Klebsiella Pneumoniae

Question 21

Red jelly sputum

Answer 21

Klebsiella Pneumoniae

Question 22

Mucoid 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

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

Small-cell carcinoma

Answer 28

Neuroendocrine

Question 29

Increased serum ACE and Ca2+

Answer 29

Sarcoidosis

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 haemosiderin

Question 32

Ghon focus

Answer 32

An area of infection and caseous necrosis at the periphery of the lung, beneath pleura

Question 33

Assmann focus

Answer 33

Apical lesion of secondary tuberculosis infection

Question 34

'Coin lesion' found on chest radiographs

Answer 34

A rounded solitary lesion e.g. primary bronchial or lung carcinoma, metastatic tumour

Question 35

Horner's syndrome

Answer 35

Can occur when there is a local spread of cancer to the intrathoracic nodes

Question 36

Acute management of asthma

Answer 36

``` OHSHIT MAN Oxygen 100% through non-rebreather mask Salbutamol nebuliser back-to-back Hydrocortisone IV or Prednisolone PO Ipratropium IV or aminophylline IV Magnesium and call an 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 X-ray

Answer 39

Baritosis, silicosis

Question 40

Management of infective exacerbation of COPD

Answer 40

``` iSOAP Ipratropium Salbutamol Oxygen Amoxicillin Prednisolone ```

Question 41

Non-smoker + lung cancer

Answer 41

(peripheral) Adenocarcinoma

Question 42

Squamous + small-cell lung cancers

Answer 42

CENTRAL

Question 43

High d-dimers

Answer 43

Suspect pulmonary embolism

Question 44

Low d-dimers

Answer 44

Exclude pulmonary embolism

Question 45

Large PE

Answer 45

Thrombolysis

Question 46

Honey-combing + pleural plaques

Answer 46

Asbestosis

Question 47

Breathless after transplant

Answer 47

Bronchiolitis obliterans

Question 48

Respiratory alkalosis

Answer 48

PE Hyperventilation Stroke Altitude

Question 49

Respiratory acidosis

Answer 49

COPD Asthma Obesity hypoventilation syndrome