Respiratory

Question 1

Stony dull to percuss

Answer 1

Pleural effusion

Question 2

Right side pleuritic chest pain

Answer 2

Most likely pneumonia

Question 3

Alveolar bat’s wings, Kerley Blines, Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion

Answer 3

Pulmonary Oedema

Question 4

Ground glass-like appearance on CXR

Answer 4

Pulmonary Fibrosis or respiratory distress syndrome of the newborn

Question 5

Ziehl-neelsen stain positive for acid fast bacilli

Answer 5

TB

Question 6

Caseous necrosis

Answer 6

TB

Question 7

What is Apical disease most likely caused by?

Answer 7

Most likely (secondary) TB

Question 8

What is an apical lesion called?

Answer 8

Assmann focus

Question 9

Miliary TB?

Answer 9

Widespread dissemination of infection through blood stream

Question 10

In miliary TB, where does dissemination occur if organism spread through:

• Pulmonary artery
• Pulmonary vein

Answer 10

• lungs

- liver, spleen and kidneys

Question 11

Positive anti-glomerular basement membrane antibodies

Answer 11

Goodpasture’s syndrome

Question 12

What bacteria causes a chest infection with a parrot/pigeon as a pet?

Answer 12

chlamydophila psittaci

Question 13

What bacteria causes a Dry cough and diarrhoea after a holiday abroad, some indication of water spread?
What would you test for antigens?

Answer 13

Legionella Pneumophila

Urine

Question 14

“Tall thin young man who indulges in marijuana”

Answer 14

Probably pneumothorax (Marfan’s)

Question 15

Bronchiole wider than neighbouring arteriole on CT?

What is this called?

Answer 15

Bronchiectasis

Signet ring sign

Question 16

Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis, weight loss

Answer 16

Sarcoidosis

Question 17

D sign on x-ray

Answer 17

Empyema

Question 18

Steeple sign on Chest x-ray

Answer 18

Laryngotracheobronchitis/ croup

Question 19

Child with barking cough

Answer 19

Croup

Question 20

What patients do Pneumocystis pneumonia frequently occur in?

Treatment?

Answer 20

HIV

Co-tramoxazole (+ prednisolone if severe)

Question 21

Which triad is asthma + nasal polyps + salicylate sensitivity

Answer 21

Samter’s triad

Question 22

What bacteria tends to cause pneumonia in alcoholics (danger of aspirating vomit)?

Answer 22

Klebsiella Pneumoniae

Question 23

Red jelly sputum?

Answer 23

Klebsiella Pneummoniae

Question 24

Mucoid Sputum?

Answer 24

Chlamydia psitaci

Question 25

Rusty sputum?

Answer 25

Pneumococcal Pneumonia

Question 26

Cannonball metastases (also weight loss and haematuria) - where from?

Answer 26

Primary renal cell carcinoma

Question 27

Morning headaches?

Answer 27

Hypercapnia or side effect of organic nitrates

Question 28

ACTH secreting lung tumour

Answer 28

Small cell carcinoma of the lung

Question 29

PTH secreting lung tumour

Answer 29

Squamous cell carcinoma of the lung

Question 30

What type of tumour is neuroendocrine, highly malignant and may be associated with ectopic endocrine conditions?

Answer 30

Small cell carcinoma

Question 31

Increased serum ACE and Ca2+

Answer 31

Sarcoidosis

Question 32

Eggshell calcification at hilar region

Answer 32

Silicosis

Question 33

What are "heart failure cells" found in alveolar spaces? | Found in?

Answer 33

Macrophages that have absorbed haemosiderin Chronic pulmonary oedema and associated (severe) left ventricular heart failure Also seen in long standing pulmonary hypertension

Question 34

What is Ghon focus? Found in what type of infection? What happens if the Ghon focus ruptures through the visceral pleura into the pleural cavity?

Answer 34

Area of infection and caseous necrosis at the periphery of the lung, beneath the pleura TB Tuberculosis Pleurisy is produced

Question 35

What is a "coin lesion" on a chest x-ray? | Common causes of this (6)

Answer 35

``` A rounded solitary lesion Primary bronchial carcinoma Metastatic tumour (especially of kidney) Bronchial Hamartoma Carcinoid tumour Granulomatous inflamation Lung abscess ```

Question 36

What is Horner's syndrome? Caused by? Symptoms? (4)

Answer 36

Group of symptoms caused by damage to the cervical sympathetic chain. Local spread of cancer to the intrathoracic nodes or a Pancoast's tumour Ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil), and lack of sweating on the ipsilateral (same side as invasion) side of the face

Question 37

Acute management of asthma

Answer 37

``` Oxygen 100% through a non-rebreather mask Salbutamol nebulised back to back Hydrocortisone IV or Prednisolone PO Ipraptropium Bromide nebulised hourly Thiophylline IV or Aminophylline IV Magnesium and call an Anaesthetist OSHIT MAN ```

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

Management of infective exacerbation of COPD

Answer 41

``` ipratropium Salbutamol Oxygen Amoxicillin Prednisolone ```

Question 42

Non-smoker and lung cancer

Answer 42

(peripheral) adenocarcinoma

Question 43

Location of squamous and small cell lung cancer

Answer 43

Central

Question 44

High d-dimers, suspect what?

Answer 44

Pulmonary embolism (send for CTPA or V/Q scan)

Question 45

What can you exclude if low d-dimer?

Answer 45

Pulmonary Embolism

Question 46

Treatment for large PE? | Small PE?

Answer 46

Thrombolysis | Low molecular weight heparin

Question 47

TB drugs?

Answer 47

2 months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, 4 months Rifampicin, Isoniazid (2 RIPE, 4 RI)

Question 48

PE risk factors

Answer 48

``` Hereditary eg factor V Leiden History - previous DVT or PE Hypomobility eg fracture or long trip Hypovolaemia eg dehydration Hypercoagulability eg smoking Hormones eg oestrogen Hyperhomocysteinemia Hyperviscosity states eg malignancy, post-surgery (8 H's) ```

Question 49

1 side effect for each TB drug

Answer 49

``` Rifampicin = orange coloured tears/ urine Isoniazid = peripheral neuropathy/ hepatitis Ethambutol = colour blindness Pyrazinamide = gout Streptomycin = hearing problems ```

Question 50

Features of sarcoidosis?

Answer 50

``` G-Granulomas E-Erythema nodosum R-Restrictive lung defect (PFTs) M-Multiple systemic manifestations A-Asteroid bodies (inclusions) N-Noncaseating granuloma, Negative TB test (GERMAN) ```