Respiratory

Question 1

stony dull to percuss

Answer 1

pleural effusion

Question 2

right sided pleuritic chest pain

Answer 2

likely pneumonia

Question 3

alveolar bat wings, kerley B lines, cardiomegaly, dilated prominent upper lobe vessels

Answer 3

pulmonary oedema

Question 4

ground-glass appearance on CXR

Answer 4

pulmonary fibrosis and respiratory distress syndrome of the newborn

Question 5

Zeihl-Neelson 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 is called an Assman focus

Question 8

positive anti-glomerular basement membrane antibodies

Answer 8

Goodpasture’s syndrome

Question 9

chest infection with parrot/pigeon as a pet

Answer 9

caused by chlamoydophila psittaci - psittacosis

Question 10

dry cough and diarrhoea after holiday abroad, some indication of water spread, air conditioning

Answer 10

Legionella pneumophila (test for urine antigens)

Question 11

tall thin young man who indulges in marijuana

Answer 11

probably pneumothorax (Marfan’s)

Question 12

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

Answer 12

sarcoidosis

Question 13

bronchiole wider than neighbouring arteriole (on CT) signet ring sign

Answer 13

bronchiectasis

Question 14

D sign on X ray

Answer 14

empyema

Question 15

‘steeple’ sign on x-ray

Answer 15

laryngotracheobronchitis/croup

Question 16

child with barking cough

Answer 16

croup

Question 17

pneumocystis pneumonia

Answer 17

HIV - treat with co-tramoxazole (plus prednisolone if severe)

Question 18

asthma + nasal polyps + salicylate sensitivity

Answer 18

Samter’s triad

Question 19

alcoholic (danger of aspiration pneumonia)

Answer 19

Klebsiella pneumoniae

Question 20

red jelly sputum

Answer 20

Klebsiella pneumoniae

Question 21

mucoid sputum

Answer 21

Chlamydia psittaci

Question 22

rusty sputum

Answer 22

pneumococcal pneumonia

Question 23

cannonball metastases (weight loss and haematuria)

Answer 23

classically from primary renal cell carcinoma

Question 24

morning headache

Answer 24

hypercapnia or side effects from organic nitrates

Question 25

ACTH secreting lung tumour

Answer 25

small cell carcinoma of the lung

Question 26

PTH secreting lung tumour

Answer 26

squamous cell carcinoma of the lung

Question 27

small cell carcinoma

Answer 27

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

Question 28

increased serum ACE and Ca2+

Answer 28

sarcoidosis

Question 29

eggshell 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 and associated with LHF and 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 note: Ghon focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy

Question 32

Assman focus

Answer 32

apical lesion of secondary TB infection

Question 33

Horner's syndrome

Answer 33

can occur when there is a local spread of cancer to the intrathoracic nodes or a Pancoast's tumour signs include: 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 due to invasion of the cervical sympathetic chain

Question 34

Acute management of asthma

Answer 34

OSHIT MAN: 1. Oxygen 100% through a non-rebreather mask 2. Salbutamol nebuliser back-to-back 3. Hydrocortisone IV or Prednisolone PO 4. Ipratropium Bromide nebulised hourly 5. Theophylline IV or aminophylline IV 6. Magnesium 7. ANaesthetist

Question 35

thumbprint sign on head xray

Answer 35

epiglottitis

Question 36

inspiratory whoop/barking cough

Answer 36

perfussis

Question 37

snow storm appearance on CXR

Answer 37

baritosis, silicosis

Question 38

management of infective exacerbation of COPD:

Answer 38

``` iSOAP: ipratropium Salbutamol Oxygen Amoxicillin Prednisolone ```

Question 39

non-smoker with lung cancer

Answer 39

(peripheral) adenocarcinoma

Question 40

squamous and small cell lung cancers

Answer 40

central

Question 41

high d-dimers

Answer 41

suspect (not diagnose) pulmonary embolism (send for CTPA or V/Q scan)

Question 42

low d-dimers

Answer 42

exclude PE

Question 43

treatment for large PE

Answer 43

thrombolysis

Question 44

treatment for small PE

Answer 44

low molecular weight heparin