Respiratory

Question 1

stony dull to percussion

Answer 1

pleural effusion

Question 2

right sided pleuritic chest pain

Answer 2

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 newborn (not enough surfactant)

Question 5

Ziehl-Neelsen stain positive for acid fast bacilli

Answer 5

TB

Question 6

caseous necrosis

Answer 6

TB

Question 7

Assmann Focus

Answer 7

Apical lesion of secondary tuberculous infection

Question 8

spread of TB organism into bloodstream

Answer 8

Miliary Tuberculous
if spread via pulmonary artery, milliary dissemination into lungs
if spread via pulmonary vein, systemic dissemination into liver, spleen and kidneys

Question 9

Chest infection with a parrot/pigeon as pet

Answer 9

chlamydophila psittaci

Question 10

Positive anti-glomerular basement membrane antibodies

Answer 10

Goodpasture’s syndrome

Question 11

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

Answer 11

Legionella pneumophila (test urine for antigens)

Question 12

Tall, thin young man who indulges in marijuana

Answer 12

probably 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-tramoxazole [± 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 or Side effects of organic nitrates

Question 26

ACTH secreting lung tumour

Answer 26

Small cell carcinoma of the lung. | Small-cell carcinoma are neuroendocrine, highly malignant, and may be associated with ectopic endocrine syndromes.

Question 27

PTH secreting lung tumour

Answer 27

Squamous cell carcinoma of lung

Question 28

Increased serum ACE and Ca2+

Answer 28

Sarcoidosis

Question 29

Eggshell calcification at hilar region

Answer 29

Silicosis

Question 30

Acute management of Asthma

Answer 30

``` OSHIT MAN: Oxygen 100% through a non-rebreather mask Salbutamol Nebulised back-to-back. Hydrocortisone IV or Prednisolone PO Ipratropium Bromide Nebulised hourly Theophylline IV or aminophylline IV Magnesium and call an Anaesthetist ```

Question 31

Thumbprint sign on head x ray

Answer 31

epiglottitis

Question 32

Inspiratory whoop/barking cough

Answer 32

pertussis

Question 33

Snow storm appearance on x ray

Answer 33

baritosis, silicosis

Question 34

Management of infective exacerbation of COPD

Answer 34

``` iSOAP i - ipratropium S - Salbutamol O - Oxygen A - amoxicillin P - prednisolone ```

Question 35

Non-smoker + lung cancer

Answer 35

(peripheral) adenocarcinoma

Question 36

Squamous + Small-cell Lung cancers

Answer 36

CENTRAL

Question 37

High d-dimers

Answer 37

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

Question 38

Low d-dimers

Answer 38

exclude Pulmonary Embolism

Question 39

Large and small PE treatment

Answer 39

large PE is thrombolysis | small PE is low molecular weight heparin

Question 40

Respiratory alkalosis

Answer 40

panic attack

Question 41

Frank pus on aspiration

Answer 41

empyema

Question 42

obstructive lung disease – raised eosinophils

Answer 42

asthma

Question 43

obstructive lung disease – raised neutrophils

Answer 43

COPD

Question 44

overnight nasal ventilation

Answer 44

Pickwickian disease | obese, sleep apnoea, hypercapnia

Question 45

Guillian-Barre disease

Answer 45

disease which causes paralysis. Normally preceded by a strep. throat/infection of respiratory or GI tract

Question 46

where are problems found in Coal workers pneumoconiosis?

Answer 46

problems found at the apex of the lung

Question 47

CXR shows bilateral alveolar shadowing

Answer 47

Adult respiratory distress

Question 48

CXR showing bats wings(perihilar shadowing), upper lobe venous diversion, fluid in horizontal fissue, kerley B lines (small horizontal lines in the periphery due to fluid in the interlobular septae and pleural effusions)

Answer 48

Pulmonary oedema

Question 49

where are problems found in the lung at asbestosis?

Answer 49

base of the lung

Question 50

Type 1 diabetic presents with vomiting and not taking her insulin. Dehydrated and deep labored breathing

Answer 50

metabolic acidosis (diabetic ketoacidosis)

Question 51

22 year old woman, weight loss, sputum, night sweats, tender well defined nodules on shins bilaterally

Answer 51

erythema nodosum

Question 52

Asthma spirometry readings (obstructive)

Answer 52

- FVC normal - FEV1 reduced - FEV1/FVC ratio reduced (due to half of ratio being reduced)

Question 53

COPD spirometry readings (obstructive)

Answer 53

- FVC reduced - FEV1 reduced - FEV1/FVC ratio normal (as both parts of the ratio have been reduced making it normal)

Question 54

Restrictive airway disease spirometry readings

Answer 54

- FVC reduced - FEV1 reduced - FEV1/FVC ratio normal (as both parts of the ratio have been reduced making it normal)

Question 55

sheep farmer infection

Answer 55

coxiella burnetti