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 wings 
Kerley B lines
Cardiomegaly 
Dilated prominent upper lobe vessels 
Pleural effusion

Answer 3

Pulmonary oedema

Question 4

Ground glass appearance on Xray

Answer 4

Pulmonary fibrosis and respiratory distress syndrome of the newborn

Question 5

Xiehl 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 
Apical lesion is called an Assmann focus

Question 8

Military TB

Answer 8

Spread of organism into bloodstream. If organism spread via pulmonary artery, military dissemination in to the lung occurs. If organism spread via pulmonary vein, there is systemic dissemination to the liver, spleen and kidneys

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 chlamoydophila 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 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)

Question 19

Asthma + nasal polyps + salicylate sensitivity

Answer 19

Samter’s triad

Question 20

Alcoholic (danger of aspiration pneumonia)

Answer 20

Klebstelle 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

Question 27

PTH secreting lung tumour

Answer 27

squamous cell carcinoma of the lung

Question 28

Small-cell carcinoma

Answer 28

Neuroendocrine, highly malignant and may be associated with ectopic endocrine syndromes

Question 29

Increased serum ACE and Ca2+

Answer 29

Sarcoid

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 - found in chronic pulmonary oedema and associated (sever) left ventricular heart failure Also seen in long standing pulmonary hypertension

Question 32

Hon focus

Answer 32

An area of infection and gaseous necrosis at the periphery of the lung, beneath the pleura - found in TB infection Hon Focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy

Question 33

Acumen Focus

Answer 33

Apical lesion of secondary TB infection

Question 34

Coin lesion found on chest radiographs

Answer 34

A rounded solitary lesion The common lesions are: Primary bronchial or lung carcinoma Metastatic tumour (esp. of kidney) Bronchial haemartoma, Carcinoid tumour, Granulomatous inflammation, lung abscess

Question 35

Horner's syndrome

Answer 35

Can occur when there is a local spread of cancer to the intrathoracic nodes for a pan coast'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. This is due to invasion, of the cervical sympathetic chain

Question 36

Thumbprint sign on head Xray

Answer 36

epiglottitis

Question 37

Inspiratory whoop/ barking cough

Answer 37

pertussis

Question 38

Snow storm appearance of X ray

Answer 38

Baritosis, silicosis

Question 39

Management of infective exacerbation of COPD

Answer 39

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

Question 40

Non smoker + lung cancer

Answer 40

Peripheral - adenocarcinoma

Question 41

Squamous + small cell lung cancers

Answer 41

Central

Question 42

High d dimers

Answer 42

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

Question 43

Low d dimers

Answer 43

Exclude PE

Question 44

Large PE

Answer 44

Thrombolysis.

Question 45

Small PE

Answer 45

Low molecular weight heparin