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 or Respiratory Distress Syndrome of the newborn

Question 5

Ziehl-Neelsen stain positive for acid fast

Answer 5

TB

Question 6

Caseous necrosis

Answer 6

TB

Question 7

Obstructive Respiratory Problem

Answer 7

Reduced FEV1
FVC is normal
Ratio of FEV1 to FVC is reduced
PEF reduced

Question 8

Miliary Tuberculous

Answer 8

spread of organism into bloodstream. If organism spread via pulmonary artery, miliary dissemination into 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 chlamydophilapsittaci

Question 11

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

Answer 11

Legionella pneumophila (test urine for antigens) - hyponatraemia

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-trimoxazole [± prednisolone if severe])SS

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

Question 27

PTH secreting lung tumour

Answer 27

Squamous cell ca. of lung

Question 28

Small-cell carcinoma

Answer 28

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

Question 29

Coxiellaburnetti

Answer 29

sheep/farm infection

Question 30

Increased serum ACE and Ca2+

Answer 30

Sarcoid

Question 31

Causes of Pulmonary Fibrosis

Answer 31

BREAST CA Bleomycin/ berrylium, Radiation, Extrinsic allergic alveolitis, Ankylosing Spondylitis, Sarcoidosis, Tuberculosis, Cryptogenic fibrosingalveolitis( idiopathic pulmonary fibrosis), Asbestosis.

Question 32

Eggshell calcification at hilar region

Answer 32

Silicosis

Question 33

Heart-failure cells’ seen in alveolar spaces

Answer 33

Macrophages that have absorbed haemosiderin - found in chronic pulmonary oedema, and associated (severe) left-ventricular heart failure. Also, seen in long-standing pulmonary hypertension

Question 34

Ghon Focus

Answer 34

An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in tuberculosis infection. Note: Ghon Focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy.

Question 35

Drugs to Treat TB

Answer 35

2 RIPE 4 RI - 2 months Rifampicin, Isoniazid, Pyrazinamide, Ethambutol, 4 months Rifampicin, Isoniazid

Question 36

Assmann Focus

Answer 36

Apical lesion of secondary tuberculous infection

Question 37

‘Coin lesion’ found on chest radiographs

Answer 37

Apical lesion of secondary tuberculous infection • ‘Coin lesion’ found on chest radiographs → a rounded solitary lesion. The common lesions are: Primary bronchial or lung carcinoma, Metastatic tumour (esp. of kidney), Bronchial hamartoma, Carcinoid tumour, Granulomatous inflammation, Lung abscess.

Question 38

Horner’s Syndrome

Answer 38

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. This is due to invasion, of the cervical sympathetic chain.

Question 39

Acute management of Asthma

Answer 39

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

Question 40

Thumbprint sign on head x

Answer 40

epiglottitis

Question 41

Snow storm appearance on x ray

Answer 41

baritosis, silicosis

Question 42

Management of infective exacerbation of COPD

Answer 42

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

Question 43

Non-smoker + lung cancer

Answer 43

(peripheral) adenocarcinoma

Question 44

Squamous + Small-cell Lung cancers

Answer 44

CENTRAL

Question 45

High d-dimers

Answer 45

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

Question 46

Low d-dimers

Answer 46

exclude Pulmonary Embolism

Question 47

Large PE

Answer 47

thrombolysis

Question 48

Small PE

Answer 48

Low Molecular Weight Heparin

Question 49

Honeycomb lung

Answer 49

fibrosingalveolitis

Question 50

What is an apical lesion called?

Answer 50

Assmann Focus

Question 51

What is a key indicator of Goodpasture's Syndrome

Answer 51

+ anti-GBM antibodies

Question 52

Inspiratory whoop/barking cough

Answer 52

pertussis

Question 53

Hyperexpanded chest

Answer 53

COPD

Question 54

Positive sweat test >60mmol/L NaCl

Answer 54

CF

Question 55

fever, night sweats, anorexia, hemoptysis

Answer 55

TB

Question 56

Swinging fever, copious foul smelling sputum

Answer 56

Lung abcess

Question 57

4 Types of Autoimmune reactions

Answer 57

ABCD – allergic, blood, clumps, delayed

Question 58

TB drug side effects

Answer 58

o TB DRUG - Orange coloured tears / urine Rifampicin o TB DRUG - Peripheral neuropathy / hepatitis Isoniazid o TB DRUG - Colour Blindness Ethambutol o TB DRUG - Gout Pyrazinamide o TB DRUG - Hearing Problems Streptomycin