Respiratory

Question 1

Stony dull to percuss

Answer 1

Pleural Effusion

Question 2

Right sided pleuritic chest pain

Answer 2

Most likely to be 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 ARDS in neonates

Question 5

Ziehl-Neelson stain positive for acid fast bacilli

Answer 5

Tuberculosis

Question 6

Caseous necrosis

Answer 6

Tuberculosis

Question 7

Apical lesion secondary to TB

Answer 7

Assmann focus

Question 8

Spread of mycobacterium tuberculosis to blood stream

Answer 8

Miliary Tuberculosis

Question 9

Positive anti glomerular basement membrane antibodies

Answer 9

Goodpasture’s Syndome

Question 10

Chest infection with a parrot/pigeon as pet

Answer 10

Chlamydophila psittaci

Question 11

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

Answer 11

Legionella pneumophila

Question 12

“Tall, thin, young man who indulges in marijuana”

Answer 12

Probably a 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

Croup (laryngotracheobronchitis)

Question 17

Child with barking cough

Answer 17

Croup (laryngotracheobronchitis)

Question 18

Pneumocystis pneumonia treatment

Answer 18

Co-trimoxazole {+/- prednisolone if severe}

Question 19

Asthma + Nasal polyps + Salicylate sensitivity

Answer 19

Samter’s triad

Question 20

Cause of Klebsiella pneumoniae

Answer 20

Alcohol abuse (danger of aspiration pneumonia)

Question 21

Red Jelly Sputum

Answer 21

Klebsiella Pneumoniae

Question 22

Mucoid Sputum

Answer 22

Chalmydophila psittaci

Question 23

Cannonball metastases (also weight loss and haematuria)

Answer 23

Classically from primary renal cell carcinoma

Question 24

Morning headache

Answer 24

Hypercapnia or side effects of 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

Increased serum ACE and Ca2+

Answer 27

Sarcoidosis

Question 28

Eggshell calcification at hilar region

Answer 28

Silicosis

Question 29

"Hear failure cells" seen in alveolar spaces

Answer 29

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

Question 30

Area of infection and caseous necrosis at lung periphery, beneath pleura, found in TB infection

Answer 30

Ghon focus

Question 31

"Coin lesion" found on chest radiographs

Answer 31

Primary bronchial or lung carcinoma/ metastatic tumour (esp kidney)/Bronchial hamartoma/Carcinoid tumour/Granulomatous inflammation/Lung abscess

Question 32

This can occur if there is local spread of cancer to intrathoracic nodes or a Pancoast tumour

Answer 32

Horner's Syndrome

Question 33

Acute management of Asthma "O SHIT MAN"

Answer 33

``` Oxygen 100% Salbutamol Nebulised back to back Hydrocortisone IV or Prednisolone PO Ipratropium Bromide Nebulised hourly Theophylline IV or aminophylline IV Magnesium and call an Anaesthatist ```

Question 34

Thumbprint sign on head X Ray

Answer 34

Epiglottitis

Question 35

Inspiratory Whoop/Barking cough

Answer 35

Pertussis

Question 36

Snow storm appearance on X Ray

Answer 36

Baritosis OR Silicosis

Question 37

Management of infective COPD exacerbation

Answer 37

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

Question 38

Non-smoker + lung cancer

Answer 38

(Peripheral) Adenocarcinoma

Question 39

CENTRAL lung cancer

Answer 39

Squamous or small cell lung cancer

Question 40

High D-dimers

Answer 40

Suspect Pulmonary Embolism (send for CTPA or V/Q scan)

Question 41

Low D-dimers

Answer 41

Exclude Pulmonary Embolism

Question 42

Large PE treatment

Answer 42

Thrombolysis

Question 43

Small PE treatment

Answer 43

Low molecular weight heparin