Respiratory

Question 1

stony dull to percuss

Answer 1

Pleural Effusion

Question 2

Right sided pleuritic chest pain

Answer 2

probably pneumonia

Question 3

Alveolar bat's wings
kerley B lines
Caridiomegaly 
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

Question 5

Ziehl-Neelson +ve 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

Miliary TB spread roung the body?

Answer 8

spread through the blood stream

Question 9

Miliary TB if spread via the pulmonary vein

Answer 9

systemic dissemination to the liver, spleen and kidneys

Question 10

Miliary TB if spread via the pulmonary artery

Answer 10

dissemination to the lungs

Question 11

Positive anti-glomerular basement membrane antibodies (anti-GBM antibodies)

Answer 11

Goodpasture’s syndrome

Question 12

Chest infection with a parrot/pigeon as a pet

Answer 12

chlamydophila psittaci

Question 13

dry cough and diarrhoea after a holiday abroad and a hint about water spread

Answer 13

Legionella pneumophila (test urine for antigens)

Question 14

“Tall, thin young man who indulges in marijuana”

Answer 14

Probably pneumothorax (Marfan’s)

Question 15

Mr Snoop Dog

Answer 15

probably pneumothorax

Question 16

Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis and weight loss

Answer 16

Sarcoidosis

Question 17

14. Bronchiole wider than neighbouring arteriole (on CT) (signet ring sign)

Answer 17

Bronchiectasis

Question 18

“D sign on X ray”

Answer 18

Empyema

Question 19

“Steeple” sign on X ray

Answer 19

laryngotracheobronchitis/ croup

Question 20

Child with barking cough

Answer 20

Croup

Question 21

Pneumocytosis pneumonia

Answer 21

HIV redflag

Question 22

Pneumocytosis treatment

Answer 22

co-tramoxazole (+prenisolone if severe)

Question 23

Asthma + nasal polyps + salicylate sensitivity

Answer 23

Sameter’s triad

Question 24

Alcoholic - danger of aspiration pneumonia

Answer 24

Klebsiella pneumonia

You drink at Kleb T

Question 25

Red Jelly Sputum

Answer 25

Klebsiella Pneumonia | jelly shots at kleb T

Question 26

Mucoid sputum

Answer 26

Chlamydia psittaci

Question 27

Rusty sputum

Answer 27

Pneumococcal pneumonia

Question 28

Cannonball metastases

Answer 28

classically from primary renal cell carcinoma

Question 29

Morning headache

Answer 29

hypercapnia or side effects of organic nitrates

Question 30

ACTH secreting hormone

Answer 30

Small cell carcinoma of the lung

Question 31

PTH secreting lung tumour

Answer 31

Squamous cell carcinoma of the lung

Question 32

neuroendocrine tumour potentially associated with ectopic endocrine syndromes and highly malignant

Answer 32

small cell carcinoma

Question 33

Increased serum ACE and Ca2+

Answer 33

sarcoid

Question 34

Eggshell calcification of the hilar region

Answer 34

silicosis

Question 35

heart failure cells in the alveolar spaces

Answer 35

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 36

Ghon focus

Answer 36

area of infection and caseous necrosis at the periphery of the lung beneath the pleura found in TB infection (Ghon focus rupture is rare through the visceral pleura into the pleural cavity and will produce TB pleurisy)

Question 37

Assmann lesion

Answer 37

apical lesion of 2ndry TB infection

Question 38

Coin lesion on chest radiographs

Answer 38

rounded solitary lesions - Primary bronchial or lung carcinoma, Metastatic tumour (esp. of kidney), Bronchial hamartoma, Carcinoid tumour, granulomatous inflammation, lung abcess

Question 39

Horner's syndrome

Answer 39

can occur when local spread of cancer to the intrathoracic nodes or a Pancoast tumour. - drooping eyelid - no sweating (on 1 side of face) - same side as invasion because cervical sympathetic chain invasion - small pupil

Question 40

thumbprint sign on the head x ray

Answer 40

epiglottis

Question 41

inspiratory whoop/ barking cough

Answer 41

pertussis

Question 42

snow storm appearance on the x ray

Answer 42

baritosis silicosis

Question 43

infective exacerbation of COPD

Answer 43

``` iSOAP i - ipratropium S - salbutamol O - oxygen A - amoxicillin P - prednisolone ```

Question 44

Non-smoker and lung cancer (peripheral)

Answer 44

adenocarcinoma

Question 45

Squamous and small cell lung cancer

Answer 45

Central

Question 46

High D dimers

Answer 46

suspect PE but need CTPA or V/Q scan to confirm

Question 47

Low D-dimers

Answer 47

exclude PE

Question 48

large PE

Answer 48

thrombolysis

Question 49

Small PE

Answer 49

low molecular weight heparin