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

ABCDE of pulmonary oedema on a CXR

Answer 3

Alveolar bat’s wings, kerley B lines, Cardiomegaly, Dialled prominent upper lobe vessels, pleural Effusions

Question 4

ground glass appearance on X-ray

Answer 4

pulmonary fibrosis

Question 5

Ziehl-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 known as assmann focus

Question 8

military TB

Answer 8

spread of organism into bloodstream.
Pulmonary artery = military dissemination into the lungs
pulmonary vein - systemic dissemination into the liver, spleen and kidneys

Question 9

Positive anti-glomerular basement membrane antibodies

Answer 9

goodpastures syndrome

Question 10

Chest infection with parrot or pigeon as pet

Answer 10

chlamoydophila psittaci

Question 11

dry cough and diarrhoea after holiday abroad

Answer 11

legionella pneumophila (test urine for antigens)

Question 12

Tall, thing young man that indulges in weed - or a mr snoop dog

Answer 12

someone who is likely to get a pneumothorax (Marfan’s)

Question 13

Bilateral hilar lymphadenopahty, erythema nodosum, granulomas, fatigue 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 CXR

Answer 15

empyema (looks like it is stuck to the edge of the chest)

Question 16

Steeple sign on CXR

Answer 16

laryngotracheobrinchitis or croup

Question 17

child with barking cough

Answer 17

croup

Question 18

Pneumocystis pneumonia

Answer 18

HIV (co-tramoxazole)

Question 19

Asthma + nasal polyps + salicylate sensitivity

Answer 19

samter’s triad

Question 20

alcoholic (danger of aspiration pneumonia)

Answer 20

klebsiella pneumonia (red jelly haemoptysis)

Question 21

rusty sputum

Answer 21

pneumococcal pneumonia

Question 22

cannonball metastases (weight loss and haematuria- blood in the urine)

Answer 22

primary renal cell carcinoma

Question 23

morning headache

Answer 23

hypercapnia or side effects of organic nitrates

Question 24

ACTH secreting lung cancer

Answer 24

Small cell lung cancer

Question 25

PTH secreting secreting lung cancer

Answer 25

Squamous cell carcinoma

Question 26

neuroendocrine, highly malignant and may be associated with exotic endocrine syndromes

Answer 26

small cell lung cancer

Question 27

increased serum ACE and Ca2+

Answer 27

sarcoidosis

Question 28

eggshell calcification

Answer 28

silicosis

Question 29

heart failure cells seen in alveolar spaces

Answer 29

macrophages that absorbed haemosiderin - chronic pulmonary oedema, left ventricular failure and long standing pulmonary hypertension

Question 30

Ghon focus

Answer 30

area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in TB

Question 31

tuberculous pleurisy

Answer 31

Ghon focus rupture through the visceral pleura into the pleural cavity

Question 32

Assmann focus

Answer 32

apical lesion of secondary TB infection

Question 33

coin lesion found on CXR - rounded solitary legion

Answer 33

common lesions are - primary bronchial or lung carcinomas, metastatic tumour (kidney), bronchial hamertoma, carcinoid tumour, granulomatous inflammation, lung abscess

Question 34

Horner's syndrome

Answer 34

occur when there is a local spread of cancer to the intrathoracic nodes signs include: drooping eyelids(ptosis), enophthalmos(sunken eye), mitosis(small pupil) and lack of sweating on the ipsilateral(same side of invasion) side of face - invasion of cervical sympathetic chain

Question 35

acute management of asthma

Answer 35

OSHITMAN | oxygen, salbutamol, hydrocortisone, ipratropium, Theophylline, magnesium, anaesthetist

Question 36

Thumprint sign on Xray

Answer 36

epiglottitis

Question 37

inspiratory whoop or barking cough

Answer 37

pertussis

Question 38

snow storm appearance on x ray

Answer 38

baritosis or silicosis

Question 39

mucoid sputum

Answer 39

chalmydia pneumonia

Question 40

Management of acute COPD exacerbation

Answer 40

ISOAP - ipratropium, salbuatamol, oxygen, amoxycillin and prednisolone

Question 41

peripheral adenocarcinoma?

Answer 41

non-smoker and lung cancer

Question 42

squamous + small cell lung cancers

Answer 42

CENTRAL

Question 43

high d dimers

Answer 43

suspect PE - send for CTPA or VQ scan

Question 44

low d dimer

Answer 44

exclude PE

Question 45

Large PE

Answer 45

thrombolysis

Question 46

Small PE

Answer 46

Low molecular weight heparin

Question 47

Forced vital capacity

Answer 47

Volume of air that can be forcibly blown out after full inspiration