Respiratory Buzzwords

Question 1

On respiratory examination: Hyperexpanded chest

Answer 1

COPD, Chronic asthma

Question 2

On respiratory examination: Postural flapping tremor

Answer 2

Acute CO2 retention

Question 3

On respiratory examination: Stony dull percussion

Answer 3

Pleural effusion

Question 4

On respiratory examination: Fine crepitations

Answer 4

Pulmonary oedema

Question 5

On respiratory examination: Pleuritic chest pain

Answer 5

Pulmonary embolism, pneumonia, pneumothorax

Question 6

On respiratory examination: Stridor

Answer 6

Upper airway obstruction, e.g. foreign body, croup

Question 7

ABCDEF: Respiratory causes of Clubbing

Answer 7

Abcess (lung), Bronchiectasis (including CF), Cancer (lung), Decreased oxygen (hypoxia, NOT COPD), Empyema, Fibrosing alveolitis

Question 8

Resp Radiological change: Kerley B lines

Answer 8

Pulmonary oedema, perhaps caused by congestive heart failure

Question 9

Resp Radiological change: Bat-wing shadowing

Answer 9

Pulmonary oedema, perhaps caused by congestive heart failure

Question 10

Resp Radiological change: Tram-line shadowing

Answer 10

Bronchiectasis

Question 11

Resp Radiological change: Miliary shadowing

Answer 11

Miliary TB

Question 12

Resp Radiological change: Wedge-shaped infarct

Answer 12

Pulmonary embolus

Question 13

Resp Radiological change: ‘Ground-glass’ appearance

Answer 13

Fibrosis

Question 14

Resp Radiological change: ‘Honeycomb’ appearance

Answer 14

Fibrosis (late)

Question 15

Resp Radiological change: Pleural mass with lobulated margin

Answer 15

Mesothelioma

Question 16

Respiratory condition: Early-onset emphysema plus liver disease. Fever, cough, shortness of breath hours after exposure to antigen (usually farmer after hay exposure). Positive serum precipitins

Answer 16

alpha1-Antitrypsin deficiency, Extrinsic allergic alveolitis

Question 17

Respiratory condition: Asymptomatic with bilateral hilar lymphadenopathy (BHL)/progressive shortness of breath/dry cough. Non-pulmonary manifestations, e.g. erythema nodosum ↑ serum ACE (angiotensin-converting enzyme) or hypercalcaemia may be mentioned

Answer 17

Sarcoidosis

Question 18

Respiratory condition: History of recurrent chest infections, failure to thrive. May mention steatorrhoea (pancreatic insufficiency). Positive sweat test (sodium, chloride > 60 mmol/L)

Answer 18

Cystic fibrosis

Question 19

Respiratory condition: Progressive dyspnoea and cyanosis. Gross clubbing, fine end-inspiratory crackles. Chest x-ray: ground-glass → honeycomb lung

Answer 19

Idiopathic pulmonary fibrosis

Question 20

Respiratory condition: Non-specific, e.g. fever, nightsweats, anorexia, haemoptysis. Ziehl–Neelsen staining shows acid-fast bacilli (AFBs)

Answer 20

TB

Question 21

Respiratory condition: Swinging fever, copious foul-smelling sputum. Usually patient has persistent, worsening pneumonia

Answer 21

Lung abscess

Question 22

Pneumonia Cause: Positive cold agglutinins

Answer 22

Mycoplasma pneumoniae

Question 23

Cause of Cavitating lung

Answer 23

Squamous Cell Carcinoma, Autoimmune (Wegener’s granulomatosis), Vascular (PE), Infection (Klebsiella, TB, Staph aureus)

Question 24

Resp drug side effect: Peripheral neuropathy, hepatitis

Answer 24

Isoniazid

Question 25

Resp drug side effect: Tremor, tachycardia

Answer 25

Salbutamol

Question 26

Resp drug side effect: Orange-coloured tears/urine. Deranged liver function tests (LFTs), hepatitis

Answer 26

Rifampicin

Question 27

Resp drug side effect: Retrobulbar/Optic neuritis (pain, loss of vision)

Answer 27

Ethambutol

Question 28

Resp drug side effect: Gout

Answer 28

Pyrazinamide

Question 29

D sign on CXR

Answer 29

Empyema

Question 30

Steeple sign on CXR

Answer 30

Croup (Laryngotracheobronchitis)

Question 31

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

Answer 31

Sarcoidosis

Question 32

Child with barking cough

Answer 32

Croup (Laryngotracheobronchitis)

Question 33

ACTH secreting lung tumour

Answer 33

Small cell carcinoma

Question 34

PTH secreting lung tumour

Answer 34

Squamous cell carcinoma

Question 35

Increased serum ACE and Ca2+, afro-carribean

Answer 35

Sarcoidosis

Question 36

Lung cancer: Sensitive to chemotherapy, highly malignant with worse prognosis

Answer 36

small cell carcinoma

Question 37

Lung cancer: Not sensitive to chemotherapy, better prognosis

Answer 37

Non small-cell carcinoma

Question 38

TB vs Sarcoidosis

Answer 38

TB has caeseous necrosis, tuberculin positive. Sarcoid does not

Question 39

Isolated area of infection and caseous necrosis at the periphery of the lung, beneath the pleura

Answer 39

Ghon focus

Question 40

Apical lesion of secondary tuberculous infection

Answer 40

Assman focus

Question 41

Ptosis (drooping of the eyelid), Enophthalmos (sunken eye), Miosis (small pupil), and lack of sweating on the Ipsilateral side of the face

Answer 41

Horner's Syndrome, possible spread of a pancoast tumour

Question 42

Non-smoker with lung cancer

Answer 42

likely adenocarcinoma

Question 43

Paraneoplastic syndromes: Cushings & inappropriate ADH

Answer 43

Small cell lung cancer (ACTH & ADH respectively) | Also Lambert–Eaton myasthenic syndrome

Question 44

Paraneoplastic syndromes: Hypercalcaemia

Answer 44

Non-small cell lung cancer (PTH)

Question 45

Sore throat, wide-spread rash after antibiotics

Answer 45

Infective Mononucleosis | Easily mistaken as allergy to said antibiotics

Question 46

Conditions where elevated ANCA (Anti neutrophil cytoplasmic antibody) is found

Answer 46

Wegener's granulomatosis Churg-strauss syndrome Microscopic polyangiitis

Question 47

autoimmune haemolytic anaemia + cold agglutins +ve

Answer 47

Mycoplasma pneumoniae

Question 48

pneumonia + lymphopenia + haematuria

Answer 48

Legionella pneumonia

Question 49

Anti glomerular basement membrane antibody

Answer 49

Goodpasture's syndrome

Question 50

Wegener's granulomatosis vs Goodpasture's syndrome

Answer 50

Both are associated with pulmonary-renal syndrome Wegener's granulomatosis is differentiated by positive cANCA, Goodpasture's involves anti-glomerular basement membrane antibody & linear staining on direct immunofluorescence of kidneys

Question 51

Occupational relations of pneumonoconiosis: silicosis, berryliosis, asbestosis, coal workers' pneumoconiosis

Answer 51

Silicosis: Mining, quarry, sand-blasting, ceramics (silicon oxide = sand) Berryliosis: Aerospace manufacturing/engineering, berylium mining, making fluorescent light bulbs Asbestosis: Shipyard, building houses, asbestos exposure Coal workers': coal mining

Question 52

Air bronchogram in area of consolidation suggests

Answer 52

Pneumonia most likely | Indicates patent bronchus and not occluded, hence pneumonia most likely

Question 53

TLCO vs KCO

Answer 53

TLCO: transfer factor for Carbon Monoxide, used to measure the ability for gaseous exchange (or surface area) Reduced TLCO = reduced area of transfer/reduced ability for gas exchange (such as COPD, fibrosis, emphysema, PE, cardiac insufficiency) Raised TLCO = raised ability for gas exchange (Increased blood volume due to exercise, left to right shunting, alveolar haemorrhage) KCO: transfer factor PER UNIT of alveolar volume. High KCO indicates good gas exchange and any SOB should be attributed to extrapulmonary origin. Low KCO indicates alveolar damage

Question 54

Intrapulmonary nodules + Rheumatoid arthritis

Answer 54

Caplan's Syndrome (Aka Rheumatoid Pneumoconiosis) | Often present with Rheumatoid arthritis on top of respiratory symptoms. Chest CT/CXR reveals round, well defined nodules

Question 55

Eggshell calcification of mediastinal nodes

Answer 55

Silicosis

Question 56

Pulmonary Renal syndrome causes

Answer 56

Goodpasture's (Anti glomerular basement membrane antibodies) Wegener's granulomatosis (cANCA) Churg-Strauss (pANCA, asthma) Microscopic Polyangiitis (don't think will come up)

Question 57

Pneumothorax + subcutaneous emphysema in the neck after episode of vomitting

Answer 57

Likely oesophageal rupture (Boeerhaave syndrome)

Question 58

Primary ciliary dyskinesia + bronchiectasis, situs inversus, chronic sinusitis

Answer 58

Kartagener's syndrome

Question 59

Morning headache + daytime somnolence that improves with overnight nasal ventilation

Answer 59

Obstructive Sleep Apnea, Pickwikian syndrome (obesity hypoventilation syndrome + sleep apnea)

Question 60

ARDS definition (ROAR)

Answer 60

R: Reduced lung compliance O: Oedema, non-cardiogenic A: Acute onset (

Question 61

ARDS causes

Answer 61

A: Aspiration/ Acute Pancreatitis/ Amniotic Fluid embolus R: Raised Intracranial pressure/ Resp tract infection (pneumonia) D: Diabetic Ketoacidosis/ Drugs S: Sepsis/ Surgery/ Severe burns/ Smoke Inhalation