Respiratory passmedicine

Question 1

Hemithorax whiteout with trachea pulled towards? (3)

Answer 1

Pneumonectomy
Lung collapse
Pulmonary hypoplasia

Question 2

Hemithorax whiteout with trachea central? (2)

Answer 2

Consolidation

Mesothelioma

Question 3

Trachea pushed away from whiteout? (3)

Answer 3

Pleural effusion
Diaphragmatic hernia
Large mass in thorax

Question 4

DDx of cavitating lung lesion on CXR? (5)

Answer 4

Abscess
Squamous cell lung cancer
Tuberculosis
Wegener's granulomatosis
Pulmonary embolism

Question 5

Lung diseases associated with asbestos exposure? (5)

Answer 5

Pleural plaques
Diffuse thickening of the pleura
Asbestosis (fibrosis)
Mesothelioma
Lung cancer

Question 6

What is the most dangerous form of asbestos?

Answer 6

Crocidolite

Question 7

Rheumatoid complications in the lung? (5)

Answer 7

Pulmonary fibrosis
Pleural effusion
MTX pneumonitis
Infection 2ndry to immunosuppression
Pleurisy

Question 8

Multisystem granulomatous disorder which often presents with dyspneoa and dry cough?

Answer 8

Sarcoidosis

Question 9

Symptoms of sarcoidosis (6)

Answer 9

Weight loss
Malaise
Dry cough
Dypsnoea
Erythema nodosum
Polyuria

Question 10

Why does polyuria occur in sarcoidosis?

Answer 10

Active sarcoid –> hypercalcaemia –> polyuria

Question 11

CXR in sarcoid?

Answer 11

Bilateral hilar lymphadenopathy

Question 12

Progressive dypsnoea, dry cough, digital clubbing and fine end-inspiratory crackles?

Answer 12

Idiopathic pulmonary fibrosis

Question 13

Pulmonary function tests in idiopathic pulmonary fibrosis indicate what kind of defect?

Answer 13

Restrictive pattern

Question 14

Diagnostic investigation in suspected idiopathic pulmonary fibrosis?

Answer 14

High resolution CT scanning of the thorax

Question 15

CT thorax findings in idiopathic pulmonary fibrosis?

Answer 15

Changes starting in lung periphery; range from “ground-glass opacification” to fibrotic “honeycomb” pattern

Question 16

The term used to describe the process of adaptation and failure of the right heart as a result of long disease?

Answer 16

Cor pulmonale

Question 17

How do diseases such as COPD and idiopathic pulmonary fibrosis lead to right ventricular failure?

Answer 17

Chronic hypoxia –> widespread arteriolar constriction –> pulmonary hypertension –> right heart hypertrophy –> failure

Question 18

Autosomal recessive ciliary dyskinesia associated with abnormal mucus clearance and recurrent respiratory infections, and male infertility

Answer 18

Kartagener syndrome

Question 19

Radiological feature of Kartagener syndrome?

Answer 19

Dextrocardia

Question 20

Methotrexate pulmonary toxicity is related to…

Answer 20

Frequency of administration

Question 21

Full blood count clue to MTX pulmonary toxicity?

Answer 21

Eosinophilia

Question 22

How is MTX pulmonary toxicity treated?

Answer 22

Steroids

Question 23

Causes/types of extrinsic allergic alveolitis?

Answer 23

Pigeon-fancier’s lung
Farmers lung (micropolyspora faeni)
Malt worker’s lung
Sugar worker’s lung

Question 24

Investigations in extrinsic allergic alveolitis?

Answer 24

Blood- neutrophilia, high ESR and CRP
Positive serum precipitins
Chronic- restrictive spirometry, reduced transfer factor

Question 25

How does TLCO increase in pulmonary haemorrhage?

Answer 25

Increased binding of CO to haemoglobin within the alveoli

Question 26

Management of extrinsic allergic alveolitis? (Acute/chronic)`

Answer 26

Acute- steroids, oxygen | Chronic- avoid/minimise exposure, sometimes long term steroids

Question 27

Which serum enzyme is often raised in sarcoidosis?

Answer 27

ACE

Question 28

Causes of bilateral hilar lymphadenopathy? (6)

Answer 28

``` Sarcoidosis Infection e.g. TB, mycoplasma Malignancy e.g. lymphoma, bronchial Organic dust disease Extrinsic allergic alveolitis Histocytosis ```

Question 29

In idiopathic pulmonary fibrosis, what does ground-glass appearance indicate?

Answer 29

Better prognosis- often regresses on treatment

Question 30

The characteristic pathological feature in extrinsic allergic alveolitis?

Answer 30

Non-caseating granuloma

Question 31

Causes of erythema nodosum? (5)

Answer 31

``` Sarcoidosis Tuberculosis Inflammatory bowel disease Streptococcal infections Drugs (oral contraceptives, sulfonamides) ```

Question 32

ANCA-associated small-medium vessel vasculitis associated with asthma, eosinophilia and sinusitis?

Answer 32

Churg-Strauss syndrome