EMQs in Respiratory Medicine 2

Question 1

Kerely B lines, bat-wing shaddowing, prominent upper lobe vessels, cardiomegaly.

Answer 1

Left Ventricular Failure

Question 2

Trachea deviated to right, horizontal fissure and right hilum displaced upwards.

Answer 2

Right Upper Lobe Collapse

Question 3

Numerous calcified nodules sized less than 5mm located predominantly in the lower zones of the lungs.

Answer 3

Previous varicella pneumonitis

Question 4

Double shadow right heart border, prominent left arterial appendage, left main bronchus elevation.

Answer 4

Mitral Stenosis

Question 5

28 year old African-Caribbean man presents with dry cough and progressive shortness of breath. His CXR shows bilateral hilar lymphadenopathy.

Answer 5

Extrinsic Allergic Alveolitis

Question 6

The CXR of a 13 year old boy with cystic fibrosis has tramline ring shadows.

Answer 6

Bronchiectasis

Question 7

A 65 year old dockyard worker presents with weight loss and dyspnoea. He is clubbed and cachectic. His CXR shows pleural calcification and a lobulated pleural mass.

Answer 7

Malignant Mesothelioma

Question 8

A 40 year old woman presents with gross clubbing and progressive dyspnoea. Examination reveals fine end-respiratory crackles. Her CXR shows a ground glass appearance of the lung.

Answer 8

Idiopathic Pulmonary Fibrosis

Question 9

A 65 year old smoker presents with shortness of breath. On the CXR, 8 ribs can be seen anteriorly above the diaphragm on each side of the chest in the mid-clavicular line.

Answer 9

Chronic Obstructive Pulmonary Disease

Question 10

A 7 year old girl with slight wheeze and shortness of breath despite inhaled salbutamol: treatment.

Answer 10

Inhaled Salbutamol with Spacer

Question 11

A 22 year old student with mild asthma who needs treatment for occasional early morning wheeze.

Answer 11

Inhaled Salbutamol (SABA = Short Acting Beta 2 Agonist)

Question 12

A 17 year old student complains that he has to use his salbutamol inhaler regularly to control wheezing.

Answer 12

Inhaled Beclomethasone (Corticosteroid)

Question 13

A 32 year old patient taking maximum dose-inhaled therapy and slow-release theophylline shows persistently inadequate control of symptoms.

Answer 13

Oral Prednisilone

Question 14

A 25 year old woman requires add-on therapy because inhaled salbutamol and beclomethasone do not adequately control her symptoms.

Answer 14

Inhaled Salmetarol =

A long-acting β₂ adrenergic receptor agonist (maintenance and prevention)