Miscellaneous

Question 1

What are the respiratory clauses of nail clubbing?

Answer 1

Lung cancer
Pyogenic conditions: cystic fibrosis, bronchiectasis, abscess, empyema
Tuberculosis
Asbestosis, mesothelioma
Fibrosing alveolitis

Question 2

What is Kartagner’s syndrome?

Answer 2

Primary ciliary dyskinesia

Question 3

What are the features of Kartagner’s syndrome?

Answer 3

Dextrocardia or complete situs inversus
Bronchiectasis
Recurrent sinusitis
Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

Question 4

What conditions cause fibrosis predominatly affecting the upper zones?

Answer 4

CHARTS

Coal workers' pneumoconiosis
Histiocytosis/hypersensitivity pneumonitis (EAA)
Ankylosing spondylitis
Radiation
Tuberculosis
Silicosis
Sarcoidosis

Question 5

What conditions cause fibrosis predominantly affecting the lower zones?

Answer 5

More common conditions

Idiopathic pulmonary fibrosis
Connective tissue disorders e.g. SLE
Asbestosis
Drug induced: amiodarone, bleomycin, methotrexate

Question 6

What is microscopic polyangiitis?

Answer 6

Small-vessel ANCA vasculitis?

Question 7

What are the features of microscopic polyangiitis?

Answer 7

Renal impairment: raised creatining, haematuria, proteinura
Fever
Systemic symptoms: letherapy, myalgia, weight loss
Rash: palpable purpura
Cough, dyspnoea, haemoptysis
Mononeuritis multiplex

Question 8

What are the investigations of microscopic polyangiitis?

Answer 8

pANCA

cANCA

Question 9

What is Psittacosis?

Answer 9

An infection caused by chlamydia psittaci (atypical pneumonia).

Question 10

What is the pathology of Psittacosis?

Answer 10

Transmission from birds or bird secretions

Question 11

What are the symptoms of Psittacosis?

Answer 11

Flu-like symptoms (90%): fever, headache, myalgia
Respiratory symptoms (82%): dyspnoea, dry cough, chest pain

Question 12

What are the signs of Psittacosis?

Answer 12

Chest: unilateral crepitation and vesicular breathing
Abdomen: hepatomegaly and splenomegaly

Question 13

What are the investigations of Psittacosis?

Answer 13

Raised inflammatory markers
Chest x-ray: consolidation (90%)
Confirm with serology

Question 14

What is the treatment of Psittacosis?

Answer 14

1st line: doxycycline (tetracyclines)

2nd like: erythromycin (macrolides)

Question 15

What conditions can cause a respiratory acidosis?

Answer 15

COPD
Decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
Neuromuscular disease
Obesity hypoventiation syndrome
Sedative drugs: benzodiazepines, opiate overdose.

Question 16

What conditions can cause a respiratory alkalosis?

Answer 16

Anxiety leading to hyperventilation
Pulmonary embolism
Salicylate poisoning
CNS disorders
Altitude
Pregnancy

Question 17

When should immediate antibiotic prescribing approach be considered?:

Answer 17

Children <2 years with bilateral acute otitis media
Children with otorrhoea who have acute otitis media
Patients with acute sore throat/acute pharyngitis/acute tonsillitis when 3 or more centor criteria are present.

If the patient is at risk of developing complications or and systemically unwell this immediate approach may also be appropriate.
(T1T2DM, HF, oral glucocorticoids)

(otherwise a delayed approach may be better)

Question 18

What are the centor criteria?

Answer 18

Presence of tonsillar exudate
Tender anterior cervical lymphadenopathy or lymphadenitis
History of fever
Absence of cough

Question 19

If there is a centor criteria score of 3 or more, what is the likely cause of a sore throat?

Answer 19

Group A Beta-haemolytic Streptococcus

Question 20

What are the respiratory manifestations of RA?

Answer 20

Pulmonary fibrosis
Pleural effusion
Pulmonary nodules
Bronchiolitis oblitereans
Methotrexate pneumonitis
Pleurisy
Caplan's syndrome
Infection secondary to immunosuppresion

Question 21

What is silicosis?

Answer 21

A fibrosing lung disease caused by the inhalation of fine particles of silica.

Question 22

What occupations are at risk of developing silicosis?

Answer 22

Mining
Slate works
Foundries
Potteries

Question 23

What are the chest x-ray features of silicosis?

Answer 23

Fibrosing lung disease

‘Egg-shell’ calcification of the hilar lymph nodes

Question 24

What drugs can be used in the aid of smoking cessation?

Answer 24

Nicotine replacement therapy
Varenicline
Bupropion