Respiratory

Question 1

Neuromuscular Weakness

Answer 1

T2RF and normal CXR

Question 2

Causes of respiratory acidosis

Answer 2

COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose

Question 3

Acute eosinophillic Pneumonia

Answer 3

It is one of several conditions that cause pulmonary eosinophilia and is characterised by a cough, shortness of breath and sometimes a history of allergy. Being a smoker, or being exposed to second-hand smoke, is also thought to be a trigger. The key to diagnosis here is the patient’s chest x-ray demonstrating patchy infiltrates, but crucially the bronchiolar lavage which shows a high eosinophil count. This condition is highly responsive to steroids and so methylprednisolone is the correct answer.

ABPA - Eosinophilia is also seen, but a positive radioallergosorbent (RAST) test to Aspergillus should be demonstrated. Oral steroids are first line followed by 2nd line Itraconazole.

Question 4

Primary Ciliary Dyskinesia

Answer 4

Otitis Media
Young patient
Clubbing
Dextrocardia
Bronchiectasis

Question 5

Pulmonary Arterial Hypertension

Answer 5

The history is primarily of worsening shortness of breath in a middle-aged person with clear lung fields and a diastolic murmur. The chest X-ray with enlarged proximal pulmonary arteries is highly suggestive. Whilst an ECG or echocardiogram may show features of pulmonary arterial hypertension right heart catheterisation is the gold standard and would be most diagnostic.