Respiratory

Question 1

Stoney dull to percuss

Answer 1

Pleural effusion

Question 2

Right sided pleuritic chest pain

Answer 2

Most likely pneumonia

Question 3

Alveolar bats wings
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusion

Answer 3

Pulmonary oedema

Question 4

Ground-glass appearance on x-ray

Answer 4

pulmonary fibrosis

Question 5

Zeihl-Neelsen stain positive for acid fast bacilli

Answer 5

TB

Question 6

Caseous necrosis

Answer 6

TB

Question 7

Apical disease

Answer 7

Most likely (secondary) TB
Apical lesion is called an Assmann focus

Question 8

Miliary tuberculous

Answer 8

Spread of organism into bloodstream
If organism spread via pulmonary artery, miliary dissemination into the lung occurs
If organism spread via pulmonary vein, there is systemic dissemination to the liver, spleen and kidneys

Question 9

Positive anti-glomerular basement membrane antibodies

Answer 9

Goodpasture’s syndrome

Question 10

Chest infection with a parrot/pigeon as a pet

Answer 10

Caused by chlamydophilia psittaci

Question 11

Dry cough and diarrhoea after holiday abroad

Answer 11

Legionella pneumophilia (test urine for antigens)

Question 12

Tall, thin young man who indulges in marijuana

Answer 12

Pneumothorax (Marfan’s)

Question 13

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

Answer 13

Sarcoidosis

Question 14

Bronchiole wider than neighbouring arteriole (on CT) (signet ring sign)

Answer 14

Bronchiectasis

Question 15

D sign on x-ray

Answer 15

Empyema

Question 16

Steeple sign on x-ray

Answer 16

larygotracheobronchitis/croup

Question 17

Child with barking cough

Answer 17

Croup

Question 18

Pneumocystis pneumonia

Answer 18

HIV

Question 19

Asthma + nasal polyps + salicylate sensitivity

Answer 19

Samter’s triad

Question 20

Alcoholic (danger of aspiration pneumonia)

Answer 20

Klebsiella pneumoniae (red jelly haemopytsis)

Question 21

Rusty sputum

Answer 21

Pneumococcal pneumonia

Question 22

Cannonball metastases (also weight loss and haematuria)

Answer 22

Classically from primary renal cell carcinoma

Question 23

Morning headache

Answer 23

Hypercapnia

Question 24

ACTH (adrenocorticotropic hormone) secreting lung tumour

Answer 24

Small cell lung carcinoma (SCLC)

Question 25

PTH (parathyroid hormone) secreting lung tumour

Answer 25

Small cell carcinoma (SCC) of lung

Question 26

Small cell carcinoma

Answer 26

Neuroendocrine Highly malignant May be associated with ectopic endocrine syndromes

Question 27

Increased serum ACE and Ca2+

Answer 27

Sarcoid

Question 28

Eggshell calcification

Answer 28

Silicosis

Question 29

Heart failure cells seen in alveolar space

Answer 29

Macrophages have been absorbed

Question 30

Haemosiderin (stores iron in the body)

Answer 30

Found in chronic pulmonary oedema Associated with (severe) left ventricular heart failure Also seen in long standing pulmonary hypertension

Question 31

Ghon focus

Answer 31

An area of infection and caseous necrosis at the periphery of the lung beneath the pleura - found in TB infection Ghon focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy

Question 32

Assman focus

Answer 32

Apical lesion of secondary tuberculous infection

Question 33

Coin lesion found on chest radiographs

Answer 33

A rounded solitary lesion The common lesions are: primary bronchial or lung carcinoma, metastatic tumour (esp. of kidney), bronchial hamartoma, carcinoid tumour, granulomatous inflammation, lung abscess

Question 34

Horner's syndrome

Answer 34

Can occur when there is a local spread of cancer to the intrathoracic nodes Signs include: ptosis (drooping of the eyelid), enophthalmos (sunken eye), mitosis (small pupil), and lack of sweating on the ipsilateral (same side as invasion) side of the face This is due to invasion of the cervical sympathetic chain

Question 35

Acute management of asthma

Answer 35

OSHITMAN Oxygen 100% through non-breather mask Salbutamol nebulised back to back Hydrocortisone IV or prednisolone PO Ipratropium bromide nebulised hourly Theophylline IV or aminophylline IV Magnesium Anaethesist

Question 36

Thumbprint sign on x-ray

Answer 36

Epiglottis

Question 37

Inspiratory whoop/barking cough

Answer 37

Pertussis (caused by bordetella pertussis)

Question 38

Snow storm appearance on x-ray

Answer 38

Baritosis Silicosis