Respiratory

Question 1

Ddx for bronchiectasis

Answer 1

congenital:

1. primary ciliary dyskinesia
2. CF
3. congenital hypogammaglobulinaemia

Acquired:

1. childhood infections
2. localised disease
   - foreign body
   - bronchial mass
   - TB
3. ABPA (central bronchiectasis)

Question 2

Ddx for restrictive lung disease

Answer 2

Pleural

• large pleural effusions
• asbestosis
• pleural scarring

Alveolar

• oedema
• haemorrhage

Interstitial

• ILD: IPF (honey-combing), NSIP (ground glass), COP
• associated with CT disease (usually NSIP pattern)

Neuromuscular

• Myasthenia Gravis
• ALS
• myopathy

Thoracic

• obesity
• kyphoscoliosis

Question 3

Ddx for hilar lymphadenopathy

Answer 3

sarcoidosis
infection
- TB, fungal, mycoplasma
Malignancy
Inorganic dust disease
- silicosis, berylliosis
Extrinsic allergic alveolitis
- bird fancier's lung
Churg Strauss disease

Question 4

Ddx for mediastinal lymphadenopathy

Answer 4

Sarcoidosis 
Infection
- TB
Malignancy
- lung or oesophageal primary
- mets
- lymphoma, leukaemia
- testicular cancer

Question 5

Ddx pulmonary fibrosis

Answer 5

upper lobes:
Sarcoidosis, Silicosis
Coal workers pneumoconiosis
Histiocytosis
ABPA, Ankylosing Spondylitis
Radiation
TB

lower lobes:
Rheumatoid arthritis
Asbestosis
Scleroderma
Cryptogenic fibrosing alveolitis
Other - drugs
- MTX, bleomycin, nitrofurantoin, amiodarone, hydralazine

Question 6

Ddx for clubbing

Answer 6

Cardiovascular: cyanotic congential heart disease, infective endocarditis

Respiratory: lung cancer, bronchiectasis, lung abscess, empyema, idiopathic pulmonary fibrosis, cystic fibrosis, asbestosis, pleural mesothelioma

Gastrointestinal: cirrhosis (especially biliary cirrhosis), inflammatory bowel disease, coeliac disease

Other: thyrotoxicosis, pregnancy, secondary hyperparathyroidism, bronchial AVM, neurogenic diaphragmatic tumour, familial

NOT seen in COPD, sarcoidosis, extrinsic allergic alveolitis, coal workers pneumoconiosis, silicosis

Question 7

Ddx for pleural effusion

Answer 7

Transudate:

• cardiac failure
• nephrotic syndrome
• liver failure
• Meigs syndrome
• hypothyroidism

Exudate:

• pneumonia
• neoplasm
• tuberculosis, sarcoidosis
• pulmonary infarction
• subphrenic abscess
• pancreatitis
• connective tissue disease
• drugs
• radiation

Question 8

Causes of pulmonary hypertension?

Answer 8

1: pulmonary arterial hypertension
Idiopathic, HIV, connective tissue disease, congenital heart disease, hereditary (BMPR-2), drugs and toxins (appetite suppressants)
2. Left heart disease
3. Lung disease - COPD, interstitial lung disease, OSA/OHS
4. Chronic thromboembolic pulmonary hypertension
5. Miscellaneous e.g. Sarcoidosis, splenectomy, myeloproliferative disorders

Question 9

Differentials for haemoptysis

Answer 9

Infection
Malignancy
Coagulopathy
Trauma
Pulmonary-renal syndromes (goodpastures, SLE granulomatosis with polyangiitis)
Nasal/oral bleeding
Pulmonary AVM
Pulmonary embolus
Recent bronchoscopy
Cardiac: congenital, MS, heart failure