Respiratory

Question 1

Stony dull to percuss

Answer 1

Pleural Effusion

Question 2

Right Sided pleuritic chest pain

Answer 2

(most likely) Pneumonia

Question 3

Alveolar bat’s wings

Kerley B lines

Cardiomegaly

Dilated prominent upper lobe vessels

Pulmonary Effusion

Answer 3

Pulmonary Oedema

Question 4

Ground-glass appearance on X-ray

Answer 4

Pulmonary Fibrosis and RDS of the newborn

Question 5

Ziehl-Neeson stain +VE for acid fast bacilli

Caseous Necrosis

Answer 5

TB

Question 6

Miliary Tuberculosis

Answer 6

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

Question 7

Positive anti-glomerular basement membrane antibodies

Answer 7

Goodpasture’s syndrome

Question 8

Chest Infection with a parrot/pigeon as a pet

Answer 8

Caused by chlamydophila psittaci

Question 9

Dry cough and diarrhoea after holiday abroad: some indication of water spread

Answer 9

Legionella Pneumonia

Question 10

Tall, thin young man who indulges in marijuana

Answer 10

Pneumothorax (Marfan’s)

Question 11

Bilateral hilar lymphadenopathy

Erythema nodosum

Granulomas

Fatigue

Uveitis

Weight loss

Answer 11

Sarcoidosis

Question 12

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

Answer 12

Bronchiectasis

Question 13

D sign on X ray

Answer 13

Empyema

Question 14

‘Steeple’ sign on X ray

Answer 14

laryngotracheobronchitis/croup

Question 15

Child with a barking cough

Answer 15

Croup

Question 16

Pneumocystis Pneumonia

Answer 16

HIV

Treat with Co-trimoxazole +/- prednisalone if severe

Question 17

Asthma

Nasal polyps

Salicylate sensitivity

Answer 17

Samter’s Triad

Question 18

Alcoholic (danger of aspiration pneumonia)

Red Jelly Sputum

Answer 18

Klebsiella pneumoniae

Question 19

Mucoid sputum

Answer 19

Chlamydia psittaci

Question 20

Rusty sputum

Answer 20

Pneumococcal pneumonia

Question 21

Cannonball metastases (also weight loss and haematuria)

Answer 21

Classically from primary renal cell carcinoma

Question 22

Morning Headache

Answer 22

Hypercapnia

Side effects of organic nitrates

Question 23

ACTH secreting lung tumour

Answer 23

Small cell carcinoma of the lung

Question 24

PTH secreting lung tumour

Answer 24

Squamous cell carcinoma of the lung

Question 25

Small cell carcinoma

Answer 25

Neuroendocrine, highly malignant and may be associated with ectopic endocrine syndromes

Question 26

Increased serum ACE and Ca²⁺

Answer 26

Sarcoid

Question 27

Eggshell calcification at hilar region

Answer 27

Silicosis

Question 28

‘Heart failure’ cells seen in alveolar spaces

Answer 28

Macrophages that have absorbed haemosiderin: found in chronic pulmonary oedema and associated (severe) LV heart failure

Also seen in long-standing hypertension

Question 29

Ghon Focus

Answer 29

• Area of infection and caseous necrosis at the periphery of the lung beneath the pleura (found in TB)

Question 30

Assman Focus

Answer 30

Apical lesion of secondary tuberculosis infection

Question 31

Coin lesion found on chest radiographs

Answer 31

A rounded solitary lesions

Common: primary bronchial or lung carcinoma, metastatic tumour, bronchial hamartoma, carcinoid tumour, granulomatous inflammation, lung abscess

Question 32

Horner’s Syndrome

Answer 32

• Can occur when there is a local spread of cancer to the intrathoracic nodes or a Pancoast’s tumour

Signs: ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil) and lack of sweating on the ipsilateral (same side as the invasion) side of face,

Due to invasion of the cervical sympathetic chain

Question 33

Acute Management of Asthma

Answer 33

Oxygen

Salbutamol (nebulised back to back)

Hydrocortisone IV or Prednisalone PO

Ipratropium Bromide (nebulised hourly)

Theophylline IV or aminophylline IV

Magnesium and call an

Anaesthetist

OH SHIT MAN

Question 34

Thumbprint sign on head X ray

Answer 34

Epiglottitis

Question 35

Inspiratory whoop/barking cough

Answer 35

Pertussis

Question 36

Snow storm appearance on X ray

Answer 36

Baritosis

Silicosis

Question 37

Management of infective exacerbation of COPD

Answer 37

i - ipratropium

S - Salbutamol

O - Oxygen

A - Amoxicillin

P - Prednisalone

Question 38

Non-smoker + Lung Cancer

Answer 38

(peripheral) adenocarcinoma

Question 39

Squamous + Small Cell Lung Cancers

Answer 39

Central

Question 40

High D Dimers

Answer 40

Suspect;

Pulmonary Embolism (send for CTPA or V/Q scan)

Question 41

Low D Dimers

Answer 41

Exclude Pulmonary Embolism

Question 42

Large PE

Answer 42

Thrombolysis

Question 43

Small PE

Answer 43

Low Molecular Weight Heparin

Question 44

Honeycomb lung

Answer 44

Fibrosing alveolitis

Question 45

TB Drugs

2 RIPE 4 RI

Answer 45

2 months = Rifampicin, Isoniazid, Pyrazinamide, Ethambutol

4 months = Rifampicin, Isoniazid

Side effects = orange tear, hepatic and renal toxicity

Question 46

Respiratory causes of Clubbing

Answer 46

ABSCESS

BRONCHIECTASIS

CARCINOMA OF THE LUNG

DECREASED PaO₂

EMPYEMA

FIBROTIC LUNG DISEASE

Question 47

PE risk factors

Answer 47

Heridatary risk factors

History

Hypomobility

Hypovolaemia

Hypercoaguability

Hormones

Hyperviscosity states

Question 48

Causes of Pulmonary Fibrosis

Answer 48

Bleomycin

Radiation

Extrinsic allergic alveolitis

Aankylosing spondylitis

Sarcoidosis

Tuberculosis

Question 49

Causes of BHL (Bilateral Hilar Lymphadenopathy)

Answer 49

Sarcoidosis

Infection (TB, Mycoplasma)

Malignancy (lymphoma, carcinoma, mediastinal tumours)

Organic Dust Disease (silicosis, berylliosis)

Extrinsic Allergic Alveolitis

Question 50

Pink Frothy Sputum

Answer 50

Pulmonary Oedema

Question 51

Increased vocal resonance

Answer 51

Fibrosis

= the thickened parenchyma conducts transmitted sounds better

Question 52

Wedge shaped infarct on CXR

Answer 52

PE

• Unusual presentation