Respiratory

Question 1

Hyperexpanded chest

Answer 1

COPD Chronic asthma

Question 2

Postural flapping tremor

Answer 2

Acute CO2 retention

Question 3

Stony dull percussion

Answer 3

Pleural effusion

Question 4

Fine crepitations

Answer 4

Pulmonary oedema Pulmonary fibrosis

Question 5

Pleuritic chest pain

Answer 5

Pulmonary embolism, pneumonia, pneumothorax

Question 6

Stridor

Answer 6

Upper airway obstruction, e.g. foreign body, croup

Question 7

Causes of clubbing

Answer 7

Bronchial Carcinoma Bronchiectasis Lung Abscess Empyema Cystic Fibrosis Cryptogenic fibrosing alveolitis mesothelioma TB NOT ASTHMA OR COPD

Question 8

Kerley B lines Bat-wing shadowing

Answer 8

Heart failure

Question 9

Tram-line shadowing

Answer 9

bronchiectasis

Question 10

Miliary shadowing

Answer 10

miliary TB

Question 11

Wedge-shaped infarct

Answer 11

Pulmonary embolus

Question 12

Ground-glass appearance

Answer 12

fibrosis

Question 13

honeycomb appearance

Answer 13

late fibrosis

Question 14

Pleural mass with lobulated margin

Answer 14

mesothelioma

Question 15

Early-onset emphysema plus liver disease Fever, cough, shortness of breath hours after exposure to antigen (usually farmer after hay exposure)

Answer 15

􏰆1-Antitrypsin deficiency Extrinsic allergic alveolitis

Question 16

Asymptomatic with bilateral hilar lymphadenopathy (BHL)/progressive shortness of breath/dry cough Non-pulmonary manifestations, e.g. erythema nodosum ↑ serum ACE (angiotensin-converting enzyme) or hypercalcaemia may be mentioned

Answer 16

Sarcoidosis

Question 17

History of recurrent chest infections, failure to thrive May mention steatorrhoea (pancreatic insufficiency) Positive sweat test (sodium, chloride 􏰈60 mmol/l)

Answer 17

Cystic fibrosis

Question 18

Progressive dyspnoea and cyanosis Gross clubbing, fine end-inspiratory crackles Chest radiograph: ground-glass → honeycomb lung

Answer 18

Fibrosing alveolitis

Question 19

Non-specific, e.g. fever, nightsweats, anorexia, haemoptysis Ziehl–Neelsen staining shows acid-fast bacilli (AFBs)

Answer 19

TB

Question 20

Swinging fever, copious foul-smelling sputum Usually patient has persistent, worsening pneumonia

Answer 20

Lung abscess

Question 21

Positive cold agglutinins

Answer 21

Mycoplasma infection

Question 22

Occupation involving water systems

Answer 22

Legionella infection

Question 23

Cavitating lung(s)

Answer 23

Staphylococcal/klebsiella infection

Question 24

Contact with birds

Answer 24

Chlamydia psittaci infection

Question 25

HIV 􏰇ve, bilateral hilar shadowing

Answer 25

Pneumocystis carinii pneumonia

Question 26

Isoniazid side effects

Answer 26

Peripheral neuropathy, hepatitis

Question 27

Rifampicin side effects

Answer 27

Orange-coloured tears/urine Deranged liver function tests (LFTs), hepatitis

Question 28

Ethambutol side effects

Answer 28

Retrobulbar neuritis (pain, loss of vision)

Question 29

Pyrazinamide side effects

Answer 29

Gout

Question 30

Salbutamol side effects

Answer 30

Tremor, tachycardia

Question 31

Inhaled high-dose corticosteroid side effects

Answer 31

Candidiasis mouth/pharynx

Question 33

What are the causes of fine crackles?

Answer 33

Pulmonary fibrosis

Pulmonary oedema

Allergic alveolitis

Bronchiectasis

Cystic fibrosis

Pneumonic consolidation

Question 34

What are the causes of coarse crackles?

Answer 34

COPD

Pneumonia

Lung abscess

TB cavities

Bronchiectasis