Respiratory

Question 1

A patient’s chest is stony dull to percussion. What is this a sign of?

Answer 1

Pleural effusion

Question 2

A patient presents with right sided pleuritic chest pain. What’s the most likely diagnosis?

Answer 2

Pneumonia

Question 3

What are the common signs of pulmonary edema?

Answer 3

Alveolar bat’s wings
Kerley B lines
Cardiomegaly
Dilated prominent upper lobe
Pleural effusion

Question 4

What is a ground-glass appearance on X-ray a sign of?

Answer 4

Pulmonary fibrosis
Or
Respiratory distress syndrome of a newborn

Question 5

A Ziehl-Neelsen stain is positive for an acid fast bacilli. Which disease does this indicate?

Answer 5

TB

Question 6

Caseous necrosis is indicative of which respiratory disease?

Answer 6

TB

Question 7

What is apical disease a sign of?

Answer 7

Most likely secondary TB

An apical lesion is called an Assmann focus

Question 8

What is miliary tuberculosis?

Answer 8

The spread of mycobacterium tuberculosis through the bloodstream

If the organism spreads via the pulmonary artery, military dissemination into the lung occurs

If the organism spreads via the pulmonary vein, there is systemic dissemination to the liver, spleen and kidneys

Question 9

A patient has positive anti-glomerular basement membrane antibodies. What is the likely diagnosis?

Answer 9

Goodpasture syndrome (GPS)

A rare autoimmune disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure.

Question 10

A patient presents with a chest infection and mentions he has pet parrots/pigeons. Which organism has caused his infection?

Answer 10

Chlamydophilla psittaci

Question 11

A patient presents with a dry cough and diarrhoea after a holiday abroad. Which organism is the most likely cause of this?

Answer 11

Legionella pneumophila

Question 12

How do you confirm that a patient has been infected by legionella pneumophila?

Answer 12

Test urine for antigens

Question 13

A tall, thin, young man who indulges in marijuana comes in with acute onset shortness of breath. What is the likely diagnosis?

Answer 13

Pneumothorax

Common in Marfan’s syndrome

Question 14

What are the most common signs and symptoms of sarcoidosis?

Answer 14

Bilateral hilarity lymphadenopathy 
Erythema nodosum 
Granulomas
Fatigue 
Uveitis
Weight loss

Question 15

A CT shows bronchioles wider than neighboring arterioles (signet ring sign). What is the diagnosis?

Answer 15

Bronchiectasis

Question 16

There is a D sign on an X-ray. What does this indicate?

Answer 16

Empyema

Question 17

There is a steeple sign on an X-ray. What is the likely diagnosis?

Answer 17

Laryngotracheocronchitis

Croup

Question 18

A child comes in with a barking cough. What is the most likely diagnosis?

Answer 18

Croup

Question 19

In which patients is pneumocystis pneumonia likely to occur?

Answer 19

Patients with a lowered immune system such as patients with HIV

Question 20

How do you treat pneumocystis pneumonia?

Answer 20

Co-tramoxazole

+ prednisolone if severe

Question 21

What is Samter’s triad?

Also known as aspirin exacerbated respiratory disease

Answer 21

Asthma
Nasal polyps
Salicylate sensitivity (such as NSAIDs or aspirin)

Question 22

Klebsiella pneumoniae is common in who?

Answer 22

Alcoholics

Question 23

A patient presents with red jelly sputum. Which organism is this patient likely to be infected by?

Answer 23

Klebsiella pneumoniae

Question 24

What is mucous sputum a sign of?

Answer 24

Chlamydia psittaci

Question 25

Rusty sputum is a sign of what?

Answer 25

Pneumococcal pneumonia

Question 26

A patient comes in with haematuria, weight loss and cannonball metastases in their lungs. What is the likely source of these?

Answer 26

Primary renal cell carcinoma

Question 27

A patient comes in with a headache since the morning. What could this be a sign of?

Answer 27

Hypercapnia | Side effects from organic nitrates

Question 28

A patient has an ACTH secreting lung tumour. What is their diagnosis?

Answer 28

Small cell carcinoma of the lung

Question 29

A patient has a PTH secreting lung tumour. What is their diagnosis?

Answer 29

Squamous cell carcinoma of the lung

Question 30

Having increased serum ACE and calcium is a sign of which condition?

Answer 30

Sarcoidosis

Question 31

A patient comes in with an eggshell calcification at the hilar region. What is their likely condition?

Answer 31

Silicosis

Question 32

What is an Assmann focus?

Answer 32

An apical lesion of secondary tuberculous infection

Question 33

What is a ghon focus?

Answer 33

An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura.

Question 34

A coin lesion is found on a chest radiograph. What is this likely to be?

Answer 34

A rounded solitary lesion is most likely: ``` A primary bronchial or lung carcinoma A metastatic tumour (esp. kidney) A bronchial hamartoma A carcinoid tumour A lung abscess Granulomatous inflammation ```

Question 35

What are some of the signs of Horner’s syndrome?

Answer 35

Ptosis (drooping of the eyelid) Enopthalmos (sunken eye) Miosis (small pupil) Lack of sweating on the ipsilateral side of the face

Question 36

When can Horner’s syndrome occur?

Answer 36

When there is local spread of cancer to the intrathoracic nodes When there is a pancoast tumour

Question 37

What is the acute management of asthma?

Answer 37

``` Oxygen (100% through a non rebreather mask) Salbutamol (nebulized) Hydrocortisone IV or prednisolone Ipratropium bromide Theophylline IV or aminophylline IV ```

Question 38

There is a thumbprint sign in a head X-ray. Which structure is that?

Answer 38

Epiglottis

Question 39

What is a whooping cough a sign of?

Answer 39

Pertussis

Question 40

There is a snow storm appearance on an x ray. What is this a sign of?

Answer 40

Baritosis | Silicosis

Question 41

What is the management of an infective exacerbation of COPD?

Answer 41

``` I - Ipratropium S - Salvutamol O - Oxygen A - Amoxicillin P - Prednosolone ```

Question 42

A non smoker has lung cancer. What is this likely to be?

Answer 42

An adenocarcinoma

Question 43

A patient comes in with shortness of breath and high d-dimers. What do you suspect?

Answer 43

PE If the d-dimer is low, exclude PE

Question 44

What is the treatment of PE?

Answer 44

Small PE - Low molecular weight heparin Large PE - Thrombolysis

Question 45

A patient comes in with shortness of breath and respiratory alkalosis. What is the likely cause?

Answer 45

Panic attack

Question 46

Which is the obstructive lung disease with raised eosinophils?

Answer 46

Asthma

Question 47

Which is the obstructive lung disease with raised neutrophils?

Answer 47

COPD

Question 48

An obese patient needs overnight nasal ventilation and has hypercapnia. Which disease do they suffer from?

Answer 48

Pickwickian disease Aka obesity hypoventilation syndrome

Question 49

What is Guillian-Barre disease?

Answer 49

A disease which causes paralysis. It is normally preceded by a strep throat/ infection of the respiratory or G.I. tract

Question 50

Describe the types of coal workers pneumoconiosis.

Answer 50

Simple coal workers pneumoconiosis (the disease in its early form) Progressive massive fibrosis (The disease in its later form)

Question 51

When does adult respiratory distress syndrome occur?

Answer 51

When non cardiogenic pulmonary oedema leads to acute respiratory failure.

Question 52

A chest X-ray shows bilateral alveolar shadowing. What is this a sign of?

Answer 52

Adult respiratory distress syndrome

Question 53

Which part of the lungs does asbestosis usually affect?

Answer 53

The bases

Question 54

A type 1 diabetic patient presents with vomiting. She is dehydrated and has deep labored breathing. She reports not having taken her insulin. What is the likely diagnosis?

Answer 54

Metabolic acidosis | Diabetic ketoacidosis

Question 55

A 22 year old woman presents with weight loss, sputum, night sweats and bilateral, tender and well defined modules on her shins bilaterally. What is the likely diagnosis?

Answer 55

Erythema nodosum

Question 56

Which is the major antigen for Farmer’s lung?

Answer 56

Saccharopolyspora rectivirgula

Question 57

A patient presents with joint pain, nasal congestion and recurrent nosebleeds. His blood tests reveal a cANCA positive result. What is the cause of this?

Answer 57

Granulomatosis with polyangiitis

Question 58

What is exudate?

Answer 58

Extra protein (> 30)

Question 59

What is transudate?

Answer 59

Less protein (< 30)

Question 60

Which type of lung cancer is sensitive to chemotherapy?

Answer 60

Small cell lung cancer (also has the worst prognosis)

Question 61

What problems arise from hypercalcemia?

Answer 61

Moans (GI conditions) - constipation, nausea, decreased appetite, abdominal pain Stones (Kidney related conditions) - Kidney stones, frequent urination Groans (psychological conditions) - confusion, dementia, memory loss, depression Bones (bone pain and bone related conditions) - bone aches and pains, fractures

Question 62

What are the spirometry readings in asthma?

Answer 62

FVC - normal FEV1 - reduced FEV1/ FVC ratio - reduced

Question 63

What are the spirometry readings in COPD?

Answer 63

FVC - reduced FEV1 - reduced FEV1/ FVC ratio - normal

Question 64

What are the spirometry readings in restrictive airway disease?

Answer 64

FVC - reduced FEV1 - reduced FEV1/ FVC ratio - normal

Question 65

What is type 1 respiratory failure?

Answer 65

Low oxygen levels

Question 66

What is type 2 respiratory failure?

Answer 66

Low oxygen levels and high CO2 levels

Question 67

What is the treatment for TB?

Answer 67

2 RIPE 4 RI ``` 2 months of: R - Rifampicin I - Isoniazid P - Pyrazinamide E - Ethambutol ``` 4 months of: R - Rifampicin I - Isoniazid

Question 68

What are some side effects of Rifampin?

Answer 68

Red/orange discoloration if urine and tears Rashes Hepatotoxicity

Question 69

What are some side effects of Isoniazid?

Answer 69

Tingling sensation | Parasthesiae of the extremities

Question 70

What are some of the side effects of pyrazinamide?

Answer 70

``` Joint pain Rash Allergic reaction Yellow skin or eyes Worsening gout ```

Question 71

What are some side effects of ethambutol?

Answer 71

Change in vision Optic neuritis Red-green color blindness

Question 72

A patient with TB has a fibrosing, cavitating apical lesion. Which type of TB is this?

Answer 72

Secondary TB (reactivation or reinfection)

Question 73

Which organism is common in pneumonia for CF patients?

Answer 73

Staphylococcus aureus | Pseudomonas aeruginosa

Question 74

What are some risk factors for PE?

Answer 74

``` Hereditary e.g. factor V Leiden History I.e. previous DVT or PE Hypo-mobility e.g. fracture or long trip Hypovolaemia e.g. dehydration Hormones e.g pregnancy or oral contraceptives Hypercoagulability e.g smoking ```

Question 75

What are some causes of pulmonary fibrosis?

Answer 75

``` B - Bleomycin R - Radiation E - Extrinsic allergic alveolitis A - Ankylosing spondylitis S - Sarcoidosis T - Tuberculosis ```

Question 76

What are some causes of erythema nodosum?

Answer 76

Nodosum spelt backwards M - Mycobacterium Tuberculosis U - Ulcerative colitis/ Crohn’s disease S - Sarcoidosis O - Other infections (streptococcus, mycoplasma, EBV) D - Drugs including the oral contraceptive pill O - Occult malignancy N - No cause found/ nurturing (pregnancy)