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
Pleural effusion

Answer 3

Pulmonary oedema

Question 4

Ground-glass appearance on X-ray

Answer 4

Pulmonary fibrosis

Question 5

Ziehl-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

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.

Answer 8

Miliary Tuberculous

Question 9

Positive anti-glomerular basement membrane antibodies

Answer 9

Goodpasture’s syndrome

Question 10

Chest infection with a parrot/pigeon as pet

Answer 10

caused by chlamydophila psittaci

Question 11

Dry cough and diarrhoea after holiday abroad

Answer 11

Legionella pneumophila (test urine for
antigens)

Question 12

“Tall, thin young man who indulges in marijuana” - or a Mr. Snoop Dogg

Answer 12

probably 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 secreting lung tumour

Answer 24

SCLC

Question 25

PTH secreting lung tumour

Answer 25

SCC of lung

Question 26

Small-cell carcinoma -

Answer 26

neuroendocrine, highly malignant, and may be associated with | ectopic endocrine syndromes.

Question 27

Increased serum ACE and Ca2+

Answer 27

Sarcoidosis

Question 28

Eggshell calcification

Answer 28

Silicosis

Question 29

‘Heart-failure cells’ seen in alveolar spaces

Answer 29

Macrophages that have absorbed haemosiderin - found in chronic pulmonary oedema, and associated (severe) left-ventricular heart failure. Also, seen in long-standing pulmonary hypertension.

Question 30

Ghon Focus

Answer 30

An area of infection and caseous necrosis at the periphery of the lung, beneath the pleura - found in tuberculosis infection. Note: Ghon Focus rupture (rare) through the visceral pleura into the pleural cavity will produce tuberculous pleurisy.

Question 31

Assmann Focus

Answer 31

Apical lesion of secondary tuberculous infection

Question 32

‘Coin lesion’ found on chest radiographs

Answer 32

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 33

Horner’s Syndrome

Answer 33

Can occur when there is a local spread of cancer to the intrathoracic nodes. Signs include: ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (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 34

Thumbprint sign on 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

Trismus (difficulty opening mouth) is a feature of

Answer 37

Peritonsillar Abscess (Quincy)