Respiratory Buzzwords

Question 1

Stony dull to percuss?

Answer 1

Pleural effusion

Question 2

Right-sided pleuritic chest pain?

Answer 2

Likely a pneumonia

Question 3

ABCDE?

Answer 3

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

Pulmonary oedema

Question 4

Ground-glass appearance on CXR?

Answer 4

Pulmonary fibrosis

Respiratory distress syndrome (newborn and adult)

Question 5

Ziehl-Nielsen stain positive for acid-fast bacilli?

Answer 5

TB

Question 6

Caseous necrosis?

Answer 6

TB

Question 7

Apical disease?

Answer 7

Assman focus due to secondary TB

Question 8

Miliary TB?

Answer 8

Spread of organism into bloodstream:
If the organism spreads via the pulmonary artery, miliary dissemination to the lung occurs
If the organism spreads via the pulmonary vein, miliary dissemination to the liver, spleen and kidneys occurs

Question 9

Positive anti-glomerular basement membrane antibodies?

Answer 9

Goodpasture’s syndrome - autoimmune disease where antibodies attach the basement membrane of the lungs and kidneys, leading to haemoptysis and renal failure

Question 10

Chest infection with a parrot/pigeon as a pet?

Answer 10

Chlamydophilia psittaci

Question 11

Dry cough and diarrhoea after a holiday abroad (with some indication of water spread)?

Answer 11

Legionella pneumophila (urinary antigen testing)

Question 12

Tall, thin young man who indulges in mariguana (Mr. Snoop Dog/Mr Martin Mitchell)?

Answer 12

Probably a pneumothorax (consider Marfan’s syndrome)

Question 13

Bilateral hilar lymphadenopathy, erythema nodosum, granulomas, fatigue, uveitis, and weight loss (Afro-Caribbean woman)?

Answer 13

Sarcoidosis

Question 14

Bronchiole wider than the arteriole next to it (signet ring sign)?

Answer 14

Bronchiectasis

Question 15

D sign on CXR?

Answer 15

Empyema

Question 16

“Steeple” sign on CXR?

Answer 16

Laryngotracheobronchitis (croup)

Question 17

Child with barking cough?

Answer 17

Croup

Question 18

Pneumocystis pneumonia (PCP)?

Answer 18

HIV (treat with co-trimoxazole; if it is severe, add prednisolone)

Question 19

Asthma + nasal polyps + aspirin sensitivity?

Answer 19

Samter’s triad

Question 20

Alcoholic (danger of aspiration pneumonia)?

Answer 20

Klebsiella pneumoniae

Question 21

Red jelly sputum?

Answer 21

Klebsiella pneumoniae

Question 22

Mucoid sputum?

Answer 22

Chlaymdia psittaci

Question 23

Rusty sputum?

Answer 23

Pneumococcal pneumonia

Question 24

Cannonball metastases (with weight loss and haematuria)?

Answer 24

Classically, from primary renal cell carcinoma

Question 25

Morning headache?

Answer 25

Hypercapnia or side effects of organic nitrates

Question 26

ACTH secreting tumour?

Answer 26

Small cell carcinoma of the lung; may cause Cushing's syndrome SCC of the lung may also secrete ADH, leading to low Na+ levels

Question 27

PTH secreting tumour?

Answer 27

Squamous cell carcinoma; results in hypercalcaemia

Question 28

Small cell carcinoma description?

Answer 28

Neuroendocrine tumour that is highly malignant and may be assos. with ectopic endocrine syndrome

Question 29

Increased serum ACE + hypercalcaemia?

Answer 29

Sarcoidosis

Question 30

Egg-shell calcification at hilar regions?

Answer 30

Silicosis

Question 31

Heart failure cells seen in alveolar spaces?

Answer 31

Macrophages that have absorbed haemosiderin; this is found in: Chronic pulmonary oedema, assoc with severe left ventricular heart failure Long-standing pulmonary hypertension

Question 32

Ghon focus?

Answer 32

Foci of granulomatous inflammation and caseous necrosis at the lung peripheries, usually in the mid-zone, due to primary TB Tuberculous pleurisy can occur due to Ghon focus rupture, through the visceral pleura and into the pleural cavity

Question 33

Assman focus?

Answer 33

Apical lesions due to secondary TB

Question 34

"Coin" lesion found on CXR?

Answer 34

``` Rounded solitary lesion; common ones are: Primary bronchial carcinoma Metastatic tumour, esp. of the kidney Bronchial hamartoma Carcinoid tumour (neuroendocrine) Granulomatous inflammation Lung abscess ```

Question 35

Horner's syndrome?

Answer 35

Can occur when there is local spread of cancer to the intra-thoracic nodes or Pancoast's tumour Signs (EVERYTHING DOWN) - ptosis (drooping of the eyelid), enophthalmos (sunken eye), miosis (small pupil) and lack of sweating on the ipsilateral side of the invasion These occur due to invasion of the cervical sympathetic chain

Question 36

Acute asthma management?

Answer 36

Oxygen (15 l/min via a non-rebreather mask) Salbutamol (nebulised back-to-back) Hydrocortisone (IV)/Prednisolone (PO) Ipratropium (IV) Theophylline/aminophylline (IV) Magnesium sulphate Anaesthetist

Question 37

Thumbprint sign on head X-ray?

Answer 37

Epiglottitis

Question 38

Inspiratory whoop/barking cough?

Answer 38

Pertussis (whooping cough)

Question 39

Snow-storm appearance on CXR?

Answer 39

Baritosis/silicosis

Question 40

Management of COPD infective exacerbation?

Answer 40

``` ipratropium Salbutamol Oxygen Amoxicillin (1st line; doxycycline is 2nd line) Prednisolone ```

Question 41

Non-smoker + lung cancer?

Answer 41

Peripheral adenocarcinoma

Question 42

Squamous and small cell lung cancers are?

Answer 42

Central

Question 43

High D-dimers?

Answer 43

Suspect, but do not diagnose, PE Send for CTPA or V/Q scan)

Question 44

Low D-dimers?

Answer 44

Exclude PE

Question 45

Treatment of small and large PEs?

Answer 45

Large - thrombolysis | Small - anti-coagulation with LWMH