Respiratory Medicine 🫁

Question 1

50+ male, smoker with h/o chronic dry distressing cough & progressive dyspnea. O/E there is clubbing & fine inspiratory B/L basal crackles.
a)What is the diagnosis?
b) Which investigation will you do to confirm the diagnosis?
c) Which findings do you expect in the investigation?

Answer 1

a) Idiopathic Pulmonary Fibrosis
b) diagnostic investigation- HRCT
c) HRCT findings:
-Ground glass changes
-Reticulonodular shadowing
-Honeycomb cysts
-Traction bronchiectasis

Question 2

Features of Cryptogenic Organising Pneumonia ( Bronchiolitis Obliterans Organising Pneumonia- BOOP)?

Answer 2

1)Clubbing absent
2)Markedly raised ESR
3)Masson bodies in biopsy
4)Excellent response to glucocorticoids

Question 3

Worsening of asthma+ proximal bronchiectasis+ fever+ productive cough+breathlessness+Raised eosinophil count in blood+ H/O hematological malignancy/immunosuppression=?

Answer 3

ABPA

Question 4

Worsening of asthma+raised eosinophil in blood+fever+rash+arthalgia+neuropathy+weight loss=?

Answer 4

EGPA

Question 5

Treatment of ABPA?

Answer 5

Oral Prednisolone

Question 6

H/O TB+Recurrent hemoptysis+CT shows fungal ball with air crescent sign=?

Answer 6

Simple Aspergilloma

Question 7

Immunocompromised+ Fever + pleural pain + hemoptysis + Profound NEUTROPENIA + HRCT shows Halo/Air crescent/ cavity/ no halo =?

Answer 7

Invasive Pulmonary Aspergillosis

Question 8

Farmer/ bird fancier presents with influenza like illness such as fever, breathlessness,wheeze. Symptoms occuring 4-8 hrs after working in the field/ bird loft, there maybe recurrent history. O/E widespread end inspiratory crackles & CT shows ground glass, cavitation & mosaicism,more in upper & lower lobe. What is the diagnosis?

Answer 8

Hypersensitivity Pneumonitis

Question 9

Middle aged female + asthma+ rhinosinusitis + nasal polyp =?

Answer 9

NSAID induced asthma

Question 10

Indications of PET scan

Answer 10

1)for Staging of mediastinal lymph nodes & distal metastatic disease in lung cancer
2)in investigation of pulmonary nodule
3)differentiate between benign & malignant pleural disease
4) to assess extent of extra pulmonary disease in sarcoidosis

Question 11

Limitations of PET Scan

Answer 11

False positive- Granulomatous disease
False negative- 1)Neuroendocrine tumor
2) lepidic adenocarcinoma

Question 12

Lung cancer patient present with pain in inner aspect of right arm. What is the site of tumor?

Answer 12

Right apex
(Pancoast- pain in inner arm due to destruction of C8 & T1 nerve root by apical lung tumor