Respiratory Medicine

Question 1

What is the differential diagnosis of a diffusely abnormal CXR?

Answer 1

Cardiac Failure/Pulmonary Oedema
Pneumonia
ARDS
Idiopathic Pulmonary Fibross
Sarcoidosis
Penumoconiosis
Hypersensitivity Penumonitis

Question 2

What lung condition is most commonly associated with occupation?

Answer 2

Hypersensitivity Pneumonitis/ EAA (80% of cases)

Question 3

What is pneumoconiosis and list the different types.

Answer 3

Any lung disease caused by mineral dust

includes silicosis, coal workers pneumoconisois and asbestosis

Question 4

What is Caplans Syndrome?

Answer 4

Pulmonary Fibrosis (usually in coal miners)
Rheumatoid Arthritis

Question 5

What are the two types of coal workers pneumoconiosis?

Answer 5

Simple pneumoconiosis - a nodular interstitial lung disease that is graded according to CXR appearance. Patients are often asymptomatic and the diagnosis is an incidental finding on CXR. Effect on lung function - Increases the risk of COPD, diminished (FEV1) and have additive effects combined with smoking
Progressive massive fibrosis - symptoms progress from shortness of breath on exertion, cough and black sputum to respiratory failure. CXR reveals large nodular, fibrotic masses in the upper lobes. Respiratory function tests show a mixed obstructive and restrictive picture with decreased lung volumes and gas transfer

Question 6

What effects does asbestos exposure have on the lung?

Answer 6

LIGHT EXPOSURE (PLEURA)
Pleural plaques, pleural fibrosis, mesothelioma
HEAVY EXPOSURE (LUNG PARENCHYMA)
Lung cancer, asbestosis

Question 7

What lesions do you see on CXR in patients with pleural plaques

Answer 7

Holly leaf lesions

Question 8

In a patient presenting with progressive breathlessness, what would the symptoms of fever and coryza point you towards a diagnosis of?

Answer 8

ALVEOLITIS (EAA/Hypersensitiviity Pneumonitis)

Flu-like coryzal symptoms = most important distinguishing feature.

Question 9

Whats the most common cause of EAA in the UK?

Answer 9

Farmers Lung

Question 10

Whats the relationship between smoking and EAA?

Answer 10

It is LESS COMMON in smokers

Question 11

Whose responsibility is it to inform the health and safety executive about work related disease

Answer 11

The employers

Question 12

What is the treatment for EAA?

Answer 12

Remove the allergen

Steroids

Question 13

What are Light’s Criteria for determining whether a fluid is an exudate or a transudate

Answer 13

A fluid is an exudate if
Effusion protein:serum protein ratio >0.5
Effusion LDH: serum LDH >0.6
Effusion LDH level >2/3 upper limit normal of serum LDH

Question 14

What 2 conditions have a calretinin positive staining test?

Answer 14

Mesothelioma

Hirshprungs Disease