Pneumo

Question 1

SLE + dry cough + no PEFR changes + non-responsive to steroids + normal or nodular or reticulonodular findings on CXR = ?

Answer 1

Bronchiolitis obliterans
- Also associated with RA

Question 2

Dry cough + fever + headache + high LDH + no organism seen on sputum culture + mononuclear cells = diagnosis and management?

Answer 2

Atypical pneumonia => Mycoplasma pneumonia
- Treated with Erythromycin

Question 3

Cystic fibrosis post-mortem autopsy will show infiltration of what cells?

Answer 3

Neutrophils

Question 4

Management of Anti-GBM glomerulonephritis (Goodpasture’s syndrome) ?

Answer 4

Prednisolone and cyclophosphamide

Question 5

Shepherd with sudden onset of high fever + headache + rhinitis/sinusitis + abnormal LFTs or features =

Answer 5

Q fever

Question 6

Trip to North America + substernal ache + arthralgia + breathlessness + upper lobe pulmonary infiltrates and mediastinal widening = ?

Answer 6

Histoplasmosis

Question 7

How to assess extrathoracic tracheal compression?

Answer 7

Flow-volume loop

Question 8

Most important vitamin supplementation in cystic fibrosis?

Answer 8

Liposoluble vitamins = A D E K

Question 9

Management of TB meningitis?

Answer 9

12 months of Rifampicine + isoniazide with pyrazinamide and another drug

Question 10

Most common cause of malignant tumour in lungs?

Answer 10

Metastatic carcinoma

Question 11

Patient with underlying pulmonary disease (COPD/bronchiectasis) + breathlessness and purulent cough for 6 months + one sample sputum showing Mycobacterium malmoense = next step?

Answer 11

A single isolate is not sufficient, at least two isolates from 2 non-sterile sites are required to establish disease

Question 12

Hypoxia in a patient with optimally managed primary pulmonary hypertension = what is the cause?

Answer 12

Intrapulmonary shunting

Question 13

Which occupational pneumopathy favours the development of Mycobacterium tuberculosis?

Answer 13

Silicosis - Silica is toxic to macrophages, leading to their impairment and subsequent tuberculosis infection

Question 14

Management of fulminant staphylococcal pneumonia?

Answer 14

IV Cefuroxime + Clarothromycin with added flucloxacillin for suspected Staphylococcus aureus pneumonia

Question 15

Strong risk factor for bronchiectasis?

Answer 15

Whooping cough in early childhood

Question 16

When to drain pleural effusions?

Answer 16

• Infected pleural liquid
• Presence of Gram stained organisms
• Frankly purulent liquid
• pH <7.2
• Slow clinical improvement despite antibiotics

Question 17

Lung cancer appearing in less than 3 months + signs of dissemination (liver) = Which cancer?

Answer 17

Small cell lung cancer

Question 18

What is the benefit of pulmonary rehabilitation in COPD?

Answer 18

• Increase walking distance
• Fewer hospital admissions because of recurrent chest problems

Question 19

In COPD patients treated with oral theophylline, what drugs to avoid?

Answer 19

Ciprofloxacin, Clarithromycin, Cimetidine, oral contraceptives, Allopurinol
- They cause increased theophylline serum levels leading to nausea, vomiting and tremor

Question 20

Pneumonia + myringitis + pharyngitis + lethargy + headache + tender muscles = diagnosis?

Answer 20

Mycoplasma pneumonia
- Management = 2 weeks of erythromycin/clarithromycin

Question 21

Breathlessness + orthopnea + dry cough + FVC supine lower than FVC standing = diagnosis?

Answer 21

Diaphragm palsy
- Obesity causes low FVC supine, but not by as much as diaphragm palsy

Question 22

Which lung fuction test to assess respiratory muscle reserve in patients with Guillain-Barré

Answer 22

Forced vital capacity

Question 23

Cough + shortness of breath + high fever + offensive sputum (or purulent) + history of inhalation (i.e epilepsy) + right middle lobe infiltration = Which organism?

Answer 23

Pneumonia due to anaerobes

Question 24

Hazy consolidation in lung area previously irradiated for cancer = diagnosis and management?

Answer 24

Radiation pneumonitis - treated with corticosteroids - symptomatic treatment of hypoxia = oxygen - symptomatic relief of cough = opioid antitussive

Question 25

Breathlessness + restrictive picture on spirometry + no history of smoking + reduced KCO and TLCO = diagnosis?

Answer 25

Interstitial lung disease

Question 26

What does sleep apnoea predispose to?

Answer 26

Stroke

Question 27

Inflammatory polyarthritis + B symptoms + pleural effusion with lymphocytosis and low glucose + upper CXR fibrotic patches + sterile culture = diagnosis?

Answer 27

Tuberculosis - Lymphocytosis suggests lymphoma, carcinoma or tuberculosis - Low glucose suggests infection, malignancy or rheumatoid condition The clincher here is the X-ray findings

Question 28

What finding is suggestive of right heart strain in pulmonary embolism?

Answer 28

Retrograde flow of contrast into inferior vena cava durin CTPA

Question 29

Most common cause of pneumonia in young Cystic Fibrosis patients? and in later teen and above?

Answer 29

Young = Staphy aureus Late teens and adults = Pseudomonas - Burkholderia is less common than pseudomonas and certainly way less common than S aureus

Question 30

What lung function abnormality is expected in Iddiopathic Pulmonary Fibrosis?

Answer 30

Increased lung elastic recoil - IPF lungs are stiff, therefore compliance is low which means elastic recoil is increased. Compliance and elastic recoil are inversely related

Question 31

Recurrent haemoptysis for 2 years + intermittent cough and respiratory infections + upper lobe collapse on CXR = diagnosis?

Answer 31

Carcinoid tumour - Recurrent haemoptysis +segmental collapse = bronchial carcinoid - Prolonged course of symptoms with no symptoms of carcinoid syndrome is typical of bronchial carcinoid

Question 32

Haemoptysis + lower lobe cancer at the costophrenic angle + metastasis = which biopsy is best?

Answer 32

Endobronchial ultrasound biopsy - CT-guided biopsy of left lower lobe mass is difficult in the costophrenic region