Your SlideShare is downloading. ×
0
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Anwser,s 4
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Anwser,s 4

329

Published on

أجوبة الحالات الشعاعية والسريرية المعروضة على الصفحة:http://www.facebook.com/dranas224

أجوبة الحالات الشعاعية والسريرية المعروضة على الصفحة:http://www.facebook.com/dranas224

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
329
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
26
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  1. Anwser,s Dr :ANAS SAHLE 1. Chest xr cases. 2. Chest clinical case. 3. Chest ct cases. 4. MRCP exam.:http://www.facebook.com/dranas224 Sunday, December 02, 2012
  2. chest xr cases Dr :anas sahle http://www.facebook.com/dranas224
  3. Cxr -7• Compare between tow viewPALATERAL:• DIAGNOSIS IS:
  4. DISCUSSION Mass density is seen in the lateral view, but not in the PA view.• This suggests a chest wall or external problem.• In film below mass in the axilla is projecting as a mass in the chest. Sunday, December 02, 2012
  5. CXR -8
  6. Non-anatomical Lines• The linear shadows do not correspond to any anatomical structure.• Consider the following: • Pleural fibrosis • Extra-thoracic density • Bleb wall • Lung fibrosis• This example represents pleural fibrosis. Sunday, December 02, 2012
  7. CXR-9
  8. Inlet to Outlet Shadow• In-homogeneous cardiac density: Right half more dense than left• Density crossing midline (right black arrow).• Right sided inlet to outlet shadow• Right para spinal line (left black arrow).• This is a case of achalasia cardia. Sunday, December 02, 2012
  9. CXR-10
  10. One Diaphragm (in lateral view)• You should be able to detect both diaphragms in the lateral view.• If one is missing, it indicates that there is a problem in that hemithorax.• By identifying which diaphragm is missing, you can locate the side of the problem.• Naturally it is easy to identify the problem from the PA view. Which lung is resected?• Note that you can see only one diaphragm in the film on the left.• The film below is pre-pneumonectomy, where you can identify both diaphragms.• The visible diaphragm has a stomach bubble underneath, indicating that it is on the left.• Hence, right lung pneumonectomy has occurred. Sunday, December 02, 2012
  11. Sunday, December 02, 2012
  12. chest clinical cases Persistent Dyspnea Despite Maximal Medical Therapy in COPDSubmitted byBrian P. Mieczkowski, DOFellowDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, OhioMichael E. Ezzie, MDAssistant Professor of Internal MedicineDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, Ohio http://www.thoracic.org/index.php
  13. History• A 64-year-old woman with a history of smoking presented with progressive shortness of breath with exertion.• The patient smoked one to two packs of cigarettes per day for forty-two years and quit smoking one year ago.• She had increasing dyspnea on exertion over the past few years that accelerated over the last year.• She reported she could now only walk short distances before sitting down to catch her breath.• Her family doctor started her on bronchodilators a few years ago.• She had improvement at the time, but now feels very limited.• She had several episodes of increased dyspnea, wheezing, and productive cough over the past two years.• These exacerbations were treated as an outpatient with oral corticosteroids and antibiotics.• Two years ago, she participated in a four week course of pulmonary rehab which resulted in improvement in her dyspnea.• She denied chest pain or palpitations with breathing symptoms.• She reported no shortness of breath at rest, except when talking for more than a few minutes.• She had no emergency department visits and had not required mechanical ventilator support for breathing.• She had no nocturnal symptoms of wheezing or shortness of breath, but did have occasional wheezing during the day along with a dry cough.• The patient was interested in discussing additional therapies for her lung disease. Sunday, December 02, 2012
  14. CONTIN-• Her past medical history was significant for smoking, depression, arthritis, hypertension, hyperlipidemia, and squamous cell carcinoma of the skin on the leg that was removed.• Her current medications included amlodipine, sertraline, aspirin, tiotropium, albuterol, salmeterol/fluticasone, and simvastatin.• The patient reported that her father had chronic obstructive pulmonary disease (COPD). There was no other family history of lung disease.• The patient had been married for forty-five years and had two children.• She was a former smoker of one to two packs per day for forty- two years. She denied alcohol or drug use.• She reported no significant occupational exposures.• A review of systems was pertinent for fatigue and occasional heartburn. Sunday, December 02, 2012
  15. Physical Exam• On examination, the patient’s weight was 118 pounds with a body mass index (BMI) of 20.3.• Her blood pressure was 120/70 mmHg with a pulse of 96 beats per minute.• Her oxygen saturation was 91% breathing ambient air.• Her general appearance was thin, and notable for a pleasant female who was alert and oriented in no acute distress.• Her oropharynx was clear without exudate and neck exam revealed no lymphadenopathy.• Her lung exam had diminished breath sounds bilaterally with comfortable respirations and an appreciably long expiratory phase. No wheezes, rhonchi or rales were noted.• Cardiac exam was normal rate with a regular rhythm.• Abdomen was thin, soft and nontender.• extremities showed no evidence of clubbing or edema. Sunday, December 02, 2012
  16. Diagnostic studies• Pulmonary Function Tests:• (FEV1): 0.84 L (34% predicted)• (FVC): 2.46 L (56% predicted)• FEV1/FVC: 0.34• Total lung capacity (TLC): 138% of predicted• Residual volume (RV): 227% of predicted• Diffusing Capacity of Carbon Monoxide (DLCO): 31% of predicted• 6-minute walk distance: She walked 900 feet and desaturated to 91%.• Cardiopulmonary exercise testing: Her power output was 20 watts.• Arterial blood gas: Baseline measurement of pCO2 was 37 and pO2 was 72.• The carboxyhemoglobin level was 0. Sunday, December 02, 2012
  17. CXR Sunday, December 02, 2012
  18. CT Sunday, December 02, 2012
  19. Lung Perfusion Scan Demonstrating her right upper lobe with 3.6% of total perfusion, her left upper lobe with 5% of total perfusion, her right middle lobe 13.6% of the total, her right lower lobe 26.3% of the total, and her left lower lobe 25.8% with left middle area 25.7%. Sunday, December 02, 2012
  20. Question 1• Based on our current understanding of gender differences in COPD, which of the following might be expected in this female patient compared to a male with an equivalent degree of airflow obstruction?A. She has more evidence of emphysema on her chest CT than her male counterpart.B. She has a greater bronchodilator response than her male counterpart.C. She has a greater number of cigarette pack-years with the same disease as her male counterpart.D. She would have greater improvement in her FEV1 one year after smoking cessation than her male counterpart.E. She is older than her male counterpart with equivalent disease. Sunday, December 02, 2012
  21. DISCUSSION• Chronic Obstructive Pulmonary Disease (COPD) is defined as airflow limitation that is not fully reversible and is progressive with an associated abnormal inflammatory response of the lung to noxious stimuli.• COPD is diagnosed by spirometry, with a forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7 and is classified by the degree of loss of FEV1.• The leading cause of COPD in the United States is cigarette smoking and the number of women dying from COPD is now equal to or surpassing the number of men.• There is an increased understanding of gender differences in COPD development and progression.• Women tend to develop COPD at an earlier age and generally have less pack-years of smoking compared to men with similar FEV1 values.• Chest CT scans of female patients have less evidence of emphysema and histological examinations demonstrate thicker airways and narrower lumens when compared to men with equivalent levels of obstruction.• Even with this phenotypic difference, there has been no data to suggest that women have a greater response to bronchodilators.• Given the increased risk of smoking-induced lung impairment, women may benefit from smoking cessation more than men.• The Lung Health Study found women had 2.5 times greater percentage improvement in FEV1 compared to men one year after smoking cessation. Sunday, December 02, 2012
  22. Question 2• Which of the following indices used to evaluate severity and mortality in COPD includes the numbers of exacerbations in the evaluation of the patient?• A.DOSE• B.BODE• C.ADO• D.Both A and B are correct Sunday, December 02, 2012
  23. DISCUSSION• Multiple indices have been developed to predict outcomes in COPD.• The BODE index described additional parameters to improve upon the FEV1-based mortality prediction in patients with COPD.• It has also been validated to predict hospitalizations.• The BODE index includes: BMI, degree of obstruction, symptoms of dyspnea, and exercise tolerance based on a six minute walk test.• The DOSE index, in addition to functional status, includes the frequency of exacerbation in its prediction for hospitalization, respiratory failure and subsequent exacerbations over the next year.• The components include dyspnea symptoms, degree of obstruction, smoking status, and exacerbation frequency.• The ADO index was designed to simplify and improve the all-cause mortality prediction of the BODE index and found age to be an important factor.• It includes age, dyspnea symptoms, and degree of obstruction.• The COPD prognostic index (CPI) is another index that uses exacerbation history to help predict future exacerbations, hospitalizations, and mortality.• The CPI was developed from pooled data of 12 randomized controlled trials.• The components include age, gender, degree of obstruction, quality of life, BMI, frequency of exacerbations, and history of cardiovascular disease. Sunday, December 02, 2012
  24. Question 3• Of the following therapies for COPD, which potential benefits would you expect to see in our patient?• A. Supplemental oxygen will improve her life expectancy by five years.• B. Tiotropium will decrease her annual exacerbation rate, but may increase her cardiac mortality.• C. The combination of salmeterol (long-acting beta agonist) and fluticasone (inhaled corticosteroid) will improve mortality related to COPD.• D. Pulmonary Rehabilitation will improve her quality of life, but will increase her healthcare utilization.• E. Lung volume reduction surgery will improve her quality of life, dead space ventilation and long term mortality. Sunday, December 02, 2012
  25. DISCUSSION• The patient does have moderately low oxygen levels on her six minute walk test to 91%, but there is no data to suggest she would have a 5 year mortality benefit from supplement oxygen.• Patients with very low oxygen levels at rest (paO2 less than 55 mmHg) had improved survival in early studies of home oxygen use (10, 11).• The ongoing Long-term Oxygen Treatment Trial (LOTT) (Clinicaltrials.gov identifier NCT00692198) is assessing the effect of supplement oxygen in COPD patients with moderate hypoxemia.• The TORCH trial evaluated the effectiveness of a long acting beta agonist (LABA) with and without an inhaled corticosteroid (ICS).• The combination was most effective at improving lung function and quality of life as well as decreasing the time to the next exacerbation (12).• The study did not however, demonstrate a statistically significant mortality benefit in regard to death from COPD with the use of a LABA with ICS.• The INSPIRE trial reported that both tiotropium and a LABA with ICS were equally effective at decreasing the annual exacerbation rate.• Similar to other trials with inhaled corticosteroids, INSPIRE did show an increased risk of pneumonia in the ICS treatment group (13). Sunday, December 02, 2012
  26. CONTIN-• The GOLD guidelines currently suggest adding an ICS in symptomatic patients with an FEV1 less than 50% who also have frequent exacerbations (1).• Based on retrospective data showing ipratropium may increase adverse cardiac events, there was a concern with a class effect with tiotropium.• The UPLIFT trial found fewer cardiac events and a decreased cardiac mortality in the tiotropium treatment group (14).• Pulmonary rehabilitation has been shown to improve exercise tolerance, quality of life, and decrease healthcare utilization, but studies have not been powered to assess the effect on mortality (15).• Lung volume reduction surgery (LVRS) has been shown to improve dyspnea scores, dead space ventilation, exercise tolerance, and quality of life.• In select patients, including our patient, LVRS may improve long-term mortality as well (16-18). Sunday, December 02, 2012
  27. Question 4• What patient population has the greatest mortality risk from LVRS?• A. Patients with homogeneous emphysema and a low exercise capacity• B. Patients with upper lobe predominate emphysema and low exercise capacity• C. Patients with homogenous emphysema and high exercise capacity• D. Patients with upper lobe predominant emphysema and high exercise capacity Sunday, December 02, 2012
  28. DISCUSSION• Lung Volume Reduction Surgery (LVRS) is done by performing a wedge resection of emphysematous lung tissue in select patients with COPD that are poorly controlled despite maximal medical therapy.• LVRS is thought to improve a patient’s functional status by increasing the elastic recoil and expiratory airflow by restoring the outward circumferential pull on small airways.• In addition, it is thought to help improve the strength and efficiency of the diaphragm by decreasing the radius of its curvature.• The National Emphysema Treatment Trial (NETT) showed that LVRS improved dyspnea symptom scoring, minute ventilation with exercise, and maximal exercise capacity (16).• A group of patients with an FEV1 less than 20% predicted and a diffusion capacity of less than 20% predicted were found to have a 30-day mortality rate of 16%.• These patients were termed high risk and were eliminated from further analysis (19).• Among the remaining non-high risk patients, mortality at 30-days was increased (2.2% in the LVRS group versus 0.2% in the maximal medical therapy group), but long term mortality at two years was similar.• A subgroup analysis divided patients into groups based on location of emphysema and high versus low exercise capacity defined by a cut off of 40 watts in men and 25 watts in women.• At 24 months, the subgroup of upper lobe predominate emphysema and low exercise capacity had improved survival, while the subgroup of patients with homogeneous emphysema and a high exercise tolerance had decreased survival.• The other two groups did not show survival benefit or an increased risk of death. Sunday, December 02, 2012
  29. Question 5• Which of the following changes to the patient’s history would exclude her from Lung Volume Reduction Surgery (LVRS)?• A. A post-rehabilitation six-minute walk test of 150 meters• B. A room air partial pressure of oxygen of 48 mmHg• C. A diffusing capacity of inhaled carbon monoxide (DLCO) that is 30% predicted• D. A total lung capacity of 100% predicted.• E. A requirement of 30 mg of prednisone a day to control symptoms Sunday, December 02, 2012
  30. DISCUSSION• Patients that have COPD with severe obstruction and upper lobe predominate emphysema with poor control despite maximal medical therapy can be considered for LVRS.• To better stratify which patients will benefit from LVRS, further evaluation of their physiology and functional status is needed.• This evaluation should include a full set of pulmonary function testing, a six minute walk, a cardiopulmonary exercise test, an ABG, and an echocardiogram.• The Centers for Medicare and Medicaid Services (CMS) require that a patient have an FEV1 less than 45% predicted and if over 75 years of age, the FEV1 must be greater than 15% predicted.• If the FEV1 is less than 20% predicted, the DLCO must be greater than 20% predicted.• The patient must also be stable on less than 20 mg of prednisone a day.• A minimal total lung capacity of 100% predicted and a residual volume of 150% predicted are needed to qualify.• There is evidence that a higher RV to TLC ratio yields greater improvement in post-operative FVC.• Participation in a minimal 6-week pre-operative pulmonary rehabilitation program is required and a post-rehabilitation six minute walk of greater than 140 meters is needed to be considered for LVRS.• An arterial partial pressure of oxygen of 45 mmHg or greater and a partial pressure of carbon dioxide less than 60 mmHg are also requirements from CMS.• If a patient has an ejection fraction of less than 45% then evaluation and approval by a cardiologist is required.• Other factors that may exclude a patient from LVRS include: active smoking, severe cachexia or obesity, comorbid lung or pulmonary vascular disease, and prior thoracic surgery. Sunday, December 02, 2012
  31. Question 6• What is the most common complication seven days out from LVRS?• A. Persistent chest tube air leak• B. Pneumonia• C. Renal failure• D. Arrhythmias Sunday, December 02, 2012
  32. DISCUSSION• The most common post-operative complications from LVRS are persistent air leaks, cardiac arrhythmias, pneumonia, and respiratory failure requiring sustained mechanical ventilation or re-intubation.• NETT found that air leaks occurred in 90% of patients with a median duration of seven days and 12% of patients had an air leak for greater than thirty days.• Cardiac arrhythmias were the next most common complication with 23% of patients developing an arrhythmia within the first thirty days.• Pneumonia develops in approximately 18% of patients in the post- operative period.• Renal failure is not a common complication after LVRS surgery (16).• A recent review of patients that underwent LVRS based on the NETT criteria had prolonged air leak (greater than 7 days) as the most common complication, occurring in 43% of patients (17).• Persistent air leaks often lead to a protracted time that the patient needs a chest tube, longer hospitalizations, and may require further surgical intervention to repair the bronchopleural fistula. Sunday, December 02, 2012
  33. Sunday, December 02, 2012
  34. chest ct cases-3 Dr :anas sahle http://www.facebook.com/dranas224
  35. HRCT-1
  36. HRCT-1• What is the major abnormality in this case?• a) Linear opacities• b) Nodules• c) Consolidation• d) Ground-glass opacity Note:The vessels are very prominent in this case because the computer was set to optimize visualization of the subtle major abnormality.
  37. HRCT-2
  38. HRCT-2• 2. What is the distribution of the abnormalities?• a) Bronchovascular.• c) Centrilobular.• d) Pleural. Note: D = dome of diaphragm
  39. HRCT-3
  40. HRCT-3• Find an area of ground-glass opacity in the right lung.• Find 2 pleural nodules in the right lung.• Find a nodule at the end of a vessel in the right lung.• Find 3 centrilobular nodules in the right lung.
  41. HRCT-3
  42. HRCT-4
  43. HRCT-4• Find a pleural nodule in the right lung.• Find 2 nodules along the major fissure of the right lung. *Identification of fissure: Vessels from upper and lower lobes branch and taper toward the fissure and are absent at the fissure.
  44. HRCT-4
  45. Histologic Features
  46. • Find two arteries obstructed by a cellular mass with central hemorrhagic necrosis.• Find the small subpleural hemorrhagic infarct caused by the arterial obstruction.
  47. Histologic Features These two vessels would appear on HRCT as nodules at ends of vessels.Note that on HRCT, some of the subpleural nodules in these cases may represent infarcts.
  48. Histologic Features
  49. • Find and outline the cellular mass within the vessel.• What is the nature of the cellular masses in this picture and in the one above?
  50. • Find and outline the cellular mass within the vessel.• What is the nature of the cellular masses in this picture and in the one above?• Hematogenous metastatic neoplasm, which may be confined to the vessel or may spread into the surrounding lung
  51. Diagnosis:Hematogenous metastatic tumor
  52. Summary• diagnostic features of numerous hematogenous metastatic nodules on HRCT: – Usually random distribution – Often smooth, well-defined – Varying size common
  53. random nodules• Differential diagnosis of on HRCT: – hematogenous metastasis (particularly from thyroid, kidney, and breast) and – miliary infections.Langerhans cell histiocytosis, sarcoidosis, and silicosis are common causes of nodules, but such nodules are rarely diffuse and haphazard.• Random nodules occur along the pleura and fissures, in a centrilobular location, and in the bronchovascular region.• The bronchovascular nodules in the case of random nodules are seen at the ends of small arteries and not in the proximal bronchovascular interstitium.• Nodules in lymphangitic tumor and sarcoidosis are frequently seen in the central bronchovascular interstitium.
  54. Sunday, December 02, 2012
  55. MRCP EXAM Respiratory 12/2/2012
  56. Q1The following are recognised associations •with pulmonary hypertension:A- An apgar of 3 at 5 minutes •B- Meconium aspiration •C- Hyaline membrane disease •D- Hypo-glycaemia •E- Oligo-hydraminos • 12/2/2012
  57. A1The following are recognised associations •with pulmonary hypertension:A- An apgar of 3 at 5 minutes (true) •B- Meconium aspiration (true) •C- Hyaline membrane disease (true) •D- Hypo-glycaemia (true) •E- Oligo-hydraminos (true) • 12/2/2012
  58. Q2The following are recognised causes of •pulmonary eosinophilia:A- Asthma •B- Loefflers Syndrome •C- Hookworm infestation •D- Aspergillus fumigatus •E- Schistosomiasis • Sunday, December 02, 2012
  59. A2The following are recognised causes of •pulmonary eosinophilia:A- Asthma (True) •B- Loefflers Syndrome (True) •C- Hookworm infestation (True) •D- Aspergillus fumigatus (True) •E- Schistosomiasis(false) • Sunday, December 02, 2012
  60. Q3The following are recognised treatments forcomplications of cystic fibrosis:A- DNAase to assist in reinflating collapsed lungsegments.B- Rectal pull-through and anastamosis for rectalprolapse.C- Pancreatic transplant for diabetes mellitus.D- Nebulised tobramycin for pseudomonascolonisation of the lower respiratory tract.E- Hypotonic saline drinks for hypernatraemicdehydration. Sunday, December 02, 2012
  61. A3The following are recognised treatments forcomplications of cystic fibrosis:A- DNAase to assist in re-inflating collapsed lungsegments (false) .B- Rectal pull-through and anastamosis for rectalprolapse (false).C- Pancreatic transplant for diabetes mellitus(false).D- Nebulised tobramycin for pseudomonascolonisation of the lower respiratory tract(true).E- Hypotonic saline drinks for hypernatraemicdehydration (false). Sunday, December 02, 2012
  62. Q4Regarding the sweat test:A- Sweating is enhanced by application ofatropine.B- The filter paper is left on for a total of about 4hours.C- At least 25mg of sweat is necessary for areliable result.D- More than 60mmol/L of chloride in sweat isdiagnostic of cystic fibrosis.E- False/positive results may be encountered inchildren with nephrotic syndrome. Sunday, December 02, 2012
  63. A4Regarding the sweat test:A- Sweating is enhanced by application ofatropine (false) .B- The filter paper is left on for a total of about 4hours (false).C- At least 25mg of sweat is necessary for areliable result (false).D- More than 60mmol/L of chloride in sweat isdiagnostic of cystic fibrosis (true).E- False/positive results may be encountered inchildren with nephrotic syndrome (false). Sunday, December 02, 2012
  64. Q5Diffusion capacity of carbon monoxide:A- Is a specific measure of lung perfusion.B- Depends on the thickness of the alveolarwall.C- Depends on the surface area available forgas exchange.D- Is increased in cigarette smokers.E- Is increased in emphysema. Sunday, December 02, 2012
  65. A5Diffusion capacity of carbon monoxide:A- Is a specific measure of lung perfusion(false) .B- Depends on the thickness of the alveolarwall (true).C- Depends on the surface area available forgas exchange (true).D- Is increased in cigarette smokers (false).E- Is increased in emphysema (false). Sunday, December 02, 2012
  66. Q6The following respiratory symptoms maybe exacerbated by gastro-oesophagealreflux:A- AsthmaB- Central apnoeaC- Obstructive apnoeaD- StridorE- Wheeze Sunday, December 02, 2012
  67. A6The following respiratory symptoms maybe exacerbated by gastro-oesophagealreflux:A- Asthma (true)B- Central apnoea (true)C- Obstructive apnoea (true)D- Stridor (true)E- Wheeze (true) Sunday, December 02, 2012
  68. Q7In lung perfusion scanning:A- Emphysema and pulmonary embolismgive similar appearances.B- Iodine sensitivity is a contraindication.C- Is always abnormal in ScimitarSyndrome.D- May show decreased upper lobeperfusion in mitral stenosis.E- Shows decreased perfusion in McLeodsSyndrome. Sunday, December 02, 2012
  69. A7In lung perfusion scanning:A- Emphysema and pulmonary embolism givesimilar appearances (false) .B- Iodine sensitivity is a contraindication (false).C- Is always abnormal in Scimitar Syndrome(true).D- May show decreased upper lobe perfusion inmitral stenosis (false).E- Shows decreased perfusion in McLeodsSyndrome (true). Sunday, December 02, 2012
  70. Q8In cystic fibrosis:A- The sweat chloride is higher than the sodium.B- The secretions are viscid because water cannotbe actively transported form the respiratoryepithelial cell.C- The amino acid at position 508 of the CTREgene acts as a regulator of the chloride channel.D- The DeltaF508 mutation explains most of the inter-racial differences in the incidence of cystic fibrosis.E- The CFTR traverses the cell membrane 7 times, andis arranged in ring formation. Sunday, December 02, 2012
  71. A8In cystic fibrosis:A- The sweat chloride is higher than the sodium (true) .B- The secretions are viscid because water cannot beactively transported form the respiratory epithelialcell (false).C- The amino acid at position 508 of the CTRE geneacts as a regulator of the chloride channel (true).D- The DeltaF508 mutation explains most of the inter-racialdifferences in the incidence of cystic fibrosis (true).E- The CFTR traverses the cell membrane 7 times, and isarranged in ring formation (true). Sunday, December 02, 2012
  72. Q9Pneumocystis carinii:A- Predisposes to pneumothorax.B- Can cause pneumonia with very fewsigns on chest x-ray.C- Is an obligate intracellular organism.D- May cause extrapulmonary infection.E- Is usually diagnosed by finding arising titre of neutralising antibodies. Sunday, December 02, 2012
  73. A9Pneumocystis carinii:A- Predisposes to pneumothorax (true) .B- Can cause pneumonia with very fewsigns on chest x-ray(false).C- Is an obligate intracellularorganism(false).D- May cause extra-pulmonary infection(true).E- Is usually diagnosed by finding a risingtitre of neutralising antibodies(false). Sunday, December 02, 2012
  74. Q10Recognised complications ofbronchoscopy include:A- HaemorrhageB- PneumothoraxC- Segmental collapseD- Hypoxic ischaemic encephalopathyE- Empyema Sunday, December 02, 2012
  75. A10Recognised complications ofbronchoscopy include:A- Haemorrhage (true)B- Pneumothorax (true)C- Segmental collapse (true)D- Hypoxic ischaemic encephalopathy(false)E- Empyema (true) Sunday, December 02, 2012
  76. Sunday, December 02, 2012

×