Anwser,s    Dr :ANAS SAHLE   1. Chest xr cases. 2. Chest clinical case.   3. Chest ct cases.    4. MRCP exam.:http://www.f...
chest xr cases   Dr :anas sahle http://www.facebook.com/dranas224
CXR-31DIAGNOSIS: Aneurysm of Descending Aorta
CXR-32              DIAGNOSIS: Fungous BallCrescent sign - semilunar air space above mass density
CXR-33a     AspergillosisSub-acute Invasive Form
CXR-33b  Cavitation with return of white countResembling fungous ball with crescentic air        Non- mobile fungous ball
CXR-33c  Cavitation with return of white countResembling fungous ball with crescentic air        Non- mobile fungous ball
CXR-34DIAGNOSIS: Blebs
CXR-35a
CXR-35b    Lingular pneumonia            Lingular pneumoniaPost obstructive pneumonia    Post obstructive pneumoniaDIAGNOS...
DIAGNOSIS: Broncholith                    Monday, December 31, 2012
CXR-36     DIAGNOSIS: Left Cervical RibYou identify the rib by the transverse process with which itarticulates.A: Transver...
CXR-37DIAGNOSIS: Dextrocardia
Note• Stomach bubble on left• Right diaphragm lower  – Position of heart determines which diaphragm is    lower, not liver...
CXR-38DIAGNOSIS: Dextrocardia / Kertageners Syndrome:
Monday, December 31, 2012
chest clinical cases        A 20 Year-Old with a         Mediastinal MassSubmitted byTyler B. Anderson, MDFellowDivision o...
History• A 20 year old Caucasian man with no significant past  medical history presented to his primary care physician  fo...
Physical Exam• The patient was in no acute distress.• Vital signs were unremarkable.• Cardiac exam demonstrated regular ra...
Lab• White blood cell count 7.2 K/uL, 56% Neutrophils,  28% Lymphocytes, 7% Eosinophils• Chemistry and liver function test...
cxr      Monday, December 31, 2012
Ct     Monday, December 31, 2012
• An abnormality was noted in the left  mediastinum which prompted his physician to  order a computed tomography (CT) of t...
Question 1• What is the most common cause of an  anterior mediastinal neoplasm?•   A. Germ cell tumor•   B. Lymphoma•   C....
Discussion•   The mediastinum is located in the central portion of the thorax.•   The boundaries are the pleural cavities ...
Question 2• What is the most common presenting  symptom in a patient with a mediastinal  mass?•   A. Chest pain Systemic• ...
Discussion• About two thirds (62%) of patients with mediastinal  masses of any etiology will have symptoms at the time of ...
Question 3• What is the most common syndrome  associated with thymoma?•   A. Hypogammaglobulinemia•   B. Myasthenia gravis...
Discussion•   Symptoms of myasthenia gravis include generalized weakness and fatigue, along with diplopia, ptosis    and d...
Question 4• Which condition(s) is/are associated  with Rebound Thymic Hyperplasia  (RTH)?•   A. Addison disease•   B. Canc...
Discussion• Rebound thymic hyperplasia (RTH) is a form of true thymic  hyperplasia which can occur in children and young a...
Question 5• What is the treatment of choice for  RTH?•   A. Chemotherapy•   B. Observation•   C. Radiation therapy•   D. S...
Discussion• The thymus is functionally active in childhood and adolescence  and may be susceptible to fluctuation in corti...
Monday, December 31, 2012
chest ct cases-7    Dr :anas sahle  http://www.facebook.com/dranas224
images 1 and 2.
Look at images 1 and 2.• This case shows multiple nodules.• Asymmetry of the lungs is due to collapse of  the left upper l...
Look at images 1 and 2.• This case shows multiple nodules.• Asymmetry of the lungs is due to collapse of the  left upper l...
HRCT-1
HRCT-1• Find the left upper lobe bronchus leading into  the left upper lobe.• Outline the collapsed left upper lobe.• In t...
HRCT-1
HRCT-2
HRCT-2• Find 2 centrilobular nodules in the right lung.• Find a nodule at the end of a vessel in the  posterior right lung.
HRCT-2
Histology of a Nodule
Q• This rounded, subpleural structure, about 0.5  cm in diameter, corresponds to the subpleural  lesions in the images abo...
Answer• 1. Possible causes include infection and tumor.   – This particular patient had known     metastatic testicular ca...
Differential diagnosis of random nodules                  on HRCT:• hematogenous metastasis (particularly from thyroid,  k...
Histologic differential diagnosis:• Metastatic tumor.• Infection should be considered.
HRCT diagnosis:• Metastatic breast cancer with hematogenous  spread throughout the lungs and  endobronchial metastasis to ...
Summary• diagnostic features of numerous  hematogenous metastatic nodules on HRCT     • Usually random distribution     • ...
Monday, December 31, 2012
MRCP EXAM  Respiratory                12/31/2012
Q1A 9 month old child presents with respiratory distress,  worsening over 2 days. Blood gases show apH of 7.25, a PCO of 7...
A1A 9 month old child presents with respiratory  distress, worsening over 2 days. Blood gases  show apH of 7.25, a PCO of ...
Q2• Long-acting ß2 agonists:• A -Can be used to prevent activity-induced  symptoms without anti-inflammatory therapy.• B- ...
A2• Long-acting ß2 agonists:• A -Can be used to prevent activity-induced  symptoms without anti-inflammatory  therapy.(tru...
Q3The oxygen dissociation curve isshifted to the right by:A- Decreased haemoglobin concentrationB- Reduced temperatureC- R...
A3The oxygen dissociation curve isshifted to the right by:A- Decreased haemoglobin concentration (False)B- Reduced tempera...
Q4In lung empyema:A- Strep. pneumoniae is usually isolated fromthe pleural cavity.B- Installation of urokinase may be help...
A4In lung empyema:A- Strep. pneumoniae is usually isolated from the pleuralcavity. (False)B- Installation of urokinase may...
Q5Regarding lung development:A- The pseudoglandular phase lasts between 16 and 26weeks.B- Alveolar capillaries first appea...
A5Regarding lung development:A- The pseudoglandular phase lasts between 16 and 26 weeks.(False)B- Alveolar capillaries fir...
Q6Recognised causes of acute upperairway obstruction include:A- Angio-oedemaB- AsthmaC- MumpsD- Retro-pharyngeal abscessE-...
A6Recognised causes of acute upperairway obstruction include:A- Angio-oedema(True)B- Asthma(False)C- Mumps(False)D- Retro-...
Q7The following lung function tests arecompatible with severe scoliosis:A- An FEV1 of 65% of normal.B- An FEV1/2 of 65% of...
A7The following lung function tests arecompatible with severe scoliosis:A- An FEV1 of 65% of normal. (True)B- An FEV1/2 of...
Q8Concerning Tuberculosis:A- The infection rate is increased in Crohns Disease.B- Overcrowded living conditions do notsign...
A8Concerning Tuberculosis:A- The infection rate is increased in Crohns Disease. (False)B- Overcrowded living conditions do...
Q9The following are signs of severeasthma:A- A silent chest in a 7 year old girl.B- Inability to feed in a 10 month old ch...
A9The following are signs of severe asthma:A- A silent chest in a 7 year old girl. (True)B- Inability to feed in a 10 mont...
Q10Lung biopsy may be useful in the followingcases:A- A 6 month old boy ventilated for adenovirusinfection.B- A 2 year old...
A10Lung biopsy may be useful in the followingcases:A- A 6 month old boy ventilated for adenovirusinfection. (True)B- A 2 y...
Monday, December 31, 2012
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Anwser,s 8

  1. 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 Monday, December 31, 2012
  2. 2. chest xr cases Dr :anas sahle http://www.facebook.com/dranas224
  3. 3. CXR-31DIAGNOSIS: Aneurysm of Descending Aorta
  4. 4. CXR-32 DIAGNOSIS: Fungous BallCrescent sign - semilunar air space above mass density
  5. 5. CXR-33a AspergillosisSub-acute Invasive Form
  6. 6. CXR-33b Cavitation with return of white countResembling fungous ball with crescentic air Non- mobile fungous ball
  7. 7. CXR-33c Cavitation with return of white countResembling fungous ball with crescentic air Non- mobile fungous ball
  8. 8. CXR-34DIAGNOSIS: Blebs
  9. 9. CXR-35a
  10. 10. CXR-35b Lingular pneumonia Lingular pneumoniaPost obstructive pneumonia Post obstructive pneumoniaDIAGNOSIS: Broncholith
  11. 11. DIAGNOSIS: Broncholith Monday, December 31, 2012
  12. 12. CXR-36 DIAGNOSIS: Left Cervical RibYou identify the rib by the transverse process with which itarticulates.A: Transverse process cervical vertebra: HorizontalB: Transverse process dorsal vertebra: Upward
  13. 13. CXR-37DIAGNOSIS: Dextrocardia
  14. 14. Note• Stomach bubble on left• Right diaphragm lower – Position of heart determines which diaphragm is lower, not liver.• Pectus accounts for increased density on left Monday, December 31, 2012
  15. 15. CXR-38DIAGNOSIS: Dextrocardia / Kertageners Syndrome:
  16. 16. Monday, December 31, 2012
  17. 17. chest clinical cases A 20 Year-Old with a Mediastinal MassSubmitted byTyler B. Anderson, MDFellowDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, OhioJonathan P. Parsons, MD, MSc, FCCPAssociate Professor of Internal MedicineDivision of Pulmonary, Allergy, Critical Care and Sleep MedicineThe Ohio State University Medical CenterColumbus, Ohio
  18. 18. History• A 20 year old Caucasian man with no significant past medical history presented to his primary care physician for chest discomfort and cough.• Two months prior to presentation, he reported having an unremarkable viral syndrome which resolved with no medical intervention.• His primary care physician prescribed a short course of antibiotics for empiric treatment of pneumonia with some initial improvement in symptoms.• His chest discomfort returned and he developed progressive dyspnea on exertion which led to a chest radiography. Monday, December 31, 2012
  19. 19. Physical Exam• The patient was in no acute distress.• Vital signs were unremarkable.• Cardiac exam demonstrated regular rate and rhythm with no murmur, gallop or rub.• Lungs were clear to auscultation bilaterally without wheezes or rales.• Abdomen was soft with no hepato/spleno-megaly.• There was no palpable cervical, supra-clavicular or axillary lymphadenopathy.• Genitourinary exam was negative for testicular masses. Neurologic exam showed no focal deficits.• Cranial nerves appeared intact. Monday, December 31, 2012
  20. 20. Lab• White blood cell count 7.2 K/uL, 56% Neutrophils, 28% Lymphocytes, 7% Eosinophils• Chemistry and liver function testing was within normal limits• Human chorionic Gonadotropin (HCG), serum <0.5 MIU/mL (normal in males <5.0 MIU/ml)• Alpha-fetoprotein (AFP), serum 2.2 NG/mL (normal 0.0-8.3 NG/ML) Monday, December 31, 2012
  21. 21. cxr Monday, December 31, 2012
  22. 22. Ct Monday, December 31, 2012
  23. 23. • An abnormality was noted in the left mediastinum which prompted his physician to order a computed tomography (CT) of the chest and to refer him to a pulmonary specialist.• This CT scan revealed a rounded, well- demarcated mass in the superoanterior mediastinal compartment.• The largest diameter measured 6.8 x 4.8cm. Monday, December 31, 2012
  24. 24. Question 1• What is the most common cause of an anterior mediastinal neoplasm?• A. Germ cell tumor• B. Lymphoma• C. Parathyroid adenoma• D. Thymoma Monday, December 31, 2012
  25. 25. Discussion• The mediastinum is located in the central portion of the thorax.• The boundaries are the pleural cavities laterally, the thoracic inlet superiorly and the diaphragm inferiorly.• The anterior compartment refers to the retrosternal space that is anterior to the heart and great vessels.• It contains the thymus, lymph nodes, adipose and connective tissue.• Approximately one half of mediastinal tumors occur in the anterior mediastinum1.• Thymomas, lymphomas and germ cell tumors are the most frequently diagnosed tumors of the anterior mediastinum with a relative incidence of 30%, 20% and 18%, respectively 2.• Thymomas are the most common neoplasm of the anterior mediastinum with an incidence of 0.15 cases per 100,0003.• Interestingly, mass location tends to predict malignancy.• Approximately two thirds of all mediastinal tumors are benign, but masses in the anterior compartment are more likely to be malignant1.• A retrospective review of 400 patients by Davis et al found that 59% of anterior masses were malignant, compared to masses in middle mediastinum (29%) and posterior mediastinum (16%)2. Monday, December 31, 2012
  26. 26. Question 2• What is the most common presenting symptom in a patient with a mediastinal mass?• A. Chest pain Systemic• B. Dysphagia• C. Hemoptysis• D. "B" symptoms (fever, weight loss, night sweats) Monday, December 31, 2012
  27. 27. Discussion• About two thirds (62%) of patients with mediastinal masses of any etiology will have symptoms at the time of diagnosis2.• Chest pain is the most frequently reported symptom (30%) followed by fever and chills (20%)2.• Anterior mediastinal masses produce symptoms at a greater frequency (75%) than masses from middle or posterior compartments, 45% and 50% respectively2.• Similar to mass location, presence of symptoms at diagnosis also predicts malignancy.• Overall, 85% of patients with a malignant neoplasm were symptomatic at presentation, while only 46% of patients with benign neoplasms had symptoms2. Monday, December 31, 2012
  28. 28. Question 3• What is the most common syndrome associated with thymoma?• A. Hypogammaglobulinemia• B. Myasthenia gravis• C. Pure red cell aplasia• D. Superior vena cava syndrome Monday, December 31, 2012
  29. 29. Discussion• Symptoms of myasthenia gravis include generalized weakness and fatigue, along with diplopia, ptosis and dysphagia.• Myasthenia gravis occurs in 30-50% of patients with thymoma; however, only about 15% of patients with myasthenia gravis have a thymoma4.• Given this strong association between thymoma and myasthenia gravis, it is recommended that all patients diagnosed with myasthenia gravis undergo CT or magnetic resonance imaging (MRI) to evaluate the mediastinum for thymoma.• Conversely, all patients with clinically suspected thymoma should have a serum antiacetylcholine receptor antibody level examined even if they are asymptomatic1.• Thymectomy gradually alleviates symptoms in approximately 25% of myasthenic patients with thymoma5.• Thymoma has been associated with a number of other paraneoplastic syndromes as well.• Hypogammaglobulinemia is then next most common paraneoplastic syndrome, and is present in approximately 10% of patients with thymoma6.• Pure red cell aplasia and Good syndrome have also been reported to be associated with thymoma in rare cases.• The patient was referred to thoracic surgery for a surgical biopsy as the diagnosis was in question.• A left parasternal mediastinoscopy (Chamberlain approach) was performed. Pathology from this specimen revealed small fragments of thymic tissue with preservation of normal architecture.• There was no histologic evidence to support malignancy and flow cytometry was negative for lymphoma.• A positron emission tomography (PET) scan revealed diffuse mild activity; the standardized uptake value (SUV) max was 3.9, consistent with benign thymic tissue.• He was diagnosed with rebound thymic hyperplasia following the viral illness in the weeks prior to presentation. Monday, December 31, 2012
  30. 30. Question 4• Which condition(s) is/are associated with Rebound Thymic Hyperplasia (RTH)?• A. Addison disease• B. Cancer, post chemotherapy• C. Hyperthyroidism• D. Severe burns• E. All of the above Monday, December 31, 2012
  31. 31. Discussion• Rebound thymic hyperplasia (RTH) is a form of true thymic hyperplasia which can occur in children and young adults recovering from systemic illness or after treatment of various malignancies.• It is characterized by generalized hyperplasia with preservation of normal thymic architecture and immunohistologic appearance7.• RTH has been documented in many clinical conditions including hyperthyroidism, Addison disease, severe burns or after chemotherapy8.• During stress, the thymus may shrink to 40% of its original volume; then over time usually grows back to its original size within 9 months9.• In RTH, the thymus can grow 50% larger than its original size9.• This may present a diagnostic challenge as RTH can clinically or radiologically mimic recurrent or metastatic mediastinal neoplasms. Monday, December 31, 2012
  32. 32. Question 5• What is the treatment of choice for RTH?• A. Chemotherapy• B. Observation• C. Radiation therapy• D. Surgical resection Monday, December 31, 2012
  33. 33. Discussion• The thymus is functionally active in childhood and adolescence and may be susceptible to fluctuation in corticosteroid levels10.• The reversal of elevated endogenous corticosteroids in many of the aforementioned conditions is thought to be a causative factor in RTH10.• Although steroids will shrink a hyperplastic thymus11 this is usually not necessary as the transient overgrowth will resolve over time.• The patient was observed with follow up CT scans of his chest.• The mass had decreased by greater than 50% of its original size at 3 months.• At 6 months (Figure 5) and 9 months the CT chest continued to show further decrease in size of the mediastinal mass with no evidence of local invasion or progressive lymphadenopathy. Monday, December 31, 2012
  34. 34. Monday, December 31, 2012
  35. 35. chest ct cases-7 Dr :anas sahle http://www.facebook.com/dranas224
  36. 36. images 1 and 2.
  37. 37. Look at images 1 and 2.• This case shows multiple nodules.• Asymmetry of the lungs is due to collapse of the left upper lobe.• 1. Are the nodules focal or diffuse?• 2. What is the anatomic location of the nodules?• a) Primarily bronchovascular b) Primarily centrilobular c) Primarily pleural d) Random
  38. 38. Look at images 1 and 2.• This case shows multiple nodules.• Asymmetry of the lungs is due to collapse of the left upper lobe.• 1. Are the nodules focal or diffuse?• diffuse• 2. What is the anatomic location of the nodules?• a) Primarily bronchovascular• b) Primarily centrilobular• c) Primarily pleural• d) Random
  39. 39. HRCT-1
  40. 40. HRCT-1• Find the left upper lobe bronchus leading into the left upper lobe.• Outline the collapsed left upper lobe.• In the right lung, find 3 pleural nodules.• Find 3 nodules at the end of vessels in the right lung.• Find 4 or 5 nodules along the fissure (F) in the right lung.
  41. 41. HRCT-1
  42. 42. HRCT-2
  43. 43. HRCT-2• Find 2 centrilobular nodules in the right lung.• Find a nodule at the end of a vessel in the posterior right lung.
  44. 44. HRCT-2
  45. 45. Histology of a Nodule
  46. 46. Q• This rounded, subpleural structure, about 0.5 cm in diameter, corresponds to the subpleural lesions in the images above.• In this case, no cellular structures are present except at the edge.• 1. What are possible causes of this nodule?• 2. What does the homogeneous pink material in the nodule represent?
  47. 47. Answer• 1. Possible causes include infection and tumor. – This particular patient had known metastatic testicular carcinoma. – The necrosis of the tumor may have resulted from therapy or ischemia or both.• 2. The homogeneous pink material represents necrosis.
  48. 48. Differential diagnosis of random nodules on HRCT:• hematogenous metastasis (particularly from thyroid, kidney, and breast)• Miliary infections.Langerhans cell histiocytosis, sarcoidosis, and silicosis are common causes of nodules, but such nodules are rarely diffuse and haphazard.
  49. 49. Histologic differential diagnosis:• Metastatic tumor.• Infection should be considered.
  50. 50. HRCT diagnosis:• Metastatic breast cancer with hematogenous spread throughout the lungs and endobronchial metastasis to the left upper lobe, resulting in collapse.
  51. 51. Summary• diagnostic features of numerous hematogenous metastatic nodules on HRCT • Usually random distribution • Often smooth, well-defined • Varying size common
  52. 52. Monday, December 31, 2012
  53. 53. MRCP EXAM Respiratory 12/31/2012
  54. 54. Q1A 9 month old child presents with respiratory distress, worsening over 2 days. Blood gases show apH of 7.25, a PCO of 7.5kPa, a PO of 8.5kPa, and a base 2 2 excess of -4.• A -Results are consistent with bronchopulmonary dysplasia.• B -Blood gases suggest type 1 respiratory failure.• C- Immediate intubation is required.• D -Results are consistent with late severe asthma.• E -Bicarbonate may be necessary to correct the acidosis. 12/31/2012
  55. 55. A1A 9 month old child presents with respiratory distress, worsening over 2 days. Blood gases show apH of 7.25, a PCO of 7.5kPa, a PO of 8.5kPa, and a 2 2 base excess of -4.• A -Results are consistent with bronchopulmonary dysplasia. (False)• B -Blood gases suggest type 1 respiratory failure. (False)• C- Immediate intubation is required. (False)• D -Results are consistent with late severe asthma.(true)• E -Bicarbonate may be necessary to correct the acidosis. (False) 12/31/2012
  56. 56. Q2• Long-acting ß2 agonists:• A -Can be used to prevent activity-induced symptoms without anti-inflammatory therapy.• B- Become less effective over time (tolerance).• C- Are beneficial in acute viral croup.• D- Protect against allergen challenge for up to 48 hours.• E -Should not be used in association with erythromycin. Monday, December 31, 2012
  57. 57. A2• Long-acting ß2 agonists:• A -Can be used to prevent activity-induced symptoms without anti-inflammatory therapy.(true)• B- Become less effective over time (tolerance). (False)• C- Are beneficial in acute viral croup. (False)• D- Protect against allergen challenge for up to 48 hours. (False)• E -Should not be used in association with erythromycin. (False) Monday, December 31, 2012
  58. 58. Q3The oxygen dissociation curve isshifted to the right by:A- Decreased haemoglobin concentrationB- Reduced temperatureC- Reduced pHD- Increased partial pressure of carbondioxideE- Increased DPG Monday, December 31, 2012
  59. 59. A3The oxygen dissociation curve isshifted to the right by:A- Decreased haemoglobin concentration (False)B- Reduced temperature (False)C- Reduced pH (True)D- Increased partial pressure of carbondioxide (True)E- Increased DPG (True) Monday, December 31, 2012
  60. 60. Q4In lung empyema:A- Strep. pneumoniae is usually isolated fromthe pleural cavity.B- Installation of urokinase may be helpful.C- Anti-TB triple therapy is indicated if the feverdoes not settle within 14 days.D- An underlying malignancy should beexcluded.E- Initial treatment of the pneumonia has beeninadequate. Monday, December 31, 2012
  61. 61. A4In lung empyema:A- Strep. pneumoniae is usually isolated from the pleuralcavity. (False)B- Installation of urokinase may be helpful. (True)C- Anti-TB triple therapy is indicated if the fever does notsettle within 14 days. (False)D- An underlying malignancy should beexcluded. (True)E- Initial treatment of the pneumonia has beeninadequate. (False) Monday, December 31, 2012
  62. 62. Q5Regarding lung development:A- The pseudoglandular phase lasts between 16 and 26weeks.B- Alveolar capillaries first appear about 20 weeks ofgestation.C- The primitive airways appear as a dorsal outpouching ofthe foregut epithelium.D- The pulmonary vascularture is derived from endoderm.E- The peribronchial mesenchyme (spalnchnopleura) playsan essential role in shaping the lungs duringembryogenesis. Monday, December 31, 2012
  63. 63. A5Regarding lung development:A- The pseudoglandular phase lasts between 16 and 26 weeks.(False)B- Alveolar capillaries first appear about 20 weeks of gestation.(False)C- The primitive airways appear as a dorsal outpouching of theforegut epithelium. (False)D- The pulmonary vascularture is derived from endoderm.(False)E- The peribronchial mesenchyme (spalnchnopleura)plays an essential role in shaping the lungs duringembryogenesis. (True) Monday, December 31, 2012
  64. 64. Q6Recognised causes of acute upperairway obstruction include:A- Angio-oedemaB- AsthmaC- MumpsD- Retro-pharyngeal abscessE- Laryngomalacia Monday, December 31, 2012
  65. 65. A6Recognised causes of acute upperairway obstruction include:A- Angio-oedema(True)B- Asthma(False)C- Mumps(False)D- Retro-pharyngeal abscess(True)E- Laryngomalacia(False) Monday, December 31, 2012
  66. 66. Q7The following lung function tests arecompatible with severe scoliosis:A- An FEV1 of 65% of normal.B- An FEV1/2 of 65% of normal.C- Total lung capacity of 95% of normal.D- Tidal volume of 105% of normal.E- Peak flow of 50% of normal. Monday, December 31, 2012
  67. 67. A7The following lung function tests arecompatible with severe scoliosis:A- An FEV1 of 65% of normal. (True)B- An FEV1/2 of 65% of normal. (False)C- Total lung capacity of 95% of normal. (False)D- Tidal volume of 105% of normal. (True)E- Peak flow of 50% of normal. (True) Monday, December 31, 2012
  68. 68. Q8Concerning Tuberculosis:A- The infection rate is increased in Crohns Disease.B- Overcrowded living conditions do notsignificantly affect prevalence.C- The treatment of lymph node infection is of agreater duration than pulmonary infection.D- The tuberculin skin test is a good indicator ofdisease activity.E- In pregnant women treatment should be delayeduntil after birth. Monday, December 31, 2012
  69. 69. A8Concerning Tuberculosis:A- The infection rate is increased in Crohns Disease. (False)B- Overcrowded living conditions do not significantly affectprevalence. (False)C- The treatment of lymph node infection is of a greaterduration than pulmonary infection. (False)D- The tuberculin skin test is a good indicator of diseaseactivity. (False)E- In pregnant women treatment should be delayed until afterbirth. (False) Monday, December 31, 2012
  70. 70. Q9The following are signs of severeasthma:A- A silent chest in a 7 year old girl.B- Inability to feed in a 10 month old child.C- A heart rate of >90 in a 5 year old child.D- Decreased right-sided breath sounds in a10 year old girl.E- A respiratory rate of 60 in a 2 year oldboy. Monday, December 31, 2012
  71. 71. A9The following are signs of severe asthma:A- A silent chest in a 7 year old girl. (True)B- Inability to feed in a 10 month old child. (True)C- A heart rate of >90 in a 5 year old child. (False)D- Decreased right-sided breath sounds in a 10 year oldgirl. (False)E- A respiratory rate of 60 in a 2 year old boy.(True) Monday, December 31, 2012
  72. 72. Q10Lung biopsy may be useful in the followingcases:A- A 6 month old boy ventilated for adenovirusinfection.B- A 2 year old with leukaemia and possibleadreamycin toxicity.C- A 4 year old child with dense lower zoneopacities on chest x-ray.D- A 3 month old Afro-Caribbean boy with"ground glass" chest x-ray.E- A 4 month old with severe confirmed RSVpositive bronchiolitis. Monday, December 31, 2012
  73. 73. A10Lung biopsy may be useful in the followingcases:A- A 6 month old boy ventilated for adenovirusinfection. (True)B- A 2 year old with leukaemia and possible adreamycintoxicity. (False)C- A 4 year old child with dense lower zone opacities onchest x-ray. (False)D- A 3 month old Afro-Caribbean boy with"ground glass" chest x-ray. (True)E- A 4 month old with severe confirmed RSV positivebronchiolitis. (False) Monday, December 31, 2012
  74. 74. Monday, December 31, 2012

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