Stage 4 CSIM2 - Chest Medicine

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0 [{"id":633906,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-12-02 15:12:03","updated_at":"2018-12-02 15:12:03","questionName":"A 75 year old man presents with breathlessness at rest. He is tired all the time and losing weight. He has had to give up racing pigeons because he is unable to climb the steps to the loft. What is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":633909,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-12-02 15:14:09","updated_at":"2018-12-02 15:14:09","questionName":"A 24 year old is having travel immunisations. A Mantoux test is positive. They have no symptoms. A chest x ray shows bihilar lymphadenopathy. What investigation is likely to give a definitive diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":632341,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-11-30 15:10:26","updated_at":"2018-11-30 15:10:26","questionName":"A patient has the following results for transfer factors - TLCO decreased, KCO increased - what is the most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"Obesity - Problem outside the lung, or one lung missing \u2013 TF 50% (half as much functional lung), KCO 100% (or raised, as the remaining normal lung works extra hard)","question_score_id":null,"lang":"","questionAudioPath":null},{"id":632331,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-11-30 15:03:38","updated_at":"2018-11-30 15:03:38","questionName":"Which one of these is NOT an obstructive pulmonary disease?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"\u2022\tFEV1\/VC ratio\r\no\t<70% = OBSTRUCTIVE (will have VC later than normal, aka prolonged expiratory phase - flatter curve)\r\n\uf0a7\tCOPD\r\n\uf0a7\tAsthma\r\n\uf0a7\tBronchiectasis\r\no\t>70%\/normal = RESTRICTIVE\r\n\uf0a7\tPulmonary fibrosis\r\n\uf0a7\tNM abnormalities\r\n\uf0a7\tThoracic cage abnormalities\r\n\uf0a7\tObesity","question_score_id":null,"lang":"","questionAudioPath":null},{"id":632347,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-11-30 15:14:11","updated_at":"2018-11-30 15:14:11","questionName":"What would be seen on biopsy from a patient with silicosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"Silicosis\r\n\u2022\tTiny sand particles\r\n\u2022\tE.g. from denim sandblasting, mining, stonemasonry, foundry work, grinding, ceramic, concrete, cement, mortar\r\n\r\n\u2022\tEffects on the lung:\r\no\tSilicosis (fibrosis)\r\n\uf0a7\tfibrotic nodules \u2013 dense fibrosis with BIREFRINGENT particles at biopsy\r\n\u2022\tFirst simple, diffuse nodules\r\n\u2022\tThen big lumpy solid mass fibrotic areas in the upper zones\r\n\uf0a7\tRESTRICTIVE abnormality\r\no\tAcute silicosis\r\no\tCOPD\r\no\tTB\r\no\tLung cancer","question_score_id":null,"lang":"","questionAudioPath":null},{"id":632338,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-11-30 15:08:36","updated_at":"2018-11-30 15:08:36","questionName":"A patient has a normal TLCO and normal KCO, which of the following is this most likely diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"In asthma the functionality of the alveolar-capillary membrane is intact so results are normal.\r\n\r\nTransfer Factor\r\n\u2022\tTest of functionality of the alveolar-capillary membrane\r\n\r\n\u2022\tTLCO \u2013 TOTAL LUNG FUNCTIONALITY: inhale small amounts of CO, measure how much goes in and out\r\no\tFactors that can influence TLCO:\r\n\uf0a7\tSupply of air to lungs\r\n\uf0a7\tGas transfer from lung to blood\r\n\uf0a7\tBlood flow\r\nSo\u2026\r\n\u2022\tVentilation Perfusion Mismatch (many lung diseases)\r\n\u2022\tReduction in the area of membranes (e.g. emphysema)\r\n\u2022\tIncreased thickness (e.g. pulmonary fibrosis)\r\n\u2022\tPulmonary Blood flow (e.g. pulmonary hypertension)\r\n\u2022\tHaemoglobin concentration (e.g. anaemia)\r\n\r\n\u2022\tKCO (transfer coefficient) \u2013 functionality PER UNIT VOLUME","question_score_id":null,"lang":"","questionAudioPath":null},{"id":633908,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-12-02 15:13:21","updated_at":"2018-12-02 15:13:21","questionName":"A 74 year old man has restrictive pattern on lung function tests, no evidence of inflammation on bloods and takes no regular medication. What investigation will provide definitive diagnosis?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null},{"id":633907,"quiz_id":"30929","answer_id":null,"answerType_id":"0","created_at":"2018-12-02 15:12:42","updated_at":"2018-12-02 15:12:42","questionName":"A 67 year old has lung function tests carried out due to gradual onset breathlessness. He is a non smoker and works as a taxi driver. He has a BMI of 23. Spirometry shows a FEV1 of 1.8L and a FVC of 2L. What is the most likely diagnosis? ","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"","question_score_id":null,"lang":"","questionAudioPath":null}]
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A 75 year old man presents with breathlessness at rest. He is tired all the time and losing weight. He has had to give up racing pigeons because he is unable to climb the steps to the loft. What is the most likely diagnosis?

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