Question Bank

The triad of erythema nodosum (tender nodules on shins), bilateral hilar lymphadenopathy (BHL), and dry cough/arthralgia is highly suggestive of acute sarcoidosis (Löfgren's syndrome).

Squamous cell carcinoma is often centrally located and is classically associated with paraneoplastic hypercalcaemia due to the secretion of parathyroid hormone-related protein (PTHrP).

Rifampicin causes orange/red discoloration of urine, tears, and sweat. Optic neuritis is associated with ethambutol; peripheral neuropathy with isoniazid; and hyperuricaemia with pyrazinamide.

HRCT is the gold standard for diagnosing bronchiectasis, showing hallmark signs such as the 'signet ring' sign (dilated bronchi wider than adjacent vessels) and lack of bronchial tapering.

The 2023 BTS Pleural Disease Guidelines updated the management of primary spontaneous pneumothorax (PSP). For a symptomatic PSP with a rim >2 cm (or >3 cm at the hilum), ambulatory management using a small-bore drain with a Heimlich valve is now the preferred first-line approach. This allows the patient to be managed as an outpatient or with a short admission, with the valve permitting one-way airflow. Needle aspiration is no longer recommended as standard first-line intervention. Conservative (watch-and-wait) management is appropriate for small (<2 cm) or asymptomatic PSP. Intercostal chest drains are reserved for failed ambulatory management or haemodynamic compromise. Pleurodesis is used for recurrent pneumothorax.

Idiopathic Pulmonary Fibrosis typically presents with clubbing and bi-basal fine crackles. HRCT characteristically shows a 'usual interstitial pneumonia' (UIP) pattern, featuring subpleural honeycombing and traction bronchiectasis.

Severe asthma is defined by any one of: PEF 33-50% predicted, respiratory rate ≥25/min, heart rate ≥110/bpm, or inability to complete sentences in one breath. Life-threatening features would include a silent chest, cyanosis, or PEF <33%.

A pleural protein level >30 g/L is classified as an exudate. Bronchial carcinoma is a common cause of exudative effusions. Heart failure, cirrhosis, and nephrotic syndrome typically cause transudates (protein <30 g/L).

While the Epworth scale and oximetry are screening tools, multi-channel polysomnography (in a sleep lab) is the gold standard for diagnosing Obstructive Sleep Apnoea (OSA). It monitors EEG, airflow, and respiratory effort.

NICE recommends adding a low-dose ICS if a patient has symptoms ≥3 times a week or is waking at night. If symptoms are uncontrolled on SABA + ICS, the next step would be adding an LTRA.

A Wells score >4 indicates that a pulmonary embolism is likely. In this clinical scenario, the patient should proceed directly to definitive imaging (CTPA) rather than a D-dimer, which is only used to rule out PE in 'unlikely' cases.

Low pH (<7.35) and high pCO2 (>6.0 kPa) indicate respiratory acidosis (Type 2 failure). The elevated bicarbonate (29 mmol/L) suggests the body has begun to compensate (chronic/partially compensated), but the pH remains acidotic.

For the first isolated growth of Pseudomonas aeruginosa in CF patients, the goal is eradication. NICE/UK protocols typically use a combination of oral ciprofloxacin and nebulised antibiotics (like colistimethate or tobramycin) for 3 months.

NICE recommends 5 days of oral prednisolone (30mg) for COPD exacerbations and a course of antibiotics if sputum is purulent. Current guidelines have moved away from longer 10-14 day courses of steroids to reduce side effects.

This patient's CURB-65 score is 5, as all five criteria are met: Confusion ✓ (present), Urea ≳7 mmol/L ✓ (8.2 mmol/L), Respiratory rate ≥30/min ✓ (32/min), Blood pressure ≤90 systolic or ≤60 diastolic ✓ (85/55 mmHg), Age ≥65 ✓ (82 years). A score of 3 or more indicates severe pneumonia with high mortality risk, mandating urgent hospital admission. A score of 4 or 5 should prompt consideration of ITU-level care. Intravenous antibiotics per local CAP protocol (typically co-amoxiclav + clarithromycin) should be commenced promptly after blood cultures are taken.