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A properly conducted medical quiz generates enthusiasm among participants and audience. However, there are no set guidelines in literature on how to conduct a medical quiz. We have made an attempt to compile a guideline based on our experience as quizmaster since last two decades. Most of the statements made here are the author’s personal opinion. Basic objective of medical quiz is assessment. Hence, quizmaster holds the key role. Quizmaster should be a good teacher with ample experience, proficient in setting up the various types of quiz questions. Quizmaster should be familiar with various type of quiz formats. Quizmaster should be impartial, should set questions with specific learning objectives and give proper explanation and discuss the answers. A written preliminary round and a final stage round can be conducted. For the stage round, 4 teams with two participants in each team is ideal. Four rounds can be conducted in the finals as general round, rapid fire round, buzzer round and audio-visual round. Fifth round may be required in case of tie. The number of questions should depend on the time allotted. One hour is the ideal time required for final stage round.

Introduction: Airborne allergens are the major cause of allergic respiratory diseases worldwide, they are present all around, suspended in the air we breathe, spanning different regions, invisible to the naked eye, while causing allergic respiratory flare-ups in susceptible individuals. Although present globally they have a unique distribution which depends on geographic and climatic factors. Hence, a select broad group of allergens cannot be accountable for causing allergic responses worldwide. It is therefore imperative to identify the offending allergens causing flare-ups in patients living in a particular region, to effectively tackle exacerbations. Objectives of Study: (1) To study the clinical profile of patients with rhinobronchial allergies, (2) To determine endemically common aeroallergens for patients with rhino bronchial allergies from Dakshina Kannada District, presenting at A. J. Institute of Medical Sciences, Mangalore, by means of skin prick test (SPT). Materials and Methods: A total of 170 patients with preexisting allergic airway diseases were included in the study over a duration of 12 months. These subjects were screened, history was taken, and then subjected to an SPT after acquiring an informed consent. A customized panel of 55 allergens was used in the test comprising dust/dust mite, animal, fungal, insect, and plant-based allergens. A wheal size of more than 3 mm was considered as a positive reaction and the findings were recorded. Results: This study included 97 male and 73 female patients, with the mean age of the patients being 33.7 years. The most common aeroallergen was found to be, Parthenium hysterophorus, followed by Dermatophagoides farine a dust mite, Typha angustata, Cyperus Rotundus, Mangifera indica, Ischaemum, and Prosopis juliflora. Cockroach, dog epithelia, and Aspergillus fumigatus were found to be most allergenic in each respective group, i.e., insect, animal, and fungal group. Conclusion: Our study showed predominantly pollen-based allergens from mainly invasive wild grasses and small plants to be causing allergic respiratory diseases in susceptible individuals, especially young adults, living in Dakshina Kannada District, Karnataka. Allergic respiratory diseases due to Dust mite D. Farine were found to cause allergic manifestation in mainly urban population included in the study. A. fumigatus, dog epithelia, and cockroach were found to be the most common antigens causing allergic reactions in each respective category.

Abstract Background Most of the morbidity and mortality in nCovid19 is due to pneumonia which can be reduced by early diagnosis and treatment. Chest CT scan plays an important role in the early diagnosis and management of respiratory complications due to nCovid19. Clinicians should be aware about the indications for the CT scan of the thorax, timing of investigation, and limitations of CT. Main body of abstract Chest CT scan is indicated in patients with moderate to severe respiratory symptoms and pretest probability of nCovid19 infection, when RT-PCR test results are negative, and in patients for whom an RT-PCR test is not performed or not readily available. When a rapid antigen test is negative and an RT-PCR test report takes time, CT can be used in seriously ill patients to decide whether it is COVID or not. For patients who are dependent on oxygen even after 2 weeks, CT may help to show the extent of lung involvement and predict long-term prognosis. CT may be done to exclude nCovid19 pneumonia. For patients with high risk for nCovid19 who require an immediate diagnosis to rule out lung involvement, CT can be done. A normal CT excludes nCovid19 pneumonia. CT scan is required in confirmed cases of nCovid19 pneumonia when complications are suspected clinically. These include pulmonary thromboembolism, pneumothorax, mediastinal/surgical emphysema, bacterial pneumonia, and unexplained deterioration with new shadows in chest X-ray. CT pulmonary angiogram is indicated when pulmonary embolism is suspected, and in other cases, plain CT should be done. In pre-operative cases where emergency surgery is required, nCovid19 disease is suspected clinically, and RT-PCR report awaited or not available, CT thorax can be done. Conclusion CT scan is useful for early diagnosis of lung involvement, detection complications, triaging of cases, risk stratification, and preoperative evaluation in select cases. CT scan should be done only when there is a definite indication so to reduce radiation hazards and to reduce health care expenditure. Normal CT excludes nCovid19 lung involvement, but the patient may have upper respiratory involvement which may progress later to involve lungs.

Hoarseness of voice with hemoptysis in an elderly smoker can occur due to malignancy in the upper respiratory tract or intrathoracic lesion. When ear, nose, and throat examination is normal in such a patient, the lesion is most likely to be intrathoracic. In this case-based discussion, we discuss regarding how to evaluate a patient with hoarseness of voice with hemoptysis. We report an unusual case for hoarseness of voice with hemoptysis in an elderly smoker.

The most common cause of hypercapnic respiratory failure is acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Many other factors can contribute to hypercapnia and may lead to refractory hypercapnia in AECOPD. One of the important causes is electrolyte imbalance. We report a case of refractory hypercapnic respiratory failure in an elderly female due to postthyroidectomy hypocalcemia. The patient responded well after the correction of hypocalcemia.

A variety of conditions/diseases can involve skin and lungs together. Knowledge about these conditions and the skin and respiratory manifestations in these conditions will lead to early diagnosis and proper management. Some of the dermatological manifestations may be very classical where the diagnosis will be obvious at a glance. Many a times, dermatological manifestations may narrow the differential diagnoses. In some cases, dermatological manifestations may indicate the severity/stage of the disease and prognosis. In some diseases with dermatological manifestations, where no obvious respiratory symptoms or signs are evident, screening for the underlying lung disease may be indicated. Some dermatological manifestations may indicate the underlying lung or other systemic diseases where further evaluation may be warranted even in the absence of other symptoms or signs. Diseases with skin and lung involvement can be classified into congenital/developmental disorders with cutaneous and pulmonary manifestations; primary dermatological diseases with pulmonary manifestations; primary pulmonary diseases with cutaneous manifestations; skin changes due to drugs used to treat respiratory diseases; and miscellaneous conditions involving skin and lungs. In this article, we discuss the various conditions/diseases with skin and lung involvement which a pulmonologist must know.

Intra thoracic tumors can lead to a variety of para-neoplastic manifestations which is often overlooked. Awareness about the para-neoplastic manifestations and the possible intra thoracic causes for the same will lead to early diagnosis and appropriate management. In this self assessment quiz we have discussed regarding the para-neoplastic manifestations in Carcinoid tumor.

Hemoptysis is a common respiratory symptom. One of the most common cause for hemoptysis in India is pulmonary tuberculosis. Pulmonary tuberculosis is more common in young and usually present with fever, cough and hemoptysis. Chest x ray usually shows upper lobe lesions. When sputum examination for AFB smear is negative and chest radiology is not typical of tuberculosis further investigations are indicated for definitive diagnosis. We report a rare case of pleomorphic carcinoma of lung in a young female mimicking pulmonary tuberculosis. Definitive diagnosis was established by biopsy from the lung lesion.

Medical viva is oral form of assessment of medical students. Viva helps to assess the competencies such as communication skills and professional attitudes which are essential to a medical graduate. Viva test delineates the limit of a candidate's knowledge and understanding of a particular subject/topic being tested. Viva should be conducted fairly, should be reliable, and free from any form of bias. Structured viva examination is better and more realistic to fulfill these criteria than traditional viva examination. Viva can be structured using viva cards. Trained and experienced examiners are a must for the proper conduct of viva.

In severe pneumonia, dyspnea occurs due to hypoxia. Usually, in pneumonia, dyspnea is proportional to the extent of lung parenchymal lesion. When a patient with pneumonia presents with disproportionate dyspnea, other causes for dyspnea should be evaluated. Here, we present a 48-year-old female with pneumonia, found to have disproportionate dyspnea. Her hypoxia did not improve despite adequate antibiotic and oxygen therapy. On further enquiry, she admitted taking dapsone for leprosy. She had saturation gap diagnostic of methemoglobinemia. Diagnosis was confirmed by estimation of methemoglobin level in blood. She was treated with intravenous methylene blue and recovered. When a patient has disproportionate dyspnea, methemoglobinemia should be considered as a differential diagnosis.