Respiratory Flashcards
1
Q
- Breathlessness
You see a 68-year-old man in clinic, with a 40 (cigarette) pack year history, who
has been experiencing breathlessness on exertion and a productive cough of white
sputum over the last four months. You assess his spirometry results which reveal an
FEV1/FVC of 51 per cent with minimal reversibility after a 2-week trial of oral
steroids. Cardiological investigations are normal. Which of the following is the
most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Left ventricular failure
D. Chronic bronchitis
E. Lung fibrosis
A
B
2
Q
- Assessment of pneumonia
A 67-year-old woman is admitted to accident and emergency with pyrexia (38.1°C)
and a cough productive of green sputum. The observations show a pulse rate of
101, BP 80/60 and respiratory rate of 32. She is alert and orientated in space and
time. Blood results reveal a WCC of 21, urea of 8.5 and chest x-ray shows a patch
of consolidation in the lower zone of the right lung. She is treated for severe
community-acquired pneumonia. Which of the following is the correct calculated
CURB-65 score?
A. 6
B. 8
C. 4
D. 0
E. 1
A
C
3
Q
- Organisms in atypical pneumonia
Which of the following organisms would typically be found in a patient with
atypical community-acquired pneumonia?
A. Staphylococcus aureus
B. Pseudomonas spp.
C. Streptococcus pneumonia
D. Legionella pneumophilia
E. Haemophilus influenza
A
D
4
Q
- Interpretation of arterial blood gases (1)
You are asked to interpret an arterial blood gas of a 76-year-old patient who was
admitted to accident and emergency with an acute onset of breathlessness and low
oxygen saturations. The test was taken on room air and read as follows: pH 7.37,
PO2 7.8, PCO2 4.1, HCO3 24, SO2 89 per cent. Choose the most likely clinical
interpretation from these arterial blood gas results:
A. Compensated respiratory acidosis
B. Type 1 respiratory failure
C. Compensated respiratory alkalosis
D. Type 2 respiratory failure
E. None of the above
A
B
5
Q
- Shortness of breath (1)
A 54-year-old woman is seen in clinic with a history of weight loss, loss of appetite
and shortnesss of breath. Her respiratory rate is 19 and oxygen saturations (on
room air) range between 93 and 95 per cent. On examination, there is reduced air
entry and dullness to percussion on the lower to midzones of the right lung. There
is also reduced chest expansion on the right. From the list below, select the most
likely diagnosis:
A. Right middle lobe pneumonia
B. Pulmonary embolism
C. Right-sided pleural effusion
D. Right-sided bronchial carcinoma
E. Right lower lobe pneumonia
A
C
6
Q
- Diagnostics in respiratory medicine (1)
A 45-year-old woman with unexpected weight loss, loss of appetite and shortness
of breath presents to you in clinic. On examination, there is reduced air entry and
dullness to percussion in the right lung. A pleural tap is performed and the aspirate
samples sent for analysis. You are told that the results reveal a protein content of
>30 g/L. From the list below, select the most likely diagnosis:
A. Bronchogenic carcinoma
B. Congestive cardiac failure
C. Liver cirrhosis
D. Nephrotic syndrome
E. Meig’s syndrome
A
A
7
Q
- Diagnostics in respiratory medicine (2)
You are discussing a patient with your registrar who has become acutely short of
breath on the ward. After performing an arterial blood gas, you have high clinical
suspicion that the patient has a pulmonary embolism. Which of the following is the
investigation of choice for detecting pulmonary embolism?
A. Magnetic resonance imaging (MRI) of the chest
B. High-resolution CT chest (HRCT)
C. Chest x-ray
D. Ventilation/perfusion scan (V/Q scan)
E. CT pulmonary angiogram (CT-Pa)
A
E
8
Q
- Management of asthma
A 28-year-old man has been newly diagnosed with asthma. He has never been
admitted to hospital with an asthma exacerbation and experiences symptoms once
or twice a week. You discuss the treatment options with him. His peak expiratory
flow reading is currently 85 per cent of the normal predicted value expected for his
age and height. Which of the following is the most appropriate first step in
treatment?
A. Short-acting beta-2 agonist inhaler
B. Long-acting beta-2 agonist inhaler
C. Low-dose steroid inhaler
D. Leukotriene receptor antagonists
E. High-dose steroid inhaler
A
A
9
Q
- Investigations
You see a 46-year-old man who has presented to accident and emergency with an
acute onset of shortness of breath. Your registrar has high clinical suspicion that
the patient is suffering from a pulmonary embolism and tells you that the patient’s
ECG has changes pointing to the suspected diagnosis. From the list below, which of
the following ECG changes are classically seen?
A. Inverted T-waves in lead I, tall/tented T-waves in lead III and flattened
T-waves in lead III
B. Deep S-wave in lead I, pathological Q-wave in lead III and inverted
T-waves in lead III
C. Flattened T-wave in lead I, inverted T-wave in lead III, and deep S-wave
in lead III
D. No changes in lead I, deep S-wave in lead III
E. Deep S-wave in lead I with no changes in lead III
A
B
10
Q
- Interpretation of arterial blood gases (2)
Which of the following arterial blood gas results, taken on room air, would you
expect to see in a 67-year-old patient who has been suffering with COPD for two
years and is not on home oxygen?
A. pH 7.35, PO2 11, PCO2 5.3, HCO3 24, SO2 98 per cent
B. pH 7.47, PO2 12, PCO2 5.1, HCO3 30, SO2 97 per cent
C. pH 7.44, PO2 8.3, PCO2 6.7, HCO3 28, SO2 93 per cent
D. pH 7.31, PO2 10.2, PCO2 6.8, HCO3 25, SO2 95 per cent
E. pH 7.30, PO2 11.5, PCO2 5.2, HCO3 18, SO2 96 per cent
A
C
11
Q
- Bronchiectasis
You see a 46-year-old woman on your ward who has been diagnosed with
bronchiectasis following a three-month history of a mucopurulent cough. Which of
the following from the list below is not a cause of bronchiectasis?
A. Kartagener’s syndrome
B. Cystic fibrosis
C. Pneumonia
D. Left ventricular failure
E. Bronchogenic carcinoma
A
D
12
Q
- Finger clubbing
A 30-year-old man presents to your clinic with a cough and finger clubbing. From
the list below, which of these answers is not a respiratory cause of finger clubbing?
A. Empyema
B. Mesothelioma
C. Bronchogenic carcinoma
D. Cystic fibrosis
E. COPD
A
E
13
Q
- Lung tumours
A 55-year-old woman, who has never smoked, presents to you on the ward with a
history of weight loss, decreased appetite and finger clubbing. You are told that her
chest x-ray revealed opacity in the hilar region of the right lung suggesting a
bronchogenic carcinoma. She is currently awaiting a CT-chest with bronchoscopy
to follow. From the list below, select the most likely diagnosis:
A. Squamous cell carcinoma of the lung
B. Adenocarcinoma of the lung
C. Small cell carcinoma of the lung
D. Large cell carcinoma of lung
E. Carcinoid tumour of the lung
A
B
14
Q
- Shortness of breath (2)
You see a 28-year-old man, with no past medical history, in accident and emergency
who developed an acute onset of pleuritic chest pain and shortness of breath while
playing football. On examination, oxygen saturations are 93 per cent on room air,
respiratory rate 20 and temperature is 37.1°C. There is decreased expansion of the
chest on the left side, hyper-resonant to percussion and reduced air entry on the
left. The most likely diagnosis is:
A. Left-sided pneumothorax
B. Left-sided pneumonia
C. Left-sided pleural effusion
D. Lung fibrosis
E. Traumatic chest injury
A
A
15
Q
- Investigating shortness of breath
You are asked to request imaging for a patient with a suspected pneumothorax who
you have just examined in accident and emergency. Which of the following would
be the most appropriate first step imaging modality?
A. CT-chest
B. Ultrasound chest
C. Chest x-ray
D. V/Q scan
E. CT-PA
A
C
16
Q
- Management of pulmonary emboli
A 68-year-old woman has presented with acute onset shortness of breath 24 hours
after a long haul flight. Her blood results show a raised D-dimer level and the
arterial blood gas shows a PO2 of 8.3 kPa and PCO2 of 5.4 kPa. Your consultant
suspects a pulmonary embolism and the patient needs to be started on treatment
while a CT-PA is awaited. From the list below, please select the most appropriate
treatment regime.
A. Commence loading with warfarin and aim for an international
normalized ratio (INR) between 2 and 3
B. Thromboembolic deterrent stockings
C. Aspirin 75 mg daily
D. Prophylactic dose subcutaneous low molecular weight heparin
+ loading with warfarin and aim for INR between 2 and 3
E. Treatment dose subcutaneous low molecular weight heparin
+ loading with warfarin and aim for INR between 2 and 3
A
E