Respiratory RACP MCQs

Question 1

RACP 2022 Q6
Pre-oxygenation is required pre-procedure to allow safe apnoea time. Safe apnoea time is reduced in obesity is due to reduction in
a. FEV1
b. FVC
c. DLCO
d. FRC

Answer 1

D

Patients living with obesity have a very different physiology in a number of ways. From a respiratory perspective, this population has a decreased Functional Residual Volume (FRC), generally lower tidal volumes, decreased compliance, higher oxygen demand, and a higher risk of atelectasis. All of these factors together result in patients with obesity desaturating significantly sooner after induction than the non-obese group.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311180/

Question 2

RACP 2022A 25.
Patient with pulmonary hypertension found on echocardiogram. Chronic
thromboembolism (CTEPH) is suspected. What is the next best investigation to confirm a diagnosis?
a. D Dimer
b. CTPA
c. V/Q scan
d. Right heart cath

Answer 2

C
The recommended diagnostic work-up of suspected CTEPH starts with transthoracic Doppler echocardiography.
The next diagnostic step for patients at “intermediate” or “high” echocardiographic probability is ventilation/perfusion lung scintigraphy.

https://erj.ersjournals.com/content/55/6/2000189#:~:text=The%20next%20diagnostic%20step%20for,is%20ventilation%2Fperfusion%20lung%20scintigraphy.

Question 3

RACP 2022A Q27.(Past question)
Female patient with adenocarcinoma of unknown origin, presents with shortness of breath. RR 24, 94% RA and BP 100/40. CXR showed globular heart.
a. Lymphangitic carcinomatosis
b. Atypical pneumonia
c. Pericardial effusion
d. PE with infarct

Answer 3

C

Not sure what the question was

A - spread to lymphatic vessel;s
B - wouldn’t cause a globular heart
D - would be SOB but again ? globular heart

Question 4

RACP 2022B Q1.
What is the primary pathology in idiopathic pulmonary arterial hypertension?
A. Angioproliferative vasculopathy of pulmonary arterioles
B. Thromboemboli of pulmonary arterioles
C. Thrombosis of pulmonary venules
D. Vasculitis of pulmonary arterioles

Answer 4

A
PAH is a proliferative vasculopathy, characterized by vasoconstriction, cell proliferation, fibrosis, and microthrombosis. Pathologic findings include hyperplasia and hypertrophy of all three layers of the vascular wall (intima, media, adventitia) in pulmonary arteries <50 microns (ie, localizes to the small pulmonary muscular arterioles). In addition, fibrosis and in situ thrombi of the small pulmonary arteries and arterioles (plexiform lesions) can be seen

https://www.uptodate.com.acs.hcn.com.au/contents/the-epidemiology-and-pathogenesis-of-pulmonary-arterial-hypertension-group-1?search=idiopathic%20pulmonary%20arterial%20hypertension&source=search_result&selectedTitle=3~115&usage_type=default&display_rank=3

Question 5

RACP 2022B Q24.
What is the impact of normal ageing on forced vital capacity and functional residual
capacity?
A. Increase FVC and increased FRC
B. Increase FVC and decreased FRC
C. Decrease FVC and increase FRC
D. Decrease FVC and decrease FRC

Answer 5

C

Question 6

RACP 2022B Q53.
Patient on 4LNP. ABG with pH 7.48, pCO2 50, HCO3 36. What is the interpretation?
A. Metabolic alkalosis without compensation
B. Metabolic alkalosis with compensation
C. Respiratory acidosis without compensation
D. Respiratory acidosis with compensation

Answer 6

Answer: D
Respiratory acidosis with compensation

Question 7

RACP 2020 84. EMQ
Volume of inhaled and exhaled air in one breath

A) Total lung capacity
B) Vital capacity
C) Diffusion capacity
D) Inspiration capacity
E) Forced exploratory volume in 1 second
F) Residual volume
G) Tidal volume
H) Inspiratory reserve volume

Answer 7

Answer G Tidal volume

Question 8

RACP 2020 Q85.
Maximum amount of air a person can expel from the lungs after a maximum inhalation

A) Total lung capacity
B) Vital capacity
C) Diffusion capacity
D) Inspiration capacity
E) Forced exploratory volume in 1 second
F) Residual volume
G) Tidal volume
H) Inspiratory reserve volume

Answer 8

Answer B: Vital capacity

Question 9

RACP 2019 Q13
A 37 year old female presents with a DVT following a cholecystectomy. There is RV dilatation on TTE . She is hemodynamically stable. What is the appropriate duration for anticoagulation?
A. 6 weeks
B. 3 months
C. 12 months
D. Indefinitely

Answer 9

Answer B: 3 months

Question 10

RACP 2022a 49.A young girl returns from theatre post-op with a central venous catheter in
situ. You are asked to review for shortness of breath. She has a resp rate 22, saturations of 97% on 2LNP, and HR 90. Her Chest Xray is shown (
showing large left-sided pneumothorax ie absent lung markers, collapse; L
subclavian line visible). What is the best definitive management?
a. Remove subclavian line
b. Chest drain
c. Needle aspiration
d. Supplemental oxygen

Answer 10

Answer : B chest drain

Question 11

RACP 2022a Q51
CXR showing area of consolidation with blurred heart border. Most consistent with:
a. RML collapse
b. Consolidation
c. Right lower lobe collapse

Question 12

RACP 2022a Q77
68 year old man with 3 months of dyspnoea, cough and bloody sputum. Nil weight loss or fevers. He has a 30 pack year smoking history. CT chest showed a 3 cm R sided central hilar mass with bilateral lymphadenopathy.
What is the most likely diagnosis?
a. Sarcoidosis
b. Lymphoma
c. Small cell carcinoma
d. Squamous cell carcinoma

Answer 12

C

Question 13

RACP 2022b Q34. A patient presents with worsening exertional dyspnoea. The transthoracic echo shows elevated pulmonary pressures with normal LV size and systolic function. A right heart cath was done which shows normal cardiac index, pulmonary vascular wood units 3.1, pulmonary capillary wedge pressure of 25.
Which feature confirms HFpEF?
A. Cardiac index
B. Pulmonary capillary wedge pressure
C. Vascular woods unit

Answer 13

Answer B: Pulmonary capillary wedge pressure

Question 14

RACP 2021a Q4. A 50 year old woman with a history of metastatic breast cancer who has recently completed her first round of chemotherapy presents with shortness of breath. Her observations include BP 100/60 and HR 125 bpm, with ECG showing sinus tachycardia. Her chest x-ray is shown below.
What is the most likely diagnosis?
A. Lymphangitis carcinomatosis
B. Pericardial effusion
C. PE with infarction
D. Atypical pneumonia

Answer 14

B

A - spread to lymphatic vessel;s
C - wouldn’t cause a globular heart
D - would be SOB but again ? globular heart

Question 15

RACP 2021 Q10.
A 46 year old female presents with new diagnosis of acute pulmonary embolism. Her HR is 94 and her blood pressure is 110/64. Her TTE shows right heart dilatation. Which of the following treatments has been shown to have the greatest improve improvement in mortality?
A. Anticoagulation
B. IVC filter placement
C. Surgical pulmonary embolectomy
D. Systemic thrombolysis

Answer 15

Answer A: Anticoagulation

Question 16

RCAP 2021 Q19.
A 52 year old man who is an ex-smoker presents to clinic with proximal muscle weakness and dysphagia. A chest x-ray reveals a large anterior mediastinal pathology. He subsequently undergoes resection of the mass.
(Q19 Cont’d) Which histopathology would best explain his clinical findings and imaging?
A. Germ cell tumor
B. Lymphoma
C. Small cell lung cancer
D. Thymoma

Answer 16

D

Question 17

RACP 2021 Q61.
A 42 year male presents with a history of dry cough for 3 months. He works in office and is a non-smoker. He does not have any other past medical history. His CXR is provided.
What is the most likely cause of his symptoms?
A. Extrinsic allergic alveolitis
B. Sarcoidosis
C. NSIP
D. Malignancy

Answer 17

A

Question 18

RACP 2021 Q81.
A 45 year old male presents to the Emergency Department with a 5 day history of worsening shortness of breath on exertion and cough. He is an ex-smoker with a 10 pack year history. On examination there is a widespread wheeze. He has the following X-ray:
What is the most likely diagnosis?
A. Lower lobe consolidation
B. Right middle lobe collapse
C. Pulmonary hypertension
D. Mediastinal mass

Question 19

RACP 2021 Q89.
A 60 year old woman with a history of bronchiectasis presents with cough productive of purulent sputum and is commenced Amoxicillin 1g TDS with no clinical improvement. Her sputum cultures grew pan-sensitive Pseudomonas aureginosa. How would you treat next?
A. Azithromycin
B. Ciprofloxacin
C. Inhaled tobramycin
D. Moxifloxacin

Answer 19

B

Question 20

RACP 2021 Oct Q7.
60 M smoker presents with cough. What is the finding based on this xray?
a. Pericardial effusion
b. Pulmonary embolism
c. Right middle lobe collapse
d. Right lower lobe consolidation

Answer 20

c

Question 21

RACP 2021 Oct Q10. When does someone with COPD and pulmonary HTN from COPD qualify for home oxygen?
a. PaO2 < 50
b. PaO2 < 55
c. PaO2 < 60
d. PaO2 < 65

Answer 21

C

Question 22

RACP 2021 Oct Q44. Young man in 20s with SOB. Right heart cath shows raised PAP, Normal
PCWP, increased pulmonary vascular resistance. CT showed thickened basal
septum .Gene mutation positive for EIF2AK4
a. Hematoma
b. pulmonary veno occlusive disease
c. ILD with pulmonary hypertension
d. Pul HTN secondary to LHF

Answer 22

B

Diseases associated with EIF2AK4 include Pulmonary Venoocclusive Disease 2, Autosomal Recessive and Pulmonary Venoocclusive Disease

Question 23

RACP 2021 Oct Q46.
Man with haemoptysis. Wheeze on the right. Bronch shows vascular right rounded cherry red lesion arising from the bronchial wall (photo given). Mildly elevated urinary 5-HIAA. PET scan unexciting. CT reports solid nodules but no LN. Diagnosis?
a. Harmatoma
b. Carcinoid
c. Epidermoid

Answer 23

A

Question 24

RACP 2021 Oct Q48.
Vape induced lung injury. What injury does it cause to the lungs?
a. Centrilobular emphysema
b. Granuloma
c. Ground grass patchy consolidation
d. ?

Answer 24

EVALI cases demonstrated a heterogeneous collection of pneumonitis patterns that included acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage and acute respiratory distress syndrome (ARDS), diffuse alveolar hemorrhage, hypersensitivity pneumonitis, peribronchiolar granulomatous pneumonitis, and the rare giant-cell interstitial pneumonitis.

Question 25

RACP 2021 Oct Q50.
What type of oxygen delivery method can give 100% fio2 in awake patient?
a. Hudson
b. Non rebreather mask
c. Venturi
d. Self inflating bag valve mask

Answer 25

B

Question 26

RACP 2021 Oct Q 51. Peripheral O2 sats are higher than and O2 sats in ABG. What causes this other than CO?
a. Methhemoglobenima
b. Tricuspid regurg
c. Left to right heart shunt
d. Peripheral vascular disease

Answer 26

A

Question 27

RACP 2021 Oct Q90.
What medication is beneficial in patients with poorly controlled asthma
with eosinophil count >0.3?

a. Mepolizumab
b. Anti-Interleukin 5 (IL-5) and IL-5Ra
c. Leukotriene inhibitor

Answer 27

A

Question 28

RACP 2021 Oct Q109.
A man with history of recurrent PEs presents with exertional dyspnoea and tiredness, echo shows RV pulmonary hypertension, what is next best step to confirm the diagnosis of CTEPH as a cause of his pulmonary hypertension?
a. right heart Cath
b. CTPA
c. VQ scan
d. PET scan

Answer 28

C

Question 29

RACP 2020a Q11.
A 38yoM presents to the emergency department with worsening shortness of breath and episodes of chest tightness for the past 2 weeks. Below are his CXR images. What is the most likely radiological diagnosis?
A) Anterior mediastinal mass
B) Bilateral hilar lymphadenopathy
C) Cardiomyopathy with left atrial enlargement
D) Right middle lobe collapse

Question 30

RACP 2020a Q14.
Patients with chronic liver disease feel more dyspnoea when standing up as opposed to lying
down (orthodeoxia). An increase in what parameter explains this phenomenon?
A) Left ventricular preload
B) Cardiac output
C) Intra-abdominal pressure
D) Pulmonary capillary vasodilation

Question 31

RACP 2020 Q22. In addition to influenza, which vaccine is indicated in COPD?
A) Hemophilus
B) Pneumococcal
C) Varicella
D) Meningococcal

Question 32

RACP 2020a 31. A 58 year old non-smoker with a past history of asthma presents to the emergency department
with 4 days of productive cough and a temperature of 38.3. Her chest X-ray is shown below (pic).
Which of the following is the most likely diagnosis?
A) Empyema
B) Middle lobe collapse/consolidation
C) Lower lobe collapse/consolidation
D) Pulmonary infarction
ANS: Picture was of right lower ZONE collapse consolidation. Appeared to have silhouette sign of
right diaphragm but not right heart border

Question 33

RACP 2020 24. Man in his 30s who works with stone kitchen bench tops presenting with dry cough. X-ray shows bilateral upper fibrosis. What is the diagnosis?
A) Tuberculosis
B) Silicosis
C) Asbestosis
D) Hypersensitivity pneumonitis

Question 34

RACP 2020 32. A 48 year old man (smoker) developed a right distal below knee DVT and bilateral PE after a
long haul flight - What is the minimum duration of anticoagulation?
A) 6 weeks
B) 3 months
C) 12 months
D) Lifelong

Question 35

RACP 2020 34. Patient admitted with dyspnea, long standing COPD. pH of 7.2, CO2 of 70. He is alert. What is
the next best step in management?
A) Bi-level non-invasive ventilation
B) Continuous positive airway pressure
C) Intubation and ventilation
D) High flow nasal cannula oxygen therapy

Question 36

RACP 2020 35. A patient with background of COPD presents with dyspnoea and oxygen saturations of 87%. His ABG at rest shows PaO2 55 and PaCO2 31. Echocardiography shows pulmonary artery
systolic pressure of 65 mmHg. Which of the following will reduce his mortality?
A) Beta-agonist bronchodilators
B) Oxygen therapy
C) Corticosteroids
D) Warfarin

Question 37

RACP 2020 49. 50-year old man with clinical features of adult onset asthma. No response to inhaled
corticosteroids or bronchodilators. What test should you do next?
A) Ct chest
B) B) FeNO
C) Sputum eosinophils
D) Spirometry

Question 38

RACP 2019 Question 10
Which of the following disease causes predominance of upper lobe pulmonary fibrosis?
A. Rheumatoid arthritis
B. Diffuse scleroderma
C. Mixed connective tissue disease
D. Ankylosing spondylitis

Question 39

RACP 2019 Question 13
A 37 year old female presents with a DVT following a cholecystectomy. There is RV dilatation on
echocardiogram. She is hemodynamically stable. What is the appropriate duration for
anticoagulation?
A. 6 weeks
B. 3 months
C. 12 months
D. Indefinitely

Question 40

RACP 2019 Question 40
Non-invasive ventilation is employed in patients with acute cardiogenic pulmonary oedema. By what mechanism does NIV lead to cardiovascular improvement?
A. Increased cardiac output
B. Decreased pulmonary vascular resistance
C. Increased after load
D. Decreased preload

Question 41

RACP 2019 Question 54
A 35 year old man presents with progressive cough for more than a year. He works in an office, does
not smoke, lives alone, and has not travelled overseas. There is no family history of lung disease and he reports no contact with other persons with pulmonary disease or chest infection. Clinical examination is unremarkable. His chest x-ray is shown:
?Unexciting CXR – not the same as last year’s though
Which of the following is the most likely diagnosis?
A. Extrinsic allergic alveolitis
B. Lung cancer
C. Sarcoidosis
D. Tuberculosis

Question 42

RACP 2019 Question 59
A 54 year old man presents with worsening exertional dyspnoea and is found to have pulmonary
hypertension with RVSP 76mmHg on echocardiogram. He undergoes a right heart catheter, the
results of which are shown below
Pulmonary artery wedge pressure 22mmHg
Mean pulmonary artery pressure 42mmHg
Right atrial pressure 12mmHg
Cardiac output 5.7L (normal)
Which of the following is the best initial management for this patient?
A. Bosentan
B. Frusemide
C. Nifedipine
D. Tadalafil

Question 43

RACP 2019 Question 60
In patients admitted with secondary spontaneous pneumothorax, which of the following is the most
prevalent underlying condition?
A. Chronic obstructive pulmonary disease
B. Lung cancer
C. Cystic fibrosis
D. Bacterial pneumonia

Question 44

RACP 2019 Question 63
A 28 year old lady presents with two days of breathlessness and chest discomfort. Her chest is clear to auscultation. The following blood results are obtained:
pH 7.50
PaO 2 92 mmHg
PaCO 2 28 mmHg
Bicarb 22 mmol/L
What is the most likely cause?
A. Aspirin overdose
B. Anxiety
C. Pulmonary embolus
D. Asthma

Question 45

RACP 2019 Question 76
A 56 year old lady with COPD and a 30 pack year history of smoking presents with an acute
exacerbation. An arterial blood gas after 24 hrs of hydrocortisone and antibiotics shows:
pH 7.29
PaCO 2 55 mmHg
PaO 2 65 mmHg
What is the most appropriate next step?
A. High flow nasal prong oxygen
B. Non-rebreather mask
C. Non-invasive ventilation
D. Intubation and ventilation

Question 46

RACP 2019 Question 18
A 75 yo male presents with dyspnoea. On examination he is found to have bilateral crepitations with
evidence of pulmonary oedema on CXR. He is diagnosed with an acute exacerbation of heart failure and is commenced on a GTN infusion.
What is the mechanism of benefit with GTN in this patient?
A. Decrease preload
B. Increase cardiac output
C. Increase afterload
D. Decrease ventilation/perfusion mismatch

Question 47

RACP 2019 Question 23
A 50 year old man has clinical features of adult onset asthma. There is no improvement with inhaled
corticosteroids and bronchodilators. Chest x-ray is normal. What is the most appropriate next
investigation?
A. CT chest
B. Fraction exhaled nitric oxide (FENO)
C. Spirometry
D. Sputum eosinophils

Question 48

RACP 2019 Question 43
Which of the following causes an increase in DLCO?
A. Pulmonary haemorrhage
B. Asthma
C. Interstitial lung disease
D. Congestive cardiac failure

Question 49

RACP 2019 A 55yo male presents with dyspnoea. Their CXR is shown below.
When the patient is lying on his left side, his oxygen saturation improves from 85% to 91%. What is
the mechanism of this improvement?
A. Improved ventilation / perfusion matching
B. Increased venous return
C. Improved compliance
D. Increased cardiac output

Question 50

RACP 2019 Question 60
A 60yo male, non-smoker, presents with persistent cough and dyspnoea. His CT is shown below:

His CT demonstrates bulky hilar lymphadenopathy. What is the most likely diagnosis?
A. Small cell lung cancer
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Hodgkin’s lymphoma

Question 51

RACP 2018 9. A 28-year-old otherwise healthy woman who is 36/40 pregnant presents with dyspnoea for
1 week and left lower limb swelling for 2 days. Temperature is 37.4 °C, blood pressure is
136/86 mmHg, heart rate 98 beats per minute, oxygen saturations 98% on room air. Her left calf
diameter measures 2 cm greater than the right. An ECG and chest radiograph are normal.
Which is the next most appropriate investigation?
A. CT pulmonary angiogram.
B. D-dimer.
C. Echocardiogram.
D. Lower limb Doppler ultrasound.
E. Ventilation/perfusion scan.

Question 52

RACP 2018 Q 13

A 62-year-old man had a recent diagnosis of lung cancer. While waiting for his cancer treatment
to commence, he presented to the hospital emergency with worsening dyspnoea
and haemoptysis, a CT scan of the chest was performed.
What is the most likely cause of the opacity indicated by the arrow?
A. Distal lung collapse.
B. Lung cancer mass.
C. Pneumonic consolidation.
D. Pulmonary haemorrhage.
E. Pulmonary infarct.

Question 53

RACP 2018 18. You have been asked to see a patient on the ward with a 10-day-old tracheostomy. He has
become acutely dyspnoeic with a respiratory rate of 34 breaths per minute and oxygen
saturations of 88% on 40% inspired oxygen via mask. In addition to supplying 100%
inspired oxygen to the face and via the tracheostomy, what should your initial management be?
A. Further inflate the tracheostomy balloon.
B. Manually ventilate via the tracheostomy.
C. Remove the tracheostomy.
D. Replace existing tracheostomy tube with a fresh tracheostomy.
E. Suction the tracheostomy.

Question 54

RACP 2018a 36. Following dyspnoea, what is the next most common clinical feature of acute pulmonary
embolism?
A. Calf swelling or pain.
B. Haemoptysis.
C. Pleuritic pain.
D. Tachycardia.
E. Wheezing.

Question 55

RACP 2018a 52. A 64-year-old woman has breathlessness on exertion. An echocardiogram is performed and
shows a left ventricular ejection fraction of 55% and an estimated pulmonary artery pressure of
58 mmHg. Cardiac catheterisation is performed.
Which cardiac pressure measurement would best determine whether pulmonary hypertension is due to pulmonary arterial hypertension?
A. Left ventricular pressure.
B. Pulmonary artery pressure.
C. Pulmonary capillary wedge pressure.
D. Right atrial pressure.
E. Right ventricular pressure.

Question 56

RACP 2018a 61. A 40-year-old HIV positive man with a CD4 count of 450 cells/μL [650–2000] presents with a
3 day history of fever, cough, sputum production and a right lower lobe consolidation on chest x-ray.
What is the most likely organism causing his pneumonia?
A. Methicillin resistant Staphylococcus aureus.
B. Mycobacterium avium complex.
C. Mycobacterium tuberculosis.
D. Pneumocystis jirovecii.
E. Streptococcus pneumoniae.

Question 57

RACP 2018a 62. A 40-year-old woman with bronchiectasis has had three infective exacerbations requiring
antibiotic treatment. Sputum culture has consistently revealed Pseudomonas aeruginosa.
Which long-term treatment is most appropriate to reduce the frequency of infective
exacerbations?
A. Amoxycillin-clavulanate.
B. Azithromycin.
C. Ciprofloxacin.
D. Doxycycline.
E. Trimethoprim-sulfamethoxazole.

Question 58

RACP 2018a 63. A 20-year-old man presents to the Emergency Department with a severe exacerbation of
asthma. There is no improvement following two doses of nebulised bronchodilators and IV
hydrocortisone. What is the most appropriate next treatment?
A. IM adrenaline.
B. IV aminophylline.
C. IV magnesium.
D. IV methylprednisolone.
E. IV salbutamol.

Question 59

RACP 2018a 67.A 35-year-old man presents with progressive cough for more than a year. He has had courses of antibiotics and inhalers with no lasting benefit. He works in an office, lives alone (no pets),does not smoke and has not travelled overseas. There is no family history of lung disease and he reports no contact with other persons with pulmonary disease or chest infection. Clinical examination is unremarkable.
His chest x-ray is shown:
Which of the following is the most likely diagnosis?
A. Allergic bronchopulmonary aspergillosis.
B. Granulomatosis with polyangiitis.
C. Lung cancer.
D. Sarcoidosis.
E. Tuberculosis.

Question 60

RACP 2018a 79.A 44-year-old man with a 10-pack year smoking history is seen in the outpatient clinic forpersistent cough and sputum production. He has the following chest x-ray.
What is the most likely diagnosis?
A. Chronic bronchitis.
B. Pericardial effusion.
C. Right lower lobe consolidation.
D. Right middle lobe collapse.
E. Situs inversus.

Question 61

RACP 2018b 104.For a standard oxygen dissociation curve, decrease in which factor will cause a right shift in the curve?
A. 2,3-diphosphoglyceric acid.
B. CO2.
C. Haemoglobin.
D. pH.
E. Temperature.

Question 62

RACP 2018b 106.The in vitro gamma interferon release assay Quantiferon TB GoldTM is commonly used in patients with suspected Mycobacterium tuberculosis (MTB).
What is the main role of the Quantiferon Gold test?
A. Detect exposure to MTB.
B. Determine extent of MTB disease.
C. Determine response to MTB therapy.
D. Predict active MTB.
E. Rule out MTB.

Question 63

RACP 2018b 108.Obstructive sleep apnoea is associated with an increased prevalence of systemic
hypertension. What is the predominant mechanism for this?
A. Increased cardiac output.
B. Increased sympathetic tone.
C. Resetting of renal pressure-natriuresis.
D. Upregulation of carotid chemoreceptor sensitivity.
E. Vasoconstriction secondary to intermittent hypercapnia.

Question 64

RACP 2018 134.What is the most common pattern of interstitial lung disease in rheumatoid arthritis?
A. Acute interstitial pneumonia.
B. Desquamative interstitial pneumonia.
C. Lymphocytic interstitial pneumonia.
D. Organising pneumonia.
E. Usual interstitial pneumonia.

Question 65

RACP 2018 136.What is the mechanism of action of inhaled mannitol in the treatment of cystic fibrosis?
A. Augments action of aminoglycosides.
B. Augments function of cystic fibrosis transmembrane conductance regulator.
C. Directly toxic to Gram-negative bacteria.
D. Increases hydration of airway surface liquid.
E. Inhibition of the biofilm matrix.

Question 66

RACP 2018 148.What is the most common cause of reduced oxygen delivery despite normal arterial oxygen
saturations?
A. Anaemia.
B. Carbon monoxide toxicity.
C. Cigarette smoking.
D. Drug toxicity.
E. Haemoglobinopathy.

Question 67

RACP 2017a Q11
Question 11

A 75-year-old Chinese man who is being treated with a TNF inhibitor for Rheumatoid Arthritis
develops fevers, night sweats and a productive cough. You suspect Tuberculosis.The most sensitive test for diagnosing active TB infection is:
a) Three consecutive sputum samples sent for acid fast bacilli staining
b) Three consecutive sputum samples sent for TB culture
c) Transbronchial biopsy
d) Quantiferon Gold Assay
e) Tuberculin Skin Test

Question 68

RACP 2017a Q19
A 58-year-old man with a 50-pack year history of smoking and background of heart failure presents
with a 3-month history of progressive dyspnoea. His CXR is below:
What is the next best step in his management?
a) Bronchoscopy
b) Transthoracic Echocardiogram
c) Positron Emission Tomography
d) CT Pulmonary Angiography
e) Diagnostic pleurocentesis

Question 69

RACP 2017a Question 31

A 66-year-old man presents with acute haemoptysis in the context of recent upper respiratory tract
infections. He is on Warfarin for AF. Investigations reveal Hb 80, INR 2.5, normal renal function and
liver function. A CT Chest was performed and demonstrated patchy ground glass changes bilaterally
on axial sections.
Pulmonary function tests demonstrate normal FEV1 and FVC, FEV1/FVC 78% (LLN 68%), and a DLCO
of 120%.
The most likely cause of his presentation is:
a) Diffuse alveolar haemorrhage
b) Viral pneumonia
c) Non-specific interstitial pneumonia
d) Lepidic adenocarcinoma
e) Acute pulmonary oedema

Question 70

RACP 2017
Which parameter in the pulmonary function test has the greatest measurement variability?
a) FVC
b) FEV 1
c) TLC
d) RV
e) DLCO

Question 71

RACP 2016 Question 9
A 50 year old female with known lung cancer presents with a one day history of shortness of breath. She has
been on a weaning course of prednisone following radiotherapy for the last month and is currently taking 25mg.
Her chest x-ray is shown below
What is the most likely diagnosis?
A. Pulmonary embolism
B. Pneumocystis jiroveci (PCP pneumonia)
C. Cardiac tamponade
D. Acute pulmonary oedema
E. Lymphangitis carcinomatosis

Question 72

RACP 2016 Question 22
A 55 year old lady, non smoker, long history of atopy, presents with productive cough, sometimes clear, other
times green. CT scan showed bilateral bronchiectasis and congestion in maxillary sinus. Eosinophil count 2.5, IgE 1500. (reference ranges were given). What the most likely diagnosis:
A. ABPA
B. PAN
C. Wegeners
D. Churg strauss
E. some syndrome (sorry if this was correct answer)

Question 73

RACP 2016 Question 59
Which of the following is a cause of a falsely elevated peripheral oxygen saturation?
A) Carbon monoxide poisoning
B) Methylene blue injection
C) Peripheral cyanosis
D) Polycythaemia
E) Hyperbilirubinaemia

Question 74

RACP 2016 Question 66
The most common indication for NIV is exacerbation of COPD. Another indication for NIV is?
A) Aspiration pneumonia
B) Cardiogenic pulmonary oedema
C) Epiglottitis
D) Pneumothorax
E) Pulmonary embolism

Question 75

RACP 2016 Question 72
What is the main cause of infertility in male patients with cystic fibrosis?
A) Ciliary dysfunction
B) Drug side effects
C) Gonadal dysgenesis
D) Obstructive azoospermia
E) Zinc deficiency

Question 76

RACP 206 Q74 Question 74
A 50 year female presented with dyspnoea, fever and a productive cough. This was on a background of asthma
treatment with combination salmeterol and fluticasone. Examination revealed right upper zone crepitations and
left lower lobe wheeze. Her WCC was 14 with a differential revealing neutrophils of 10 and eosinophils of 2.
Her CXR at presentation is shown below. She was commenced on ceftriaxone, azithromycin and prednisone 50mg daily. 3 days later her symptoms have
improved, her WCC has normalised including eosinophils and her chest x-ray is repeated (shown below). That most likely diagnosis is?
A) Bacterial pneumonia
B) Eosinophilic pneumonia
C) Pulmonary vasculitis
D) Viral pneumonia
E) ABPA

Question 77

RACP 2016 Question 78
23 yo male with intermittent asthma presents to ED with an acute severe exacerbation. He was transferred into
the resuscitation bay and treated with multimodal therapy. Later he became hypotensive and bradycardic.
Which agent is most likely to be responsible?
A) Aminophylline
B) Magnesium
C) Prednisone
D) Salbutamol
E) Ipratopium

Question 78

RCAP 2016 Question 86.
A 60 year old gentleman who has a heavy smoking history presents with weight loss and confusion. CT chest
reveals a left lower lobe lesion with mediastinal lymphadenopathy. CT brain with contrast showed no cerebral
metastasis. The following bloods are obtained
Hb 102g/L (130-180g/L)
Platelets 400 x 10 9 /L (150-400 x 10 9 /L)
WCC 10 x 10 9 /L (4-11 x 10 9 /L)
Neutrophils 8 x 10 9 /L (2.5-7.5 x 10 9 /L)
Corrected Calcium 2.5mmol/L (2.12-2.65mmol/L)
Sodium 120 mmol/L (135-145mmol/L)
Urea 4.0mmol/L (2.5-6.7mmol/L)

He undergoes a FNA of the lesion. What diagnosis is most likely?
A) Large cell carcinoma
B) Small cell carcinoma
C) Germ cell tumour
D) Adenocarcinoma
E) Squamous cell carcinoma

Question 79

RACP 2016 Question 26
Which of the following antibodies is related with ILD and scleroderma
A. Anti smith
B. Anti-topoisomerase I
C. Anti RNA polymerase III
D. Anti centromere
E. Ds-DNA

Question 80

RACP 2016 Question 66
Oxygenation can be improved in mechanical ventilation by increasing function residual capacity. Which of the
following changes in ventilation setting can increased FRC
A) FIO2
B) RR
C) PEEP
D) Expiratory time
E) Peak inspiratory flow rate

Question 81

RACP 2015 Question 8
A 50 year old female with a background of liver cirrhosis presents with shortness of breath.
On standing her Sp02 is 84%, this improves to 94% when she lays flat. What is the cause of her SOB?
A. Intrapulmonary Shunt
B. Ascites
C. Diaphragmatic weakness
D. Pulmonary Effusion
E. Long QT syndrome

Question 82

RACP 2015 Question 12
Which of the following has the greatest effect on the Well’s Criteria for Pulmonary Embolism?
A. Likely diagnosis is PE or alternative diagnosis is less likely
B. Immobilisation
C. Malignancy
D. Previous DVT/PE
E. Haemoptysis

Answer 82

A

Question 83

RACP 2015 Question 29
A 55 year old man is evaluated for worsening exertional dyspnoea over a few months. His
PFTs are summarised below.
Tests are the best of three attempts. [no curve was given, no DLCO, possibly some other
numbers]
FEV1 58% pred
FVC 60% pred
FEV1/FVC ratio = 0.80
TLC 60% predicted
Slow VC 58%
What description best characterises the pattern seen?
A. Obstructive
B. Restrictive
C. Mixed obstructive restrictive
D. Neuromuscular weakness
E. Poor technique/effort

Question 84

RACP 2015 Question 77
A 35 year old female nursing student has been diagnosed with latent tuberculosis by a
positive IGRA (Quantiferon Gold). This was done through pre-occupational screening.
Which of the following factors would be put her at an increased risk to transition to active
tuberculosis and would thus sway you to treat her with latent TB prophylaxis such as isoniazid?
A. A positive TST
B. Migrating from an endemic TB country at age 10
C. Her age of 35
D. Exposure to TB 2 years ago
E. No BCG vaccine

Question 85

RACP 2015
Question 99:
55M businessman, presents for evaluation of daytime sleepiness. Wife states he snores
terribly. He wakes unrefreshed each day after sleeping 7-8hrs. Apnoea/hypopnea index = 25/hr on sleep study, daytime sleep latency 23min.
What is the most likely cause?
A. Obstructive sleep apnoea
B. Central sleep apnoea
C. Idiopathic hypersomnia
D. Primary insomnia
E. Phase shift
F. Narcolepsy
G. Restless legs syndrome

Question 86

RACP 2015 Question 100:
Young female graphic designer presents with daytime sleepiness. Sleeps 10 hours per
night, wakes with alarm clock. Light snoring. No alcohol, cigarettes, drugs. Always wakes
unrefreshed. Dependent on coffee to get through the day. AHI = 4/hr, MSL 4 minutes.
A. Obstructive sleep apnoea
B. Central sleep apnoea
C. Idiopathic hypersomnia
D. Primary insomnia
E. Phase shift
F. Narcolepsy
G. Restless legs syndrome

Question 87

RACP 2015 Question 18
What is the main role of PET in lung cancer?
A. Diagnosis
B. Assessing the extent of disease
C. Molecular identification of disease
D. Deciding on chemotherapy
E. Rhubarb

Question 88

RACP 2015 Question
What is the treatment for stage IIIA and IIIB non-small cell lung cancer who do not have surgical resection?
A. Definitive chemotherapy
B. Chemoradiotherapy
C. Radiotherapy
D. Palliative chemotherapy
E. Rhubarb

Question 89

RACP 2015 Question
A middle aged man presents feeling short of breath and unwell. A pair of ABGs is below, the
first on room and the other on FiO2 40%.
Room air: pH 7.43, pO2 56, pCO2 34.8, SpO2 82%
FiO2 40%: pH 7.43, pO2 116, pCO2 34.4, SpO2 86%. What is the most likely cause for this picture?
A. Carbon monoxide poisoning
B. Rhubarb
C. Methaemoglobinaemia
D. COPD
E. Intrapulmonary shunt

Question 90

RACP 2015 Question
What is the main reason patients are asked to avoid caffeine prior to lung function testing?
A. Bronchoconstriction
B. Bronchodilation
C. Increased heart rate
D. Decreased DLCO
E. Increased DLCO

Answer 90

B