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  • Question 1 - A 14 year old known asthmatic presents to the A&E department with difficulty...

    Incorrect

    • A 14 year old known asthmatic presents to the A&E department with difficulty breathing. She was seen by her regular doctor the day before with a sore throat which he diagnosed as tonsillitis and was prescribed oral Amoxicillin for 5 days. Past medical history:Ulcerative colitis diagnosed four years ago.Current medications:Inhaled salbutamol and beclomethasoneMesalazine 400 mg TDSShe was observed to be alert and oriented but she had laboured breathing. Inspiratory wheeze was noted. She was pale, sweaty and cyanosed. Her temperature was 36.7ºC, pulse 121/minute and blood pressure 91/40 mmHg. The lungs were clear and the remainder of the examination was normal. She was given high-flow oxygen through a face mask but despite this her breathing became increasingly difficult. What is the most likely causative agent?

      Your Answer: Corynebacterium diphtheriae

      Correct Answer: Haemophilus influenzae

      Explanation:

      Acute epiglottitis is a life-threatening disorder with serious implications to the anaesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. There is inflammatory oedema of the arytenoids, aryepiglottic folds and the epiglottis| therefore, supraglottitis may be used instead or preferred to the term acute epiglottitis.Acute epiglottitis can occur at any age. The responsible organism used to be Hemophilus influenzae type B (Hib), but infection with group A b-haemolytic Streptococci has become more frequent after the widespread use of Hemophilus influenzae vaccination. The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. There is usually drooling because of difficulty and pain on swallowing. Acute epiglottitis usually leads to generalized toxaemia. The most common differential diagnosis is croup and a foreign body in the airway. A late referral to an acute care setting with its serious consequences may result from difficulty in differentiation between acute epiglottitis and less urgent causes of a sore throat, shortness of breath and dysphagia.

    • This question is part of the following fields:

      • Respiratory
      154.1
      Seconds
  • Question 2 - A 13-year-old boy complains of chest pain. Examination reveals hypotension and tachycardia with...

    Correct

    • A 13-year-old boy complains of chest pain. Examination reveals hypotension and tachycardia with distended neck veins and a displaced trachea. What is the next appropriate management?

      Your Answer: Needle thoracocenthesis

      Explanation:

      The patient history suggests a spontaneous tension pneumothorax which is a life-threatening situation in which excess air is introduced into the pleural space surrounding the lung. When there is a significant amount of air trapped in the pleural cavity, the increasing pressure from this abnormal air causes the lung to shrink and collapse, leading to respiratory distress. This pressure also pushes the mediastinum (including the heart and great vessels) away from its central position, e.g. deviated trachea, and diminishing the cardiac output. Tension pneumothoraxes cause chest pain, extreme shortness of breath, respiratory failure, hypoxia, tachycardia, and hypotension. These are definitively managed by insertion of a chest tube. However, in the emergency setting temporizing measures are needed while chest tube materials are being gathered. In these situations, urgent needle thoracostomy (also called needle decompression) is performed.

    • This question is part of the following fields:

      • Respiratory
      55.6
      Seconds
  • Question 3 - A 15 month old boy has a history of repeated bacterial pneumonia, failure...

    Incorrect

    • A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?

      Your Answer: Selective IgA deficiency

      Correct Answer: X-linked agammaglobulinemia

      Explanation:

      Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
      Acute leukaemia causes immunodeficiency but not so specific.
      DiGeorge syndrome is due to lack of T cell function.
      Aplastic anaemia and EBV infection does not cause immunodeficiency.

    • This question is part of the following fields:

      • Respiratory
      32.1
      Seconds
  • Question 4 - A 1 year old child presents with barking cough, coryza and shortness of...

    Correct

    • A 1 year old child presents with barking cough, coryza and shortness of breath. What will be the most likely outcome associated with this condition?

      Your Answer: Natural resolution

      Explanation:

      Croup is the most common aetiology for hoarseness, cough, and onset of acute stridor in febrile children. Symptoms of coryza may be absent, mild, or marked. The vast majority of children with croup recover without consequences or sequelae.

    • This question is part of the following fields:

      • Respiratory
      39.6
      Seconds
  • Question 5 - A 16-year-old girl was brought to the ED by her gym instructor after...

    Correct

    • A 16-year-old girl was brought to the ED by her gym instructor after developing severe shortness of breath and chest pain at the gym. She has a history of asthma since childhood. Her skin colour looked normal| however, breath sounds were found to be diminished on auscultation of the right lung. Which investigation will you order first?

      Your Answer: Chest x-ray

      Explanation:

      Asthma patients have an increased risk of developing complications like pneumonia or collapsed lung. A clear visualization of the lungs through a CXR will define the management necessary for this patient.

    • This question is part of the following fields:

      • Respiratory
      30.2
      Seconds
  • Question 6 - Surfactant reduces the surface tension at the air/liquid interface in the lung. Which...

    Correct

    • Surfactant reduces the surface tension at the air/liquid interface in the lung. Which of the following cells produce surfactant in the lung parenchyma?

      Your Answer: Type II pneumocyte

      Explanation:

      Pulmonary surfactant is a mixture of lipids and proteins which is secreted by the epithelial type II cells into the alveolar space.

    • This question is part of the following fields:

      • Respiratory
      14.6
      Seconds
  • Question 7 - A 6 year-old boy is brought to you coughing. He is suspected to...

    Correct

    • A 6 year-old boy is brought to you coughing. He is suspected to have aspirated a Lego piece which he was seen playing with. Where would you expect the piece to be?

      Your Answer: Right main bronchus

      Explanation:

      Inhaled objects are more likely to enter the right lung for several reasons. First the right bronchus is shorter, wider and more vertical than the left bronchus. Also, the carina (a ridge-like structure at the point of tracheal bifurcation) is set a little towards the left. The terminal bronchiole is a very small space and impossible for the seed to lodge here.

    • This question is part of the following fields:

      • Respiratory
      203.3
      Seconds
  • Question 8 - A 15-year-old girl with acute Guillain-Barre syndrome has developed worsening weakness of her...

    Incorrect

    • A 15-year-old girl with acute Guillain-Barre syndrome has developed worsening weakness of her proximal muscles. Which of the following tests should be used to monitor her respiratory function?

      Your Answer: Arterial blood gas

      Correct Answer: Vital capacity

      Explanation:

      One-third of patients with Guillain-Barre syndrome suffer from diaphragm weakness which can lead to further respiratory complications if there is involvement of the tongue, palate, and neck muscles. Forced vital capacity (FVC) is the best way to monitor respiratory muscle function by assessing it repeatedly. Admission for ITU is suggested when FVC is below 20ml/kg and intubation recommended when FVC is 15ml/kg or below. FVC is used in any neurological disorders wherein the respiratory muscles are affected.

    • This question is part of the following fields:

      • Respiratory
      111.7
      Seconds
  • Question 9 - A 2-year-old boy's illness started with a 4-day history of fever and cough....

    Incorrect

    • A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?

      Your Answer: Chest X Ray

      Correct Answer: Blood for culture and sensitivity

      Explanation:

      Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.

    • This question is part of the following fields:

      • Respiratory
      26.5
      Seconds
  • Question 10 - A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the...

    Incorrect

    • A 14-year-old uncontrolled asthmatic is started on a steroid inhaler. Which of the following is the most common adverse effect he might complain about?

      Your Answer: Dental abscess

      Correct Answer: Dysphonia

      Explanation:

      Usage of inhaled corticosteroids are less associated with systemic adverse effects. However they are associated with local complications including dental caries and most commonly dysphonia.

    • This question is part of the following fields:

      • Respiratory
      39.2
      Seconds
  • Question 11 - A father brought his 6-year-old son with cystic fibrosis to the ER department...

    Correct

    • A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?

      Your Answer: Bleeding oesophageal varices

      Explanation:

      Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.

    • This question is part of the following fields:

      • Respiratory
      101.6
      Seconds
  • Question 12 - A 4-year-old child is referred to the chest clinic due to recurrent chest...

    Incorrect

    • A 4-year-old child is referred to the chest clinic due to recurrent chest infections. The mother says she has a productive cough with greenish sputum. Chest x-ray shows multiple ringed shadows and thickening of the bronchial walls at both bases. The most likely diagnosis is?

      Your Answer: Hypersensitivity pneumonitis

      Correct Answer: Bronchiectasis

      Explanation:

      The x-ray is suggestive of bronchiectasis. The most probable aetiology especially considering recurrent chest infections at such a young age is cystic fibrosis.

    • This question is part of the following fields:

      • Respiratory
      79.3
      Seconds
  • Question 13 - A 15 year old girl presented to the emergency with a history of...

    Correct

    • A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?

      Your Answer: Macrophage

      Explanation:

      The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
      Mast cells are only few in number and fibroblasts lay down collagen.
      Basophils are not present.
      The giant cell made up of macrophages are the most abundant cells in this inflammatory process.

    • This question is part of the following fields:

      • Respiratory
      30.3
      Seconds
  • Question 14 - A 7-year-old asthmatic boy presented to the pulmonologist with an exacerbation of shortness...

    Incorrect

    • A 7-year-old asthmatic boy presented to the pulmonologist with an exacerbation of shortness of breath for 3 days. At the time of admission, he was still experiencing breathlessness with oxygen saturation found to be less than 90%. CXR shows bilateral hyperinflation. Which of the following should be done?

      Your Answer: Spirometry

      Correct Answer: Arterial blood gas

      Explanation:

      Arterial blood gas is useful for the evaluation of oxygen and carbon dioxide gas exchange, respiratory function including hypoxia, and acid/base balance. This will quickly indicate if assisted ventilation is required for this patient.

    • This question is part of the following fields:

      • Respiratory
      196.7
      Seconds
  • Question 15 - A 15 year old girl presented to the emergency with a history of...

    Correct

    • A 15 year old girl presented to the emergency with a history of chronic cough, fever and weight loss. Her chest X-ray showed multiple nodules 1-4 cm in size and some of them with cavitation especially in the upper lobe. A sputum sample was positive for acid fast bacilli. Which of the following cells played a part in the development of the lung lesions?

      Your Answer: Macrophage

      Explanation:

      The characteristic cells in granulomatous inflammation are giant cells, formed from merging macrophages and epithelioid cells elongated with granular eosinophilic cytoplasm. Granulomatous reactions are seen in patients with tuberculosis. A tuberculous/caseating granuloma is characterised by a zone of central necrosis lined with giant multinucleated giant cells (Langhans cells) and surrounded by epithelioid cells, lymphocytes and fibroblasts. The caseous zone is present due to the damaged and dead giant cells and epithelioid cells.
      Mast cells are only few in number and fibroblasts lay down collagen.
      Basophils are not present.
      The giant cell made up of macrophages are the most abundant cells in this inflammatory process.

    • This question is part of the following fields:

      • Respiratory
      17.4
      Seconds
  • Question 16 - A 15 month old boy has a history of repeated bacterial pneumonia, failure...

    Correct

    • A 15 month old boy has a history of repeated bacterial pneumonia, failure to thrive and a sputum culture positive for H.influenzea and S.pneumoniae. There is no history of congenital anomalies. He is most likely suffering from?

      Your Answer: X-linked agammaglobulinemia

      Explanation:

      Recurrent bacterial infections may be due to lack of B-cell function, consequently resulting in a lack of gamma globulins production. Once the maternal antibodies have depleted, the disease manifests with greater severity and is called x-linked agammaglobulinemia also known as ‘X-linked hypogammaglobulinemia’, ‘XLA’ or ‘Bruton-type agammaglobulinemia. it is a rare x linked genetic disorder that compromises the bodies ability to fight infections.
      Acute leukaemia causes immunodeficiency but not so specific.
      DiGeorge syndrome is due to lack of T cell function.
      Aplastic anaemia and EBV infection does not cause immunodeficiency.

    • This question is part of the following fields:

      • Respiratory
      11.3
      Seconds
  • Question 17 - A 3-year-old girl presented with rhinorrhoea, barking cough and inspiratory stridor. She was...

    Incorrect

    • A 3-year-old girl presented with rhinorrhoea, barking cough and inspiratory stridor. She was diagnosed with laryngotracheobronchitis. If untreated at this stage which of the following would be the most probable outcome?

      Your Answer: Bronchiectasis

      Correct Answer: Complete resolution

      Explanation:

      The prognosis for croup is excellent, and recovery is almost always complete with complications being quite rare. The possible complications are pneumonia, bacterial tracheitis, pulmonary oedema, pneumothorax, pneumomediastinum, lymphadenitis or otitis media. Bacterial tracheitis is a life-threatening infection that can arise after the onset of an acute viral respiratory infection.

    • This question is part of the following fields:

      • Respiratory
      16.1
      Seconds
  • Question 18 - A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions...

    Correct

    • A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?

      Your Answer: Transient tachypnoea of the new-born

      Explanation:

      Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:- Aspiration pneumonia shows infiltrates in the lower lobes of the lungs- Congenitally acquired pneumonia shows patchy, asymmetrical densities- Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease- Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins.

    • This question is part of the following fields:

      • Respiratory
      51.2
      Seconds
  • Question 19 - A chloride sweat test was performed on a 13-year-old boy. Results indicated a...

    Correct

    • A chloride sweat test was performed on a 13-year-old boy. Results indicated a high likelihood of cystic fibrosis. This diagnosis is associated with a higher risk of developing which of the following?

      Your Answer: Bronchiectasis

      Explanation:

      Cystic fibrosis is a life-threatening disorder that causes the build up of thick mucus in the lungs, digestive tract, and other areas of the body. It is a hereditary autosomal-recessive disease caused by mutations of the CFTR gene. Cystic fibrosis eventually results in bronchiectasis which is defined as a permanent dilatation and obstruction of bronchi or bronchioles.

    • This question is part of the following fields:

      • Respiratory
      19
      Seconds
  • Question 20 - A 6 year old boy presents with a history of repeated respiratory and...

    Correct

    • A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?

      Your Answer: Cystic fibrosis

      Explanation:

      Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.

    • This question is part of the following fields:

      • Respiratory
      77.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory (12/20) 60%
Passmed