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Question 1
Incorrect
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A 60-year old male presented to the OPD with a complaint of a rusty-coloured sputum along with a cough for 3 days. His has a history of smoking for 40 years, and a history of significant weight loss. His chest X-ray revealed solid nodules in both lungs and bilateral hilar lymphadenopathy. Out of the following, which one is the most appropriate investigation?
Your Answer: CT
Correct Answer: LN biopsy
Explanation:The patient’s age, a history of long-term smoking, and bilateral hilar lymphadenopathy are strong indications of malignancy. Lymph node biopsy would be essential in order to check the degree of metastasis in the mediastinal lymph nodes.
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This question is part of the following fields:
- Respiratory
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Question 2
Incorrect
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A 32 year old woman presents with a history of breathlessness and pyrexia. She's been diagnosed with eczema and tuberculosis (TB). The following findings were established: pre-broncho-dilator test=2/3.5, post-broncho-dilator=3/3.7. What is the most likely diagnosis?
Your Answer: Pulmonary Embolus
Correct Answer: Chronic obstructive pulmonary disease (COPD)
Explanation:The clinical picture of the patient together with paraclinical investigations (spirometry) suggest COPD.
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This question is part of the following fields:
- Respiratory
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Question 3
Incorrect
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A 40-year-old female is suffering from chronic cough. Which of the following additional symptoms will strongly indicate that she has asthma?
Your Answer:
Correct Answer:
Explanation:An attack of asthma is characterized by severe dyspnoea accompanied by wheezing. During an attack, the person experiences breathing difficulty during inspiration and expiration, but might feel completely well between attacks. An attack can be triggered by factors like cold, dry air, tobacco smoke, pollen, pet dander, as well as stressful situations like exercise. Dizziness, voice disturbances, and coryzal illness are not features of asthma.
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This question is part of the following fields:
- Respiratory
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Question 4
Incorrect
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A 69-year-old man complains of a significant decrease in weight, SOB, chest pain discomfort and cough. Examination results are constricted left pupil and drooping left eyelid. What is the most likely diagnosis?
Your Answer:
Correct Answer: Pancoast tumour
Explanation:Destructive lesions of the thoracic inlet is related to the apical lung cancer called Pancoast tumour, along with the involvement of cervical sympathetic nerves (the stellate ganglion) and brachial plexus which can lead to a Horner’s syndrome
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This question is part of the following fields:
- Respiratory
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Question 5
Incorrect
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A 21-year-old male presents with severe right-sided chest pain. On examination, percussion was hyper-resonant and breath sounds were reduced on the right side. He has no history of any respiratory illness or trauma. What condition is this patient suffering from?
Your Answer:
Correct Answer: Simple Pneumothorax
Explanation:Pneumothorax refers to a condition in which air or gases accumulate inside the pleural space causing the lungs to collapse. Because the patient did not have a history of any previous pulmonary disease or trauma, this is a case of simple pneumothorax.
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This question is part of the following fields:
- Respiratory
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Question 6
Incorrect
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A 62 year male presented with epistaxis, nasal blockage, double vision, ear fullness and left sided conductive deafness for 1 week. He was a heavy smoker and alcoholic. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Nasopharyngeal ca
Explanation:Because of the involvement of nose, ear and vision, the most probable diagnosis is nasopharyngeal carcinoma. Both smoking and alcohol are risk factors.
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This question is part of the following fields:
- Respiratory
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Question 7
Incorrect
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A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish papillary reaction. What is the most likely explanation for her symptoms?
Your Answer:
Correct Answer: Paraneoplastic syndrome
Explanation:Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.
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This question is part of the following fields:
- Respiratory
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Question 8
Incorrect
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A 48 year old chronic smoker who smokes 20 cigarettes per day, presented with a persistent cough, wheezing and difficulty in breathing. He was treated with oxygen but the symptoms did not improve. Which of the following is the next step?
Your Answer:
Correct Answer: Check ABG
Explanation:The history is suggestive of a COPD exacerbation. As he is not responding to oxygen, an ABG should be performed to assess the level of hypoxaemia and then a decision about further management can be made. A CXR and salbutamol are also important in the acute management.
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This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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A 50-year-old farmer presented with fever, malaise, cough, and shortness of breath. He also reports a history of severe weight loss. Examination revealed tachypnoea, coarse end-inspiratory crackles and wheeze. His chest X-ray showed fluffy nodular shadowing and lab results showed polymorphonuclear leucocytosis. Which of the following is the most appropriate diagnosis?
Your Answer:
Correct Answer: Extrinsic allergic alveolitis
Explanation:Extrinsic allergic alveolitis, also known as hypersensitivity pneumonitis, is an allergic response of the lungs to an environmental allergen. Nodular shadowing in the chest X-ray is characteristic of extrinsic allergic alveolitis.
Churg-Strauss syndrome is an auto-immune disorder that is known to cause vasculitis mostly in patients having a pre-existing airway disease.
Cryptogenic organizing pneumonia is an inflammatory condition of the alveoli. The CXR of which shows ground-glass opacifications.
The CXR of progressive massive fibrosis also shows opacifications normally in the upper lung lobes. -
This question is part of the following fields:
- Respiratory
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Question 10
Incorrect
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A 24 year old patient known with alpha-1-antitrypsin deficiency is expecting her first child. She is concerned whether her child will be affected or not. What is the pattern of inheritance of alpha-1-antitrypsin deficiency?
Your Answer:
Correct Answer:
Explanation:Alpha-1 antitrypsin deficiency is inherited in an autosomal codominant pattern, meaning that one defective allele tends to result in milder disease than two defective alleles.
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This question is part of the following fields:
- Respiratory
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Question 11
Incorrect
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An soccer player suddenly collapsed on the field and started coughing along with shortness of breath. The investigation of choice in this case would be?
Your Answer:
Correct Answer: Chest x-ray
Explanation:Exercise induced asthma is characterised by sudden onset wheezing, cough and shortness of breath while performing hectic physical activity. The best investigation to perform is a chest X-ray.
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This question is part of the following fields:
- Respiratory
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Question 12
Incorrect
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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:
Correct 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.
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This question is part of the following fields:
- Respiratory
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Question 13
Incorrect
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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 possible outcome?
Your Answer:
Correct Answer:
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.
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This question is part of the following fields:
- Respiratory
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Question 14
Incorrect
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A 22 year old male with exercise induced asthma, has had good control with a salbutamol inhaler. But recently he has had asthma attacks with exercise. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Sodium cromoglycate
Explanation:Steroids and theophylline have less of a role in the treatment of exercise induced asthma. The best method of treatment is pre-exercise short-acting β2-agonist administration. Long-acting β2-agonists, mast cell stabilizers (e.g.: Sodium cromoglycate), and antileukotriene drugs also play a role.
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This question is part of the following fields:
- Respiratory
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Question 15
Incorrect
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A 74 year old man presents to the physician with complaints of hoarseness of voice and cough for the past 3 weeks. The patient has been a smoker and quit 3 years ago. Radiological examination reveals a mass in the mediastinum. Which investigation should be employed to establish a diagnosis?
Your Answer:
Correct Answer: LN biopsy
Explanation:Masses in the middle mediastinum most commonly represent lymph nodes that are enlarged by a malignant, infectious, or inflammatory process. Masses in the posterior mediastinum are usually benign tumours or cysts originating from either the nerves that are present in this area (neurogenic tumours) or from the oesophagus (foregut duplication cysts). Lymph node biopsy would be the ideal choice of investigation in this case.
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This question is part of the following fields:
- Respiratory
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Question 16
Incorrect
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A 68-year-old palliative care patient with bronchial cancer is suffering from recurrent, distressing cough because he cannot cough up his secretions. Which of the following drugs would most likely be helpful?
Your Answer:
Correct Answer: Scopolamine
Explanation:When death is imminent, oral and respiratory secretions become salient symptoms. It is important to separate the nursing concerns of frequent suctioning, the family concerns of chest crackles, and the true symptoms of dyspnoea or cough sensed by the patient. While opioids are the most successful agents for management of dyspnoea, anticholinergic agents such as scopolamine and glycopyrrolate are preferred for control of copious secretions. Symptoms such as pain and dyspnoea that do not respond to initial therapy should prompt referral to palliative care and pain management specialists, from the time of presentation until the last days of life.
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This question is part of the following fields:
- Respiratory
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Question 17
Incorrect
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A 62-year-old patient with shortness of breath has a chest x ray, which shows right lower lobe consolidation. Dyspnoea started one week ago. Which of the following would support admission of the patient?
Your Answer:
Correct Answer: A respiratory rate of 32/min
Explanation:CURB-65 is a clinical prediction score that has been validated for predicting mortality in community-acquired pneumonia. It is comprised of five features which are given a point if present on the patient.
C=confusion
U=urea >7mmol/L
R=respiratory rate >30/min or more
B=blood pressure (SBP)<90mmHg or (DBP)<60mmHg.
Lastly, the patient gets a point if he/she is 65-year-old or older. The score provides guidance for management:
0-1: Treat as an outpatient
2: Consider a short stay in hospital or watch very closely as an outpatient
3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit. -
This question is part of the following fields:
- Respiratory
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Question 18
Incorrect
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A 37-year-old woman presents with signs of decreased air entry at the right base after an emergency laparotic cholecystectomy 18h ago but with no obvious abnormality showed on her CXR. What is the most appropriate management strategy?
Your Answer:
Correct Answer: Chest physiotherapy
Explanation:Non-invasive action via chest physiotherapy is helpful in the reduction or clearance of excessive secretions from airways.
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This question is part of the following fields:
- Respiratory
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Question 19
Incorrect
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A 60 old patient with a history of chronic cough was found to have partial ptosis, constricted pupil and loss of hemifacial sweating. What is the most probable diagnosis?
Your Answer:
Correct Answer:
Explanation:Horner syndrome (oculosympathetic paresis) results from an interruption of the sympathetic nerve supply to the eye. It is characterized by the classic triad of miosis (i.e., constricted pupil), partial ptosis, and loss of hemifacial sweating (i.e., anhidrosis). As this patient presented with chronic cough most probably he has Pancoast tumour (tumour in the apex of the lung, most commonly squamous cell carcinoma).
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This question is part of the following fields:
- Respiratory
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Question 20
Incorrect
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A 45 year old appears at the OPD with symptoms of persistent cough and purulent sputum. He is a chronic smoker and had measles in the past. Upon auscultation, inspiratory crepitation and finger clubbing are noted. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Bronchiectasis
Explanation:A history of measles, whooping cough, or other severe lung infections like tuberculosis (TB) and pneumonia can lead to airway damage and possibly bronchiectasis.
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This question is part of the following fields:
- Respiratory
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Question 21
Incorrect
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An 85 year old elderly male presents with complaint of worsening breathlessness over the last 2 years. He has a longstanding history of COPD and currently takes salbutamol, ipratropium, salmeterol, beclomethasone and theophylline. FEV1 comes out to be less than 30%. What will be the most suitable next step in the management of this patient?
Your Answer:
Correct Answer: Assessment for long term O2 therapy
Explanation:Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with severe chronic obstructive pulmonary disease (COPD) associated with resting hypoxaemia. When appropriately prescribed and correctly used, LTOT has clearly been shown to improve survival in hypoxemic COPD patients. Requirements to proceed to LTOT is the patient should be stable and on appropriate optimum therapy (as in given case) and having stopped smoking tobacco. The patient should be shown to have a PaO2 of less than 7.3 kPa and/or a PaCO2 of greater than 6 kPa on two occasions at least 3 weeks apart. FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may benefit from LTOT.
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This question is part of the following fields:
- Respiratory
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Question 22
Incorrect
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A 26 year old male has been taken to the emergency department with chest pain and increasing shortness of breath. He revealed that he has been a heavy smoker for the last 4 years, but doesn't have any past medical history. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Pneumothorax
Explanation:Increasing shortness of breath, chest pain, and no previous medical history are consistent with a pneumothorax diagnosis. Heavy tobacco use is also a risk factor for developing this condition spontaneously.
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This question is part of the following fields:
- Respiratory
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Question 23
Incorrect
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A 57-year-old male presented to the OPD with a complaint of fever, cough and chest pain for 3 days. The right lung base was dull on percussion and the breath sounds were reduced in intensity. Which of the following investigations is most appropriate?
Your Answer:
Correct Answer: CXR
Explanation:Because of the patient’s acute presentation of symptoms accompanied by lung abnormalities observed on physical examination, the next step is to visualize the suspected acute inflammatory process by ordering a CXR. Bronchoscopy, CT and MRI are done in cases in which there is suspicion of any tumour formation. V/Q scan is done in cases where pulmonary embolism is suspected.
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This question is part of the following fields:
- Respiratory
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Question 24
Incorrect
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A 55-year-old male underwent a pneumonectomy. Post operatively he was drowsy and found to have a hyponatremia. What would be the most likely reason for his condition?
Your Answer:
Correct Answer: Removal of hormonally active tumour
Explanation:The syndrome of inappropriate antidiuretic hormone (SIADH) is often associated with small-cell lung carcinoma which manifests as a paraneoplastic disorder. SIADH due to non-small-cell cancer has been shown to be triggered following open surgical procedures, however this is an extremely rare phenomenon.
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This question is part of the following fields:
- Respiratory
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Question 25
Incorrect
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A 60 year old male smoker presented in the emergency room with a history of chest pain and a cough for the last few days. He is now complaining of increasing dyspnoea and sharp pains around the 4th and 5th ribs. On CXR, there is right sided hilar enlargement. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer:
Explanation:The history of smoking with a cough and bone pain is suggestive of bronchogenic carcinoma. CXR findings are also supportive of this diagnosis. In COPD, a cough with dyspnoea and wheezing is prominent.
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This question is part of the following fields:
- Respiratory
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Question 26
Incorrect
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A 20-year-old male presented with fever, cough and right sided chest pain for 4 days. On examination he was febrile and mildly dyspnoeic. His respiratory rate was 30, O2 sats 94% and there ware crepitations at the right lung base on auscultation. What is the most suitable investigation to be done at this stage to arrive at a diagnosis?
Your Answer:
Correct Answer: CXR
Explanation:The most probable diagnosis is a right sided lobar pneumonia. CXR at this stage will help to confirm the diagnosis. Blood for C&S is also an important investigation but not the others.
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This question is part of the following fields:
- Respiratory
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Question 27
Incorrect
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From the following drugs, which is an inhaled glucocorticoid that is used for maintenance therapy, but not important in mild asthmatic attacks?
Your Answer:
Correct Answer: Fluticasone propionate
Explanation:From the given answers Fluticasone propionate is the inhaled glucocorticoid. It is not important as a reliever medication but important in maintenance therapy.
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This question is part of the following fields:
- Respiratory
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Question 28
Incorrect
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A 35 year old male complains of a headache that gets worse when he moves his head forward. From the list of options, which is the most likely diagnosis?
Your Answer:
Correct Answer: Chronic Sinusitis
Explanation:Symptoms such as pain worsening when bending forward, are consistent with chronic sinusitis. Sinusitis also does not present with nausea or vomiting, which is worsened by loud noises or bright lights.
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This question is part of the following fields:
- Respiratory
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Question 29
Incorrect
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A 25-year-old man is complaining of respiratory distress and chest pain. Examination reveals distention of neck veins, hypotension, and tachycardia. His breathing sounds on the left side are diminished and absent on the right side. The trachea is also deviated to the left side. What is the next appropriate immediate management?
Your Answer:
Correct Answer: Right needle thoracostomy
Explanation:The patient history suggests a 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.
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This question is part of the following fields:
- Respiratory
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Question 30
Incorrect
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A 44-year-old call centre worker with asthma is prescribed a leukotriene inhibitor. He presents with severe abdominal pain and a pleural effusion. Which of the following is the most likely cause of the effusion?
Your Answer:
Correct Answer: Churg-Strauss syndrome
Explanation:Churg-Strauss syndrome is characterised by reactions in the serosal membranes. Hence, pericardial effusions and pleural effusions are common. Cytological analysis of the transudate shows high levels of eosinophils. Leukotriene inhibitors are known to increase the incidence of this syndrome.
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This question is part of the following fields:
- Respiratory
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SESSION STATS - PERFORMANCE PER SPECIALTY
