Exam practice

Question 1

56 year old male after an MI. BMI = 22.8, Total Cholesterol =7.18mmol/l (normal 0-5), HDL = 0.9mmol/l (normal 0.6-2.5), LDL = 5.13mmol/l (normal <3.0).

What is the MOST EFFECTIVE dietary advice for this patient as a secondary prevention of cardiovascular disease?

A: Aim to reduce body weight by 5-10%.
B: Increase intake of omega-3-fatty-acids.
C: Increase intake of trans-fatty acids.
D: Omit foods containing cholesterol, such as eggs and prawns.
E: Take a supplement containing anti-oxidant vitamins.

Answer 1

B: Increase intake of omega-3-fatty-acids.

Explanation: Eating omega-3-fatty acids helps to improve survival post MI.

Patient’s BMI is within healthy range, trans-fatty acids should be reduced, eating cholesterol does not have much of an impact as eating saturated fat, but some evidence exists to support the use of vitamin supplements- but fresh fruit and veg is better.

Question 2

Rapidly contracting human muscle cells start producing lactic acid. Which best explains this finding?
A: The cells have to convert NADH into NAD+.
B: Lactic acid acts as a substrate for gluconeogenesis.
C: Lactic acid is oxidised in the Krebs cycle.
D: Most cells utilise lactic acid as an energy source.
E: Lactic acid is a normal waste product of aerobic metabolism.

Answer 2

A: The cells have to convert NADH into NAD+.

Explanation: Rapidly contracting muscle cells require large amounts of energy in the form of ATP. If they are unable to produce enough via oxidative phosphorylation, e.g. because not enough oxygen is supplied in time, then cells require another way of regenerating NAD+. Without regenerating NAD+, the cells would not be able to produce ATP by glycolysis either.

B is a correct statement, but does not explain WHY muscle cells produce it.

Question 3

Transcription and translation of a gene composed of 30 nucleotides would form a protein containing no more than \_\_ amino acids.
A: 10
B: 15
C: 30
D: 60
E: 90

Answer 3

A: 10

Explanation: Ribosomes are the site of protein synthesis (translation) and catalyses the recruitment of amino acid carrying aminoacyl t-RNAs to a specific triplet sequence of nucleotides encoded by mRNA. The ratio of amino acids translated to protein to nucleotides read is 3:1.

Question 4

Select the most appropriate assessment for the following situation in a patient with a chest infection.

1. Performed initially when undertaking a systematic patient assessment.
2. To indicate a problem with the patient’s peripheral circulation.

A: Blood pressure.
B: Blood sugar levels.
C: Capillary refill time (CRT).
D: Electrocardiogram (ECG).
E: Heart rate.
F: Neurological response (AVPU).
G: Oxygen saturation levels.
H: Patency of airway.
I: Respiratory rate.
J: Review of medical notes.

Answer 4

1. H: Respiratory rate.
   Explanation: Management of acutely unwell patients should be A-B-C approach. Ensure airway patency first.
2. C: Capillary refill time.
   Peripheral circulation is assessed by skin colour and temperature, pulse and capillary refill time.

Question 5

The enzyme that transcribes genetic material is:
A. Ligase.
B. DNA polymerase.
C. RNA polymerase. 
D. Amino-acyl transferase.
E. DNA transcriptase.

Answer 5

C: RNA polymerase.

Explanation: RNA polymerase transcribes messenger RNA from DNA that transcribes the exon (coding) regions of a gene.

Question 6

Germ layers are formed during which stage of embryogenesis?
A: Cleavage.
B: Fertilisation.
C: Gastrulation.
D: Morphogenesis.
E: Organogenesis.

Answer 6

C: Gastrulation

Explanation: Gastrulation involves the migration of cells through the primitive streak to form the germ layers.

Fertilisation is the union of sperm and oocyte. Cleavage refers to the earliest cell divisions of the embryo. Morphogenesis is the formation of the body plan. Organogenesis is the development of the primordial of all of the organs of the body.

Question 7

50 y/o male presents with heartburn, which he has suffered from for many years. He usually self-controls with antacids. Recently his symptoms have worsened and are disrupting his sleep. He also admits that he has occasional difficulty swallowing.

Select the MOST LIKELY underlying pathology from the options below:
A. Plaque formation and inflammation of the central nervous system.
B. Uncontrolled proliferation of epithelial cells in upper 2/3 of oesophagus.
C. Metaplasia of squamous epithelium to columnar epithelium.
D: Uncontrolled proliferation of epithelial cells in large airways of lung.
E. Constricted lower oesophageal sphincter.
F. Uncontrolled proliferation of mucous gland cells in lower 1/3 of oesophagus.
G. Uncontrolled proliferation of mucous gland cells in upper 2/3 of the oesophagus.
H. Scar tissue leading to stricture formation.
I: Gastric acid erosion of the gastric mucosa.
J: Uncontrolled proliferation of epithelial cells in the lower 1/3 of the oesophagus.

Answer 7

C: Metaplasia of squamous epithelium to columnar epithelium.

Explanation: Patient has Barrett’s Oesophagus in which metaplasia of squamous epithelium to columnar epithelium in the lower 1/3 of the oesophagus occurs due to chronic acid reflux. It is pre-malignant, and so patients should be regularly monitored.

Question 8

A 55 y/o female presents with a “sore stomach” which is worse after eating, she points to epigastrium to indicate point of pain origin. She complain of bloating and difficulty swallowing, which is reducing her appetite. She admits to having a recent episode of black stools.

Select the MOST LIKELY underlying pathology from the options below:
A. Plaque formation and inflammation of the central nervous system.
B. Uncontrolled proliferation of epithelial cells in upper 2/3 of oesophagus.
C. Metaplasia of squamous epithelium to columnar epithelium.
D: Uncontrolled proliferation of epithelial cells in large airways of lung.
E. Constricted lower oesophageal sphincter.
F. Uncontrolled proliferation of mucous gland cells in lower 1/3 of oesophagus.
G. Uncontrolled proliferation of mucous gland cells in upper 2/3 of the oesophagus.
H. Scar tissue leading to stricture formation.
I: Gastric acid erosion of the gastric mucosa.
J: Uncontrolled proliferation of epithelial cells in the lower 1/3 of the oesophagus.

Answer 8

I: Gastric acid erosion of the gastric mucosa.

Explanation: This patient has a peptic ulcer which may be caused by a Helicobacter Pylori infection. This infection stimulates gastrin production, which increases gastric acid secretion. This increased gastric acid erodes the gastric mucosa leading to ulcer formation.

Question 9

A 70 y/o male presents with difficulty swallowing, and pain on swallowing. He has a long history of Barrett’s Oesophagus, but never attended review appointments. The only alcohol he drinks is a glass of wine at New Year. He has never smoked.

Select the MOST LIKELY underlying pathology from the options below:
A. Plaque formation and inflammation of the central nervous system.
B. Uncontrolled proliferation of epithelial cells in upper 2/3 of oesophagus.
C. Metaplasia of squamous epithelium to columnar epithelium.
D: Uncontrolled proliferation of epithelial cells in large airways of lung.
E. Constricted lower oesophageal sphincter.
F. Uncontrolled proliferation of mucous gland cells in lower 1/3 of oesophagus.
G. Uncontrolled proliferation of mucous gland cells in upper 2/3 of the oesophagus.
H. Scar tissue leading to stricture formation.
I: Gastric acid erosion of the gastric mucosa.
J: Uncontrolled proliferation of epithelial cells in the lower 1/3 of the oesophagus.

Answer 9

F: Uncontrolled proliferation of mucous gland cells in the lower 1/3 of the oesophagus.

Explanation: Patient has an adenocarcinoma of the lower 1/3 of the oesophagus, adenocarcinoma arises from gland cells. Barrett’s oesophagus is a major risk factor for this, and not attending review appointments allows malignant change to go undetected. Squamous cell carcinoma of the oesophagus is more likely to affect the upper 2/3 and is associated with smoking and excess alcohol consumption. Squamous cell carcinoma arises from epithelial cells.

Question 10

In a female patient whose mother was affected by breast cancer at the age of 48, and has no other family history, how would you describe the patient’s risk of developing breast cancer?

A: zero.
B: below population risk.
C: Population risk.
D: Slightly increased above population risk.
E: Much higher than population risk.

Answer 10

D: Slightly increased above population risk.

Explanation: Multiple polymorphisms affect risk of disease in most conditions. If one parent has cancer, they are likely to have multiple polymorphisms that confer a small additional risk for that condition. As a child of an affected parent, you will share some of the “increased risk” polymorphisms, and therefore be at some increased risk over the population. Very rarely, risk is inherited as a single autosomal dominant gene (e.g. BRCA1), but in this case there would be multiple affected family members at a younger age.

Question 11

The most common cause of bacterial food poisoning diagnosed in UK laboratories.

A: Bacillus cereus
B: Campylobacter
C: Clostridium botulinum
D: Clostridium difficile
E: Clostridium perfringens
F: Cryptosporidium
G: E Coli 0157
H: Salmonella enteritidis
I: Shigella sonnet
J: Staphylococcus aureus

Answer 11

B: Campylobacter

Explanation: Campylobacter is the most common cause of bacterial food poisoning diagnosed in the laboratory in the UK. Most cases are sporadic and caused by eating undercooked poultry. Most of those affected acquire the bacteria from the same food source as it less transmissible person to person than e.g. Salmonella.

Question 12

Classically associated with food poisoning after eating rice which has been stored too long at room temperature.

A: Bacillus cereus B: Campylobacter
C: Clostridium botulinum D: Clostridium difficile
E: Clostridium perfringens F: Cryptosporidium
G: E Coli 0157 H: Salmonella enteritidis
I: Shigella sonnet J: Staphylococcus aureus

Answer 12

A: Bacillus cereus.

Explanation: Bacillus cereus is found on cereal crops, such as rice. It produces spores, which if left overnight at room temperature can germinate in the warm, moist, leftover rice. In doing so, it produces a heat stable toxin that causes sudden onset of vomiting within 6 hours of consumption.

Question 13

Infection with this organism may lead to Haemolytic Uraemic Syndrome as a complication.

A: Bacillus cereus B: Campylobacter
C: Clostridium botulinum D: Clostridium difficile
E: Clostridium perfringens F: Cryptosporidium
G: E Coli 0157 H: Salmonella enteritidis
I: Shigella sonnet J: Staphylococcus aureus

Answer 13

G: E Coli 0157

Explanation: E Coli 0157 may lead to sudden onset of Haemolytic Uraemic Syndrome (HUS) which is one of the main causes of renal failure, especially in children. Use of antibiotics may precipitate the onset of HUS and for this reason, they must be avoided in patients with this infection if possible.

Question 14

A 35 y/o woman presents with breathlessness and a dry cough, which has been worsening over several months. She has tender nodules on her shins and also reports fatigue, joint pain and weight loss in the same period. A chest X-ray shows hilar lymphadenopathy.

Select the MOST LIKELY underlying pathology.
A: Uncontrolled proliferation of epithelial cells in large airways of the lung.
B: Idiopathic inflammation of alveoli with thickening of the alveolar walls.
C: Ventilation-perfusion mismatch due to blockage of a pulmonary artery.
D: Reversible airway obstruction and bronchospasm.
E: Inflammation of the mucous membrane of the nasal cavity.
F: Non-caseating granuloma formation.
G: Hypotonia of lower oesophageal sphincter leading to acid reflux.
H: Chronic airway obstruction with air trapping.
I: Caseating granuloma formation.
J: Inflammation of the larynx, trachea and large bronchi.

Answer 14

F: Non-caseating granuloma formation.

Explanation: Patient has sarcoidosis; a granulomatous disease where non-caseating granulomas develop in many body organs, including the lungs. In the lungs, an interstitial lung disease pattern develops, with symptoms of breathlessness, dry cough and clinical signs of hilar lymphadenopathy on CXR. Often, erythema nodosum is present on the shins. There may also be other skin rashes, arthritis, joint swelling, blurred vision, dry eyes, fatigue and weight loss.

Question 15

A 65 y/o male presents with a worsening cough over the last few months. He admits that he has coughed up fresh blood, and lost weight over the same period. Over the last couple days he has developed a fever and is producing thick green sputum.

Select the MOST LIKELY underlying pathology.
A: Uncontrolled proliferation of epithelial cells in large airways of the lung.
B: Idiopathic inflammation of alveoli with thickening of the alveolar walls.
C: Ventilation-perfusion mismatch due to blockage of a pulmonary artery.
D: Reversible airway obstruction and bronchospasm.
E: Inflammation of the mucous membrane of the nasal cavity.
F: Non-caseating granuloma formation.
G: Hypotonia of lower oesophageal sphincter leading to acid reflux.
H: Chronic airway obstruction with air trapping.
I: Caseating granuloma formation.
J: Inflammation of the larynx, trachea and large bronchi.

Answer 15

A: uncontrolled proliferation of epithelial cells in the large airways of the lung.

Explanation: This man has a squamous cell carcinoma of the lung. His risk factors of smoking and age, alongside red flag symptoms of haemoptysis and weight loss make lung cancer the most likely diagnosis. Squamous cell carcinomas are more likely to develop nearer the larger airways of the lung. This can cause obstruction leading to lobar pneumonia. This is likely in this case due to the recent development of fever, and production of thick green sputum.

Question 16

15 y/o girl presents to A&E with severe breathlessness, wheeze and a cough. She has become increasingly breathless over the last few days, but her mother reports that she has refused to use her “puffers”.

Select the MOST LIKELY underlying pathology.
A: Uncontrolled proliferation of epithelial cells in large airways of the lung.
B: Idiopathic inflammation of alveoli with thickening of the alveolar walls.
C: Ventilation-perfusion mismatch due to blockage of a pulmonary artery.
D: Reversible airway obstruction and bronchospasm.
E: Inflammation of the mucous membrane of the nasal cavity.
F: Non-caseating granuloma formation.
G: Hypotonia of lower oesophageal sphincter leading to acid reflux.
H: Chronic airway obstruction with air trapping.
I: Caseating granuloma formation.
J: Inflammation of the larynx, trachea and large bronchi.

Answer 16

D: Reversible airway obstruction and bronchospasm.

Explanation: Patient is experiencing an acute asthma exacerbation. “Puffers” suggests she has been diagnosed with asthma, and refusal to use inhalers increases her risk of an acute exacerbation. Key features of acute asthma exacerbation are wheeze, cough and breathlessness. Asthma is caused by reversible airway obstruction (reversible by using steroids to dampen down inflammation) and bronchospasm (relieved by beta-2-agonists).

Question 17

Mean arterial blood pressure (MAP) equals:

A: Systolic pressure - diastolic pressure.
B: Diastolic pressure + 2/3 (Systolic - Diastolic).
C: Diastolic pressure + 1/3 (Systolic - Diastolic).
D. Systolic pressure - 1/3 (Systolic - Diastolic).
E. Systolic pressure +1/3 (Systolic - Diastolic).

Answer 17

C: Diastolic pressure + 1/3 (Systolic - Diastolic).

Question 18

A patient who is though to be suffering from shock from substantial blood loss would have which of the following pulse rates:

A: Fast.
B: Slow.
C: Bounding.
D: Normal.
E: No pulse.

Answer 18

A: Fast.

Explanation: this is due to sympathetic compensatory response to low blood pressure.

Question 19

At risk drinking for men is the regular consumption of:
A: More than 2 units per day.
B: More than 2 pints per day.
C: More than 3 units per day.
D: More than 3 pints per day.
E: More than 28 units per week.

Answer 19

C: More than 3 units per day.

Explanation: Safe drinking limits are 3 units per day or less for men.

NB: 1 pint = 2 units.

Question 20

A 20 y/o student presents with lethargy, headaches, fever, nausea and abdominal pain over 4 days. He has no rash. He returned from backpacking in India about 28 days ago. His friends notice his eyes are yellow.

What is the most likely infection?
A: Hepatitis A.
B: Hepatitis C.
C: Epstein-Barr Virus.
D: HIV seroconversion.
E: Dengue fever.

Answer 20

A: Hepatitis A.

Explanation: Hepatitis A is common in developing countries, particularly in areas with limited access to good hygiene/sanitation (suggested by backpacking). Typical incubation period is 28 days. Jaundice can be subtle at first, e.g. yellow sclera.

Dengue fever and HIV seroconversion typically present with rash. Acute Hep. C is unlikely, as it doesn’t normally present until late, and other signs of chronic liver disease would be expected.

Question 21

A 46 y/o male visits GP worried that he may have high blood pressure as his brother has just been started on medication for hypertension. His BP on two separate occasions was 142/98mmHg and 144/95mmHg.

What is the next MOST APPROPRIATE step to diagnose hypertension?
A: Reassess in 1 month.
B: Reassess in 3 months.
C: Reassess every year.
D: Ambulatory blood pressure monitoring.
E: Home blood pressure monitoring.

Answer 21

D: Ambulatory blood pressure monitoring.

Explanation: NICE guidelines state that to confirm a diagnosis of hypertension (BP 140/90mmHg or higher), ambulatory blood pressure monitoring is necessary.

If blood pressure is higher than 180/110, then antihypertensive drugs should be started immediately without waiting for results of ABPM.

Question 22

Chronic agonist induced stimulation of airway beta-2-receptors results in..

Select the most appropriate answer:
A. Airway remodelling and irreversible airway obstruction.
B. Enhanced hyper-reactivity on bronchial challenge testing.
C. Reduced airway hyper-reactivity on bronchial challenge testing.
D. Beta-2 receptor up regulation and enhanced receptor coupling to G-protein adenylyl-cyclase.
E. Beta-2-receptor down regulation and reduced receptor coupling to G-protein adenylyl-cyclase.
F. Increased pulmonary vascular resistance and right ventricular afterload.
G. Reduced pulmonary vascular resistance and right ventricular afterload.
H. Alveolar cell hyperplasia.
I. Alveolar cell desquamation.
J. Alveolar wall fibrosis.

Answer 22

E: Beta-2-receptor down regulation and reduced receptor coupling to G-protein adenylyl-cyclase.

Explanation: Chronic exposure to an exogenous beta-agonist, especially a long acting drug e.g. Salmeterol or Folmeterol, results in 24/7 beta-2-receptor occupancy and stimulation.

This results in an adaptive mechanism, including internalisation and uncoupling of beta-receptors, which manifests as reduced agonist stimulated response, known as tachyphylaxis or tolerance.

This is most evident as loss of the protective effect of LABA against bronchoconstrictor stimuli, such as exercise or allergen production, e.g. if one was to compare first and last dose protection upon chronic exposure, last dose protection would be reduced compared to first dose.

Question 23

Sensitisation of airway smooth muscle by asthmatic inflammatory mediators results in….

Select the most appropriate answer:
A. Airway remodelling and irreversible airway obstruction.
B. Enhanced hyper-reactivity on bronchial challenge testing.
C. Reduced airway hyper-reactivity on bronchial challenge testing.
D. Beta-2 receptor up regulation and enhanced receptor coupling to G-protein adenylyl-cyclase.
E. Beta-2-receptor down regulation and reduced receptor coupling to G-protein adenylyl-cyclase.
F. Increased pulmonary vascular resistance and right ventricular afterload.
G. Reduced pulmonary vascular resistance and right ventricular afterload.
H. Alveolar cell hyperplasia.
I. Alveolar cell desquamation.
J. Alveolar wall fibrosis.

Answer 23

B: Enhanced hyper-reactivity on bronchial challenge testing.

Airway hyper-reactivity/responsiveness is one of the hallmarks of the asthmatic inflammatory cascade. It results in airway smooth muscle becoming excessively twitchy in response to a variety of stimuli and can be measured using metacholine, histamine or mannitol challenge testing.

Question 24

Which statement is true regarding streptococcus?

A. Appears as gram -ve cocci in chain on gram film.
B. Coagulase test is important in the classification of this genus.
C. It appears as gram -ve cocci in clusters on gram stain.
D. Haemolysis is important in the classification of this genus.
E. Appears as gram -ve bacilli on gram stain.

Answer 24

D: Haemolysis is important in the classification of this genus.

Explanation: Streptococci and Staphylococci are gram +ve cocci on film. Streptococci are classified according to their haemolysis on blood agar, (alpha, beta, non-haemolytics).

Question 25

The processes that exchange oxygen and CO2 between the external environment and the cells of the body.

A. Transmural pressure gradient.
B. Boyle's Law.
C. Internal respiration.
D. External respiration.
E. Law of LaPlace.
F. Type II alveolar cells.
G. Alveolar interdependence
H. Elastic recoil.
I. Alveolar surfactant.
J. Intrapleural fluid.

Answer 25

D. External respiration.

Question 26

Comprises ventilation, gas exchange between the alveoli and blood, gas transport and gas exchange at the tissues.

A. Transmural pressure gradient.
B. Boyle's Law.
C. Internal respiration.
D. External respiration.
E. Law of LaPlace.
F. Type II alveolar cells.
G. Alveolar interdependence
H. Elastic recoil.
I. Alveolar surfactant.
J. Intrapleural fluid.

Answer 26

D. External respiration

Question 27

Maintains alveolar potency through the elastic recoil of surrounding alveoli preventing alveolar collapse.

A. Transmural pressure gradient.
B. Boyle's Law.
C. Internal respiration.
D. External respiration.
E. Law of LaPlace.
F. Type II alveolar cells.
G. Alveolar interdependence
H. Elastic recoil.
I. Alveolar surfactant.
J. Intrapleural fluid.

Answer 27

G. Alveolar interdependence.

Question 28

Fick’s Law of Diffusion:

A. Smaller alveoli have a greater tendency to collapse.
B. Gas diffusion across a surface is proportional to surface thickness and inversely proportional to its area.
C. Larger alveoli have a greater tendency to collapse.
D. The total pressure of a mixture of gases equals the sum of the partial pressures of each component gas.
E. Alveolar surfactant helps prevent alveolar collapse.
F. The total pressure of a mixture of gases equals the product of the partial pressures of each component gas.
G. Gas diffusion across a surface is proportional to surface area and thickness.
H. The total pressure of a mixture of gas equals the mean of the partial pressures of each component gas.
I. Gas diffusion across a surface is inversely proportional to surface thickness and proportional to area.

Answer 28

I. Gas diffusion across a surface is inversely proportional to surface thickness and proportional to area.

Question 29

Dalton’s law:

A. Smaller alveoli have a greater tendency to collapse.
B. Gas diffusion across a surface is proportional to surface thickness and inversely proportional to its area.
C. Larger alveoli have a greater tendency to collapse.
D. The total pressure of a mixture of gases equals the sum of the partial pressures of each component gas.
E. Alveolar surfactant helps prevent alveolar collapse.
F. The total pressure of a mixture of gases equals the product of the partial pressures of each component gas.
G. Gas diffusion across a surface is proportional to surface area and thickness.
H. The total pressure of a mixture of gas equals the mean of the partial pressures of each component gas.
I. Gas diffusion across a surface is inversely proportional to surface thickness and proportional to area.

Answer 29

D. The total pressure of a mixture of gases equals the sum of the partial pressures of each component gas.

Question 30

The Law of LaPlace:

A. Smaller alveoli have a greater tendency to collapse.
B. Gas diffusion across a surface is proportional to surface thickness and inversely proportional to its area.
C. Larger alveoli have a greater tendency to collapse.
D. The total pressure of a mixture of gases equals the sum of the partial pressures of each component gas.
E. Alveolar surfactant helps prevent alveolar collapse.
F. The total pressure of a mixture of gases equals the product of the partial pressures of each component gas.
G. Gas diffusion across a surface is proportional to surface area and thickness.
H. The total pressure of a mixture of gas equals the mean of the partial pressures of each component gas.
I. Gas diffusion across a surface is inversely proportional to surface thickness and proportional to area.

Answer 30

The Law of LaPlace

A. Smaller alveoli have a greater tendency to collapse.

Question 31

Is a palpable reference point that can be used in basic emergency care.

A. Right 4th ribs
B. Rib 2
C. Rib 6
D. Superior to the clavicle
E. Between right ribs 4 and 6
F. 2nd intercostal space
G. T11 vertebra
H. Xiphoid process
I. T3 vertebra
J. 5th intercostal space

Answer 31

H. Xiphoid process

Question 32

The site used in decompressing a tension pneumothorax.

A. Right 4th ribs
B. Rib 2
C. Rib 6
D. Superior to the clavicle
E. Between right ribs 4 and 6
F. 2nd intercostal space
G. T11 vertebra
H. Xiphoid process
I. T3 vertebra
J. 5th intercostal space

Answer 32

F. 2nd intercostal space.

Question 33

The site of the oblique fissure ANTERIORLY.

A. Right 4th ribs
B. Rib 2
C. Rib 6
D. Superior to the clavicle
E. Between right ribs 4 and 6
F. 2nd intercostal space
G. T11 vertebra
H. Xiphoid process
I. T3 vertebra
J. 5th intercostal space

Answer 33

C. Rib 6.

Question 34

An accessory muscle of respiration in the neck.

A. External intercostals
B. Intrinsic laryngeal muscles
C. Internal intercostals
D. External laryngeal muscles
E. Internal obliques
F. Rectus abdominis
G. External obliques
H. Diaphragm
I. Sternocleidomastoid

Answer 34

I. Sternocleidomastoid.

Question 35

A major inspiratory muscle in a sheet, containing crura.

A. External intercostals
B. Intrinsic laryngeal muscles
C. Internal intercostals
D. External laryngeal muscles
E. Internal obliques
F. Rectus abdominis
G. External obliques
H. Diaphragm
I. Sternocleidomastoid

Answer 35

H. Diaphragm.

Question 36

Thoracic muscles involved in active expiration.

A. External intercostals
B. Intrinsic laryngeal muscles
C. Internal intercostals
D. External laryngeal muscles
E. Internal obliques
F. Rectus abdominis
G. External obliques
H. Diaphragm
I. Sternocleidomastoid

Answer 36

C. Internal intercostals.

Question 37

Carries deoxygenated blood, drains into the superior vena cava and arches round the right lung root.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Azygous vein

Answer 37

J. Azygous vein.

Question 38

Arises from the anterior surface of the descending aorta.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Azygous vein

Answer 38

H. Bronchial arteries.

Question 39

Surrounded by vessels, and may appear black on dissection.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Azygous vein

Answer 39

E. Pulmonary lymph nodes.

Question 40

Contains hyaline cartilage, and is surrounded by the arch of the azygous vein.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Bronchial veins

Answer 40

F. Right main bronchus.

Question 41

Carry oxygenated blood, and are sited inferoposteriorly within the lung root.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Bronchial veins

Answer 41

C. Pulmonary vein.

Question 42

Carry deoxygenated blood, and are sited superomedially within the lung root.

A. Pulmonary artery
B. Parietal pleura
C. Pulmonary vein
D. Left main bronchus
E. Pulmonary lymph nodes
F. Right main bronchus
G. Visceral pleura
H. Bronchial arteries
I. Intercostal arteries
J. Bronchial veins

Answer 42

A. Pulmonary artery.

Question 43

The maximum volume of air that can be expired in a single breath following maximum inspiration.

a) Tidal volume
b) Vital capacity
c) Inspiratory capacity
d) Expiratory reserve volume
e) Residual volume
f) Inspiratory reserve volume
g) Functional residual capacity
h) Total lung capacity

Answer 43

B. Vital capacity is the maximum volume of air that can be expired in a single breath following maximum inspiration.

Question 44

The volume of air entering or leaving the lungs in a single breath.

a) Tidal volume
b) Vital capacity
c) Inspiratory capacity
d) Expiratory reserve volume
e) Residual volume
f) Inspiratory reserve volume
g) Functional residual capacity
h) Total lung capacity

Answer 44

A. Tidal volume is the volume of air entering or leaving the lungs in a single breath.

Question 45

Equals vital capacity plus residual volume.

a) Tidal volume
b) Vital capacity
c) Inspiratory capacity
d) Expiratory reserve volume
e) Residual volume
f) Inspiratory reserve volume
g) Functional residual capacity
h) Total lung capacity

Answer 45

H: Total lung capacity equals vital capacity plus residual volume.

Question 46

Chronic adaptation caused by hypoxia.

a) Hypoventilation with a severe metabolic alkalosis.
b) Hyperventilation with a severe metabolic acidosis.
c) Hypoventilation with a severe metabolic acidosis.
d) Hyperventilation with a severe metabolic alkalosis.
e) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic alkalosis.
f) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis.
g) Increased mitochondria, 2,3-BPG, capillaries and anaemia with a metabolic acidosis.
h) Fatigue, headache, bradycardia, dizziness and shortness of breath, slipping into unconsciousness.
i) Fatigue, pyrexia, tachycardia, increased temperature and shortness of breath, slipping into unconsciousness.
j) Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness.

Answer 46

F. Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis is a chronic adaptation caused by hypoxia.

Question 47

Acute mountain sickness.

a) Hypoventilation with a severe metabolic alkalosis.
b) Hyperventilation with a severe metabolic acidosis.
c) Hypoventilation with a severe metabolic acidosis.
d) Hyperventilation with a severe metabolic alkalosis.
e) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic alkalosis.
f) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis.
g) Increased mitochondria, 2,3-BPG, capillaries and anaemia with a metabolic acidosis.
h) Fatigue, headache, bradycardia, dizziness and shortness of breath, slipping into unconsciousness.
i) Fatigue, pyrexia, tachycardia, increased temperature and shortness of breath, slipping into unconsciousness.
j) Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness.

Answer 47

J: Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness is a result of acute mountain sickness.

Question 48

Diabetic ketoacidosis:

a) Hypoventilation with a severe metabolic alkalosis.
b) Hyperventilation with a severe metabolic acidosis.
c) Hypoventilation with a severe metabolic acidosis.
d) Hyperventilation with a severe metabolic alkalosis.
e) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic alkalosis.
f) Increased mitochondria, 2,3-BPG, capillaries and polycythaemia with a metabolic acidosis.
g) Increased mitochondria, 2,3-BPG, capillaries and anaemia with a metabolic acidosis.
h) Fatigue, headache, bradycardia, dizziness and shortness of breath, slipping into unconsciousness.
i) Fatigue, pyrexia, tachycardia, increased temperature and shortness of breath, slipping into unconsciousness.
j) Fatigue, headache, tachycardia, dizziness and shortness of breath, slipping into unconsciousness.

Answer 48

B: Hyperventilation with a severe metabolic acidosis is a result of diabetic ketoacidosis.

Question 49

Results in increased pulmonary compliance, produces hyper inflated lungs and will show an obstructive defect on spirometry:

a) Asthma
b) Emphysema
c) Pulmonary fibrosis
d) Obstructive lung diseases
e) Restrictive lung diseases
f) Pneumonia
g) Combined restrictive-obstructive lung disease
h) Normal lungs

Answer 49

B: Emphysema results in increased pulmonary compliance, produces hyper inflated lungs and will show an obstructive defect on spirometry.

Question 50

Causes shortness of breath on exertion, a restrictive defect on spirometry and reduced pulmonary compliance, but no sign of infection.

a) Asthma
b) Emphysema
c) Pulmonary fibrosis
d) Obstructive lung diseases
e) Restrictive lung diseases
f) Pneumonia
g) Combined restrictive-obstructive lung disease
h) Normal lungs

Answer 50

C: Pulmonary fibrosis causes shortness of breath on exertion, a restrictive defect on spirometry and reduced pulmonary compliance, but no sign of infection.

Question 51

Will show a low FVC, a low FEV1 and a low FEV1/FVC% on spirometry.

a) Asthma
b) Emphysema
c) Pulmonary fibrosis
d) Obstructive lung diseases
e) Restrictive lung diseases
f) Pneumonia
g) Combined restrictive-obstructive lung disease
h) Normal lungs

Answer 51

G. Combined restrictive-obstructive lung disease will show a low FVC, a low FEV1 and a low FEV1/FVC% on spirometry.

Question 52

An 18 year old man is admitted to hospital acutely short of breath. He cannot speak in full sentences and is audibly wheezing. He has been given a beta-2 adrenoceptor agonist and steroids, and his doctor wishes to give him a further inhaled drug.

a) Salbutamol as required
b) Inhaled beclometasone
c) Oral prednisolone
d) Nebulised salbutamol
e) Domicilary oxygen
f) IV aminophylline
g) Nebulised ipratropium
h) Oral carbocysteine
i) Oral theophylline
j) Subcutaneous omalizumab

Answer 52

G. nebulised ipratropium

Question 53

A 68 year old man with long-standing COPD has been prescribed several medications. However, he is struggling to cope at home, and when he is examined you see is SaO2 is 82%.

a) Salbutamol as required
b) Inhaled beclometasone
c) Oral prednisolone
d) Nebulised salbutamol
e) Domicilary oxygen
f) IV aminophylline
g) Nebulised ipratropium
h) Oral carbocysteine
i) Oral theophylline
j) Subcutaneous omalizumab

Answer 53

E. Domiciliary oxygen.

Question 54

A 22 year old woman has been using a reliever inhaler for some time, but is finding she is now wheezing and feels more breathless when she exercises.

a) Salbutamol as required
b) Inhaled beclometasone
c) Oral prednisolone
d) Nebulised salbutamol
e) Domicilary oxygen
f) IV aminophylline
g) Nebulised ipratropium
h) Oral carbocysteine
i) Oral theophylline
j) Subcutaneous omalizumab

Answer 54

B: inhaled beclometasone.

Question 55

A 59 year old man presents to his GP with a cough that he has been suffering from for at least six months. He tells you he brings up clear phlegm daily, but that it has occasionally been green and unpleasant when he gets a cold. He has come in today because he heard that long term coughs should be checked by a doctor. He smokes approximately 40 cigarettes a day, and has been smoking for over 30 years. He is much more breathless when walking around than he used to be.

a) Chronic bronchitis
b) Emphysema
c) Acute exacerbation of COPD
d) Acute asthma
e) Intrinsic asthma
f) Extrinsic asthma
g) Airway collapse
h) Respiratory bronchiolitis
i) Obstructive sleep apnoea

Answer 55

A. Chronic bronchitis.

Question 56

A 78 year old woman is admitted to hospital short of breath. She feels that even sitting talking to you is too much effort, and she is struggling to get up to the bathroom without help. She is generally unwell, with a temperature of 38.2, but no other investigations have been returned yet. She has a 50 pack-year smoking history. She has a cough, which she says is normal for her, but she is bringing up thick yellow sputum, which she does not normally. She takes regular inhaled medicines, but feels these are not helping her as they usually do.

a) Chronic bronchitis
b) Emphysema
c) Acute exacerbation of COPD
d) Acute asthma
e) Intrinsic asthma
f) Extrinsic asthma
g) Airway collapse
h) Respiratory bronchiolitis
i) Obstructive sleep apnoea

Answer 56

C: Acute exacerbation of COPD.

Question 57

A 35 year old woman visits her GP complaining of shortness of breath. She finds she feels her chest is tight and that she is struggling to breathe. This mostly affects her at home, and tends not to be as bad any other time. She is coughing at night, but this is non-productive. On examination she has a generalised wheeze, but no other abnormal findings. When you are discussing your thoughts, she mentions that her and her partner recently bought a kitten, and wonders if this is the cause of her problem.

a) Chronic bronchitis
b) Emphysema
c) Acute exacerbation of COPD
d) Acute asthma
e) Intrinsic asthma
f) Extrinsic asthma
g) Airway collapse
h) Respiratory bronchiolitis
i) Obstructive sleep apnoea

Answer 57

F: extrinsic asthma.

Question 58

Tiotropium:

a) A short acting drug that blocks acetylcholine receptors non-selectively. Can be delivered intranasally to treat rhinorrhoea.
b) An anticholinergic drug, selective for M3 receptors with a long half life.
c) A phosphodiesterase-4 inhibitor, given orally for severe COPD.
d) A long-acting beta-2 adrenoceptor agonist. Used in combination with antimuscarinic drugs to increase FEV1 in moderate COPD.
e) An inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.
f) A competitive H1 receptor antagonist used to treat allergic rhinitis.
g) A drug that acts as a mast cell stabiliser, used in asthma and allergic rhinitis.
h) A cysteinyl leukotriene receptor antagonist used to treat asthma and allergic rhinitis.
i) A methylxanthine drug with bronchodilator and anti-inflammatory action. Has many side effects and drug interactions.
j) An oral steroid, used in severe or intractable rhinitis, acute asthma or an exacerbation of COPD.

Answer 58

B. Tiotropium is an anticholinergic drug, selective for M3 receptors with a long half life.

Question 59

Monteleukast

a) A short acting drug that blocks acetylcholine receptors non-selectively. Can be delivered intranasally to treat rhinorrhoea.
b) An anticholinergic drug, selective for M3 receptors with a long half life.
c) A phosphodiesterase-4 inhibitor, given orally for severe COPD.
d) A long-acting beta-2 adrenoceptor agonist. Used in combination with antimuscarinic drugs to increase FEV1 in moderate COPD.
e) An inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.
f) A competitive H1 receptor antagonist used to treat allergic rhinitis.
g) A drug that acts as a mast cell stabiliser, used in asthma and allergic rhinitis.
h) A cysteinyl leukotriene receptor antagonist used to treat asthma and allergic rhinitis.
i) A methylxanthine drug with bronchodilator and anti-inflammatory action. Has many side effects and drug interactions.
j) An oral steroid, used in severe or intractable rhinitis, acute asthma or an exacerbation of COPD.

Answer 59

H: Monteleukast is a cysteinyl leukotriene receptor antagonist used to treat asthma and allergic rhinitis.

Question 60

Beclometasone:

a) A short acting drug that blocks acetylcholine receptors non-selectively. Can be delivered intranasally to treat rhinorrhoea.
b) An anticholinergic drug, selective for M3 receptors with a long half life.
c) A phosphodiesterase-4 inhibitor, given orally for severe COPD.
d) A long-acting beta-2 adrenoceptor agonist. Used in combination with antimuscarinic drugs to increase FEV1 in moderate COPD.
e) An inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.
f) A competitive H1 receptor antagonist used to treat allergic rhinitis.
g) A drug that acts as a mast cell stabiliser, used in asthma and allergic rhinitis.
h) A cysteinyl leukotriene receptor antagonist used to treat asthma and allergic rhinitis.
i) A methylxanthine drug with bronchodilator and anti-inflammatory action. Has many side effects and drug interactions.
j) An oral steroid, used in severe or intractable rhinitis, acute asthma or an exacerbation of COPD.

Answer 60

E: Beclometasone is an inhaled corticosteroid. Used in combination with a beta-2 adrenoceptor agonist, particularly in frequent exacerbations of COPD.

Question 61

The stage of lung maturation that takes place between 16-28 weeks’ gestation. It sees the branching of terminal bronchioles into respiratory bronchioles and finally alveolar ducts.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 61

E- canalicular is the stage of lung maturation that takes place between 16-28 weeks’ gestation. It sees the branching of terminal bronchioles into respiratory bronchioles and finally alveolar ducts.

Question 62

The germ layer that forms the lining of the trachea and bronchial tree.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 62

D- Endoderm is the germ layer that forms the lining of the trachea and bronchial tree.

Question 63

The structure that develops on the anterior foregut and is the first respiratory structure to develop.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 63

H: Respiratory diverticulum

is the structure that develops on the anterior foregut and is the first respiratory structure to develop.

Question 64

Olfactory epithelium:

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 64

G. olfactory epithelium lines the roof of the nasal cavity.

Question 65

Cuboidal ciliated epithelium and non-ciliated Clara cells

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 65

I. The terminal bronchioles are lined by cuboidal ciliated epithelium and non-ciliated Clara cells.

Question 66

Pseudostratified ciliated columnar epithelium and goblet cells with hyaline cartilage rings and cartilage plates

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 66

B. Pseudostratified ciliated columnar epithelium and goblet cells with hyaline cartilage rings and cartilage plates lines the trachea.

Question 67

An 18 year old man is admitted with sudden onset shortness of breath and is complaining of right-sided chest pain. On examination he is tachycardic, tachypnoeic and hypertensive. His right side is hyperresonant when percussed. His PA chest X-ray shows a line parallel to the right chest wall.

a) Left upper lobe collapse
b) Right upper lobe collapse
c) Right lower lobe collapse
d) Left lower lobe collapse
e) Right middle lobe pneumonia
f) Lingular pneumonia
g) Left lower lobe pneumonia
h) Left upper lobe pneumonia
i) Right-sided tension pneumothorax
j) Left-sided tension pneumothorax

Answer 67

I. Right-sided tension pneumothorax.

Question 68

A 60 year old woman is admitted to hospital by her GP. She has been unwell for the past few days and has not responded to the GP’s initial treatment. On examination she is tachycardic, tachypnoeic, pyrexial and mildly hypertensive. On percussion her right middle zone is dull. Her PA chest X-ray shows loss of the right heart border.

a) Left upper lobe collapse
b) Right upper lobe collapse
c) Right lower lobe collapse
d) Left lower lobe collapse
e) Right middle lobe pneumonia
f) Lingular pneumonia
g) Left lower lobe pneumonia
h) Left upper lobe pneumonia
i) Right-sided tension pneumothorax
j) Left-sided tension pneumothorax

Answer 68

E: right middle lobe pneumonia.

Question 69

A 20 year old male patient complains of shortness of breath. On PA chest X-ray his right horizontal fissure is displaced. There is an opacity in his upper right zone.

a) Left upper lobe collapse
b) Right upper lobe collapse
c) Right lower lobe collapse
d) Left lower lobe collapse
e) Right middle lobe pneumonia
f) Lingular pneumonia
g) Left lower lobe pneumonia
h) Left upper lobe pneumonia
i) Right-sided tension pneumothorax
j) Left-sided tension pneumothorax

Answer 69

B- Right upper lobe collapse.

Question 70

An infection affecting the distal airspaces, usually accompanied by an inflammatory exudate causing consolidation.

a) Fungal infection
b) Empyema
c) Lung abscess
d) Arteriovenous malformation
e) Granuloma
f) Pneumonia
g) Bronchiectasis
h) Ghon focus
i) Miliary tuberculosis
j) Bronchial carcinoma

Answer 70

F. Pneumonia is an infection affecting the distal airspaces, usually accompanies by an inflammatory exudate causing consolidation.

Question 71

Fixed dilatation of the bronchi, usually as a result of scarring or distal to a chronic obstruction. Causes the accumulation of purulent secretions.

a) Fungal infection
b) Empyema
c) Lung abscess
d) Arteriovenous malformation
e) Granuloma
f) Pneumonia
g) Bronchiectasis
h) Ghon focus
i) Miliary tuberculosis
j) Bronchial carcinoma

Answer 71

G: bronchiectasis is the fixed dilatation of the bronchi, usually as a result of scarring or distal to a chronic obstruction. Causes the accumulation of purulent secretions.

Question 72

A collection of pus in the pleural space, which can be seen on a chest X-ray as a D-shaped abnormality.

a) Fungal infection
b) Empyema
c) Lung abscess
d) Arteriovenous malformation
e) Granuloma
f) Pneumonia
g) Bronchiectasis
h) Ghon focus
i) Miliary tuberculosis
j) Bronchial carcinoma

Answer 72

B: Empyema is a collection of pus in the pleural space, which can be seen on a chest X-ray as a D-shaped abnormality.

Question 73

Pseudostratified ciliated columnar epithelium and goblet cells. Incomplete cartilage rings. Basal lamina. Lamina propria of connective tissue and elastic fibres. Submucosa of loose connective tissue and subserous glands.

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 73

B: Trachea is lined by Pseudostratified ciliated columnar epithelium and goblet cells. Incomplete cartilage rings. Basal lamina. Lamina propria of connective tissue and elastic fibres. Submucosa of loose connective tissue and subserous glands.

Question 74

Pseudostratified ciliated columnar epithelium and goblet cells covering cartilage and intrinsic muscles.

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 74

C: Larynx, excluding the vocal folds, are lined by pseudostratified ciliated columnar epithelium and goblet cells covering cartilage and intrinsic muscles.

Question 75

Stratified squamous epithelium surrounded by respiratory epithelium.

a) Vocal folds
b) Trachea
c) Larynx, excluding the vocal folds
d) Bronchioles
e) Main bronchi
f) Oropharynx
g) Roof of the nasal cavity
h) Nasal cavity
i) Terminal bronchioles
j) Alveoli

Answer 75

A. Vocal folds are lined by stratified squamous epithelium surrounded by respiratory epithelium.

Question 76

The stage of lung maturation that takes place between 6-16 weeks’ gestation. It involves the development of multiple branches of the bronchial tree down to the level of the terminal bronchioles.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 76

A: Pseudoglandular phase = The stage of lung maturation that takes place between 6-16 weeks’ gestation. It involves the development of multiple branches of the bronchial tree down to the level of the terminal bronchioles.

Question 77

The stage of lung maturation that takes place between 26 days’ and 6 weeks’ gestation. It involves the first stages of lung development, and sees the formation of the lungs’ lobes and segments.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 77

F: Embryonic phase= The stage of lung maturation that takes place between 26 days’ and 6 weeks’ gestation. It involves the first stages of lung development, and sees the formation of the lungs’ lobes and segments.

Question 78

The germ layer that forms the cartilage and smooth muscle in the thorax.

a) Pseudoglandular
b) Saccular
c) Alveolar
d) Endoderm
e) Canalicular
f) Embryonic
g) Ectoderm
h) Respiratory diverticulum
i) Visceral Mesoderm
j) Bronchial buds

Answer 78

I: Visceral mesoderm is the germ layer that forms the cartilage and smooth muscle in the thorax.

Question 79

A 28 year old female complains of shortness of breath and a dry cough as well as feeling tired. On further questioning she says she has had night sweats and weight loss and painful joints. On examination, she has red patches of skin on her legs and her left eye is inflamed. A chest X-ray shows bilateral hilar lympadenopathy. She has a raised serum ACE level.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 79

C: Sarcoidosis.

Question 80

A 50 year old man visits his GP due to increasing breathlessness which is interfering with his work as a welder. He has a dry cough, but blames this on smoking (he smokes 15 cigarettes a day and has done for many years). On examination, his fingers are clubbed, and late inspiratory crackles can be auscultated at both lung bases. A chest X-ray seems normal, but a later HRCT shows a ground-glass appearance, with pleural thickening.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 80

J: Asbestosis.

Question 81

A 35 year old woman is admitted to hospital with chest pain and shortness of breath. On examination, she has a red rash across her face, and has oral ulcers. She takes no medication. Her full blood count shows she is thrombocytopenic, and an auto-antibody screen shows raised ds-DNA and ANA antibodies.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 81

I: Systemic lupus

Question 82

A 30 year old woman is seen in the respiratory outpatient clinic. She is short of breath on exertion. General examination reveals a rash on her lower legs. Her investigations show a raised serum ACE and she has bi-hilar lymphadenopathy on chest x ray.

a) scoliosis
b) pulmonary oedema
c) pneumonia
d) rheumatoid
e) sarcoidosis
f) pneumoconiosis
g) Churg-Strauss syndrome
h) ascites
i) acute respiratory distress syndrome
j) obesity hypoventilation syndrome

Answer 82

E: Sarcoidosis.

Question 83

A 55 year old male known to the gastroenterologists is referred to the chest physicians. He is short of breath. This has come on over the past few weeks, but is new restricting even minimal exertion. On general examination, he is jaundiced and his abdomen is distended. He has spider naevi on his trunk. His LFTs are deranged and he has a macrocytic anaemia.

a) scoliosis
b) pulmonary oedema
c) pneumonia
d) rheumatoid
e) sarcoidosis
f) pneumoconiosis
g) Churg-Strauss syndrome
h) ascites
i) acute respiratory distress syndrome
j) obesity hypoventilation syndrome

Answer 83

H: Ascites.

Question 84

A 29 year old woman is referred to the respiratory outpatient clinic by her GP for worsening shortness of breath. She has become gradually more breathless over the past year, and her systemic enquiry reveals other problems with her eyes, joints and skin. An autoantibody screen reveals anti-CCP antibodies at 1:640.

a) scoliosis
b) pulmonary oedema
c) pneumonia
d) rheumatoid
e) sarcoidosis
f) pneumoconiosis
g) Churg-Strauss syndrome
h) ascites
i) acute respiratory distress syndrome
j) obesity hypoventilation syndrome

Answer 84

D. Rheumatoid.

Question 85

A 28 year old female complains of shortness of breath and a dry cough as well as feeling tired. On further questioning she says she has had night sweats and weight loss and painful joints. On examination, she has red patches of skin on her legs and her left eye is inflamed. A chest X-ray shows bilateral hilar lympadenopathy. She has a raised serum ACE level.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 85

C: Sarcoidosis.

Question 86

A 60 year old man is admitted to hospital acutely short of breath. He cannot lie down, as this makes his breathing much worse. He says he has been coughing up frothy pink sputum. On examination, he has an audible wheeze. A chest X-ray shows cardiomegaly and pleural effusions.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 86

B: Pulmonary oedema.

Question 87

A 55 year old woman complains of being increasingly short of breath, and that she is struggling to cope at work as a primary school teacher and around the house, especially with stairs. On examination, she has clubbed fingers, and on auscultation has bibasal crepitations. She also mentions that she has been finding the joints in her hands increasingly stiff when she gets up in the morning, and she has lost weight. Her CRP and ESR are both raised.

a) Pulmonary embolism
b) Pulmonary oedema
c) Sarcoidosis
d) Extrinsic allergic alveolitis
e) Acute respiratory distress syndrome
f) Pneumonia
g) Rheumatoid
h) Drug-induced pulmonary fibrosis
i) Systemic lupus erythematosus
j) Asbestosis

Answer 87

G: Rheumatoid.

Question 88

A 65 year old man complains of a constant, dull ache in his chest. He has pain on both his right and his left sides that disturbs his sleep. He says he has gradually been finding it harder to catch his breath when he exercises, and has lost about a stone in weight in the last six weeks. He is now retired but used to work at a shipyard.

a) Gastro-oesophageal reflux
b) Musculoskeletal chest pain
c) Pulmonary embolism
d) Pleuritis
e) Angina
f) Myocardial infarction
g) Mesothelioma
h) Pneumothorax
i) Pericarditis
j) Myeloma

Answer 88

D: Pleuritis

Question 89

A 50 year old man visits his GP complaining of a burning chest pain. He has noticed it come on late in the evening, particularly when he lies down to go to sleep and it is worse when he has had a large meal. He complains of an irritating cough, but the pain is his main worry. He is overweight and works as a teacher.

a) Gastro-oesophageal reflux
b) Musculoskeletal chest pain
c) Pulmonary embolism
d) Pleuritis
e) Angina
f) Myocardial infarction
g) Mesothelioma
h) Pneumothorax
i) Pericarditis
j) Myeloma

Answer 89

A: GORD

Question 90

A 45 year old man visits his GP about a pain in the right side of his chest. He noticed the pain this morning, and has never had anything like this before. It hurts when he breathes deeply or stretches. He says he is usually fit and well, and takes no medication, but admits he is not as active as he used to be. On further questioning, he says he was helping a friend move house at the weekend, but otherwise has done nothing unusual.

a) Gastro-oesophageal reflux
b) Musculoskeletal chest pain
c) Pulmonary embolism
d) Pleuritis
e) Angina
f) Myocardial infarction
g) Mesothelioma
h) Pneumothorax
i) Pericarditis
j) Myeloma

Answer 90

B: Musculoskeletal chest pain

Question 91

A 60 year old man who works in the coal industry has had rheumatoid arthritis for a number of years. He is referred to the chest clinic due to worsening breathlessness. His chest x rays reveal multiple small nodules throughout the lung fields.

a) benign pleural plaques
b) baritosis
c) complicated pneumoconiosis
d) reactive airway dysfunction syndrome
e) Caplan’s syndrome
f) simple pneumoconiosis
g) mesothelioma
h) silicosis
i) sarcoidosis
j) asbestosis

Answer 91

E: Caplan’s Syndrome

Question 92

A 70 year old man is referred by his GP to the chest clinic due to worsening breathlessness. He has been experiencing night sweats and has lost weight recently, but he has put this down to the weather and feeling unwell. He is retired and used to work in the shipyards. His imaging reveals extensive pleural disease with peritoneal deposits.

a) benign pleural plaques
b) baritosis
c) complicated pneumoconiosis
d) reactive airway dysfunction syndrome
e) Caplan’s syndrome
f) simple pneumoconiosis
g) mesothelioma
h) silicosis
i) sarcoidosis
j) asbestosis

Answer 92

G: Mesothelioma

Question 93

A 29 year old woman is admitted to the emergency department acutely dyspnoeic and wheezing. She is managed appropriately, and a senior respiratory review is sought once she is more stable. When taking her history, she says she is a lifeguard and has had several episodes of wheezing and coughing whilst at work, but this is the worst episode to date.

a) benign pleural plaques
b) baritosis
c) complicated pneumoconiosis
d) reactive airway dysfunction syndrome
e) Caplan’s syndrome
f) simple pneumoconiosis
g) mesothelioma
h) silicosis
i) sarcoidosis
j) asbestosis

Answer 93

D. Reactive airway dysfunction syndrome

Question 94

A 35 year old woman complains to her GP of being unable to sleep. She coughs at night, which keeps her awake. She sometimes feels short of breath. Both the cough and the dyspnoea are worse when she has visited her parents who have a cat. She smokes 15 cigarettes per day. Her past medical history includes eczema.

a) Chronic asthma
b) pulmonary embolism
c) left-sided tension pneumothorax
d) right-sided tension pneumothorax
e) acute asthma
f) exacerbation of COPD
g) interstitial lung disease
h) pneumonia
i) acute respiratory distress syndrome
j) obstructive sleep apnoea

Answer 94

A: chronic asthma

Question 95

A 63 year old man has a long history of cigarette smoking. He says he always feels short of breath. He coughs, producing white sputum, most days. On auscultation, he has a widespread wheeze. He was admitted to hospital with pyrexia, increasing dyspnoea, tachycardia, tachypnoea and is now coughing up green sputum.

a) Chronic asthma
b) pulmonary embolism
c) left-sided tension pneumothorax
d) right-sided tension pneumothorax
e) acute asthma
f) exacerbation of COPD
g) interstitial lung disease
h) pneumonia
i) acute respiratory distress syndrome
j) obstructive sleep apnoea

Answer 95

F: Exacerbation of COPD

Question 96

A 59 year old woman complains of being short of breath when she is active. She is worried as she now struggles to climb the stairs at home. She has a non-productive cough. Her past medical history includes rheumatoid arthritis, for which she takes methotrexate and folic acid.

a) Chronic asthma
b) pulmonary embolism
c) left-sided tension pneumothorax
d) right-sided tension pneumothorax
e) acute asthma
f) exacerbation of COPD
g) interstitial lung disease
h) pneumonia
i) acute respiratory distress syndrome
j) obstructive sleep apnoea

Answer 96

G: Interstitial lung disease.

Question 97

A 29 year old woman is admitted to hospital due to a sudden onset of chest pain and coughing up blood. She is currently 34 weeks pregnant. Her chest pain is right-sided, and worse when she tries to breathe deeply. She says she feels a bit breathless, but her PaO2 is normal. On examination she has a swollen and red left leg and on auscultation she has a pleural rub on the right.

a) Trauma
b) Pneumonia
c) Tuberculosis
d) Bronchial carcinoma
e) Pulmonary embolism
f) Granumolatosis with polyangiitis
g) Goodpasture’s syndrome
h) Fungal infection
i) Arteriovenous malformation
j) Inhaled foreign body

Answer 97

E: Pulmonary embolism.

Question 98

A 27 year old smoker has experienced some haemoptysis. He has been unwell with what he felt was ‘just a cold’ recently, but is now coughing again, feels short of breath and tired as well as coughing up blood. The only finding on examination is inspiratory crackes throughout his lungs. Investigations show he has impaired renal function and he has a raised anti-GBM antibody level.

a) Trauma
b) Pneumonia
c) Tuberculosis
d) Bronchial carcinoma
e) Pulmonary embolism
f) Granumolatosis with polyangiitis
g) Goodpasture’s syndrome
h) Fungal infection
i) Arteriovenous malformation
j) Inhaled foreign body

Answer 98

G: Goodpasture’s Syndrome

Question 99

A 35 year old woman is brought to hospital having coughed up blood. On examination, she has reduced chest expansion on her left side, reduced air entry and some bruising and swelling over her 4th, 5th and 6th left ribs. She has left-sided chest pain which is worse on movement and breathing, and her chest X-ray shows she has fractured her ribs.

a) Trauma
b) Pneumonia
c) Tuberculosis
d) Bronchial carcinoma
e) Pulmonary embolism
f) Granumolatosis with polyangiitis
g) Goodpasture’s syndrome
h) Fungal infection
i) Arteriovenous malformation
j) Inhaled foreign body

Answer 99

A: Trauma

Question 100

Seen in heart failure and low protein states causing fluid shift, and resulting in a low protein fluid in the thoracic cavity.

a) Neonatal respiratory distress syndrome
b) Pneumothorax
c) Pulmonary hypertension
d) Fat embolus
e) Empyema
f) Acute respiratory distress syndrome
g) Pulmonary thromboembolus
h) Pulmonary infarction
i) Pleural transudate
j) Pleural exudate

Answer 100

I: Pleural transudate

Question 101

Seen in infectious, inflammatory and malignant processes, where a a high protein content fluid is within the thoracic cavity.

a) Neonatal respiratory distress syndrome
b) Pneumothorax
c) Pulmonary hypertension
d) Fat embolus
e) Empyema
f) Acute respiratory distress syndrome
g) Pulmonary thromboembolus
h) Pulmonary infarction
i) Pleural transudate
j) Pleural exudate

Answer 101

J: Pleural exudate

Question 102

Occurs in prematurely delivered infants and is due to the high surface tension within alveoli. Reduced incidence following maternal IM dexamethasone, which matures the lungs, increasing surfactant production.

a) Neonatal respiratory distress syndrome
b) Pneumothorax
c) Pulmonary hypertension
d) Fat embolus
e) Empyema
f) Acute respiratory distress syndrome
g) Pulmonary thromboembolus
h) Pulmonary infarction
i) Pleural transudate
j) Pleural exudate

Answer 102

A: Neonatal respiratory distress syndrome

Question 103

A 55 year old woman has a persistent cough. She says she is coughing up whitish sputum, which used to only happen occasionally but this has been happening almost daily for the past few months. She is a heavy smoker, and struggles to breathe when she is climbing stairs or doing any strenuous activity.

a) COPD
b) Pertussis
c) Acute epiglottitis
d) Asthma
e) Bronchial carcinoma
f) Drug-induced cough
g) Cystic fibrosis
h) Sarcoidosis
i) Pneumonia
j) Inhaled foreign body

Answer 103

a: COPD

Question 104

A 6 year old boy is brought into hospital by his father. His father describes his son as having a barking cough and saying he had a sore throat earlier in the day, and his breathing is now worrying him. On examination, the boy is febrile, drooling and has obvious cervical lymphadenopathy. He has clearly audible stridor and is tachypnoeic and tachycardic.

a) COPD
b) Pertussis
c) Acute epiglottitis
d) Asthma
e) Bronchial carcinoma
f) Drug-induced cough
g) Cystic fibrosis
h) Sarcoidosis
i) Pneumonia
j) Inhaled foreign body

Answer 104

C: Acute epiglottis

Question 105

A 22 year old man is referred to the respiratory outpatient clinic due to recurring chest infections. He says he coughs up green sputum frequently, and has several respiratory infections every year. On examination his fingers are clubbed and on auscultation he has widespread crackles. A sputum culture grows Pseudomonas aeruginosa.

a) COPD
b) Pertussis
c) Acute epiglottitis
d) Asthma
e) Bronchial carcinoma
f) Drug-induced cough
g) Cystic fibrosis
h) Sarcoidosis
i) Pneumonia
j) Inhaled foreign body

Answer 105

G: Cystic fibrosis

Question 106

A 70 year old man is short of breath. He has known COPD and has been hospitalised for an exacerbation. He is coughing up sputum that is more purulent than normal. On examination, he has sacral and ankle pitting oedema and has crackles audible on auscultation. His CXR shows cardiomegaly and bilateral pleural effusions with no consolidation.

a) Emergency needle decompression in the 2nd intercostal space
b) Urgent HRCT chest
c) Insert a chest drain
d) Prescribe antibiotics
e) Prescribe furosemide
f) Symptomatic management (e.g. analgesia)
g) Send samples for microscopy, cultures and sensitivity
h) High flow oxygen
i) Pleurodesis
j) No intervention required

Answer 106

E: Prescribe furosemide

Question 107

A 25 year old man is recovering in hospital following a car accident. He has several broken ribs with some overlying surgical emphysema. He has a small apical pneumothorax but is asymptomatic. His pain is well-controlled and clinically he is improving.

a) Emergency needle decompression in the 2nd intercostal space
b) Urgent HRCT chest
c) Insert a chest drain
d) Prescribe antibiotics
e) Prescribe furosemide
f) Symptomatic management (e.g. analgesia)
g) Send samples for microscopy, cultures and sensitivity
h) High flow oxygen
i) Pleurodesis
j) No intervention required

Answer 107

J: No intervention required

Question 108

A 19 year old female is admitted to the emergency department acutely short of breath, which is worsening. She is hyperresonant to percuss on the right, with absent breath sounds. Her trachea is deviated to the left, CXR shows the left hemi-diaphragm superior to the right hemi-diaphragm and air in the pleural cavity.

a) Emergency needle decompression in the 2nd intercostal space
b) Urgent HRCT chest
c) Insert a chest drain
d) Prescribe antibiotics
e) Prescribe furosemide
f) Symptomatic management (e.g. analgesia)
g) Send samples for microscopy, cultures and sensitivity
h) High flow oxygen
i) Pleurodesis
j) No intervention required

Answer 108

A: Emergency needle compression in the 2nd intercostal space.

Question 109

A 32 year old man has recently been coughing up small amounts of blood. He has experienced some weight loss and has night sweats. An induced sputum is negative for acid fast bacilli, but results are still pending from a subsequent broncho-alveolar lavage. He recently returned from a year living and working abroad, is a non-smoker and is usually fit and well.

a) Pneumonia
b) Mallory-Weiss tear
c) Trauma
d) Bronchial carcinoma
e) Pulmonary infarction
f) Acute pulmonary oedema
g) Pulmonary embolism
h) Goodpasture’s syndrome
i) Laryngeal cancer
j) Tuberculosis

Answer 109

J: Tuberculosis

Question 110

A 58 year old man known to have advanced COPD and recently diagnosed bladder cancer has been coughing up blood in his sputum. He is apyrexial, and his sputum is clear but blood-streaked. He has pleuritic chest pain and a hot, swollen and painful left leg.

a) Pneumonia
b) Mallory-Weiss tear
c) Trauma
d) Bronchial carcinoma
e) Pulmonary infarction
f) Acute pulmonary oedema
g) Pulmonary embolism
h) Goodpasture’s syndrome
i) Laryngeal cancer
j) Tuberculosis

Answer 110

G: Pulmonary embolism

Question 111

A 90 year old woman has been admitted to hospital acutely short of breath. She has a past medical history orthopnoea, paroxysmal nocturnal dyspnoea and heart failure. She is coughing up pink frothy sputum and her ankles are more swollen than normal. Her CXR shows multiple abnormal findings.

a) Pneumonia
b) Mallory-Weiss tear
c) Trauma
d) Bronchial carcinoma
e) Pulmonary infarction
f) Acute pulmonary oedema
g) Pulmonary embolism
h) Goodpasture’s syndrome
i) Laryngeal cancer
j) Tuberculosis

Answer 111

F: Acute pulmonary oedema

Question 112

A 26 year old woman is admitted to hospital acutely short of breath. She has a positive D-dimer and CTPA shows a large pulmonary embolus. After starting treatment, she mentions a family history of blood clots and thyroid disease, and says she has suffered multiple miscarriages. She has alopecia and her younger sister has type 1 diabetes.

a) ECG
b) HRCT chest/abdo/pelvis
c) arterial blood gas
d) Autoantibody screen
e) pulse oximetry
f) D-dimer
g) pregnancy test
h) CTPA (computed tomography pulmonary angiography)
i) Chest x ray
j) V/Q scan

Answer 112

E: Pulse oximetry

Question 113

A 22 year old woman is undergoing investigations for breathlessness. She is found to have multiple small pulmonary emboli. She has no symptoms or signs of underlying malignancy and is not taking the oral contraceptive pill. She does not have a hot, red, swollen lower limb. Her only other complaint is of nausea and tiredness.

a) ECG
b) HRCT chest/abdo/pelvis
c) arterial blood gas
d) Autoantibody screen
e) pulse oximetry
f) D-dimer
g) pregnancy test
h) CTPA (computed tomography pulmonary angiography)
i) Chest x ray
j) V/Q scan

Answer 113

G: pregnancy test

Question 114

A 72 year old woman is admitted to hospital for a suspected chest infection - she is mildly febrile and dyspnoeic. Routine admission investigations reveal pulmonary emboli. She has a previous history including COPD and breast cancer.

a) ECG
b) HRCT chest/abdo/pelvis
c) arterial blood gas
d) Autoantibody screen
e) pulse oximetry
f) D-dimer
g) pregnancy test
h) CTPA (computed tomography pulmonary angiography)
i) Chest x ray
j) V/Q scan

Answer 114

B: HRCT chest/abdo/pelvis