RACP-Respiratory

Question 1

A 30 year old man is fund unconscious at home and is brought into hospital by ambulance. He regains consciousness in ED. After a detailed history and examination it was determined that the likely cause of the patient’s loss of consciousness was secondary to a faulty gas heater. The patients initial COHb was 25% and he was treated with supplemental oxygen. The patients following blood gas showered a COHb < 10%.
The next day the patient was alert and examination was unremarkable. Which of the following organ systems is the most likely to be affected long term following this event?

A) Cardiac
B) Hepatic
C) Neurological
D) Reproductive
E) Respiratory

Answer 1

C-Neurological

Question 2

Which of the following is a cause of a falsely elevated peripheral oxygen saturation?

A) Carbon monoxide poisoning
B) Methylene blue injection
C) Peripheral cyanosis
D) Polycythaemia
E) Hyperbilirubinaemia

Answer 2

A) Carbon monoxide poisoning

Question 3

Oxygenation can be improved in mechanical ventilation by increasing function residual capacity. Which of the following changes in ventilation setting can increased FRC

A) FIO2
B) RR
C) PEEP
D) Expiratory time
E) Peak inspiratory flow rate

Answer 3

C) PEEP

Question 4

Which of the following disease causes predominance of upper lobe pulmonary fibrosis?

A. Rheumatoid arthritis
B. Diffuse scleroderma
C. Mixed connective tissue disease
D. Ankylosing spondylitis

Answer 4

D. Ankylosing spondylitis

Upper lobe fibrosis can be associated with:
- Cystic fibrosis
- Pulmonary sarcoidosis
- Langerhans cell histiocytosis
- Pulmonary TB
- Pneumoconiosis, e.g. silicosis
- Allergic bronchopulmonary aspergillosis
- Histoplasmosis
- Progressive massive fibrosis
- Drug induced lung disease
- Ankylosing spondylitis
- Pleuroparenchymal fibroelastosis

Question 5

Non-invasive ventilation is employed in patients with acute cardiogenic pulmonary oedema. By what mechanism does NIV lead to cardiovascular improvement?

A. Increased cardiac output
B. Decreased pulmonary vascular resistance
C. Increased after load
D. Decreased preload

Answer 5

D. Decreased preload

Question 6

36. Pirfenodine, an anti-fibrotic agent, has been shown to reduce rate of decline in which condition?
    A) Sarcoidosis
    B) Silicosis
    C) Idiopathic pulmonary fibrosis

Answer 6

C) Idiopathic pulmonary fibrosis

Question 7

2021

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

Answer 7

A. Anticoagulation

Question 8

Q40. Pre-oxygenation is used in procedural sedation to increase safe apnoea time. Safe apnoea time is reduced in
obese patients due mostly to a decrease in which of the following lung parameters?
A. DLCO
B. FEV1
C. FVC
D. FRC

Answer 8

D. FRC

Question 9

Q44. Which of the following interventions have been proven to slow decline in FEV1 in a patient with advanced
COPD (FEV1/FVC <30%)?
A. LAMA
B. Pulmonary rehab
C. Long term domiciliary/home oxygen
D. Smoking cessation

Answer 9

D. Smoking cessation

Question 10

Describe the monitoring of a solitary pulmonary nodule

Answer 10

<6mm - no follow up, unless high risk

6-8mm: CT at 6-12 months

> 8mm: CT at 3 months, PET/CT or sampling

Question 11

Describe the different abnormalities in spirometry

Answer 11