RESP

Question 1

A 34-year-old man is seen in GP surgery for a 2-week history of productive cough, night sweats and malaise. He recently developed a fever 3 days ago. His temperature is 38.3˚C, blood pressure is 120/76mmHg, heart rate is 92 beats per minute, respiratory rate is 18 breaths per minute and oxygen saturation is 98% on room air. He grew up in Pakistan and works as a nurse.

Which is the next best step in management?

(A) Recommend antibiotic therapy
(B) Arrange skin Mantoux testing
(C) Admit to hospital
(D) Order chest x-ray
(E) Order TB quantiferon ELISA

Answer 1

(D) Order chest x-ray

Question 2

A 66-year-old woman with active breast cancer is seen in A&E for acute-onset dyspnoea and pleuritic chest pain for the past hour. She also reports coughing up some blood since this began. Her temperature is 37.6 ˚C, blood pressure 130/84 mmHg, heart rate 104 beats per minute, respiratory rate 22 breaths per minute and oxygen saturation is 94% on room air.

Which investigation is indicated?
(A) CT pulmonary angiogram (CTPA)
(B) Chest x-ray
(C) ECG
(D) Serum D-dimer
(E) Serum troponin

Answer 2

(A) CT pulmonary angiogram (CTPA)

Question 3

An 18-month-old is brought into the GP surgery by her father. The patient has had an unproductive cough and rhinorrhoea for the past one week. Over the past two days the patient has been having coughing fits where she appears to not be breathing and sometimes vomits after coughing. The patient’s observations are normal, and her lungs are clear on auscultation.

Which investigation is indicated?
(A) Chest x-ray
(B) Nasopharyngeal swab for PCR testing
(C) Serology testing
(D) Lateral neck x-ray
(E) No investigation is needed

Answer 3

(B) Nasopharyngeal swab for PCR testing

Question 4

A 45-year-old woman has been seen in GP surgery with a 2 month history of intermittent shortness of breath and a non-productive cough. A spirometry was performed with the following results:

FVC 76%
FEV1 70%
FEV1/FVC 0.60
Post-bronchodilator FEV1/FVC 0.73

Which is the most likely diagnosis?
(A) COPD
(B) Asthma
(C) Chronic bronchitis
(D) Idiopathic pulmonary fibrosis
(E) Pneumonia

Answer 4

(A) COPD