respiratory

Question 1

what cell type releases inflammatory mediators in the allergic response?

a) neutrophils
b) mast cells
c) antigen presenting cells
d) B cells
e) T cells

Answer 1

mast cells

Question 2

which antibody Is involved in the allergic response?

a) IgG
b) IgA
c) IgM
d) IgE
e) IgD

Answer 2

IgE

Question 3

which inflammatory factor released by mast cells is a major therapeutic target in allergies?

a) histamine
b) cox2
c) IL-6
d) TNF
e) IL-1

Answer 3

histamine

Question 4

which adrenergic receptor do SABA target?

a) alpha 1
b) alpha 2
c) beta 1
d) beta 2
e) beta 3

Answer 4

Beta 2

Question 5

what is the purpose of budesonide and formoterol when used in a MART regime?

Answer 5

Budesonide is an inhaled corticosteroid. It is a preventer that provides long term control.

Formoterol is a LABA. It is a reliever, it relieves symptoms for longer durations than a SABA and provides bronchodilation. It is given multiple times a day.

Question 6

a 58 yr female admitted to hospital with acute severe asthma. which of the following meds would NOT be considered as part of acute severe asthma management?

a) hydrocortisone (IV)
b) ipatropium (ICS)
c) prednisolone (OC)
d) salbutamol (SABA)
e) salmetarol (LABA)

Answer 6

salmeterol (LABA)

Question 7

33 yr pt admitted to hospital with asthma attack. peak flow is 280L/min (best 600L/min) and on admission, HR was 98bpm, RR was 22bpm and oxygen saturation 96%. what is the severity? what would be initial tx for pt?

Answer 7

acute severe asthma; peak flow is 33-50% of best (46%)

tx:
1. SABA; salbutamol 2.5-5mg via nebulizer (hospital)
2. prednisolone 30mg OD for 5 days

if pef 33-50% of best, HR > 110bpm, RR > 25bpm, can’t complete sentences in one breath (only one needs to be present)

Question 8

destruction of the alveoli walls is mostly associated with which lung condition?

a) asthma
b) cystic fibrosis
c) emphysema
d) chronic bronchitis
e) acute bronchitis

Answer 8

emphysema

Question 9

bronchial fibrosis and mucus production is mostly associated with which lung condition?

a) asthma
b) cystic fibrosis
c) emphysema
d) chronic bronchitis
e) acute bronchitis

Answer 9

chronic bronchitis

Question 10

72 yr pt fully adherent to their meds but experiencing inc breathlessness and sputum production over last 6 months. no evidence of asthmatic features and blood eosinophils are insignificantly raised.

currently they take 100mcg/puff 2 puffs PRN and inc ellipse (umeclidinium bromide) 1 puff OD

what would be a step up therapy?

a) fostair NEXThaler (formoterol/beclomethasone)
b) relvar eleita (fluticasone/vilanterol)
c) seebri breezehaler (glycopyrronium bromide)
d) spoilto Respimat (tiotropium/olodaterol)
e) trilogy ellipta (fluticasone/vilanterol/umeclidinium bromide)

Answer 10

spiolto Respimat (tiotropium/olodaterol)

Question 11

48 yr pt w COPD inc breathlessness + sputum production. Suffering from worsening symptoms for 3 days. sputum is purulent + bright green. Basic observations show temp 38.5 degrees. you diagnose pt with infective exacerbation of COPD and had rash after taking amoxicillin.

what is the 1st line antibiotic?

a) amoxicillin
b) clarithromycin
c) doxycycline
d) ciprofloxacin
e) nitrofurantoin

Answer 11

doxycycline

Question 12

which of these observations are abnormal?

a) bp 148/82mmHg
b) pulse rate: 98 bpm
c) oxygen saturations: 96%
d) RR: 19bpm
e) temp: 37.3 degrees

Answer 12

bp 148/82mmHg

120/80mmHg

Question 13

which of the following would NOT be a typical feature of otitis media?

a) bulging tympanic membrane when viewed using an otoscope
b) discharge from the ear canal
c) ear tugging
d) otalgia
e) temp of 37.7

Answer 13

discharge from the ear canal

bec otitis externa

Question 14

27 yrs with ear pain for 24 hours. You diagnose with acute otitis external.

a) describe the general observations that would have been noted and the findings seen during the ear examination to confirm otitis externa.

b) what tx would you recommend?

Answer 14

a) fluid discharge, swelling + redness of ear canal, eczematous style rash on outside of ear, hearing loss

b) acetic acid spray (ear calm), pain relief, referral if bacterial infection (foul smelling discharge)

Question 15

48 yrs breathlessness + productive cough over 2 days. Pain in chest when breathing in/out, not delerious. Temp 38.2, bp 108/92mmHg, RR of 21bpm, HR 98bpm. Suspecting CAP and refer to GP.

what score of CRB-65 tool?

a) 0
b) 1
c) 2
d) 3
e) 4

Answer 15

0

Question 16

assess 33 yr female for CAP. You run a CRP. what will measuring a patient’s CRP tell us?

a) if they have inflammation
b) if they have reduced renal function
c) if they have a bacterial infection
d) if they have a viral infection
e) if they have raised white blood cells

Answer 16

if they have inflammation

Question 17

34 yr pt takes theophylline for severe asthma. They have recently been prescribed cimetidine for GORD and 3 days later admitted to hospital with tachycardia and palpitations. what is the most likely electrolyte imbalance associated with the pt’s presenting symptoms?

a) hyperkalaemia
b) hypokalaemia
c) hypernatraemia
d) hyponatraemia
e) hypocalcaemia

Answer 17

hypokalaemia

Question 18

64 yr diagnosed with CAP. Which is incorrect regarding CURB-65?

a) used to assess severity of pneumonia
b) one point is awarded for a RR above 30 bpm
c) one point is awarded for urea levels
d) one point is awarded for being over the age of 65 yrs
e) one point is awarded for a bp of 99/68mmHg

Answer 18

one point awarded for a bp of 99/68mmHg

Question 19

45 yr female pt suspected chest infection. You decide to run a full blood count to assess for underlying infection.

How will carrying out ‘full blood count’ help us determine if a pt has an infection?

a) it will tell us if a pt hb levels are low
b) it will tell us if a pt is anaemic
c) it will tell us if white blood cells are raised

Answer 19

it will tell us if white blood cells are raised

Question 20

67 yr pt increasing breathlessness and sputum production. Diagnosed with COPD and suspected to have infective exacerbation. Pt is prescribed with empirical tx.

What does ‘empirical’ tx mean?

a) we do not know which organism is causing the infection but start to treat based on the most likely organism causing the infection
b) we know which organism is causing the infection and can choose an appropriate antibiotic
c) we need to wait until we know what the organism is until we can treat the patient.

Answer 20

we do not know which organism is causing the infection but start to treat based on the most likely organism causing the infection.

Question 21

which of the following in the first line antibiotic to treat low-severity CAP?

a) amoxicillin
b) ampicillin
c) co-amoxiclav
d) doxycycline
e) erythromycin

Answer 21

amoxicillin

Question 22

What is one of the main investigations in which pneumonia and acute bronchitis can be differentiated?

a) assessment of the type of cough
b) chest x-ray
c) full blood count
d) heart rate
e) sputum culture

Answer 22

chest x-ray

Question 23

68 yr male with 2 week hx of dry cough. The cough is not made better or worse by anything. He also mentioned he was struggling with a headache and sore throat. Which of the following treatments would be most appropriate?

a) dextromethorphan
b) glycerol & honey
c) guafenasin
d) pholcodine
e) simple linctus

Answer 23

dextromethorphan

Question 24

montelukast has a side effect profile which is monitored by the MHRA. What side effects would you explain to a pt that require reporting to the MHRA?

a) appetite changes
b) chest pains
c) skin reactions
d) sleep disturbances
e) speech impairment

Answer 24

sleep disturbances

Question 25

14 yr pt with allergic rhinitis. She is mainly troubled by nasal congestion and has asked to purchased beconase nasal spray as she was previously prescribed by her GP. You refuse the sale as the medication is not licensed due to her age. What is the licensed age for the sale of beconase nasal spray?

a) 15 yrs
b) 16 yrs
c) 17 yrs
d) 18 yrs
e) 19 yrs

Answer 25

18 yrs

Question 26

18 month old presented with itchy swollen eyes for a week on and off. You diagnose with allergic rhinitis. Which of the following treatments would be most appropriate?

a) cetirizine 1mg/mL oral solution
b) chlorphenamine 1mg/mL oral solution
c) loratidine 1mg/mL oral solution
d) sodium coromoglycate 2% eye drops
e) sodium chloride 0.9% eye drops

Answer 26

chlorphenamine 1mg/mL oral solution