Respiratory

Question 1

Which muscle can act as an accessory muscle of inspiration due to its attachment to rib 1?

Answer 1

Scalenus anterior

Question 2

Where does pecoralis minor attach to?

Answer 2

Ribs 3,4 and 5

Coracoid process

Question 3

Where does the sternocleidomastoid muscle attach to?

Answer 3

Sternum
Medial and of the clavicle
Mastoid process of temporal bone

Question 4

Where does the rectus abdominis attach to?

Answer 4

Xiphoid process

Pubic symphysis

Question 5

Which “layer” is most closely associated to the route of the phrenic nerve through the chest?

Answer 5

Fibrous pericardium

Question 6

What substance acts on the post junctional muscarinic end plate receptor on airway smooth muscle to mediate constriction?

Answer 6

Acetylcholine

Question 7

Which hormone acts on the membrane bound beta-2 adrenoceptor on airway smooth muscle to mediate relaxation?

Answer 7

Adrenaline

Question 8

Which metabolite of the arachadonic acid pathway released from eosinophils and mast cells mediates airway smooth muscle constriction, increased vascular permeability and mucous secretion?

Answer 8

Leukotriene D4

Question 9

What is the most likely spirometry finding for COPD?

Answer 9

Reduced FEV1
Reduced FVC
Reduced FEV1/FVC ratio
Reduced PEF

Question 10

What is the most likely spirometry finding for asthma?

Answer 10

Reduced FEV!
Persevered FVC
Reduced FEV1/FVC ratio
Reduced PEF

Question 11

What is the most likely spirometry finding for a restrictive lung defect?

Answer 11

Reduced FEV1
Reduced FVC
Preserved FEV1/FVC ratio
Preserved PEF

Question 12

A granuloma is a collection of…

Answer 12

Macrophages

Question 13

Can sarcoid like granulomatous infiltrates be a reaction to nearby malignancy?

Answer 13

Yes

Question 14

Assessment to differentiate between asthma and COPD

Answer 14

Spirometry

Question 15

Assessment to differentiate between mild and moderate CAP?

Answer 15

CURB Score 
Confucion 
Urea 
Respiratory rate 
BP 
Age

Question 16

Assessment to differentiate between Type 1 and Type 2 respiratory failure?

Answer 16

Arterial blood gas
Type 1 = Low PO2, normal PCO2
Type 2 = Low PO2, high PCO2

Question 17

Which microbe discovered in 2001 was shown to be a common cause of bronchiolitis?

Answer 17

Metapneumovirus

Question 18

What is the most appropriate treatment for a 50 year old, persistent asthmatic taking beclomethasone and salmeterol, but feeling increasingly breathless and wheezy after a cold?

Answer 18

Nebulisation

Seven day course of oral corticosteroid (e.g. oral prednisolone)

Question 19

What treatment would you give a severe asthmatic who has presented to A+E in extremis in order to buy time before an anaesthetist arrives?

Answer 19

IV magnesium and/or IV aminophylline

Question 20

Which antibiotic would you prescribe a 67 year old with cough, fever, mild confusion, 38 temp, 97/57mmHg BP, RR 24, Urea 9 with no known allergies?

Answer 20

CURB = 4
Severe CAP
IV co-amoxiclav and IV clarithromycin

Question 21

Which antibiotic would you prescribe an 87 year old with ride sided weakness and dysarthria who lay on the floor for 1 day prior to admission?

Answer 21

Severe aspiration pneumonia

IV amoxicillin, gentamicin, metronidazole

Question 22

Which antibiotic would you prescribe a 72 year old smoker with 3 day history of SOB, productive cough and wheeze who is allergic to penicillin?

Answer 22

Exacerbation of COPD

Oral doxycycline