Respiratory medicine Flashcards
You see a 68-year-old man in clinic, with a 40 (cigarette) pack year history, who has been experiencing breathlessness on exertion and a productive cough of white sputum over the last four months. You assess his spirometry results which reveal an FEV1/FVC of 51 per cent with minimal reversibility after a 2-week trial of oral steroids. Cardiological investigations are normal. Which of the following is the most likely diagnosis?
A. Asthma
B. Chronic obstructive pulmonary disease (COPD)
C. Left ventricular failure
D. Chronic bronchitis
E. Lung fibrosis
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A 67-year-old woman is admitted to accident and emergency with pyrexia (38.1°C) and a cough productive of green sputum. The observations show a pulse rate of 101, BP 80/60 and respiratory rate of 32. She is alert and orientated in space and time. Blood results reveal a WCC of 21, urea of 8.5 and chest x-ray shows a patch of consolidation in the lower zone of the right lung. She is treated for severe community-acquired pneumonia. Which of the following is the correct calculated CURB-65 score? A. 6 B. 8 C. 4 D. 0 E. 1
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Which of the following organisms would typically be found in a patient with atypical community-acquired pneumonia? A. Staphylococcus aureus B. Pseudomonas spp. C. Streptococcus pneumonia D. Legionella pneumophilia E. Haemophilus influenza
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You are asked to interpret an arterial blood gas of a 76-year-old patient who was admitted to accident and emergency with an acute onset of breathlessness and low oxygen saturations. The test was taken on room air and read as follows: pH 7.37, PO2 7.8, PCO2 4.1, HCO3 24, SO2 89 per cent. Choose the most likely clinical interpretation from these arterial blood gas results: A. Compensated respiratory acidosis B. Type 1 respiratory failure C. Compensated respiratory alkalosis D. Type 2 respiratory failure E. None of the above
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A 54-year-old woman is seen in clinic with a history of weight loss, loss of appetite and shortnesss of breath. Her respiratory rate is 19 and oxygen saturations (on room air) range between 93 and 95 per cent. On examination, there is reduced air entry and dullness to percussion on the lower to midzones of the right lung. There is also reduced chest expansion on the right. From the list below, select the most likely diagnosis: A. Right middle lobe pneumonia B. Pulmonary embolism C. Right-sided pleural effusion D. Right-sided bronchial carcinoma E. Right lower lobe pneumonia
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Diagnostics in respiratory medicine (1) A 45-year-old woman with unexpected weight loss, loss of appetite and shortness of breath presents to you in clinic. On examination, there is reduced air entry and dullness to percussion in the right lung. A pleural tap is performed and the aspirate samples sent for analysis. You are told that the results reveal a protein content of >30g/L. From the list below, select the most likely diagnosis: A. Bronchogenic carcinoma B. Congestive cardiac failure C. Liver cirrhosis D. Nephrotic syndrome E. Meig’s syndrome
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You are discussing a patient with your registrar who has become acutely short of breath on the ward. After performing an arterial blood gas, you have high clinical suspicion that the patient has a pulmonary embolism. Which of the following is the investigation of choice for detecting pulmonary embolism?
A. Magnetic resonance imaging (MRI) of the chest
B. High-resolution CT chest (HRCT)
C. Chest x-ray
D. Ventilation/perfusion scan (V/Q scan)
E. CT pulmonary angiogram (CT-Pa)
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A 28-year-old man has been newly diagnosed with asthma. He has never been admitted to hospital with an asthma exacerbation and experiences symptoms once or twice a week. You discuss the treatment options with him. His peak expiratory flow reading is currently 85 per cent of the normal predicted value expected for his age and height. Which of the following is the most appropriate first step in treatment? A. Short-acting beta-2 agonist inhaler B. Long-acting beta-2 agonist inhaler C. Low-dose steroid inhaler D. Leukotriene receptor antagonists E. High-dose steroid inhaler
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You see a 46-year-old man who has presented to accident and emergency with an acute onset of shortness of breath. Your registrar has high clinical suspicion that the patient is suffering from a pulmonary embolism and tells you that the patient’s ECG has changes pointing to the suspected diagnosis. From the list below, which of the following ECG changes are classically seen?
A. Inverted T-waves in lead I, tall/tented T-waves in lead III and flattened T-waves in lead III
B. Deep S-wave in lead I, pathological Q-wave in lead III and inverted T-waves in lead III
C. Flattened T-wave in lead I, inverted T-wave in lead III, and deep S-wave in lead III
D. No changes in lead I, deep S-wave in lead III
E. Deep S-wave in lead I with no changes in lead III
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Which of the following arterial blood gas results, taken on room air, would you expect to see in a 67-year-old patient who has been suffering with COPD for two years and is not on home oxygen?
A. pH 7.35, PO2 11, PCO2 5.3, HCO3 24, SO2 98 per cent B. pH 7.47, PO2 12, PCO2 5.1, HCO3 30, SO2 97 per cent C. pH 7.44, PO2 8.3, PCO2 6.7, HCO3 28, SO2 93 per cent
D. pH 7.31, PO2 10.2, PCO2 6.8, HCO3 25, SO2 95 per cent
E. pH 7.30, PO2 11.5, PCO2 5.2, HCO3 18, SO2 96 per cent
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You see a 46-year-old woman on your ward who has been diagnosed with bronchiectasis following a three-month history of a mucopurulent cough. Which of the following from the list below is not a cause of bronchiectasis? A. Kartagener’s syndrome B. Cystic fibrosis C. Pneumonia D. Left ventricular failure E. Bronchogenic carcinoma
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A 30-year-old man presents to your clinic with a cough and finger clubbing. From the list below, which of these answers is not a respiratory cause of finger clubbing? A. Empyema B. Mesothelioma C. Bronchogenic carcinoma D. Cystic fibrosis E. COPD
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A 55-year-old woman, who has never smoked, presents to you on the ward with a history of weight loss, decreased appetite and finger clubbing. You are told that her chest x-ray revealed opacity in the hilar region of the right lung suggesting a bronchogenic carcinoma. She is currently awaiting a CT-chest with bronchoscopy to follow. From the list below, select the most likely diagnosis: A. Squamous cell carcinoma of the lung B. Adenocarcinoma of the lung C. Small cell carcinoma of the lung D. Large cell carcinoma of lung E. Carcinoid tumour of the lung
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You see a 28-year-old man, with no past medical history, in accident and emergency who developed an acute onset of pleuritic chest pain and shortness of breath while playing football. On examination, oxygen saturations are 93 per cent on room air, respiratory rate 20 and temperature is 37.1°C. There is decreased expansion of the chest on the left side, hyper-resonant to percussion and reduced air entry on the left. The most likely diagnosis is: A. Left-sided pneumothorax B. Left-sided pneumonia C. Left-sided pleural effusion D. Lung fibrosis E. Traumatic chest injury
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You are asked to request imaging for a patient with a suspected pneumothorax who you have just examined in accident and emergency. Which of the following would be the most appropriate first step imaging modality? A. CT-chest B. Ultrasound chest C. Chest x-ray D. V/Q scan E. CT-PA
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A 68-year-old woman has presented with acute onset shortness of breath 24 hours after a long haul flight. Her blood results show a raised D-dimer level and the arterial blood gas shows a PO2 of 8.3kPa and PCO2 of 5.4kPa. Your consultant suspects a pulmonary embolism and the patient needs to be started on treatment while a CT-PA is awaited. From the list below, please select the most appropriate treatment regime.
A. Commence loading with warfarin and aim for an international normalized ratio (INR) between 2 and 3
B. Thromboembolic deterrent stockings
C. Aspirin 75mg daily
D. Prophylactic dose subcutaneous low molecular weight heparin + loading with warfarin and aim for INR between 2 and 3
E. Treatment dose subcutaneous low molecular weight heparin + loading with warfarin and aim for INR between 2 and 3
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You see a 67-year-old man who has been referred to the chest clinic following a three-month history of weight loss and signs which may suggest a Pancoast’s tumour. Which of the following symptoms from the list below is not associated with a Pancoast’s tumour? A. Hoarse voice B. Miosis C. Anhydrosis D. Exopthalmos E. Ptosis
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A 50-year-old Afro-Caribbean man, with no past medical history, presents with a four-month history of dry cough and shortness of breath on exertion. The patient’s GP referred him to the chest clinic after performing blood tests which revealed a raised erythrocyte sedimentation rate (ESR) and serum angiotensin-converting enzyme (ACE) level. You review the patient’s chest x-ray which reveals bilateral hilar lyphadenopathy. From the list below, select the most likely diagnosis: A. Rheumatoid arthritis B. Systemic lupus erythematosus (SLE) C. Sarcoidosis D. Idiopathic pulmonary fibrosis E. Bronchogenic carcinoma
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A 67-year-old man presents with dyspnoea and fatigue with signs of a raised jugular venous pressure (JVP), hepatomegaly and peripheral oedema. The patient has a longstanding history of COPD. You suspect cor pulmonale. Which of the following is not a cause of cor pulmonale? A. Pulmonary fibrosis B. Primary pulmonary hypertension C. Myasthenia gravis D. COPD E. Multiple sclerosis
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You are told by your registrar that a 69-year-old man has been admitted to the chest ward with dyspnoea, cyanosis and finger clubbing. His chest x-ray shows bilateral lower zone reticulo-nodular shadowing. From the list below, which is the most likely diagnosis? A. Bronchiectasis B. Pulmonary fibrosis C. Bronchogenic carcinoma D. Bronchitis E. COPD
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A 25-year-old woman is admitted to accident and emergency with a severe exacerbation of asthma. On examination, her respiratory rate is 30, oxygen saturations are 95 per cent on 15L O2 and temperature is 37.2°C. As you feel the peripheral pulse, the volume falls as the patient inspires. Which of the following explains this clinical sign?
A. Increased left atrial filling pressures on inspiration
B. Decreased right ventricular filling pressures on inspiration
C. Peripheral vasodilation
D. Decreased right atrial filling pressures on inspiration
E. Decreased left atrial filling pressures on inspiration
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A 55-year-old man, who has never smoked and with no past medical history, has been diagnosed with right basal community-acquired pneumonia. There are minimal changes on his chest x-ray and bloods reveal a neutrophil count of 8.2 and a C-reactive protein (CRP) of 15. He has no drug allergies. Although he has a productive cough of green sputum, his respiratory rate is 16, oxygen saturations are 97 per cent on room air and his temperature is 37.4°C. You are asked to place him on treatment. Which of the following treatment options would be appropriate for this patient?
A. Oral amoxicillin
B. Oral erythromycin
C. Intravenous ertapenem
D. Intravenous ertapenem with a macrolide (e.g. clarithromycin)
E. Intravenous tazocin
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A 56-year-old woman who has recently been discharged from your ward, with oral antibiotics for right basal community-acquired pneumonia, is re-admitted with transient pyrexia and shortness of breath. She is found to have a right-sided pleural effusion which is drained and some pleural aspirate sent for analysis. The results reveal an empyema. Which of the following, from the pleural aspirate analysis, would typically be found in a patient with an empyema? A. pH >7.2, ↑ LDH, ↑ glucose B. pH <7.2, ↑ LDH, ↑ glucose C. pH >7.2, ↓ LDH, ↓ glucose D. pH <7.2, ↑ LDH, ↓ glucose E. pH <7.2, ↔ LDH, ↔ glucose
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You are told that a patient in clinic has been diagnosed with cystic fibrosis using the sodium chloride sweat test. Which of the following results from the latter test would indicate a positive diagnosis of cystic fibrosis? A. Sodium chloride <40mmol/L B. Sodium chloride >60mmol/L C. Sodium chloride >50mmol/L D. Sodium chloride <60mmol/L E. Sodium chloride <30mmol/L
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