Respiratory RACP MCQs Flashcards
RACP 2022 Q6
Pre-oxygenation is required pre-procedure to allow safe apnoea time. Safe apnoea time is reduced in obesity is due to reduction in
a. FEV1
b. FVC
c. DLCO
d. FRC
D
Patients living with obesity have a very different physiology in a number of ways. From a respiratory perspective, this population has a decreased Functional Residual Volume (FRC), generally lower tidal volumes, decreased compliance, higher oxygen demand, and a higher risk of atelectasis. All of these factors together result in patients with obesity desaturating significantly sooner after induction than the non-obese group.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9311180/
RACP 2022A 25.
Patient with pulmonary hypertension found on echocardiogram. Chronic
thromboembolism (CTEPH) is suspected. What is the next best investigation to confirm a diagnosis?
a. D Dimer
b. CTPA
c. V/Q scan
d. Right heart cath
C
The recommended diagnostic work-up of suspected CTEPH starts with transthoracic Doppler echocardiography.
The next diagnostic step for patients at “intermediate” or “high” echocardiographic probability is ventilation/perfusion lung scintigraphy.
https://erj.ersjournals.com/content/55/6/2000189#:~:text=The%20next%20diagnostic%20step%20for,is%20ventilation%2Fperfusion%20lung%20scintigraphy.
RACP 2022A Q27.(Past question)
Female patient with adenocarcinoma of unknown origin, presents with shortness of breath. RR 24, 94% RA and BP 100/40. CXR showed globular heart.
a. Lymphangitic carcinomatosis
b. Atypical pneumonia
c. Pericardial effusion
d. PE with infarct
C
Not sure what the question was
A - spread to lymphatic vessel;s
B - wouldn’t cause a globular heart
D - would be SOB but again ? globular heart
RACP 2022B Q1.
What is the primary pathology in idiopathic pulmonary arterial hypertension?
A. Angioproliferative vasculopathy of pulmonary arterioles
B. Thromboemboli of pulmonary arterioles
C. Thrombosis of pulmonary venules
D. Vasculitis of pulmonary arterioles
A
PAH is a proliferative vasculopathy, characterized by vasoconstriction, cell proliferation, fibrosis, and microthrombosis. Pathologic findings include hyperplasia and hypertrophy of all three layers of the vascular wall (intima, media, adventitia) in pulmonary arteries <50 microns (ie, localizes to the small pulmonary muscular arterioles). In addition, fibrosis and in situ thrombi of the small pulmonary arteries and arterioles (plexiform lesions) can be seen
https://www.uptodate.com.acs.hcn.com.au/contents/the-epidemiology-and-pathogenesis-of-pulmonary-arterial-hypertension-group-1?search=idiopathic%20pulmonary%20arterial%20hypertension&source=search_result&selectedTitle=3~115&usage_type=default&display_rank=3
RACP 2022B Q24.
What is the impact of normal ageing on forced vital capacity and functional residual
capacity?
A. Increase FVC and increased FRC
B. Increase FVC and decreased FRC
C. Decrease FVC and increase FRC
D. Decrease FVC and decrease FRC
C
RACP 2022B Q53.
Patient on 4LNP. ABG with pH 7.48, pCO2 50, HCO3 36. What is the interpretation?
A. Metabolic alkalosis without compensation
B. Metabolic alkalosis with compensation
C. Respiratory acidosis without compensation
D. Respiratory acidosis with compensation
Answer: D
Respiratory acidosis with compensation
RACP 2020 84. EMQ
Volume of inhaled and exhaled air in one breath
A) Total lung capacity
B) Vital capacity
C) Diffusion capacity
D) Inspiration capacity
E) Forced exploratory volume in 1 second
F) Residual volume
G) Tidal volume
H) Inspiratory reserve volume
Answer G Tidal volume
RACP 2020 Q85.
Maximum amount of air a person can expel from the lungs after a maximum inhalation
A) Total lung capacity
B) Vital capacity
C) Diffusion capacity
D) Inspiration capacity
E) Forced exploratory volume in 1 second
F) Residual volume
G) Tidal volume
H) Inspiratory reserve volume
Answer B: Vital capacity
RACP 2019 Q13
A 37 year old female presents with a DVT following a cholecystectomy. There is RV dilatation on TTE . She is hemodynamically stable. What is the appropriate duration for anticoagulation?
A. 6 weeks
B. 3 months
C. 12 months
D. Indefinitely
Answer B: 3 months
RACP 2022a 49.A young girl returns from theatre post-op with a central venous catheter in
situ. You are asked to review for shortness of breath. She has a resp rate 22, saturations of 97% on 2LNP, and HR 90. Her Chest Xray is shown (
showing large left-sided pneumothorax ie absent lung markers, collapse; L
subclavian line visible). What is the best definitive management?
a. Remove subclavian line
b. Chest drain
c. Needle aspiration
d. Supplemental oxygen
Answer : B chest drain
RACP 2022a Q51
CXR showing area of consolidation with blurred heart border. Most consistent with:
a. RML collapse
b. Consolidation
c. Right lower lobe collapse
RACP 2022a Q77
68 year old man with 3 months of dyspnoea, cough and bloody sputum. Nil weight loss or fevers. He has a 30 pack year smoking history. CT chest showed a 3 cm R sided central hilar mass with bilateral lymphadenopathy.
What is the most likely diagnosis?
a. Sarcoidosis
b. Lymphoma
c. Small cell carcinoma
d. Squamous cell carcinoma
C
RACP 2022b Q34. A patient presents with worsening exertional dyspnoea. The transthoracic echo shows elevated pulmonary pressures with normal LV size and systolic function. A right heart cath was done which shows normal cardiac index, pulmonary vascular wood units 3.1, pulmonary capillary wedge pressure of 25.
Which feature confirms HFpEF?
A. Cardiac index
B. Pulmonary capillary wedge pressure
C. Vascular woods unit
Answer B: Pulmonary capillary wedge pressure
RACP 2021a Q4. A 50 year old woman with a history of metastatic breast cancer who has recently completed her first round of chemotherapy presents with shortness of breath. Her observations include BP 100/60 and HR 125 bpm, with ECG showing sinus tachycardia. Her chest x-ray is shown below.
What is the most likely diagnosis?
A. Lymphangitis carcinomatosis
B. Pericardial effusion
C. PE with infarction
D. Atypical pneumonia
B
A - spread to lymphatic vessel;s
C - wouldn’t cause a globular heart
D - would be SOB but again ? globular heart
RACP 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 has been shown to have the greatest improve improvement in mortality?
A. Anticoagulation
B. IVC filter placement
C. Surgical pulmonary embolectomy
D. Systemic thrombolysis
Answer A: Anticoagulation
RCAP 2021 Q19.
A 52 year old man who is an ex-smoker presents to clinic with proximal muscle weakness and dysphagia. A chest x-ray reveals a large anterior mediastinal pathology. He subsequently undergoes resection of the mass.
(Q19 Cont’d) Which histopathology would best explain his clinical findings and imaging?
A. Germ cell tumor
B. Lymphoma
C. Small cell lung cancer
D. Thymoma
D
RACP 2021 Q61.
A 42 year male presents with a history of dry cough for 3 months. He works in office and is a non-smoker. He does not have any other past medical history. His CXR is provided.
What is the most likely cause of his symptoms?
A. Extrinsic allergic alveolitis
B. Sarcoidosis
C. NSIP
D. Malignancy
A
RACP 2021 Q81.
A 45 year old male presents to the Emergency Department with a 5 day history of worsening shortness of breath on exertion and cough. He is an ex-smoker with a 10 pack year history. On examination there is a widespread wheeze. He has the following X-ray:
What is the most likely diagnosis?
A. Lower lobe consolidation
B. Right middle lobe collapse
C. Pulmonary hypertension
D. Mediastinal mass
RACP 2021 Q89.
A 60 year old woman with a history of bronchiectasis presents with cough productive of purulent sputum and is commenced Amoxicillin 1g TDS with no clinical improvement. Her sputum cultures grew pan-sensitive Pseudomonas aureginosa. How would you treat next?
A. Azithromycin
B. Ciprofloxacin
C. Inhaled tobramycin
D. Moxifloxacin
B
RACP 2021 Oct Q7.
60 M smoker presents with cough. What is the finding based on this xray?
a. Pericardial effusion
b. Pulmonary embolism
c. Right middle lobe collapse
d. Right lower lobe consolidation
c
RACP 2021 Oct Q10. When does someone with COPD and pulmonary HTN from COPD qualify for home oxygen?
a. PaO2 < 50
b. PaO2 < 55
c. PaO2 < 60
d. PaO2 < 65
C
RACP 2021 Oct Q44. Young man in 20s with SOB. Right heart cath shows raised PAP, Normal
PCWP, increased pulmonary vascular resistance. CT showed thickened basal
septum .Gene mutation positive for EIF2AK4
a. Hematoma
b. pulmonary veno occlusive disease
c. ILD with pulmonary hypertension
d. Pul HTN secondary to LHF
B
Diseases associated with EIF2AK4 include Pulmonary Venoocclusive Disease 2, Autosomal Recessive and Pulmonary Venoocclusive Disease
RACP 2021 Oct Q46.
Man with haemoptysis. Wheeze on the right. Bronch shows vascular right rounded cherry red lesion arising from the bronchial wall (photo given). Mildly elevated urinary 5-HIAA. PET scan unexciting. CT reports solid nodules but no LN. Diagnosis?
a. Harmatoma
b. Carcinoid
c. Epidermoid
A
RACP 2021 Oct Q48.
Vape induced lung injury. What injury does it cause to the lungs?
a. Centrilobular emphysema
b. Granuloma
c. Ground grass patchy consolidation
d. ?
EVALI cases demonstrated a heterogeneous collection of pneumonitis patterns that included acute eosinophilic pneumonia, organizing pneumonia, lipoid pneumonia, diffuse alveolar damage and acute respiratory distress syndrome (ARDS), diffuse alveolar hemorrhage, hypersensitivity pneumonitis, peribronchiolar granulomatous pneumonitis, and the rare giant-cell interstitial pneumonitis.
RACP 2021 Oct Q50.
What type of oxygen delivery method can give 100% fio2 in awake patient?
a. Hudson
b. Non rebreather mask
c. Venturi
d. Self inflating bag valve mask
B
RACP 2021 Oct Q 51. Peripheral O2 sats are higher than and O2 sats in ABG. What causes this other than CO?
a. Methhemoglobenima
b. Tricuspid regurg
c. Left to right heart shunt
d. Peripheral vascular disease
A
RACP 2021 Oct Q90.
What medication is beneficial in patients with poorly controlled asthma
with eosinophil count >0.3?
a. Mepolizumab
b. Anti-Interleukin 5 (IL-5) and IL-5Ra
c. Leukotriene inhibitor
A
RACP 2021 Oct Q109.
A man with history of recurrent PEs presents with exertional dyspnoea and tiredness, echo shows RV pulmonary hypertension, what is next best step to confirm the diagnosis of CTEPH as a cause of his pulmonary hypertension?
a. right heart Cath
b. CTPA
c. VQ scan
d. PET scan
C
RACP 2020a Q11.
A 38yoM presents to the emergency department with worsening shortness of breath and episodes of chest tightness for the past 2 weeks. Below are his CXR images. What is the most likely radiological diagnosis?
A) Anterior mediastinal mass
B) Bilateral hilar lymphadenopathy
C) Cardiomyopathy with left atrial enlargement
D) Right middle lobe collapse
RACP 2020a Q14.
Patients with chronic liver disease feel more dyspnoea when standing up as opposed to lying
down (orthodeoxia). An increase in what parameter explains this phenomenon?
A) Left ventricular preload
B) Cardiac output
C) Intra-abdominal pressure
D) Pulmonary capillary vasodilation
RACP 2020 Q22. In addition to influenza, which vaccine is indicated in COPD?
A) Hemophilus
B) Pneumococcal
C) Varicella
D) Meningococcal
RACP 2020a 31. A 58 year old non-smoker with a past history of asthma presents to the emergency department
with 4 days of productive cough and a temperature of 38.3. Her chest X-ray is shown below (pic).
Which of the following is the most likely diagnosis?
A) Empyema
B) Middle lobe collapse/consolidation
C) Lower lobe collapse/consolidation
D) Pulmonary infarction
ANS: Picture was of right lower ZONE collapse consolidation. Appeared to have silhouette sign of
right diaphragm but not right heart border
RACP 2020 24. Man in his 30s who works with stone kitchen bench tops presenting with dry cough. X-ray shows bilateral upper fibrosis. What is the diagnosis?
A) Tuberculosis
B) Silicosis
C) Asbestosis
D) Hypersensitivity pneumonitis
RACP 2020 32. A 48 year old man (smoker) developed a right distal below knee DVT and bilateral PE after a
long haul flight - What is the minimum duration of anticoagulation?
A) 6 weeks
B) 3 months
C) 12 months
D) Lifelong
RACP 2020 34. Patient admitted with dyspnea, long standing COPD. pH of 7.2, CO2 of 70. He is alert. What is
the next best step in management?
A) Bi-level non-invasive ventilation
B) Continuous positive airway pressure
C) Intubation and ventilation
D) High flow nasal cannula oxygen therapy
RACP 2020 35. A patient with background of COPD presents with dyspnoea and oxygen saturations of 87%. His ABG at rest shows PaO2 55 and PaCO2 31. Echocardiography shows pulmonary artery
systolic pressure of 65 mmHg. Which of the following will reduce his mortality?
A) Beta-agonist bronchodilators
B) Oxygen therapy
C) Corticosteroids
D) Warfarin