MCQs on Respiratory System for Staff Nurse and Medical Exams
by ADMIN
September 25, 2016
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1- The following are recognized features of Pancoast's tumour except:
1) ipsilateral Horner's syndrome
2) wasting of the dorsal interossei
3) pain in the arm radiating to the fourth and fifth fingers
4) erosion of the first rib
5) weakness of abduction at the shoulder
2- Which of the following is true concerning Whooping cough (pertussis)?
1) is a greater threat to children during the second 6 months of life, after maternal antibody has declined, than during the first 6 months
2) may lead to hemiplegia
3) is characteristically associated with a polymorph leucocytosis
4) is associated with convulsions less frequently than is the case with other febrile conditions
5) rapidly resolves with antibiotic treatment
3- A 19-year-old female developed pleural effusions, ascites and ankle swelling. Her blood pressure was 112/76 mmHg.
Investigations revealed:
What is the next most appropriate investigation?
1) Antinuclear antibody
2) Pregnancy test
3) Prothrombin time
4) Serum protein electrophoresis
5) Urinary protein estimation
4- A 51 year old businessman complains of dyspnoea on exertion. He recently returned from a business trip to the USA. He has distant heart sounds on auscultation of the chest. A chest radiograph reveals that there is a thin rim of calcification surrounding the cardiac outline. Which of the following conditions is most likely responsible for these findings?
1) Uraemia
2) Tuberculosis
3) Group B coxsackie virus
4) Sarcoidosis
5) Metastatic carcinoma
5- A 48-year-old woman presented with shortness of breath, cough with heavy sputum production, and a low grade fever. She has smoked 20 cigarettes per day for 30 years. Her arterial blood gases revealed pH of 7.4, PaCO2 of 45 and a PaO2 of 78. What is the most likely diagnosis?
1) Bronchial asthma
2) Chronic bronchitis
3) Cryptogenic fibrosing alveolitis
4) Paraneoplastic syndrome
5) Pulmonary embolism
6- A 49-year-old man with a long history of alcoholism presents with cough, haemoptysis and pleuritic chest pain. He has had night sweats and 10 kg weight loss in the last three months. On chest X-ray tgere is a subtle nodular pattern throughout the lung. He underwent a transbronchial biopsy which showed multinucleated giant cells, epithelioid cells and necrotic debris. Which of the following is the most likely diagnosis?
1) Aspergillosis
2) Pneumocystis carinii pneumonia
3) Small cell carcinoma
4) Squamous cell carcinoma
5) Tuberculosis
7- A 55 year old man who has a 25 year pack history of smoking presents with productive cough with mucoid sputum of 2 year duration. On examination he has scattered ronchi and wheezing. The likeliest diagnosis is :
1) Bronchial Asthma
2) Bronchiectasis
3) Chronic Bronchitis
4) Pneumonitis
5) Fibrosing Alveolitis
8- A 67 year old who is known to suffer from severe chronic bronchitis is admitted from home with an acute exacerbation. Which of the following is true?
1) An Acidosis with a low bicarbonate would be expected
2) Extensor plantar responses feature
3) Gentamicin would be a reasonable initial treatment until cultures are available
4) Oxygen therapy should aim to increase the pO2 to above 8kPa (60mmHg)
5) Peripheral oedema indicates coexisting heart failure
9- A 65-year-old woman, has smoked 50 cigarettes a day for 40 years. She has had increasing dyspnoea for the several years, but no cough. A Chest X-ray shows increased lung size along with flattening of the diaphragms, consistent with emphysema. Over the next several years she develops worsening peripheral oedema. Her vital signs show T° 36.7 C, P 80, RR 15, and BP 120/80 mm Hg. Which of the following cardiac findings is most likely to be present?
1) Mitral valve stenosis
2) Constrictive pericarditis
3) Right ventricular hypertrophy
4) Left ventricular aneurysmm
5) Non-bacterial thrombotic endocarditis
10 -In which of the following cases of lung cancer would surgical resection of the tumour be a reasonable therapeutic option?
1) A 56-year-old woman with an adenocarcinoma of the right lung. CT scan shows enlarged lymph nodes in the right and left hilum. PFTs show an FEV1 of 2.25 L.
(55% predicted).
2) A 59-year-old man who is found at bronchoscopy to have a tumour in the right mainstem bronchus extending to within 1 cm of the carina. Pulmonary Function
Tests (PFTs) show an FEV1 of 2.1 liters (65% of predicted normal).
3) A 62-year-old lady with a small peripheral mass who has elevated liver enzymes and a computed tomography (CT) scan showing probable metastatic deposits in
the liver PFTs show an FEV1 of 3.5 Liters (80% of predicted normal).
4) A 70-year-old man with a right lower lobe tumour 2 cm in diameter with no evidence of regional adenopathy or distant spread of disease. PFTs show an FEV1
of 0.8 Liters (28% predicted).
5) A 71-year-old man with a 3 cm tumor obstructing the right lower lobe bronchus.
PFTs show an FEV1 of 1.98 L. (43% predicted).
1) ipsilateral Horner's syndrome
2) wasting of the dorsal interossei
3) pain in the arm radiating to the fourth and fifth fingers
4) erosion of the first rib
5) weakness of abduction at the shoulder
2- Which of the following is true concerning Whooping cough (pertussis)?
1) is a greater threat to children during the second 6 months of life, after maternal antibody has declined, than during the first 6 months
2) may lead to hemiplegia
3) is characteristically associated with a polymorph leucocytosis
4) is associated with convulsions less frequently than is the case with other febrile conditions
5) rapidly resolves with antibiotic treatment
3- A 19-year-old female developed pleural effusions, ascites and ankle swelling. Her blood pressure was 112/76 mmHg.
Investigations revealed:
- serum alanine transferase 17 U/L (5 - 15)
- serum total bilirubin 17 umol/L (1 - 22)
- serum albumin 21 g/L (34 - 94)
- serum total cholesterol 9.8 mmol/L (<5.2)
What is the next most appropriate investigation?
1) Antinuclear antibody
2) Pregnancy test
3) Prothrombin time
4) Serum protein electrophoresis
5) Urinary protein estimation
4- A 51 year old businessman complains of dyspnoea on exertion. He recently returned from a business trip to the USA. He has distant heart sounds on auscultation of the chest. A chest radiograph reveals that there is a thin rim of calcification surrounding the cardiac outline. Which of the following conditions is most likely responsible for these findings?
1) Uraemia
2) Tuberculosis
3) Group B coxsackie virus
4) Sarcoidosis
5) Metastatic carcinoma
5- A 48-year-old woman presented with shortness of breath, cough with heavy sputum production, and a low grade fever. She has smoked 20 cigarettes per day for 30 years. Her arterial blood gases revealed pH of 7.4, PaCO2 of 45 and a PaO2 of 78. What is the most likely diagnosis?
1) Bronchial asthma
2) Chronic bronchitis
3) Cryptogenic fibrosing alveolitis
4) Paraneoplastic syndrome
5) Pulmonary embolism
6- A 49-year-old man with a long history of alcoholism presents with cough, haemoptysis and pleuritic chest pain. He has had night sweats and 10 kg weight loss in the last three months. On chest X-ray tgere is a subtle nodular pattern throughout the lung. He underwent a transbronchial biopsy which showed multinucleated giant cells, epithelioid cells and necrotic debris. Which of the following is the most likely diagnosis?
1) Aspergillosis
2) Pneumocystis carinii pneumonia
3) Small cell carcinoma
4) Squamous cell carcinoma
5) Tuberculosis
7- A 55 year old man who has a 25 year pack history of smoking presents with productive cough with mucoid sputum of 2 year duration. On examination he has scattered ronchi and wheezing. The likeliest diagnosis is :
1) Bronchial Asthma
2) Bronchiectasis
3) Chronic Bronchitis
4) Pneumonitis
5) Fibrosing Alveolitis
8- A 67 year old who is known to suffer from severe chronic bronchitis is admitted from home with an acute exacerbation. Which of the following is true?
1) An Acidosis with a low bicarbonate would be expected
2) Extensor plantar responses feature
3) Gentamicin would be a reasonable initial treatment until cultures are available
4) Oxygen therapy should aim to increase the pO2 to above 8kPa (60mmHg)
5) Peripheral oedema indicates coexisting heart failure
9- A 65-year-old woman, has smoked 50 cigarettes a day for 40 years. She has had increasing dyspnoea for the several years, but no cough. A Chest X-ray shows increased lung size along with flattening of the diaphragms, consistent with emphysema. Over the next several years she develops worsening peripheral oedema. Her vital signs show T° 36.7 C, P 80, RR 15, and BP 120/80 mm Hg. Which of the following cardiac findings is most likely to be present?
1) Mitral valve stenosis
2) Constrictive pericarditis
3) Right ventricular hypertrophy
4) Left ventricular aneurysmm
5) Non-bacterial thrombotic endocarditis
10 -In which of the following cases of lung cancer would surgical resection of the tumour be a reasonable therapeutic option?
1) A 56-year-old woman with an adenocarcinoma of the right lung. CT scan shows enlarged lymph nodes in the right and left hilum. PFTs show an FEV1 of 2.25 L.
(55% predicted).
2) A 59-year-old man who is found at bronchoscopy to have a tumour in the right mainstem bronchus extending to within 1 cm of the carina. Pulmonary Function
Tests (PFTs) show an FEV1 of 2.1 liters (65% of predicted normal).
3) A 62-year-old lady with a small peripheral mass who has elevated liver enzymes and a computed tomography (CT) scan showing probable metastatic deposits in
the liver PFTs show an FEV1 of 3.5 Liters (80% of predicted normal).
4) A 70-year-old man with a right lower lobe tumour 2 cm in diameter with no evidence of regional adenopathy or distant spread of disease. PFTs show an FEV1
of 0.8 Liters (28% predicted).
5) A 71-year-old man with a 3 cm tumor obstructing the right lower lobe bronchus.
PFTs show an FEV1 of 1.98 L. (43% predicted).
11- A 20-year-old male student is assessed for shortness of breath that occurs whilst running. He has no other symptoms and does not smoke. Examination, full blood count, and chest X-ray are normal. Which of the following is most likely to be helpful in confirming the suspected diagnosis?
1) Arterial blood gas studies before and after exercise
2) Determination of lung volumes and diffusing capacity
3) Measurement of venous blood lactate before and after exercise
4) Spirometry before and after administration of bronchodilators
5) Spirometry before and after exercise
12- A 40-year-old worker presents with wheezing and breathlessness which seem to improve over weekends and holiday periods when he is not working. What is he most likely to be exposed to at work?
1) Platinum salts
2) Avian bloom
3) Aspergillus clavatus
4) Work in the Silver industry
5) Exposure to spores of Actinomyces
13- The pulmonary vascular system is different from the systemic circulation in that the pulmonary system demonstrates which of the following?
1) High pressures, high flow rates, highly compliant vessels
2) High pressures, high flow rates, low compliance vessels
3) Low pressures, high flow rates, high compliance vessels
4) Low pressures, low flow rates, high compliance vessels
5) Low pressures, low flow rates, low compliance vessels
14- A 60 year old man with ankylosing spondylitis presents with cough, weight loss and tiredness. His CXR shows longstanding upper lobe fibrosis. Three sputum tests stain positive for Acid fast bacilli but are consistently negative for Mycobacterium tuberculosis on culture. Which of the following is the most likely cause?
1) Mycobacterium avium intracellulare complex
2) Micropolyspora faeni
3) Allergic Bronchopulmonary Aspergillosis
4) Sarcoidosis
5) Tuberculosis
15- Which of the following is a recognised cause of a phrenic nerve palsy?
1) Aortic aneurysm
2) Dermoid
3) Ganglioneuroma
4) Pericardial cyst
5) Sarcoidosis
16- Which of the following statements is true of the pulmonary function test's vital capacity (VC)?
1) Vital capacity cannot be measured from spirometry alone
2) Vital capacity is increased in emphysema and reduced in interstitial fibrosis
3) Vital capacity is the maximal amount of air which can be exhaled after maximal inspiration
4) Vital capacity is the sum of tidal volume (VT) and inspiratory capacity (IC)
5) Vital capacity, when reduced, is a specific indication of restrictive lung disease
17- A 24 year old asthmatic female is admitted with acute severe asthma. Which of the following statements regarding the diagnosis is correct?
1) Agitation should be managed with a benzodiazepine
2) A high inspired Oxygen concentration should be used routinely
3) Inhaled salmeterol is indicated as first line therapy
4) Normal arterial pCO2 is reassuring
5) Pulsus paradoxus is a reliable sign of severity
18- Recognised associations. Which of the following is correct?
1) pneumoconiosis and clubbing
2) lung carcinoids and pleural effusion
3) pulmonary embolus and left bundle branch block
4) pulmonary fibrosis and hypercapnia
5) bronchopulmonary aspergillosis and wheezing
19- dry cough. Her chest X-ray shows an area of dense pneumonia-like consolidation in the right lower lobe. A course of antibiotics did not improve her symptoms or chest X-ray. Bronchioalveolar lavage (BAL) retrieved 'atypical' cells. What is the most likely diagnosis?
1) Bronchioloalveolar cell carcinoma
2) Mycoplasma pneumonia
3) Pulmonary alveolar proteinosis
4) Pulmonary embolism with infarction
5) Sarcoidosis
20- Randomised controlled trials have shown that long-term oxygen therapy (LTOT) reduces mortality in:
1) cryptogenic fibrosing alveolitis
2) cor pulmonale due to chronic airflow obstruction
3) asthma
4) cystic fibrosis
5) pulmonary sarcoidosis
1) Arterial blood gas studies before and after exercise
2) Determination of lung volumes and diffusing capacity
3) Measurement of venous blood lactate before and after exercise
4) Spirometry before and after administration of bronchodilators
5) Spirometry before and after exercise
12- A 40-year-old worker presents with wheezing and breathlessness which seem to improve over weekends and holiday periods when he is not working. What is he most likely to be exposed to at work?
1) Platinum salts
2) Avian bloom
3) Aspergillus clavatus
4) Work in the Silver industry
5) Exposure to spores of Actinomyces
13- The pulmonary vascular system is different from the systemic circulation in that the pulmonary system demonstrates which of the following?
1) High pressures, high flow rates, highly compliant vessels
2) High pressures, high flow rates, low compliance vessels
3) Low pressures, high flow rates, high compliance vessels
4) Low pressures, low flow rates, high compliance vessels
5) Low pressures, low flow rates, low compliance vessels
14- A 60 year old man with ankylosing spondylitis presents with cough, weight loss and tiredness. His CXR shows longstanding upper lobe fibrosis. Three sputum tests stain positive for Acid fast bacilli but are consistently negative for Mycobacterium tuberculosis on culture. Which of the following is the most likely cause?
1) Mycobacterium avium intracellulare complex
2) Micropolyspora faeni
3) Allergic Bronchopulmonary Aspergillosis
4) Sarcoidosis
5) Tuberculosis
15- Which of the following is a recognised cause of a phrenic nerve palsy?
1) Aortic aneurysm
2) Dermoid
3) Ganglioneuroma
4) Pericardial cyst
5) Sarcoidosis
16- Which of the following statements is true of the pulmonary function test's vital capacity (VC)?
1) Vital capacity cannot be measured from spirometry alone
2) Vital capacity is increased in emphysema and reduced in interstitial fibrosis
3) Vital capacity is the maximal amount of air which can be exhaled after maximal inspiration
4) Vital capacity is the sum of tidal volume (VT) and inspiratory capacity (IC)
5) Vital capacity, when reduced, is a specific indication of restrictive lung disease
17- A 24 year old asthmatic female is admitted with acute severe asthma. Which of the following statements regarding the diagnosis is correct?
1) Agitation should be managed with a benzodiazepine
2) A high inspired Oxygen concentration should be used routinely
3) Inhaled salmeterol is indicated as first line therapy
4) Normal arterial pCO2 is reassuring
5) Pulsus paradoxus is a reliable sign of severity
18- Recognised associations. Which of the following is correct?
1) pneumoconiosis and clubbing
2) lung carcinoids and pleural effusion
3) pulmonary embolus and left bundle branch block
4) pulmonary fibrosis and hypercapnia
5) bronchopulmonary aspergillosis and wheezing
19- dry cough. Her chest X-ray shows an area of dense pneumonia-like consolidation in the right lower lobe. A course of antibiotics did not improve her symptoms or chest X-ray. Bronchioalveolar lavage (BAL) retrieved 'atypical' cells. What is the most likely diagnosis?
1) Bronchioloalveolar cell carcinoma
2) Mycoplasma pneumonia
3) Pulmonary alveolar proteinosis
4) Pulmonary embolism with infarction
5) Sarcoidosis
20- Randomised controlled trials have shown that long-term oxygen therapy (LTOT) reduces mortality in:
1) cryptogenic fibrosing alveolitis
2) cor pulmonale due to chronic airflow obstruction
3) asthma
4) cystic fibrosis
5) pulmonary sarcoidosis
21- A 65-year-old woman, a heavy smoker for many years, has had worsening dyspnoea for the past 5 years, without a significant cough. A chest X-ray shows increased lung size along with flattening of the diaphragms, consistent with emphysema. Over the next several years she develops worsening peripheral oedema. BP 115/70 mmHg. Which of the following cardiac findings is most likely to be present?
1) Constrictive pericarditis
2) Left ventricular aneurysm
3) Mitral valve stenosis
4) Non-bacterial thrombotic endocarditis
5) Right ventricular hypertrophy
22- A 45-year-old solicitor had an onset of severe, crushing, substernal chest pain while attending a football match. He collapsed on his way to the car. Bystander Cardiorespiratory Resuscitation was begun immediately and continued until arrival in Casualty where an endotracheal tube was inserted and ventilation was maintained on 100% oxygen. Investigations revealed:
Based on these laboratory values, which of the following statements best describes his current pathophysiology?
1) He is demonstrating a primary respiratory alkalosis
2) He probably developed a large right to left intracardiac shunt
3) His anion gap is probably normal
4) His oxyhemoglobin curve is shifted to the left
5) His pulmonary artery pressure is probably elevated
23- Obstructive sleep apnoea characteristically associated with:
1) hypersomnolence
2) impotence
3) macrognathia
4) insomnia
5) polydipsia
24- A 26-year-old man with a history of alcohol and drug abuse was admitted with a 14 day history of fever, cough and fatigue. He was emaciated. His temperature was 39.4°C. Cervical and axillary lymphadenopathy were present. Chest X-ray revealed bilateral areas of pulmonary shadowing. Which of the following is the most likely diagnosis?
1) alcoholic cardiomyopathy
2) pneumococcal pneumonia
3) pneumocystis pneumonia
4) pulmonary tuberculosis
5) tricuspid endocarditis
25- A 75-year-old man with squamous cell carcinoma is thought to have resectable disease. Which of the following would be a contraindication to surgery?
1) clubbing
2) FEV1 of 0.75 L
3) his age of 75 years
4) pleural effusion
5) Syndrome of Inappropriate ADH
26- A 36 year old woman presents with dyspnoea, cough and fever. Crackles are heard on auscultation of the lungs. Circulating precipitans to Micropolyspora faeni are positive. Which of the following is the most likely diagnosis?
1) Malt workers' lung
2) Pigeon fanciers' lung
3) Allergic Bronchopulmonary Aspergillosis
4) Brucellosis
5) Farmers' lung
27- A 41 year old man with a history of nasal congestion, breathlessness, cough and wheeze presents with a left foot drop. Which of the following is the most likely diagnosis?
1) Diabetes mellitus
2) Wegeners Granulomatosis
3) Churg Staus Syndrome
4) Pulmonary eosinophilia
5) Polyarteritsis Nodosa
28- In asbestos related disorders which of the following statements is correct?
1) basal fibrotic shadowing on CXR suggests coincidental idiopathic fibrosing alveolitis
2) increased incidence of primary lung cancer
3) pleural effusion develops more than 20 years after causative asbestos exposure
4) pleural plaques are recognized precursors of mesothelioma
5) the risk of malignant mesothelioma is greatly increased in smokers compared with non-smokers
29- A 60 year old man was admitted with community-acquired pneumonia and deteriorated over the next few hours. Which one of the following indicates a poor prognosis?
1) A total white cell count of 17 x 109/L (4-11)
2) Blood pressure of 110/70 mm Hg
3) Respiratory rate of 35 breaths/min
4) Rigors
5) Temperature of 39oC
30- Which of the following statements concerning industrial lung disorders is correct?
1) pneumoconiosis can be diagnosed in the absence of chest X-ray abnormalities
2) occupational asthma occurs more frequently in atopic persons
3) silo fillers disease is caused by allergy to grain
4) widespread crepitations are typically heard in extrinsic allergic alveolitis
5) symptoms occur within minutes if exposure to mouldy hay in Farmer's lung
1) Constrictive pericarditis
2) Left ventricular aneurysm
3) Mitral valve stenosis
4) Non-bacterial thrombotic endocarditis
5) Right ventricular hypertrophy
22- A 45-year-old solicitor had an onset of severe, crushing, substernal chest pain while attending a football match. He collapsed on his way to the car. Bystander Cardiorespiratory Resuscitation was begun immediately and continued until arrival in Casualty where an endotracheal tube was inserted and ventilation was maintained on 100% oxygen. Investigations revealed:
- pH 7.13
- PaO2 560 mmHg
- PaCO2 18 mmHg
- Bicarbonate 5.8
- SaO2 98%
Based on these laboratory values, which of the following statements best describes his current pathophysiology?
1) He is demonstrating a primary respiratory alkalosis
2) He probably developed a large right to left intracardiac shunt
3) His anion gap is probably normal
4) His oxyhemoglobin curve is shifted to the left
5) His pulmonary artery pressure is probably elevated
23- Obstructive sleep apnoea characteristically associated with:
1) hypersomnolence
2) impotence
3) macrognathia
4) insomnia
5) polydipsia
24- A 26-year-old man with a history of alcohol and drug abuse was admitted with a 14 day history of fever, cough and fatigue. He was emaciated. His temperature was 39.4°C. Cervical and axillary lymphadenopathy were present. Chest X-ray revealed bilateral areas of pulmonary shadowing. Which of the following is the most likely diagnosis?
1) alcoholic cardiomyopathy
2) pneumococcal pneumonia
3) pneumocystis pneumonia
4) pulmonary tuberculosis
5) tricuspid endocarditis
25- A 75-year-old man with squamous cell carcinoma is thought to have resectable disease. Which of the following would be a contraindication to surgery?
1) clubbing
2) FEV1 of 0.75 L
3) his age of 75 years
4) pleural effusion
5) Syndrome of Inappropriate ADH
26- A 36 year old woman presents with dyspnoea, cough and fever. Crackles are heard on auscultation of the lungs. Circulating precipitans to Micropolyspora faeni are positive. Which of the following is the most likely diagnosis?
1) Malt workers' lung
2) Pigeon fanciers' lung
3) Allergic Bronchopulmonary Aspergillosis
4) Brucellosis
5) Farmers' lung
27- A 41 year old man with a history of nasal congestion, breathlessness, cough and wheeze presents with a left foot drop. Which of the following is the most likely diagnosis?
1) Diabetes mellitus
2) Wegeners Granulomatosis
3) Churg Staus Syndrome
4) Pulmonary eosinophilia
5) Polyarteritsis Nodosa
28- In asbestos related disorders which of the following statements is correct?
1) basal fibrotic shadowing on CXR suggests coincidental idiopathic fibrosing alveolitis
2) increased incidence of primary lung cancer
3) pleural effusion develops more than 20 years after causative asbestos exposure
4) pleural plaques are recognized precursors of mesothelioma
5) the risk of malignant mesothelioma is greatly increased in smokers compared with non-smokers
29- A 60 year old man was admitted with community-acquired pneumonia and deteriorated over the next few hours. Which one of the following indicates a poor prognosis?
1) A total white cell count of 17 x 109/L (4-11)
2) Blood pressure of 110/70 mm Hg
3) Respiratory rate of 35 breaths/min
4) Rigors
5) Temperature of 39oC
30- Which of the following statements concerning industrial lung disorders is correct?
1) pneumoconiosis can be diagnosed in the absence of chest X-ray abnormalities
2) occupational asthma occurs more frequently in atopic persons
3) silo fillers disease is caused by allergy to grain
4) widespread crepitations are typically heard in extrinsic allergic alveolitis
5) symptoms occur within minutes if exposure to mouldy hay in Farmer's lung
31- A young child presents with respiratory distress, worsening over 2 days. Blood gases show a pH of 7.25, a PCO2 of 7.5kPa, a PO2 of 8.5kPa, and a base excess of -4. Which of the following interpretations is correct?
1) Results are consistent with bronchopulmonary dysplasia.
2) Blood gases suggest type 1 respiratory failure.
3) Immediate intubation is required.
4) Results are consistent with late severe asthma.
5) Bicarbonate may be necessary to correct the acidosis.
32- A 19 year old female presents with acute breathlessness. She has had asthma for approximately 3 years and recently commenced new therapy. Which agent may be responsible for this exacerbation?
1) Salmeterol
2) Theophylline
3) Beclomethasone
4) Ipratropium bromide
5) Monteleukast
33- A 22 year old lady recently returned from a holiday in Malta was admitted with a 3 day history of fever, generalised lymphadenopathy and a macular rash over the trunk and legs. Which of the following is the most likely diagnosis?
1) Sarcoidosis
2) Tuberulosis
3) Familial Mediterranean Fever
4) Infectious Mononucleosis
5) Actinomycosis
34- Which of the following is a recognised treatment for complications of cystic fibrosis?
1) DNAase to assist in reinflating collapsed lung segments.
2) Rectal pull-through and anastamosis for rectal prolapse.
3) Pancreatic transplant for diabetes mellitus.
4) Nebulised tobramycin for pseudomonas colonisation of the lower respiratory tract.
5) Hypotonic saline drinks for hypernatraemic dehydration.
35- Which of the following is a typical feature of Farmer's lung?
1) basal crackles
2) Eosinophilia
3) Haemoptysis
4) Increased pCO2
5) Positive serum paraproteins
36- A 28 year old man who had had tuberculosis of the mediastinal lymph nodes diagnosed two weeks previously and who had been started on chemotherapy with rifampicin, isoniazid and pyrazinamide was admitted because of the increasing dyspnoea and stridor. Chest X-ray showed compression of both main bronchi by carinal lymph node enlargement. What is the next step in management?
1) Start prednisolone
2) Mediastinoscopy and biopsy
3) Refer for stent insertion/tracheostomy
4) Refer for urgent CT scan of the mediastinum
5) The addition of ethambutol
37- A 24 year old male presents after developing a bluish discolouration of the body, lips and nails. He denies any relevant past medical history. Examination reveals a central cyanosis and a grey complexion.
Investigation revealed:
What is the most likely diagnosis?
1) Argyria
2) Cyanotic congenital heart disease
3) Haemochromatosis
4) Methaemoglobinaemia
5) Methylene blue poisoning
38- Which of the following is true of BCG vaccination?
1) is contraindicated in neonates
2) is a killed polysaccharide antigen vaccine
3) should be given to all children who have a strongly positive tuberculin test
4) is presently routinely offered in the UK at age 16 years
5) Provides protection against leprosy
39 -Carcinoid tumors of the lung (bronchial adenomas) originate from which of the following cell types?
1) Ciliated cell
2) Clara cell
3) Kulchitsky (K) cell
4) Mucus (goblet) cell
5) Type 2 Alveolar cell
40- A 55-year-old woman on treatment for long-standing rheumatoid arthritis has recently become dyspnoeic on mild exertion and developed a dry cough. The oxygen saturation was found to be 87% on air. The chest x-ray showed a diffuse bilateral interstitial infiltrate. An extensive infection screen was negative and her symptoms were felt to be druginduced. Which drug is most likely to have caused this adverse effect?
1) azathioprine
2) cyclosporin
3) hydroxychloroquine
4) methotrexate
5) sulphasalazine
1) Results are consistent with bronchopulmonary dysplasia.
2) Blood gases suggest type 1 respiratory failure.
3) Immediate intubation is required.
4) Results are consistent with late severe asthma.
5) Bicarbonate may be necessary to correct the acidosis.
32- A 19 year old female presents with acute breathlessness. She has had asthma for approximately 3 years and recently commenced new therapy. Which agent may be responsible for this exacerbation?
1) Salmeterol
2) Theophylline
3) Beclomethasone
4) Ipratropium bromide
5) Monteleukast
33- A 22 year old lady recently returned from a holiday in Malta was admitted with a 3 day history of fever, generalised lymphadenopathy and a macular rash over the trunk and legs. Which of the following is the most likely diagnosis?
1) Sarcoidosis
2) Tuberulosis
3) Familial Mediterranean Fever
4) Infectious Mononucleosis
5) Actinomycosis
34- Which of the following is a recognised treatment for complications of cystic fibrosis?
1) DNAase to assist in reinflating collapsed lung segments.
2) Rectal pull-through and anastamosis for rectal prolapse.
3) Pancreatic transplant for diabetes mellitus.
4) Nebulised tobramycin for pseudomonas colonisation of the lower respiratory tract.
5) Hypotonic saline drinks for hypernatraemic dehydration.
35- Which of the following is a typical feature of Farmer's lung?
1) basal crackles
2) Eosinophilia
3) Haemoptysis
4) Increased pCO2
5) Positive serum paraproteins
36- A 28 year old man who had had tuberculosis of the mediastinal lymph nodes diagnosed two weeks previously and who had been started on chemotherapy with rifampicin, isoniazid and pyrazinamide was admitted because of the increasing dyspnoea and stridor. Chest X-ray showed compression of both main bronchi by carinal lymph node enlargement. What is the next step in management?
1) Start prednisolone
2) Mediastinoscopy and biopsy
3) Refer for stent insertion/tracheostomy
4) Refer for urgent CT scan of the mediastinum
5) The addition of ethambutol
37- A 24 year old male presents after developing a bluish discolouration of the body, lips and nails. He denies any relevant past medical history. Examination reveals a central cyanosis and a grey complexion.
Investigation revealed:
- Haemoglobin 17.0 g/dL (13.0-18.0)
- PaO2 13.0 kPa (11.3-12.6)
- SaO2 (using an oximeter) 85% (>95)
What is the most likely diagnosis?
1) Argyria
2) Cyanotic congenital heart disease
3) Haemochromatosis
4) Methaemoglobinaemia
5) Methylene blue poisoning
38- Which of the following is true of BCG vaccination?
1) is contraindicated in neonates
2) is a killed polysaccharide antigen vaccine
3) should be given to all children who have a strongly positive tuberculin test
4) is presently routinely offered in the UK at age 16 years
5) Provides protection against leprosy
39 -Carcinoid tumors of the lung (bronchial adenomas) originate from which of the following cell types?
1) Ciliated cell
2) Clara cell
3) Kulchitsky (K) cell
4) Mucus (goblet) cell
5) Type 2 Alveolar cell
40- A 55-year-old woman on treatment for long-standing rheumatoid arthritis has recently become dyspnoeic on mild exertion and developed a dry cough. The oxygen saturation was found to be 87% on air. The chest x-ray showed a diffuse bilateral interstitial infiltrate. An extensive infection screen was negative and her symptoms were felt to be druginduced. Which drug is most likely to have caused this adverse effect?
1) azathioprine
2) cyclosporin
3) hydroxychloroquine
4) methotrexate
5) sulphasalazine
41- The following is true about Cystic Fibrosis:
1) Is an autosomal dominant condition.
2) Is due to mutation of CFTR gene on chromosome 17
3) Skin test may be positive for aspergillus
4) Median survival rate is 10 to 15 years.
5) Is a cause of mental retardation.
42- A 67-year-old man presents with a long history of cough,breathlessness on minimal exertion and ankle swelling. He smokes 30-40 cigarettes per day.
Investigations are as follows:
What is the most likely explanation of these results?
1) acute respiratory acidosis
2) chronic respiratory acidosis
3) chronic respiratory alkalosis
4) metabolic acidosis
5) metabolic alkalosis
43- Which of the following statement is true of infections with Mycobacterium tuberculosis:
1) non-sputum producing patients are non-infectious
2) a positive tuberculin test indicates active disease
3) lymph node positive disease requires longer treatment than pulmonary disease
4) in pregnant women treatment should not be given until after delivery
5) pyrazinamide has high activity against active extracellular organisms
44- In restrictive lung disease due to respiratory muscle weakness, which of the following statements is true?
1) Low FEV1/FVC, high RV/TLC
2) Low FEV1/FVC, normal TLC
3) Low VC, low FEV1, normal TLC, low RV/TLC
4) Low VC, low RV, low TLC
5) Low VC, low TLC, high RV/TLC
45- Which of the following would be the least likely finding in a patient with sarcoidosis?
1) Hepatic granulomas
2) Restrictive pulmonary function tests
3) Skin lesions
4) Uveitis
5) X bodies on bronchoalveolar lavage (BAL) fluid
46- A 72-year-old lifelong smoker presents with progressive dyspnoea on exertion. He has a chronic, nonproductive cough. On examination he is thin, breathing with pursed lips, respiratory rate 25/min, with mild wheezing on chest auscultation.
Investigations show
What is the predominant mechanism of the airflow limitation in this gentleman?
1) Bronchospasm
2) Foreign body obstruction
3) Increased airways resistance
4) Loss of elastic recoil
5) Mucus plugging in the small airways
47- Which of the following statements regarding cryptogenic fibrosing alveolitis is correct?
1) Active inflammation may be suggested by a CT scan
2) peak flow rate is a good guide to severity
3) 80 per cent of patients iniiration
4) Reduced cardiac output
5) Reduced airway resistance
48- A 54-year old woman was admitted with acute breathlessness. On examination she had a temperature of 37.9oC, a respiratory rate of 32 breaths per minute, a pulse of 120 beats per minute, a blood pressure of 100/60 mmHg, and a peak expiratory flow rate of 250 litres per minute. Auscultation of the heart and chest was normal. The Chest X-ray was normal and blood gases on air showed: pH 7.35 (7.36 - 7.44)
She was started on high flow oxygen. What is the most important next treatment?
1) amoxycillin intravenously
2) aminophylline intravenously
3) intravenous fluids
4) low molecular weight heparin
5) nebulised salbutamol
49- A 76-year-old with a recent history of cerebral haemorrhage is admitted with a cough, worsening breathlessness and right pleuritic chest pain. He is also mildly pyrexial. His ventilation-perfusion scan reveals several areas of ventilation/perfusion mismatches. What is the most appropriate line of management?
1) aspirin therapy
2) antibiotics
3) inferior vena cava filter
4) low molecular weight heparin treatment
5) warfarin treatment
50- Which of the following is a recognised feature of massive pulmonary embolism?
1) reduced plasma lactate levels
2) an increase in serum troponin levels
3) an arterial pH less than 7.2
4) blood gases show increased pCO2 on air
5) normal D-dimer levels
1) Is an autosomal dominant condition.
2) Is due to mutation of CFTR gene on chromosome 17
3) Skin test may be positive for aspergillus
4) Median survival rate is 10 to 15 years.
5) Is a cause of mental retardation.
42- A 67-year-old man presents with a long history of cough,breathlessness on minimal exertion and ankle swelling. He smokes 30-40 cigarettes per day.
Investigations are as follows:
- Haemoglobin 19g/dl
- white blood count 7.3
- PaO2 (air) 6.2kPa
- PaCO2 (air) 8.9kPa
- serum [H+] 44 nmol/l
- serum [HCO3] 36 mmol/l
What is the most likely explanation of these results?
1) acute respiratory acidosis
2) chronic respiratory acidosis
3) chronic respiratory alkalosis
4) metabolic acidosis
5) metabolic alkalosis
43- Which of the following statement is true of infections with Mycobacterium tuberculosis:
1) non-sputum producing patients are non-infectious
2) a positive tuberculin test indicates active disease
3) lymph node positive disease requires longer treatment than pulmonary disease
4) in pregnant women treatment should not be given until after delivery
5) pyrazinamide has high activity against active extracellular organisms
44- In restrictive lung disease due to respiratory muscle weakness, which of the following statements is true?
1) Low FEV1/FVC, high RV/TLC
2) Low FEV1/FVC, normal TLC
3) Low VC, low FEV1, normal TLC, low RV/TLC
4) Low VC, low RV, low TLC
5) Low VC, low TLC, high RV/TLC
45- Which of the following would be the least likely finding in a patient with sarcoidosis?
1) Hepatic granulomas
2) Restrictive pulmonary function tests
3) Skin lesions
4) Uveitis
5) X bodies on bronchoalveolar lavage (BAL) fluid
46- A 72-year-old lifelong smoker presents with progressive dyspnoea on exertion. He has a chronic, nonproductive cough. On examination he is thin, breathing with pursed lips, respiratory rate 25/min, with mild wheezing on chest auscultation.
Investigations show
- FEV1 0.8 L
- FVC 1.6 L
- pH 7.35
- paCO2 45 mmHg
- paO2 55 mmHg
What is the predominant mechanism of the airflow limitation in this gentleman?
1) Bronchospasm
2) Foreign body obstruction
3) Increased airways resistance
4) Loss of elastic recoil
5) Mucus plugging in the small airways
47- Which of the following statements regarding cryptogenic fibrosing alveolitis is correct?
1) Active inflammation may be suggested by a CT scan
2) peak flow rate is a good guide to severity
3) 80 per cent of patients iniiration
4) Reduced cardiac output
5) Reduced airway resistance
48- A 54-year old woman was admitted with acute breathlessness. On examination she had a temperature of 37.9oC, a respiratory rate of 32 breaths per minute, a pulse of 120 beats per minute, a blood pressure of 100/60 mmHg, and a peak expiratory flow rate of 250 litres per minute. Auscultation of the heart and chest was normal. The Chest X-ray was normal and blood gases on air showed: pH 7.35 (7.36 - 7.44)
- Pa02 6.0
- kPa (11.3 - 12.6)
- PaC02 3.9
- kPa (4.7 - 6.0)
- Serum bicarbonate 20 mmol/l (20 - 28)
She was started on high flow oxygen. What is the most important next treatment?
1) amoxycillin intravenously
2) aminophylline intravenously
3) intravenous fluids
4) low molecular weight heparin
5) nebulised salbutamol
49- A 76-year-old with a recent history of cerebral haemorrhage is admitted with a cough, worsening breathlessness and right pleuritic chest pain. He is also mildly pyrexial. His ventilation-perfusion scan reveals several areas of ventilation/perfusion mismatches. What is the most appropriate line of management?
1) aspirin therapy
2) antibiotics
3) inferior vena cava filter
4) low molecular weight heparin treatment
5) warfarin treatment
50- Which of the following is a recognised feature of massive pulmonary embolism?
1) reduced plasma lactate levels
2) an increase in serum troponin levels
3) an arterial pH less than 7.2
4) blood gases show increased pCO2 on air
5) normal D-dimer levels
51- Which of the following statements is true of the diffusion capacity of carbon monoxide?
1) Is a specific measure of lung perfusion.
2) Depends on the thickness of the alveolar wall.
3) Depends on the surface area available for gas exchange.
4) Is increased in cigarette smokers.
5) Is increased in emphysema.
52- A 19 year old woman became breathless while travelling on an aeroplane. Which one of the following features most strongly supports a diagnosis of acute hyperventilation related to a panic disorder?
1) Carpal spasm.
2) Finger paraesthesiae.
3) Hypotension.
4) Light-headedness.
5) Loss of conciousness
53- A 64-year-old man is found to have squamous cell bronchogenic carcinoma. Which of the following statements is true regarding surgical resection?
1) An FEV1 of 2 L is a major contraindication to surgical resection.
2) Hypercalcaemia makes further assessment for surgery unnecessary.
3) Is precluded if a CT scan of the thorax shows enlarged mediastinal lymph nodes.
4) Positive sputum cytology excludes the need for bronchoscopic examination of the airways.
5) The presence of finger clubbing indicates that liver metastases are already present.
54- A 60-year-old man with breathlessness, fever and headache is suspected of having Farmers Lung. A CXR shows diffuse nodular shadowing predominantly in the mid and lower zones. What would be the most useful diagnostic test?
1) Blood Culture
2) Sputum Culture
3) Serum precipitating antibodies to Micropolyspora faeni
4) Serum Precipitating antibodies to Aspergillus clavatus
5) Serum Precipitating antibodies to Cryptostroma corticale
55- A 43-year-old asthmatic develops worsening breathlessness and his full blood count has revealed an eosinophilia. Which of the following statements is true with allergic bronchopulmonary aspergillosis that the patient is likely to suffer from?
1) The immediate skin test to an extract of aspergillus fumigatus is negative
2) Circulating IgG precipitins to aspergillus fumigatus are positive
3) The CO transfer factor is unaffected
4) Recurrent haemoptysis is a characteristic feature
5) Pleural effusion is a complication
56- A 35-year-old man presents after 3 months of chronic cough with purulent sputum and shortness of breath on exertion. He gives a history of at least two sinus or bronchial infections per year requiring treatment with antibiotics. He also says he and his wife have been unable to have children. He smokes 15 cigarettes per day. Examination is normal except for some wheezing and an area of focal crackles at the left lung base.
Chest X-ray shows patchy infiltrates at both bases.
Investigations revealed
What is the most likely diagnosis?
1) alpha-1-Antitrypsin (Antiprotease) deficiency
2) Asthma
3) Cystic fibrosis
4) Hypogammaglobulinemia
5) Immotile cilia syndrome
57- An 18 year old attending the A+E department is noted to have central cyanosis. She is perfectly well but was told to go to A+E by her friends who said she looked blue. What is the most likely cause?
1) Carbon Monoxide Poisoning
2) Lead Poisoning
3) Drinking water contaminated with nitrates
4) Anorexia Nervosa
5) Severe Anaemia
58- A 59 year old female smoker is diagnosed with oat cell carcinoma of the bronchus. Which of the following relating to this diagnosis is true?
1) The tumour is likely to be radiosensitive
2) occurs with equal frequency in smokers and non-smokers
3) has a 5 year survival greater than 20%
4) Is associated with the elaboration of ectopic ADH secretion
5) Is typically associated with ectopic parathormone secretion.
59- Which of the following conditions may give a false/positive sweat test?
1) Congenital adrenal hyperplasia
2) Hyperthyroidism
3) Hyperparathyroidism
4) Obesity
5) Glucose-6-phosphatase deficiency
60- A 60-year-old man was diagnosed last year with adenocarcinoma of the lung, and a 4 cm mass lesion was treated with a right lower lobectomy. He now has an abdominal CT scan that reveals scattered hepatic mass lesions and hilar lymphadenopathy. For several weeks, he has had increasing malaise. A urinalysis reveals marked proteinuria, and a 24 hour urine protein collection is 2.7 g/24hr. His serum urea is 30 mmol/L (2.5 - 7.5) with creatinine of 450 µmol/L (60 - 110). A renal biopsy is performed, and there is focal deposition of IgG and C3 with a granular pattern. He is most likely to have which of the following conditions?
1) Goodpasture's syndrome
2) Membranous glomerulonephritis
3) Minimal change glomerulonephritis
4) Nodular glomerulosclerosis
5) Rapidly progressive glomerulonephritis
1) Is a specific measure of lung perfusion.
2) Depends on the thickness of the alveolar wall.
3) Depends on the surface area available for gas exchange.
4) Is increased in cigarette smokers.
5) Is increased in emphysema.
52- A 19 year old woman became breathless while travelling on an aeroplane. Which one of the following features most strongly supports a diagnosis of acute hyperventilation related to a panic disorder?
1) Carpal spasm.
2) Finger paraesthesiae.
3) Hypotension.
4) Light-headedness.
5) Loss of conciousness
53- A 64-year-old man is found to have squamous cell bronchogenic carcinoma. Which of the following statements is true regarding surgical resection?
1) An FEV1 of 2 L is a major contraindication to surgical resection.
2) Hypercalcaemia makes further assessment for surgery unnecessary.
3) Is precluded if a CT scan of the thorax shows enlarged mediastinal lymph nodes.
4) Positive sputum cytology excludes the need for bronchoscopic examination of the airways.
5) The presence of finger clubbing indicates that liver metastases are already present.
54- A 60-year-old man with breathlessness, fever and headache is suspected of having Farmers Lung. A CXR shows diffuse nodular shadowing predominantly in the mid and lower zones. What would be the most useful diagnostic test?
1) Blood Culture
2) Sputum Culture
3) Serum precipitating antibodies to Micropolyspora faeni
4) Serum Precipitating antibodies to Aspergillus clavatus
5) Serum Precipitating antibodies to Cryptostroma corticale
55- A 43-year-old asthmatic develops worsening breathlessness and his full blood count has revealed an eosinophilia. Which of the following statements is true with allergic bronchopulmonary aspergillosis that the patient is likely to suffer from?
1) The immediate skin test to an extract of aspergillus fumigatus is negative
2) Circulating IgG precipitins to aspergillus fumigatus are positive
3) The CO transfer factor is unaffected
4) Recurrent haemoptysis is a characteristic feature
5) Pleural effusion is a complication
56- A 35-year-old man presents after 3 months of chronic cough with purulent sputum and shortness of breath on exertion. He gives a history of at least two sinus or bronchial infections per year requiring treatment with antibiotics. He also says he and his wife have been unable to have children. He smokes 15 cigarettes per day. Examination is normal except for some wheezing and an area of focal crackles at the left lung base.
Chest X-ray shows patchy infiltrates at both bases.
Investigations revealed
- FEV1 2.0 L
- FVC 2.7 L
- pH 7.38
- PaCO2 40 mmHg
- PaO2 82 mmHg
What is the most likely diagnosis?
1) alpha-1-Antitrypsin (Antiprotease) deficiency
2) Asthma
3) Cystic fibrosis
4) Hypogammaglobulinemia
5) Immotile cilia syndrome
57- An 18 year old attending the A+E department is noted to have central cyanosis. She is perfectly well but was told to go to A+E by her friends who said she looked blue. What is the most likely cause?
1) Carbon Monoxide Poisoning
2) Lead Poisoning
3) Drinking water contaminated with nitrates
4) Anorexia Nervosa
5) Severe Anaemia
58- A 59 year old female smoker is diagnosed with oat cell carcinoma of the bronchus. Which of the following relating to this diagnosis is true?
1) The tumour is likely to be radiosensitive
2) occurs with equal frequency in smokers and non-smokers
3) has a 5 year survival greater than 20%
4) Is associated with the elaboration of ectopic ADH secretion
5) Is typically associated with ectopic parathormone secretion.
59- Which of the following conditions may give a false/positive sweat test?
1) Congenital adrenal hyperplasia
2) Hyperthyroidism
3) Hyperparathyroidism
4) Obesity
5) Glucose-6-phosphatase deficiency
60- A 60-year-old man was diagnosed last year with adenocarcinoma of the lung, and a 4 cm mass lesion was treated with a right lower lobectomy. He now has an abdominal CT scan that reveals scattered hepatic mass lesions and hilar lymphadenopathy. For several weeks, he has had increasing malaise. A urinalysis reveals marked proteinuria, and a 24 hour urine protein collection is 2.7 g/24hr. His serum urea is 30 mmol/L (2.5 - 7.5) with creatinine of 450 µmol/L (60 - 110). A renal biopsy is performed, and there is focal deposition of IgG and C3 with a granular pattern. He is most likely to have which of the following conditions?
1) Goodpasture's syndrome
2) Membranous glomerulonephritis
3) Minimal change glomerulonephritis
4) Nodular glomerulosclerosis
5) Rapidly progressive glomerulonephritis
61- The morphological appearance of Pneumocystis carinii infection in the lung is best characterised as which one of the following?
1) A bronchopneumonia with abscess formation
2) A haemorrhagic and necrotizing pneumonia
3) An acute respiratory distress syndrome (ARDS) with widespread hyaline membrane formation
4) An interstitial pneumonitis with foamy intra-alveolar exudate
5) An organizing bronchopneumonia
62- Which of the following statements is NOT true of primary pulmonary tuberculosis:
1) It is characteristically asymptomatic
2) Miliary spread is commoner in a younger age group
3) The initial immunological response causes hilar lympadenopathy
4) pleural effusion occurs before tuberculin skin testing is positive
5) A positive tuberculin skin test develops within two weeks of infection
63- In which of the following have randomised controlled trials shown that long-term oxygen therapy (LTOT) reduces mortality?
1) Asthma
2) Cor pulmonale due to chronic airflow obstruction
3) Cryptogenic fibrosing alveolitis
4) Cystic fibrosis
5) Pulmonary sarcoidosis
64- Which ONE of the following is true regarding acute pulmonary embolism?
1) a normal ECG excludes the diagnosis
2) embolectomy is more effective than thrombolysis in improving survival
3) Heparin is as effective as thrombolytic therapy
4) the presence of hypoxaemia is an indication for thrombolysis
5) thrombolysis administered through a peripheral vein is as effective as through a pulmonary artery catheter
65- A 36 year old man complains of a persistent cough. A CXR shows fibrosis of both upper lobes. What is the most likely diagnosis?
1) Systemic Sclerosis
2) Primary Pulmonary Hypertension
3) Cystic Fibrosis
4) Ankylosing Spondylitis
5) Allergic bronchopulmonary aspergillosis
66- Which one of the following statements is true of chronic obstructive pulmonary disease?
1) patients show at least a 15 per cent improvement in the FEV1 after nebulised bronchodilator
2) inhaled corticosteroid usage does not improve long-term prognosis
3) breathlessness is uncommon until the FEV1 falls to approximately 50 per cent of predicted
4) emphysema is associated with increased transfer factor
5) in advanced cases there is reduced pulmonary vascular resistance
67- A 16 year old boy with cystic fibrosis presents with abdominal pain. Which of the following is most likely to be the cause?
1) Ulcerative colitis
2) Irritable Bowel Syndrome
3) Pyelonephritis
4) Meconium Ileus Equivalent Syndrome
5) Renal Calculi
68- A patients' arterial blood gases give the following results; pO2 10 kPa (75mmHg), pCO2 7 kPa (52 mmHg), pH 7.47, [HCO3-] 37. Which of the following is the most likely cause?
1) Chronic Hyperventilation Syndrome
2) Acute exacerbation of COPD
3) Several days of Pyloric obstruction
4) Pulmonary Embolism
5) Diabetic Coma
69- A patient with Rheumatoid arthritis complains of progressive breathlessness. Which of the following is the most likely cause?
1) Pulmonary Eosinophilia
2) Asthma [0]
3) Pulmonary nodules
4) Fibrosing Alveolitis
5) Pulmonary Embolus
70- In the normal adolescent lung which of the following is correct?
1) There is an intrapleural pressure of 30 cmH2O (3kPa) at the end of normal expiration.
2) There is a resting pulmonary blood flow of 10L/min.
3) The V:Q ratio is greater in apical than basal segments of the lung when upright and at rest.
4) The majority of airway resistance is from large airways.
5) Cartilage is present in all respiratory bronchioles.
1) A bronchopneumonia with abscess formation
2) A haemorrhagic and necrotizing pneumonia
3) An acute respiratory distress syndrome (ARDS) with widespread hyaline membrane formation
4) An interstitial pneumonitis with foamy intra-alveolar exudate
5) An organizing bronchopneumonia
62- Which of the following statements is NOT true of primary pulmonary tuberculosis:
1) It is characteristically asymptomatic
2) Miliary spread is commoner in a younger age group
3) The initial immunological response causes hilar lympadenopathy
4) pleural effusion occurs before tuberculin skin testing is positive
5) A positive tuberculin skin test develops within two weeks of infection
63- In which of the following have randomised controlled trials shown that long-term oxygen therapy (LTOT) reduces mortality?
1) Asthma
2) Cor pulmonale due to chronic airflow obstruction
3) Cryptogenic fibrosing alveolitis
4) Cystic fibrosis
5) Pulmonary sarcoidosis
64- Which ONE of the following is true regarding acute pulmonary embolism?
1) a normal ECG excludes the diagnosis
2) embolectomy is more effective than thrombolysis in improving survival
3) Heparin is as effective as thrombolytic therapy
4) the presence of hypoxaemia is an indication for thrombolysis
5) thrombolysis administered through a peripheral vein is as effective as through a pulmonary artery catheter
65- A 36 year old man complains of a persistent cough. A CXR shows fibrosis of both upper lobes. What is the most likely diagnosis?
1) Systemic Sclerosis
2) Primary Pulmonary Hypertension
3) Cystic Fibrosis
4) Ankylosing Spondylitis
5) Allergic bronchopulmonary aspergillosis
66- Which one of the following statements is true of chronic obstructive pulmonary disease?
1) patients show at least a 15 per cent improvement in the FEV1 after nebulised bronchodilator
2) inhaled corticosteroid usage does not improve long-term prognosis
3) breathlessness is uncommon until the FEV1 falls to approximately 50 per cent of predicted
4) emphysema is associated with increased transfer factor
5) in advanced cases there is reduced pulmonary vascular resistance
67- A 16 year old boy with cystic fibrosis presents with abdominal pain. Which of the following is most likely to be the cause?
1) Ulcerative colitis
2) Irritable Bowel Syndrome
3) Pyelonephritis
4) Meconium Ileus Equivalent Syndrome
5) Renal Calculi
68- A patients' arterial blood gases give the following results; pO2 10 kPa (75mmHg), pCO2 7 kPa (52 mmHg), pH 7.47, [HCO3-] 37. Which of the following is the most likely cause?
1) Chronic Hyperventilation Syndrome
2) Acute exacerbation of COPD
3) Several days of Pyloric obstruction
4) Pulmonary Embolism
5) Diabetic Coma
69- A patient with Rheumatoid arthritis complains of progressive breathlessness. Which of the following is the most likely cause?
1) Pulmonary Eosinophilia
2) Asthma [0]
3) Pulmonary nodules
4) Fibrosing Alveolitis
5) Pulmonary Embolus
70- In the normal adolescent lung which of the following is correct?
1) There is an intrapleural pressure of 30 cmH2O (3kPa) at the end of normal expiration.
2) There is a resting pulmonary blood flow of 10L/min.
3) The V:Q ratio is greater in apical than basal segments of the lung when upright and at rest.
4) The majority of airway resistance is from large airways.
5) Cartilage is present in all respiratory bronchioles.
71- Sleep Apnoea syndrome is best diagnosed by the following:
1) Polygraphic Sleep Studies
2) therapeutic trial of amphetamines
3) EEG
4) Blood gases during apneic episodes
5) Presence of HLA-DR2 and DQw1
72- A 70-year-old man presented with weight loss and haemoptysis. He was a heavy smoker. A chest radiograph showed a mass lesion in the left lung bronchoscopic biopsies confirmed a squamous carcinoma.
1) Chest wall invasion by primary tumour
2) An enlarged mediastinal lymph node on CT scanning
3) Forced expiratory volume (FEV1) of 1.2 litres
4) Hypercalcaemia
5) Malignant pleural effusion
73- Which of the following statements regarding prognosis in lung cancer is true?
1) Combined modality therapy (chemotherapy, radiation therapy and surgery) has improved overall lung cancer survival to 40% at 5 years.
2) Overall lung cancer survival is < 15% at 5 years.
3) Patients undergoing radiation therapy have a 5 year survival of 40%.
4) Patients who qualify for surgery have a 50% 5 year survival.
5) With chemotherapy, overall survival in small cell (oat cell) carcinomas has risen to 60% at 5 years.
74- A breathless patient undergoes pulmonary Function testing. The following results are obtained; FEV1 = 74% predicted, FVC = 68% predicted, TLC = 77% predicted, Tlco = 46% predicted, Kco = 53% predicted. Which of the following is the most likely cause ?
1) COPD
2) Asthma
3) Cryptogenic Fibrosing Alveolitis
4) Morbid obesity
5) kyphoscoliosis
75- A lifelong non-smoker is diagnosed with emphysema. Which of the following would be the most likely aetiological agent ?
1) Isocyanates
2) Cadmium Exposure
3) Steel
4) Zinc
5) Asbestos
76- Which cell type is responsible for the early asthmatic response?
1) Basophil
2) Eosinophil
3) Mast cell
4) Neutrophil
5) TH1-lymphocyte
77- A 43-year-old Caribbean female Comprehensive school teacher complains of slowly increasing breathlessness. She has no smoking history. Investigations reveal she has bilateral enlarged hilar lymph nodes, elevated serum calcium, interstitial lung disease, and enlarged liver and spleen. What is the most likely diagnosis?
1) Coccidioidomycosis [0]
2) Hyperparathyroidism [0]
3) Hypervitaminosis D [0]
4) Sarcoidosis [100]
5) Tuberculosis [0]
78- A 58-year-old man presents with weight loss and haemoptysis. He has smoked most of his life. On examination he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 3.2mM. Which of the following histological type of lung cancer is he most likely to suffer from?
1) mesothelioma
2) small cell carcinoma
3) large cell carcinoma
4) squamous cell carcinoma
5) adenocarcinoma
79- A 68-year-old man presents with a one-month history of dyspnoea and a 3kg weight loss. On examination there were signs of a large left pleural effusion, confirmed on Chest X-ray.
Investigations revealed:
Cytology a few lymphocytes and red blood cells.
Which one of the following investigations should be considered next?
1) Bronchoscopy.
2) CT scan of thorax.
3) Repeat pleural aspiration with biopsy.
4) Thoracoscopic pleural biopsy.
5) Tuberculin test.
80- A 63-year-old woman presents a 5 day history of progressive shortness of breath. Her family brought her in because she was increasingly sleepy during the last 24 hours. She was diagnosed with Chronic Obstructive Pulmonary Disease 3 years ago and has a FEV1 less than 50% of predicted. She has an oxygen concentrator at home.
Examination revealed depressed consciousness and a respiratory rate of 24 with shallow breaths. There were decreased breath sounds with minimal air movement. If an arterial blood gas on room air were to be performed, which of the following results would you expect?
1) pH 7.16 paCO2 70 paO2 50 HCO3 24
2) pH 7.24 paCO2 80 paO2 55 HCO3 30
3) pH 7.32 paCO2 60 paO2 70 HCO3 30
4) pH 7.41 paCO2 40 paO2 50 HCO3 24
5) pH 7.48 paCO2 30 paO2 85 HCO3 24
1) Polygraphic Sleep Studies
2) therapeutic trial of amphetamines
3) EEG
4) Blood gases during apneic episodes
5) Presence of HLA-DR2 and DQw1
72- A 70-year-old man presented with weight loss and haemoptysis. He was a heavy smoker. A chest radiograph showed a mass lesion in the left lung bronchoscopic biopsies confirmed a squamous carcinoma.
1) Chest wall invasion by primary tumour
2) An enlarged mediastinal lymph node on CT scanning
3) Forced expiratory volume (FEV1) of 1.2 litres
4) Hypercalcaemia
5) Malignant pleural effusion
73- Which of the following statements regarding prognosis in lung cancer is true?
1) Combined modality therapy (chemotherapy, radiation therapy and surgery) has improved overall lung cancer survival to 40% at 5 years.
2) Overall lung cancer survival is < 15% at 5 years.
3) Patients undergoing radiation therapy have a 5 year survival of 40%.
4) Patients who qualify for surgery have a 50% 5 year survival.
5) With chemotherapy, overall survival in small cell (oat cell) carcinomas has risen to 60% at 5 years.
74- A breathless patient undergoes pulmonary Function testing. The following results are obtained; FEV1 = 74% predicted, FVC = 68% predicted, TLC = 77% predicted, Tlco = 46% predicted, Kco = 53% predicted. Which of the following is the most likely cause ?
1) COPD
2) Asthma
3) Cryptogenic Fibrosing Alveolitis
4) Morbid obesity
5) kyphoscoliosis
75- A lifelong non-smoker is diagnosed with emphysema. Which of the following would be the most likely aetiological agent ?
1) Isocyanates
2) Cadmium Exposure
3) Steel
4) Zinc
5) Asbestos
76- Which cell type is responsible for the early asthmatic response?
1) Basophil
2) Eosinophil
3) Mast cell
4) Neutrophil
5) TH1-lymphocyte
77- A 43-year-old Caribbean female Comprehensive school teacher complains of slowly increasing breathlessness. She has no smoking history. Investigations reveal she has bilateral enlarged hilar lymph nodes, elevated serum calcium, interstitial lung disease, and enlarged liver and spleen. What is the most likely diagnosis?
1) Coccidioidomycosis [0]
2) Hyperparathyroidism [0]
3) Hypervitaminosis D [0]
4) Sarcoidosis [100]
5) Tuberculosis [0]
78- A 58-year-old man presents with weight loss and haemoptysis. He has smoked most of his life. On examination he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 3.2mM. Which of the following histological type of lung cancer is he most likely to suffer from?
1) mesothelioma
2) small cell carcinoma
3) large cell carcinoma
4) squamous cell carcinoma
5) adenocarcinoma
79- A 68-year-old man presents with a one-month history of dyspnoea and a 3kg weight loss. On examination there were signs of a large left pleural effusion, confirmed on Chest X-ray.
Investigations revealed:
- Pleural fluid analysis:
- Protein 38 g/L
Cytology a few lymphocytes and red blood cells.
Which one of the following investigations should be considered next?
1) Bronchoscopy.
2) CT scan of thorax.
3) Repeat pleural aspiration with biopsy.
4) Thoracoscopic pleural biopsy.
5) Tuberculin test.
80- A 63-year-old woman presents a 5 day history of progressive shortness of breath. Her family brought her in because she was increasingly sleepy during the last 24 hours. She was diagnosed with Chronic Obstructive Pulmonary Disease 3 years ago and has a FEV1 less than 50% of predicted. She has an oxygen concentrator at home.
Examination revealed depressed consciousness and a respiratory rate of 24 with shallow breaths. There were decreased breath sounds with minimal air movement. If an arterial blood gas on room air were to be performed, which of the following results would you expect?
1) pH 7.16 paCO2 70 paO2 50 HCO3 24
2) pH 7.24 paCO2 80 paO2 55 HCO3 30
3) pH 7.32 paCO2 60 paO2 70 HCO3 30
4) pH 7.41 paCO2 40 paO2 50 HCO3 24
5) pH 7.48 paCO2 30 paO2 85 HCO3 24
81- A 47 year old woman presenting with breathlessness has arterial blood gases taken which give the following results: pO2 8.7 kPa (65mmHg), pCO2 4.4 kPa (33mmHg), pH 7.46, {HCO3-] 24. Which of the following is the most likely diagnosis.
1) Hyperventilation syndrome
2) Acute severe asthma
3) Emphysema
4) Kyphoscoliosis
5) Opiate overdose
82- Which of the following forms of pulmonary embolism is the commonest cause of secondary pulmonary hypertension?
1) Air embolism (Caisson's disease)
2) Fat embolism
3) Massive pulmonary embolism (e.g., saddle embolism)
4) Multiple small recurrent pulmonary embolism
5) Paradoxical embolism
83- Primary Pulmonary tuberculosis:
1) Leads to pleural effusion
2) Is highly infective
3) Commonly leads to military TB
4) May be totally asymptomatic
5) Usually produces cavitation
84- An elderly man with a history of asthma, congestive heart failure, and peptic ulcer disease is admitted with bronchospasm and rapid atrial fibrillation. He recieves frequent nebulised salbutamol and IV digoxin loading, his regular medications are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most likely to have caused this abnormality.
1) Digoxin
2) ACE inhibitor
3) Salbutamol
4) Ranitidine
5) Spironolactone
85- The parents of a child with cystic fibrosis consult you wishing to know what is the risk of their next child being a carrier of the condition. Which ONE of the following percentages is the correct risk?
1) 0%
2) 25%
3) 50%
4) 75%
5) 100%
86- Most of the cells that fill the alveoli in desquamative interstitial pneumonitis (DIP) are which of the following?
1) Eosinophils
2) Lymphocytes
3) Macrophages
4) Neutrophils
5) Plasma cells
87- A 50-year-old male is taken to the General Practitioner by his long suffering wife. His snoring (which has been steadily increasing in loudness over the past 18 months) is troublesome at home. She says that he makes noises and moves around whilst asleep. He reports no problems with sleeping. He does admit to gaining 20 kg in weight over the past one year, and to falling asleep during the day.
A sleep study is performed. Which of the following findings would be most compatible with this man's clinical presentation?
1) Fragmented sleep, cessations of airflow measured at the nose accompanied by an increase in oesophageal pressure swings and episodic oxygen desaturation.
2) Normal sleep quality, bradycardic episodes, oxygen desaturation but normal airflow.
3) Normal sleep quality but cessations of airflow measured at the nose with decreased abdominal wall motion during these flow cessations.
4) Progressive oxygen desaturation during the night and alternating periods of hyperventilation and hypoventilation.
5) Tachycardia, sleep fragmentation, episodes of hypoventilation with minimal oxygen desaturation.
88- A 42 year old woman presents with an acute attack of asthma. She is able to speak in short sentences. Her respiratory rate is 28 breaths per minute and the peak expiratory flow rate 120L/min (predicted 480 L/min. What is the most appropriate treatment for this patient?
1) Intravenous aminophylline.
2) Intravenous salbutamol
3) Nebulized salbutamol
4) Oral salbutamol
5) Oral theophylline
89- A 15 year old boy presented with wheezing when playing football and nocturnal cough.
Which is the best test to confirm the underlying condition?
1) A trial of oral corticosteroids
2) A trial of inhaled corticosteroids
3) A trial of inhaled salbutamol
4) Serial peak expiratory flow rate measurements
5) Spirometry alone
90- Which of the following is NOT true with regard to the radiological appearance of a chest X-ray?
1) Consolidation of the right middle lobe will obliterate the right atrial shadow in the PA view
2) Consolidation of the right apical lobe will extend to the horizontal fissure in the PA view
3) Consolidation of the right anterior segment of the right middle lobe will extend to the right transverse fissure and the right hilum in PA view
4) A consolidation of the lingular lobe will obliterate the aortic knuckle and pulmonary trunk in the PA view
5) A consolidation of the left lower lobe will elevate the left hemidiaphragm
1) Hyperventilation syndrome
2) Acute severe asthma
3) Emphysema
4) Kyphoscoliosis
5) Opiate overdose
82- Which of the following forms of pulmonary embolism is the commonest cause of secondary pulmonary hypertension?
1) Air embolism (Caisson's disease)
2) Fat embolism
3) Massive pulmonary embolism (e.g., saddle embolism)
4) Multiple small recurrent pulmonary embolism
5) Paradoxical embolism
83- Primary Pulmonary tuberculosis:
1) Leads to pleural effusion
2) Is highly infective
3) Commonly leads to military TB
4) May be totally asymptomatic
5) Usually produces cavitation
84- An elderly man with a history of asthma, congestive heart failure, and peptic ulcer disease is admitted with bronchospasm and rapid atrial fibrillation. He recieves frequent nebulised salbutamol and IV digoxin loading, his regular medications are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most likely to have caused this abnormality.
1) Digoxin
2) ACE inhibitor
3) Salbutamol
4) Ranitidine
5) Spironolactone
85- The parents of a child with cystic fibrosis consult you wishing to know what is the risk of their next child being a carrier of the condition. Which ONE of the following percentages is the correct risk?
1) 0%
2) 25%
3) 50%
4) 75%
5) 100%
86- Most of the cells that fill the alveoli in desquamative interstitial pneumonitis (DIP) are which of the following?
1) Eosinophils
2) Lymphocytes
3) Macrophages
4) Neutrophils
5) Plasma cells
87- A 50-year-old male is taken to the General Practitioner by his long suffering wife. His snoring (which has been steadily increasing in loudness over the past 18 months) is troublesome at home. She says that he makes noises and moves around whilst asleep. He reports no problems with sleeping. He does admit to gaining 20 kg in weight over the past one year, and to falling asleep during the day.
A sleep study is performed. Which of the following findings would be most compatible with this man's clinical presentation?
1) Fragmented sleep, cessations of airflow measured at the nose accompanied by an increase in oesophageal pressure swings and episodic oxygen desaturation.
2) Normal sleep quality, bradycardic episodes, oxygen desaturation but normal airflow.
3) Normal sleep quality but cessations of airflow measured at the nose with decreased abdominal wall motion during these flow cessations.
4) Progressive oxygen desaturation during the night and alternating periods of hyperventilation and hypoventilation.
5) Tachycardia, sleep fragmentation, episodes of hypoventilation with minimal oxygen desaturation.
88- A 42 year old woman presents with an acute attack of asthma. She is able to speak in short sentences. Her respiratory rate is 28 breaths per minute and the peak expiratory flow rate 120L/min (predicted 480 L/min. What is the most appropriate treatment for this patient?
1) Intravenous aminophylline.
2) Intravenous salbutamol
3) Nebulized salbutamol
4) Oral salbutamol
5) Oral theophylline
89- A 15 year old boy presented with wheezing when playing football and nocturnal cough.
Which is the best test to confirm the underlying condition?
1) A trial of oral corticosteroids
2) A trial of inhaled corticosteroids
3) A trial of inhaled salbutamol
4) Serial peak expiratory flow rate measurements
5) Spirometry alone
90- Which of the following is NOT true with regard to the radiological appearance of a chest X-ray?
1) Consolidation of the right middle lobe will obliterate the right atrial shadow in the PA view
2) Consolidation of the right apical lobe will extend to the horizontal fissure in the PA view
3) Consolidation of the right anterior segment of the right middle lobe will extend to the right transverse fissure and the right hilum in PA view
4) A consolidation of the lingular lobe will obliterate the aortic knuckle and pulmonary trunk in the PA view
5) A consolidation of the left lower lobe will elevate the left hemidiaphragm
91- Which of the following statements is true of psittacosis (ornithosis):
1) It is only a risk from contact with psittacines (parrots), not other birds
2) It usually causes many polymorphs to be present in the sputem
3) It is more of a risk to children than to adults who are exposed to birds
4) It does spread from person to person
5) Infection responds rapidly to penicillin therapy
92- Which of the following statements is true regarding smoking in pregnancy?
1) Smoking assists in maturation of the fetal lung.
2) The reduction in birth weight is related to the number of cigarettes smoked per day.
3) Maternal smoking may adversely affect testicular function in male children.
4) Dysmorphic facies is a recognised complication.
5) The newborn baby may require adjustments in drug dosages because of it.
93- A 54-year old woman was admitted with acute breathlessness. On examination she had a temperature of 37.9oC, a respiratory rate of 32 breaths per minute, a pulse of 120 beats per minute, a blood pressure of 100/60 mmHg, and a peak expiratory flow rate of 250 litres per minute.
Auscultation of the heart and chest was normal.
Investigations:
The Chest X-ray was normal.
blood gases on air showed:
She was started on high flow oxygen. What is the most important next treatment?
1) amoxycillin intravenously
2) aminophylline intravenously
3) intravenous fluids
4) low molecular weight heparin
5) nebulised salbutamol
94- A 45 year old female presents with a 6 month history of exertional dyspnoea and is diagnosed with pulmonary fibrosis. Over the last one year she has received a variety of medications. Which of the following drugs could be responsible?
1) Dexamethasone
2) Ibuprofen
3) nalidixic acid
4) penicillamine
5) sulphasalazine
95- Which one of the following is correct regarding long-acting beta-2 agonists?
1) Can be used to prevent activity-induced symptoms without anti-inflammatory therapy.
2) Become less effective over time (tolerance).
3) Are beneficial in acute viral croup.
4) Protect against allergen challenge for up to 48 hours.
5) Should not be used in association with erythromycin.
96- A 45-year-old man develops facial swelling and breathlessness. His chest X-ray reveals paratracheal lymphadenopathy. Which of the following statements is most accurate regarding the superior vena caval obstruction?
1) the most common cause is squamous cell carcinoma
2) treatment of choice is radiotherapy
3) it may be associated with voice hoarseness
4) it is associated with Kussmaul's sign
5) the commonest symptom is stridor
97- A 55 year old man presents with ataxia and bilateral gynaecomastia.
Which of the following is the most likely diagnosis?
1) Kleinfelters Syndrome
2) Long term treatment with cyclophosphamide for Wegener's Granulomatosis
3) Long term treatment with oral steroids for chronic asthma
4) Bronchial Carcinoma
5) Hypereosinophilic Syndrome
98- A 55-year-old plumber presented with a dry nocturnal cough and increasing exertional breathlessness.
On examination he had early finger clubbing, cyanosis and bilateral basal crackles. A chest X-ray showed bilateral lower zone shadowing.
Investigations revealed:
Which of the following investigations is most likely to establish the diagnosis?
1) Echocardiography.
2) High resolution CT scan of chest
3) Measurement of diffusion capacity
4) Serum angiotensin-converting enzyme (ACE) level
5) Transbronchial lung biopsy
99- Which of the following statemtns regarding the sweat test is true?
1) Sweating is enhanced by application of atropine.
2) The filter paper is left on for a total of about 4 hours.
3) At least 25mg of sweat is necessary for a reliable result.
4) More than 60mmol/L of chloride in sweat is diagnostic of cystic fibrosis.
5) False/positive results may be encountered in children with nephrotic syndrome.
100- A 7 month old boy is presented to a doctor by his parents with symptoms of reccurent upper respiratory tract infections. No other members of the family suffer from any smiliar infections.Physical examination showed mild facial hypoplasia. Biochemistry investigations revealed hypocalcaemia. Microbiological investigations were normal and immunoglobulins were within normal limits. The infants immune function would show the following deficiency:
1) Complement Deficieny
2) B cell number and function
3) T cell number and function
4) Plasma Cell
5) Macrophage number and function
101- Progressive Massive Fibrosis (PMF) is most likely to be found in which of the following?
1) Complicated silicosis
2) Extrinsic allergic alveolitis
3) Lobar pneumonia
4) Sarcoidosis
5) Simple coal workers pneumoconiosis
102-A 17-year-old girl with known cystic fibrosis presents with a chest infection. What antibiotic would be most suitable for her?
1) Augmentin
2) Cefotaxime
3) Ceftazidime
4) Gentamicin
5) Amoxicillin
103-A 21-year-old gentleman with cystic fibrosis presents with infertility. What is the most likely cause for this?
1) Chronic prostatic insufficiency
2) Failure of development of the vas deferens
3) Increasing alkalinisation of semen
4) Primary failure of testosterone production
5) Production of anti-sperm antibodies
104-A 16-year-old girl presents with shortness of breath and insomnia prior to an examination. Clinical examination is normal. CXR and PEFR are normal. Which of the following investigations is most suggestive of asthma?
1) diurnal variation in PEFR> 20%
2) positive skin prick test to common allergens
3) past medical history of hayfever and eczema
4) increased total IgE
5) resolution of symptoms the day after the exam
105-A 65-year-old female presents with a 3 week history of malaise and blood in her sputum. Bronchoscopy reveals a mass in the right main bronchus, and histology demonstrates it to be a small cell carcinoma. Further investigation fails to show any metastases. What is the most appropriate step in management?
1) Chemotherapy
2) Endobronchial laser therapy
3) Radiotherapy
4) Surgery
5) Palliative therapy
Go to next Page: 1) It is only a risk from contact with psittacines (parrots), not other birds
2) It usually causes many polymorphs to be present in the sputem
3) It is more of a risk to children than to adults who are exposed to birds
4) It does spread from person to person
5) Infection responds rapidly to penicillin therapy
92- Which of the following statements is true regarding smoking in pregnancy?
1) Smoking assists in maturation of the fetal lung.
2) The reduction in birth weight is related to the number of cigarettes smoked per day.
3) Maternal smoking may adversely affect testicular function in male children.
4) Dysmorphic facies is a recognised complication.
5) The newborn baby may require adjustments in drug dosages because of it.
93- A 54-year old woman was admitted with acute breathlessness. On examination she had a temperature of 37.9oC, a respiratory rate of 32 breaths per minute, a pulse of 120 beats per minute, a blood pressure of 100/60 mmHg, and a peak expiratory flow rate of 250 litres per minute.
Auscultation of the heart and chest was normal.
Investigations:
The Chest X-ray was normal.
blood gases on air showed:
- pH 7.35 (7.36 - 7.44)
- Pa02 6.0
- kPa (11.3 - 12.6)
- PaC02 3.9
- kPa (4.7 - 6.0)
- Serum bicarbonate 20 mmol/l (20 - 28)
She was started on high flow oxygen. What is the most important next treatment?
1) amoxycillin intravenously
2) aminophylline intravenously
3) intravenous fluids
4) low molecular weight heparin
5) nebulised salbutamol
94- A 45 year old female presents with a 6 month history of exertional dyspnoea and is diagnosed with pulmonary fibrosis. Over the last one year she has received a variety of medications. Which of the following drugs could be responsible?
1) Dexamethasone
2) Ibuprofen
3) nalidixic acid
4) penicillamine
5) sulphasalazine
95- Which one of the following is correct regarding long-acting beta-2 agonists?
1) Can be used to prevent activity-induced symptoms without anti-inflammatory therapy.
2) Become less effective over time (tolerance).
3) Are beneficial in acute viral croup.
4) Protect against allergen challenge for up to 48 hours.
5) Should not be used in association with erythromycin.
96- A 45-year-old man develops facial swelling and breathlessness. His chest X-ray reveals paratracheal lymphadenopathy. Which of the following statements is most accurate regarding the superior vena caval obstruction?
1) the most common cause is squamous cell carcinoma
2) treatment of choice is radiotherapy
3) it may be associated with voice hoarseness
4) it is associated with Kussmaul's sign
5) the commonest symptom is stridor
97- A 55 year old man presents with ataxia and bilateral gynaecomastia.
Which of the following is the most likely diagnosis?
1) Kleinfelters Syndrome
2) Long term treatment with cyclophosphamide for Wegener's Granulomatosis
3) Long term treatment with oral steroids for chronic asthma
4) Bronchial Carcinoma
5) Hypereosinophilic Syndrome
98- A 55-year-old plumber presented with a dry nocturnal cough and increasing exertional breathlessness.
On examination he had early finger clubbing, cyanosis and bilateral basal crackles. A chest X-ray showed bilateral lower zone shadowing.
Investigations revealed:
- PaO2 (breathing air) 8.2 kPa (11.3-12.6)
- FEV1/FVC ratio 85%
Which of the following investigations is most likely to establish the diagnosis?
1) Echocardiography.
2) High resolution CT scan of chest
3) Measurement of diffusion capacity
4) Serum angiotensin-converting enzyme (ACE) level
5) Transbronchial lung biopsy
99- Which of the following statemtns regarding the sweat test is true?
1) Sweating is enhanced by application of atropine.
2) The filter paper is left on for a total of about 4 hours.
3) At least 25mg of sweat is necessary for a reliable result.
4) More than 60mmol/L of chloride in sweat is diagnostic of cystic fibrosis.
5) False/positive results may be encountered in children with nephrotic syndrome.
100- A 7 month old boy is presented to a doctor by his parents with symptoms of reccurent upper respiratory tract infections. No other members of the family suffer from any smiliar infections.Physical examination showed mild facial hypoplasia. Biochemistry investigations revealed hypocalcaemia. Microbiological investigations were normal and immunoglobulins were within normal limits. The infants immune function would show the following deficiency:
1) Complement Deficieny
2) B cell number and function
3) T cell number and function
4) Plasma Cell
5) Macrophage number and function
101- Progressive Massive Fibrosis (PMF) is most likely to be found in which of the following?
1) Complicated silicosis
2) Extrinsic allergic alveolitis
3) Lobar pneumonia
4) Sarcoidosis
5) Simple coal workers pneumoconiosis
102-A 17-year-old girl with known cystic fibrosis presents with a chest infection. What antibiotic would be most suitable for her?
1) Augmentin
2) Cefotaxime
3) Ceftazidime
4) Gentamicin
5) Amoxicillin
103-A 21-year-old gentleman with cystic fibrosis presents with infertility. What is the most likely cause for this?
1) Chronic prostatic insufficiency
2) Failure of development of the vas deferens
3) Increasing alkalinisation of semen
4) Primary failure of testosterone production
5) Production of anti-sperm antibodies
104-A 16-year-old girl presents with shortness of breath and insomnia prior to an examination. Clinical examination is normal. CXR and PEFR are normal. Which of the following investigations is most suggestive of asthma?
1) diurnal variation in PEFR> 20%
2) positive skin prick test to common allergens
3) past medical history of hayfever and eczema
4) increased total IgE
5) resolution of symptoms the day after the exam
105-A 65-year-old female presents with a 3 week history of malaise and blood in her sputum. Bronchoscopy reveals a mass in the right main bronchus, and histology demonstrates it to be a small cell carcinoma. Further investigation fails to show any metastases. What is the most appropriate step in management?
1) Chemotherapy
2) Endobronchial laser therapy
3) Radiotherapy
4) Surgery
5) Palliative therapy
MCQs on Respiratory System for Staff Nurse and Medical Exams
Reviewed by ADMIN
on
September 25, 2016
Rating: 5
Reviewed by ADMIN
on
September 25, 2016
Rating: 5
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