Respiratory PLAB

A 26yo woman being treated for a carcinoma of the bronchus with steroids presents with vomiting, abdominal pain and sudden falls in the morning. What is the most specific cause for her symptoms? a. Steroid side effects b. Postural hypotension c. Adrenal insufficiency d. Conn's disease e. Cushing's disease

c. Adrenal insufficiency

Pt presented with hemoptysis 7d post-tonsillectomy. What is the next step? a. Packing b. Oral antibiotics + discharge c. Admit + IV antibiotics d. Return to theatre and explore e. Ice cream and cold fluids

c. Admit + IV antibiotics Infections.

A 29yo man was involved in an RTA. He presents with distended neck veins, clear breath sounds and a trachea which is in the midline. His RR=34bpm, BP=60/0mmHg. What is the most likely dx? a. Simple pneumothorax b. Tension pneumothorax c. Cardiac tamponade d. Pericarditis

c. Cardiac tamponade

A 25yo pt came to the OPD with complaint of fever, malaise, breathlessness, cough and anorexia. His gf has got similar symptoms. He had hx of sore throat and ear discharge a month ago. What is the single most likely causative organism? a. Legionella b. Mycoplasma c. Chlamydia pneumonia d. PCP e. Chlamydia psitacci

c. Chlamydia pneumonia Person to person contact, ear discharge, sore throat are clinchers

A 71yo man with a hx of 50yrs of smoking presents with cough, hemoptysis, dyspnea and chest pain. He also has anorexia and weight loss. The dx of lung cancer has been stabilized. Which electrolyte abnormality can be seen? a. Hyperkalemia b. Hypocalcemia c. Hyponatremia d. Hypernatremia e. Hypomagnesemia

c. Hyponatremia

A 63yo man presented with sudden onset of severe dyspnea, orthopnea, raised JVP and bilateral basal crackles 3d after an episode of MI. A dx of acute congestive cardiac failure was made and IV furosemide was started for this pt. What electrolyte abnormality is expected? a. High Na+, Low K+ b. Low Na+, High K+ c. Low Na+, Low K+ d. High Na+, High K+ e. Low Na+, Normal K+

c. Low Na+, Low K+

A 7yo boy with frequent episodic asthma is on tx with sodium cromoglycate. His physician wants to add a non-steroid preventer. The mother of the boy, a teacher, has just read about a nonsteroidal medication which acts on the mast cells, stopping them from releasing harmful chemicals. Her physician agrees to add this medication to the boy's drug regimen. Which medication is the physician most likely to add to the boy's treatment? a. Inhaled short acting bronchodilator b. SC adrenaline c. Nedocromil Sodium d. Inhaled long acting bronchodilator e. Inhaled sodium cromoglycate

c. Nedocromil Sodium

A 4yo child comes with a sprain in his foot. Hx reveals that the child has had recurrent admissions to the hosp due to severe asthma. What is the most appropriate analgesic? a. Diclofenac sodium b. Ibuprofen c. Paracetamol d. Codeine

c. Paracetamol to prevent drug-induce asthma which nsaids will cause, hence avoid.

A 54 year old smoker man presents with progressive dyspnoea. He complains of cough, wheeze and a table spoonful of mucopurulent sputum which he coughs out daily for the last 15 months. A spirometry was performed. His FEV1/FVC is 2.4/3.7. After taking salbutamol, the spirometry was performed again which gave a ratio of 2.5/3.8. What is the SINGLE most likely diagnosis? A. Chronic bronchitis B. Asthma C. Bronchiectasis D. Lung fibrosis E. Sarcoidosis

A. Chronic bronchitis COPD

A 10 year old girl with diagnosed asthma is having frequent coughs and wheezing that wakes her up at night. She is compliant with her asthma medication of inhaled corticosteroid 800 mcg/day, short-acting bronchodilators as required, inhaled long-acting B2 agonist (LABA) and theophylline. Her inhaler technique is good. What is the SINGLE most appropriate next step in management? A. Add oral corticosteroids B. Increase dose of inhaled corticosteroids C. Add sodium cromoglycate D. IM adrenaline E. Magnesium sulphate

A. Add oral corticosteroids TX of chronic asthma. SSLTP

An 8 year old boy diagnosed with asthma is on salbutamol inhaler and beclomethasone inhaler. However, he wakes up at night with wheezing and shortness of breath. What is the SINGLE most appropriate management? A. Add inhaled long-acting B2 agonist (LABA) B. Increase inhaled corticosteroid dose C. Aminophylline D. Oral prednisolone E. Sodium cromoglycate

A. Add inhaled long-acting B2 agonist (LABA)

A 53 year old man with previous history of chronic obstructive pulmonary disease presents with breathlessness and purulent sputum. His oxygen saturation are 85% on air. Arterial blood gas show: PaO2 = 7.6 kPa PaCOS = 7.1 kPa What is the SINGLE most appropriate initial management for his condition? A. 24% oxygen B. Mechanical ventilation C. 100% oxygen D. Nebulized salbutamol E. Intravenous antibiotics

A. 24% oxygen SOS.avi

A 56 year old man who has a history of hypertension and asthma recently had a change of medication which was prescribed by his GP. 2 days after starting the new medication, he develops wheezing and shortness of breath. What is the SINGLE most likely medication that would have caused this? A. Atenolol B. Ramipril C. Bendroflumethiazide D. Verapamil E. Furosemide

A. Atenolol Diagnosis is drug induced asthma

A 33 year old man has a temperature of 38.5°C, productive cough and chest pain on the right side on inspiration. He has a blood pressure of 100/60 mmHg and a pulse rate of 108 beats/minute. He appears slightly short of breath and has an oxygen saturation of 94% on room air. What is the SINGLE most likely organism causing the patient's symptoms? A. Gram +ve cocci B. Coagulase +ve cocci C. Gram +ve Bacilli D. Acid-Fast Bacilli E. Gram -ve cocci

A. Gram +ve cocci

A 33 year old chronic smoker attends the outpatient department with complaints of persistent cough, copious amount of purulent sputum and dyspnoea. He has a history of recurrent chest infections in the past. Coarse crackles are found at the base of his lung on auscultation. Bronchiectasis is suspected. What is the SINGLE most definitive test to diagnose bronchiectasis? A. High-resolution computed tomography (HRCT) chest B. Serum immunoglobulins C. Chest X-ray D. Lung function tests E. Bronchoscopy

A. High-resolution computed tomography (HRCT) chest

A 28 year old male is admitted with acute exacerbation of asthma. He has a temperature of 38.1°C and a productive cough. He is treated initiated with 100% oxygen and salbutamol nebulizers. Despite treatment, his oxygen saturation is 88% and respiratory rate is 34 breaths/minute. What is the SINGLE most appropriate next step in management? A. Hydrocortisone IV B. IV antibiotics C. IV salbutamol D. IM adrenaline E. IV adrenaline

A. Hydrocortisone IV SOS MVAS

A 64 year old man who was previously exposed to asbestos for 35 years while working as a builder has chest pain and shortness of breath. The diagnosis of mesothelioma has been made. His shortness of breath has been worsening over the last couple of days. A recent chest x-ray shows bilateral pleural effusion. What is the SINGLE most appropriate management? A. Indwelling pleural drain B. Physiotherapy C. Radiation therapy D. Pneumonectomy E. Chemotherapy

A. Indwelling pleural drain

A 33 year old man has mild headache and myalgia for 2 days followed by high fever, chills, rigors and a cough. His cough was initially dry but progressed to be productive. He has just returned from a conference in Greece where he mentions that he swam and used the hot tubs in the hotel. He has a temperature of 38.1°C and is seen to be dyspnoeic. Chest X-ray shows patchy alveolar infiltrates. What is the SINGLE most likely organism which would have caused his symptoms? A. Legionella pneumophila B. Mycoplasma pneumoniae C. Staphylococcus aureus D. Streptococcus pneumoniae E. Klebsiella pneumoniae

A. Legionella pneumophila

A 67 year old smoker presents with cough, breathlessness and wheeze. 24% oxygen by Venturi face mask was initiated and nebulized salbutamol and hydrocortisone were administered. As his dyspnoea did not improve, intravenous aminophylline was administered and an arterial blood gas was sent. He has a respiratory rate of 32 breaths/minute. His arterial blood gas results show: pH 7.32 pCO2 7.7 kPa pO2 10.1 kPa What is the SINGLE most appropriate next step in management? A. Non-invasive ventilation B. Invasive mechanical ventilation C. Long-acting beta-adrenoceptor agonist D. Intravenous doxapram hydrochloride E. Oral amoxicillin

A. Non-invasive ventilation

A 27 year old male is admitted with acute exacerbation of asthma. He is treated initiated with 100% oxygen and salbutamol nebulizers. IV hydrocortisone was prescribed but it was not available in the department. What is the SINGLE most appropriate next step in management? A. Oral prednisolone 40 mg B. IV magnesium sulphate C. IV salbutamol D. IM adrenaline E. IV adrenaline

A. Oral prednisolone 40 mg Oral prednisolone and IVhydrocortisone has been shown to have similar efficacy.

A 56 year old lady with lung cancer presents with urinary retention, postural hypotension, diminished reflexes and sluggish pupillary reaction. What is the SINGLE most likely explanation for her symptoms? A. Paraneoplastic syndrome B. Progression of lung cancer C. Brain metastasis D. Hyponatraemia E. Spinal cord compression

A. Paraneoplastic syndrome autonomic neuropathy a well-known feature of Paraneoplastic syndrome

A 24 year old male is admitted with acute exacerbation of asthma. He is treated initiated with 100% oxygen. He continues to deteriorate. What is the SINGLE most appropriate next step in management? A. Salbutamol nebulized with oxygen B. IV magnesium sulphate C. IV salbutamol D. IM adrenaline E. IV adrenaline

A. Salbutamol nebulized with oxygen

A 68 year old woman presents to the emergency department from her nursing home complaining of shortness of breath. She has a temperature of 38.7°C and productive cough. Her sputum is noted to be a rusty color. On auscultation, crackles are heard over the right lung base. A chest X-ray was done and shows right lower lobe consolidation. She has a blood pressure of 100/65 mmHg and a pulse rate of 102 beats/minute. A urinalysis shows 1+ leucocytes with no nitrates or protein. What is the SINGLE most likely organism causing her symptoms? A. Streptococcus pneumoniae B. Staphylococcus aureus C. Coxiella burnetii D. Mycoplasma pneumoniae E. Escherichia coli

A. Streptococcus pneumoniae This is normal community acquired pneumonia

A 28 year old male is admitted with acute exacerbation of asthma. He is treated initiated with 100% oxygen, salbutamol nebulizers and hydrocortisone 100mg IV. Despite treatment, his oxygen saturation is 89% and respiratory rate is 30 breaths/minute. What is the SINGLE most appropriate next step in management? A. Prednisolone 40mg PO B. Add in ipratropium 0.5 mg to nebulizers C. IV salbutamol D. IM adrenaline E. Stop administration of oxygen

B. Add in ipratropium 0.5 mg to nebulizers

A 11 year old girl has a history of asthma and is currently on short-acting bronchodilators. Her parents feels that it is not well controlled as she frequently wakes up at night with wheezing and coughing. Her inhaler technique is good. What is the SINGLE most appropriate next step in management? A. Add oral corticosteroids B. Add inhaled steroid C. Add sodium cromoglycate D. Add leukotriene receptor antagonist E. Add inhaled long-acting B2 agonist (LABA)

B. Add inhaled steroid SSLTP

A 26-year-old smoker has a history of wheezing, chest tightness and breathlessness at night and early morning. Her past medical history includes eczema. What is the SINGLE most likely diagnosis? A. COPD B. Asthma C. Pneumoconiosis D. Bronchiectasis E. Chronic bronchitis

B. Asthma Why not COPD? HX of eczema (atopy) is unique to asthma

A 21 year old lady who smokes has a history of wheezing, chest tightness and coughing at night. She also notices these symptoms occur when she goes out in the cold and breathes cold air. What is the SINGLE most likely diagnosis? A. COPD B. Asthma C. Pneumoconiosis D. Bronchiectasis E. Chronic bronchitis

B. Asthma Why not COPD? the hx of trigger

A 60 year old lady is on treatment for ischaemic heart disease, hypertension and hyperlipidaemia. During the night, she complains of wheezing and shortness of breath. What is the SINGLE most likely medication that is responsible for her symptoms? A. Amlodipine B. Atenolol C. Ramipril D. Simvastatin E. Bendroflumethiazide

B. Atenolol

A 32 year old previously healthy woman has developed pain and swelling on both knees and ankles with a nodular rash over her shins. As part of the investigation a chest X-ray was performed. What is the SINGLE most likely appearance on the chest X-ray? A. Apical granuloma B. Bilateral hilar lymphadenopathy C. Lobar consolidation D. Pleural effusion E. Reticular shadowing in the bases

B. Bilateral hilar lymphadenopathy

A 70 year old man admits to asbestos exposure 20 years ago. He was a heavy smoker but has quit smoking 3 years ago. He has noted weight loss and hoarseness of voice. Which is the SINGLE most likely type of cancer associated with the risk factors and symptoms present? A. Basal cell carcinoma B. Bronchial carcinoma C. Oesophageal carcinoma D. Nasopharyngeal carcinoma E. Oral carcinoma

B. Bronchial carcinoma. Most pry lung tumors are bronchial. adenocarcinomas are too and they are often associated with asbestos

A 29 year old HIV positive man attends the outpatient department with complaints of persistent cough and copious amount of purulent sputum. He also has dyspnoea and chest pain. On auscultation, inspiratory crepitations are heard at the base of the lung. A chest X-ray shows tram track opacities. What is the SINGLE most likely diagnosis? A. Interstitial lung disease B. Bronchiectasis C. Tuberculosis D. Influenza E. Sarcoidosis

B. Bronchiectasis

A 45 year old chronic smoker attends the outpatient department with complaints of persistent cough and copious amount of purulent sputum. He had history of measles in the past. On examination, finger clubbing is noted and inspiratory crepitations on auscultation is heard. A chest X-ray shows tram track opacities. What is the SINGLE most likely diagnosis? A. Interstitial lung disease B. Bronchiectasis C. Asthma D. COPD E. Sarcoidosis

B. Bronchiectasis

A 54 year old patient 7 days after a total hip replacement presents with acute onset breathlessness, and chest pain. On examination, an elevated jugular venous pressure was observed. Her right calf looks swollen. Her pulse rate is 95 bpm and respiratory rate is 24/min. Which SINGLE investigations will be most helpful in leading to a diagnosis? A. Chest X-ray B. CT pulmonary angiogram (CTPA) C. V/Q scan D. D-Dimer E. Doppler ultrasound of legs

B. CT pulmonary angiogram (CTPA) It will lead to diagnosis.

A 17 year old boy with a history of asthma suddenly develops chest pain and increasing breathlessness during a game of football. He has reduced breath sounds on the right side. His oxygen saturation is 94% on air. What is the SINGLE most appropriate investigation? A. Sweat test B. Chest X-ray C. CT chest D. Exercise challenge E. D-dimer

B. Chest X-ray

A 48 year old man was admitted with cough and dyspnoea. He has a long history of smoking and has lost 8 kg in the past 5 months. A chest X-ray was performed and showed consolidation on the lower left lobe. He was started on antibiotics and is due for discharge. What is the SINGLE most appropriate follow up investigations to perform after discharge? A. Bronchoscopy B. Chest X-ray C. Sputum culture D. Computed tomography (CT) E. Magnetic resonance imaging (MRI)

B. Chest X-ray

A 68 year old man has malaise and cough for 5 days. He has a temperature of 38.5°C. There is dullness on percussion of the left lung base. What is the SINGLE most appropriate investigation? A. Bronchoscopy B. Chest X-ray C. CT chest D. MRI E. V/Q scan

B. Chest X-ray diagnosis is pneumonia

A 22-year-old, tall thin man develops sudden chest pain and becomes breathless while driving. There is no history of trauma. What is the SINGLE most appropriate investigation? A. Cardiac enzymes B. Chest X-ray C. CT D. ECG E. V/Q scan

B. Chest X-ray Diagnosis is spontaneous pneumothorax

A 24 year old male is admitted with acute severe asthma. He is treated initiated with 100% oxygen, nebulized salbutamol, and IV hydrocortisone. Ipratropium bromide was added to nebulizers. Despite the initial treatment there has been no improvement. What is the SINGLE most appropriate next step in management? A. IV aminophylline B. IV magnesium sulphate C. IV salbutamol D. IM adrenaline E. IV adrenaline

B. IV magnesium sulphate SOS MVAS

A 32 year old female smoker has a history of wheeze, shortness of breath and fever. Her past medical history includes eczema. FEV1/forced vital capacity (FVC) was measured and was found to be low. This was improved after taking bronchodilators. What is the SINGLE most likely diagnosis? A. COPD B. Infective exacerbation of asthma C. Tuberculosis D. Bronchiectasis E. Chronic bronchitis

B. Infective exacerbation of asthma

A 27 year old man presents with chest pain and respiratory distress following a road traffic accident. On examination, his neck veins are noted to be distended and trachea is deviated to the left. Breath sounds are absent on the left and diminished on the right lung field. He has a blood pressure of 80/40 mmHg and a heart rate of 120 beats/minute. What is the SINGLE most appropriate next action? A. Chest X-ray B. Insertion of a cannula into the right second intercostal space C. Insertion of a cannula into the left second intercostal space D. Insertion of a chest drain into right mid-axillary line E. Insertion of a chest drain into left mid-axillary line

B. Insertion of a cannula into the right second intercostal space

A 74 year old man who has been a smoker since he was 20 has recently been diagnosed with small cell lung cancer. What Is the SINGLE most likely serum electrolyte picture that confirms the presence of Syndrome of inappropriate antidiuretic hormone secretion (SIADH)? A. High serum Na, low serum osmolality, high urine osmolarity B. Low serum Na, low serum osmolality, high urine osmolarity C. Low serum Na, high serum osmolality, high urine osmolarity D. High serum Na, low serum osmolality, low urine osmolarity E. High serum Na, high serum osmolality, low urine osmolarity

B. Low serum Na, low serum osmolality, high urine osmolarity

A 68 year old smoker has left sided chest pain which worsens when taking deep breaths. His medical history includes diabetes mellitus and hypertension. On examination, he has a miotic left eye and partial ptosis on the left. There is also wasting of small muscles of the left hand. What is the SINGLE most likely diagnosis? A. Costochondritis B. Lung cancer C. Goodpasture's syndrome D. Motor neuron disease E. Progressive massive fibrosis

B. Lung cancer (pancoast tumor)

A 28 year old female who has returned from the USA to the UK presents to Accident & Emergency with shortness of breath and a productive cough beginning 3 days after her return to the United Kingdom. Her cough initially contained blood but is now dry. Her only significant history is that she is on the combined oral contraceptive pill. What is the SINGLE most likely diagnosis for this woman's symptoms? A. Community acquired pneumonia B. Pulmonary embolism C. Pulmonary tuberculosis D. Lymphoma E. Lung cancer

B. Pulmonary embolism

A 23 year old woman who is on several medications and inhalers for her asthma presents to the hospital with palpitations. Her heart rate is 110 beats/minute. Her peak expiratory flow rate is 400 L/minute. What is the SINGLE most appropriate management? A. Lifestyle changes B. Review medications C. 24 hour ECG monitoring D. Admit for investigations E. Chest X-ray

B. Review medications One of the common side effects of beta agonist is palpitations and tachycardia

A 20 year old man suddenly develops shortness of breath over the last day. It started when he was playing football. The shortness of breath was associated with right sided pleuritic chest pain. On examination, reduced air entry with hyper-resonance was noted over the right lung field. His oxygen saturation was 91% on room air. What is the SINGLE most likely diagnosis? A. Asthma B. Spontaneous pneumothorax C. Tension pneumothorax D. Sarcoidosis E. Chronic obstructive pulmonary disease (COPD)

B. Spontaneous pneumothorax

A 56yo man complains of increased vol of sputum with specks of blood and chest pain. He has a hx of DVT. Exam: clubbing. What is the cause of blood in his sputum? a. Pulmonary thrombosis b. Bronchial carcinoma c. Bronchiectasis d. Pulmonary TB

a. Pulmonary thrombosis

A 19 year old man has a history of exercise induced asthma which has previously been controlled using a salbutamol inhaler as required. He is taking beclomethasone inhaler regularly but he now gets asthma attacks with exercise. What is the SINGLE most appropriate action? A. Add on tiotropium B. Take regular salbutamol and add on budesonide inhaler C. Add on sodium cromoglycate D. Add on oral steroid E. Increase Inhaled steroid

C. Add on sodium cromoglycate

A 21 year old man has exercised induced asthma and is using a salbutamol inhaler as required and beclomethasone inhaler 400 mcg/day. He complains of wheeze and shortness of breath during exercise despite using salbutamol inhaler just before exercise. What is the SINGLE most appropriate action? A. Add on tiotropium B. Take regular salbutamol and add on budesonide inhaler C. Add on sodium cromoglycate D. Add on oral steroid E. Increase Inhaled steroid

C. Add on sodium cromoglycate

An 8 year old girl with diagnosed asthma is having frequent night coughs and mild exercise-induced wheezing. She is compliant with her asthma medication of inhaled corticosteroid 400 mcg/day and short-acting bronchodilators as required. Her inhaler technique is good. What is the SINGLE most appropriate next step in management? A. Add leukotriene antagonist B. Add oral theophylline C. Add regular inhaled long-acting B2 agonist (LABA) D. Increase dose of inhaled corticosteroid E. Short course of oral corticosteroid

C. Add regular inhaled long-acting B2 agonist (LABA) SSLTP

A 33 year old man is referred for an X-ray as he complains of a persistent cough, chest pain and excessive purulent sputum. He has a history of recurrent chronic chest infections. On examination, drumstick-shaped fingers were noted. What is the SINGLE most likely diagnosis? A. Fibrosing alveolitis B. Mesothelioma C. Bronchiectasis D. Pulmonary tuberculosis E. Bacterial endocarditis

C. Bronchiectasis

A 56 year old man complains of increased volume of sputum with specks of blood and chest pain. He has a history of recurrent chronic chest infections and deep vein thrombosis which happened 3 years ago. Finger clubbing was noted on examination. A chest X-ray shows tramlines but is otherwise normal. What is the SINGLE most likely diagnosis? A. Pulmonary embolism B. Bronchial carcinoma C. Bronchiectasis D. Pulmonary tuberculosis E. Chronic sinusitis

C. Bronchiectasis

A 39 year old chronic smoker attends the outpatient department with complaints of persistent cough and copious amount of purulent sputum. He has recurrent chronic chest infections in the past. Finger clubbing is noted in examination and inspiratory crackles are heard on auscultation. A chest X-ray was done and results were normal. What is the SINGLE most likely diagnosis? A. Emphysema B. Rheumatoid arthritis C. Bronchiectasis D. Lung cancer E. Sarcoidosis

C. Bronchiectasis Normal xrays or tram lines

A 35 year old lady had an emergency C-section following an obstructed labour. Three days post-op she develops a sudden onset of left sided chest pain associated with breathlessness. Her heart rate is 105 bpm. Her left leg is swollen and is pain on palpation. What is the SINGLE best investigation to provide a definitive diagnosis? A. Arterial blood gases B. Chest X-ray C. CT pulmonary angiogram (CTPA) D. D-dimer E. Electrocardiogram (ECG)

C. CT pulmonary angiogram (CTPA)

A 50 year old woman returned by air to the UK from Australia. 3 days days later, she presents with a sharp chest pain and breathlessness. Her chest X-ray and ECG are normal. What is the SINGLE most appropriate investigation? A. Bronchoscopy B. Cardiac enzymes C. CT pulmonary angiogram (CTPA) D. MRI E. Pulse oximetry

C. CT pulmonary angiogram (CTPA)

A 2 year old girl presents with a 4 day history of fever which started with a cough. She has a respiratory rate of 45 beats/minute, oxygen saturation of 94% and a temperature of 38.9C. There are crepitations at the left base on auscultation of the lung fields. Urine dipstick was found to be negative. What is the SINGLE investigations most likely to lead to diagnosis? A. Blood culture and sensitivity B. Erythrocyte sedimentation rate (ESR) C. Chest X-ray D. Urine for Culture and sensitivity E. Cerebrospinal fluid analysis

C. Chest X-ray

A 15 year old boy presents to the Emergency Department with a sudden onset of chest pain and increasing shortness of breath during a beach volleyball game. He has a medical history of asthma and is on a beta-2 agonist inhaler. On examination, there is no cyanosis but there are reduced breath sounds on the left side. Which of the following is the SINGLE most appropriate investigation? A. D-dimer B. CT chest C. Chest x-ray D. Peak flow meter E. Spirometry

C. Chest x-ray

A 58 year old man who used to work in the shipyard industry was having chronic cough and shortness of breath for several months. He was given salbutamol nebulisers and intravenous antibiotics and admitted to the ward. A computed tomography was performed which showed patchy infiltrates, pleural thickening and pleural effusion. He died 3 days later after which this case was referred to the coroner. What is the SINGLE most likely reason for the referral to the coroner? A. Incorrect diagnosis and management B. Inpatient death in the wards C. Death likely due to industrial disease D. Cancer research purposes E. Death by natural causes

C. Death likely due to industrial disease

A 20 year old man presents to A&E after having severe injuries from a road traffic accident. On presentation he is breathless and has severe chest pain. A Chest X-ray shows fractures of the 5th to 7th rib. His systolic blood pressure is 85 bpm, respiratory rate is 25 breaths/min and his pulse rate is 110/min. What is the SINGLE most appropriate initial action? A. Antibiotics B. Analgesia C. High flow oxygen D. Secure venous access E. Refer to surgeon

C. High flow oxygen

A 65 year old known case of liver cancer and metastasis presents with gastric reflux and bloatedness. Osteoporosis was diagnosed on a dexa scan. He also has shortness of breath and basal consolidation in the left lung was seen on a Chest X-ray. What is the SINGLE most appropriate next step in management? A. Proton pump inhibitor IV B. Alendronate C. IV antibiotics D. Analgesia E. Proton pump inhibitor PO

C. IV antibiotics Questions of this sort, triage and ask yourself, which is the most urgent to sort out.

A 61 year old man has suddenly become very short of breath. In the last hour, he has had a CT-guided biopsy of a mass in the right lung. His temperature is 36.5°C, heart rate is 120 bpm, BP 90/60 mmHg, and SaO 2 78% on 15L oxygen. He looks cyanosed, his trachea is deviated towards the left, and breath sounds are much louder over the left hemi-thorax. Which is the SINGLE most appropriate course of action? A. Arterial blood gas B. Urgent chest X-ray C. Insertion of a cannula into the right second intercostal space D. Insertion of a cannula into the left second intercostal space E. Insertion of a chest drain

C. Insertion of a cannula into the right second intercostal space

A 46 year old man is being treated for a pleural effusion. A chest drain has been sited just below the 4th rib in the mid-axillary line on his right side. What SINGLE structure is at particular risk of injury? A. Azygos vein B. Diaphragm C. Intercostal artery D. Internal thoracic artery E. Liver

C. Intercostal artery. They run in a groove below the ribs. hence insert chest drain above rib

A 20yo prv healthy woman presents with general malaise, severe cough and breathlessness which has not improved with a seven day course of amoxycillin. There is nothing significant to find on examination. The x-ray shows patchy shadowing throughout the lung fields. The blood film shows clumping of red cells with suggestion of cold agglutinins. a. Mycobacterium avium complex b. Coxiella burnetii c. Mycoplasma pneumonia d. Haemophilus influenza e. Legionella pneumophila f. Strep pneumococcus g. TB

C. Mycoplasma pneumonia

A 16 year old boy who attends boarding school feels unwell. He developed a dry cough for the last few days. On examination, there are target lesions seen on the back of his hands. A chest X-ray was performed and it shows bilateral consolidations. What is the SINGLE most likely causative organism? A. Staphylococcus aureus B. Legionella C. Mycoplasma pneumoniae D. Klebsiella E. Streptococcus pneumoniae

C. Mycoplasma pneumoniae

A 27 year old female attends outpatient department with a fever and dry cough. She has had a headache, muscle pain and joint pain for more than one week. She has a temperature of 37.5°C, a pulse of 100 beats/minute, a blood pressure of 110/70 mmHg and a respiratory rate of 20 breaths/minute. A Chest X-ray report shows bilateral patchy consolidation. What is the SINGLE most likely causative organism? A. Pneumococcal pneumonia B. Legionella C. Mycoplasma pneumoniae D. Klebsiella E. Chlamydia pneumoniae

C. Mycoplasma pneumoniae

A 33 year old man is brought into the emergency department following a road traffic accident. He is seen to be very short of breath. He has no breath sounds over the right side of his chest. On percussion, the right chest is noted to be hyper-resonant. On examination, his trachea is deviated to the left. His heart rate is 120 beats/minute. His blood pressure is 90/65 mmHg, and has an oxygen saturation of 85% on 15L of oxygen. What is the SINGLE most appropriate course of action? A. Arterial blood gas B. Urgent chest X-ray C. Needle decompression D. Urgent computed tomography scan of chest E. Insertion of a chest drain

C. Needle decompression 2nd ICS MCL

A 10 year old boy who takes regular dose inhaled steroids for his longstanding asthma has been advised to use bronchodilators to control his acute attacks. His parents are unsure when he should use his bronchodilator. What is the SINGLE most appropriate investigation to perform? A. Chest X-ray B. Pulmonary function test C. Peak flow rate diary D. Pulse oximetry E. Blood test to look for eosinophilia

C. Peak flow rate diary shows diurnal variation and when the inhaler should therefore be used.

A 34 year old HIV positive man presents with fever, dry cough and shortness of breath. He is tachypnoeic but his chest is clear. Oxygen saturation is normal at rest but drops on exercise. What is the SINGLE most likely diagnosis? A. Cytomegalovirus infection B. Candida infection C. Pneumocystis carinii infection D. Cryptococcal infection E. Toxoplasmosis

C. Pneumocystis carinii infection

A 55 year old woman with a persistent cough and history of smoking develops left sided chest pain exacerbated by deep breathing. She has a temperature of 38.2°C and basal crackles are heard on auscultation. What is the SINGLE most likely diagnosis? A. Dissecting aneurysm B. Pericarditis C. Pneumonia D. Pneumothorax E. Pulmonary embolism

C. Pneumonia

A 35 year old man presents with progressive breathlessness. He has a history of polyarthralgia with painful red lumps appearing on his shins. They are cherry sized and are about 20 or more in number. His chest X-ray shows bilateral hilar lymphadenopathy. What is the SINGLE most likely diagnosis? A. Bronchial asthma B. Cystic fibrosis C. Sarcoidosis D. Bronchiectasis E. Pneumonia

C. Sarcoidosis Lofgren syndrome

A 38 year old woman is brought to the A&E after falling down the stairs and injuring her rib. She complains of shortness of breath. A chest X-ray was performed to rule out a rib fracture. Bilateral hilar lymphadenopathy was seen on the chest X-ray. On auscultation, there are vesicular breath sounds. On examination, there are red lesions on both her shins which are tender. What is the SINGLE most likely diagnosis? A. Bronchial asthma B. Cystic fibrosis C. Sarcoidosis D. Bronchiectasis E. Silicosis

C. Sarcoidosis when you see "bilateral hilar lymphadenopathy" with a lesion on the shin, you should be thinking of Sarcoidosis

A 34yo IVDA (intra venous drug abuser) presents with a 4m hx of productive cough. He has lost 10kgs. What is the single most appropriate inv? a. Sputum for AFB b. Laryngoscopy c. Bronchoscopy d. CT neck e. CXR

a. Sputum for AFB Diagnosis: TB

A 4yo child presents with repeated chest infections. He has yellow discoloration of sclera and the mother gives a hx of diarrhea as well. What is the single inv most likely to lead to a dx? a. Sweat chloride test b. Anti-endomysial antiboides c. LFT d. Jejunal biopsy e. TFT

a. Sweat chloride test

A 79 year old man with longstanding chronic obstructive pulmonary disease has become progressively breathless over the last 2 years. His medications for his COPD include salbutamol and salmeterol inhalers, inhaled corticosteroids and theophylline. His forced expiratory volume in one second (FEV1) is less than 30%. His oxygen saturations are 89% on room air. What is the next appropriate management? Assessment for lung transplant B. Trial of continuous positive airway pressure C. Trial of noninvasive ventilation D. Assessment for long term oxygen therapy E. Assessment for a short course of oxygen therapy

D. Assessment for long term oxygen therapy

A 34 year old woman with a smoking history has had an uneventful laparoscopic cholecystectomy 18 hours ago. She is now complaining of shortness of breath. She has a pulse rate of 108 bpm and a temperature of 37.8°C. There are signs of reduced air entry at the right base. Chest X-ray shows no obvious abnormality. What is the SINGLE most appropriate next step? A. Unfractionated heparin B. IV Ceftriaxone C. PO Chlorpheniramine D. Chest physiotherapy E. D-dimers

D. Chest physiotherapy

A 50 year old chronic smoker attended the outpatient department with complaints of chronic productive cough, dyspnoea and wheeze. A chest X-ray was ordered and reported as hyperinflated lung with flattened hemidiaphragm and a small cardiac silhouette. Full blood count shows an increase in haematocrit. What is the SINGLE most likely diagnosis? A. Interstitial lung disease B. Wegener's granulomatosis C. Lung cancer D. Chronic obstructive pulmonary disease (COPD) E. Amyloidosis

D. Chronic obstructive pulmonary disease (COPD)

A 48 year old farmer presents with malaise, dry cough, chest tightness and shortness of breath. The shortness of breath and cough started only a few hours ago. On auscultation, a wheeze is heard throughout the chest. He has a temperature of 39.2°C, a pulse of 96 beats/minute, a blood pressure of 110/70 mmHg and a respiratory rate of 29 breaths/minute. His chest X-ray shows diffuse micronodular interstitial shadowing. What is the SINGLE most appropriate diagnosis? A. Pulmonary embolism B. Churg-strauss syndrome C. Cryptogenic organizing pneumonia D. Extrinsic allergic alveolitis E. Progressive massive fibrosis

D. Extrinsic allergic alveolitis

A 65 year old retired builder complains of persistent dull chest pain and shortness of breath. He is a smoker and started smoking since a young age. He looks thin and his clothes are oversized. Finger clubbing is noted on examination. What is the SINGLE most likely diagnosis? A. Fibrosing alveolitis B. Bronchiectasis C. Tuberculosis D. Mesothelioma E. Cystic fibrosis

D. Mesothelioma

A 62 year old man has been smoking 15 cigarettes a day for the past 40 years. His is a retired builder and has been working since he was 24 year old. He presents with chest pain, shortness of breath, and has lost significant weight over the last couple of years. Chest X-ray shows bilateral fibrosis and left sided pleural effusion. What is the SINGLE best investigations that will lead to diagnosis? A. Acid fast staining B. Cytology of pleural fluid aspiration C. Magnetic resonance imaging D. Pleural biopsy E. Computed tomography

D. Pleural biopsy

A 29 year old woman has been short of breath for the last 15 hours and is feeling unwell. An arterial blood gas is taken: PaO2 8.8 kPa PaCO2 3.2 kPa pH 7.50 Bicarbonate (HCO3-) 20 mmol/L Normal Values: Pa02 > 10 kPa PaCO2 4.7-6 kPa pH 7.35 - 7.45 Bicarbonate (HCO3-) 22-26 mmol/L What is the SINGLE most likely diagnosis? A. Diabetic ketoacidosis B. Methanol overdose C. Panic attack D. Pulmonary embolus E. Severe vomiting

D. Pulmonary embolus hypoxia and hypocapnia due to secondar hyperventilation

A 6 year old girl has had 2 short episodes of cough and wheeze over the last 12 months. These 2 acute episodes responded quickly to bronchodilator. She has no symptoms or abnormal physical signs at the moment. She has slight eczema and her mother has a history of asthma when she was young. What is the SINGLE most appropriate investigation? A. Chest X-ray B. Peak flow rate diary C. Pulse oximetry D. Spirometry E. Sweat test

D. Spirometry

A 22 year old man presents with episodes of dyspnoea, starting suddenly. This usually occurs when he is in a crowded area like a lift. When he is breathless, he also notices tingling around his mouth and he feels light-headed. These episodes usually go away after a while. An arterial sample was taken for blood gases during one of the episodes. What is the SINGLE most likely result of the arterial blood gas (ABG)? Normal Values: Pa02 > 10 kPa PaCO2 4.7-6 kPa pH 7.35 - 7.45 Bicarbonate (HCO3-) 22-26 mmol/L A. Pa02 = 8.1 kPa, PaCO2 = 2.6 kPa, pH = 7.55, HCO3- = 26 mmol/l B. Pa02 = 13.6 kPa, PaCO2 = 2.5 kPa, pH = 7.56, HCO3- = 13 mmol/l C. Pa02 = 13.5 kPa, PaCO2 = 6.3 kPa, pH = 7.28, HCO3- = 24 mmol/l D. Pa02 = 8.3 kPa, PaCO2 = 6.4 kPa, pH = 7.27, HCO3- = 24 mmol/l E. Pa02 = 13.1 kPa, PaCO2 = 2.7 kPa, pH = 7.57, HCO3- = 25 mmol/l

E. Pa02 = 13.1 kPa, PaCO2 = 2.7 kPa, pH = 7.57, HCO3- = 25 mmol/l Diagnosis: panic attack causing hyperventilatioin of sudden onset.

A 50 year old man has had hoarseness of voice and a left drooping eyelid for the past 2 months. He also has diminished sweating on same side of face. Finger clubbing is noted on examination. He smokes 20 cigarettes a day for the last 30 years. What is the SINGLE most likely diagnosis? A. Laryngeal carcinoma B. Thyroid carcinoma C. Carcinoma of right bronchus D. Mesothelioma E. Pancoast tumour

E. Pancoast tumour

A 10 year old girl is brought to the emergency department by her dad after having fallen in the park. Her elbows are full of cuts and she has not stopped crying since the injury. Her medical history includes asthma. What is the SINGLE most appropriate analgesia to administer? A. Aspirin B. Diclofenac C. Co-codamol D. Ibuprofen E. Paracetamol

E. Paracetamol

A 25 year old tall man presents to A&E with increasing dyspnoea and right-sided chest pain. He has been a heavy smoker for the past 4 years. He has no past medical history. What is the SINGLE most likely diagnosis? A. Pulmonary embolism B. Myocardial infarction C. Asthma D. Pleural effusion E. Primary Pneumothorax

E. Primary Pneumothorax

A 48 year old presents with increasing shortness of breath over the last few months and a dry cough. He has worked in coal mines for 18 years. Chest x-ray and CT scan of the chest demonstrates characteristic upper zone mass-like scarring with calcification and volume loss. The lung opacifications are seen to be associated with radiating strands. What is the SINGLE most likely diagnosis? A. Churg-strauss syndrome B. Cryptogenic organizing C. Extrinsic allergic alveolitis D. Goodpasture's syndrome E. Progressive massive fibrosis

E. Progressive massive fibrosis

A 72yo man is receiving chemotherapy for SCLC. He has his 4th tx 8 days ago. He has a cough with some green sputum but feels well. Temp=37.6C. Chest exam = few coarse crepitations in the right base. HR=92bpm. CBC: Hgb=12.5g/dL, WBC=1.1, Neutrophils=0.6, Plt=89. Sputum, urine and blood culture sent to microbiology. What is the most appropriate management? a. Broad spectrum antibiotics IV b. Broad spectrum antibiotics PO c. GCSF d. Postpone tx until bacteriology results available e. Reassure and send home

a. Broad spectrum antibiotics IV

An 8yo boy has longstanding asthma. He has admitted with a severe episode and is tired and drowsy. He has not improved on oxygen, inhaled B2 agonist and IV hydrocortisone. CXR shows bilateral hyperinflation. He is too breathless to use a peakflow meter and is O2 sat <90%. What is the single most appropriate inv? a. CBG b. CXR c. CT chest d. Pulse oximetry e. Spirometry

a. CBG

During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What is the inv of choice? a. CXR b. CT c. MRI d. V/Q scan e. CTPA

a. CXR

A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking salbutamol, the ratio=2.4/3.7. What is the most likely dx? a. Chronic bronchitis b. Asthma c. Bronchiectasis d. Lung fibrosis e. Sarcoidosis

a. Chronic bronchitis

A 16yo girl has been unwell for 5days with malaise, headache and dry cough. She has a few crackles in her chest. Her CXR shows patchy consolidation in the lower lobes. What is the single most likely causative organism? a. Cold agglutinins b. Gram -ve diplococci in sputum c. Gram +ve diplococcic in sputum d. Serology for legionella e. Sputum staining for mycobacterium TB

a. Cold agglutinins mycoplasma = dry cough pneumonia

A 55yo man has weight loss, dyspnea and syncope. He smokes 20 cigarettes/day. Inv confirms squamous cell carcinoma in the left bronchus. What is the single most likely biochemical abnormality to be a/w the condition? a. Hypercalcemia b. Hyperkalemia c. Hypoernatremia d. Hypocalcemia e. Hypomagnesium

a. Hypercalcemia

A child suffering from asthma presents with Temp 39C, drooling saliva on to the mother's lap, and taking oxygen by mask. What sign will indicate that he is deteriorating? a. Intercostal recession b. Diffuse wheeze c. Drowsiness

a. Intercostal recession

A 70yo pt presents with cough and SOB. He stopped smoking cigarettes 2yrs ago but has a 50yr smoking hx before quitting. CXR=consolidation and bilateral bihilar lymphadenopathy. What is the best inv for this pt? a. LN biopsy b. Pleural fluid cytology c. CT d. MRI e. US

a. LN biopsy

A 62yo man presents with cough, breathlessness and wheeze. 24% O2, salbutamol and hydrocortisone were given. The symptoms haven't improved and so nebulized bronchodilator was repeated and IV aminophylline was given. ABG: pH=7.31, RR=32. What is the next appropriate management? a. Nasal IPPV b. Intubation and ventilation c. LABA d. Toxapram e. Amoxicillin PO

a. Nasal IPPV SOS AVI

A 22yo man reports a 2d hx of hoarseness of voice. He denies any weight loss but he has been smoking for 4yrs. What is the single most appropriate inv? a. None b. Laryngoscopy c. Bronchoscopy d. BAL e. CXR

a. None Young man, 2 days hx: let the man go jare!

A 28yo man has developed a red, raised rash on trunk after playing football. His PMH shows he had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx? a. Oral chlorpheneraime b. Oral amoxicillin c. IM adrenaline d. Nebulized salbutamol e. Histamine

a. Oral chlorpheneraime

A 56 yo lady with lung cancer presents with urinary retention, postural hypotension, diminished reflexes and sluggish papillary reaction. What is the most likely explanation for her symptoms? a. Paraneoplastic syndrome b. Progression of lung cancer c. Brain metastasis d. Hyponatremia e. Spinal cord compression

a. Paraneoplastic syndrome

A 70yo man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. He has noted weight loss and hoarseness of voice. Choose the single most likely type of cancer a.w risk factors present. a. Basal cell carcinoma b. Bronchial carcinoma c. Esophageal carcinoma d. Nasopharyngeal carcinoma e. Oral carcinoma

b. Bronchial carcinoma

A man with chronic cough presents with copious purulent sputum. What is the single most dx? a. Bronchitis b. Bronchiectasis c. COPD d. Pneumonia e. Emphysema

b. Bronchiectasis

A 64yo man complains of increasing SOB and cough for the past 18m. He coughs up a Table spoon of mucopurulent sputum with occasional specks of blood. What is the most likely underlying cause? a. Acute bronchitis b. Bronchiectasis c. Chronic bronchitis d. Lung cancer e. Pneumonia

b. Bronchiectasis why not chronic bronchitis? no wheeze, hemoptysis hx is more in keeping with bronchiectasis too.

A 54yo pt 7 days after a total hip replacement presents with acute onset breathlessness and raised JVP. Which of the following inv will be most helpful in leading to a dx? a. CXR b. CTPA c. V/Q scan d. D-Dimer e. Doppler US of legs

b. CTPA

A tall thin young man has sudden pain in the chest and becomes breathless while crying. What is the single most appropriate inv? a. Cardiac enzymes b. CXR c. CT d. ECG e. V/Q scan

b. CXR

A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. What would you do to improve his symptoms? a. Aspiration b. Chest drain c. Chemotherapy d. Diuretic

b. Chest drain

An old alcoholic presents with cough, fever, bilateral cavitating consolidation. What is the most probable cause? a. Gram +ve diplococcic b. Coagulase +ve cocci c. Gram -ve cocci d. AFB e. Coagulase -ve cocci

b. Coagulase +ve cocci

A 10yo boy has fallen from a tree and injured his right chest. He has pain and difficulty breathing. He is tachypenic and tender with an area of paradoxical chest wall movement on the right side. What is the single most likely dx? a. Diaphragmatic rupture b. Flail chest c. Fx ribs d. Hemothorax e. Tension pneumothorax

b. Flail chest

A 55yo male presents to the ED after an RTA with breathlessness, engorged neck veins and a dull percussion note on the right side of his chest. Exam: pulse=140bpm, BP=80/50mmHg. What is the most likely dx? a. Hemothorax b. Hemopneumothorax c. Tension pneumothorax d. Simple pneumothorax

b. Hemopneumothorax

A 16yo teenager was brought to the ED after being stabbed on the upper right side of his back. Erect CXR revealed homogenous opacity on the lower right lung, trachea was centrally placed. What is the most probable explanation for the XR findings? a. Pneumothorax b. Hemothorax c. Pneumonia d. Tension pneumothorax e. Empyema

b. Hemothorax

A 27yo man presents with chest pain and respiratory distress. Exam: tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing sounds on right side are absent and diminished on left side. What is the next appropriate management? a. CXR b. Right side aspiration (16G) c. Left side aspiration (16G) d. Right side drain with a small tube (12F) e. Left side drain with a small tube (12F)

b. Right side aspiration (16G)

A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most likely inv? a. Endomyseal/Alpha glidin antibody b. Sweat test c. Barium meal d. ECG e. Glucose tolerance test

b. Sweat test Diagnoses is cystic fibrosis Why not a? coeliac dx does not affect the chest

A pt who works in a pet shop has temp=37.5C, dyspnea, chest pain and cough. CXR: patchy consolidation. What is the most suitable tx? a. Amoxicillin b. Tetracyclin c. Erythromycin d. Clarithromycin e. Penicillin

b. Tetracyclin Pet shop is chlamydia psitacci

A 32yo female has a hx of SOB and fever. Pre-bronchodilation test was done and it was 2/3.5 and post-bronchodilator was 3/3.7. The pt was dx of eczema and TB. What is the possible dx? a.COPD b.Asthma c.Pneumonia d.Bronchiectasis

b.Asthma FEV gets better with bronchodilator

An 8yo girl is complying with her asthma treatment of low-dose inhaled corticosteroid prophylaxis and short-acting bronchodilators as required. Her inhaler technique is good. She now has a frequent night cough and mild exercise-induced wheeze. What would be the SINGLE most appropriate change in her treatment? a. Add leukotriene antagonist b. Add oral theophylline c. Add regular long-acting bronchodilator d. Increase dose of inhaled corticosteroid e. Short course of oral corticosteroid

c. Add regular long-acting bronchodilator SSLTP Note that a and d come up as alternatives second class to c

A mother brings her 1yo infant to her pediatrician. She describes that following a common cold her child's voice has become hoarse and has developed a cough that sounds harsh and brassy and was worse at night. Exam: the child was noted to have trouble drawing air into its lungs between coughs and had trouble drawing air into its lungs. There was visible stridor on inhalation. The cause is most likely to be? a. EBV b. Rhinovirus c. Parainfluenza d. Flavivirus e. HIV f. Rotavirus g. CMV

c. Parainfluenza

A 32yo man working in a shipyard comes with SOB. Exam: dullness on left side of the chest, pain in left side of chest, pleuritic rub and crackles been heard on the same side. What is the single most likely dx? a. Pericarditis b. Pleurisy c. Pleural effusion d. CCF e. TB

c. Pleural effusion

A 50yo man presents with itching after hot shower with dizziness, chest pain after exercise. Exam: splenomegaly. What is the single most likely causative factor? a. ALL b. Lymphoma c. Polycythemia d. Scabies e. Eczema

c. Polycythemia

A mother presents with her 3yo son who has indistinct nasal speech. He snores at night and has restless sleep. He is tired by day. What is the best management strategy? a. Arrange hearing test b. Assess development milestones c. Refer to ENT surgeon d. Refer to speech therapist e. MRI brain

c. Refer to ENT surgeon

An 89yo pt has lung cancer. His Na+=122mmol/l. What is the tx for this? a. Demeclocycline b. Vasopressin c. Restrict fluids d. Reassure

c. Restrict fluids why not demeclocycline? NICE guidelines says fluid restriction first

A 30yo woman is taking tx for asthma. She has a HR=130bpm and peak expiratory flow rate=400. What is the most appropriate management? a. Atenolol b. Digoxin c. Review drugs

c. Review drugs A and B have no role in Asthma

A 35yo man presents with progressive breathlessness. He gave a hx of polyarthralgia withpainful lesions on the shin. CXR: bilateral hilar lymphadenopathy. What's the most likely dx? a. Bronchial asthma b. Cystic fibrosis c. Sarcoidosis d. Bronchiectasis e. Pneumonia

c. Sarcoidosis

A 19yo man has exercised induced asthma and is using a salbutamol inhaler as req and beclamethasone 400ug BD. He complains that he has to wake up at night for his inhaler. What is the single most appropriate tx? a. Beclo b. Regular salbutamol and budesonide c. Sodium cromoglycate d. Oral steroid e. Inhaled steroid

c. Sodium cromoglycate

A 49yo man comes with hx of cough and SOB. His CD4 count is measured as 350. CXR shows lobar consolidation. What is the single most appropriate option? a. Mycobacterium avium intercellular b. CMV c. Streptococcus d. Toxoplasmosis e. Pneumocystis jerovici

c. Streptococcus Diagnosis is community acquired pneumonia. The CD4 is a deliberate attempt to see if the candidate knows at which point opportunistic organisms infect in HIV Note that opportunistic infection in HIV usually cause neumonia when CD4 is <200

A 20yo student who recently visited Asia came to the OPD with complains of low grade fever, night sweats, anorexia and productive cough. Inv: CXR=cavitatory lesions in upper lobes. What is the single most likelt causative organism? a. Mycoplasma b. Klebsiella c. TB d. PCP e. Viral pneumonia

c. TB

A 48yo woman is admitted to ED with a productive cough and moderate fever. She has often central chest pain and regurgitation of undigested food most times but doesn't suffer from acid reflux. These symptoms have been present for the last 3.5 months which affects both food and drink. A CXR shows an air-fluid level behind a normal sized heart. What is the most likely dx? a. Pharyngeal pouch b. Hiatus hernia c. Bulbar palsy d. Achalasia e. TB

d. Achalasia Why not pharyngeal pouch? halitosis Why not Hiatus hernia: xray will show gas filled structure behind cardia frame

A 50yo chronic smoker came to OPD with complaint of chronic productive cough, SOB and wheeze. Labs: CBC=increase in PCV. CXR >6ribs seen above the diaphragm in midclavicular line. ABG=pO2 decreased. What is the most likely dx? a. Interstitial lung disease b. Wegener's granulomatosis c. Ca bronchi d. COPD e. Amyloidosis

d. COPD

A 35yo woman had an uneventful lap chole 18h ago. She has a pulse=108bpm, temp 37.8C. There are signs of reduced air entry at the right base but the CXR doesn't show an obvious abnormality. What is the most appropriate management strategy? a. Cefuroxime PO b. Ceftriaxone IV c. Chlorpheniramine PO d. Chest physiotherapy e. Reassure

d. Chest physiotherapy

A 48yo farmer presented with fever, malaise, cough and SOB. Exam: tachypnea, coarse Endinspiratory crackles and wheeze throughout, cyanosis. Also complaint severe weight loss. His CXR shows fluffy nodular shadowing and there is PMN leukocytosis. What is the single most appropriate dx? a. Ankylosing spondylitis b. Churg-strauss syndrome c. Cryptogenic organizing d. Extrinsic allergic alveolitis e. Progressive massive fibrosis

d. Extrinsic allergic alveolitis

A 50yo DM pt came to the OPD with complaint of of fever, muscle ache, dry cough and anorexia. Inv: CXR=upper lobe cavitation. What is the single most likely causative organism? a. Legionella b. Mycoplasma c. Staphylococcus d. Klebsiella e. Streptococcus

d. Klebsiella

Pt with a long hx of smoking is now suffering from bronchial ca. histology reveals there are sheets of large polygonal or giant MNC. What is the most likely dx? a. Squamous cell ca b. Small cell ca c. Adenocarcinoma d. Large cell ca e. Oat cell ca

d. Large cell ca

A 37yo woman had an elective LSCS 1d ago. You are called to see her as she becomes SOB with left sided chest pain and a cough. She has had 3 children, 2 born by LSCS. Exam: she has reduced air entry at left lung base. Her observations include sat=92% on air, BP=105/84mmHg, pulse=120bpm, temp=37.2C. Choose among the options which C-section complications has she developed? a. Aspiration pneumonia b. Aspiration pneumonitis c. Spontaneous pneumothorax d. Pulmonary embolism e. DVT

d. Pulmonary embolism

A 6yo girl has had 2 short episodes of cough and wheeze over the last 12m. These 2 acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical signs. She has slight eczema and her mother has asthma. What is the single most appropriate inv? a. CXR b. Peak flow rate diary c. Pulse oximetry d. Spirometry e. Sweat test

d. Spirometry This is the test to diagnose asthma. If we knew the diagnosis and wanted a test for follow up then => Peak flow rate diary

A man with suspected active TB wants to be treated at home. What should be done to prevent the spread of disease? a. Immediate start of the tx with Anti-TB drugs b. All family members should be immediately vaccinated with BCG vaccine c. Patient should be isolated in a negative pressure chamber in his house d. Universal prevention application protocol

d. Universal prevention application protocol

A teacher had a respiratory infection for which she was prescribed antibiotics. After the antibiotic course when she rejoined school, she lost her voice completely. What is the single most appropriate dx? a. Recurrent laryngeal nerve palsy b. Angioedema c. Laryngeal obstruction by medication d. Laryngitis e. Functional dysphonia/vocal cords

e. Functional dysphonia/vocal cords

A 5yo boy is rescued from a burning building and is presented to the ED. He has 5% partial thickness burns over the arms and legs and had soot in the mouth and nose. His breathing has become noisy. What is the single most immediate management? a. Nebulized adrenaline b. Nebulized salmetarol and oxygen c. Needle cricothyrodotomy d. Oropharyngeal airway e. Intubation of airway

e. Intubation of airway

A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is the best inv to confirm the dx? a. Bronchoscopy b. Thoracoscopy c. US d. CT thorax e. LN biopsy

e. LN biopsy

A 48yo woman who has been taking medications for asthma for a long time has now presented with decreasing vision. What is the most probable cause for her decrease in vision? a. Inhaled salbutamol b. Inhaled steroids c. Aminophylline d. Beta-blockers e. Oral steroids

e. Oral steroids

A 26yo man present to ED with increasing SOB on left side and chest pain. He has been a heavy smoker for the past 4 years. He doesn't have any past med hx. What is the likely dx? a. Pulmonary embolism b. MI c. Asthma d. Pleural effusion e. Pneumothorax

e. Pneumothorax

A nonsmoker who has worked in coal mines for 20yrs presents with gradually increasing SOB, limited exercise tolerance and a dry cough. His CXR shows round fibrotic tissue demonstrating a mixed restrictive and obstructive ventilator defect with irreversible airflow limitation and reduced gas transfer. What is the single most appropriate dx? a. Churg-strauss syndrome b. Cryptogenic organizing c. Extrinsic allergic alveolitis d. Good pasture syndrome e. Progressive massive fibrosis f. Molluscum

e. Progressive massive fibrosis coal mine is clincher for pneumoconiosis PMF occurs in pneumoconiosis and silicosis

A patient with chronic neutropenia develops a chronic cough. A CXR reveals a cavitating intrapulmonary lesion containing a movable rounded ball lesion. A likely dx is? a. Tuberculosis b. Bronchiectasis c. Cystic fibrosis d. Pulmonary hemosiderosis e. Mitral stenosis f. Aspergillosis

f. Aspergillosis