MRCP-0948
From the options provided below, which intervention plays the greatest role in increasing survival in patients with COPD?
Category: Respiratory
MRCP-0933
A 73 year old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop. On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest. Investigations show: Haemoglobin 14.2 g/dl (13.5-17.7) White cell count 8.4 x 109/l (4-11) Platelets 300 x 109/l (150-400) Sodium 137 mmol/l (135-146) Potassium 4.1 mmol/l (3.5-5) Creatinine 127 micromole/l (79-118) pH 7.4 (7.35-7.45) pCO2 7.5 kPa (4.8-6.1) pO2 9.7 kPa (10-13.3) Chest x-ray – Predominant upper lobe emphysema. FEV1 – 30% of predicted. Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?
MRCP-0934
A 20 year old heroin addict is admitted following an overdose. She is drowsy and has a respiratory rate of 6 bpm. Which of the following arterial blood gas results (taken on room air) are most consistent with this?
MRCP-0935
An 80 year old woman is admitted with a right lower lobe pneumonia. There is consolidation and a moderate sized pleural effusion on the same side. An ultrasound guided pleural fluid aspiration is performed. The appearance of the fluid is clear and is sent off for culture. Whilst awaiting the culture results, which one of the following is the most important factor when determining whether a chest tube should be placed?
MRCP-0936
A 21 year-old male, who is a known alcoholic, presents with a fever, haemoptysis, green sputum and an effusion clinically. There is concern that it may be an empyema. Which test would be most useful to resolve the suspicion?
MRCP-0937
An 80 year-old Zimbabwean woman with known rheumatoid arthritis was admitted to hospital with a four week history of weight loss, night sweats and cough. She was given a course of Amoxicillin for the past week but her condition deteriorated and she was referred to the hospital when she developed haemoptysis. She was on maintenance prednisolone 10 mg once per day and four weeks earlier, she had received infliximab for a flare up of rheumatoid arthritis. She lived with her husband but had been admitted to hospital himself with influenza four days earlier. She was a lifelong non-smoker and worked most of her life as a missionary in Zimbabwe and South Africa. On examination she looked cachexic and was pyrexial with a temperature of 38.5°C. Her blood pressure was 181/101 mmHg, pulse 121 beats per minute and oxygen saturations of 89% on room air. Her heart sounds were normal and there were no audible murmurs. Auscultation of her lung fields revealed bronchial breath sounds in the left upper zone. Examination of her abdomen was normal. Mantoux test < 5mm (after 48 hours) A chest radiograph revealed cavitating left upper lobe consolidation. What is the most likely diagnosis?
MRCP-0922
A 68 year old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa. Which one of the following interventions is most likely to increase survival in this patient?
MRCP-0923
A 28-year-old 9 week pregnant woman is newly diagnosed with asthma. She is not on any medication at the moment. Her PEFR diary shows wide diurnal variations and she also gives a past history of eczema. Which of the following is correct?
MRCP-0924
A 20-year-old man presents with an acute exacerbation of asthma associated with a chest infection. He is unable to complete a sentence and his peak flow rate was 34% of his normal level. He is treated with high-flow oxygen, nebulised bronchodilators, and oral corticosteroids for three days, but his condition has not improved. Which of the following intravenous treatments would be the best option for this patient?
MRCP-0925
A 14 year old girl with cystic fibrosis (CF) presents with abdominal pain. Which of the following is the pain most likely linked to?