Category: Respiratory

MRCP-0920

A 27-year-old man with a history of asthma presents for review. He has recently been discharged from hospital following an acute exacerbation and reports generally poor control with a persistent night time cough and exertional wheeze. His current asthma therapy is: salbutamol inhaler 100mcg prn Clenil (beclomethasone dipropionate) inhaler 800mcg bd salmeterol 50mcg bd He has a history of missing appointments and requests a prescription with as few side-effects as possible. What is the most appropriate next step in management?

MRCP-0921

A 35-year-old woman is referred to the acute medical unit with a 5 day history of polyarthritis and a low-grade fever. Examination reveals shin lesions which the patient states are painful. Chest x-ray shows a bulky mediastinum. What is the most appropriate diagnosis?

MRCP-0906

A 50 year old retired coal miner with simple silicosis presented with shortness of breath. He had been short of breath for 3 months. Around 3 months ago he began keeping turtle doves as pets. On auscultation he had basal crepitations and chest x-ray showed fine nodular shadowing in the apices.   What is the most likely diagnosis?

MRCP-0907

A 70 year old thyroid cancer patient is admitted due to dyspnoea. Which investigation should be done to assess for possible compression of the upper airways?

MRCP-0908

An elderly woman is referred with worsening chronic pulmonary disease (COPD). She smokes seven cigarettes per day. Her exercise tolerance is only a few yards around the house now. Her FEV1 is 37% of predicted. What is the most appropriate intervention for this patient?

MRCP-0909

A 14 year old known asthmatic presents to the A&E department with difficulty breathing. She was seen by her regular doctor the day before with a sore throat which he diagnosed as tonsillitis and was prescribed oral Amoxicillin for 5 days. Past medical history: Ulcerative colitis diagnosed four years ago. Current medications: Inhaled salbutamol and beclomethasone Mesalazine 400 mg TDS She was observed to be alert and oriented but she had laboured breathing. Inspiratory wheeze was noted. She was pale, sweaty and cyanosed. Her temperature was 36.7ºC, pulse 121/minute and blood pressure 91/40 mmHg. The lungs were clear and the remainder of the examination was normal. She was given high-flow oxygen through a face mask but despite this her breathing became increasingly difficult.   What is the most likely causative agent?

MRCP-0910

A 32-year-old asthmatic woman presents with an acute attack. Her arterial blood gases breathing air are as follows: pH 7.31 pO2 9.6 kPa pCO2 5.1 kPa What do these results signify?

MRCP-0911

A 66 year old COPD patient visits the clinic for a review. He has no increase in his sputum volume or change in its colour. He has been a smoker for 39 years and previously worked at the shipping docks. On examination, he is pursed lip breathing but managing complete sentences. Investigations: BP is 141/72 mmHg Pulse 82 bpm and regular Sp(O2) 92% on room air RR 19 breaths/min Temperature 37.1°C. Examination of his chest revealed a widespread wheeze with coarse crepitations heard in the L mid-zone. FEV1 :FVC ratio in the clinic today was 68%.   Which of the following would be the most useful investigation that should be performed to establish the diagnosis?

MRCP-0912

A 63 year old man presents to the clinic complaining of a 6-month history of shortness of breath on exertion and a non-productive cough.   On examination there is clubbing, and crepitations heard at the lung bases. Lung function tests show a reduced vital capacity and an increased FEV1/FVC ratio.   What is his diagnosis?

MRCP-0913

A 26 year old woman visits the clinic with an acute asthma attack. Which lung function abnormality is she most likely to have?