Category: Respiratory

MRCP-0888

An elderly man presents with complaints of a chronic cough with haemoptysis and night sweats on a few nights per week for the past four months. He is known to smoke 12 cigarettes per day and he had previously undergone treatment for Tuberculosis seven years ago. His blood pressure was found to be 143/96mmHg and he is mildly pyrexial 37.5°C. Evidence of consolidation affecting the right upper lobe was also found. Investigations;   Hb 11.9 g/dL, WCC 11.1 x109/L, PLT 190 x109/L, Na+ 138 mmol/L, K+ 4.8 mmol/L, Creatinine 105 μmol/L, CXR Right upper lobe cavitating lesion Aspergillus precipitins positive Which of the following is most likely the diagnosis?

MRCP-0889

A young man is reviewed for difficulty breathing. Lung function tests showed that his peak expiratory flow rate is 54% below the normal range for his age and height. What is a possible diagnosis?

MRCP-0890

A 41 year old man who has had two episodes of pneumonia in succession and an episode of haemoptysis is observed to have paroxysms of coughing and increasing wheezing. A single lesion which is well-defined is seen in the lower right lower lobe on a chest x-ray. There is no necrosis but biopsy shows numerous abnormal cells, occasional nuclear pleomorphism and absent mitoses. Which diagnosis fits the clinical presentation?

MRCP-0891

A 23 year old female presents with a five month history of worsening breathlessness and daily productive cough. As a young child, she had occasional wheezing with viral illnesses and she currently works in a ship yard and also smokes one pack of cigarettes daily for the past three years. Which of the following is the likely diagnosis?

MRCP-0892

A 40 year old truck operator who smokes one and a half packs of cigarette per day complains of a cough and fever for the last three days. He also has right-sided chest pain when he inhales. On examination he is slightly cyanosed, has a temperature of 38.1°C, a respiratory rate of 39/min, a BP of 104/71 mm/Hg and a pulse rate of 132/min. He has basal crepitations and dullness to percussion at the right lung base. What could be a probable diagnosis?

MRCP-0893

Which of the following is not a known cause of occupational asthma?

MRCP-0894

A 21 year old university student is taken to the A&E. She lives alone in a small apartment. She is normally fit and well but she has been complaining of difficulty with concentrating in classes. She is a one pack per day smoker and she has no significant past medical history. She is also not on any medication. She had a pulse of 123 beats per minute and her blood pressure was measured to be 182/101mmHg. She looked flushed. Chest x-ray was normal and her oxygen saturations were normal. She has typical features of carbon monoxide poisoning.   Initial investigations showed:

  • Haemoglobin 13.0 g/dL (11.5-16.5)
  • White cell count 10.3 x109/L (4-11 x109)
  • Platelets 281 x109/L (150-400 x109)
  • Serum sodium 133 mmol/L (137-144)
  • Serum potassium 3.7 mmol/L (3.5-4.9)
  • Serum urea 7.3 mmol/L (2.5-7.5)
  • Serum creatinine 83 μmol/L (60-110)

Drug screen Negative

Arterial blood gases on air:

  • pO2 7.9 kPa (11.3-12.6)
  • pCO2 4.7 kPa (4.7-6.0)
  • pH 7.43 (7.36-7.44)

Which test would confirm this diagnosis?

MRCP-0895

An elderly woman is admitted to the hospital with a community-acquired pneumonia (CAP). Her medical notes state that she developed a skin rash after taking penicillin a few years ago. She has a CURB score of 4 and adverse prognostic features. Which of the following would be an appropriate empirical antibiotic choice?

MRCP-0896

A 23 year old female presents to the hospital with worsening shortness of breath, increased volume of purulent sputum and left-sided chest pain. She has a history of cystic fibrosis. Medical notes state that she is under consideration for the transplant list and for some years has been colonised with pseudomonas. On examination she has a temperature of 38.4°C and FEV1 falling below 75% of the previous value that was recorded. She looks unwell and is tachycardic and hypotensive with a respiratory rate of 21/min. Burkholderia cepacia is confirmed as the pathogen in this case. What would be the most appropriate antibiotic regime?

MRCP-0897

A 66 year old man visits the clinic because he has been experiencing increasing breathlessness for the past five months while doing daily tasks. His exercise tolerance is now limited to 75 metres while on a flat surface and walking up the stairs makes him breathless. He sleeps on four pillows and has swollen ankles in the morning. He occasionally coughs up phlegm. Past Medical history of importance: 36 pack year smoking history Hypertension Ischaemic heart disease Coronary artery stenting done 10 months ago Pulmonary function testing revealed: FEV1 0.90 L (1.80 – 3.02 predicted) FVC 1.87 L (2.16 – 3.58 predicted) Diffusion capacity 3.0 mmol/min/kPa (5.91 – 9.65 predicted) Total lung capacity 4.50 L (4.25 – 6.22 predicted) Residual volume 2.70 L (1.46 – 2.48 predicted)   Which condition does he have?