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  • Question 1 - A husband visits the clinic with his wife because he wants to be...

    Incorrect

    • A husband visits the clinic with his wife because he wants to be screened for cystic fibrosis. His brother and wife had a child with cystic fibrosis so he is concerned. His wife is currently 10 weeks pregnant. When screened, he was found to be a carrier of the DF508 mutation for cystic fibrosis but despite this result, the wife declines testing. What are the chances that she will have a child with cystic fibrosis, given that the gene frequency for this mutation in the general population is 1/20?

      Your Answer:

      Correct Answer:

      Explanation:

      The chance of two carriers of a recessive gene having a child that is homozygous for that disease (that is both genes are transmitted to the child) is 25%. Therefore, the chances of this couple having a child with CF are 25%(1/4) x 1/20 = 1/80.

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  • Question 2 - A 40 year old truck operator who smokes one and a half packs...

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    • 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?

      Your Answer:

      Correct Answer: Bronchopneumonia

      Explanation:

      Bronchopneumonia presents as a patchy consolidation involving one or more lobes, usually the dependent lung zones, a pattern attributable to aspiration of oropharyngeal contents.

      Symptoms of bronchopneumonia may be like other types of pneumonia. This condition often begins with flu-like symptoms that can become more severe over a few days. The symptoms include:
      – fever
      – a cough that brings up mucus
      – shortness of breath
      – chest pain
      – rapid breathing
      – sweating
      – chills
      – headaches
      – muscle aches
      – pleurisy, or chest pain that results from inflammation due to excessive coughing
      – fatigue
      – confusion or delirium, especially in older people

      There are several factors that can increase your risk of developing bronchopneumonia. These include:
      – Age: People who are 65 years of age or older, and children who are 2 years or younger, have a higher risk for developing bronchopneumonia and complications from the condition.
      – Environmental: People who work in, or often visit, hospital or nursing home facilities have a higher risk for developing bronchopneumonia.
      – Lifestyle: Smoking, poor nutrition, and a history of heavy alcohol use can increase your risk for bronchopneumonia.
      – Medical conditions: Having certain medical conditions can increase your risk for developing this type of pneumonia. These include: chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD), HIV/AIDS, having a weakened immune system due to chemotherapy or the use of immunosuppressive drugs.

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  • Question 3 - A 41 year old man who has had two episodes of pneumonia in...

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    • 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?

      Your Answer:

      Correct Answer: Bronchial carcinoid

      Explanation:

      Bronchial carcinoids are uncommon, slow growing, low-grade, malignant neoplasms, comprising 1-2% of all primary lung cancers.
      It is believed to be derived from surface of bronchial glandular epithelium. Mostly located centrally, they produce symptoms and signs of bronchial obstruction such as localized wheeze, non resolving recurrent pneumonitis, cough, chest pain, and fever. Haemoptysis is present in approximately 50% of the cases due to their central origin and hypervascularity.
      Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodules or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion depending on how small it is.

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  • Question 4 - Which of the following measurements is a poor prognostic factor in patients suffering...

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    • Which of the following measurements is a poor prognostic factor in patients suffering from pneumonia?

      Your Answer:

      Correct Answer: Respiratory rate 35/min

      Explanation:

      CURB Pneumonia Severity Score estimates the mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
      Select Criteria:
      Confusion (abbreviated Mental Test Score <=8) (1 point)
      Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point)
      Respiratory Rate > 30 per minute (1 point)
      Blood Pressure: diastolic < 60 or systolic < 90 mmHg (1 point) The CURB-65 scores range from 0 to 5. Clinical management decisions can be made based on the score:
      Score Risk Disposition
      0 or 1 – 1.5% mortality – Outpatient care
      2 – 9.2% mortality – Inpatient vs. observation admission
      ≥ 3 – 22% mortality – Inpatient admission with consideration for ICU admission with score of 4 or 5

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  • Question 5 - A young man is reviewed for difficulty breathing. Lung function tests showed that...

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    • 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?

      Your Answer:

      Correct Answer: Asthma

      Explanation:

      Peak Expiratory Flow (PEF), also called Peak Expiratory Flow Rate (PEFR) is a person’s maximum speed of expiration, as measured with a peak flow meter. Measurement of PEFR requires some practise to correctly use a meter and the normal expected value depends on a patient’s gender, age and height.
      It is classically reduced in obstructive lung disorders, such as Asthma, COPD or Cystic Fibrosis.

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  • Question 6 - A 40 year old farmer who is a non-smoker is experiencing increasing shortness...

    Incorrect

    • A 40 year old farmer who is a non-smoker is experiencing increasing shortness of breath on exertion. He has been having chest tightness and a non-productive cough which becomes worse when he is at the dairy farm. He has no respiratory history of note. Extrinsic allergic alveolitis is the suspected diagnosis. Which factor would be responsible for this diagnosis?

      Your Answer:

      Correct Answer: Contaminated hay

      Explanation:

      Extrinsic allergic alveolitis (EAA) refers to a group of lung diseases that can develop after exposure to certain substances. The name describes the origin and the nature of these diseases:

      ‘extrinsic’ – caused by something originating outside the body
      ‘allergic’ – an abnormally increased (hypersensitive) body reaction to a common substance
      ‘alveolitis’ – inflammation in the small air sacs of the lungs (alveoli)

      Symptoms can include: fever, cough, worsening breathlessness and weight loss. The diagnosis of the disease is based on a history of symptoms after exposure to the allergen and a range of clinical tests which usually includes: X-rays or CT scans, lung function and blood tests.

      EAA is not a ‘new’ occupational respiratory disease and occupational causes include bacteria, fungi, animal proteins, plants and chemicals.

      Examples of EAA include:

      Farmer’s lung
      This is probably the most common occupational form of EAA and is the outcome of an allergic response to a group of microbes, which form mould on vegetable matter in storage. During the handling of mouldy straw, hay or grain, particularly in a confined space such as a poorly ventilated building, inhalation of spores and other antigenic material is very likely.

      There also appears to be a clear relationship between water content of crops, heating (through mould production) and microbial growth, and this would apply to various crops and vegetable matter, with the spores produced likely to cause EAA.

      Farmer’s lung can be prevented by drying crops adequately before storage and by ensuring good ventilation during storage. Respiratory protection should also be worn by farm workers when handling stored crops, particularly if they have been stored damp or are likely to be mouldy.

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  • Question 7 - A 50 year old doctor developed a fever of 40.2 °C which lasted...

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    • A 50 year old doctor developed a fever of 40.2 °C which lasted for two days. He has had diarrhoea for a day, shortness of breath and dry cough.
      His blood results reveal a hyponatraemia and deranged LFTs. His WBC count is 10.4 × 109/L and CX-ray shows bibasal consolidation.
       
      Which treatment would be the most effective for his condition?

      Your Answer:

      Correct Answer: Clarithromycin

      Explanation:

      Pneumonia is the predominant clinical manifestation of Legionnaires disease (LD). After an incubation period of 2-10 days, patients typically develop the following nonspecific symptoms:
      Fever
      Weakness
      Fatigue
      Malaise
      Myalgia
      Chills

      Respiratory symptoms may not be present initially but develop as the disease progresses. Almost all patients develop a cough, which is initially dry and non-productive, but may become productive, with purulent sputum and, (in rare cases) haemoptysis. Patients may experience chest pain.
      Common GI symptoms include diarrhoea (watery and non bloody), nausea, vomiting, and abdominal pain.

      Fever is typically present (98%). Temperatures exceeding 40°C occur in 20-60% of patients. Lung examination reveals rales and signs of consolidation late in the disease course.

      Males are more than twice as likely as females to develop Legionnaires disease.

      Age
      Middle-aged and older adults have a high risk of developing Legionnaires disease while it is rare in young adults and children. Among children, more than one third of reported cases have occurred in infants younger than 1 year.

      Situations suggesting Legionella disease:
      -Gram stains of respiratory samples revealing many polymorphonuclear leukocytes with few or no organisms

      -Hyponatremia

      -Pneumonia with prominent extrapulmonary manifestations (e.g., diarrhoea, confusion, other neurologic symptoms)

      Specific therapy includes antibiotics capable of achieving high intracellular concentrations (e.g., macrolides, quinolones, ketolides, tetracyclines, rifampicin).
      Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila. In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated.
      Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila.

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  • Question 8 - Which area in the body controls the hypoxic drive to breathe? ...

    Incorrect

    • Which area in the body controls the hypoxic drive to breathe?

      Your Answer:

      Correct Answer: Carotid body

      Explanation:

      The carotid body consists of chemosensitive cells at the bifurcation of the common carotid artery that respond to changes in oxygen tension and, to a lesser extent, pH. In contrast to central chemoreceptors (which primarily respond to PaCO2) and the aortic bodies (which primarily have circulatory effects: bradycardia, hypertension, adrenal stimulation, and also bronchoconstriction), carotid bodies are most sensitive to PaO2. At a PaO2 of approximately 55-60 mmHg, they send their impulses via CN IX to the medulla, increasing ventilatory drive (increased respiratory rate, tidal volume, and minute ventilation). Thus, patients who rely on hypoxic respiratory drive will typically have a resting PaO2 around 60 mm Hg.

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  • Question 9 - An elderly man presents with complaints of a chronic cough with haemoptysis and...

    Incorrect

    • 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?

      Your Answer:

      Correct Answer: Aspergilloma

      Explanation:

      An aspergilloma is a fungus ball (mycetoma) that develops in a pre-existing cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, cystic fibrosis, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall. Aspergilloma may manifest as an asymptomatic radiographic abnormality in a patient with pre-existing cavitary lung disease due to sarcoidosis, tuberculosis, or other necrotizing pulmonary processes. In patients with HIV disease, aspergilloma may occur in cystic areas resulting from prior Pneumocystis jiroveci pneumonia. Of patients with aspergilloma, 40-60% experience haemoptysis, which may be massive and life threatening. Less commonly, aspergilloma may cause cough and fever.

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  • Question 10 - Which of the following is not a known cause of occupational asthma? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Cadmium

      Explanation:

      Occupational asthma (OA) could be divided into a nonimmunological, irritant-induced asthma and an immunological, allergy-induced asthma. In addition, allergy-induced asthma can be caused by two different groups of agents: high molecular weight proteins (>5,000 Da) or low molecular weight agents (<5,000 Da), generally chemicals like the isocyanates.
      Isocyanates are very reactive chemicals characterized by one or more isocyanate groups (–N=C=O). The main reactions of this chemical group are addition reactions with ethanol, resulting in urethanes, with amines (resulting in urea derivates) and with water. Here, the product is carbamic acid which is not stable and reacts further to amines, releasing free carbon dioxide.

      Diisocyanates and polyisocyanates are, together with the largely nontoxic polyol group, the basic building blocks of the polyurethane (PU) chemical industry, where they are used solely or in combination with solvents or additives in the production of adhesives, foams, elastomers, paintings, coatings and other materials.

      The complex salts of platinum are one of the most potent respiratory sensitising agents having caused occupational asthma in more than 50% of exposed workers. Substitution of ammonium hexachlor platinate with platinum tetra amine dichloride in the manufacture of catalyst has controlled the problem in the catalyst industry. Ammonium hexachlorplatinate exposure still occurs in the refining process.

      Rosin based solder flux fume is produced when soldering. This fume is a top cause of occupational asthma.

      Bakeries, flour mills and kitchens where flour dust and additives in the flour are a common cause of occupational asthma.

      Cadmium was not found to cause occupational asthma.

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