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  • Question 1 - As part of the investigation of breathlessness, a 68-year-old patient has spirometry performed....

    Incorrect

    • As part of the investigation of breathlessness, a 68-year-old patient has spirometry performed. You learn that he spent all his working life in a factory. The following results are available:
      Measured Expected
      FEV1 (L) 2.59 3.46
      FVC (L) 3.16 4.21
      Ratio (%) 82 81
      Which of the following is the most likely cause?

      Your Answer: Allergic bronchopulmonary aspergillosis (ABPA)

      Correct Answer: Asbestosis

      Explanation:

      Possible Respiratory Diagnoses Based on Pulmonary Function Testing Results

      Based on the patient’s age and history of factory work, along with a restrictive defect on pulmonary function testing, asbestosis is the most likely diagnosis. Other possible respiratory diagnoses include allergic bronchopulmonary aspergillosis (ABPA), asthma, emphysema, and bronchiectasis. ABPA and asthma are associated with an obstructive picture on pulmonary function tests, while emphysema and bronchiectasis are also possible differentials based on the history but are associated with an obstructive lung defect. However, it would be unusual for an individual to have their first presentation of asthma at 72 years old. Therefore, a thorough evaluation of the patient’s medical history, physical examination, and additional diagnostic tests may be necessary to confirm the diagnosis.

    • This question is part of the following fields:

      • Respiratory
      47.4
      Seconds
  • Question 2 - A 31-year-old man and his wife, who have been trying to have a...

    Incorrect

    • A 31-year-old man and his wife, who have been trying to have a baby, visit a Fertility Clinic to receive the results of their tests. The man's semen sample has revealed azoospermia. Upon further inquiry, the man reports having a persistent cough that produces purulent sputum. What test would confirm the underlying condition?

      Your Answer: Computed tomography (CT) thorax and sputum culture

      Correct Answer: Cystic fibrosis transmembrane conductance regulator (CFTR) genetic screening and sweat test

      Explanation:

      Investigations for Male Infertility: A Case of Azoospermia and Bronchiectasis

      Azoospermia, or the absence of sperm in semen, can be caused by a variety of factors, including genetic disorders and respiratory diseases. In this case, a man presents with a longstanding cough productive of purulent sputum and is found to have azoospermia. The combination of azoospermia and bronchiectasis suggests a possible diagnosis of cystic fibrosis (CF), a genetic disorder that affects the respiratory and reproductive systems.

      CF is diagnosed via a sweat test showing high sweat chloride levels and genetic screening for two copies of disease-causing CFTR mutations. While most cases of CF are diagnosed in infancy, some are diagnosed later in life, often by non-respiratory specialties such as infertility clinics. Klinefelter syndrome, a genetic disorder characterized by an extra X chromosome in males, can also cause non-obstructive azoospermia and is diagnosed by karyotyping.

      Computed tomography (CT) thorax can be helpful in diagnosing bronchiectasis, but the underlying diagnosis in this case is likely to be CF. Testicular biopsy and testing FSH and testosterone levels can be used to investigate the cause of azoospermia, but in this case, investigating for CF is the most appropriate next step. Nasal biopsy can diagnose primary ciliary dyskinesia, another cause of bronchiectasis and subfertility, but it is not relevant in this case.

      In conclusion, a thorough evaluation of male infertility should include a comprehensive medical history, physical examination, and appropriate investigations to identify any underlying conditions that may be contributing to the problem.

    • This question is part of the following fields:

      • Respiratory
      29.6
      Seconds
  • Question 3 - After a tennis match, a thin 25-year-old woman complains of left-sided chest pain...

    Correct

    • After a tennis match, a thin 25-year-old woman complains of left-sided chest pain that radiates into her abdomen. The physical examination reveals reduced air entry at the left base of the lung with hyper-resonant percussion sounds at the left side of the chest. The abdominal examination shows generalised tenderness. A few minutes later she develops cyanosis.
      What is the diagnosis?

      Your Answer: Tension pneumothorax

      Explanation:

      Differentiating Tension Pneumothorax from Other Conditions: Clinical Features and Management

      Tension pneumothorax is a medical emergency that occurs when the pressure in the pleural space exceeds atmospheric pressure during both inspiration and expiration. This can lead to impaired venous return, reduced cardiac output, and hypoxemia. The development of tension pneumothorax is not dependent on the size of the pneumothorax, and clinical presentation can be sudden and severe, with rapid, labored respiration, cyanosis, sweating, and tachycardia.

      It is important to differentiate tension pneumothorax from other conditions that may present with similar symptoms. Acute pancreatitis, ectopic pregnancy, myocardial infarction, and pulmonary embolism can all cause abdominal pain and other non-specific symptoms, but they do not typically present with decreased air entry and hyper-resonant percussion note, which are indicative of pneumothorax.

      Prompt management of tension pneumothorax is crucial and involves inserting a cannula into the pleural space to remove air until the patient is no longer compromised, followed by insertion of an intercostal tube. Advanced Trauma Life Support (ATLS) guidelines recommend using a cannula of at least 4.5 cm in length for needle thoracocentesis in patients with tension pneumothorax. The cannula should be left in place until bubbling is confirmed in the underwater-seal system to ensure proper function of the intercostal tube.

      In summary, recognizing the clinical features of tension pneumothorax and differentiating it from other conditions is essential for prompt and effective management.

    • This question is part of the following fields:

      • Respiratory
      27.3
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  • Question 4 - A 65-year-old man with rheumatoid arthritis has been on long term therapy to...

    Correct

    • A 65-year-old man with rheumatoid arthritis has been on long term therapy to manage his condition. He complains of worsening shortness of breath and a chest x-ray reveals 'bilateral interstitial shadowing'. Which medication is the probable culprit for his symptoms?

      Your Answer: Methotrexate

      Explanation:

      Methotrexate as a Cause and Treatment for Pulmonary Fibrosis

      Pulmonary fibrosis is a condition where the lung tissue becomes scarred and thickened, making it difficult for the lungs to function properly. Methotrexate, a chemotherapy drug, is a known cause of pulmonary fibrosis. However, it is also sometimes used as a treatment for idiopathic pulmonary fibrosis as a steroid sparing agent.

      According to medical research, other chemotherapy drugs such as alkylating agents, asparaginase, bleomycin, and procarbazine have also been linked to pulmonary parenchymal or pleural reactions in patients with malignant diseases. In addition, drug-related interstitial pneumonia should be considered in rheumatoid arthritis patients who are taking methotrexate or newer drugs like leflunomide.

      Despite its potential risks, methotrexate can be a useful treatment option for some patients with pulmonary fibrosis. However, it is important for healthcare providers to carefully monitor patients for any adverse reactions and adjust treatment plans accordingly.

    • This question is part of the following fields:

      • Respiratory
      14.2
      Seconds
  • Question 5 - A trauma call is initiated in the Emergency Department after a young cyclist...

    Correct

    • A trauma call is initiated in the Emergency Department after a young cyclist is brought in following a road traffic collision. The cyclist was riding on a dual carriageway when a car collided with them side-on, causing them to land in the middle of the road with severe injuries, shortness of breath, and chest pain. A bystander called an ambulance which transported the young patient to the Emergency Department. The anaesthetist on the trauma team assesses the patient and diagnoses them with a tension pneumothorax. The anaesthetist then inserts a grey cannula into the patient's second intercostal space in the mid-clavicular line. Within a few minutes, the patient expresses relief at being able to breathe more easily.

      What signs would the anaesthetist have observed during the examination?

      Your Answer: Contralateral tracheal deviation, reduced chest expansion, increased resonance on percussion, absent breath sounds

      Explanation:

      Understanding Tension Pneumothorax: Symptoms and Treatment

      Tension pneumothorax is a medical emergency that occurs when air enters the pleural space but cannot exit, causing the pressure in the pleural space to increase and the lung to collapse. This condition can be diagnosed clinically by observing contralateral tracheal deviation, reduced chest expansion, increased resonance on percussion, and absent breath sounds. Treatment involves inserting a wide-bore cannula to release the trapped air. Delay in treatment can be fatal, so diagnosis should not be delayed by investigations such as chest X-rays. Other respiratory conditions may present with different symptoms, such as normal trachea, reduced chest expansion, reduced resonance on percussion, and normal vesicular breath sounds. Tracheal tug is a sign of severe respiratory distress in paediatrics, while ipsilateral tracheal deviation is not a symptom of tension pneumothorax. Understanding the symptoms of tension pneumothorax is crucial for prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Respiratory
      48.4
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  • Question 6 - A 28-year-old Afro-Caribbean lady undergoes a routine chest X-ray during a career-associated medical...

    Correct

    • A 28-year-old Afro-Caribbean lady undergoes a routine chest X-ray during a career-associated medical examination. The chest X-ray report reveals bilateral hilar lymphadenopathy. On closer questioning the patient admits to symptoms of fatigue and weight loss and painful blue-red nodules on her shins.
      What is the most likely diagnosis in this case?

      Your Answer: Sarcoidosis

      Explanation:

      Differential Diagnosis for a Patient with Hilar Lymphadenopathy and Erythema Nodosum

      Sarcoidosis is a condition characterized by granulomas affecting multiple systems, with lung involvement being the most common. It typically affects young adults, especially females and Afro-Caribbean populations. While the cause is unknown, infections and environmental factors have been suggested. Symptoms include weight loss, fatigue, and fever, as well as erythema nodosum and anterior uveitis. Acute sarcoidosis usually resolves without treatment, while chronic sarcoidosis requires steroids and monitoring of lung function, ESR, CRP, and serum ACE levels.

      Tuberculosis is a potential differential diagnosis, as it can also present with erythema nodosum and hilar lymphadenopathy. However, the absence of a fever and risk factors make it less likely.

      Lung cancer is rare in young adults and typically presents as a mass or pleural effusion on X-ray.

      Pneumonia is an infection of the lung parenchyma, but the absence of infective symptoms and consolidation on X-ray make it less likely.

      Mesothelioma is a cancer associated with asbestos exposure and typically presents in older individuals. The absence of exposure and the patient’s age make it less likely.

    • This question is part of the following fields:

      • Respiratory
      35.4
      Seconds
  • Question 7 - A 35-year-old male presents with recurrent dyspnoea and cough. He has a medical...

    Incorrect

    • A 35-year-old male presents with recurrent dyspnoea and cough. He has a medical history of asthma and has been hospitalized in the past due to asthma and two recent cases of pneumonia. On examination, he has bilateral wheeze and a mild fever. His sputum is thick and sticky. Blood tests reveal an ESR of 72 mm/hr (1-10) and elevated IgE levels. What is the most probable diagnosis?

      Your Answer: Tuberculosis

      Correct Answer: Allergic bronchopulmonary aspergillosis

      Explanation:

      Allergic Bronchopulmonary Aspergillosis: Symptoms and Treatment

      Allergic bronchopulmonary aspergillosis is a condition that occurs when the body has an allergic reaction to Aspergillus fumigatus. This can result in symptoms such as wheezing, coughing, difficulty breathing, and recurrent pneumonia. Blood tests may show an increase in IgE levels and eosinophil count. Unfortunately, it is difficult to completely eliminate the fungus, so treatment typically involves high doses of prednisolone to reduce inflammation while waiting for clinical and radiographic improvement.

      Allergic bronchopulmonary aspergillosis is a condition that occurs when the body has an allergic reaction to Aspergillus fumigatus. This can result in symptoms such as wheezing, coughing, difficulty breathing, and recurrent pneumonia. Blood tests may show an increase in IgE levels and eosinophil count.

      Unfortunately, it is difficult to completely eliminate the fungus, so treatment typically involves high doses of prednisolone to reduce inflammation while waiting for clinical and radiographic improvement.

    • This question is part of the following fields:

      • Respiratory
      38.5
      Seconds
  • Question 8 - An 80-year-old man comes to the clinic complaining of increasing shortness of breath...

    Correct

    • An 80-year-old man comes to the clinic complaining of increasing shortness of breath and dry cough over the past three months. He gets breathless after walking a few hundred metres. He is a non-smoker and takes medication for type II diabetes mellitus. During examination, his pulse is 80/minute and regular, blood pressure (BP) 130/70 mmHg, bilateral clubbing of digits, oxygen saturation (SpO2) in room air is 90%. Auscultation reveals bilateral, fine, late inspiratory crackles, more marked in the mid-zones and at the lung bases. Chest X-ray reveals patchy shadowing at the lung bases. What is the definitive investigation to guide his management?

      Your Answer: High-resolution computed tomography (HRCT) chest

      Explanation:

      High-resolution computed tomography (HRCT) chest is the most reliable test for diagnosing idiopathic pulmonary fibrosis (IPF). The radiological pattern seen in IPF is called usual interstitial pneumonia (UIP), which is characterized by honeycombing, reticular opacities, and lung architectural distortion. In advanced cases, there may be lobar volume loss, particularly in the lower lobes.

      Antinuclear antibody (ANA) and anti-cyclic citrullinated peptide (anti-CCP) tests are not useful for diagnosing IPF, as they are typically normal or only mildly elevated in this condition. These tests may be helpful in diagnosing interstitial lung disease associated with rheumatologic conditions, such as systemic lupus erythematosus or rheumatoid arthritis.

      Arterial blood gas (ABG) analysis can be performed in patients with IPF who are experiencing respiratory distress. This test typically shows type I respiratory failure with low oxygen levels and normal or decreased carbon dioxide levels. However, ABG analysis is not the definitive test for diagnosing IPF.

      Bronchoalveolar lavage may be considered if HRCT chest cannot detect the UIP pattern, but it is not typically necessary for diagnosing IPF.

      Pulmonary function tests (PFTs) can help differentiate between obstructive and restrictive lung diseases. In IPF, PFTs typically show a restrictive pattern, with decreased forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), and a normal or increased FEV1/FVC ratio. While PFTs are a useful initial test for evaluating lung function in patients with suspected IPF, they are not definitive for establishing a diagnosis.

    • This question is part of the following fields:

      • Respiratory
      45.2
      Seconds
  • Question 9 - A 35-year-old call centre operator with a 6-year history of sarcoidosis presents with...

    Incorrect

    • A 35-year-old call centre operator with a 6-year history of sarcoidosis presents with worsening shortness of breath during his visit to Respiratory Outpatients. This is his fifth episode of this nature since his diagnosis. In the past, he has responded well to tapered doses of oral steroids. What initial test would be most useful in evaluating his current pulmonary condition before prescribing steroids?

      Your Answer: High-resolution computed tomography (HRCT) of the chest

      Correct Answer: Pulmonary function tests with transfer factor

      Explanation:

      Pulmonary Function Tests with Transfer Factor in Sarcoidosis: An Overview

      Sarcoidosis is a complex inflammatory disease that can affect multiple organs, with respiratory manifestations being the most common. Pulmonary function tests with transfer factor are a useful tool in assessing the severity of sarcoidosis and monitoring response to treatment. The underlying pathological process in sarcoidosis is interstitial fibrosis, leading to a restrictive pattern on pulmonary function tests with reduced transfer factor. While steroids are often effective in treating sarcoidosis, monitoring transfer factor levels can help detect exacerbations and assess response to treatment. Other diagnostic tests, such as arterial blood gas, chest X-ray, serum ACE levels, and HRCT of the chest, may also be useful in certain situations but are not always necessary as an initial test. Overall, pulmonary function tests with transfer factor play a crucial role in the management of sarcoidosis.

    • This question is part of the following fields:

      • Respiratory
      27.2
      Seconds
  • Question 10 - A 55-year-old female presents with worsening dyspnoea and the need to sit down...

    Correct

    • A 55-year-old female presents with worsening dyspnoea and the need to sit down frequently. She has had no other health issues. The patient works in an office.
      During the physical examination, the patient is found to have clubbing and fine end-inspiratory crackles upon auscultation. A chest X-ray reveals diffuse reticulonodular shadows, particularly in the lower lobes.
      What is the most suitable next step in managing this patient?

      Your Answer: Oxygen therapy

      Explanation:

      Treatment Options for Pulmonary Fibrosis

      Pulmonary fibrosis is a condition that can be diagnosed through a patient’s medical history. When it comes to treatment options, oxygen therapy is the most appropriate as it can prevent the development of pulmonary hypertension. However, there are other treatments available such as steroids and immune modulators like azathioprine, cyclophosphamide methotrexate, and cyclosporin. In some cases, anticoagulation may also be used to reduce the risk of pulmonary embolism. It is important to consult with a healthcare professional to determine the best course of treatment for each individual case.

    • This question is part of the following fields:

      • Respiratory
      21.9
      Seconds
  • Question 11 - A 49-year-old farmer presented with progressive dyspnoea. He had a dry cough and...

    Incorrect

    • A 49-year-old farmer presented with progressive dyspnoea. He had a dry cough and exercise intolerance. On examination, few crackles were found in the upper zones of both lungs. Surgical lung biopsy was done which was reported as:
      Interstitial inflammation, chronic bronchiolitis, and two foci of non-necrotizing granuloma.
      What is the most likely clinical diagnosis?

      Your Answer: Aspergillosis

      Correct Answer: Hypersensitivity pneumonitis

      Explanation:

      Differentiating Lung Disorders: Histological Features

      Hypersensitivity Pneumonitis: This lung disorder is caused by a hypersensitivity reaction to mouldy hay or other organic materials. A farmer is likely to develop this condition due to exposure to such materials. The histological triad of hypersensitivity pneumonitis includes lymphocytic alveolitis, non-caseating granulomas, and poorly formed granulomas.

      Aspergillosis: This lung disorder is rarely invasive. In cases where it is invasive, lung biopsy shows hyphae with vascular invasion and surrounding tissue necrosis.

      Sarcoidosis: This lung disorder of unknown aetiology presents with non-caseating granuloma. Schumann bodies, which are calcified, rounded, laminated concretions inside the non-caseating granuloma, are found in sarcoidosis. The granulomas are formed of foreign body giant cells. Within the giant cells, there are star-shaped inclusions called asteroid bodies.

      Histiocytosis X: This lung disorder presents with scattered nodules of Langerhans cells. Associated with it are eosinophils, macrophages, and giant cells. The Langerhans cells contain racket-shaped Birbeck granules.

      Tuberculosis: This lung disorder typically has caseating granulomas in the lung parenchyma. There is also fibrosis in later stages. Ziehl–Neelsen staining of the smear reveals acid-fast bacilli (AFB) in many cases. Vasculitic lesions can also be found.

    • This question is part of the following fields:

      • Respiratory
      31.7
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  • Question 12 - A 58-year-old woman presents with a history of recurrent cough, haemoptysis, and copious...

    Correct

    • A 58-year-old woman presents with a history of recurrent cough, haemoptysis, and copious amounts of mucopurulent sputum for the past 10 years. Sputum analysis shows mixed flora with anaerobes present. During childhood, she experienced multiple episodes of pneumonia.

      What is the probable diagnosis for this patient?

      Your Answer: Bronchiectasis

      Explanation:

      Recognizing Bronchiectasis: Symptoms and Indicators

      Bronchiectasis is a respiratory condition that can be identified through several symptoms and indicators. One of the most common signs is the production of large amounts of sputum, which can be thick and difficult to cough up. Additionally, crackles may be heard when listening to the chest with a stethoscope. In some cases, finger clubbing may also be present. This occurs when the fingertips become enlarged and rounded, resembling drumsticks.

      It is important to note that bronchiectasis can be caused by a variety of factors, including childhood pneumonia or previous tuberculosis. These conditions can lead to damage in the airways, which can result in bronchiectasis.

    • This question is part of the following fields:

      • Respiratory
      10.2
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  • Question 13 - A 42-year-old man with advanced lung disease due to cystic fibrosis (CF) is...

    Correct

    • A 42-year-old man with advanced lung disease due to cystic fibrosis (CF) is being evaluated for a possible lung transplant. What respiratory pathogen commonly found in CF patients would make him ineligible for transplantation if present?

      Your Answer: Burkholderia cenocepacia

      Explanation:

      Common Respiratory Pathogens in Cystic Fibrosis and Their Impact on Lung Transplantation

      Cystic fibrosis (CF) is a genetic disorder that affects the respiratory and digestive systems. Patients with CF are prone to chronic respiratory infections, which can lead to accelerated lung function decline and poor outcomes following lung transplantation. Here are some common respiratory pathogens in CF and their impact on lung transplantation:

      Burkholderia cenocepacia: This Gram-negative bacterium is associated with poor outcomes following lung transplantation and renders a patient ineligible for transplantation in the UK.

      Methicillin-resistant Staphylococcus aureus (MRSA): This Gram-positive bacterium is resistant to many antibiotics but is not usually a contraindication to lung transplantation. Attempts at eradicating the organism from the airways should be made.

      Pseudomonas aeruginosa: This Gram-negative bacterium is the dominant respiratory pathogen in adults with CF and can cause accelerated lung function decline. However, it is not a contraindication to transplantation.

      Aspergillus fumigatus: This fungus is commonly isolated from sputum cultures of CF patients and may be associated with allergic bronchopulmonary aspergillosis. Its presence does not necessarily mandate treatment and is not a contraindication to transplantation.

      Haemophilus influenzae: This Gram-negative bacterium is commonly seen in CF, particularly in children. It is not associated with accelerated lung function decline and is not a contraindication to transplantation.

      In summary, respiratory infections are a common complication of CF and can impact the success of lung transplantation. It is important for healthcare providers to monitor and manage these infections to optimize patient outcomes.

    • This question is part of the following fields:

      • Respiratory
      8.3
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  • Question 14 - A 35-year-old male patient presented to the Emergency department with sudden onset chest...

    Correct

    • A 35-year-old male patient presented to the Emergency department with sudden onset chest pain and shortness of breath that had been ongoing for six hours. The symptoms appeared out of nowhere while he was watching TV, and lying flat made the breathlessness worse. The patient denied any recent history of infection, cough, fever, leg pain, swelling, or travel.
      Upon examination, the patient was apyrexial and showed no signs of cyanosis. Respiratory examination revealed reduced breath sounds and hyperresonance in the right lung.
      What is the most likely diagnosis?

      Your Answer: Primary spontaneous pneumothorax

      Explanation:

      Diagnosis and Management of a Primary Spontaneous Pneumothorax

      Given the sudden onset of shortness of breath and reduced breath sounds from the right lung, the most likely diagnosis for this patient is a right-sided primary spontaneous pneumothorax (PSP). Primary pneumothoraces occur in patients without chronic lung disease, while secondary pneumothoraces occur in patients with existing lung disease. To rule out a pulmonary embolism, a D-dimer test should be performed. A positive D-dimer does not necessarily mean a diagnosis of pulmonary embolism, but a negative result can rule it out. If the D-dimer is positive, imaging would be the next step in management.

      A 12-lead ECG should also be performed to check for any ischaemic or infarcted changes, although there is no clinical suspicion of acute coronary syndrome in this patient. Bornholm disease, a viral infection causing myalgia and severe pleuritic chest pain, is unlikely given the examination findings. An asthma attack would present similarly, but there is no history to suggest this condition in this patient.

      In summary, a primary spontaneous pneumothorax is the most likely diagnosis for this patient. A D-dimer test should be performed to rule out a pulmonary embolism, and a 12-lead ECG should be done to check for any ischaemic or infarcted changes. Bornholm disease and asthma are unlikely diagnoses.

    • This question is part of the following fields:

      • Respiratory
      21
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  • Question 15 - A 5-year-old girl comes to her general practice clinic with her mother. She...

    Correct

    • A 5-year-old girl comes to her general practice clinic with her mother. She has been experiencing nasal congestion, sneezing, and a sore throat for the past few days. During the examination, her pulse rate is 80 bpm, respiratory rate is 20 breaths per minute, and temperature is 36.9 °C. She has no significant medical history. What is the probable diagnosis?

      Your Answer: Common cold

      Explanation:

      Possible Diagnosis for a Young Girl with Respiratory Symptoms

      A young girl is experiencing respiratory symptoms, including sore throat, sneezing, and nasal congestion. Here are some possible diagnoses to consider:

      1. Common cold: This is a common viral infection that can cause mild fever, especially in children.

      2. Hay fever: This is an allergic reaction to specific allergens, such as pollen, that can cause similar symptoms to the common cold, but with a chronic and fluctuating course.

      3. Infectious mononucleosis: This is a viral infection that can cause fatigue, fever, laryngitis, and a rash, but is less likely in this case.

      4. influenzae: This is a seasonal viral infection that can cause more severe symptoms, such as high fever, headache, and muscle aches.

      5. Meningitis: This is a serious bacterial infection that can cause non-specific respiratory symptoms, but also tachycardia, hypotension, high fever, photophobia, neck stiffness, and petechial rash, which are not mentioned here.

      Possible Diagnoses for a Young Girl with Respiratory Symptoms

    • This question is part of the following fields:

      • Respiratory
      170.6
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  • Question 16 - A 52-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents...

    Correct

    • A 52-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents to the Emergency Department with an acute exacerbation. He is experiencing severe shortness of breath and his oxygen saturation levels are at 74% on room air. The medical team initiates treatment with 15 litres of high-flow oxygen and later transitions him to controlled oxygen supplementation via a 28% venturi mask. What is the optimal target range for his oxygen saturation levels?

      Your Answer: 88–92%

      Explanation:

      Understanding Oxygen Saturation Targets for Patients with COPD

      Patients with COPD have specific oxygen saturation targets that differ from those without respiratory problems. The correct range for a COPD patient is 88-92%, as they rely on low oxygen concentrations to drive their respiratory effort. Giving them too much oxygen can potentially remove their drive to breathe and worsen their respiratory situation. In contrast, unwell individuals who are not at risk of type 2 respiratory failure have a target of 94-98%. A saturation target of 80% is too low and can cause hypoxia and damage to end organs. Saturations of 90-94% may indicate a need for oxygen therapy, but it may still be too high for a patient with COPD. It is vital to obtain an arterial blood gas (ABG) in hypoxia to check if the patient is a chronic CO2 retainer. Understanding these targets is crucial in managing patients with COPD and ensuring their respiratory effort is not compromised.

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      • Respiratory
      13.7
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  • Question 17 - A 45-year-old woman with known asthma presents to the Emergency Department with severe...

    Correct

    • A 45-year-old woman with known asthma presents to the Emergency Department with severe breathlessness and wheeze.
      Which of the following is the most concerning finding on examination and initial investigations?

      Your Answer: PaCO2 5.5 kPa

      Explanation:

      Assessing the Severity of an Acute Asthma Exacerbation

      When assessing the severity of an acute asthma exacerbation, several factors must be considered. A PaCO2 level of 5.5 kPa in an acutely exacerbating asthmatic is a worrying sign and is a marker of a life-threatening exacerbation. A respiratory rate of 30 breaths per minute or higher is a sign of acute severe asthma, while poor respiratory effort is a sign of life-threatening asthma. Peak expiratory flow rate (PEFR) can also be used to help assess the severity of an acute exacerbation of asthma. A PEFR of 33-35% best or predicted is a sign of acute severe asthma, while a PEFR < 33% best or predicted is a sign of life-threatening asthma. A heart rate of 140 bpm or higher is a feature of acute severe asthma, while arrhythmia and/or hypotension are signs of life-threatening asthma. Inability to complete sentences in one breath is a sign of acute severe asthma, while an altered conscious level is a sign of life-threatening asthma. By considering these factors, healthcare professionals can accurately assess the severity of an acute asthma exacerbation and provide appropriate treatment.

    • This question is part of the following fields:

      • Respiratory
      16.7
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  • Question 18 - The blood gases with pH 7.38, pO2 6.2 kPa, pCO2 9.2 kPa, and...

    Correct

    • The blood gases with pH 7.38, pO2 6.2 kPa, pCO2 9.2 kPa, and HCO3– 44 mmol/l are indicative of a respiratory condition. Which respiratory condition is most likely responsible for these blood gas values?

      Your Answer: Chronic obstructive pulmonary disease (COPD)

      Explanation:

      Respiratory Failure in Common Lung Conditions

      When analyzing blood gases, it is important to consider the type of respiratory failure present in order to determine the underlying cause. In cases of low oxygen and high carbon dioxide, known as type 2 respiratory failure, chronic obstructive pulmonary disease (COPD) is the most likely culprit. Asthma, on the other hand, typically causes type 1 respiratory failure, although severe cases may progress to type 2 as the patient tires. Pulmonary embolism and pneumonia are also more likely to cause type 1 respiratory failure, while pulmonary fibrosis is associated with this type of failure as well. Understanding the type of respiratory failure can aid in the diagnosis and management of these common lung conditions.

    • This question is part of the following fields:

      • Respiratory
      68.9
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  • Question 19 - A 28-year-old woman presents to her Occupational Health Service. She works in the...

    Correct

    • A 28-year-old woman presents to her Occupational Health Service. She works in the sterile supplies group at her local hospital. Over the past few months, she has noticed increasing shortness of breath with cough and wheeze during the course of a working week, but improves when she takes a week off on holiday. On examination at the general practitioner’s surgery, after a few weeks off, her chest is clear.
      Peak flow diary:
      Monday p.m 460 l/min (85% predicted)
      Tuesday p.m 440 l/min
      Wednesday p.m 400 l/min
      Thursday p.m 370 l/min
      Friday p.m 350 l/min
      Saturday a.m 420 l/min
      Which of the following is the most appropriate treatment choice?

      Your Answer: Redeployment to another role if possible

      Explanation:

      Managing Occupational Asthma: Redeployment and Avoiding Suboptimal Treatment Options

      Based on the evidence from the patient’s peak flow diary, it is likely that they are suffering from occupational asthma. This could be due to a number of agents, such as glutaraldehyde used in hospital sterilisation units. The best course of action would be to redeploy the patient to another role, if possible, and monitor their peak flows at work. Starting medical management for asthma would not be the optimal choice in this case. Other causes of occupational asthma include isocyanates, metals, animal antigens, plant products, acid anhydrides, biological enzymes, and wood dusts. While salbutamol inhaler may provide temporary relief, it is not a long-term solution. Inhaled steroids like beclomethasone or fluticasone/salmeterol may help manage symptoms, but since the cause has been identified, they would not be the most appropriate course of action. A 7-day course of oral prednisolone would only provide temporary relief and is not a realistic long-term treatment option.

    • This question is part of the following fields:

      • Respiratory
      33.8
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  • Question 20 - A 40-year-old Romanian smoker presents with a 3-month history of cough productive of...

    Correct

    • A 40-year-old Romanian smoker presents with a 3-month history of cough productive of blood-tinged sputum, fever, night sweats and weight loss. At presentation he is haemodynamically stable, has a fever of 37.7°C and appears cachectic. On examination, there are coarse crepitations in the right upper zone of lung. Chest radiograph reveals patchy, non-specific increased upper zone interstitial markings bilaterally together with a well-defined round opacity with a central lucency in the right upper zone and bilateral enlarged hila.
      What is the most likely diagnosis?

      Your Answer: Tuberculosis

      Explanation:

      Differential Diagnosis for a Subacute Presentation of Pulmonary Symptoms

      Tuberculosis is a growing concern, particularly in Eastern European countries where multi-drug resistant strains are on the rise. The initial infection can occur anywhere in the body, but often affects the lung apices and forms a scarred granuloma. Latent bacteria can cause reinfection years later, leading to post-primary TB. Diagnosis is based on identifying acid-fast bacilli in sputum. Treatment involves a 6-month regimen of antibiotics. Staphylococcal and Klebsiella pneumonia can also present with pneumonia symptoms and cavitating lesions, but patients would be expected to be very ill with signs of sepsis. Squamous cell bronchial carcinoma is a possibility but less likely in this case. Primary pulmonary lymphoma is rare and typically occurs in HIV positive individuals, with atypical presentation and radiographic findings. Contact screening is essential for TB.

    • This question is part of the following fields:

      • Respiratory
      22.8
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory (15/20) 75%
Passmed