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  • Question 1 - Patients with severe pneumonia may face various risk factors that increase their chances...

    Incorrect

    • Patients with severe pneumonia may face various risk factors that increase their chances of death. Which of the following factors does not contribute to this risk?

      Your Answer: Diastolic blood pressure < 60 mmHg

      Correct Answer: Age 49 years

      Explanation:

      Understanding the CURB-65 Score for Mortality Prediction in Pneumonia

      Pneumonia is a serious respiratory infection that can lead to mortality, especially in older patients. Several factors can increase the risk of death, including elevated urea levels, low blood pressure, leukopenia, and atrial fibrillation. To predict mortality in pneumonia, healthcare professionals use the CURB-65 score, which considers five parameters: confusion, urea >7 mmol/l, respiratory rate >30/min, systolic blood pressure <90 mmHg or diastolic blood pressure <60 mmHg, and age >65 years. Each parameter scores a point, and the higher the total score, the higher the associated mortality.

      Based on the CURB-65 score, healthcare professionals can make informed decisions about treatment and admission to hospital. Patients with a score of 0 or 1 can be treated at home with oral antibiotics, while those with a score of 2 should be considered for hospital admission. Patients with a score of 3 or higher should be admitted to hospital, and those with a score of 4-5 may require high dependency or intensive therapy unit admission. However, individual circumstances, such as the patient’s performance status, co-morbidities, and social situation, should also be considered when making treatment decisions.

      In summary, the CURB-65 score is a valuable tool for predicting mortality in pneumonia and guiding treatment decisions. By considering multiple factors, healthcare professionals can provide the best possible care for patients with this serious infection.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 2 - At a coffee shop, you observe a young woman beginning to cough and...

    Correct

    • At a coffee shop, you observe a young woman beginning to cough and wheeze. Approaching her, you inquire if she is choking. She replies that she believes a sip of hot coffee went down the wrong way. What should be your initial course of action?

      Your Answer: Encourage him to cough

      Explanation:

      Dealing with Choking Emergencies

      Choking is a serious medical emergency that can be life-threatening. It occurs when the airway is partially or completely blocked, often while eating. The first step in dealing with a choking victim is to ask them if they are choking. If they are able to speak and breathe, it may be a mild obstruction. However, if they are unable to speak or breathe, it is a severe obstruction and requires immediate action.

      According to the Resus Council, mild airway obstruction can be treated by encouraging the patient to cough. However, if the obstruction is severe and the patient is conscious, up to five back-blows and abdominal thrusts can be given. If these methods are unsuccessful, the cycle should be repeated. If the patient is unconscious, an ambulance should be called and CPR should be started.

      It is important to note that choking can happen to anyone, so it is important to be prepared and know how to respond in an emergency. By following these steps, you can help save a life.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 3 - A 75-year-old man is brought to the emergency department by ambulance after being...

    Incorrect

    • A 75-year-old man is brought to the emergency department by ambulance after being found unresponsive in his home. His medical records show that he had recently been prescribed doxycycline for an unknown reason. Upon assessment, he is breathing rapidly with a respiratory rate of 40 breaths/min and has bibasal crackles. His heart rate is 96 beats/min and his blood pressure is 82/44 mmHg. His blood glucose is 4.1mmol/L, his temperature 38.9ºC and his Glasgow Coma Scale (GCS) is 9 (E3M4V2). He is given a fluid bolus and an arterial blood gas (ABG) on 4L/min of oxygen is taken, revealing an abnormal pH. What is the most likely cause of the abnormal pH?

      Your Answer: Acute kidney injury (AKI)

      Correct Answer: Lactic acidosis

      Explanation:

      Understanding Metabolic Acidosis and Anion Gap

      Metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not able to remove enough acid from the body. It is commonly classified according to the anion gap, which can be calculated by subtracting the sum of chloride and bicarbonate levels from the sum of sodium and potassium levels. The normal range for anion gap is 10-18 mmol/L. If a question supplies the chloride level, it may be a clue that the anion gap should be calculated.

      There are two types of metabolic acidosis based on anion gap levels. Normal anion gap or hyperchloraemic metabolic acidosis is caused by gastrointestinal bicarbonate loss, prolonged diarrhea, ureterosigmoidostomy, fistula, renal tubular acidosis, drugs, ammonium chloride injection, and Addison’s disease. On the other hand, raised anion gap is caused by lactate, ketones, urate, acid poisoning, and other factors.

      Metabolic acidosis secondary to high lactate levels may be subdivided into two types: lactic acidosis type A and lactic acidosis type B. Lactic acidosis type A is caused by sepsis, shock, hypoxia, and burns, while lactic acidosis type B is caused by metformin. Understanding the different types of metabolic acidosis and anion gap levels can help in diagnosing and treating the condition.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 4 - A 65-year-old man presents with gradually worsening exertional dyspnoea and a dry cough...

    Incorrect

    • A 65-year-old man presents with gradually worsening exertional dyspnoea and a dry cough over the past year. He quit smoking 25 cigarettes/day about 25 years ago. Upon examination, his oxygen saturation is 96% on room air, respiratory rate is 16/min, and there are fine bibasal crackles. Finger clubbing is also present. The following investigations were conducted:
      - B-type natriuretic peptide: 90 pg/ml (< 100pg/ml)
      - ECG: sinus rhythm, 68/min
      - Spirometry:
      - FEV1: 1.6 L (51% of predicted)
      - FVC: 1.7 L (40% of predicted)
      - FEV1/FVC: 95%

      What is the most likely diagnosis?

      Your Answer: Heart failure

      Correct Answer: Idiopathic pulmonary fibrosis

      Explanation:

      A common scenario for idiopathic pulmonary fibrosis involves a man between the ages of 50 and 70 who experiences worsening shortness of breath during physical activity. Other symptoms may include clubbing of the fingers and a restrictive pattern on spirometry testing. However, a normal B-type natriuretic peptide level suggests that heart failure is not the cause of these symptoms.

      Understanding Idiopathic Pulmonary Fibrosis

      Idiopathic pulmonary fibrosis (IPF) is a chronic lung condition that causes progressive fibrosis of the interstitium of the lungs. Unlike other causes of lung fibrosis, IPF has no underlying cause. It is typically seen in patients aged 50-70 years and is more common in men.

      The symptoms of IPF include progressive exertional dyspnoea, dry cough, clubbing, and bibasal fine end-inspiratory crepitations on auscultation. Diagnosis is made through spirometry, impaired gas exchange tests, and imaging such as chest x-rays and high-resolution CT scans.

      Management of IPF includes pulmonary rehabilitation, but very few medications have been shown to be effective. Some evidence suggests that pirfenidone, an antifibrotic agent, may be useful in selected patients. Many patients will eventually require supplementary oxygen and a lung transplant.

      The prognosis for IPF is poor, with an average life expectancy of around 3-4 years. CT scans can show advanced pulmonary fibrosis, including honeycombing. While there is no cure for IPF, early diagnosis and management can help improve quality of life and potentially prolong survival.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 5 - Among the following options, which condition is considered a restrictive lung disease/condition? ...

    Incorrect

    • Among the following options, which condition is considered a restrictive lung disease/condition?

      Your Answer: Emphysema

      Correct Answer: Severe scoliosis

      Explanation:

      Different Types of Lung Diseases and their Spirometry Patterns

      Scoliosis and Lung Function
      Severe scoliosis can affect the respiratory muscles and the natural movements of the thoracic cage, leading to a restrictive pattern in pulmonary function tests. This can prevent the lungs from expanding correctly, compromising their function.

      Cystic Fibrosis and Lung Function
      In early stage cystic fibrosis, the presence of inflammation and thick secretions in the airways can cause an obstructive pattern in spirometry tests. As damage to the lung tissue occurs, a restrictive component can also develop, resulting in a combined obstructive and restrictive pattern.

      Emphysema and Lung Function
      Emphysema is a type of obstructive lung disease characterized by abnormal and irreversible enlargement of air spaces and alveolar wall destruction. This leads to airflow limitation and a spirometry pattern typical of obstructive lung disease.

      Asthma and Lung Function
      Asthma is an inflammatory disorder of the airways that causes hyperresponsiveness and constriction of the airways in response to various stimuli. This leads to airflow limitation and a spirometry pattern typical of obstructive lung disease.

      Bronchiectasis and Lung Function
      Bronchiectasis is characterized by abnormal and irreversible dilatation of the bronchial walls, leading to accumulation of secretions and recurrent inflammation of the airways. This produces an obstructive pattern in pulmonary function tests.

      In summary, different types of lung diseases can affect lung function in various ways, leading to different spirometry patterns. Understanding these patterns can help in the diagnosis and management of these conditions.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 6 - A 50-year-old female comes to an after-hours general practitioner complaining of worsening fever,...

    Incorrect

    • A 50-year-old female comes to an after-hours general practitioner complaining of worsening fever, chest pain that worsens when inhaling, and a productive cough with blood-streaked sputum. She reports that she had symptoms of a dry cough, myalgia, and lethargy a week ago, but this week her symptoms have changed to those she is presenting with today. Her chest x-ray shows a cavitating lesion with a thin wall on the right side and an associated pleural effusion. What is the probable causative organism?

      Your Answer: Legionella pneumophila

      Correct Answer: Staphylococcus aureus

      Explanation:

      Causes of Pneumonia

      Pneumonia is a respiratory infection that can be caused by various infectious agents. Community acquired pneumonia (CAP) is the most common type of pneumonia and is caused by different microorganisms. The most common cause of CAP is Streptococcus pneumoniae, which accounts for around 80% of cases. Other infectious agents that can cause CAP include Haemophilus influenzae, Staphylococcus aureus, atypical pneumonias caused by Mycoplasma pneumoniae, and viruses.

      Klebsiella pneumoniae is another microorganism that can cause pneumonia, but it is typically found in alcoholics. Streptococcus pneumoniae, also known as pneumococcus, is the most common cause of community-acquired pneumonia. It is characterized by a rapid onset, high fever, pleuritic chest pain, and herpes labialis (cold sores).

      In summary, pneumonia can be caused by various infectious agents, with Streptococcus pneumoniae being the most common cause of community-acquired pneumonia. It is important to identify the causative agent to provide appropriate treatment and prevent complications.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 7 - A 65-year-old man with known chronic obstructive pulmonary disease (COPD) presents to the...

    Correct

    • A 65-year-old man with known chronic obstructive pulmonary disease (COPD) presents to the Emergency Department with sudden shortness of breath, a productive cough and feeling generally unwell. He reports that he has not traveled recently and has been practicing social distancing.
      What is the most probable reason for this patient's exacerbation?
      Choose the SINGLE most likely cause from the options provided.

      Your Answer: Haemophilus influenzae

      Explanation:

      Bacterial Causes of Acute COPD Exacerbation

      Acute exacerbation of chronic obstructive pulmonary disease (COPD) can be caused by various bacterial pathogens. Among them, Haemophilus influenzae is the most common, followed by Streptococcus pneumoniae and Moraxella catarrhalis. Staphylococcus aureus and Staphylococcus epidermidis are less likely to cause COPD exacerbation unless there is an underlying immunodeficiency. Symptoms of bacterial infection include breathlessness, productive cough, and malaise. Treatment with doxycycline can effectively manage Haemophilus influenzae infection.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 8 - A 32-year-old man with cystic fibrosis (CF) has been experiencing a significant increase...

    Incorrect

    • A 32-year-old man with cystic fibrosis (CF) has been experiencing a significant increase in productive cough with large amounts of sputum, occasional haemoptysis and difficulty breathing for the past few months.
      What is the most probable diagnosis?

      Your Answer: Bronchiolitis

      Correct Answer: Bronchiectasis

      Explanation:

      Identifying Bronchiectasis in a Patient with Cystic Fibrosis

      Cystic Fibrosis (CF) is a genetic disorder that can lead to the development of bronchiectasis. Bronchiectasis is a condition characterized by dilated, thick-walled bronchi, which can result from continual or recurrent infection and inflammation caused by thick, difficult to expectorate mucus in patients with CF. In contrast, bronchiolitis is an acute lower respiratory infection that occurs in children aged <2 years, while asthma typically presents with variable wheeze, cough, breathlessness, and chest tightness. Chronic obstructive pulmonary disease (COPD) typically develops in smokers aged >40, and interstitial lung disease generally affects patients aged >45 and is associated with persistent breathlessness on exertion and cough. Therefore, in a patient with CF presenting with symptoms such as cough, breathlessness, and chest infections, bronchiectasis should be considered as a possible diagnosis.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 9 - A 67-year-old man comes to the emergency department complaining of feeling generally unwell...

    Correct

    • A 67-year-old man comes to the emergency department complaining of feeling generally unwell and feverish for 3 days. During the examination, coarse crackles and dullness to percussion were detected in the right lung base.
      What is the most probable diagnosis?

      Your Answer: Lobar pneumonia

      Explanation:

      Differentiating Lobar Pneumonia from Other Respiratory Conditions

      Lobar pneumonia is the most common cause of focal crackles and dullness in the lower zone. However, it is important to differentiate it from other respiratory conditions with similar symptoms. Empyema, for example, is associated with high fevers, night sweats, chest pain, cough, breathlessness, and fatigue. Bronchiectasis, on the other hand, is characterized by a persistent dry cough with copious purulent sputum and occasional haemoptysis. Congestive cardiac failure usually causes bilateral crepitations and peripheral oedema, while pulmonary embolism may cause reduced breath sounds and acute breathlessness, pleuritic chest pain, haemoptysis, dizziness, or syncope. By carefully assessing the patient’s symptoms and conducting appropriate tests, healthcare professionals can accurately diagnose and treat respiratory conditions.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 10 - A 25-year-old female patient presents with a persistent cough and runny nose for...

    Incorrect

    • A 25-year-old female patient presents with a persistent cough and runny nose for the past 48 hours. She seeks treatment for her symptoms, but you explain that she is likely experiencing a common cold that will resolve on its own. What is the most frequent cause of the common cold?

      Your Answer: Respiratory syncytial virus

      Correct Answer: Rhinovirus

      Explanation:

      Rhinoviruses are responsible for causing the common cold, while respiratory syncytial virus is a common cause of bronchiolitis. Influenza virus is the culprit behind the flu, while Streptococcus pneumonia is the most frequent cause of community-acquired pneumonia. Parainfluenza virus is commonly associated with croup.

      Respiratory Pathogens and Their Associated Conditions

      Respiratory pathogens are microorganisms that cause infections in the respiratory system. The most common respiratory pathogens include respiratory syncytial virus, parainfluenza virus, rhinovirus, influenza virus, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, Legionella pneumophilia, and Pneumocystis jiroveci. Each of these pathogens is associated with a specific respiratory condition.

      Respiratory syncytial virus is known to cause bronchiolitis, while parainfluenza virus is associated with croup. Rhinovirus is the most common cause of the common cold, while influenza virus causes the flu. Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, and Haemophilus influenzae is the most common cause of bronchiectasis exacerbations and acute epiglottitis. Staphylococcus aureus is known to cause pneumonia, particularly following influenza. Mycoplasma pneumoniae causes atypical pneumonia, which is characterized by flu-like symptoms that precede a dry cough. Legionella pneumophilia is another cause of atypical pneumonia, which is typically spread by air-conditioning systems and causes a dry cough. Pneumocystis jiroveci is a common cause of pneumonia in HIV patients, and patients typically have few chest signs and develop exertional dyspnea. Mycobacterium tuberculosis causes tuberculosis, which can present in a wide range of ways, from asymptomatic to disseminated disease. Cough, night sweats, and weight loss may be seen in patients with tuberculosis.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 11 - What is the most effective antibiotic for treating Chlamydia pneumonia? ...

    Correct

    • What is the most effective antibiotic for treating Chlamydia pneumonia?

      Your Answer: Clarithromycin

      Explanation:

      Antibiotics for Chlamydia Pneumoniae Infections

      Chlamydia pneumoniae infections are commonly treated with macrolide antibiotics such as clarithromycin or erythromycin. These antibiotics are effective against atypical pneumonias and should be taken for a long period of time (usually 10-14 days) with strict compliance to avoid suboptimal doses. However, the most common side effects of these antibiotics are nausea, vomiting, and diarrhea.

      Clindamycin is not recommended for the treatment of Chlamydia pneumoniae infections. Piperacillin and ampicillin are also not indicated due to in vitro resistance shown by the bacteria. Imipenem is also not recommended for the treatment of Chlamydia pneumoniae infections. It is important to consult with a healthcare professional for proper diagnosis and treatment of any infection.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 12 - A 55-year-old man with a history of alcohol dependence presents with fever and...

    Correct

    • A 55-year-old man with a history of alcohol dependence presents with fever and malaise. On admission, a chest x-ray reveals consolidation in the right upper lobe with early cavitation. What is the probable causative agent responsible for this condition?

      Your Answer: Klebsiella pneumoniae

      Explanation:

      Causes of Pneumonia

      Pneumonia is a respiratory infection that can be caused by various infectious agents. Community acquired pneumonia (CAP) is the most common type of pneumonia and is caused by different microorganisms. The most common cause of CAP is Streptococcus pneumoniae, which accounts for around 80% of cases. Other infectious agents that can cause CAP include Haemophilus influenzae, Staphylococcus aureus, atypical pneumonias caused by Mycoplasma pneumoniae, and viruses.

      Klebsiella pneumoniae is another microorganism that can cause pneumonia, but it is typically found in alcoholics. Streptococcus pneumoniae, also known as pneumococcus, is the most common cause of community-acquired pneumonia. It is characterized by a rapid onset, high fever, pleuritic chest pain, and herpes labialis (cold sores).

      In summary, pneumonia can be caused by various infectious agents, with Streptococcus pneumoniae being the most common cause of community-acquired pneumonia. It is important to identify the causative agent to provide appropriate treatment and prevent complications.

    • This question is part of the following fields:

      • Respiratory Medicine
      1.5
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  • Question 13 - A 70-year-old male, who migrated to the UK from India 8 years ago,...

    Incorrect

    • A 70-year-old male, who migrated to the UK from India 8 years ago, presents to the respiratory clinic with a persistent cough and recent episodes of haemoptysis. The patient has never smoked and there are no notable findings on physical examination. A chest X-ray reveals a crescent of air partially outlining a cavitating mass in the right upper lobe. A CT scan of the chest is performed in both supine and prone positions, demonstrating movement of the mass within the cavity. The patient has not previously been screened for tuberculosis. What is the most probable cause of the mass?

      Your Answer: Sarcoidosis

      Correct Answer: Aspergilloma

      Explanation:

      Cavitating lung lesions can be caused by various factors, including infections and malignancies. In this case, the absence of a smoking history makes small cell and squamous cell lung cancers less likely. Small cell lung cancers typically affect the hilar or peri-hilar areas, while squamous cell lung cancers may present with pulmonary symptoms or paraneoplastic syndromes.

      An aspergilloma is a fungal ball that forms in an existing lung cavity, often caused by conditions such as tuberculosis, lung cancer, or cystic fibrosis. While it may not cause any symptoms, it can lead to coughing and severe haemoptysis (coughing up blood). Diagnosis can be made through a chest x-ray, which will show a rounded opacity with a possible crescent sign, as well as high levels of Aspergillus precipitins. In some cases, a CT scan may also be necessary to confirm the presence of the aspergilloma.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 14 - A 63-year-old man visits his doctor with a persistent cough that has lasted...

    Incorrect

    • A 63-year-old man visits his doctor with a persistent cough that has lasted for 5 weeks. He reports coughing up smelly, green phlegm and experiencing night sweats, left-sided chest pain, and occasional fevers. He denies any weight loss. During the examination, the lower left lung is dull to percussion with low-pitched bronchial breath sounds, and he has a temperature of 38.2°C. The patient has not traveled recently or had any contact with sick individuals. The doctor notes that he was treated for pneumonia 7 weeks ago. What is the most probable cause of this patient's presentation?

      Your Answer: TB

      Correct Answer: Lung abscess

      Explanation:

      The most likely diagnosis for this patient is lung abscess, as they are presenting with a subacute productive cough, foul-smelling sputum, and night sweats. The duration of a cough can be categorized as acute, subacute, or chronic, and this patient falls under the subacute category. The patient’s recent history of aspiration pneumonia and examination findings, such as dullness on percussion, bronchial breath sounds, and fever, support the diagnosis of lung abscess.

      Lung cancer is not the most likely diagnosis for this patient, as they do not have weight loss and have other findings that point towards lung abscess. Pulmonary fibrosis is also unlikely, as it is rare to have unilateral pulmonary fibrosis, and the patient’s examination findings do not support this diagnosis. Recurrent pneumonia is a good differential, but the presence of bronchial breath sounds and night sweats make lung abscess a more likely diagnosis.

      Understanding Lung Abscess

      A lung abscess is a localized infection that occurs within the lung tissue. It is commonly caused by aspiration pneumonia, which can be triggered by poor dental hygiene, reduced consciousness, or previous stroke. Other potential causes include haematogenous spread, direct extension, and bronchial obstruction. The infection is typically polymicrobial, with Staphylococcus aureus, Klebsiella pneumonia, and Pseudomonas aeruginosa being the most common monomicrobial causes.

      The symptoms of lung abscess are similar to pneumonia, but they tend to develop more slowly over several weeks. Patients may experience fever, productive cough, foul-smelling sputum, chest pain, and dyspnea. Some may also have systemic features such as night sweats and weight loss, while a minority may experience haemoptysis. Physical examination may reveal dull percussion and bronchial breathing, as well as clubbing in some cases.

      To diagnose lung abscess, a chest x-ray is usually performed, which shows a fluid-filled space within an area of consolidation. Sputum and blood cultures should also be obtained to identify the causative organism. Treatment typically involves intravenous antibiotics, but if the infection does not resolve, percutaneous drainage or surgical resection may be required in rare cases.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 15 - A 45-year-old man presents with worsening dyspnea. He has been a smoker for...

    Incorrect

    • A 45-year-old man presents with worsening dyspnea. He has been a smoker for the past 20 years. Upon conducting pulmonary function tests, the following results were obtained:
      - FEV1: 1.3 L (predicted 3.6 L)
      - FVC: 1.6 L (predicted 4.2 L)
      - FEV1/FVC: 80% (normal > 75%)

      What respiratory disorder is most likely causing these findings?

      Your Answer: Laryngeal malignancy

      Correct Answer: Neuromuscular disorder

      Explanation:

      Pulmonary function tests reveal a restrictive pattern in individuals with neuromuscular disorders, while obstructive patterns may be caused by other conditions.

      Understanding Pulmonary Function Tests

      Pulmonary function tests are a useful tool in determining whether a respiratory disease is obstructive or restrictive. These tests measure the amount of air a person can exhale forcefully and the total amount of air they can exhale. The results of these tests can help diagnose conditions such as asthma, COPD, bronchiectasis, and pulmonary fibrosis.

      Obstructive lung diseases are characterized by a significant reduction in the amount of air a person can exhale forcefully (FEV1) and a reduced FEV1/FVC ratio. Examples of obstructive lung diseases include asthma, COPD, bronchiectasis, and bronchiolitis obliterans.

      On the other hand, restrictive lung diseases are characterized by a significant reduction in the total amount of air a person can exhale (FVC) and a normal or increased FEV1/FVC ratio. Examples of restrictive lung diseases include pulmonary fibrosis, asbestosis, sarcoidosis, acute respiratory distress syndrome, infant respiratory distress syndrome, kyphoscoliosis, and neuromuscular disorders.

      Understanding the results of pulmonary function tests can help healthcare professionals diagnose and manage respiratory diseases more effectively.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 16 - A new mother in her early thirties, who has asthma, has just given...

    Correct

    • A new mother in her early thirties, who has asthma, has just given birth to her first child. She experienced a sudden worsening of her asthma symptoms and was prescribed 30mg of oral prednisolone. She is now concerned about the safety of taking prednisolone while breastfeeding and wonders if she should switch to a different medication.

      Your Answer: It is safe to continue 30mg prednisolone and breastfeed

      Explanation:

      When a mother who is breastfeeding takes prednisolone, the amount of the drug that is transferred to the breast milk is minimal. Therefore, it is unlikely to have any negative impact on the baby.

      Management of Acute Asthma

      Acute asthma is classified by the British Thoracic Society (BTS) into three categories: moderate, severe, and life-threatening. Patients with any of the life-threatening features should be treated as having a life-threatening attack. A fourth category, Near-fatal asthma, is also recognized. Further assessment may include arterial blood gases for patients with oxygen saturation levels below 92%. A chest x-ray is not routinely recommended unless the patient has life-threatening asthma, suspected pneumothorax, or failure to respond to treatment.

      Admission criteria include a previous near-fatal asthma attack, pregnancy, an attack occurring despite already using oral corticosteroid, and presentation at night. All patients with life-threatening asthma should be admitted to the hospital, and patients with features of severe acute asthma should also be admitted if they fail to respond to initial treatment. Oxygen therapy should be started for hypoxaemic patients. Bronchodilation with short-acting beta₂-agonists (SABA) is recommended, and all patients should be given 40-50mg of prednisolone orally daily. Ipratropium bromide and IV magnesium sulphate may also be considered for severe or life-threatening asthma. Patients who fail to respond require senior critical care support and should be treated in an appropriate ITU/HDU setting. Criteria for discharge include stability on discharge medication, checked and recorded inhaler technique, and PEF levels above 75% of best or predicted.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 17 - A 72-year-old man presents to the emergency department with shortness of breath. Upon...

    Incorrect

    • A 72-year-old man presents to the emergency department with shortness of breath. Upon examination, reduced breath sounds and dullness to percussion are noted in the right axilla. His heart rate is 98 bpm, blood pressure is 100/75 mmHg, respiratory rate is 30 per minute, and his oxygen saturation is 93% on room air. Blood tests, including an arterial blood gas with the patient on 2L/minute oxygen via a nasal cannula, reveal the following results:

      Hb 142 g/l Na+ 140 mmol/l
      Platelets 502 * 109/l K+ 4.2 mmol/l
      WBC 15.8 * 109/l Urea 6.9 mmol/l
      Neuts 14.2 * 109/l Creatinine 90 µmol/l
      Lymphs 1.6 * 109/l CRP 205.4 mg/l
      pH 7.29
      pO2 12.5 kPa
      pCO2 2.2 kPa
      HCO3- 13 mmol/l
      Base excess -7.2
      Lactate 3.1 mmol/l

      A chest x-ray shows consolidation of the right middle zone with blunting of the right costophrenic angle. The left lung field is clear. Based on these findings, what is the most likely acid-base disorder present in this patient?

      Your Answer: A mixed acidosis

      Correct Answer: A partially compensated metabolic acidosis

      Explanation:

      The patient in this scenario has an acute sepsis with a right middle lobe pneumonia as the likely cause. The blood gas results show an acidosis with low bicarbonate and high lactate, indicating a metabolic cause. However, the pCO2 is low due to tachypnea, which suggests respiratory compensation for the metabolic acidosis. If the pH were normal, it would be considered a fully compensated acidosis, but since the patient is still acidotic, it is classified as a partial compensation. Normal blood gas ranges for pH, pO2, pCO2, and HCO3- are 7.35-7.45, 10.0-14.0 kPa, 4.5-6.0 kPa, and 22-26 mmol/l, respectively. A mixed acidosis would show both low bicarbonate and high pCO2, while an uncompensated metabolic acidosis would have low bicarbonate and normal pCO2, and an uncompensated respiratory acidosis would have high pCO2 and normal bicarbonate.

      Arterial Blood Gas Interpretation Made Easy

      Arterial blood gas interpretation can be a daunting task for healthcare professionals. However, the Resuscitation Council (UK) has provided a simple 5-step approach to make it easier. The first step is to assess the patient’s overall condition. The second step is to determine if the patient is hypoxaemic, which is indicated by a PaO2 level of less than 10 kPa on air. The third step is to check if the patient is acidaemic or alkalaemic, which is determined by the pH level. A pH level of less than 7.35 indicates acidaemia, while a pH level of more than 7.45 indicates alkalaemia.

      The fourth step is to assess the respiratory component by checking the PaCO2 level. A PaCO2 level of more than 6.0 kPa suggests respiratory acidosis, while a PaCO2 level of less than 4.7 kPa suggests respiratory alkalosis. The fifth and final step is to evaluate the metabolic component by checking the bicarbonate level or base excess. A bicarbonate level of less than 22 mmol/l or a base excess of less than -2mmol/l indicates metabolic acidosis, while a bicarbonate level of more than 26 mmol/l or a base excess of more than +2mmol/l indicates metabolic alkalosis.

      To make it easier to remember, healthcare professionals can use the ROME acronym. Respiratory is opposite, which means that low pH and high PaCO2 indicate acidosis, while high pH and low PaCO2 indicate alkalosis. Metabolic is equal, which means that low pH and low bicarbonate indicate acidosis, while high pH and high bicarbonate indicate alkalosis. By following this simple approach, healthcare professionals can easily interpret arterial blood gas results and provide appropriate treatment for their patients.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 18 - A 45-year-old man has a 3-month history of weight loss, fatigue and difficulty...

    Incorrect

    • A 45-year-old man has a 3-month history of weight loss, fatigue and difficulty breathing with a 20-pack-year smoking history. A chest X-ray reveals multiple rounded nodules of different sizes spread throughout both lungs.
      What is the most probable diagnosis?

      Your Answer: Rib fractures

      Correct Answer: Pulmonary metastases

      Explanation:

      Differential diagnosis of lung nodules on chest radiograph

      Pulmonary metastases is a likely diagnosis for lung nodules on a chest radiograph, especially in patients with a history of cancer. Other possible causes of lung nodules include infections, such as lung abscesses or tuberculosis, occupational lung diseases, such as silicosis, and traumatic injuries, such as rib fractures. However, the clinical presentation and radiological features of these conditions differ from those of pulmonary metastases. Therefore, a thorough evaluation of the patient’s medical history, physical examination, laboratory tests, and imaging studies is necessary to establish the correct diagnosis and guide the appropriate treatment.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 19 - A 25-year-old female presents to the emergency department after collapsing. Limited information is...

    Incorrect

    • A 25-year-old female presents to the emergency department after collapsing. Limited information is available, but an arterial blood gas has been obtained on room air with the following results:
      - paO2: 13 kPa (11-13)
      - paCO2: 3.5 kPa (4.7-6)
      - pH: 7.31 (7.35-7.45)
      - Na+: 143 mmol/L (135-145)
      - K+: 5 mmol/L (3.5-5.0)
      - Bicarbonate: 17 mEq/L (22-29)
      - Chloride: 100 mmol/L (98-106)

      What potential diagnosis could explain these blood gas findings?

      Your Answer: Pulmonary embolism

      Correct Answer: Septic shock

      Explanation:

      An anion gap greater than 14 mmol/L typically indicates a raised anion gap metabolic acidosis, rather than a normal anion gap. In the absence of other information about the patient, an arterial blood gas (ABG) can provide a clue to the diagnosis. In this case, the ABG shows a normal paO2, indicating a respiratory cause of the patient’s symptoms is less likely. However, the pH is below 7.35, indicating acidosis, and the bicarbonate is low, suggesting metabolic acidosis. The low paCO2 shows partial compensation. Calculating the anion gap reveals a value of 31 mmol/L, indicating metabolic acidosis with a raised anion gap. Septic shock is the only listed cause of raised anion gap metabolic acidosis, resulting in acidosis due to the production of lactic acid from inadequate tissue perfusion. Addison’s disease is another cause of metabolic acidosis, but it results in normal anion gap metabolic acidosis due to bicarbonate loss from mineralocorticoid deficiency. Prolonged diarrhea can cause normal anion gap metabolic acidosis due to gastrointestinal loss of bicarbonate. Pulmonary embolism is unlikely due to normal oxygen levels and hypocapnia occurring as compensation. Prolonged vomiting can cause metabolic alkalosis, not metabolic acidosis, due to the loss of hydrogen ions in vomit. This patient’s electrolyte profile does not fit with prolonged vomiting.

      The anion gap is a measure of the difference between positively charged ions (sodium and potassium) and negatively charged ions (bicarbonate and chloride) in the blood. It is calculated by subtracting the sum of bicarbonate and chloride from the sum of sodium and potassium. A normal anion gap falls between 8-14 mmol/L. This measurement is particularly useful in diagnosing metabolic acidosis in patients.

      There are various causes of a normal anion gap or hyperchloraemic metabolic acidosis. These include gastrointestinal bicarbonate loss due to conditions such as diarrhoea, ureterosigmoidostomy, or fistula. Renal tubular acidosis, drugs like acetazolamide, ammonium chloride injection, and Addison’s disease can also lead to a normal anion gap.

      On the other hand, a raised anion gap metabolic acidosis can be caused by lactate due to shock or hypoxia, ketones in conditions like diabetic ketoacidosis or alcoholism, urate in renal failure, acid poisoning from substances like salicylates or methanol, and 5-oxoproline from chronic paracetamol use. Understanding the anion gap and its potential causes can aid in the diagnosis and treatment of metabolic acidosis.

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      • Respiratory Medicine
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  • Question 20 - A 20-year-old woman presents with a 4-day history of cough, headache, fever and...

    Incorrect

    • A 20-year-old woman presents with a 4-day history of cough, headache, fever and joint pains. Blood tests show the presence of raised antibody titres and the presence of cold agglutinins. A diagnosis of Mycoplasma pneumoniae infection is made.
      Which of the following drugs would you prescribe as first-line treatment for this patient?

      Your Answer: Penicillin

      Correct Answer: Clarithromycin

      Explanation:

      Treatment options for Mycoplasma pneumoniae infection

      Mycoplasma pneumoniae is a bacterium that causes atypical pneumonia and is transmitted through respiratory droplets. The symptoms vary but can include fever, malaise, myalgia, headache, and a rash. Diagnosis is usually confirmed with serology, and treatment typically involves a macrolide antibiotic such as clarithromycin for at least 10-14 days. Penicillin and other beta-lactam antibiotics are ineffective as Mycoplasma pneumoniae lacks a cell wall. Tetracycline can be used but macrolides are preferred due to a better side-effect profile. Rifampicin is mostly limited to the treatment of tuberculosis and leprosy, while co-trimoxazole is not indicated for Mycoplasma pneumoniae infection. Extrapulmonary involvement is possible and may suggest the diagnosis in a patient presenting with pneumonia. A chest radiograph is non-specific and typically shows a reticulonodular or patchy consolidation pattern.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 21 - In which of the following respiratory diseases is clubbing not a feature? ...

    Incorrect

    • In which of the following respiratory diseases is clubbing not a feature?

      Your Answer: Asbestosis

      Correct Answer: Bronchitis

      Explanation:

      The Significance of Finger Clubbing in Respiratory and Non-Respiratory Diseases

      Finger clubbing, the loss of the natural angle between the nail and the nailbed, is a significant clinical sign that can indicate underlying respiratory and non-respiratory diseases. Suppurative lung diseases such as long-standing bronchiectasis, acute lung abscesses, and empyema are commonly associated with finger clubbing. However, uncomplicated bronchitis and chronic obstructive pulmonary disease (COPD) do not typically cause clubbing, and patients with COPD who develop clubbing should be promptly investigated for other causes, particularly lung cancer.

      Finger clubbing is also commonly found in fibrosing alveolitis (idiopathic pulmonary fibrosis), asbestosis, and malignant diseases such as bronchial carcinoma and mesothelioma. In cases where finger clubbing is associated with hypertrophic pulmonary osteoarthropathy, a painful osteitis of the distal ends of the long bones of the lower arms and legs, it is designated grade IV.

      Overall, finger clubbing is an important clinical sign that should prompt further investigation to identify underlying respiratory and non-respiratory diseases.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 22 - A 67-year-old man attending the respiratory clinic receives a suspected diagnosis of chronic...

    Incorrect

    • A 67-year-old man attending the respiratory clinic receives a suspected diagnosis of chronic obstructive pulmonary disease.
      Which of the following is the most appropriate investigation to confirm diagnosis?

      Your Answer: Peak flow

      Correct Answer: Spirometry

      Explanation:

      Investigations for COPD: Spirometry is Key

      COPD is a chronic obstructive airway disease that is diagnosed through a combination of clinical history, signs, and investigations. While several investigations may be used to support a diagnosis of COPD, spirometry is the most useful and important tool. A spirometer is used to measure functional lung volumes, including forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). The FEV1:FVC ratio provides an estimate of the severity of airflow obstruction, with a normal ratio being 75-80%. In patients with COPD, the ratio is typically <0.7 and FEV1 <80% predicted. Spirometry is essential for establishing a baseline for disease severity, monitoring disease progression, and assessing the effects of treatment. Other investigations, such as echocardiography, chest radiography, ECG, and peak flow, may be used to exclude other pathologies or assess comorbidities, but spirometry remains the key investigation for diagnosing and managing COPD.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 23 - On presentation, what is the most frequently observed symptom of lung cancer? ...

    Incorrect

    • On presentation, what is the most frequently observed symptom of lung cancer?

      Your Answer: Shortness of breath

      Correct Answer: Cough

      Explanation:

      Symptoms of Lung Cancer: What to Look Out For

      Lung cancer is a serious condition that can be difficult to detect in its early stages. However, there are certain symptoms that may indicate the presence of lung cancer. The most common symptom is a persistent cough, which is present in about 40% of patients. If you have had a cough for three weeks or more, it is recommended that you seek medical attention to evaluate the possibility of lung cancer.

      In addition to coughing, chest pain is another symptom that may indicate lung cancer. About 15% of patients present with both cough and chest pain, while chest pain alone is present in up to 22% of patients.

      Coughing up blood, or haemoptysis, is another symptom that may suggest the presence of lung cancer. However, only 7% of patients with lung cancer actually present with this symptom.

      Less common symptoms of lung cancer include shortness of breath, hoarseness, weight loss, and malaise. If you are experiencing any of these symptoms, it is important to seek medical attention as soon as possible to determine the cause and receive appropriate treatment.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 24 - Which of the following interventions is most likely to improve survival in individuals...

    Correct

    • Which of the following interventions is most likely to improve survival in individuals with COPD?

      Your Answer: Long-term oxygen therapy

      Explanation:

      Long-term oxygen therapy is one of the few interventions that has been proven to enhance survival in COPD following smoking cessation.

      NICE guidelines recommend smoking cessation advice, annual influenza and one-off pneumococcal vaccinations, and pulmonary rehabilitation for COPD patients. Bronchodilator therapy is first-line treatment, with the addition of LABA and LAMA for patients without asthmatic features and LABA, ICS, and LAMA for those with asthmatic features. Theophylline is recommended after trials of bronchodilators or for patients who cannot use inhaled therapy. Azithromycin prophylaxis is recommended in select patients. Mucolytics should be considered for patients with a chronic productive cough. Loop diuretics and long-term oxygen therapy may be used for cor pulmonale. Smoking cessation and long-term oxygen therapy may improve survival in stable COPD patients. Lung volume reduction surgery may be considered in selected patients.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 25 - A 28-year-old woman is being seen in the asthma clinic. She is currently...

    Incorrect

    • A 28-year-old woman is being seen in the asthma clinic. She is currently on salbutamol inhaler 100mcg prn and beclometasone dipropionate inhaler 400 mcg bd, but is experiencing frequent asthma exacerbations and has recently undergone a course of prednisolone. In accordance with NICE guidelines, what would be the most suitable course of action for her management?

      Your Answer: Start to take the salbutamol regularly, 2 puffs qds

      Correct Answer: Add a leukotriene receptor antagonist

      Explanation:

      According to NICE 2017 guidelines, if a patient with asthma is not effectively managed with a SABA + ICS, the first step should be to add a LTRA rather than a LABA.

      The management of asthma in adults has been updated by NICE in 2017, following the 2016 BTS guidelines. One of the significant changes is in ‘step 3’, where patients on a SABA + ICS whose asthma is not well controlled should be offered a leukotriene receptor antagonist instead of a LABA. NICE does not follow the stepwise approach of the previous BTS guidelines, but to make the guidelines easier to follow, we have added our own steps. The steps range from newly-diagnosed asthma to SABA +/- LTRA + one of the following options, including increasing ICS to high-dose, a trial of an additional drug, or seeking advice from a healthcare professional with expertise in asthma. Maintenance and reliever therapy (MART) is a form of combined ICS and LABA treatment that is only available for ICS and LABA combinations in which the LABA has a fast-acting component. It should be noted that NICE does not recommend changing treatment in patients who have well-controlled asthma simply to adhere to the latest guidance. The definitions of what constitutes a low, moderate, or high-dose ICS have also changed, with <= 400 micrograms budesonide or equivalent being a low dose, 400 micrograms - 800 micrograms budesonide or equivalent being a moderate dose, and > 800 micrograms budesonide or equivalent being a high dose for adults.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 26 - A 57-year-old woman, who is known to have rheumatoid arthritis, complains that she...

    Incorrect

    • A 57-year-old woman, who is known to have rheumatoid arthritis, complains that she has had recurrent haemoptysis for over five years. She has never smoked and only takes a non-steroidal anti-inflammatory agent. According to her, she coughs up phlegm every day and at times this contains streaks of fresh blood. She has no known respiratory disease, but tends to get frequent chest infections that are relieved by a course of antibiotics.
      Which of the following is the most likely diagnosis?

      Your Answer: Pulmonary embolism

      Correct Answer: Bronchiectasis

      Explanation:

      Understanding Bronchiectasis: Causes, Symptoms, and Treatment

      Bronchiectasis is a condition characterized by permanent and irreversible dilatations of the bronchial walls. It can be caused by various factors, including cystic fibrosis, immune system deficiencies, lung infections, foreign body aspiration, and smoking. Common symptoms of bronchiectasis include high sputum production, recurrent chest infections, and haemoptysis. A high-resolution computed tomography (HR-CT) scan of the lungs is usually used to diagnose bronchiectasis. Treatment involves a multidisciplinary approach, including chest physiotherapy, patient education, antibiotic treatment, and bronchodilators. While treatment of the underlying cause may be necessary, it does not provide reversal of the existing bronchiectasis. Other conditions, such as atypical pneumonia, lung cancer, tuberculosis, and pulmonary embolism, may have similar symptoms but require different diagnoses and treatments.

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      • Respiratory Medicine
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  • Question 27 - An 80-year-old man arrives at the emergency department complaining of difficulty breathing. He...

    Incorrect

    • An 80-year-old man arrives at the emergency department complaining of difficulty breathing. He had been diagnosed with community-acquired pneumonia by his doctor and treated with antibiotics at home. However, his condition suddenly worsened, and he now has a heart rate of 120/min, respiratory rate of 22/min, oxygen saturation of 77%, and a temperature of 38°C. The patient has a medical history of COPD and is a carbon dioxide retainer. What is the best course of action to address his low oxygen saturation?

      Your Answer: 40% Venturi mask at 10 litres/min

      Correct Answer: 28% Venturi mask at 4 litres/min

      Explanation:

      Guidelines for Emergency Oxygen Therapy

      The British Thoracic Society has updated its guidelines for emergency oxygen therapy in 2017. The guidelines recommend that in critically ill patients, such as those experiencing anaphylaxis or shock, oxygen should be administered via a reservoir mask at 15 l/min. However, certain conditions, such as stable myocardial infarction, are excluded from this recommendation.

      The guidelines also provide specific oxygen saturation targets for different patient groups. Acutely ill patients should aim for a saturation range of 94-98%, while patients at risk of hypercapnia, such as those with COPD, should aim for a lower range of 88-92%. Oxygen therapy should be reduced in stable patients with satisfactory oxygen saturation.

      For COPD patients, a 28% Venturi mask at 4 l/min should be used prior to availability of blood gases. The target oxygen saturation range for these patients should be 88-92% if they have risk factors for hypercapnia but no prior history of respiratory acidosis. If the pCO2 is normal, the target range can be adjusted to 94-98%.

      The guidelines also highlight situations where oxygen therapy should not be used routinely if there is no evidence of hypoxia. These include myocardial infarction and acute coronary syndromes, stroke, obstetric emergencies, and anxiety-related hyperventilation.

      Overall, these guidelines provide clear recommendations for the administration of emergency oxygen therapy in different patient groups and situations.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 28 - A 38-year-old woman underwent bowel resection and 48 hours post-operation, she became breathless,...

    Incorrect

    • A 38-year-old woman underwent bowel resection and 48 hours post-operation, she became breathless, tachycardic, tachypnoeic and complained of pleuritic chest pain.
      Which of the following is the most definitive investigation to request?

      Your Answer: Echocardiogram

      Correct Answer: CT pulmonary angiogram (CTPA)

      Explanation:

      Diagnostic Tests for Pulmonary Embolism: A Comparison

      Pulmonary embolism (PE) is a serious medical condition that requires prompt diagnosis and treatment. There are several diagnostic tests available for PE, but not all are equally effective. Here, we compare the most commonly used tests and their suitability for diagnosing PE.

      CT pulmonary angiogram (CTPA) is the gold standard diagnostic test for PE. It is highly sensitive and specific, making it the most definitive investigation for PE. Patients with a history of recent surgery and subsequent symptoms pointing towards PE should undergo a CTPA.

      Electrocardiography (ECG) is not a first-line diagnostic test for PE. Although classic ECG changes may occur in some patients with PE, they are not specific to the condition and may also occur in individuals without PE.

      Chest radiograph is less definitive than CTPA for diagnosing PE. While it may show some abnormalities, many chest radiographs are normal in PE. Therefore, it is not a reliable test for diagnosing PE.

      Echocardiogram may show right-sided heart dysfunction in very large PEs, but it is not a first-line diagnostic test for PE and is not definitive in the investigation of PE.

      Positron emission tomography (PET)/CT of the chest is not recommended for the investigation of PE. It is a radioisotope functional imaging technique used in the imaging of tumours and neuroimaging, but not for diagnosing PE.

      In conclusion, CTPA is the most definitive diagnostic test for PE and should be used in patients with a high suspicion of the condition. Other tests may be used in conjunction with CTPA or in specific cases, but they are not as reliable or definitive as CTPA.

    • This question is part of the following fields:

      • Respiratory Medicine
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  • Question 29 - In the diagnosis of asthma, which statement is the most appropriate? ...

    Incorrect

    • In the diagnosis of asthma, which statement is the most appropriate?

      Your Answer: Once diagnosed with asthma, children remain asthmatic for the rest of their lives

      Correct Answer: Cough is an important diagnostic feature

      Explanation:

      Myths and Facts about Asthma Diagnosis and Treatment

      Cough is a crucial diagnostic feature in asthma, especially if it occurs at night. However, it is not the only symptom, and other factors must be considered to reach a diagnosis. While asthma often presents in childhood, it can also appear later in life, and some patients may experience a recurrence of symptoms after a period of remission. The 15% reversibility test is useful but not essential for diagnosis, and there is no single test that can definitively diagnose asthma. Inhaled corticosteroids are not bronchodilators and do not have an immediate effect, but they are essential for managing inflammation and preventing irreversible airway damage. Finally, family history is a crucial factor in asthma diagnosis, as there is a strong genetic component to the disease.

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      • Respiratory Medicine
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  • Question 30 - A 58-year-old man with chronic obstructive pulmonary disease (COPD) experiences an exacerbation of...

    Incorrect

    • A 58-year-old man with chronic obstructive pulmonary disease (COPD) experiences an exacerbation of breathlessness and a productive cough with green sputum.
      What is the most appropriate treatment option for him?

      Your Answer: Nitrofurantoin

      Correct Answer: Doxycycline and prednisolone

      Explanation:

      Treatment Options for COPD Exacerbations: Antibiotics and Corticosteroids

      COPD exacerbations are characterized by a sudden worsening of symptoms beyond the patient’s usual stable state. These symptoms include increased breathlessness, cough, sputum production, and changes in sputum color. To treat exacerbations, a combination of antibiotics and corticosteroids is often used.

      Oral corticosteroids, such as prednisolone, should be prescribed for five days to patients experiencing a significant increase in breathlessness that interferes with daily activities. Antibiotics are recommended for exacerbations associated with purulent sputum, with first-line agents including amoxicillin, doxycycline, and clarithromycin.

      It is important to follow local microbiologist guidance when initiating empirical antibiotic treatment. Flucloxacillin and clindamycin are not useful in treating COPD exacerbations and are recommended for other conditions such as skin infections and bacterial vaginosis, respectively. Nitrofurantoin and trimethoprim are used for urinary tract infections and may be considered as first or second-line agents depending on antibiotic resistance and previous sensitivity.

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      • Respiratory Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory Medicine (7/30) 23%
Passmed