RESPIRATORY MCQ

1.
Asthmatic 48 yrs old, FEV1 1.0L, FVC 2.4 L, predicted 2.6/3.2. Nightly symptoms for a week. Currently not
distressed when examined. On fluticasone 500 mg bd and salmeterol 40 bd. Due for cholecystectomy in 4 weeks.
Her preoperative management would be:
a.
b.
c.
d.
e.

admit for iv hydrocortisone

prednisone and review in 2/52
admit 3/7 prior
increase the salmeterol
add ipratropium bromide

2.
Chest xray, left lung white out and lymph node positive for neuron specific enolase. Bronchoscopy done, left
main tumour. Biopsy = poorly differentiated carcinoma.
Best option for management:
a.
b.
c.
d.
e.

chemotherapy
radiotherapy
palliative
surgery
bronchoscopic laser

3.
Young male, ex-smoker, productive cough. Spirometry FEV1/FVC 1.9/4.6
CT scan = bronchiectasis. Diagnosis is?
Alternative of same Q:
A male smoker in his 50's presents with increasing shortness of breath and a productive
cough. A CT chest is shown (consensus is that showed bronchiectatic changes). Spirometry represents obstructive
picture. The most likely diagnosis is?
a.
b.
c.
d.
e.
f.
g.

bronchiectasis (ie can you recognise bronchiectasis on CT?)

fibrosing alveolitis
EAA
hypersensitivity pneumonitis
ABPA
Idiopathic pulmonary fibrosis
Asthma

4.
Truck driver who keeps falling asleep. BMI 25. Sleep study does show sleep apnoea. Had lots of arousals
(26/hour) and decreased sleep latency. Management:
a.
b.
c.
d.
e.

uvuloplasty
CPAP
sleep hygiene and reassure
lose weight
methylphenidate.

5.

A 30 year old asthmatic male presents with dyspnoea and the following blood gases:
pH
7.20
pCO2 50
pO2
60
HCO3- 18.
He has:

a.
b.
c.
d.

Partially compensated metabolic acidosis

Partially compensated respiratory acidosis
Mixed metabolic and respiratory acidosis
Respiratory acidosis

e.
f.
g.

Compensated respiratory acidosis

FiO2 greater than 0.21
Theophylline toxicity

6.

A flow volume loop is shown with plateauing of the inspiratory loop only. The most likely cause is:

a.
b.
c.
d.
e.

Fixed extra-thoracic obstruction

Variable extra-thoracic obstruction
Fixed intra-thoracic obstruction
Variable intra-thoracic obstruction
Small airways narrowing

7.
Young male with RLL pneumonia. Sputum shows Gram +ve cocci. Initially responds to treatment with
penicillin, but then worsens over next few days. The most likely explanation for this is:
a.
b.
c.
d.

Legionella pneumophila
Pleural empyema
Resistant pneumococcus
Lung abscess

8.

A patient with severe COPD enters a respiratory rehabilitation program. This is most likely to improve:

a.
b.
c.
d.
e.

ABG's
Survival
Exercise tolerance
Spirometry
Diffusion capacity

9.
A patient presents with end-stage COPD on maximal bronchodilators and inhaled steroids. He has a raised
JVP and ankle oedema. He complains of increasing shortness of breath. The therapy most likely to improve survival
is:
a.
b.
c.
d.
e.

Oral steroids
Continuous oxygen therapy
IV Ventolin
Theophylline
Intal

10.
A 55 yo obese truck driver presents with increasing daytime somnolence and snoring. A sleep study is
performed and is reported as no apnoeas, no desaturations, but multiple arousals per hour ( ?40). A multiple sleep
latency test shows decreased sleep latency. The most appropriate therapy:
a.
b.
c.

Nasal C-PAP
Reassurance and advice about sleep hygiene
Amphetamine prescription

11.

Regarding Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene and glycoprotein:

a.
b.
c.
d.
e.

It acts as a sodium channel on the apical membrane

At present only 16 alleles of CFTR are recognised
Male infertility is caused by reduced sperm motility
Stimulates outwardly rectifying chloride channels (ORCs)
Abnormal gene is on chromosome 10q

12.

Rate of O2 diffusion across lung increased by:

a.
b.
c.
d.
e.

anaemia
capillary volume
inspired O2
blood flow
acidosis

13.

Alveolar macrophages:

a.
b.
c.
d.
e.

Constitute 80% of cells in normal BAL

Have receptors for C3
Have increased activity after viral infections
Utilise oxygen free radicals in killing
Produce surfactant

14.
35 yo man with asthma. 3/12 Hx of cough and dyspnoea. CXR shown - left midzone opacity.
eosinophils. Likely organism:
a.
b.
c.
d.
e.

Aspergillus fumigatus
Chlamydia psittaci
Mycoplasma pneumoniae
Mycobacterium avium
Nocardia

15.

With respect to pleural plaques which of the following statements is INCORRECT?

a.
b.

Pleural plaques are discrete raised areas that may be situated in any part of the visceral pleura
They are strongly associated with exposure to asbestos although they are also found in subjects from whom no
history of exposure can be elicited.
Plaques may occur after slight asbestos exposure
The prevalence of plaques correlates with the dose of asbestos inhaled and time after first exposure to asbestos
The prevalence of plaques is not related to smoking.

c.
d.
e.

16.
With respect to cystic fibrosis transmembrane conductance regulator (CFTR) which of the following statement
is INCORRECT:
a.
b.
c.
d.
e.

CFTR functions as a chloride channel regulated by cyclic AMP

CFTR functions as a regulator of other ion channels
The most frequent mutation, present on approximately 70% of CF chromosomes world-wide, results in the
deletion of a phenylalanine residue at codon 508 (F508).
Idiopathic pancreatitis is associated with abnormalities of CFTR that do not cause pulmonary disease
The severity and course of the pulmonary disease are predicted solely by the genotype

17.

All of the following statements about pleural effusions are true, EXCEPT:

a.
b.
c.
d.
e.

5-10% of malignant pleural effusions are transudates.

In malignant pleural effusions, a low pH predicts a shorter survival time.
Tuberculous pleural effusions are usually bloody
pleural effusion eosinophilia usually indicates a benign process
Chylous pleural effusions are most commonly caused by lymphoma

18.

Which of the following will most increase arterial O2 delivery?

a.
b.
c.

PaO2 from 60 to l00 mmHg

Cardiac output from 4 to 4.4 L/min
Haemoglobin from 8 to 10

d.
e.

Arterial pH from 7.40 to 7.50

A, B and C will have the same effect

19.

Fatal asthma attacks are best predicted by:

a.
b.
c.
d.
e.

onset in childhood
increased bronchodilator use
smoking
multiple hospital admissions
atopy

20.
During exercise, pulmonary artery pressure is increased in patients with emphysema, in comparison with
controls. What is the mechanism underlying this phenomenon?
a.
b.
c.
d.
e.

increased blood viscosity

lactic acidosis
decreased blood volume
decreased pulmonary vascular capacity
inability to clear CO2

21.

A patient with asthma has the following arterial blood gases:

pH
7.10
pCO2 50
pO2
75
(HCO3 & BE not given)
What best explains this?

a.
b.
c.
d.
e.

salicylate toxicity
metabolic acidosis
partially compensated respiratory acidosis
mixed metabolic and respiratory acidosis
FiO2 >21%

22. Which of the following is most likely to cause oxygen desaturation in COAD patients during REM sleep?
a.
b.
c.
d.
e.

intercostal muscle hypotonia

increased PEEP
decreased sensitivity to hypoxia and hypercapnia
increased nasal obstruction
intermittent upper airways obstruction

23.
A 70 year old female complains that for the past two years her gentle 72 year old husband wakes her at night
shouting obscenities and has struck her in bed causing bruising. She is not aware whether he snores or has apnoeic
episodes. He is very concerned that he has been having uncharacteristically violent dreams for two years. What is
most likely?
a.
b.
c.
d.

He is having typical nocturnal seizures

He has a REM sleep behaviour disorder
He needs psychiatric evaluation for depression
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swelling, and what she describes as insect bites over her lower limbs. She has been feeling tired and generally
unwell. On examinations she has diffusely swollen but non-oedematous ankles with apparent synovial thickening, and
several raised indurated purple lesions about 2x2(?) cm over her calves, shins and ankles. RhF, ANA and ANCA all
normal. ESR 24. CXR shows bilateral hilar and paratracheal lymphadenopathy with no parenchymal changes.
Which if the following statement is true?
a.
b.
c.
d.
e.

biopsy of the skin lesions will avoid the need to further evaluate her hilar lymphadenopathy.
she should be reassured that the condition has a favourable prognosis in over 95% of cases
mediastinoscopy and lymph node biopsy is essential to rule out TB
She is likely to develop granulomatous lesions in the liver.
Treatment with corticosteroids at a dose of 0.5 mg/kg should be commenced immediately.

26.

With regard to inhaled long acting 2 agonists:

a.
b.
c.
d.
e.

Salmeterol xinefoate has a large hydrophilic side chain which facilitates its binding to the cell membrane of
respiratory epithelium
Salmeterol xinefoate has a shorter onset of action than Eformoterol fumarate
Are ineffective at preventing bronchospasm induced by inhaled allergens
Plasma levels are predictive of therapeutic effect
Binding to the beta receptor activated adenylate cyclase leading to an increase in intracellular cyclic AMP

27.

Each of the following is a risk factor for lung cancer except:

a.
b.
c.
d.
e.

Asbestos
Radon
coal products
lead
cigarette tar

28.
A middle-aged lady has a short history of dry cough and dyspnoea. She was a heavy smoker. CXR is shown
LLL collapse and left pleural effusion. The next best investigation to make a diagnosis is?
a.
b.
c.
d.

CT chest
V/Q scan
sputum cytology
bronchoscopy

29.

Regarding allergic rhinitis:

a.
b.
c.
d.
e.

Early response is accentuated after repeated allergen challenges

Early and late responses are prevented by oral and nasal corticosteroids
Treatment of rhinitis has no effect on asthma control
Symptoms of allergic rhinitis are less intense in a cold environment
nasal steroids are not effective in patients with nasal polyps

30.

Regarding the Cystic Fibrosis Transmembrane Conductance Regulator ( CFTR) gene and glycoprotein

a.
b.
c.
d.
e.

It acts as a sodium channel on the apical membrane

At present only 16 alleles of CFTR are recognised
Male infertility is caused by reduced sperm motility
Stimulates outwardly-reacting chloride channels (ORCs)
Abnormal gene is on chromosome 10q

31.
An elderly lady who is and ex-smoker presents for management of dyspnoea. FEV1/FVC is 0.9/2.0, with no
improvement post ventolin. She has worsening RVF. ABGs show pH 7.36, pCO2 60, pO2 62. She is already on low
dose prednisolone and puffers. The best initial management is:
a.
b.
c.
d.
e.

increased steroids
change puffers to nebs
O2 therapy 19 hours per day
GHPS
overnight sleep study

32.

Concerning lung cancer:

a.
b.

In Australia, the incidence in women is falling.

The use of chemotherapy in combination with radiotherapy in patients with stage IIIB non-small cell lung
cancer is associated with improved survival.
Chemotherapy for metastatic non-small cell lung cancer improves quality of life but not survival.
The optimal treatment for limited stage small cell lung cancer is with chemotherapy alone.
Paraneoplastic manifestations occur in the majority of patients.

c.
d.
e.

33.
A middle-aged lady presents with SOBOE and had a spontaneous PTX six months ago. CXR shows bilateral
hilar adenopathy and diffuse interstitial infiltrates. The next best investigation to establish a diagnosis is?
a.
b.
c.
d.
e.

gallium scan
serum ACE
CT chest
open lung biopsy
transbronchial biopsy

34.
A woman. age 32, presents with increasing dyspnoea on exertion without other significant symptoms. She has
been a smoker of 10-20 cigarettes a day for 13 years. Lung function tests reveal the following:
FEV1
90% pred.
FVC
89% pred.
FEV1/FVC
79%.
FEF 25-75
70% pred.
TLC
102% pred.
FRC
96% pred.
RV
93% pred.
KCO
52% pred. Good single breath estimate of TLC
Hb
142 g/L
FiO2 0.21:
pO2
94 mmHg
pCO2 31 mmHg
pH
7.49
BE
-2 mmol/L.
The diagnosis most compatible with these findings is:
a.
b.
c.
d.
e.

Primary pulmonary hypertension

Early emphysema
Smoking related small airways disease
Asthma
Sarcoidosis

35.
A 50 year old male who is a heavy smoker is diagnosed with adenocarcinoma after biopsy
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in ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:

e.

PEEP
RR
RR
TV
FiO2

37.

Increased rate of diffusion of O2 across the alveolar membrane occurs with

a.
b.
c.
d.

a.
b.
c.
d.
e.

anaemia
FiO2
metabolic acidosis
cardiac output
pulmonary capillary blood flow

38.

Small cell lung cancer is associated with

a.
b.
c.
d.
e.

hypercalcaemia
clubbing
ectopic ACTH production
Lambert-Eaton myaesthenic syndrome (LEMS)
hyponatraemia

39.

A man is having chemo for small cell lung Ca. His ECOG score of 1 is least likely to influence:

a.
b.
c.
d.
e.

survival
quality of life
toxicity of chemo
the amount/dose of chemo required
response to chemo.

40.
A young man develops ARDS following trauma. He is intubated but is now breathing spontaneously. He has
a CVL with TPN, and a Swan-Ganz catheter in situ, both for the last 10 days. He is on ceftriaxone for persisting
bilateral pulmonary infiltrates and blood cultures to date have been negative. He becomes very unwell and clinically
septic, with T 40, BP 70/50. His blood and urine are sent for culture, and his CXR is unchanged. After the initial
resuscitation you should;
a.
b.
c.
d.

change all lines and send for culture

culture tracheal aspirate
perform bronchoscopy +/- transbronchial biopsy
echo

41.
A middle-aged man presents with sever community-acquired pneumonia. CXR shows LLL, RLL and RML
consolidation. The best treatment would be;
a.
b.
c.
d.
e.

erythromycin
ceftriaxone and erythromycin
cefotaxime
penicillin
ceftriaxone and gentamicin

42.
A steroid-dependent patient with COPD presents with an exacerbation. Gases on room air pH 7.49, pCO 2 50,
pO2 48, HCO3- 32. This is consistent with:
a.
b.
c.
d.
e.

metabolic alkalosis secondary to steroids

chronic respiratory acidosis with acute hyperventilation
salicylate overdose
hypercapnia secondary to O2 given in the ambulance
acute hypercapnic respiratory failure

43.
A middle-aged male presents with bilateral hilar adenopathy and interstitial changes. He has a past history of
PTX. The next best test is;
a.
b.
c.
d.

serum ACE
gallium scan
open lung biopsy
transbronchial biopsy

44.

The predominant cell responsible for the late phase of asthma is:

a.
b.
c.
d.
e.

neutrophils
eosinophils
basophils
monocytes
mast cells

45.

An HIV+ patient with a CD4+ count of 400 presents with pneumonia. The most likely organism is:

a.
b.
c.
d.
e.

TB
PCP
MAC
strep pneumoniae
mycoplasma

46.

With regard to muscles of respiration, which one of the following statements is most correct?

a.
b.
c.
d.
e.

the diaphragm contracts more forcefully in patients with hyperexpanded lungs

the abdominal muscles are supplementary muscles of inspiration
orthopnoea is experienced in bilateral diaphragm paralysis
the scalene muscles do not contribute to normal, quiet inspiration
the external intercostal muscles are aligned downwards and backwards

47.

In patients with obstructive sleep apnoea, which of the following is correct/

a.
b.
c.
d.
e.

systemic hypertension is found in over 8% of cases

the usual site of airway obstruction is at the level of the soft palate
apnoeas are more likely to occur in stage 3 and stage 4 sleep
neck circumference is a better predictor of severity than BMI
tracheostomy is the treatment of choice if the SaO2 dips below 75% on overnight polysomnography

48.
A 47 yo ex smoker (35 pack years) presents with a three day history of haemoptysis and SOB. The
expectorated volume of blood is 15-20 mL daily, and it is slightly frothy. He is constitutionally unwell. Examination
reveals him to be mildly febrile (375), SOB at rest, and pale. Chest examination is unremarkable apart from a few
crackles at the bases. His CXR reveals patchy consolidation in both lung fields. There is no evidence of hilar
adenopathy or mediastinal widening. Which of the following investigations is most likely to yield the diagnosis/
a.

transbronchial biopsy

b.
c.
d.
e.

ANCA
video-assisted thoracoscopic lung biopsy
bronchoscopy
anti GBM titre

49.
A 26 year old man who has worked as a spray painter for 4 years is referred with a history of intermittent
wheeze, SOB and cough. His symptoms are usually worse at night, but apparently resolve when he is on holidays.
Physical examination and spirometry are normal at the initial visit. Which of the following statements is most correct?
a.
b.

CXR will show fleeting linear opacities

bronchial reactivity to histamine will be no G999 99 9
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daytime hypersomnolence, following an MVA caused by falling asleep at the wheel. On further questioning his
daytime sleepiness has been present for 12-15 years. He has always been obese, but over the last three years had
gained 32 kg in weight. His current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal measurements are
small, and uvula is slightly oedematous. BP 150/100. Which of the following statements is true?
a.

e.

In a multiple sleep latency test, narcolepsy would be diagnosed if 2 out of 5 naps had a sleep latency of 10
minutes or less
If overnight oximetry demonstrates that desaturations are no more than 2% from baseline, then obstructive
sleep apnoea is excluded as a cause of the hypersomnolence
Narcolepsy is confirmed if REM sleep occurs in 2 or more naps during a multiple sleep latency test
If periodic limb movements are shown to be present on overnight polysomnography, then they are likely to be
the cause of his symptoms
a trial of nasal CPAP should be offered, irrespective of the results of polysomnography.

51.

During REM sleep all of the following occur except:

a.
b.
c.
d.
e.

somnambulism
nightmares
enuresis
penile erection
periodic limb movement disorder

b.
c.
d.