A 65-year-old man known to have COPD presented with progressive respiratory failure. He was treated in ITU with mechanical ventilation and improved. After extubation he was transferred to the ward. On the second day on the ward, his temperature spiked and he developed a productive cough with a yellow-greenish sputum. Blood results showed leucocytosis. A chest X-ray revealed a right-sided middle and lower lobe pneumonia.
What is the most probable cause of his pneumonia?
1- Pneumococcal pneumonia
2- Aspiration pneumonia
3- Pseudomonas pneumonia
4- Staphylococcal pneumonia
5- Haemophilus pneumonia
Answer: 3- Pseudomonas pneumonia
A 48-year-old woman is admitted with a couple of days’ history of fever with rigors and breathlessness. On examination she looks extremely unwell and is confused, cyanosed, has a respiratory rate of 36/min and a systolic blood pressure of 86 mmHg. There is dullness on percussion and bronchial breathing at her right base. The chest radiograph reveals consolidation.
Which of the following would be the most appropriate antibiotic regimen to use?
1- Oral amoxicillin
2- Oral amoxicillin and oral clarithromycin
3- Intravenous cefotaxime and intravenous clarithromycin
4- Intravenous ceftazidime and intravenous vancomycin
5- Intravenous amoxicillin and intravenous clarithromycin
Answer: 3- Intravenous cefotaxime and intravenous clarithromycin
A 46-year-old meat-factory worker is found to have Q fever pneumonia.
Which of the following statements is correct?
1- He requires high-dose penicillin for his treatment
2- His occupation is not important for the diagnosis
3- There is no long-term sequel of the disease
4- The organism responsible is Coxiella pneumoniae
5- The organism is usually inhaled from infected dust
Answer: 5- The organism is usually inhaled from infected dust
B6 supplementation should be given in all the following ,EXCEPT:
- Pregnant mother with pulmonary TB.
- TB in patient with chronic malabsorption.
- Any patient given the usual 6 months course.
- Tuberculous meningitis with long treatment course.
- Patient with chronic diarrhea and TB peritonitis.
Answer: 3- Any patient given the usual 6 months course.
Sleep apnea associate with, EXCEPT:
- Increased risk of road traffic accident.
- Transient ischemic attack
- Decreased insulin secretion.
Answer: 5- Decreased insulin secretion
A 65-year-old man with severe rheumatoid arthritis (RA) is admitted with a right pleural effusion. He has been complaining of dyspnoea on exertion for the last three months. He has never smoked and has not worked for over 20 years when he was diagnosed to be suffering from rheumatoid arthritis.
Which of the following is true?
1- Pleural effusions with rheumatoid arthritis occur in over 50% of patients
2- A glucose level in pleural fluid of < 1.6 mmol/l is characteristic of a rheumatoid pleural effusion
3- Pleural effusions associated with RA have low levels of cholesterol
4- The most appropriate treatment is chemical pleurodesis
5- Bilateral pleural effusions do not occur in RA
Answer: 2- A glucose level in pleural fluid of < 1.6 mmol/l is characteristic of a rheumatoid pleural effusion
Which pulmonary function test may be altered to a similar degree in both restrictive lung disease and obstructive lung disease?
1- Residual volume
2- Tidal volume
3- Total lung capacity
4- Forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio
5- Forced expiratory volume in 1 second (FEV1)
Answer: 2- Tidal volume
A 24 years old male with chest infection and pleurisy, the following can be seen in clinical evaluation EXCEPT:
- Usually knife like pain
- Severe pain may presented with platypnea
- Pleural rub may be audible.
- Loss of pleural rub indicate recovery in all cases.
- Normal chest X ray cannot exclude pulmonary cause.
Answer: 4- Loss of pleural rub indicate recovery in all cases.
An 82-year-old man living alone in a bungalow came to the clinic complaining of feeling generally unwell for about the last 3-4 months and of losing about 9.5 kg (21 lbs) in weight during this period. On further enquiry he said he had been having night sweats for the last month. He also has a past history of angina and arthritis and was on medication. On examination he did not look well. He was pyrexic and without lymphadenopathy. Bibasal crepitus on the lower zone was heard on chest auscultation. He had hepatosplenomegaly and clubbing. Investigations showed WBC 12.3 x 106/l (neutrophils 52%, lymphocytes 39%), Hb 9.1 g/dl, with all other routine investigations being normal. A chest X-ray showed 1-2 cm diameter miliary shadows all over the lung field. The Mantoux test was negative. No bacteria grew in a sputum culture.
What is the probable cause of the illness and the X-ray finding?
2- Mycoplasma pneumonia
3- Staphylococcal pneumonia
4- Miliary tuberculosis
5- Bacterial endocarditis
Answer: 4- Miliary tuberculosis
All of the followings are target of blood pressure treatment Except
- SBP<150mmHg in 63 years old male
- DBP<90mmHg in Diabetic patient
- SBP<150mmHg in patient with eGFR of 37
- DBP<90 mmHg in patient with eGFR of 45
- SBP<140mmHg in patient of 58 years old
Answer: 3- SBP<150mmHg in patient with eGFR of 37
A 65-year-old man came to clinic with a history of proximal muscle weakness. He has had a cough for 8 weeks. There is associated pain in the small joints of the hands, and has small haemorrhages in the nail folds. He is apyrexic and on examination there is no lymphadenopathy or clubbing. Bibasal crackles can be heard and his chest X-ray reveals diffuse reticular infiltrates. Lung function tests show a restrictive pattern.
What is the underlying cause of his interstitial lung disease?
1- Cryptogenic fibrosing alveolitis
3- Ankylosing spondylitis
5- Rheumatoid arthritis
Answer: 4- Polymyositis
Which of the followings is inappropriate for the management of ACS
- Routine Oxygen therapy
- Admission to CCU
- Aspirin and Clopidogrel
Answer: 1- Routine Oxygen therapy
At the time of discharge of a 75-year-old non-smoker, with known COPD, it was decided that, according to the criteria, he should be having long-term oxygen therapy in home.
What is not considered as a lone criterium for LTOT among the following options?
1- Arterial blood gas showing pa(O2) 7.5 kPa
2- Cor pulmonale
3- FEV1 < 1.5 litres despite maximal treatment
4- FVC < 2 litres despite maximal treatment
5- Arterial blood gas showing pa(O2) 7.8 kPa with pulmonary hypertension
Answer: 1- Arterial blood gas showing pa(O2) 7.5 kPa
A 32-year-old Black woman presents with a 3-month history of a non-productive cough, dyspnoea and pleuritic chest pain, especially with climbing stairs. She reports intermittent fevers of up to 39°C and a 3.5-kg weight loss. She complains of wrist and ankle pain that has interfered with her work. She smokes two packets of cigarettes per day. Her full blood count is normal and serum ANA is negative. On examination there are red nodules over her lower legs.
What is the most likely diagnosis?
1- Goodpasture’s syndrome
2- Adenocarcinoma of the lung
3- Systemic lupus erythematosus
Answer: 4- Sarcoidosis
A 24-year-old thin man complains of constant daytime sleepiness. He mentions involuntary naps, often in the middle of activity, which occur suddenly and without warning. He also caused an accident when he fell asleep while driving home from work.
The patient works as an office manager and has no history of exposure to chemicals.
Which of the following treatments would be indicated?
5- Continuous positive airway pressure-breathing device
Answer: 4- Modafinil
As the medical SHO on call you are summoned to A&E to see a 25-year-old man whose condition has suddenly deteriorated. He arrived about 45 minutes earlier with a 2-hour history of central pleuritic-type chest pain and breathlessness. He collapsed while awaiting radiography. He is now agitated and cyanosed. His pulse is 128/min and BP 76/40 mmHg. Oxygen saturation is reading 76% with the patient breathing high-flow oxygen via a re-breathing mask. On respiratory examination you hear reduced breath sounds in the right lung field with deviation of the trachea towards the left. On percussion it is resonant bilaterally.
What immediate course of action should you take?
1- Contact the ITU for urgent mechanical ventilation
2- Insert a large-bore needle into the left, second intercostal space
3- Insert a large-bore needle into the right, second intercostal space
4- Check his arterial blood gases and start nebulisation with salbutamol
5- Ask for an urgent portable chest radiograph
Answer: 3- Insert a large-bore needle into the right, second intercostal space
The 18-year-old son of an immigrant from Bangladesh who recently came to the UK has been complaining of tiredness, weight loss and generally not feeling well for the last month. He presents to his GP because of haemoptysis, especially in the morning.
What is the most likely diagnosis?
2- Pulmonary embolism
3- Lung cancer
4- Pulmonary tuberculosis
Answer: 4- Pulmonary tuberculosis
A 36-year-old primary schoolteacher from the East End of London presents with increasing shortness of breath accompanied by sudden-onset, right-sided pleuritic chest pain. She gives a history of influenza for a few days before this acute presentation and also says she suffered a pulmonary embolus 2 years ago while taking the contraceptive pill and describes her pain as identical to that occasion. On further questioning it transpires that her mother had suffered from recurrent deep vein thrombosis. Arterial blood gases reveal a p(O2) of 7.2 kPa on a re-breather mask, with a p(CO2) of 3.2 kPa. Her chest X-ray reveals a wedge-shaped area of consolidation affecting her right middle and lower lobes. The white blood cell count is normal.
Which diagnosis fits best with this clinical picture?
1- Recurrent pulmonary embolism
2- Staphlyoccal pneumonia
5- Bronchial carcinoma
Answer: 1- Recurrent pulmonary embolism
A patient with tuberculosis was initially treated with streptomycin, which was later changed to a combination of isoniazid, rifampicin, pyrazinamide and ethambutol. Abnormal liver functions are noted on this, his follow-up, visit.
Which drug is most likely to be responsible?
Answer: 5- Isoniazid
A patient with cystic fibrosis presents with a severe bronchopneumonia.
What is the most likely pathogen?
1- Streptococcus pyogenes
2- Streptococcus pneumoniae
3- Pseudomonas aeruginosa
4- Klebsiella pneumoniae
5- An atypical Mycobacteria sp
Answer: 3- Pseudomonas aeruginosa
A 16-year-old girl presents to A&E with a severe asthma attack.
What is the most important therapy to relieve her bronchoconstriction?
Answer: 2- Salbutamol
A 36-year-old lorry driver who smokes heavily presents with a 2-day history of cough associated with fever. He also complains of right-sided chest pain on inspiration. On examination he is slightly cyanosed. His temperature is 38°C, respiratory rate 38/min, BP 100/70 mmHg and pulse 130/min. He has basal crepitations and dullness to percussion at the right lung base.
What is the most important next step in confirming the diagnosis?
1- ESR (Erythrocyte sedimentation rate)
3- Chest X-ray
4- Sputum sample
5- Blood cultures
Answer: 3- Chest X-ray
A 25-year-old patient with epilepsy aspirated gastric juice after a seizure (Mendelson syndrome).
What is the most likely clinical symptom?
2- Paradoxical breathing
5- Tenderness to percussion
Answer: 3- Bronchospasm