Respiratory Module 2

A 65-year-old male patient with a history of smoking presents with a lung nodule identified on a chest CT scan. The radiologist notes that the nodule has a volume doubling time of 150 days. Given this information, what is the likelihood that the nodule is malignant?

What is the primary mechanism by which hypercalcemia develops in sarcoidosis?

Which of the following type of interstitial lung disease tends to resolve with smoking cessation?

A 40-year-old male presents with a parapneumonic effusion. The following are indications for prompt pleural space drainage, except?

A 45-year-old woman is admitted to Christchurch Hospital with a right lower lobe pneumonia and is treated with appropriate antibiotics.

Six days later, she develops clinical and radiological signs of a right pleural effusion with a CRP above 300.

A diagnostic tap is performed and showed a pleural pH of 7.1.

She proceeded to have a chest drain insertion and Streptococcus milleri was cultured from the pleural fluid. Her drain output was excellent for the first 24hrs then it slowed down significantly.

A bedside USS shows a large right sided pleural effusion with multiple loculations.

Which of the following intervention is most helpful in reducing the need for surgical drainage?

The RAPID score is a validated clinical risk score that could be used to help identify patients who are at risk of poor outcome following a pleural infection.

Which of the following clinical marker is NOT part of this scoring system?

Which of the following does NOT shift the oxyhaemoglobin dissociation curve to the left?

A 40-year-old woman presents with increasing breathlessness and wheeze. Inspiratory and expiratory flow-volume curves show normal expiration but the flow limitation during inspiration produces an “inspiratory plateau”.

The most likely diagnosis to explain this flow volume curve is?

A 41-year-old man has the following lung function test results:

• FEV1 1.40 L (30% predicted)
• FVC 1.9 L (82% predicted)
• FEV1/FVC (28% predicted)
• TLC 124% predicted
• RV 196% predicted
• FRC 173%
• DLCO 56% predicted
• KCO 69% predicted 10% improvement in FEV1 after bronchodilator
• His body mass index (BMI) is 31 kg/m2 [18-25].

Which of the following is the best explanation for these results?

A 50-year-old male presents to the emergency department with acute dyspnea on exertion and a 2-week history of left calf pain.

Today, he experienced two episodes of syncope. Vital signs reveal hypotension (BP 80/50 mmHg) and tachycardia (HR 130 bpm).

Laboratory tests show markedly elevated BNP and D-dimer levels. Arterial blood gas analysis indicates respiratory alkalosis with a pH of 7.47, PaCO2 of 25 mmHg, and PaO2 of 56 mmHg.

Computed tomography pulmonary angiography (CTPA) reveals a large pulmonary embolus extending from the common pulmonary artery into the pulmonary valve.

In this scenario, which parameter most strongly indicates the need for immediate thrombolytic therapy with tissue plasminogen activator (tPA)?

Which of the following investigation would provide the highest diagnostic yield for the diagnosis of pleural mesothelioma?

In which of the following condition would the LENT be most applicable?

A 55 year old current smoker with a background of moderate COPD presents with acute dyspnea with markedly reduced breath sounds on the left.

His chest x-ray shows a large left pneumothorax measuring 6cm between the lung margin and the chest wall (at the level of the hilum).

What would be the most appropriate next step in management?

Which of the following factor has the greatest impact on prognosis in non small cell lung cancer (NSCLC)?

A 41-year-old previously fit and well male with a BMI of 31 kg/m2 presents with a large right upper lobe tumour proven to be adenocarcinoma on lung biopsy with stage 1 disease confirmed on PET CT.

His lung function tests show an FEV1 at 75% predicted, FVC at 82% predicted, FEV1/FVC ratio at 68% predicted, TLC at 124% predicted, RV at 196% predicted, FRC at 173%, DLCO at 76% predicted, and KCO at 69% predicted. Post-bronchodilator, there is a 10% improvement in FEV1.

What is the recommended treatment for his early-stage cancer?

A 55 year old man with Stage II lung cancer has just undergone curative surgical resection of his lung cancer.

Which is the recommended adjuvant chemotherapy regime?

What is the treatment of choice for non-resectable stage III NSCLC in a patient with a good performance status?

Erlonitib has been proven to improve the survival in the following types of cancer except?

What is the mechanism of action of Erlotinib?

A patient with metastatic lung cancer, currently undergoing treatment with Erlotinib, reports to the clinic with a sudden onset of dyspnea.

Considering the patient’s medical history and current medication, which of the following is the most probable diagnosis?

Which of the following statements regarding nitric oxide in the airway is incorrect?

Which of the following factors would confer a better response to Erlotinib?

Which of the following patient factors would have a higher likelihood of response to Erlotinib?

Which one of the following organism is the least likely cause of hospital acquired pneumonia?

What is the most common cause of community acquired pneumonia?

A patient arrives to the Emergency Department with symptoms suggestive of a lung abscess, characterized by a productive cough, fever, malaise, and weight loss.

Imaging studies confirm the presence of a cavity within the lung parenchyma, consistent with an abscess.

Given the clinical and radiological findings, what is the most appropriate management strategy for this patient?

What is the most common organism that causes lung abscess?

A 30 year old lady, lifelong non-smoker is referred by her GP with a history of chronic cough for 15 years. She is New Zealand born and has no known TB contacts. She has been treated for asthma for many years with Symbicort but in recent times her cough has become a major problem despite inhaler therapy.

Her CXR is pictured below:

She proceeded to have a bronchoscopy and a BAL was performed.

The cytologic preparation contains alveolar macrophages, bronchial epithelial cells and inflammatory cells. No malignant cells seen. No AFB seen. TB culture pending.

• Cell differentials (200 cells counted):
• Macrophages 19%
• Eosinophils 60%
• Neutrophils 4%
• Lymphocytes 16%

Which of the following treatment is most likely to be effective?

A 41-year-old female presents with 3 day history of a dry cough and shortness of breath. This was preceded by flu-like symptoms.

On examination there is a symmetrical, erythematous rash with ‘target’ lesions over the whole body.

What is the likely organism causing the symptoms?

Which one of the following types of lung cancer is most associated with cavitating lesions?

A 55-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with a 4-day history of increasing shortness of breath, fever, and productive cough. His medical history is significant for smoking 1 pack of cigarettes per day for the past 30 years.

On physical examination, decreased breath sounds and dullness to percussion are noted in the right lower lung zone. A chest X-ray reveals a right-sided pleural effusion.

The patient is admitted, and empirical broad-spectrum antibiotic therapy is initiated to cover community-acquired pathogens, considering the possibility of a complicated parapneumonic effusion secondary to pneumonia.

A diagnostic thoracentesis is performed to further evaluate the pleural effusion. The pleural fluid analysis shows a pH of 7.3, and the Gram stain does not reveal any organisms. The pleural fluid is exudative based on Light’s criteria but without evidence of bacterial infection from the Gram stain.

Given the clinical context and pleural fluid analysis results, what is the most appropriate next step in the management of this patient’s pleural effusion?

A surgical lung biopsy has a crucial role in the diagnosis of interstitial lung disease in all of the following scenario except?

The ISARIC 4-C score predicts inpatient mortality in patients with COVID-19 pneumonia. 

Which of the following is NOT part of this scoring system?

The following patient group will most likely benefit from Adaptive Servo Ventilation (ASV), except?