Copy of Respiratory Module 2

Which of the following type of interstitial lung disease resolves with smoking cessation?

A patient presents with a parapneumonic effusion .The following are indications for prompt pleural space drainage except?

A 40 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 man presents to ED with sudden onset of breathlessness on exertion and a 2 weeks history of painful left calf. He collapsed twice at home today.His current BP is 80/50, HR 130. Both BNP and D-dimer are significantly elevated. His ABG shows a pH of 7.47, PaCO2 of 25mmHg, PaO2 of 56mmHg. An urgent CTPA showed a massive embolus of the common pulmonary artery reaching through the pulmonary valve.

Which of the following parameters would be an indication for urgent thrombolysis with tPA?

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

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

A 55 year old current smoker with a background of moderate COPD presents with acute shortness of breath with markedly reduced breath sounds on the left. CXR 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 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].
What is the treatment of early stage disease in NSCLC?

A patient with Stage II lung cancer has undergone surgical resection.Which chemo regime is the standard of care for adjuvant chemo following surgical resection?

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 on Erlotinib now presents with acute shortness of breath.What would be the most like 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 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 presents with a lung abscess.what is best management?

what is the most common organism causing 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 patient presence with a parapneumonic effusion and a broad spectrum antibiotic started.
A diagnostic pleural tap is performed. pH 7.3 gram stain negative.

What is the next step?

Oral Pirfenidone (antifibrotic therapy) is an established form of treatment for idiopathic pulmonary fibrosis.

However, which of the following parameter is unlikely to improve despite treatment with pirfenidone?

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?