Respiratory Module 2

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

Increased production of 1,25-dihydroxyvitamin D

Correct Incorrect Correct answer

Impaired renal calcium excretion

Correct Incorrect Correct answer

Enhanced bone resorption

Correct Incorrect Correct answer

Elevated parathyroid hormone levels

Correct Incorrect Correct answer

Granulomatous production of 25-hydroxyvitamin D

Correct Incorrect Correct answer

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?

Suspicious for malignancy

Correct Incorrect Correct answer

Definitively benign

Correct Incorrect Correct answer

Requires immediate surgical intervention

Correct Incorrect Correct answer

Likely due to an infectious process

Correct Incorrect Correct answer

Highly unlikely to be malignant

Correct Incorrect Correct answer

A 45-year-old man presents to your clinic with a 2-month history of cough and fleeting opacities on chest radiograph. Laboratory tests reveal elevated total serum IgE concentration >500 international units/mL and detectable serum IgE levels against Aspergillus fumigatus (≥0.35 kU/L). He also has elevated Aspergillus fumigatus-specific IgG levels by enzyme immunoassay. There is no history of asthma or cystic fibrosis, and his spirometry results are normal.

The patient was previously diagnosed with allergic bronchopulmonary aspergillosis (ABPA), but you are considering revising this diagnosis.

What could be the reason for questioning the accuracy of the original diagnosis?

The absence of asthma or cystic fibrosis in the patient's history makes it unlikely that he has ABPA, as one of these conditions is typically present in this disease.

Correct Incorrect Correct answer

The patient's Aspergillus fumigatus-specific IgG levels are not high enough to support a diagnosis of ABPA.

Correct Incorrect Correct answer

The patient's normal spirometry results rule out the possibility of ABPA.

Correct Incorrect Correct answer

The patient's symptoms are more consistent with chronic obstructive pulmonary disease (COPD) than ABPA.

Correct Incorrect Correct answer

The patient's laboratory tests are not specific enough to support a diagnosis of ABPA.

Correct Incorrect Correct answer

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

Respiratory Associated Bronchiolitis Asssociated Intersitial Lung Disease (RBILD)

Correct Incorrect Correct answer

Acute Interstitial Pneumonitis (AIP)

Correct Incorrect Correct answer

Lymphocytic Intersitial Pneumonia (LIP)

Correct Incorrect Correct answer

Usual Interstitial Pneumonitis (UIP)

Correct Incorrect Correct answer

Non Specific Intersitial Pneumonitis (NSIP)

Correct Incorrect Correct answer

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

pH 7.4 on pleural fluid.

Correct Incorrect Correct answer

Large free flowing pleural effusion more than 1/2 hemithorax

Correct Incorrect Correct answer

Positive culture on pleural fluid

Correct Incorrect Correct answer

Presence of pus on pleural fluid

Correct Incorrect Correct answer

Positive gram stain on pleural fluid

Correct Incorrect Correct answer

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?

Alteplase and Dornase

Correct Incorrect Correct answer

Streptokinase

Correct Incorrect Correct answer

Alteplase alone

Correct Incorrect Correct answer

Streptokinase and Dornase

Correct Incorrect Correct answer

Regular saline flushes twice daily.

Correct Incorrect Correct answer

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?

rise in serum creatinine

Correct Incorrect Correct answer

age

Correct Incorrect Correct answer

purulence of pleural fluid

Correct Incorrect Correct answer

albumin

Correct Incorrect Correct answer

source of infection

Correct Incorrect Correct answer

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

Decrease in pH.

Correct Incorrect Correct answer

Decrease in 2,3 diphosphoglycerate in the red cell.

Correct Incorrect Correct answer

Decrease in carbon dioxide tension

Correct Incorrect Correct answer

Decrease in temperature

Correct Incorrect Correct answer

Presence of carboxyhaemoglobin

Correct Incorrect Correct answer

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?

vocal cord paralysis

Correct Incorrect Correct answer

tracheal stenosis

Correct Incorrect Correct answer

goiter

Correct Incorrect Correct answer

tracheomalacia

Correct Incorrect Correct answer

emphysema

Correct Incorrect Correct answer

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?

Emphysema

Correct Incorrect Correct answer

Previous lobectomy

Correct Incorrect Correct answer

Obesity

Correct Incorrect Correct answer

Pulmonary haemorrhage

Correct Incorrect Correct answer

Asthma

Correct Incorrect Correct answer

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)?

Hypotension

Correct Incorrect Correct answer

Hypoxia on ABG

Correct Incorrect Correct answer

Raised serum BNP

Correct Incorrect Correct answer

Raised serum D-dimer

Correct Incorrect Correct answer

Massive embolus on CTPA

Correct Incorrect Correct answer

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

Pleural biopsy via thoracoscopy

Correct Incorrect Correct answer

Serum mesothelin

Correct Incorrect Correct answer

Serum fibulin 3

Correct Incorrect Correct answer

High resolution CT chest.

Correct Incorrect Correct answer

Pleural fluid cytology

Correct Incorrect Correct answer

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

Malignant pleural effusion

Correct Incorrect Correct answer

Community acquired pneumonia

Correct Incorrect Correct answer

Asthma

Correct Incorrect Correct answer

Sarcoidosis

Correct Incorrect Correct answer

Hospital acquired pneumonia

Correct Incorrect Correct answer

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?

Insertion of a small bore chest tube

Correct Incorrect Correct answer

Insertion of a large bore chest tube

Correct Incorrect Correct answer

Observation

Correct Incorrect Correct answer

Commence High flow nasal oxygen

Correct Incorrect Correct answer

Simple needle aspiration

Correct Incorrect Correct answer

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

Staging of cancer at presentation

Correct Incorrect Correct answer

Presence of systemic symptoms

Correct Incorrect Correct answer

Histology type

Correct Incorrect Correct answer

Weight loss

Correct Incorrect Correct answer

Poor performance status

Correct Incorrect Correct answer

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?

lobectomy followed by adjuvant chemo

Correct Incorrect Correct answer

chemotherapy

Correct Incorrect Correct answer

stereotactic ablative radiotherapy

Correct Incorrect Correct answer

surgical resection only

Correct Incorrect Correct answer

supportive care

Correct Incorrect Correct answer

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?

Cisplatin and Vinorelbine

Correct Incorrect Correct answer

Cisplatin only

Correct Incorrect Correct answer

Vinorelbine only

Correct Incorrect Correct answer

Etoposide

Correct Incorrect Correct answer

Ara-C

Correct Incorrect Correct answer

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

Concurrent chemo-radiotherapy

Correct Incorrect Correct answer

Radiotherapy alone

Correct Incorrect Correct answer

Chemotherapy

Correct Incorrect Correct answer

Supportive care

Correct Incorrect Correct answer

Start erlotinib

Correct Incorrect Correct answer

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

testicular cancer

Correct Incorrect Correct answer

head cancer

Correct Incorrect Correct answer

neck cancer

Correct Incorrect Correct answer

colorectal cancer

Correct Incorrect Correct answer

lung cancer

Correct Incorrect Correct answer

What is the mechanism of action of Erlotinib?

EGFR Tyrosine kinase inhibitor

Correct Incorrect Correct answer

VEGF Tyrosine kinase inhibitor

Correct Incorrect Correct answer

PDGF Tyrosine kinase inhibitor

Correct Incorrect Correct answer

mTOR inhibitor

Correct Incorrect Correct answer

PDGFR inhibitor

Correct Incorrect Correct answer

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?

Interstitial pneumonitis

Correct Incorrect Correct answer

Pulmonary embolism

Correct Incorrect Correct answer

Acute pulmonary edema

Correct Incorrect Correct answer

Acute respiratory distress syndrome

Correct Incorrect Correct answer

Tuberculosis

Correct Incorrect Correct answer

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

Is decreased significantly in unstable asthma

Correct Incorrect Correct answer

Causes airway smooth muscle relaxation

Correct Incorrect Correct answer

Is derived from airway epithelium

Correct Incorrect Correct answer

Is a product of metabolism of L-arginine

Correct Incorrect Correct answer

Is useful to monitor inflammatory status during treatment

Correct Incorrect Correct answer

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

EGFR mutation

Correct Incorrect Correct answer

Wild type EGFR

Correct Incorrect Correct answer

EGFR polysomy < 4 copies

Correct Incorrect Correct answer

K-ras mutation

Correct Incorrect Correct answer

VEGF mutation

Correct Incorrect Correct answer

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

Asian, female, never-smoker, adenocarcinoma

Correct Incorrect Correct answer

Caucasian, male, smoker, adenocarcinoma

Correct Incorrect Correct answer

Asian, male, non-smoker, adenocarcinoma

Correct Incorrect Correct answer

Caucasian, female, non-smoker, adenocarcinoma

Correct Incorrect Correct answer

Asian, female, ex-smoker, adenocarcinoma

Correct Incorrect Correct answer

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

Candida albicans

Correct Incorrect Correct answer

Escherichia coli

Correct Incorrect Correct answer

Klebsiella pneumoniae

Correct Incorrect Correct answer

Enterobacter spp.

Correct Incorrect Correct answer

Acinetobacter spp.

Correct Incorrect Correct answer

What is the most common cause of community acquired pneumonia?

Streptococcus pneumoniae

Correct Incorrect Correct answer

Haemophilus influenzae

Correct Incorrect Correct answer

Branhamella catarrhalis

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Legionella pneumophilla

Correct Incorrect Correct answer

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?

Intravenous clindamycin

Correct Incorrect Correct answer

Intravneous linezolid

Correct Incorrect Correct answer

Intercostal catheter

Correct Incorrect Correct answer

Oral albendazole

Correct Incorrect Correct answer

Intravenous gentamicin

Correct Incorrect Correct answer

What is the most common organism that causes lung abscess?

Anaerobes

Correct Incorrect Correct answer

Klebsiella

Correct Incorrect Correct answer

Nocardia

Correct Incorrect Correct answer

Staph aureus

Correct Incorrect Correct answer

Streptococcus milleri

Correct Incorrect Correct answer

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?

prednisone

Correct Incorrect Correct answer

rifampicin, isoniazid, pyrazinamide and ethambutol.

Correct Incorrect Correct answer

Prolonged course of oral Augmentin

Correct Incorrect Correct answer

Oral azithromycin

Correct Incorrect Correct answer

Penicillin

Correct Incorrect Correct answer

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?

Mycoplasma pneumoniae

Correct Incorrect Correct answer

Pseudomonas

Correct Incorrect Correct answer

Staphylococcus aureus

Correct Incorrect Correct answer

Chlamydia pneumoniae

Correct Incorrect Correct answer

Legionella pneumophilia

Correct Incorrect Correct answer

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

Squamous cell

Correct Incorrect Correct answer

Carcinoid

Correct Incorrect Correct answer

Large cell

Correct Incorrect Correct answer

Small cell

Correct Incorrect Correct answer

Adenocarcinoma

Correct Incorrect Correct answer

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?

Observe

Correct Incorrect Correct answer

Intercostal catheter

Correct Incorrect Correct answer

Surgery

Correct Incorrect Correct answer

Change to metronidazole

Correct Incorrect Correct answer

Intravenous ticarcillin/clavulanic acid.

Correct Incorrect Correct answer

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

radiographic evidence of end-stage fibrosis

Correct Incorrect Correct answer

pulmonary vascular disease of unclear origin

Correct Incorrect Correct answer

excluding a neoplastic process that may be mimicking progressive interstitial lung disease

Correct Incorrect Correct answer

unexplained hypoxemia with restrictive ventilatory defect on pulmonary function test

Correct Incorrect Correct answer

a concern regarding chronic hypersensitivity pneumonitis

Correct Incorrect Correct answer

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?

D-dimer

Correct Incorrect Correct answer

Gender

Correct Incorrect Correct answer

Respiratory rate

Correct Incorrect Correct answer

Number of co-morbidities

Correct Incorrect Correct answer

CRP

Correct Incorrect Correct answer

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

Central sleep apnea in a heart failure patient with reduced ejection fraction below 45 percent

Correct Incorrect Correct answer

Complex sleep apnea syndrome

Correct Incorrect Correct answer

Central sleep apnea in a heart failure patient with preserved ejection fraction (HFpEF)

Correct Incorrect Correct answer

Treatment emergent central sleep apnea

Correct Incorrect Correct answer

Average score
Your score

Respiratory Module 2

Quiz Summary

Information

Results

Results

Categories

1. Question

2. Question

3. Question

4. Question

5. Question

6. Question

7. Question

8. Question

9. Question

10. Question

11. Question

12. Question

13. Question

14. Question

15. Question

16. Question

17. Question

18. Question

19. Question

20. Question

21. Question

22. Question

23. Question

24. Question

25. Question

26. Question

27. Question

28. Question

29. Question

30. Question

31. Question

32. Question

33. Question

34. Question

35. Question