Mock Respiratory Module 5

Which of the following best explains how tirzepatide can be beneficial in the treatment of obstructive sleep apnoea (OSA)?

Tirzepatide facilitates significant weight loss, which in turn reduces peripharyngeal fat deposition and improves airway patency.

Correct Incorrect Correct answer

Tirzepatide directly stimulates the upper airway muscles, preventing airway collapse during sleep.

Correct Incorrect Correct answer

Tirzepatide primarily reduces the inflammatory response in the upper airway, thereby improving airflow.

Correct Incorrect Correct answer

Tirzepatide enhances the activity of diaphragm muscles, leading to more effective breathing during sleep.

Correct Incorrect Correct answer

Tirzepatide increases the production of surfactant in the lungs, improving overall lung compliance and function.

Correct Incorrect Correct answer

A 32-year-old man is referred to the general medical outpatient clinic after he and his wife were referred by their GP to the infertility clinic for consideration of assisted conception.

He is generally fit and well and works as a central heating engineer. He has a chronic productive cough, a history of recurrent chest infections since childhood, and recurrent sinusitis.

Investigations show:

Sweat chloride test: Normal (normal <30 mmol/L; intermediate 30–59 mmol/L; abnormal ≥60 mmol/L)
Immunoglobulins (IgG, IgM, IgA): Normal

What is the most likely diagnosis?

Primary ciliary dyskinesia

Correct Incorrect Correct answer

Chédiak-Higashi syndrome

Correct Incorrect Correct answer

Cystic fibrosis

Correct Incorrect Correct answer

Situs inversus

Correct Incorrect Correct answer

Bronchiectasis

Correct Incorrect Correct answer

A 57-year-old male ex-smoker presents with a 3-month history of headache, dyspnoea and unexplained weight loss.

On examination he has marked facial oedema with distended veins over the chest and neck, and facial plethora. Resting oxygen saturation is 92% on room air.

What is the most appropriate next investigation?

CT chest with contrast

Correct Incorrect Correct answer

Morning serum cortisol level

Correct Incorrect Correct answer

Polysomnography

Correct Incorrect Correct answer

Measure IGF-1 level

Correct Incorrect Correct answer

Liver function tests

Correct Incorrect Correct answer

A 62-year-old woman is considered a good candidate for surgical resection of a primary right upper lobe lung cancer.

On the basis of her recent CT report, the treating physician is concerned about possible distant metastases.

What is the best investigation to assess for distant metastatic disease?

FDG PET-CT

Correct Incorrect Correct answer

Whole-body MRI

Correct Incorrect Correct answer

Nuclear medicine bone scan

Correct Incorrect Correct answer

Tumour markers

Correct Incorrect Correct answer

Sputum cytology

Correct Incorrect Correct answer

Which of the following interstitial lung diseases carries the poorest prognosis?

Acute interstitial pneumonia

Correct Incorrect Correct answer

Usual interstitial pneumonia

Correct Incorrect Correct answer

Nonspecific interstitial pneumonia

Correct Incorrect Correct answer

Desquamative interstitial pneumonia

Correct Incorrect Correct answer

Lymphocytic interstitial pneumonia

Correct Incorrect Correct answer

Which type of interstitial lung disease is most likely to resolve with smoking cessation?

Respiratory bronchiolitis–associated interstitial lung disease

Correct Incorrect Correct answer

Acute interstitial pneumonia

Correct Incorrect Correct answer

Lymphocytic interstitial pneumonia

Correct Incorrect Correct answer

Usual interstitial pneumonia

Correct Incorrect Correct answer

Nonspecific interstitial pneumonia

Correct Incorrect Correct answer

Which type of interstitial lung disease is characteristically associated with Sjögren syndrome?

Lymphocytic interstitial pneumonia

Correct Incorrect Correct answer

Nonspecific interstitial pneumonia

Correct Incorrect Correct answer

Usual interstitial pneumonia

Correct Incorrect Correct answer

Respiratory bronchiolitis–associated interstitial lung disease

Correct Incorrect Correct answer

Desquamative interstitial pneumonia

Correct Incorrect Correct answer

Which HRCT feature most strongly suggests usual interstitial pneumonia (UIP) rather than nonspecific interstitial pneumonia (NSIP)?

Honeycombing

Correct Incorrect Correct answer

Traction bronchiectasis

Correct Incorrect Correct answer

Bronchial dilatation

Correct Incorrect Correct answer

Architectural distortion

Correct Incorrect Correct answer

Areas of irregular linear opacity

Correct Incorrect Correct answer

A 60-year-old patient with a long history of COPD presents with increasing dyspnoea and clear sputum production.

Which intervention is most likely to reduce the risk of hospitalisation?

Oral corticosteroids

Correct Incorrect Correct answer

Oral antibiotics

Correct Incorrect Correct answer

Inhaled corticosteroids

Correct Incorrect Correct answer

Intravenous theophylline

Correct Incorrect Correct answer

Intravenous magnesium

Correct Incorrect Correct answer

Which of the following is the strongest indication for thrombolysis in a patient with pulmonary embolism?

Hypotension (systolic blood pressure <90mmHg).

Correct Incorrect Correct answer

Pre-existing pulmonary hypertension

Correct Incorrect Correct answer

Tachycardia (pulse >120/minute).

Correct Incorrect Correct answer

Right ventricular enlargement on echocardiography

Correct Incorrect Correct answer

A large perfusion defect on ventilation-perfusion scan

Correct Incorrect Correct answer

A 30-year-old woman at 33 weeks’ gestation presents with acute dyspnoea and pleuritic chest pain. She has sinus tachycardia at 110 bpm and a swollen right leg. Her chest is clear on auscultation. ECG shows sinus tachycardia and the chest radiograph is normal.

What is the most appropriate next step in management?

Compression Doppler ultrasound of the lower limbs

Correct Incorrect Correct answer

D-dimer

Correct Incorrect Correct answer

CT pulmonary angiography

Correct Incorrect Correct answer

Ventilation-perfusion scan

Correct Incorrect Correct answer

Empiric treatment with LMWH for 6 months

Correct Incorrect Correct answer

Which of the following carries the strongest risk factor for the development of a secondary spontaneous pneumothorax?

An FEV1/FVC ratio <40%

Correct Incorrect Correct answer

Idiopathic pulmonary fibrosis

Correct Incorrect Correct answer

Infrequent intermittent asthma

Correct Incorrect Correct answer

Pulmonary sarcoidosis

Correct Incorrect Correct answer

Rheumatoid arthritis

Correct Incorrect Correct answer

A 20-year-old male non-smoker, usually fit and well, presents with acute-onset left-sided chest pain while playing soccer. His admission chest radiograph shows a moderate-sized left pneumothorax. His vital signs are stable, he denies breathlessness, and his current pain score is 2/10.

What is the recommended acute management for this patient?

Continued observation

Correct Incorrect Correct answer

Chest tube insertion

Correct Incorrect Correct answer

High flow nasal oxygen

Correct Incorrect Correct answer

Immediate surgical pleurodesis

Correct Incorrect Correct answer

Needle aspiration

Correct Incorrect Correct answer

Non-invasive ventilation has been shown to provide a short-term mortality benefit in which of the following situations?

A 60-year-old man with hypercapnic respiratory failure secondary to a COPD exacerbation

Correct Incorrect Correct answer

A 20-year-old woman with status asthmaticus

Correct Incorrect Correct answer

A 40-year-old morbidly obese man with obstructive sleep apnoea

Correct Incorrect Correct answer

A 70-year-old man with acute cardiogenic pulmonary oedema

Correct Incorrect Correct answer

An 80-year-old woman with bronchiectasis and hypoxaemic respiratory failure

Correct Incorrect Correct answer

Which of the following features is most suggestive of nicotine dependence?

Smoking within the first 30 minutes of waking

Correct Incorrect Correct answer

A history of a smoking-related illness

Correct Incorrect Correct answer

A family history of cigarette smoking

Correct Incorrect Correct answer

Absence of previous quit attempts

Correct Incorrect Correct answer

Smoking 20 cigarettes per day

Correct Incorrect Correct answer

A 50-year-old woman with limited cutaneous systemic sclerosis presents with worsening exertional dyspnoea. Examination reveals a raised JVP and a loud P2. Echocardiography shows a normal left ventricle and a moderately dilated, hypokinetic right ventricle, with an estimated right ventricular systolic pressure of 65 mmHg. Right heart catheterisation confirms pre-capillary pulmonary hypertension with a negative acute vasoreactivity response to inhaled nitric oxide.

Which is the most appropriate therapy to improve her symptoms over the next 3 months?

Bosentan

Correct Incorrect Correct answer

Exercise training programme

Correct Incorrect Correct answer

Frusemide

Correct Incorrect Correct answer

Nifepine

Correct Incorrect Correct answer

Supplemental home oxygen

Correct Incorrect Correct answer

In a patient with idiopathic pulmonary fibrosis, which of the following treatments is most likely to result in the greatest survival benefit?

Lung transplantation

Correct Incorrect Correct answer

Prednisone

Correct Incorrect Correct answer

Pirfenidone

Correct Incorrect Correct answer

Nintedanib

Correct Incorrect Correct answer

Supplemental oxygen

Correct Incorrect Correct answer

Which of the following is the best predictor of mortality in patients with idiopathic pulmonary fibrosis?

DLCO and FVC

Correct Incorrect Correct answer

FVC alone

Correct Incorrect Correct answer

FEV1

Correct Incorrect Correct answer

FEV1/FVC ratio

Correct Incorrect Correct answer

TLC

Correct Incorrect Correct answer

What is the DLCO threshold that supports referral for lung transplant assessment in patients with idiopathic pulmonary fibrosis?

Below 40%

Correct Incorrect Correct answer

Below 50%

Correct Incorrect Correct answer

Below 60%

Correct Incorrect Correct answer

Below 70%

Correct Incorrect Correct answer

Below 80%

Correct Incorrect Correct answer

In a critically ill, haemodynamically unstable patient, which of the following findings would be most suggestive of an underlying pulmonary embolism?

Right ventricular dysfunction on echocardiography

Correct Incorrect Correct answer

Widened mediastinum on chest radiograph

Correct Incorrect Correct answer

Positive D-dimer

Correct Incorrect Correct answer

Positive leg ultrasound for proximal DVT

Correct Incorrect Correct answer

Raised JVP

Correct Incorrect Correct answer

A 67-year-old man presents with acute dyspnoea and right-sided pleuritic chest pain. He underwent laparotomy with bowel resection 2 weeks ago for bowel cancer. He is now critically ill and haemodynamically unstable. CTPA confirms a large saddle embolus in the right main pulmonary artery.

What is the best management?

Catheter-directed or surgical embolectomy

Correct Incorrect Correct answer

Warfarin

Correct Incorrect Correct answer

Systemic thrombolysis

Correct Incorrect Correct answer

Low-molecular-weight heparin alone

Correct Incorrect Correct answer

Aspirin

Correct Incorrect Correct answer

A patient with severe COPD presents to the emergency department with an acute exacerbation. Oral prednisolone 40 mg once daily is started on admission.

What is the optimum duration of oral corticosteroid therapy?

Five days total

Correct Incorrect Correct answer

Fourteen days total

Correct Incorrect Correct answer

Taper by 10 mg per week over 4 weeks

Correct Incorrect Correct answer

Taper by 5 mg per week over 4 weeks

Correct Incorrect Correct answer

Taper by 10 mg per week over 6 weeks

Correct Incorrect Correct answer

Which radiological feature is an independent predictor of mortality in patients with idiopathic pulmonary fibrosis?

Extent of reticulation and honeycombing

Correct Incorrect Correct answer

Micronodules

Correct Incorrect Correct answer

Extent of traction bronchiectasis

Correct Incorrect Correct answer

Extensive ground-glass attenuation

Correct Incorrect Correct answer

Extensive mediastinal lymphadenopathy

Correct Incorrect Correct answer

Which of the following bronchial provocation agents causes direct constriction of airway smooth muscle?

Methacholine

Correct Incorrect Correct answer

Mannitol

Correct Incorrect Correct answer

Hypertonic saline

Correct Incorrect Correct answer

Exercise challenge

Correct Incorrect Correct answer

Adenosine monophosphate

Correct Incorrect Correct answer

A 64-year-old man with moderate COPD (FEV1 55% predicted) is newly diagnosed with metastatic squamous cell carcinoma of the lung.

In addition to referral to medical oncology for consideration of systemic therapy, which of the following is the most appropriate next step?

Early palliative care referral

Correct Incorrect Correct answer

Optimise bronchodilator therapy

Correct Incorrect Correct answer

Arrange urgent lung function testing with DLCO

Correct Incorrect Correct answer

Optimise nutritional status prior to chemotherapy

Correct Incorrect Correct answer

Referral to pulmonary rehabilitation

Correct Incorrect Correct answer

A 37-year-old man was recently diagnosed with sarcoidosis complicated by mild hypercalcaemia (2.6 mmol/L; reference range 2.10–2.60 mmol/L) and commenced on oral prednisone. Last week his GP started an oral thiazide diuretic for blood pressure control. He has been advised he is at high risk of kidney stones and has been partially adherent to a restricted calcium and oxalate diet. He now presents to the emergency department with confusion and is found to have severe hypercalcaemia (5.0 mmol/L).

What is the most likely cause of his worsening hypercalcaemia?

Thiazide diuretic

Correct Incorrect Correct answer

Inadequate restriction of dietary calcium

Correct Incorrect Correct answer

Inadequate restriction of dietary oxalate

Correct Incorrect Correct answer

Prednisone use

Correct Incorrect Correct answer

Underlying malignancy causing excess PTHrP secretion.

Correct Incorrect Correct answer

Dupilumab is effective in the treatment of moderate-to-severe uncontrolled asthma.

Which pro-inflammatory signalling pathway does it block?

Interleukin-4 and interleukin-13.

Correct Incorrect Correct answer

Interleukin-5.

Correct Incorrect Correct answer

Interleukin-17 and interleukin-23.

Correct Incorrect Correct answer

Interleukin-4 and interleukin-17.

Correct Incorrect Correct answer

Interleukin-5 and interleukin-13.

Correct Incorrect Correct answer

Which of the following cytotoxic agents carries the highest risk of interstitial pneumonia and lung injury?

Bleomycin

Correct Incorrect Correct answer

Paclitaxel

Correct Incorrect Correct answer

Peplomycin

Correct Incorrect Correct answer

Vinorelbine

Correct Incorrect Correct answer

Pemetrexed

Correct Incorrect Correct answer

Pulmonary function testing is central to monitoring interstitial lung disease.

Which change from baseline is regarded as clinically significant when monitoring disease progression?

A 10% decline in FVC OR a 15% decline in DLCO from baseline

Correct Incorrect Correct answer

A 10% change in FEV1 AND 15% change in DLCO from baseline

Correct Incorrect Correct answer

A 15% change in FVC OR 10% change in DLCO from baseline

Correct Incorrect Correct answer

A 15% change in FEV1 OR 15% change in DLCO from baseline

Correct Incorrect Correct answer

A 10% change in FVC OR 10% change in DLCO from baseline

Correct Incorrect Correct answer

Which of the following conditions has a predominantly lymphocytic cellular pattern on bronchoalveolar lavage?

Sarcoidosis

Correct Incorrect Correct answer

Eosinophilic pneumonia

Correct Incorrect Correct answer

Idiopathic pulmonary fibrosis

Correct Incorrect Correct answer

Diffuse alveolar damage

Correct Incorrect Correct answer

Asbestosis

Correct Incorrect Correct answer

A 75-year-old man presents with several months of dry cough and progressive exertional breathlessness. On examination he has finger clubbing, reduced chest expansion and fine bibasal “velcro” inspiratory crackles. His oxygen saturation is 88% on room air.

HRCT demonstrates subpleural honeycombing with moderate-to-severe bibasal traction bronchiectasis and extensive right lower lobe reticulation. You suspect an interstitial lung disease.

Which investigation should be avoided as part of the diagnostic work-up?

Surgical lung biopsy

Correct Incorrect Correct answer

Bronchoalveolar lavage

Correct Incorrect Correct answer

Discussion at a multidisciplinary meeting

Correct Incorrect Correct answer

Pulmonary function testing

Correct Incorrect Correct answer

Serological testing

Correct Incorrect Correct answer

Which of the following treatments should be avoided in patients with idiopathic pulmonary fibrosis?

Combination of prednisone, azathioprine and N-acetylcysteine

Correct Incorrect Correct answer

Pirfenidone

Correct Incorrect Correct answer

Nintedanib

Correct Incorrect Correct answer

Omeprazole

Correct Incorrect Correct answer

Domiciliary oxygen

Correct Incorrect Correct answer

Mepolizumab is a humanised monoclonal antibody used in severe eosinophilic asthma. What is its molecular target?

Interleukin-5

Correct Incorrect Correct answer

Immunoglobin E (IgE)

Correct Incorrect Correct answer

Interleukin-4

Correct Incorrect Correct answer

Thymic stromal lymphopoietin (TSLP)

Correct Incorrect Correct answer

Interleukin-13

Correct Incorrect Correct answer

Blocking the actions of which of the following cytokines is LEAST likely to improve severe asthma control?

Interleukin-23

Correct Incorrect Correct answer

Interleukin-5

Correct Incorrect Correct answer

Interleukin-33

Correct Incorrect Correct answer

Thymic stromal lymphopoetin (TSLP)

Correct Incorrect Correct answer

Interleukin-4

Correct Incorrect Correct answer

In COPD patients with type 2 inflammation, blocking which pro-inflammatory cytokine(s) has been shown to reduce exacerbations?

Interleukin-4 and interleukin-13

Correct Incorrect Correct answer

Interleukin-5

Correct Incorrect Correct answer

Thymic stromal lymphopoietin (TSLP)

Correct Incorrect Correct answer

Interleukin-4 and interleukin-5

Correct Incorrect Correct answer

Interleukin-23

Correct Incorrect Correct answer

Which of the following is NOT a component of the Asthma Control Questionnaire-5 (ACQ-5)?

Asthma symptoms on waking in the morning

Correct Incorrect Correct answer

Nocturnal asthma symptoms

Correct Incorrect Correct answer

Limitation of activities due to asthma

Correct Incorrect Correct answer

Confidence in leaving home because of the lung condition

Correct Incorrect Correct answer

Frequency of wheezing in the past week

Correct Incorrect Correct answer

Gefapixant is a P2X3 receptor antagonist for refractory or unexplained chronic cough.

What is its most common adverse effect?

Taste disturbance (dysgeusia)

Correct Incorrect Correct answer

Severe nausea

Correct Incorrect Correct answer

Autoimmune encephalitis

Correct Incorrect Correct answer

Hallucinations

Correct Incorrect Correct answer

Postural hypotension

Correct Incorrect Correct answer

What is recommended for treating a pneumothorax with a persistent air leak in an adult who is not fit for surgery?

Tube drainage

Correct Incorrect Correct answer

Chemical pleurodesis

Correct Incorrect Correct answer

Autologous blood pleurodesis

Correct Incorrect Correct answer

Repeated needle aspirations

Correct Incorrect Correct answer

Clinical observation alone

Correct Incorrect Correct answer

Mock Respiratory Module 5

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

36. Question

37. Question

38. Question