Copy of Respiratory Module 5

A 57 year old male, ex-smoker presents with symptoms of headache and dyspnea for the last 3 months including unexplained weight loss.

Clinically, he has marked facial edema with distended veins in both his chest and neck. His face appears flushed. Resting oxygen saturation is 92 percent on air. 

What is the most appropriate step?

A 62 year old female patient is thought to be a good candidate for surgical resection of her primary lung cancer in the right upper lobe.

However, based on her recent CT report, the physician is concerned about the possibility of distant metastases.

What would be the best investigation for this?

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

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

Which of the following types of ILD is associated with sjogren’s disease?

Which of the following feature on radiology would strongly suggest the presence of usual interstitial pneumonia (UIP) as opposed to non specific interstitial pneumonia (NSIP)?

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

Which of the following intervention is most likely to reduce risk of hospitalization?

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

A 30 year old female at 33 weeks gestation presents with acute dyspnea and pleuritic chest pain. She has a sinus tachycardia of 110 bpm and a swollen right leg. Her chest was clear on auscultation.

ECG revealed sinus tachycardia with rate of 110/min and a CXR was normal.

What is the next most appropriate step in management?

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

A 20 year old male non-smoker, usually fit and well presents with acute onset of left sided chest pain while playing soccer. 

His admission chest x-ray shows a moderate sized left sided pneumothorax. His vital signs are otherwise stable.He denies being short of breath and current pain score is 2/10.

What would be the recommended acute management for this patient? 

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

Which of the following feature is highly suggestive of nicotine dependence?

A 50 year old woman with limited scleroderma presents with worsening shortness of breath on exertion. Examination reveals raised JVP and loud P2.

Her ECHO shows normal LV and moderately dilated and hypokinetic right ventricle. Her estimated right ventricular systolic pressure is 65mmHg.

Right heart catheter study confirms elevated right heart pressures with no change to inhaled nitric oxide.

What is the most effective therapy to improve her symptoms in the next 3 months?

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

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

What is the DLCO cut-off for transplant referral in patients with idiopathic pulmonary fibrosis?

In a critically ill patient who is hemodynamically unstable, which of the following finding would be highly suggestive of an underlying pulmonary embolism?

A 67 year old male presents with acute dyspnea and right sided pleuritic chest pain. He had just underwent a laparotomy with bowel resection 2 weeks ago for bowel cancer.

He is now critically ill and has become hemodynamically unstable.

CTPA confirms the presence of a large saddle embolus in the right main pulmonary artery.

What is the best management?

A patients with severe COPD presents to the emergency department with an acute exacerbation of COPD. As part of the treatment, oral Prednisone 40mg once daily was started on admission. What is the optimum duration of oral glucocorticoid therapy?

Which of the following radiological feature is an independent predictor of mortality in patients with interstitial pulmonary fibrosis (IPF)?

Which of the following bronchial challenge test causes a direct constriction of the airway smooth muscles?

A 64 year old man with a background of moderate COPD (FEV1 of 55%) has been newly diagnosed with metastatic lung squamous cell carcinoma. Apart from referring him to the medical oncologist for consideration of systemic chemotherapy,which of the following is the most appropriate next step in management?

A 37 year old man has been recently diagnosed with sarcoidosis associated with mild hypercalcemia of 2.6 mmol/L and has been recently commenced on oral prednisone for his sarcoidosis. Last week, he visited his GP and was started on an oral thiazide diuretic for blood pressure control. He has been informed that he is at high risk of developing kidney stones so have been somewhat compliant with a restricted calcium and oxalate diet. However, he now presents to ED with increased confusion and is found to have severe hypercalcemia of 5 mmol/L.

What is the most likely cause for his worsening hypercalcemia?

Dupilumab has been recently shown to be effective in the treatment of moderate to severe uncontrolled asthma.

Which pro-inflammatory signal does it block?

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

Pulmonary function test has an essential role in monitoring the progression of interstitial lung disease. When used for monitoring disease progression, which parameter could be regarded as significant?

Which of the following condition has a predominantly lymphocytic cellular pattern on bronchoalveolar lavage (BAL)?

A 75 year old man presents with several months history of dry cough and progressive breathlessness on exertion. On examination, he has finger clubbing, reduced chest expansion and on chest auscultation, fine velcro inspiratory crackles can be heard bi-basally. His current oxygen saturation is 88 percent on air.

A HRCT performed demonstrates areas of subpleural honeycombing with moderate to severe traction bronchiectasis bibasally along with extensive reticulation in the right lower lobe.

You suspect that this patient has some form of interstitial lung disease but which of the following investigation should be avoided as part of your diagnostic work up?

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

Mepolizumab is a humanized monoclonal antibody that has been recently recognized as being effective in the treatment of severe chronic eosinophilic asthma. 

What is the target receptor for this medication?

You are more likely to improve severe asthma control by blocking the actions of the following pro-inflammatory cytokines except?

In COPD patients with Type 2 inflammation, the blocking of which pro-inflammatory cytokine/s can likely lead to fewer exacerbations?

The following statements are all part of the Asthma Control Questionnaire-5 (ACQ-5) except?

Gefapixant is a P2X3 receptor antagonist that has shown promising results for the treatment of refractory and unexplained chronic cough. 

What is the most common side effect of this medication?

What is recommended for treating pneumothorax with persistent air leak in adults who are not fit for surgery?