AMC MCQ Respiratory Medicine 2 — Questions and Answers
Question 1: A 24-year-old with known asthma presents with a silent chest, exhaustion, and SpO2 of 88% on air. What is the most appropriate immediate management?
- Oral prednisolone and discharge
- Nebulised salbutamol, oxygen, IV hydrocortisone and call for senior/ICU help (Correct answer)
- Reassurance and peak flow diary
- IV antibiotics alone
Correct answer: Nebulised salbutamol, oxygen, IV hydrocortisone and call for senior/ICU help
A silent chest with hypoxia indicates life-threatening asthma requiring oxygen, nebulised bronchodilators, systemic steroids and urgent senior/ICU involvement.
Question 2: Which finding on arterial blood gas is most concerning in an acute severe asthma attack?
- A low PaCO2
- A normal or rising PaCO2 (Correct answer)
- A high PaO2
- A mild respiratory alkalosis
Correct answer: A normal or rising PaCO2
A normalising or rising PaCO2 signals tiring respiratory muscles and impending respiratory failure.
Question 3: A patient with COPD has chronic CO2 retention. What is the recommended target oxygen saturation range during an exacerbation?
- 94–98%
- 88–92% (Correct answer)
- 100%
- Below 85%
Correct answer: 88–92%
In CO2-retaining COPD patients controlled oxygen targeting 88–92% avoids worsening hypercapnia.
Question 4: Which organism is the most common cause of community-acquired pneumonia?
- Staphylococcus aureus
- Streptococcus pneumoniae (Correct answer)
- Legionella pneumophila
- Mycoplasma pneumoniae
Correct answer: Streptococcus pneumoniae
Streptococcus pneumoniae is the most frequent pathogen in community-acquired pneumonia.
Question 5: A CURB-65 score of 4 in a patient with pneumonia indicates which management approach?
- Home treatment with oral antibiotics
- Consideration of ICU admission (Correct answer)
- No antibiotics needed
- Outpatient follow-up only
Correct answer: Consideration of ICU admission
A high CURB-65 score (3–5) indicates severe pneumonia warranting hospital and possible ICU care.
Question 6: Which feature most strongly suggests Legionella pneumonia rather than typical pneumonia?
- Productive rusty sputum
- Hyponatraemia with confusion and diarrhoea (Correct answer)
- Localised pleuritic chest pain only
- Rapid response to penicillin
Correct answer: Hyponatraemia with confusion and diarrhoea
Legionella classically causes hyponatraemia, neurological features and gastrointestinal symptoms.
Question 7: What is the first-line investigation when pulmonary embolism is suspected in a haemodynamically stable patient with normal renal function?
- CT pulmonary angiography (Correct answer)
- Bronchoscopy
- Sputum culture
- Spirometry
Correct answer: CT pulmonary angiography
CT pulmonary angiography is the investigation of choice for diagnosing pulmonary embolism.
AMC MCQ Respiratory Medicine 2
A 24-year-old with known asthma presents with a silent chest, exhaustion, and SpO2 of 88% on air.
What is the most appropriate immediate management?