AMC MCQ Respiratory Medicine 3 — Questions and Answers
Question 1: A young tall man presents with sudden pleuritic chest pain and breathlessness; chest X-ray shows a 1 cm rim of air with no mediastinal shift. What is the appropriate management?
- Immediate needle decompression
- Observation with high-flow oxygen and reassessment (Correct answer)
- Urgent thoracotomy
- IV antibiotics
Correct answer: Observation with high-flow oxygen and reassessment
A small primary spontaneous pneumothorax without significant breathlessness can be managed conservatively with observation and oxygen.
Question 2: Which clinical sign indicates a tension pneumothorax requiring immediate decompression?
- Bilateral wheeze
- Tracheal deviation away from the affected side with hypotension (Correct answer)
- Productive cough
- Clubbing
Correct answer: Tracheal deviation away from the affected side with hypotension
Tension pneumothorax causes mediastinal shift with tracheal deviation, hypotension and distended neck veins, requiring emergency decompression.
Question 3: Spirometry shows FEV1/FVC ratio of 0.62 with reduced FEV1. This pattern is characteristic of which condition?
- Pulmonary fibrosis
- Obstructive airways disease such as COPD (Correct answer)
- Chest wall deformity
- Neuromuscular weakness
Correct answer: Obstructive airways disease such as COPD
A reduced FEV1/FVC ratio below 0.7 indicates an obstructive ventilatory defect such as COPD or asthma.
Question 4: Which spirometry pattern is typical of idiopathic pulmonary fibrosis?
- Reduced FEV1/FVC with high lung volumes
- Restrictive pattern with reduced FVC and preserved or increased FEV1/FVC ratio (Correct answer)
- Normal spirometry
- Isolated raised residual volume
Correct answer: Restrictive pattern with reduced FVC and preserved or increased FEV1/FVC ratio
Pulmonary fibrosis produces a restrictive defect with reduced lung volumes and a preserved or raised FEV1/FVC ratio.
Question 5: A patient with idiopathic pulmonary fibrosis is most likely to have which examination finding?
- Coarse early inspiratory crackles
- Fine bibasal end-inspiratory crackles and clubbing (Correct answer)
- Expiratory wheeze
- Bronchial breathing at the apex
Correct answer: Fine bibasal end-inspiratory crackles and clubbing
Fine bibasal end-inspiratory crackles with finger clubbing are characteristic of pulmonary fibrosis.
Question 6: Which is the most appropriate first-line investigation for suspected obstructive sleep apnoea?
- Overnight polysomnography or sleep study (Correct answer)
- Chest X-ray
- Echocardiogram
- Sputum cytology
Correct answer: Overnight polysomnography or sleep study
A sleep study (polysomnography) is the diagnostic investigation for obstructive sleep apnoea.
Question 7: What is the first-line treatment for moderate to severe obstructive sleep apnoea?
- Continuous positive airway pressure (CPAP) (Correct answer)
- Long-term oral steroids
- Nightly benzodiazepines
- Supplemental daytime oxygen only
Correct answer: Continuous positive airway pressure (CPAP)
CPAP is the mainstay treatment for moderate to severe obstructive sleep apnoea.
AMC MCQ Respiratory Medicine 3
A young tall man presents with sudden pleuritic chest pain and breathlessness; chest X-ray shows a 1 cm rim of air with no mediastinal shift.
What is the appropriate management?