MRCP Part 1 Respiratory Medicine 2

Question 1

A 50-year-old man with a 30-pack-year smoking history presents with haemoptysis and a right hilar mass on CXR. CT confirms a central lung mass with mediastinal lymphadenopathy. What is the most likely histological type?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma is the most common central lung tumour in smokers, arising from bronchial epithelium. It is associated with haemoptysis, central location, and hilar masses. Adenocarcinoma is more common peripherally. Small cell is central but has distinct paraneoplastic syndromes.

Question 2

A patient with small cell lung cancer presents with hyponatraemia (Na 118 mmol/L) and inappropriately concentrated urine. What paraneoplastic syndrome does this represent?

Accepted Answer

SIADH

Answer

SIADH (Syndrome of Inappropriate Antidiuretic Hormone secretion) is the most common paraneoplastic syndrome in small cell lung cancer. Ectopic ADH production causes dilutional hyponatraemia with inappropriately concentrated urine (urine osmolality >100 mOsm/kg despite low plasma osmolality).

Question 3

In obstructive sleep apnoea (OSA), which investigation is the gold standard for diagnosis?

Accepted Answer

Polysomnography (full overnight sleep study)

Answer

Full polysomnography (overnight sleep study) measuring airflow, respiratory effort, oxygen saturation, EEG, EMG, and ECG is the gold standard for diagnosing OSA and characterising its severity (AHI). Limited respiratory polygraphy may be used in straightforward cases.

Question 4

Which spirometric pattern is characteristic of idiopathic pulmonary fibrosis?

Accepted Answer

Restrictive: reduced FVC, normal or increased FEV1/FVC ratio

Answer

Idiopathic pulmonary fibrosis causes a restrictive pattern: reduced FVC, reduced TLC, preserved or elevated FEV1/FVC ratio. The fibrosis stiffens the lung, reducing volume but not obstructing flow proportionally. DLCO is also characteristically reduced.

Question 5

What is the first-line antibiotic for a hospitalised patient with moderate community-acquired pneumonia according to UK NICE guidelines?

Accepted Answer

Amoxicillin plus a macrolide (e.g., clarithromycin)

Answer

For moderate CAP requiring hospitalisation, UK NICE guidelines recommend amoxicillin plus a macrolide (clarithromycin or azithromycin) to cover both typical organisms (pneumococcus) and atypical pathogens (Mycoplasma, Legionella, Chlamydophila).

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Respiratory Medicine 2