MRCP Part 1 Respiratory Medicine

Question 1

A patient with COPD has an FEV1/FVC ratio of 0.6 and an FEV1 of 45% predicted. According to GOLD criteria, what severity is this?

Accepted Answer

GOLD 3 (severe)

Answer

GOLD 1 (mild)

Answer

GOLD 2 (moderate)

Answer

GOLD 4 (very severe)

Question 2

Which organism is the most common causative pathogen in community-acquired pneumonia (CAP)?

Accepted Answer

Streptococcus pneumoniae

Answer

Klebsiella pneumoniae

Answer

Legionella pneumophila

Answer

Staphylococcus aureus

Question 3

A patient with known asthma has a PEFR of 33% best and cannot complete sentences. What severity of asthma attack is this?

Accepted Answer

Life-threatening asthma

Answer

Moderate acute asthma

Answer

Severe acute asthma

Answer

Near-fatal asthma

Question 4

A 25-year-old non-smoker presents with progressive dyspnoea and a CXR showing bilateral basal emphysematous changes. What rare condition should be considered?

Accepted Answer

Alpha-1-antitrypsin deficiency

Answer

Sarcoidosis

Answer

Lymphangioleiomyomatosis

Answer

Hypersensitivity pneumonitis

Question 5

Which of the following pleural fluid findings are most consistent with an exudate using Light's criteria?

Accepted Answer

Pleural protein/serum protein ratio >0.5

Answer

Pleural LDH < 2/3 upper limit of normal serum LDH

Answer

Pleural LDH/serum LDH ratio <0.6

Answer

Pleural protein <25 g/L

Question 6

What is the most appropriate first-line treatment for a Wells score of 3 and a positive D-dimer in a patient with suspected PE?

Accepted Answer

Request CT pulmonary angiography and treat if confirmed

Answer

Commence therapeutic anticoagulation immediately

Answer

Arrange V/Q scan first before treating

Answer

Arrange echocardiogram and treat only if right heart strain is seen