MRCP Part 1 Respiratory Medicine 1

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 severity is based on FEV1 % predicted (post-bronchodilator): GOLD 1 ≥80%, GOLD 2 50–79%, GOLD 3 30–49%, GOLD 4 <30%. An FEV1 of 45% predicted places this patient in GOLD 3 (severe). The FEV1/FVC <0.7 confirms obstruction.

Question 2

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

Accepted Answer

Streptococcus pneumoniae

Answer

Streptococcus pneumoniae (pneumococcus) is the most common cause of community-acquired pneumonia in the UK, accounting for approximately 30–40% of cases requiring hospitalisation. It typically causes a lobar pattern of consolidation.

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

Life-threatening asthma is defined by any of: PEFR <33% best/predicted, SpO2 <92%, PaO2 <8 kPa, normal/high PaCO2 (>4.6 kPa), silent chest, poor respiratory effort, cyanosis, bradycardia, confusion, or exhaustion. PEFR 33% with inability to speak indicates life-threatening severity.

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

Alpha-1-antitrypsin (AAT) deficiency should be suspected in young, non-smoking patients with premature emphysema, particularly with a basal distribution (unlike smoking-related emphysema which is upper lobe). Serum AAT levels and phenotyping confirm the diagnosis.

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

Light's criteria classify an exudate if ANY of: (1) pleural protein/serum protein ratio >0.5, (2) pleural LDH/serum LDH ratio >0.6, or (3) pleural LDH > 2/3 upper limit of normal serum LDH are met. A pleural/serum protein ratio >0.5 alone classifies as an exudate.

MRCP Part 1 Practice Test

MRCP Part 1 Practice Test

MRCP Part 1 Respiratory Medicine 1