Respiratory MCQ’s
1
A homeless alcoholic presents to your emergency department complaining of cough, rigors, pleuritic chest pain, and difficulty breathing. Chest radiograph shows a right upper-lobe pneumonia. What organism must be considered?
A
Klebsiella pneumoniae
B
Escherichia coli
C
Haemophilus influenzae
D
Pneumococcus
Answer
2
Which of the following pulmonary infections is MOST commonly associated with rust coloured sputum?
A
Klebsiella
B
Staphylococcus
C
Group A streptococcus
D
Pneumococcus
Answer
3 Which of the following organisms is resistant to antibiotics that act on the cell wall? A
Streptococcus pneumoniae
B
Klebsiella pneumoniae
C
Mycoplasma pneumoniae
D
Pseudomonas
Answer
4 A foreign body lodged in the distal one third of the airway can cause all of the following EXCEPT A
recurrent pneumonia
B
inspiratory wheezing
C
air trapping on the affected side
D
elevation of the affected diaphragm on decubitus film
Answer
5
All of the following are true concerning lung abscesses EXCEPT
A
lung abscesses are usually polymicrobial with 60% containing anaerobes
B
mortality is 10%
C
penicillin G or clindamycin are acceptable treatments
D
outpatient management with oral antibiotics is acceptable in nonimmunocompromised patients
Answer
6
Which is the earliest sign of pulmonary oedema on chest radiograph?
A
Alveolar oedema
B
Upper lobe diversion of vessels
C
Interstitial oedema
D
Kerley B lines
Answer
7
Which is FALSE in regard to spontaneous pneumothorax
A
most common in men between 20–40 years of age
B
If tension is present, the trachea is deviated to the side of the collapsed lung
C
women can have recurrent spontaneous pneumothorax during menses
D
smokers are at increased risk
Answer
8
Which of the following is MOST helpful in the diagnosis of a tension pneumothorax?
A
Chest radiograph showing mediastinal shift
B
Tracheal deviation toward the affected side
C
Bradycardia
D
Distended neck veins
Answer
9 A
Which of the following is MOST correct with respect to massive haemoptysis? Greater than 200 ml in 24 hours
B
Patient should be placed in reverse Trendelenburg
C
Controlled hypotension should be induced to prevent further bleeding
D
Patient should lie with bleeding side down
Answer
10
What is the MOST common organism that causes a parapneumonic effusion?
A
Staphylococcus aureus
B
Legionella
C
Streptococcus pneumoniae
D
Haemophilus influenzae
Answer
11
Which of the following is true regarding pulmonary aspiration?
A
Broad spectrum antibiotics are indicated
B
Steroid therapy should begin at once to decrease acid destruction
C
All patients should be immediately intubated and suctioned
D
Bronchodilators are useful to treat bronchospasm
Answer
12
Which features best characterises Pneumocystis carinii pneumonia (PCP)?
A
It is readily isolated and cultured in affected individuals
B
It usually presents as lobar pneumonia
C
It is a bacterial infection that responds well to intravenous sulfa-trimethoprim
D
Tuberculosis and atypical mycobacterium infection must be ruled out if PCP is suspected
Answer
13
Pneumonia due to an unusual or atypical organism should be considered in patients with all of the following conditions EXCEPT
A
uraemia
B
splenectomy
C
steroid treatment
D
hyperthyroidism
Answer
14
All of the following are true concerning Mycoplasma pneumonia EXCEPT
A
radiographic findings often appear worse than the clinical picture
B
it is most common in adolescents and young adults
C
complications are unusual
D
a positive serum cold agglutinin test is diagnostic
Answer
15
Which of the following radiographic findings on chest radiograph is least likely to be seen in active tuberculosis?
A
cavitation
B
diffuse, patchy infiltrates
C
pleural effusion
D
cardiomegaly
Answer
16
All of the following statements concerning acute respiratory distress syndrome (ARDS) are true EXCEPT
A
it appears histologically and radiographically as pulmonary oedema
B
most instances are associated with other disorders
C
mechanical ventilatory support is necessary in most cases
D
pulmonary capillary wedge pressure is elevated
Answer
17
All of the following are true regarding high-altitude pulmonary oedema (HAPE) EXCEPT
A
it is the leading cause of death related to high altitude
B
it may occur at altitudes as low as 5000 ft above sea level
C
a previous episode is a risk factor for recurrent HAPE
D
pulmonary capillary wedge pressure is not elevated
Answer
18
The primary treatment for HAPE is
A
100% O2 by nonrebreather mask
B
oral acetazolamide, 200 mg, 4 times per day
C
oral nifedipine, 10–20 mg, 3 times per day
D
immediate descent
Answer
19
Which of the following statements is true?
A
6 litres of oxygen via a Hudson mask administers approximate FiO2 of 65%
B
A PaO2 of 60mmHg equates to an oxygen saturation of 80%
C
Ventilation is likely indicated when measured tidal volume is l< 5 ml/kg
D
When estimating pneumothorax size on CXR, an average interpleural distance ( AID) of 2 cm is equivalent to a pneumothorax size of 16 %
Answer
20
The Mantoux Test may be recorded as positive when
A
4mm induration in HIV +ve patients
B
> 10 mm erythema only
C
read between 24 and 48 hours
D
> 10mm induration, with no previous BCG vaccination
Answer
21
Regarding medication in the treatment of asthma, which one is FALSE?
A
Methylxanthines potentiate the effect of Adenosine
B
Cromolyn causes a decrease of mast cell degranulation
C
Theophylline has a low Volume of Distribution
D
Rapid Theophylline withdrawal can cause bronchoconstriction
22
Which of the following is CORRECT?
A
Strep. Pneumoniae is responsible for 50% of pneumonias
B
Psittacosis is associated with epistaxis in 25% of cases
C
Macrolides are treatment of choice for Psittacosis
D
ARDS is associated with pulmonary oedema and CCF
Answer
23
With regard to pneumonia which of the following is INCORRECT?
A
S. pneumoniae is the agent most frequently associated with death.
B
Pleuritic chest pain is associated with increased mortality.
C
Legionella pneumophilia is not associated with person to person transmission.
D
Staph. Aureus pneumonia is associated with cavitating lesions.
Answer
24
Which of the following is FALSE regarding COPD?
A
PaCO2 > 50mmHg in Type II respiratory failure.
B
COPD is diagnosed with FEV1 < 80%.
C
Long term prophylactic antibiotics are recommended in severe COPD.
D
Long term oxygen therapy reduces mortality.
Answer
25
Regarding a spontaneous pneumothorax, which statement is FALSE?
A
Lateral decubitus CXR is as sensitive as CT chest for diagnosis of PTX
B
Inspiration and expiration CXRs markedly increase the sensitivity of plain films in the detection of small PTX
C
The likelihood of re-expansion pulmonary oedema increases with the length of time a lung has been collapsed
D
A visible rim of 2cm on an erect adult CXR roughly corresponds to 50% PTX
Answer
26
Regarding acute asthma in adults, which is FALSE?
A
A tapering short course of oral steroids is better at preventing relapse than a short course stopped abruptly
B
Spirometry is the most reliable measure of response to treatment
C
FEV1 < 50% predicted indicates severe acute asthma
D
In life-threatening asthma, Adrenaline IV is preferred over IM
Answer
27 Regarding NIV used alone in acute asthma, which is FALSE? A
Reduces airway resistance
B
Improves gas exchange
C
Bronchodilatation
D
Counter atelectasis
Answer
28
Regarding asthma management, which is TRUE?
A
Oxygen doesn’t reverse bronchoconstriction
B
Meta-analysis supports the use of IV beta2 agonists in acute severe asthma
C
Addition of anticholinergic offers a modest but statistically significant improvement in lung function
D
Steroids don’t reduce admission rates
Answer
29
With regards to respiratory function tests, which of the following is TRUE?
A
An increased FEV1/FVC ratio indicates a restrictive pattern
B
Total lung capacity = vital capacity + tidal volume
C
Restrictive lung disease has a high VC
D
Peak expiratory flow rate in severe asthma is anything less than 60% of predicted.
Answer
30
The principles of mechanical ventilation in severe asthma include all of the following EXCEPT,
A
Permissive hypercarbia
B
Shorter exhalation times
C
Paralysis often required.
D
May need the addition of an inhalational agent for further bronchodilatation
31
Alcoholic diabetic patients are at most risk of the following infectious agents, EXCEPT for
A
Burkholderia pseudomallei.
B
Klebsiella pneumonia
C
Staph aureus
D
Mycoplasma pneumoniae
32
Regarding the management of Croup
A
Ribavirin is indicated in the hospitalised patient
B
10% of hospitalised children require intubation
C
Adenovirus is a cause of croup
D
The dose of nebulised adrenaline in a 1 yr old is 5ml 1/1000
Answer
33
In assessing a child with breathing difficulties, which is TRUE?
A
The WHO uses a cut-off respiratory rate of 60 in infants and young children for pneumonia
B
Intercostal recession is more easily seen in children older than 6 because their lungs are less compliant than younger infants
C
Stridor is a low pitched inspiratory noise that suggesting poor airway positioning or pharyngeal obstruction
D
All children who have respiratory compromise will have increased work of breathing
Answer
34
Which is FALSE regarding asthma in kids?
A
IV aminophylline has a role in children with severe asthma
B
IV magnesium has a proven benefit in children with severe asthma
C
There is evidence to support heliox in children with severe asthma
D
A single dose of oral steroid has the same efficacy as a 3 or 5 day course
Answer
35
With regard to the differential diagnosis in croup which of the following is FALSE?
A
A congenital airway or vascular abnormality should be considered if the child is very young and has a history of low-grade stridor
B
Toxic or trauma should be enquired of
C
Dysphagia and drooling may suggest epiglottitis, retropharyngeal abscess or inhaled foreign body
D
The child with bacterial tracheitis requires no investigations as the diagnosis is a clinical one
Answer
36
With regard to the management of bronchiolitis which of the following is FALSE?
A
Children with an oxygen saturation of less than 94% need admission
B
Children alert, feeding >50% of normal and older than 6 weeks may be considered for outpatient management
C
Steroids are of marginal benefit
D
CPAP has no role
Answer
37
Which is NOT a risk factor for death from Asthma?
A
2 or more hospitalisations from asthma in the past year
B
Use of >2MDI short acting corticosteroid canisters per month
C
Difficulty perceiving asthma severity
D
Hospitalisation or an ED visit for asthma in the past month
Answer
38
Regarding Pleural Effusions which is NOT an Exudative cause?
A
Mesothelioma
B
Rheumatoid arthritis
C
Pulmonary Infarction
D
Myxoedema
Answer
39
Regarding Pneumothorax
A
Women have higher incidence of primary spontaneous
B
Traumatic pneumothorax occurs in 15-20% of patients sustaining blunt chest trauma
C
Expiration chest films significantly increase detection of clinically relevant pneumothorax
D
Recurrence after first primary or secondary pneumothorax is 30%
Answer
40
In regard to Community acquired Pneumonia
A
The presence of SIRS in community acquired pneumonia is highly predictive of death, severe sepsis or shock
B
PSI is more useful at distinguishing which patients require ICU treatment than other scoring systems
C
Non-invasive ventilation prior to intubation is associated with better outcome
D
Combination of a macrolide with amoxicillin has always been shown to be effective against Drug Resistant Strep Pneumonia (DRSP)
Answer
41
Which statement regarding COPD is INCORRECT
A
Cessation of smoking and home oxygen reduces mortality
B
A 10 day course of Prednisolone requires gradual tapering due to adrenal suppression
C
BIPAP improves short term survival
D
Aminophylline improved diaphragmatic contractility
Answer
42
Which statement regarding pleural effusions is CORRECT
A
Lymphoma is the most common malignancy causing a pleural effusion
B
CCF more commonly causes a left sided effusion
C
PE more commonly produces a transudate
D
A lateral decubitus CXR is more sensitive at detecting effusions than AP or PA CXR
Answer
43
With regard to resolution of pneumonia, which statement is TRUE?
A
Improvement clinically should occur within 12-24hrs of treatment commencing
B
Symptomatic improvement lags behind radiological improvement
C
Mycoplasma takes 8-12 weeks to resolve and often causes scarring and fibrosis
D
Legionella takes 12-20 weeks to resolve
Answer
44
Which feature does NOT form a part of the Well’s Score for predicting the probability of PE?
A
HR>100
B
Haemoptysis
C
Age>50
D
Malignancy
Answer
45
In pharyngitis due to infection with beta-haemolytic streptococcus group A, treatment with the appropriate antibiotics reduces the incidence of all of the following complications EXCEPT:
A
Post-streptococcal glomerulonephritis
B
Acute rheumatic fever
C
Peritonsillar abscess
D
Otitis media
Answer
46
Which one of the following statements regarding community-acquired pneumonia in the adult is TRUE:
A
1 gram amoxycillin 8 hourly orally is often sufficient to treat Streptococcus pneumoniae that is classed as “high-level resistant to penicillin” based on culture and sensitivity studies
B
Haemophilus influenzae is the most common cause
C
Mycoplasma pneumoniae causes pneumonia mainly in the elderly
D
Pneumonia caused by Legionella is relatively more common in the elderly
Answer
47
Regarding non cardiogenic pulmonary oedema, which of the following is FALSE
A
Opiate overdose is not one of the causes
B
When measured. Pulmonary capillary wedge pressure is < 18 mmHg
C
PCP and salicylates can both cause it
D
Can be precipitated at high altitude
Answer
48
Regarding Mycoplasma pneumonia
A
It has a 3 day incubation period
B
It is the least common atypical pneumonia
C
CXR usually shows only minor changes in an unwell patient
D
Associated with meningitis and encephalitis
Answer
Answers
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25.
A D C D D B B D D C D D D D D D B D C D A C B C B
26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48.
A B C A B D C A B D D B D B D B D D C A A A D
Cameron – p278 COPDX Guidelines 2003 BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003; 58(Suppl II):ii39-ii52. Asthma Management Handbook 2006. National Asthma Council Australia Cameron page 27 Dunn(asthma management) B – TLC = VC + RV. D < 40%. E this is expiratory reserve volume Long expiratory times 1:4 IE to allow complete emptying of lungs. th
APLS manual 4 edition th APLS manual 4 edition Textbook of paediatric emergency medicine p159 Textbook of paediatric emergency medicine p156 Rosens Chapter 71 pg893 Rosens Chapter 75 pg 944 rd Cameron et al, (3 ed) Ch 6.6 rd Cameron e al (3 ed) p 286-292 Dunn pages 782-785 Dunn p808-809 Dunn, p 787 Dunn, p794 rd Textbook of Adult Emergency Medicine (Cameron et al., 3 ed.), p. 277 rd Textbook of Adult Emergency Medicine (Cameron et al., 3 ed.) pp. 283-284 Drugs that can cause it: MOPS! meprobamate, opiate OD, PCP, Salicylate 14 day incubation, most common, CXR usually worse than the patient, assoc bullous myringitis, erythema multiforme, Guillain Barre as well
with
