Respiratory MCQs

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 non-
immunocompromised 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 2040 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

Which of the following is MOST correct with respect to massive
haemoptysis?
A 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, 1020 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 FEV
1
< 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 doesnt 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 dont 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 Wells 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. A
2. D
3. C
4. D
5. D
6. B
7. B
8. D
9. D
10. C
11. D
12. D
13. D
14. D
15. D
16. D
17. B
18. D
19. C
20. D
21. A
22. C
23. B Cameron p278
24. C COPDX Guidelines 2003
25. B BTS guidelines for the management of spontaneous pneumothorax. Thorax 2003;
58(Suppl II):ii39-ii52.
26. A Asthma Management Handbook 2006. National Asthma Council Australia
27. B Cameron page 27
28. C Dunn(asthma management)
29. A B TLC = VC + RV. D < 40%. E this is expiratory reserve volume
30. B Long expiratory times 1:4 IE to allow complete emptying of lungs.
31. D
32. C
33. A APLS manual 4
th
edition
34. B APLS manual 4
th
edition
35. D Textbook of paediatric emergency medicine p159
36. D Textbook of paediatric emergency medicine p156
37. B Rosens Chapter 71 pg893
38. D Rosens Chapter 75 pg 944
39. B Cameron et al, (3
rd
ed) Ch 6.6
40. D Cameron e al (3
rd
ed) p 286-292
41. B Dunn pages 782-785
42. D Dunn p808-809
43. D Dunn, p 787
44. C Dunn, p794
45. A Textbook of Adult Emergency Medicine (Cameron et al., 3
rd
ed.), p. 277
46. A Textbook of Adult Emergency Medicine (Cameron et al., 3
rd
ed.) pp. 283-284
47. A Drugs that can cause it: MOPS! meprobamate, opiate OD, PCP, Salicylate
48. D 14 day incubation, most common, CXR usually worse than the patient, assoc with
bullous myringitis, erythema multiforme, Guillain Barre as well