71- Sleep Apnoea syndrome is best diagnosed by the following:
1) Polygraphic Sleep Studies
2) therapeutic trial of amphetamines
3) EEG
4) Blood gases during apneic episodes
5) Presence of HLA-DR2 and DQw1
Answers-1
72- A 70-year-old man presented with weight loss and haemoptysis. He was a heavy smoker. A chest radiograph showed a mass lesion in the left lung bronchoscopic biopsies confirmed a squamous carcinoma.
1) Chest wall invasion by primary tumour
2) An enlarged mediastinal lymph node on CT scanning
3) Forced expiratory volume (FEV1) of 1.2 litres
4) Hypercalcaemia
5) Malignant pleural effusion
Answers-5
73- Which of the following statements regarding prognosis in lung cancer is true?
1) Combined modality therapy (chemotherapy, radiation therapy and surgery) has improved overall lung cancer survival to 40% at 5 years.
2) Overall lung cancer survival is < 15% at 5 years.
3) Patients undergoing radiation therapy have a 5 year survival of 40%.
4) Patients who qualify for surgery have a 50% 5 year survival.
5) With chemotherapy, overall survival in small cell (oat cell) carcinomas has risen to 60% at 5 years.
Answers-2
74- A breathless patient undergoes pulmonary Function testing. The following results are obtained; FEV1 = 74% predicted, FVC = 68% predicted, TLC = 77% predicted, Tlco = 46% predicted, Kco = 53% predicted. Which of the following is the most likely cause ?
1) COPD
2) Asthma
3) Cryptogenic Fibrosing Alveolitis
4) Morbid obesity
5) kyphoscoliosis
Answers-3
75- A lifelong non-smoker is diagnosed with emphysema. Which of the following would be the most likely aetiological agent ?
1) Isocyanates
2) Cadmium Exposure
3) Steel
4) Zinc
5) Asbestos
Answers-2
76- Which cell type is responsible for the early asthmatic response?
1) Basophil
2) Eosinophil
3) Mast cell
4) Neutrophil
5) TH1-lymphocyte
Answers-3
77- A 43-year-old Caribbean female Comprehensive school teacher complains of slowly increasing breathlessness. She has no smoking history. Investigations reveal she has bilateral enlarged hilar lymph nodes, elevated serum calcium, interstitial lung disease, and enlarged liver and spleen. What is the most likely diagnosis?
1) Coccidioidomycosis [0]
2) Hyperparathyroidism [0]
3) Hypervitaminosis D [0]
4) Sarcoidosis [100]
5) Tuberculosis [0]
Answers-4
78- A 58-year-old man presents with weight loss and haemoptysis. He has smoked most of his life. On examination he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 3.2mM. Which of the following histological type of lung cancer is he most likely to suffer from?
1) mesothelioma
2) small cell carcinoma
3) large cell carcinoma
4) squamous cell carcinoma
5) adenocarcinoma
Answers-4
79- A 68-year-old man presents with a one-month history of dyspnoea and a 3kg weight loss. On examination there were signs of a large left pleural effusion, confirmed on Chest X-ray.
Investigations revealed:
Pleural fluid analysis:
Protein 38 g/L
Cytology a few lymphocytes and red blood cells.
Which one of the following investigations should be considered next?
1) Bronchoscopy.
2) CT scan of thorax.
3) Repeat pleural aspiration with biopsy.
4) Thoracoscopic pleural biopsy.
5) Tuberculin test.
Answers-4
80- A 63-year-old woman presents a 5 day history of progressive shortness of breath. Her family brought her in because she was increasingly sleepy during the last 24 hours. She was diagnosed with Chronic Obstructive Pulmonary Disease 3 years ago and has a FEV1 less than 50% of predicted. She has an oxygen concentrator at home.
Examination revealed depressed consciousness and a respiratory rate of 24 with shallow breaths. There were decreased breath sounds with minimal air movement. If an arterial blood gas on room air were to be performed, which of the following results would you expect?
1) pH 7.16 paCO2 70 paO2 50 HCO3 24
2) pH 7.24 paCO2 80 paO2 55 HCO3 30
3) pH 7.32 paCO2 60 paO2 70 HCO3 30
4) pH 7.41 paCO2 40 paO2 50 HCO3 24
5) pH 7.48 paCO2 30 paO2 85 HCO3 24
Answers-2
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1) Polygraphic Sleep Studies
2) therapeutic trial of amphetamines
3) EEG
4) Blood gases during apneic episodes
5) Presence of HLA-DR2 and DQw1
Answers-1
72- A 70-year-old man presented with weight loss and haemoptysis. He was a heavy smoker. A chest radiograph showed a mass lesion in the left lung bronchoscopic biopsies confirmed a squamous carcinoma.
1) Chest wall invasion by primary tumour
2) An enlarged mediastinal lymph node on CT scanning
3) Forced expiratory volume (FEV1) of 1.2 litres
4) Hypercalcaemia
5) Malignant pleural effusion
Answers-5
73- Which of the following statements regarding prognosis in lung cancer is true?
1) Combined modality therapy (chemotherapy, radiation therapy and surgery) has improved overall lung cancer survival to 40% at 5 years.
2) Overall lung cancer survival is < 15% at 5 years.
3) Patients undergoing radiation therapy have a 5 year survival of 40%.
4) Patients who qualify for surgery have a 50% 5 year survival.
5) With chemotherapy, overall survival in small cell (oat cell) carcinomas has risen to 60% at 5 years.
Answers-2
74- A breathless patient undergoes pulmonary Function testing. The following results are obtained; FEV1 = 74% predicted, FVC = 68% predicted, TLC = 77% predicted, Tlco = 46% predicted, Kco = 53% predicted. Which of the following is the most likely cause ?
1) COPD
2) Asthma
3) Cryptogenic Fibrosing Alveolitis
4) Morbid obesity
5) kyphoscoliosis
Answers-3
75- A lifelong non-smoker is diagnosed with emphysema. Which of the following would be the most likely aetiological agent ?
1) Isocyanates
2) Cadmium Exposure
3) Steel
4) Zinc
5) Asbestos
Answers-2
76- Which cell type is responsible for the early asthmatic response?
1) Basophil
2) Eosinophil
3) Mast cell
4) Neutrophil
5) TH1-lymphocyte
Answers-3
77- A 43-year-old Caribbean female Comprehensive school teacher complains of slowly increasing breathlessness. She has no smoking history. Investigations reveal she has bilateral enlarged hilar lymph nodes, elevated serum calcium, interstitial lung disease, and enlarged liver and spleen. What is the most likely diagnosis?
1) Coccidioidomycosis [0]
2) Hyperparathyroidism [0]
3) Hypervitaminosis D [0]
4) Sarcoidosis [100]
5) Tuberculosis [0]
Answers-4
78- A 58-year-old man presents with weight loss and haemoptysis. He has smoked most of his life. On examination he is clubbed and has clinical evidence of right pleural effusion. His serum calcium is 3.2mM. Which of the following histological type of lung cancer is he most likely to suffer from?
1) mesothelioma
2) small cell carcinoma
3) large cell carcinoma
4) squamous cell carcinoma
5) adenocarcinoma
Answers-4
79- A 68-year-old man presents with a one-month history of dyspnoea and a 3kg weight loss. On examination there were signs of a large left pleural effusion, confirmed on Chest X-ray.
Investigations revealed:
Pleural fluid analysis:
Protein 38 g/L
Cytology a few lymphocytes and red blood cells.
Which one of the following investigations should be considered next?
1) Bronchoscopy.
2) CT scan of thorax.
3) Repeat pleural aspiration with biopsy.
4) Thoracoscopic pleural biopsy.
5) Tuberculin test.
Answers-4
80- A 63-year-old woman presents a 5 day history of progressive shortness of breath. Her family brought her in because she was increasingly sleepy during the last 24 hours. She was diagnosed with Chronic Obstructive Pulmonary Disease 3 years ago and has a FEV1 less than 50% of predicted. She has an oxygen concentrator at home.
Examination revealed depressed consciousness and a respiratory rate of 24 with shallow breaths. There were decreased breath sounds with minimal air movement. If an arterial blood gas on room air were to be performed, which of the following results would you expect?
1) pH 7.16 paCO2 70 paO2 50 HCO3 24
2) pH 7.24 paCO2 80 paO2 55 HCO3 30
3) pH 7.32 paCO2 60 paO2 70 HCO3 30
4) pH 7.41 paCO2 40 paO2 50 HCO3 24
5) pH 7.48 paCO2 30 paO2 85 HCO3 24
Answers-2
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