Basketball Match, Player fell (936/1700)

During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What is the inv of choice?
a. CXR
b. CT
c. MRI
d. V/Q scan
e. CTPA

Progressive dyspnea, cough and mucopurulent sputum (903/1700)

A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of
mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking salbutamol, the ratio=2.4/3.7. What is the most likely dx?

a. Chronic bronchitis
b. Asthma
c. Bronchiectasis
d. Lung fibrosis
e. Sarcoidosis

Pain relief in a young asthmatic child (1496/1700)

A 4yo child comes with a sprain in his foot. Hx reveals that the child has had recurrent admissions to the hosp due to severe asthma. What is the most appropriate analgesic?

a. Diclofenac sodium
b. Ibuprofen
c. Paracetamol
d. Codeine

Pneumonia (1418/1700)

A 49yo man comes with hx of cough and SOB. His CD4 count is measured as 350. CXR shows lobar consolidation. What is the single most appropriate option?

a. Mycobacterium avium intercellular
b. CMV
c. Streptococcus
d. Toxoplasmosis
e. Pneumocystis jerovici

Pleural effusion and lung shadowing (1492/1700)

A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. What would you do to improve his symptoms?

a. Aspiration
b. Chest drain
c. Chemotherapy
d. Diuretic

Severe asthma (1488/1700)

A child came to the ED with severe asthma and not responding to salbutamol nebulizer and vomiting many times. What is the most appropriate management?

a. Salmetrol
b. Montelukast
c. Prednisolone
d. Budesonide inhaler
e. Oxygen
f. IV salbutamol

Pneumonia (1438/1700)

A 50yo DM pt came to the OPD with complaint of of fever, muscle ache, dry cough and anorexia. Inv: CXR=upper lobe cavitation. What is the single most likely causative organism?
a. Legionella
b. Mycoplasma
c. Staphylococcus
d. Klebsiella
e. Streptococcus

Mass in mediastinum (963/1700)

A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with
hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is
the best inv to confirm the dx?

a. Bronchoscopy
b. Thoracoscopy
c. US
d. CT thorax
e. LN biopsy

Pneumonia (924/1700)

924. A 33yo man has a temp=38.5C, cough and chest pain on the right side on inspiration. He also has purulent sputum. What is the most likely organism to cause pneumonia in this pt?
a. Gram +ve diplococcic
b. Coagulase +ve cocci
c. PCP cold agglutinins
d. AFB
e. Gram –ve diplococci

Fever, chest pain, localized crackles (550/1700)

A 55yo woman with a persistent cough and hx of smoking develops left sided chest pain
exacerbated by deep breathing with fever and localized crackles. What is the single most
appropriate dx?
a. Dissecting aneurysm
b. Pericarditis
c. Pneumonia
d. Pneumothorax
e. Pulmonary embolism

Tall thin man, chest pain (548/1700)

A tall thin young man has sudden pain in the chest and becomes breathless while crying. What is
the single most appropriate inv?
a. Cardiac enzymes
b. CXR
c. CT
d. ECG
e. V/Q scan

Chest pain following long haul flight (547/1700)

A 50yo woman returned by air to the UK from Australia. 3days later she presented with sharp
chest pain and breathlessness. Her CXR and ECG are normal. What is the single most
appropriate inv?
a. Bronchoscopy
b. Cardiac enzymes
c. CT
d. MRI
e. Pulse oximetry
f. V/Q scan
g. CTPA

CT reveals opacity in mediastinum (543/1700)

A 67yo man with hx of weight loss complains of hoarseness of voice. CT reveals opacity in the
right upper mediastinum. He denied any hx of difficulty breathing. What is the single most
appropriate inv?
a. Laryngoscopy
b. Bronchoscopy
c. LN biopsy
d. Bronchoalevolar lavage
e. Barium swallow

Lung cancer histopathology (910/1700)

Pt with a long hx of smoking is now suffering from bronchial ca. histology reveals there are
sheets of large polygonal or giant MNC. What is the most likely dx?
a. Squamous cell ca
b. Small cell ca
c. Adenocarcinoma
d. Large cell ca
e. Oat cell ca

Asthma (536/1700)

A 10yo boy who takes regular high dose inhaled steroids for his longstanding asthma has been
advised to use bronchodilators to control his acute attacks. His parents are unsure when should
he use his bronchodilator. What is the single most appropriate inv?

a. CXR
b. None
c. Peak flow rate diary
d. Pulse oximetry

Dullness on percussion (530/1700)

A 68yo man has had malaise for 5 days and fever for 2 days. He has cough and there is dullness
to percussion at the left lung base. What is the single most appropriate inv?
a. Bronchoscopy
b. CXR
c. CT
d. MRI
e. V/Q scan

Cough, clubbing, inspiratory crepitations (529/1700)

A 45yo chronic smoker attends the OPD with complaints of persistent cough and copious
amount of purulent sputum. He had hx of measles in the past. Exam: finger clubbing and
inspiratory crepitations on auscultation. What is the single most likely dx/
a. Interstitial lung disease
b. Bronchiectasis
c. Asthma
d. COPD
e. Sarcoidosis

Boy with Asthma (522/1700)

An 8yo boy has longstanding asthma. He has admitted with a severe episode and is tired and
drowsy. He has not improved on oxygen, inhaled B2 agonist and IV hydrocortisone. CXR shows
bilateral hyperinflation. He is too breathless to use a peakflow meter and is O2 sat <90%. What
is the single most appropriate inv?

a. CBG
b. CXR
c. CT chest
d. Pulse oximetry
e. Spirometry

Pneumonia (691/1700)

691. A 16yo girl has been unwell for 5days with malaise, headache and dry cough. She has a few crackles in her chest. Her CXR shows patchy consolidation in the lower lobes. What is the single most likely causative organism?
a. Cold agglutinins
b. Gram –ve diplococci in sputum
c. Gram +ve diplococcic in sputum
d. Serology for legionella
e. Sputum staining for mycobacterium TB

Chest infection in lymphoma pt (481/1700)

A pt with hodgkins lymphoma who is under tx develops high fever. His blood results show WBC
<2800 and has a chest infection. Choose the most likely tx?
a. Co-amoxiclav
b. Piperacillin+tazobactam
c. Erythromycin
d. Piperacillin+Co-amoxiclav
e. Penicillin+tazobactam