Respiratory Medicine 10 Single Best Answer (SBA)
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1. A 4-month-old boy presents with a 2-day history of poor feeding, cough, and increased work of breathing. On examination, there is nasal flaring, subcostal recession, and widespread wheeze. Oxygen saturation is 88%. What is the most appropriate immediate management?
Answer: A. Admit for oxygen therapy and monitoring
Hypoxaemia (<90% saturation) and respiratory distress warrant hospital admission for oxygen and monitoring.
2. A 25-year-old male presents with sudden onset sharp chest pain and dyspnoea after lifting weights. He is stable with no evidence of tension pneumothorax. A chest X-ray confirms a small right-sided pneumothorax. What is the most appropriate management?
Answer: A. Observation and follow-up
Small, stable primary spontaneous pneumothoraces often resolve with observation and repeat imaging.
3. A 35-year-old woman presents with fatigue, dry cough, and erythema nodosum. Chest X-ray reveals bilateral hilar lymphadenopathy. What is the most likely diagnosis?
Answer: A. Sarcoidosis
Bilateral hilar lymphadenopathy with erythema nodosum is classic for sarcoidosis.
4. A 7-year-old boy presents with a 2-week history of paroxysmal coughing followed by vomiting. His mother mentions a "whooping" sound during his coughing fits. What is the most appropriate next step?
Answer: A. Prescribe oral clarithromycin
Macrolides reduce transmission and may shorten the illness if started early.
5. A 72-year-old former smoker presents with exertional dyspnoea and frequent winter chest infections. Examination reveals prolonged expiratory phase and decreased breath sounds bilaterally. Spirometry shows an FEV1/FVC ratio of 0.6. What is the next step in management?
Answer: A. Prescribe a short-acting bronchodilator
This is the first-line management for symptomatic COPD.
6. A 34-year-old man presents with a 3-month history of weight loss, night sweats, and a persistent cough with haemoptysis. Chest X-ray shows cavitary lesions in the upper lobes. What is the most likely diagnosis?
Answer: A. Tuberculosis
Systemic symptoms with upper lobe cavitation are classic for TB.
7. A 5-year-old child is brought to A&E with sudden onset fever, drooling, and difficulty breathing. He is sitting upright, leaning forward, and appears in distress. What is the most appropriate immediate management?
Answer: A. Secure the airway
Airway obstruction is the most critical concern in epiglottitis.
8. A 58-year-old male is admitted with fever, pleuritic chest pain, and persistent cough. Chest X-ray shows a pleural effusion. Pleural fluid analysis reveals low pH and glucose. What is the next best step?
Answer: A. Start antibiotics and insert a chest drain
Empyema requires drainage and antibiotics to resolve infection.
9. A 42-year-old woman presents with sudden dyspnoea, pleuritic chest pain, and tachycardia. She had recent knee surgery. What is the most appropriate initial investigation?
Answer: B. CT pulmonary angiography (CTPA)
CTPA is the gold standard for diagnosing PE in high-risk patients.
10. A 55-year-old woman presents with a chronic productive cough, intermittent haemoptysis, and recurrent chest infections. High-resolution CT confirms bronchiectasis. What is the cornerstone of long-term management?
Answer: A. Chest physiotherapy
Physiotherapy aids mucus clearance and reduces infection risk in bronchiectasis.
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