Respiratory Medicine 10 Single Best Answer (SBA)
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1. A 45-year-old woman presents with sudden onset fever, myalgia, headache, and dry cough. She mentions recent exposure to colleagues with similar symptoms. Examination reveals no chest signs of infection. What is the most appropriate management?
Answer: Reassure and recommend supportive care
In healthy adults, influenza is often self-limiting. Supportive measures (hydration, analgesics, rest) are typically sufficient unless risk factors are present.
2. A 50-year-old man with HIV presents with fever, non-productive cough, and dyspnoea. His CD4 count is 150 cells/µL. Chest X-ray reveals diffuse interstitial infiltrates. What is the most likely diagnosis?
Answer: Pneumocystis jirovecii pneumonia (PJP)
In HIV patients with a CD4 count below 200 cells/µL, PJP is a common cause of pneumonia, typically presenting with diffuse interstitial infiltrates.
3. A 55-year-old woman with a history of breast cancer presents with breathlessness. Chest X-ray shows a large left-sided pleural effusion. What is the most appropriate next step?
Answer: Diagnostic thoracocentesis
In a patient with possible malignant pleural effusion, fluid analysis (cytology, protein, LDH) is crucial before definitive management.
4. A 72-year-old male presents with 6 months of exertional dyspnoea and a dry cough. Examination reveals fine bibasal inspiratory crackles. High-resolution CT shows honeycombing. What is the most appropriate initial management?
Answer: Prescribe pirfenidone
In idiopathic pulmonary fibrosis, antifibrotic agents like pirfenidone or nintedanib are recommended to slow disease progression.
5. A 40-year-old non-smoker presents with flushing, diarrhoea, and episodic wheezing. CT scan reveals a 3 cm lesion in the right lung. What is the most likely diagnosis?
Answer: Carcinoid tumour
Carcinoid tumours arise from neuroendocrine cells and can release substances causing classic flushing, diarrhoea, and wheezing (carcinoid syndrome).
6. A 45-year-old woman presents with progressive exertional dyspnoea and fatigue. Echocardiography reveals a pulmonary artery pressure of 50 mmHg. She has no history of chronic lung disease or heart failure. What is the most likely cause of her condition?
Answer: Idiopathic pulmonary arterial hypertension
IPAH presents with progressive dyspnoea, elevated pulmonary artery pressures, and no underlying heart or lung disease.
7. A 35-year-old woman presents with worsening shortness of breath, wheezing, and nocturnal symptoms over the past two days. Peak flow is 50% of her predicted value. What is the most appropriate immediate management in primary care?
Answer: Prescribe oral prednisolone and increase inhaled corticosteroids
Acute asthma exacerbations often require a short course of oral steroids to quickly address inflammation, plus optimization of inhaled therapy.
8. A 65-year-old smoker presents with a 2 cm pulmonary nodule incidentally found on a chest X-ray. He has no symptoms and no previous history of malignancy. What is the most appropriate next step?
Answer: Request a CT scan
High-resolution imaging is critical for incidental nodules, especially in smokers, to determine the likelihood of malignancy.
9. A 58-year-old man who worked in a coal mine for 30 years presents with chronic cough and dyspnoea. Chest X-ray shows small nodular opacities in the upper lobes. What is the most likely diagnosis?
Answer: Coal workers' pneumoconiosis
Prolonged coal dust exposure causes coal workers' pneumoconiosis, typically affecting the upper lung zones.
10. A 52-year-old obese man presents with excessive daytime sleepiness and loud snoring reported by his partner. What is the most appropriate initial investigation?
Answer: Epworth Sleepiness Scale
The Epworth Sleepiness Scale is a simple questionnaire that estimates the severity of daytime sleepiness and helps decide on further investigations.
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