Medicine
Respiratory Medicine
Which acid-base pattern is typical in chronic compensated hypercapnic respiratory failure due to advanced COPD?
A. High PaCO2 with elevated bicarbonate
B. Low PaCO2 with low bicarbonate
C. Normal PaCO2 with severe metabolic acidosis
D. Low PaCO2 with elevated anion gap only
Correct Answer: A
Chronic respiratory acidosis is compensated by renal bicarbonate retention, so both PaCO2 and serum bicarbonate are elevated.
Medicine
Respiratory Medicine
A patient after long-haul travel has unilateral leg swelling and sudden dyspnea. He becomes hypotensive and bedside echo shows right ventricular strain. If there is no major contraindication, what treatment should be considered?
A. Systemic thrombolysis
B. Oral antihistamine
C. Pleural aspiration
D. Inhaled corticosteroid only
Correct Answer: A
Hemodynamically unstable high-risk pulmonary embolism may require urgent reperfusion therapy such as systemic thrombolysis when not contraindicated.
Medicine
Respiratory Medicine
A patient with COPD and chronic severe resting hypoxemia despite optimal therapy is most likely to benefit from which intervention for survival?
A. Long-term oxygen therapy when criteria are met
B. Routine oral steroids indefinitely
C. Daily antibiotics for life in all cases
D. SABA monotherapy
Correct Answer: A
Long-term oxygen therapy improves survival in appropriately selected COPD patients with severe chronic resting hypoxemia.
Medicine
Respiratory Medicine
A 44-year-old woman has episodic dyspnea, normal chest X-ray and normal baseline spirometry, but asthma remains suspected. Which test can demonstrate variable airway hyperresponsiveness?
A. Methacholine challenge
B. D-dimer
C. Pleural biopsy
D. Right heart catheterization
Correct Answer: A
Bronchoprovocation testing can demonstrate airway hyperresponsiveness when baseline spirometry is normal but asthma remains clinically suspected.
Medicine
Respiratory Medicine
A patient with pneumonia develops a loculated pleural effusion with low pleural pH and frank pus. What management is required?
A. Observation only
B. Chest-tube drainage plus antibiotics
C. Inhaled bronchodilator only
D. Immediate lung transplant
Correct Answer: B
Empyema or a complicated parapneumonic effusion generally requires pleural drainage in addition to antimicrobial therapy.
Medicine
Respiratory Medicine
Which test confirms persistent airflow obstruction in COPD?
A. Post-bronchodilator spirometry
B. Chest CT alone
C. Arterial blood gas in all patients
D. Sputum eosinophils
Correct Answer: A
COPD diagnosis requires persistent airflow obstruction demonstrated on post-bronchodilator spirometry.
Medicine
Respiratory Medicine
A patient has progressive exertional dyspnea, dry cough, bibasal fine crackles and HRCT showing subpleural basal honeycombing. What is the most likely diagnosis?
A. Idiopathic pulmonary fibrosis
B. Acute bronchitis
C. Bronchiectasis
D. Pulmonary edema
Correct Answer: A
Basal subpleural reticulation and honeycombing with fine inspiratory crackles are characteristic of usual interstitial pneumonia/IPF in the appropriate clinical setting.
Medicine
Respiratory Medicine
A patient with severe asthma is unable to speak full sentences, has a silent chest and rising PaCO2. What does the rising PaCO2 indicate?
A. Clinical improvement
B. Impending respiratory failure
C. Simple hyperventilation only
D. Pulmonary embolism is excluded
Correct Answer: B
In severe asthma, normalization or rise of PaCO2 can signal respiratory muscle fatigue and impending ventilatory failure.
Medicine
Respiratory Medicine
A 35-year-old woman has bilateral hilar lymphadenopathy, erythema nodosum and ankle arthritis. Which diagnosis is most likely?
A. Sarcoidosis
B. Tuberculosis only
C. Silicosis
D. Idiopathic pulmonary fibrosis
Correct Answer: A
The combination of bilateral hilar adenopathy, erythema nodosum and ankle arthritis is classic for acute sarcoidosis such as Löfgren syndrome.
Medicine
Respiratory Medicine
A patient with obesity and daytime somnolence has loud snoring and witnessed apneas. What is the diagnostic test of choice?
A. Peak expiratory flow
B. Polysomnography or validated sleep study
C. Sputum culture
D. Bronchoscopy
Correct Answer: B
Obstructive sleep apnea is diagnosed using sleep testing that measures respiratory events during sleep.
Medicine
Respiratory Medicine
Which pleural fluid finding satisfies Light criteria for an exudative effusion?
A. Pleural protein/serum protein ratio below 0.3
B. Pleural LDH/serum LDH ratio above 0.6
C. Pleural glucose above serum glucose
D. Very low pleural cell count
Correct Answer: B
A pleural LDH to serum LDH ratio greater than 0.6 is one of Light criteria for an exudate.
Medicine
Respiratory Medicine
A tall young man develops sudden dyspnea and unilateral absent breath sounds. He is hypotensive with tracheal deviation. What should be done immediately?
A. Wait for chest X-ray
B. Needle/finger decompression followed by chest tube
C. Give oral steroids only
D. Perform spirometry
Correct Answer: B
Tension pneumothorax is a clinical emergency requiring immediate decompression without waiting for imaging.
Medicine
Respiratory Medicine
A patient with sudden pleuritic chest pain, tachycardia and hypoxemia has high clinical probability of pulmonary embolism and is stable. What is the preferred diagnostic imaging test?
A. CT pulmonary angiography
B. Routine chest X-ray only
C. Bronchoscopy
D. Echocardiography alone
Correct Answer: A
CT pulmonary angiography is the standard imaging test for most hemodynamically stable patients with suspected pulmonary embolism and high clinical probability.
Medicine
Respiratory Medicine
A COPD patient has worsening dyspnea, increased sputum volume and purulent sputum. Which feature most strongly supports adding antibiotics?
A. Bradycardia
B. Purulent sputum with increased respiratory symptoms
C. Mild ankle edema only
D. Stable chronic cough
Correct Answer: B
Antibiotics are most useful in COPD exacerbations when bacterial features such as sputum purulence accompany increased dyspnea or sputum volume.
Medicine
Respiratory Medicine
A 22-year-old with asthma has symptoms most days and wakes at night twice weekly. Which controller principle is preferred over SABA-only treatment?
A. Use SABA alone as needed
B. Use an inhaled corticosteroid-containing regimen
C. Use oral antibiotics daily
D. Use theophylline as sole first-line therapy
Correct Answer: B
Current asthma strategy recommends ICS-containing treatment because SABA-only therapy does not address airway inflammation and is associated with higher exacerbation risk.
Medicine
Respiratory Medicine
Which symptom is particularly characteristic of clinically significant OSA?
A. Persistent hematuria
B. Isolated jaundice
C. Severe unilateral leg weakness
D. Excessive daytime sleepiness with witnessed nocturnal apneas
Correct Answer: D
Recurrent nocturnal obstruction fragments sleep and commonly causes daytime somnolence.
Medicine
Respiratory Medicine
Which complication or major adverse outcome is particularly associated with Obstructive sleep apnea (OSA)?
A. Cardiac arrest from obstructive shock
B. Empyema
C. Systemic hypertension and cardiovascular risk
D. Pulmonary hypertension and chronic respiratory failure
Correct Answer: C
Untreated OSA is associated with hypertension, arrhythmia and broader cardiovascular risk.
Medicine
Respiratory Medicine
A patient is diagnosed with Obstructive sleep apnea (OSA). Which is the most appropriate management principle?
A. Start anticoagulation when PE is confirmed or strongly suspected and bleeding risk is acceptable; use reperfusion therapy for selected unstable patients
B. Use weight-management measures and positive airway pressure therapy when indicated
C. Immediate thoracic decompression followed by definitive chest drainage
D. Treat the underlying cause and drain the effusion when large, infected or causing significant symptoms
Correct Answer: B
CPAP is highly effective for clinically significant OSA, alongside risk-factor treatment.
Medicine
Respiratory Medicine
In a patient with suspected Obstructive sleep apnea (OSA), which investigation or diagnostic approach is most appropriate at this stage?
A. Sleep study or validated home sleep apnea testing in an appropriate patient
B. Chest radiography plus severity-guided laboratory and microbiologic testing
C. Risk-stratified evaluation using clinical probability, D-dimer when appropriate and CT pulmonary angiography when indicated
D. Clinical diagnosis; do not wait for chest imaging in an unstable patient
Correct Answer: A
Objective sleep testing quantifies respiratory events and confirms OSA.
Medicine
Respiratory Medicine
A patient has loud snoring, witnessed apneas, obesity and excessive daytime sleepiness. What is the most likely diagnosis?
A. Acute exacerbation of chronic obstructive pulmonary disease (COPD)
B. Community-acquired pneumonia
C. Acute pulmonary embolism
D. Obstructive sleep apnea (OSA)
Correct Answer: D
Nocturnal upper-airway obstruction causes repeated apneas, sleep fragmentation and daytime symptoms.