Respiratory 51-100 MRQ

A 65-year-old man presents with a chronic productive cough, progressive shortness of breath, and frequent respiratory infections over the past five years. He denies any history of asthma or allergies. Pulmonary function tests reveal an FEV₁/FVC ratio of 55% post-bronchodilator.

Which of the following are risk factors for chronic obstructive pulmonary disease (COPD)? Select five (5) Correct answer.

A 58-year-old woman from a rural area presents with progressive dyspnea, a chronic productive cough, and frequent respiratory infections.. Pulmonary function tests show an FEV₁/FVC ratio of 58%.

Which of the following are risk factors for COPD in non-smokers? Select five (5) Correct answer.

A 68-year-old man presents to your clinic with worsening breathlessness over the past three years. He has a chronic productive cough, especially in the mornings, and finds it increasingly difficult to perform daily activities without stopping to catch his breath. He smoked one pack of cigarettes per day for 45 years before quitting last year.

On examination, he appears thin and fatigued. His respiratory rate is 24 breaths per minute, and his oxygen saturation is 91% on room air. Which of the following are clinical signs of chronic obstructive pulmonary disease (COPD)? Select five (5) Correct answer.

A 72-year-old woman with long-standing COPD presents with worsening shortness of breath and ankle swelling over the past six months. She reports frequent coughing with white sputum and has been hospitalized twice in the past year for COPD exacerbations. She uses a home oxygen concentrator at night.

On examination, her oxygen saturation is 88% on room air, and her respiratory rate is 28 breaths per minute. She has diffuse wheezing, and mild peripheral edema.

Which of the following are clinical features of severe COPD and its complications? Select five (5) Correct answer.

A 65-year-old man presents to your clinic with progressive shortness of breath, chronic productive cough, and wheezing over the past five years. He reports that his symptoms worsen in cold weather and he struggles with daily activities, often needing to stop and rest when walking. He smoked 20 cigarettes per day for 45 years before quitting two years ago.

On examination, his respiratory rate is 22 breaths per minute, and he has a barrel-shaped chest with decreased breath sounds and a prolonged expiratory phase. His oxygen saturation is 93% on room air.

Which of the following investigations would be most useful in diagnosing and assessing the severity of COPD? Select five (5) Correct answer.

A 72-year-old woman with severe COPD presents to the emergency department with worsening shortness of breath, increased sputum production, and confusion over the past 24 hours. She has been using her salbutamol inhaler frequently with minimal relief. She reports no fever or chest pain. On examination, she has a respiratory rate of 28 breaths per minute, pursed-lip breathing, and use of accessory muscles. Her oxygen saturation is 86% on room air, and she is drowsy but responsive.

Which of the following investigations would be crucial in assessing this COPD exacerbation? Select five (5) Correct answer.

A 67-year-old man with moderate COPD presents for a routine follow-up. He has a 20-year smoking history and quit five years ago. He reports shortness of breath with exertion but can still perform daily activities. He has a chronic productive cough but no recent exacerbations. His current medications include salbutamol (SABA) as needed. Spirometry shows an FEV₁ of 65% predicted, with an FEV₁/FVC ratio of 0.65 post-bronchodilator.

According to Australian RACGP guidelines, which of the following are appropriate long-term management strategies for stable COPD? Select five (5) Correct answer.

A 75-year-old woman with severe COPD presents to the emergency department with worsening shortness of breath and increased sputum production over the past three days. She is using her salbutamol inhaler every two hours with little relief. Her oxygen saturation is 88% on room air, and she is using accessory muscles to breathe. Spirometry from six months ago showed an FEV₁ of 38% predicted, and she has had three hospital admissions for COPD exacerbations in the past year.

According to Australian RACGP guidelines, which of the following are appropriate acute management steps for a COPD exacerbation? Select five (5) Correct answer.

A 72-year-old man with severe COPD presents for a follow-up. He has been hospitalized twice in the past year for exacerbations and requires home oxygen therapy at night. He experiences persistent dyspnea at rest and struggles with basic activities like dressing and walking short distances. He quit smoking 10 years ago but had a 50-pack-year history. His latest spirometry shows FEV₁ of 30% predicted, and he has developed peripheral edema and jugular venous distension.

Which of the following factors are associated with a poor prognosis in COPD? Select five (5) Correct answer.

A 60-year-old woman with moderate COPD presents for a review. She has mild exertional dyspnea, can perform daily activities without limitations, and has had no hospitalizations in the past year. She quit smoking 15 years ago and has been following a structured pulmonary rehabilitation program. Her latest spirometry shows FEV₁ of 65% predicted, and she has no significant weight loss or comorbidities.

Which of the following factors are associated with a good prognosis in COPD? Select five (5) Correct answer.

A 70-year-old man with severe COPD presents to the emergency department with worsening shortness of breath and increasing ankle swelling over the past month. He reports frequent exacerbations requiring hospital admissions and has been using home oxygen therapy at night. He denies fever or chest pain but mentions significant fatigue and difficulty breathing while lying flat.

On examination, he has a respiratory rate of 28 breaths per minute, mild cyanosis, and jugular venous distension. His breath sounds are diminished bilaterally with scattered wheezing. There is pitting edema up to his knees, and his heart sounds reveal a loud second heart sound (P2).

Which of the following are complications of severe COPD? Select five (5) Correct answer.

On examination, she is drowsy, with a respiratory rate of 10 breaths per minute and a flapping tremor (asterixis). Her oxygen saturation is 94% on 4L/min of oxygen. Arterial blood gas (ABG) shows:

Which of the following are serious complications of COPD that could explain her condition? Select five (5) Correct answer.

A 55-year-old woman presents with chronic productive cough and frequent respiratory infections over the past five years. She reports daily sputum production that is thick and yellow-green, often requiring antibiotics. She also experiences occasional hemoptysis and worsening breathlessness. She denies smoking or significant occupational exposure to irritants.

She has not traveled recently and does not report any systemic symptoms like weight loss or fever.

Which of the following are risk factors for developing bronchiectasis? Select five (5) Correct answer.

A 42-year-old man presents with chronic daily cough, excessive sputum production, and recurrent chest infections over the past 10 years. He reports occasional hemoptysis and breathlessness on exertion. His medical history includes asthma, chronic sinusitis, and multiple lung infections as a child.

He has never smoked His sputum cultures in the past have grown Pseudomonas aeruginosa. His brother has similar symptoms and was diagnosed with some chronic condition but he cannot recall the name.

Which of the following are major risk factors for developing bronchiectasis? Select five (5) Correct answer.

A 65-year-old woman presents with a chronic productive cough, recurrent chest infections, and worsening breathlessness over the past five years. She describes daily thick sputum production, particularly in the morning, and occasional episodes of hemoptysis. She has a history of asthma and recurrent pneumonia as a child.

You suspect that she has bronchiectasis

Which of the following are clinical signs of bronchiectasis? Select five (5) Correct answer.

A 55-year-old man with long-standing bronchiectasis presents with worsening breathlessness and increased sputum production. He describes frequent chest infections requiring antibiotics and coughing up blood occasionally. He denies weight loss or fever but notes that his breathlessness has gradually worsened over the past year.

On examination, he appears fatigued, with a respiratory rate of 26 breaths per minute. His oxygen saturation is 89% on room air.

Which of the following clinical signs suggest worsening or severe bronchiectasis? Select five (5) Correct answer.

A 54-year-old woman presents with a chronic productive cough and frequent respiratory infections over the past five years. She describes large volumes of thick yellow-green sputum daily, occasionally tinged with blood. Her breathlessness has progressively worsened, and she often feels fatigued. She has a history of asthma and multiple childhood pneumonias.

On examination, she has coarse crackles over both lung bases, mild finger clubbing, and a respiratory rate of 24 breaths per minute. Chest X-ray shows increased lung markings but no consolidation.

Which of the following investigations would be most useful in confirming the diagnosis and assessing bronchiectasis severity? Select five (5) Correct answer.

A 65-year-old woman presents with chronic cough, frequent lung infections, and daily mucus expectoration for the past eight years. She was treated multiple times for bronchitis and pneumonia, with temporary improvement but frequent relapses. Her sputum cultures have grown Pseudomonas aeruginosa in the past.

On examination, she has clubbing of the fingers, coarse inspiratory crackles at the lung bases, and mild central cyanosis. Her chest X-ray shows thickened bronchial walls and patchy infiltrates.

Which of the following investigations would be crucial in identifying underlying causes and guiding management? Select five (5) Correct answer.

A 58-year-old woman with bronchiectasis presents for a routine follow-up. She reports daily thick sputum production, which has been stable, but experiences occasional mild breathlessness with exertion. She has had two exacerbations requiring antibiotics in the past year. Her most recent sputum culture grew Haemophilus influenzae, and her pulmonary function tests show moderate airflow obstruction.

She has never smoked and has no significant cardiac or autoimmune conditions. She is currently using salbutamol (SABA) as needed and performing daily airway clearance exercises.

According to Australian RACGP guidelines, which of the following are appropriate long-term management strategies for stable bronchiectasis? Select five (5) Correct answer.

A 63-year-old man with severe bronchiectasis presents to the emergency department with worsening cough, increased sputum production, and breathlessness for the past three days. His sputum has become thicker and darker, and he has a mild fever. He has a history of Pseudomonas aeruginosa colonization, and previous exacerbations required oral antibiotics.

On examination, his respiratory rate is 28 breaths per minute, and he has coarse inspiratory crackles bilaterally. His oxygen saturation is 92% on room air, and his chest X-ray shows no new infiltrates.

According to Australian RACGP guidelines, which of the following are appropriate acute management steps for a bronchiectasis exacerbation? Select five (5) Correct answer.

A 62-year-old woman with long-standing bronchiectasis presents to the emergency department with worsening breathlessness, increased sputum production, and hemoptysis over the past two days. She has had multiple exacerbations in the past year, requiring frequent antibiotics. She denies fever or chest pain but has noticed progressive fatigue and ankle swelling over the last few months.

On examination, she appears mildly cyanotic, with a respiratory rate of 26 breaths per minute and an oxygen saturation of 90% on room air. She has bilateral coarse crackles, wheezing, and mild pitting edema in both ankles. A chest X-ray shows widespread bronchial thickening and hyperinflation.

Which of the following are potential complications of bronchiectasis? Select five (5) Correct answer.

A 55-year-old man with severe bronchiectasis presents with increasing cough, fatigue, and low-grade fever over the past three weeks. He reports foul-smelling sputum, occasional hemoptysis, and night sweats. His condition has been worsening despite completing a recent course of antibiotics. He denies recent weight loss or known tuberculosis exposure.

On examination, his respiratory rate is 28 breaths per minute, and he has coarse inspiratory crackles over the right lower lung field. His oxygen saturation is 88% on room air, and he appears fatigued. A chest X-ray shows a cavitating lesion with an air-fluid level in the right lower lobe.

Which of the following are serious complications of bronchiectasis that could explain his current condition? Select five (5) Correct answer.

A 64-year-old man with bronchiectasis presents for a routine follow-up. He reports daily sputum production, but his symptoms have been stable over the past year. He engages in regular pulmonary physiotherapy and has had only one exacerbation requiring antibiotics in the past year.

His spirometry shows FEV₁ of 65% predicted, and his most recent sputum cultures have not shown Pseudomonas aeruginosa. He denies significant weight loss, hemoptysis, or worsening breathlessness.

Which of the following factors are associated with a good prognosis in bronchiectasis? Select five (5) Correct answer.

A 59-year-old woman with severe bronchiectasis presents with worsening breathlessness, frequent exacerbations, and progressive weight loss over the past six months. She has had three hospitalizations in the past year for respiratory infections, and her most recent sputum cultures have grown Pseudomonas aeruginosa.

Her spirometry shows an FEV₁ of 32% predicted, and she has developed cor pulmonale with mild peripheral edema. She reports fatigue, reduced exercise tolerance, and morning headaches.

Which of the following factors are associated with a poor prognosis in bronchiectasis? Select five (5) Correct answer.

A 67-year-old man presents with chronic cough, progressive weight loss, and occasional blood-streaked sputum over the past three months. He reports increasing shortness of breath and chest discomfort but denies fever or recent infections. He has no significant family history of lung cancer but has a history of Tye 2 Diabetes Mellitus. A chest X-ray reveals a mass in the right upper lobe.

Which of the following are major risk factors for lung cancer? Select five (5) Correct answer.

A 59-year-old woman presents with persistent cough, unintentional weight loss, and mild chest pain over the past four months. She has never smoked but worked as a flight attendant for 30 years. She denies occupational chemical exposure but has a family history of lung cancer in her father, who was a smoker.

She has no history of asthma or COPD. A CT scan of her chest shows a 3 cm mass in the left upper lobe, prompting further investigation.

Which of the following are important risk factors for lung cancer in non-smokers? Select five (5) Correct answer.

A 67-year-old man presents with progressive shortness of breath, chronic cough, and weight loss over the past four months. He has a 50-pack-year smoking history and reports occasional hemoptysis. On examination, he appears cachectic, with a respiratory rate of 22 breaths per minute. His hands show clubbing. You suspect Lung cancer

Which of the following clinical signs suggest lung cancer? Select five (5) Correct answer.

A 61-year-old woman with a history of smoking and chronic cough presents with increasing fatigue, weight loss, and intermittent chest pain.. She denies fever, night sweats, or recent infections.

On examination, she is mildly tachypneic, with a respiratory rate of 24 breaths per minute. You suspect bronchiogenic carcinoma.

Which of the following clinical signs are associated with lung cancer? Select five (5) Correct answer.

A 64-year-old man with a 50-pack-year smoking history presents with persistent cough, hemoptysis, and unexplained weight loss over the past four months. His symptoms have progressively worsened, and he now reports chest discomfort and breathlessness.

On examination, he appears cachectic, with clubbing of the fingers and dullness to percussion over the right lung base. A chest X-ray shows a 3 cm mass in the right upper lobe with hilar lymphadenopathy.

Which of the following investigations are essential for confirming the diagnosis and staging of lung cancer? Select five (5) Correct answer.

A 58-year-old woman presents with progressive breathlessness, a chronic cough, and unexplained weight loss over the past six months. She denies smoking but has a history of secondhand smoke exposure from childhood. A recent chest X-ray revealed a left lung mass with mediastinal widening.

She has also experienced hoarseness and difficulty swallowing in the past month. Her physical examination reveals reduced breath sounds over the left lung field, clubbing, and mild facial swelling.

Which of the following investigations are necessary to establish the diagnosis and assess the extent of lung cancer? Select five (5) Correct answer.

A 70-year-old man presents with persistent cough, weight loss, and hemoptysis for the past three months. He has a 45-pack-year smoking history and was recently diagnosed with non-small cell lung cancer (NSCLC), stage IIIB, based on PET-CT and biopsy results.

His performance status is ECOG 1 (mild symptoms but independent in daily activities). His pulmonary function tests show FEV₁ of 65% predicted, and he has no evidence of distant metastases. The tumor is locally advanced, involving mediastinal lymph nodes but not invading major structures.

According to Australian RACGP guidelines, which of the following are appropriate management options for this patient’s lung cancer? Select five (5) Correct answer.

A 62-year-old woman with extensive-stage small cell lung cancer (SCLC) presents with progressive breathlessness, fatigue, and a persistent cough. PET-CT confirms metastatic spread to the liver and bones, and she has mild anemia but no respiratory failure. She has an ECOG performance status of 2 (ambulatory but limited in self-care tasks).

She is concerned about her treatment options and asks about prognosis and symptom management.

According to Australian RACGP guidelines, which of the following are appropriate management strategies for extensive-stage SCLC? Select five (5) Correct answer.

A 68-year-old man with a history of heavy smoking and chronic cough presents with worsening breathlessness, fatigue, and hemoptysis over the past two months. He was recently diagnosed with non-small cell lung cancer (NSCLC), stage IIIB, and is undergoing chemotherapy.

Over the past week, he has developed increasing facial and neck swelling, which worsens when he lies down. He also reports new-onset headache and dizziness. His physical examination reveals engorged neck veins, facial plethora, and upper limb edema.

Which of the following are potential complications of lung cancer? Select five (5) Correct answer.

A 61-year-old woman with metastatic non-small cell lung cancer (NSCLC) presents with worsening confusion, nausea, and severe muscle weakness over the past three days. Her family reports that she has been drinking excessive water and appears lethargic. She has no history of kidney disease or diabetes.

On examination, she is disoriented, mildly tachycardic, and has reduced deep tendon reflexes. Blood tests show a serum sodium of 120 mmol/L (normal: 135-145). Her chest CT shows progression of her lung mass with new mediastinal lymphadenopathy.

Which of the following are serious complications of lung cancer? Select five (5) Correct answer.

A 66-year-old man with stage IV non-small cell lung cancer (NSCLC) presents for a follow-up appointment. He was diagnosed six months ago and has been receiving immunotherapy with pembrolizumab. His most recent PET-CT shows progression of metastatic lesions in the liver and adrenal glands, and his weight has declined by 8 kg in the last three months.

His performance status is ECOG 2 (able to walk but limited in daily activities), and he reports severe fatigue and loss of appetite. His serum albumin is 28 g/L (low), and his lactate dehydrogenase (LDH) is elevated. He asks about his prognosis and what factors determine life expectancy.

Which of the following are poor prognostic factors for lung cancer? Select five (5) Correct answer.

A 55-year-old woman with limited-stage small cell lung cancer (SCLC) completed chemoradiotherapy and prophylactic cranial irradiation (PCI) six months ago. She had a complete radiologic response, and her performance status remains ECOG 0 (fully active). She is a lifelong non-smoker and has no significant comorbidities.

She asks about her long-term prognosis and what factors influence survival in lung cancer.

Which of the following are favorable prognostic factors for lung cancer? Select five (5) Correct answer.