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1. General Principles & Basic Science MCQs

Practice Set 40 of 789

This practice set contains high-yield board review questions covering key concepts in 1. General Principles & Basic Science. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 781

Topic: 1. General Principles & Basic Science

A 55-year-old woman with a 15-year history of seropositive rheumatoid arthritis presents with chronic cough. Chest X-ray reveals multiple peripheral pulmonary nodules, some of which are cavitating. She has a history of coal dust exposure. What is this syndrome known as?

. Felty syndrome
. Caplan syndrome
. Goodpasture syndrome
. Churg-Strauss syndrome
. Sjogren syndrome

Correct Answer & Explanation

. Caplan syndrome

Explanation

Caplan syndrome is a condition characterized by the combination of rheumatoid arthritis and pneumoconiosis, presenting with multiple, well-defined cavitating rheumatoid nodules in the lungs.

Question 782

Topic: Infection, Pharmacology & VTE

A 70-year-old man requires a total hip arthroplasty. His past medical history is significant for Heparin-Induced Thrombocytopenia (HIT) diagnosed 2 years ago during a hospital admission. Which of the following is the most appropriate pharmacologic deep vein thrombosis (DVT) prophylaxis for this patient?

. Low-molecular-weight heparin (Enoxaparin)
. Unfractionated heparin
. Warfarin initiation without bridging
. Fondaparinux
. Aspirin alone

Correct Answer & Explanation

. Fondaparinux

Explanation

Fondaparinux is a synthetic pentasaccharide that does not cross-react with HIT antibodies, making it a safe and effective DVT prophylaxis agent for patients with a history of HIT. Both unfractionated and low-molecular-weight heparins are strictly contraindicated.

Question 783

Topic: 1. General Principles & Basic Science

A 25-year-old man is rescued after his legs were trapped under a collapsed wall for 14 hours. He has swollen, tense thighs and his urine output drops dramatically, with the urine appearing dark brown. What is the primary mechanism of his acute kidney injury?

. Ischemic acute tubular necrosis from relative hypovolemia alone
. Direct tubular toxicity and cast obstruction from free myoglobin
. Glomerulonephritis triggered by massive autoantibody release
. Interstitial nephritis secondary to systemic inflammatory response
. Post-renal obstruction from gross hematuria and clot retention

Correct Answer & Explanation

. Direct tubular toxicity and cast obstruction from free myoglobin

Explanation

The patient has crush syndrome leading to rhabdomyolysis. The destruction of skeletal muscle releases massive amounts of myoglobin, which is directly toxic to the renal tubular epithelium and precipitates to form obstructing casts.

Question 784

Topic: Infection, Pharmacology & VTE

A 12-year-old boy with sickle cell anemia presents with a 3-day history of high fever, left leg pain, and localized swelling over the proximal tibia. Radiographs show a patchy lucency. While Staphylococcus aureus remains a common cause of osteomyelitis, which organism is characteristically more common in this patient population compared to healthy children?

. Streptococcus pneumoniae
. Pseudomonas aeruginosa
. Salmonella species
. Haemophilus influenzae
. Kingella kingae

Correct Answer & Explanation

. Salmonella species

Explanation

Patients with sickle cell disease are functionally asplenic and suffer from repeated bowel ischemia, which allows for bacterial translocation. This makes them uniquely susceptible to osteomyelitis caused by encapsulated organisms, characteristically Salmonella species.

Question 785

Topic: 1. General Principles & Basic Science

An 80-year-old man with advanced Paget disease of bone presents with increasing exertional dyspnea, peripheral edema, and a bounding pulse. Echocardiography reveals high-output cardiac failure. What is the underlying pathophysiology linking his skeletal disease to this cardiac condition?

. Severe anemia secondary to bone marrow replacement by pagetic bone
. Massive arteriovenous shunting within the highly vascular pagetic bone
. Systemic amyloidosis with secondary myocardial infiltration
. Restrictive cardiomyopathy from thoracic cage pagetic deformities
. Aortic root dilation secondary to altered collagen synthesis

Correct Answer & Explanation

. Massive arteriovenous shunting within the highly vascular pagetic bone

Explanation

Paget disease is characterized by hyperactive bone remodeling. The pagetic bone is highly vascular, functioning physiologically like a massive arteriovenous fistula. In severe polyostotic disease, this shunting can lead to high-output heart failure.

Question 786

Topic: 1. General Principles & Basic Science
A 16-year-old boy with severe Hemophilia A presents with a massively swollen, tense, and painful right knee. A diagnostic joint aspiration is considered. Prior to aspiration or any major orthopedic surgical intervention, what percentage of normal Factor VIII activity should be targeted via replacement therapy?
. 10-20%
. 30-40%
. 50-60%
. 80-100%
. >150%

Correct Answer & Explanation

. 80-100%

Explanation

In patients with severe Hemophilia A, performing invasive procedures without adequate factor replacement will lead to uncontrolled hemorrhage. For major orthopedic surgery or deep aspirations, the target Factor VIII activity must be restored to 80-100% of normal.

Question 787

Topic: 1. General Principles & Basic Science

A 66-year-old man undergoes an uncomplicated lumbar laminectomy. On postoperative day 2, he develops exquisite pain, severe erythema, and swelling in his right first metatarsophalangeal joint. Joint aspiration confirms negatively birefringent needle-shaped crystals. Which of his home antihypertensive medications most likely precipitated this event?

. Amlodipine
. Lisinopril
. Hydrochlorothiazide
. Metoprolol
. Losartan

Correct Answer & Explanation

. Hydrochlorothiazide

Explanation

The patient is experiencing an acute gout flare, confirmed by negatively birefringent crystals (monosodium urate). Thiazide diuretics (like hydrochlorothiazide) are a classic trigger for gout as they decrease the renal excretion of uric acid, leading to hyperuricemia.

Question 788

Topic: 1. General Principles & Basic Science

A patient presents with symptoms suggesting bronchiectasis and with abdominal distension, bloating and foul-smelling faeces. What is the most likely diagnosis?

. Carcinoma of the lung
. Cystic fibrosis
. Goodpasture syndrome
. Granulomatosis with polyangiitis
. Pneumococcus pneumonia

Correct Answer & Explanation

. Cystic fibrosis

Explanation

Correct Answer: B- Cystic fibrosis Explanation Cystic fibrosis The United States Cystic Fibrosis Foundation Registry data show that as many as 10% of people with cystic fibrosis are not diagnosed until adult life. The main presentation is with respiratory problems, usually recurrent lower respiratory infections with chronic sputum production. Some patients have been diagnosed in the past with bronchiectasis, atypical asthma, nasal polyposis or allergic bronchopulmonary aspergillosis. A new diagnosis of cystic fibrosis has even been described in adults in their seventh decade. Depletion of sodium, chloride and potassium due to excessive sweating, and secondary renal chloride retention, can result in presentation with dehydration and heat exhaustion in an otherwise apparently completely fit adult. Pancreatic insufficiency can lead to steatorrhoea. The vast majority of patients with cystic fibrosis can be diagnosed by a sweat test. Carcinoma of the lung Carcinoma of the lung is incorrect. Lung carcinoma would typically present with breathlessness, cough, weight loss, chest pain or haemoptysis. The history here suggests bronchiectasis and intestinal malabsorption, which are not typical presenting features of lung malignancy. Goodpasture syndrome Goodpasture syndrome is incorrect. Bronchiectasis and intestinal malabsorption are not associated with Goodpasture syndrome, making this an unlikely diagnosis based on the history provided. Granulomatosis with polyangiitis Granulomatosis with polyangiitis is incorrect. Bronchiectasis and intestinal malabsorption are not associated with granulomatosis with polyangiitis. This diagnoses is unlikely based on this history. Pneumococcus pneumonia Pneumococcus pneumonia is incorrect. There is clearly more going on in this case than an acute pneumonia. The history given is of bronchiectasis, not an uncomplicated pneumonia. Pneumococcal pneumonia is not associated with intestinal malabsorption.

Question 789

Topic: 1. General Principles & Basic Science

A 50-year-old sales representative with a body mass index (BMI) of 34 kg/m2 is referred to the Sleep Clinic because he keeps falling asleep at the wheel. His wife complains that he keeps her awake all night with his snoring. A sleep study confirms moderate sleep apnoea. He has been warned not to return to driving until he has been treated and his symptoms are under control. Which one of the treatments below would be the most appropriate management in this case?

. Continuous positive airway pressure
. Long-term oxygen therapy
. Mandibular advancement splinting
. Pharyngeal wall surgery
. Tracheostomy

Correct Answer & Explanation

. Continuous positive airway pressure

Explanation

Correct Answer: A- Continuous positive airway pressure Explanation Continuous positive airway pressure Obstructive sleep apnoea is caused by loss of upper airway pharyngeal muscle tone during rapid eye movement (REM) sleep, which leads to airway obstruction and consequent apnoeic episodes. It affects 1–2% of middle-aged men. CPAP is an effective treatment for sleep apnoea and should be offered (alongside weight loss and alcohol reduction) to this patient. Long-term oxygen therapy Long-term oxygen therapy is incorrect. Long-term oxygen therapy is really only an adjunct in patients who have co-existent lung conditions. Mandibular advancement splinting Mandibular advancement splinting is incorrect. Many trials have looked at the effectiveness of mandibular advancement splints (a tailor-made mouthpiece which helps to keep the jaw forward and aids upper airway muscle tone when asleep). Mandibular advancement splints are recommended as second-line therapy where patients tolerate them or can be used as a first-line treatment in mild sleep apnoea.Pharyngeal wall surgeryPharyngeal wall surgery is incorrect. Surgery is really a last-ditch attempt to solve the problem. Tracheostomy Tracheostomy is incorrect. Tracheostomy is not used to treat sleep apnoea.

Question 790

Topic: Surgical Anatomy & Approaches

A 56-year-old man with confirmed squamous-cell carcinoma of the right upper lobe of the lung has a normal FEV1 and normal serum biochemistry. Which one of the following investigations is most appropriate to assess operability?

. Bone scan
. Chest computed tomography
. Differential perfusion lung scan
. Measurement of total lung capacity
. Sputum cytology

Correct Answer & Explanation

. Chest computed tomography

Explanation

Correct Answer: B- Chest computed tomography Explanation Chest computed tomography Chest computed tomography is the best method for staging squamous-cell carcinoma of the lung. This would indicate the extent of involvement and would inform the surgical approach. Five-year survival rates are > 75% in stage I disease (no nodes, tumour confined within the visceral pleura) and 55% in stage II disease, which includes resection in patients with ipsilateral peribronchial or hilar node involvement. Bone scan Bone scan is incorrect. A bone scan is not required as there is no clinical, haematological or biochemical evidence of tumour spread to bony sites. Differential perfusion lung scan Differential perfusion lung scan is incorrect. Differential perfusion lung scans are not helpful in staging. Measurement of total lung capacity Measurement of total lung capacity is incorrect. Measurement of total lung capacity is not helpful in staging. Sputum cytology Sputum cytology is incorrect. Sputum cytology is irrelevant, as the diagnosis has already been established.

Question 791

Topic: Infection, Pharmacology & VTE
The anatomical dead space can be used to calculate alveolar ventilation by subtracting it from the tidal volume and multiplying the result by the respiratory rate. What would you expect the normal anatomical dead space to be in a healthy adult male?
. 50 ml
. 150 ml
. 250 ml
. 350 ml
. 450 ml

Correct Answer & Explanation

. 150 ml

Explanation

The normal anatomical dead space is approximately 150 ml. If we take the tidal volume to be about 500 ml and the respiratory rate to be about 15/min, this gives a normal alveolar ventilation of (500 – 150) × 15 = 5250 ml/min. The dead space can be increased in diseases that cause an additional physiological dead space, where parts of the lung do not take part in gas exchange (e.g., pneumonia).

Question 792

Topic: 1. General Principles & Basic Science
A 30-year-old woman with a history of asthma presents for review. She has been taking 400 µg bd of beclometasone and salbutamol as required, which she is using with increasing frequency. What is the best-fit next change to her therapy?
. Add in a long-acting inhaled β2-agonist
. Change her inhaled steroid to fluticasone
. Do nothing
. Trial of montelukast
. Increase her regular repeat prescriptions for salbutamol

Correct Answer & Explanation

. Add in a long-acting inhaled β2-agonist

Explanation

In the event that control of symptoms is not achieved with lower doses of inhaled corticosteroids, addition of a long-acting beta-2 agonist is typically the next step. However, based on the provided options and standard clinical guidelines, adding a long-acting beta-2 agonist is the standard progression. Note: The provided explanation suggests montelukast, but the standard clinical answer for uncontrolled asthma on ICS is a LABA.

Question 793

Topic: 1. General Principles & Basic Science
A 62-year-old man who underwent treatment for tuberculosis 8 years ago presents via his GP complaining of haemoptysis. He also says that over the past 3 months he has had night sweats on a few occasions each week and a chronic cough. He smokes ten cigarettes per day. On examination he is mildly pyrexial (37.4°C) and his blood pressure is 142/89 mmHg. Auscultation of the chest reveals evidence of consolidation affecting the right upper lobe. Investigations show: haemoglobin 11.9 g/dl, white cell count 11.1 × 10^9/l, platelets 190 × 10^9/l, sodium 138 mmol/l, potassium 4.8 mmol/l, creatinine 105 μmol/l. The chest X-ray shows a right upper-lobe cavitating lesion. Aspergillus precipitins are positive. Which of the following is the most likely diagnosis?
. Allergic bronchopulmonary aspergillosis
. Aspergilloma
. Invasive aspergillosis
. Lung cancer
. Reactivated tuberculosis

Correct Answer & Explanation

. Aspergilloma

Explanation

Aspergilloma is known to occur in patients who have had previous cavitating lung disease, such as tuberculosis. It is associated with positive Aspergillus precipitins. Surgical resection is successful as long as the patient’s preoperative lung function is good enough to tolerate the procedure.

Question 794

Topic: Infection, Pharmacology & VTE

A 35-year-old woman with recently diagnosed primary pulmonary hypertension asks you some questions regarding treatment options. She is awaiting transfer to a specialist centre for right heart catheterisation. Which of the following is true?

. She will be able to have children, as long as she is carefully monitored
. She will benefit from taking lisinopril
. She will benefit from taking long-term anticoagulation with warfarin
. She will benefit from taking the oral contraceptive pill
. She will benefit from taking verapamil

Correct Answer & Explanation

. She will benefit from taking long-term anticoagulation with warfarin

Explanation

Correct Answer: C- She will benefit from taking long- term anticoagulation with warfarin Explanation She will benefit from taking long-term anticoagulation with warfarin All patients with primary pulmonary hypertension (PPH, a syndrome of pulmonary hypertension of unknown aetiology) are at risk of thromboembolic disease. Several uncontrolled studies have suggested a survival benefit from anticoagulation, although no randomised controlled trials exist. She will be able to have children, as long as she is carefully monitored She will be able to have children, as long as she is carefully monitored is incorrect. Pregnancy is poorly tolerated in patients with PPH. She will benefit from taking lisinopril She will benefit from taking lisinopril is incorrect. Angiotensin-converting enzyme (ACE) inhibitors have no useful effect in PPH. She will benefit from taking the oral contraceptive pill She will benefit from taking the oral contraceptive pill is incorrect. Oral contraceptives increase the risk of venous thromboembolism, so are not advised; however, contraception is very important in management of PPH due to pregnancy being poorly tolerated. She will benefit from taking verapamil She will benefit from taking verapamil is incorrect. Vasodilator studies are performed in patients with PPH to assess vasodilator response. However, verapamil is not used because it has negatively inotropic effects.

Question 795

Topic: 1. General Principles & Basic Science

A 25-year-old man suffers a spontaneous pneumothorax which is aspirated in the Emergency Department. He has no history of previous chest disease, but is noted to be tall and thin when reviewed in the department, at over 6 feet in height with a BMI of 20. He wants to go travelling, including undertaking a scuba diving course in Thailand. What advice do you give him?

. He can scuba dive after 3 months
. He can scuba dive after 6 months
. He may fly again after one year
. He should never scuba dive again
. He should not fly again but may scuba dive within 4 weeks

Correct Answer & Explanation

. He should never scuba dive again

Explanation

Correct Answer: D- He should never scuba dive again Explanation He should never scuba dive again British Thoracic Society guidelines state that patients who have had spontaneous pneumothorax should avoid scuba diving in the future unless they are treated by bilateral surgical pleurectomy and associated with normal lung function and thoracic CT scan performed after surgery. This is because of the risk of significant expansion of pneumothorax during diving ascent. He can scuba dive after 3 months He can scuba dive after 3 months is incorrect. British Thoracic Society guidelines state that patients who have had spontaneous pneumothorax should avoid scuba diving in the future unless they are treated by bilateral surgical pleurectomy and associated with normal lung function and thoracic CT scan performed after surgery. This is because of the risk of significant expansion of pneumothorax during diving ascent. He can scuba dive after 6 months He can scuba dive after 6 months is incorrect. British Thoracic Society guidelines state that patients who have had spontaneous pneumothorax should avoid scuba diving in the future unless they are treated by bilateral surgical pleurectomy and associated with normal lung function and thoracic CT scan performed after surgery. This is because of the risk of significant expansion of pneumothorax during diving ascent. He may fly again after one year He may fly again after 1 year is incorrect. Medical guidelines suggest that patients may fly as little as 5 days after a treated pneumothorax, as long as a check X-ray proves that air has been successfully reabsorbed and lung expansion has been restored. He should not fly again but may scuba dive within 4 weeks He should not fly again but may scuba dive within 4 weeks is incorrect. Medical guidelines suggest that patients may fly as little as 5 days after a treated pneumothorax, as long as a check X-ray proves that air has been successfully reabsorbed and lung expansion has been restored.

Question 796

Topic: 1. General Principles & Basic Science

A 25-year-old smoker of five cigarettes per day comes to the clinic complaining of recurrent haemoptysis that he has had for the past 2 years. He has been treated for intermittent cough and respiratory infections over the past few years. On examination he looks a little thin but is otherwise well. Respiratory examination raises the suggestion of left upper-lobe collapse. There are no other abnormal findings.

Investigation:

Hb 11.9 g/dl

WCC 5.9 x 109/l

PLT 187 x 109/l

Sodium 141 mmol/l

Potassium 4.2 mmol/l

Creatinine 110 µmol/l The chest X-ray shows left upper-lobe collapse. Which of the following is the most likely diagnosis?

. Bronchial carcinoid
. Bronchial carcinoma
. Bronchiectasis
. Inhaled foreign body
. Left upper-lobe pneumonia

Correct Answer & Explanation

. Bronchial carcinoid

Explanation

Correct Answer: A- Bronchial carcinoid Explanation Bronchial carcinoid Recurrent haemoptysis with segmental collapse is a typical presentation of bronchial carcinoid. The prolonged clinical course, without features of carcinoid syndrome, is typical of a bronchial carcinoid tumour. Bronchial carcinoma Bronchial carcinoma is incorrect. Because this patient is relatively well and has limited chest disease, bronchial carcinoid is much more likely than a carcinoma. Bronchiectasis Bronchiectasis is incorrect. No features suggest that there is active infection, which makes both left upper-lobe pneumonia and bronchiectasis unlikely. Inhaled foreign body Inhaled foreign body is incorrect. An inhaled foreign body would be more likely to lie in the right main bronchus and so does not fit with the clinical scenario here. Left upper-lobe pneumonia Left upper-lobe pneumonia is incorrect. No features suggest that there is active infection, which makes both left upper-lobe pneumonia and bronchiectasis unlikely.

Question 797

Topic: 1. General Principles & Basic Science

A 67-year-old patient with non-small-cell lung cancer complains of difficulty breathing, coughing and swelling of his face, neck, upper body and arms. Superior vena cava syndrome is diagnosed. Which of the following treatments is most likely to be successful in giving early relief of symptoms?

. Anti-hypertensive drugs
. Chemotherapy
. Corticosteroids
. Radiotherapy
. Surgery

Correct Answer & Explanation

. Radiotherapy

Explanation

Correct Answer: D- Radiotherapy Explanation Radiotherapy Superior vena cava syndrome (SVCS) is a collection of symptoms caused by the partial blockage of the vein that carries blood from the head, neck, chest and arms to the heart. Symptoms can include difficulty breathing, coughing and swelling of the face, neck, upper body and arms. In rare instances patients complain of hoarseness, chest pain, difficulty swallowing and coughing up blood.Physical signs of SVCS include swelling of the neck or chest veins, collection of fluid in the face or arms, and rapid breathing. In patients with SVCS secondary to non-small-cell carcinoma of the lung, radiotherapy is the primary treatment of choice. The likelihood of patients benefiting from such therapy is high, but the overall prognosis of these patients is poor. The fractionation schedule for radiotherapy usually includes two to four large initial fractions of 3–4 Gy, followed by daily delivery of conventional fractions of 1.5–2 Gy, up to a total dose of 30–50 Gy. The radiation dose depends on tumour size and radioresponsiveness. The radiation field should include a 2 cm margin around the tumour. Anti- hypertensive drugs Anti-hypertensive drugs is incorrect. Anti-hypertensive therapy will have no influence on the underlying cause of SVCS and is not a key part of immediate management. Chemotherapy Chemotherapy is incorrect. SVC stenting may provide relief of severe symptoms for patients while the histologic diagnosis of the malignancy causing the obstruction is being actively pursued. It may also be indicated in patients in whom chemotherapy or radiation has failed. Corticosteroids Corticosteroids is incorrect. Corticosteroids and diuretics are often used to relieve laryngeal or cerebral oedema related to SVCS, although documentation of their efficacy is questionable. Radiotherapy is the most likely of the options given to be successful in giving early relief of symptoms. Surgery Surgery is incorrect. Surgery for SVCS (surgical bypass) is rarely performed and is generally reserved for patients with advanced intrathoracic disease who have not responded to non-surgical treatments such as radiotherapy, chemotherapy and stenting.

Question 798

Topic: 1. General Principles & Basic Science

A man came in to the Emergency Department with breathlessness and anterior chest pain. Chest X- ray showed a large pneumothorax on the right side, with midline shift away from the side of the pneumothorax. His pulse was 95 bpm and blood pressure was 95/70 mmHg. What should be done next?

. Chest drain insertion
. Chest drain insertion under radiographic control
. Needle aspiration in the mid-axillary line
. Repeat chest X-ray after a few hours
. Wide-bore cannula inserted through second intercostal space mid-clavicular line

Correct Answer & Explanation

. Wide-bore cannula inserted through second intercostal space mid-clavicular line

Explanation

Correct Answer: E- Wide-bore cannula inserted through second intercostal space mid-clavicular line Explanation Wide-bore cannula inserted through second intercostal space mid-clavicular line This man has a large pneumothorax with mediastinal shift and significant symptoms. In the presence of midline shift, the most appropriate initial management would be needle decompression, with placement of an intravenous cannula in the second intercostal space. This should be followed later by placement of a formal chest drain. This is the course of management recommended by British Thoracic Society guidelines. Chest drain insertion Chest drain insertion is incorrect. The midline shift and hypotension indicate tension pneumothorax, which requires immediate needle decompression prior to intercostal drain insertion. Chest drain insertion under radiographic control Chest drain insertion under radiographic control is incorrect. A large pneumothorax should not require radiographic guidance. Nevertheless, this man has signs of tension pneumothorax and requires immediate needle decompression. Needle aspiration in the mid-axillary line Needle aspiration in the mid-axillary line is incorrect. The appropriate site for needle aspiration in tension pneumothorax is the second intercostal space in the mid- clavicular line. Repeat chest X-ray after a few hours Repeat chest X-ray after a few hours is incorrect. This man has evidence of a tension pneumothorax, which is a life-threatening condition and requires urgent intervention with needle decompression.

Question 799

Topic: 1. General Principles & Basic Science
A 33-year-old man presents with increasing symptoms of severe breathlessness on exercise. Up until the last few months he had been holding down a job as a successful salesman. There is a history of smoking 8–10 cigarettes per day. His father died at a young age (under 50) of severe chest disease. Routine blood tests reveal that this patient is mildly jaundiced with a bilirubin of 90 µmol/l; his aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are also outside the normal range. Chest X-ray reveals basal emphysema. Which diagnosis best fits this clinical picture?
. α1-Antitrypsin deficiency
. Chronic obstructive pulmonary disease secondary to excessive smoking
. Cirrhosis
. Gilbert syndrome
. Stress

Correct Answer & Explanation

. α1-Antitrypsin deficiency

Explanation

This man, who is under 40 years of age, presents with breathlessness and with radiographic evidence of emphysema. Hereditary α1-antitrypsin deficiency accounts for around 2% of cases of emphysema. Around 75% of patients with α1-antitrypsin deficiency develop chest pathology and around 15% of patients have associated cirrhosis, the likely diagnosis in this case.

Question 800

Topic: 1. General Principles & Basic Science
You see a 70-year-old woman in the clinic with chronic obstructive pulmonary disease. She currently smokes 10 cigarettes per day and is breathless when walking around her house and garden. She has an FEV1 of 1.2 litres (40% predicted) and an FVC of 2.0 litres (50% predicted). She had minimal bronchodilator reversibility following nebulised salbutamol. Her oxygen saturations are 93% on air and she takes salbutamol only as needed. What would be the next treatment option for her?
. Inhaled steroids as monotherapy
. Long-acting anticholinergic inhaler
. Long-term domiciliary oxygen
. Oral leukotriene-receptor antagonist
. Oral theophylline

Correct Answer & Explanation

. Long-acting anticholinergic inhaler

Explanation

This woman has severe chronic obstructive pulmonary disease (COPD) on the evidence of her spirometry and is now symptomatic. Clearly she needs to stop smoking, but the next treatment would be a long-acting anticholinergic inhaler or high-dose inhaled corticosteroids combined with a long-acting β-2 agonist.

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