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1. General Principles & Basic Science MCQs

Practice Set 43 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 841

Topic: Biology, Genetics & Bone Healing

In the evaluation of bone morphogenetic proteins (BMPs), which BMP has been FDA-approved for use in acute open tibial shaft fractures?

. BMP-2
. BMP-3
. BMP-4
. BMP-6
. BMP-7

Correct Answer & Explanation

. BMP-2

Explanation

Recombinant human BMP-2 (rhBMP-2) is FDA-approved for use as an adjunct in acute, open tibial shaft fractures stabilized with an intramedullary nail. It is also approved for anterior lumbar interbody fusion (ALIF).

Question 842

Topic: 1. General Principles & Basic Science

A 30-year-old man sustains a clean zone II flexor tendon laceration. During the repair, preserving the pulleys is essential to prevent bowstringing. Which two annular pulleys are most critical to preserve?

. A1 and A2
. A2 and A4
. A3 and A5
. A1 and A5
. A2 and A3

Correct Answer & Explanation

. A2 and A4

Explanation

The A2 and A4 pulleys are mechanically the most crucial for preventing bowstringing of the flexor tendons and maintaining full active range of motion of the digit.

Question 843

Topic: Biomechanics & Biomaterials

A 21-year-old athlete undergoes an Achilles tendon repair. Postoperatively, the biomechanical property of the tendon where it deforms gradually over time under a constant load is known as:

. Stress relaxation
. Viscoelasticity
. Creep
. Hysteresis
. Fatigue failure

Correct Answer & Explanation

. Creep

Explanation

Creep refers to the progressive time-dependent deformation of a viscoelastic material when subjected to a constant force. Stress relaxation, conversely, is the decrease in stress over time when the material is held at a constant strain.

Question 844

Topic: Infection, Pharmacology & VTE

A 70-year-old woman undergoes a total hip arthroplasty. Four days postoperatively, she experiences sudden onset pleuritic chest pain and dyspnea. An ECG shows sinus tachycardia and an S1Q3T3 pattern. What is the most appropriate initial diagnostic imaging test for the suspected condition?

. Chest radiograph
. Transthoracic echocardiogram
. CT pulmonary angiography
. Ventilation/perfusion (V/Q) scan
. Venous Doppler ultrasound of the lower extremities

Correct Answer & Explanation

. CT pulmonary angiography

Explanation

The clinical presentation strongly suggests a pulmonary embolism. CT pulmonary angiography is the gold standard and most appropriate initial imaging test to diagnose a PE in this setting.

Question 845

Topic: 1. General Principles & Basic Science

The conversion of 25-hydroxyvitamin D to its most active form, 1,25-dihydroxyvitamin D, primarily occurs in the kidneys. Extrarenal 1-alpha-hydroxylase activity leading to hypercalcemia is classically seen in which of the following pulmonary conditions?

. Asthma
. Sarcoidosis
. Chronic obstructive pulmonary disease
. Idiopathic pulmonary fibrosis
. Primary pulmonary hypertension

Correct Answer & Explanation

. Sarcoidosis

Explanation

Sarcoidosis and other granulomatous diseases can cause hypercalcemia due to ectopic production of 1-alpha-hydroxylase by alveolar macrophages within the granulomas.

Question 846

Topic: Biology, Genetics & Bone Healing

A 65-year-old female with a recent acute osteoporotic vertebral compression fracture is started on Denosumab. What is the specific mechanism of action of this medication?

. Inhibits osteoclast farnesyl pyrophosphate synthase
. Monoclonal antibody against RANKL
. Recombinant parathyroid hormone analog
. Selective estrogen receptor modulator
. Monoclonal antibody against sclerostin

Correct Answer & Explanation

. Monoclonal antibody against RANKL

Explanation

Denosumab is a fully human monoclonal antibody that binds to RANKL (Receptor Activator of Nuclear factor Kappa-B Ligand), preventing it from activating RANK on the surface of osteoclasts, thereby inhibiting osteoclast maturation and survival.

Question 847

Topic: 1. General Principles & Basic Science
A 55-year-old diabetic male presents with rapidly progressive erythema, swelling, and severe pain in his lower leg. Crepitus is absent, but the LRINEC score is 10. Intraoperative findings reveal grayish necrotic fascia and a lack of normal tissue resistance to blunt dissection. Which organism is classically associated with Type II (monomicrobial) necrotizing fasciitis?
. Clostridium perfringens
. Group A Streptococcus (Streptococcus pyogenes)
. Staphylococcus epidermidis
. Pseudomonas aeruginosa
. Bacteroides fragilis

Correct Answer & Explanation

. Group A Streptococcus (Streptococcus pyogenes)

Explanation

Type II necrotizing fasciitis is monomicrobial and is most classically caused by Group A Streptococcus (Streptococcus pyogenes), sometimes in conjunction with Staphylococcus aureus.

Question 848

Topic: Biology, Genetics & Bone Healing
Articular cartilage relies on a specific extracellular matrix composition for its unique biomechanical properties, including load-bearing and low friction. Which collagen type is the predominant structural protein in the extracellular matrix of normal adult hyaline articular cartilage?
. Type I
. Type II
. Type III
. Type IV
. Type X

Correct Answer & Explanation

. Type II

Explanation

Type II collagen accounts for 90-95% of the collagen in normal hyaline articular cartilage. It provides the tensile strength and framework that restrains the swelling pressure of the proteoglycans.

Question 849

Topic: Biomechanics & Biomaterials

An orthopedic surgeon is planning to revise a fractured femoral stem but opts to retain a well-fixed cobalt-chromium modular head. If a new titanium alloy stem is implanted and mated with the existing cobalt-chromium head, what type of corrosion is theoretically most accelerated at this modular junction?

. Crevice corrosion
. Pitting corrosion
. Galvanic corrosion
. Fretting corrosion
. Intergranular corrosion

Correct Answer & Explanation

. Galvanic corrosion

Explanation

Galvanic corrosion occurs when two dissimilar metals (such as titanium and cobalt-chromium) are in physical contact within an electrolytic solution (body fluid), creating a local electrochemical cell that accelerates corrosion of the less noble metal.

Question 850

Topic: Infection, Pharmacology & VTE

A 36-year-old woman with systemic sclerosis develops breathlessness on exertion. Her pulmonary function tests show normal spirometry but a decreased gas transfer factor (Tlco, transfer factor for carbon monoxide) and transfer coefficient (Kco). Which of the following is the most likely explanation for this abnormality?

. Interstitial lung disease
. Pleural involvement
. Pulmonary vascular disease
. Respiratory muscle weakness
. Severe thoracic skin thickening

Correct Answer & Explanation

. Pulmonary vascular disease

Explanation

Correct Answer: C- Pulmonary vascular disease Explanation Pulmonary vascular disease Isolated decreases in gas transfer are typical of pulmonary vascular diseases such as vasculitis and recurrent pulmonary embolism. Interstitial lung disease Interstitial lung disease is incorrect. In interstitial lung disease you would also expect to see decreased lung volumes with a restrictive ratio (> 80%) on spirometry. Pleural involvement Pleural involvement is incorrect. In pleural involvement these investigations would give a picture of extrapulmonary restriction, with a restrictive ratio, lowTlco but normal/high Kco (ie the same cardiac output is going through a smaller alveolar volume). Respiratory muscle weakness Respiratory muscle weakness is incorrect. In respiratory muscle weakness, these investigations would give a picture of extrapulmonary restriction, with a restrictive ratio, low Tlco but normal/high Kco (ie the same cardiac output is going through a smaller alveolar volume). Severe thoracic skin thickening Severe thoracic skin thickening is incorrect. In severe thoracic skin thickening these investigations would give a picture of extrapulmonary restriction, with a restrictive ratio, low Tlco but normal/high Kco (ie the same cardiac output is going through a smaller alveolar volume).

Question 851

Topic: 1. General Principles & Basic Science

A 24-year-old man with HIV and a CD4 lymphocyte count of 150/mm3 has been complaining of gradually worsening dyspnoea associated with a non-productive cough and fever for the last 2 weeks. A chest X-ray shows bilateral diffuse ground-glass opacities. What is the most appropriate therapy?

. Ampicillin
. Cefaclor
. Co-trimoxazole
. Erythromycin
. Glucocorticoids

Correct Answer & Explanation

. Co-trimoxazole

Explanation

Correct Answer: C- Co-trimoxazole Explanation Co-trimoxazole Pneumocystis jirovecii (formerly called P. carinii) pneumonia typically presents with gradually increasing dyspnoea and cough over a period of weeks, but it sometimes presents as an acute illness, with rapid deterioration occurring over a few days. Although the chest X-ray usually shows diffuse ground-glass opacities, which strongly suggests the diagnosis, it sometimes shows nodular opacities, lobar consolidation, or even a normal film. High-dose co-trimoxazole (120 mg/kg daily in divided doses) for 3 weeks is the first-line treatment for Pneumocystispneumonia. Oral therapy is often adequate, but in moderate and severe cases the drug should be given intravenously. Cystic abnormalities and spontaneous pneumothoraces in patients with known or suspected HIV infection are usually caused by Pneumocystis pneumonia. However, Pneumocystis pneumonia is unlikely in a patient who has had a CD4 cell count above 200 cells/mm3 in the preceding 2 months in the absence of other HIV-associated symptoms. Approximately 90% of patients with Pneumocystis pneumonia have an elevated serum lactate dehydrogenase, but this can occur with other pulmonary diseases. All HIV patients with a CD4 count below 200/mm3 should receive effective prophylaxis with low- dose suppressive therapy to prevent Pneumocystis pneumonia. Co-trimoxazole is the preferred agent. Dapsone and inhaled pentamidine are also used. Ampicillin Ampicillin is incorrect. Ampicillin would not be considered as first-line treatment for Pneumocystis pneumonia. Cefaclor Cefaclor is incorrect. Cefaclor would not be considered as first-line treatment for Pneumocystis pneumonia. Erythromycin Erythromycin is incorrect. Erythromycin would not be considered as first-line treatment for Pneumocystis pneumonia. Glucocorticoids Glucocorticoids is incorrect. Glucocorticoids would not be considered as first-line treatment for Pneumocystis pneumonia.

Question 852

Topic: 1. General Principles & Basic Science

Which of the following is the main limiting feature of spiral computed tomographic (CT) scanning for pulmonary embolism?

. High incidence of artefacts due to unavoidable chest movement during respiration
. Long scanning time
. Low sensitivity for detecting pulmonary emboli in main pulmonary arteries
. Low sensitivity for detecting pulmonary emboli in subsegmental pulmonary arteries
. Technical difficulty in passing a catheter into the pulmonary artery

Correct Answer & Explanation

. Low sensitivity for detecting pulmonary emboli in subsegmental pulmonary arteries

Explanation

Correct Answer: D- Low sensitivity for detecting pulmonary emboli in subsegmental pulmonary arteries Explanation Low sensitivity for detecting pulmonary emboli in subsegmental pulmonary arteries CT angiography is less accurate for imaging peripheral emboli in the subsegmental arteries. High incidence of artefacts due to unavoidable chest movement during respiration High incidence of artefacts due to unavoidable chest movement during respiration is incorrect. Spiral CT scanning allows imaging of the entire chest with the use of intravenous contrast enhancement during a single breath-hold. Long scanning time Long scanning time is incorrect. Spiral CT scanning allows imaging of the entire chest with the use of intravenous contrast enhancement during a single breath- hold. Low sensitivity for detecting pulmonary emboli in main pulmonary arteries Low sensitivity for detecting pulmonary emboli in main pulmonary arteries is incorrect. The majority of studies performed to date have shown CT angiography to be an accurate non-invasive tool in the diagnosis of pulmonary embolus at the main, lobar and segmental pulmonary artery levels. The sensitivity and specificity of this technique is generally regarded as being comparable to that of standard pulmonary angiography. Technical factors cause approximately 5–10% of CT angiography to be non-diagnostic, but this is a similar figure to the non-diagnostic rate for standard pulmonary angiography. Technical difficulty in passing a catheter into the pulmonary artery Technical difficulty in passing a catheter into the pulmonary artery is incorrect. Spiral CT uses intravenous contrast via a peripheral vein. No catheters are passed.

Question 853

Topic: 1. General Principles & Basic Science

A 39-year-old woman presented with sudden-onset pleuritic chest pain and shortness of breath. Her blood pressure was 89/50 mmHg, pulse 110 bpm, respiratory rate 30/min. The chest X-ray was normal and arterial blood gases showed Po2 6.74 kPa (the others all normal). Which of the following is the most appropriate initial management step?

. Antibiotics
. Culture
. Intravenous fluids
. Low-molecular-weight heparin
. Oxygen

Correct Answer & Explanation

. Oxygen

Explanation

Correct Answer: E- Oxygen Explanation Oxygen This woman has type I respiratory failure. The normal chest X-ray excludes a pneumothorax. Acute asthma is a possibility, as is infection, but the sudden onset makes pulmonary embolus the most likely diagnosis. The most important initial management steps are oxygen and analgesia. Antibiotics Antibiotics is incorrect. This is a history suggestive of pulmonary embolus. Antibiotics and cultures would not be required empirically here when there is no mention of a fever or other signs of sepsis. Culture Culture is incorrect. This is a history suggestive of pulmonary embolus. Antibiotics and cultures would not be required empirically here when there is no mention of a fever or other signs of sepsis. Intravenous fluids Intravenous fluids is incorrect. Intravenous fluids to maintain the blood pressure and perfusion to organs are necessary, but oxygen therapy is the first treatment required. Low-molecular-weight heparin Low-molecular-weight heparin is incorrect. Most deaths from pulmonary embolus occur within the first few hours after presentation. If the patient does not respond quickly to supportive measures and her systolic blood pressure remains <90 mmHg, then thrombolysis with streptokinase should be considered rather than treatment with low-molecular-weight heparin.

Question 854

Topic: 1. General Principles & Basic Science

A 60-year-old man presents with inspiratory stridor. His chest X-ray reveals compression of the trachea by a retrosternal goitre. Which of the following investigations is the most useful to assess the severity of his airway obstruction?

. Flow–volume loop
. Forced expiratory volume
. Forced vital capacity
. Peak expiratory flow rate
. Residual volume

Correct Answer & Explanation

. Flow–volume loop

Explanation

Correct Answer: A- Flow–volume loop Explanation Flow–volume loop Flow–volume loop examination is the best way to ascertain the effects of extrathoracic tracheal compression. Patients with retrosternal goitre show proportionally more reduction in the inspiratory flow rate than in the expiratory flow rate. The test is useful to differentiate these patients from patients who have severe airflow limitation or intrathoracic large-airway obstruction. Partial thyroidectomy might be considered where there is considerable inspiratory airflow restriction. Forced expiratory volume Forced expiratory volume is incorrect. Flow–volume loop would be a more useful measure to assess the severity of his airway obstruction. Forced vital capacity Forced vital capacity is incorrect. Flow–volume loop would be a more useful measure to assess the severity of his airway obstruction. Peak expiratory flow rate Peak expiratory flow rate is incorrect. Flow–volume loop would be a more useful measure to assess the severity of his airway obstruction. Residual volume Residual volume is incorrect. Flow–volume loop would be a more useful measure to assess the severity of his airway obstruction.

Question 855

Topic: 1. General Principles & Basic Science

A 45-year-old patient presents with shortness of breath. He has been referred by his GP to the renal clinic a few weeks earlier because his creatinine is elevated at 154 micromol/l. His transfer coefficient (Kco) is 160% of predicted. What is the most likely cause?

. Acute exacerbation of asthma
. Interstitial lung disease
. Pneumonia
. Pulmonary embolus
. Pulmonary haemorrhage

Correct Answer & Explanation

. Pulmonary haemorrhage

Explanation

Correct Answer: E- Pulmonary haemorrhage Explanation Pulmonary haemorrhage The transfer coefficient (Kco), which is obtained along with the Tlco, represents the uptake of carbon monoxide per litre of effective alveolar volume (Va):Kco = Tlco/Va To a large extent, the Kco allows correction for any real or effective reduction of alveolar volume, tending to be normal after lung resection, when both Tlco and Va are reduced to roughly the same degree. In some conditions, the Kco can increase. This usually results from an increase in red blood cells in the lungs due to greater blood flow, haemorrhage, or polycythaemia. The Kco is also increased if (at full inflation) the density of pulmonary capillaries per unit alveolar volume is greater than normal. This occurs most commonly in patients with extrapulmonary volume restriction, when the density of pulmonary capillaries is unusually high in relation to the (restricted) lung volume at which the measurement is made. Acute exacerbation of asthma Acute exacerbation of asthma is incorrect. Acute exacerbation of asthma is associated with a reduced transfer factor. Interstitial lung disease Interstitial lung disease is incorrect. Interstitial lung disease is associated with a reduced transfer factor. Pneumonia Pneumonia is incorrect. Pneumonia is associated with a reduced transfer factor. Pulmonary embolus Pulmonary embolus is incorrect. Pulmonary embolus is associated with a reduced transfer factor.

Question 856

Topic: 1. General Principles & Basic Science
At the time of discharge of a 75-year-old non-smoker with known chronic obstructive pulmonary disease, it was decided that, according to the criteria, he should be having long-term oxygen therapy (LTOT) at home. Which of the following options is not considered as a lone criterion for LTOT (where FVC = forced vital capacity; FEV1 = forced expiratory volume in 1 second)?
. Arterial blood gas showing PaO2 7.2 kPa
. Arterial blood gas showing PaO2 7.8 kPa with pulmonary hypertension
. Cor pulmonale
. FEV1 < 1.5 l despite maximal treatment
. FVC < 2 l despite maximal treatment

Correct Answer & Explanation

. FEV1 < 1.5 l despite maximal treatment

Explanation

Cor pulmonale in the absence of hypoxia may have a primary cardiological underlying cause and therefore may not require home oxygen therapy. An MRC trial showed that if PaO2 was maintained > 8.0 kPa for > 15 hours a day, the 3-year survival improved by 50%. UK Department of Health guidelines suggest that long-term oxygen therapy (LTOT) should be provided for: Patients who are clinically stable and non-smokers with PaO2 < 7.3 kPa, FEV1 ≤ 1.5 l and FVC < 2 l despite maximal treatment. These values should be stable on two occasions more than 3 weeks apart. Patients with a PaO2 of 7.3–8.0 kPa and pulmonary hypertension showing right ventricular hypertrophy and a loud S2 and features of cor pulmonale.

Question 857

Topic: Infection, Pharmacology & VTE
You are trying to introduce D-dimer testing into your Emergency Department to reduce the number of patients who are admitted for suspected pulmonary embolus who are heparinized unnecessarily. Which of the following is true regarding the use of D-dimer measurement in the diagnosis of pulmonary embolus (PE)?
. A D-dimer should be performed in patients with a probable massive PE
. A positive result is of more use clinically than a negative result
. It is a useful screening test for PE
. It is likely to be useful in confirming PE for a patient with pleuritic chest pain, in the absence of breathlessness
. It is not useful for confirming PE when the clinical probability is high

Correct Answer & Explanation

. It is not useful for confirming PE when the clinical probability is high

Explanation

Correct Answer: E - It is not useful for confirming PE when the clinical probability is high. D-dimer measurements should not be performed if: 1. An alternative diagnosis is likely, 2. The clinical probability is high, 3. There is a probable massive PE. The D-dimer test misses 10% of patients with pulmonary embolism, while only 30% of patients with positive D-dimer findings have a confirmatory diagnosis of pulmonary embolism (i.e., the negative predictive value is greater than the positive predictive value). D-dimer measurement should not be used as a screening test for PE because D-dimers can be positive in hospitalized patients, obstetric patients, patients with peripheral vascular disease, cancer, inflammatory conditions, and with increasing age.

Question 858

Topic: 1. General Principles & Basic Science

A 45-year-old woman presents with progressive idiopathic pulmonary fibrosis. When performing lung function tests, which of the following parameters would you expect to be normal?

. Carbon monoxide transfer factor
. FEV1/FVC (ratio of the forced expiratory volume in 1 s to the forced vital capacity)
. Forced vital capacity
. Total lung capacity
. Vital capacity

Correct Answer & Explanation

. FEV1/FVC (ratio of the forced expiratory volume in 1 s to the forced vital capacity)

Explanation

Correct Answer: B- FEV1/FVC (ratio of the forced expiratory volume in 1 s to the forced vital capacity) ExplanationFEV1/FVC (ratio of the forced expiratory volume in 1 s to the forced vital capacity) Gas transfer is reduced by both the emphysematous and the fibrosing processes, whereas lung volumes will tend to be increased by emphysema but reduced by fibrosis. These two opposing influences result in relatively normal-sized lungs radiographically and physiologically. Carbon monoxide transfer factor Carbon monoxide transfer factor is incorrect. Carbon monoxide transfer factor (Dlco, a measure of diffusion capacity) is reduced and might be the only abnormality in early disease. In most patients the gas transfer measurement adjusted for alveolar volume (Kco) is also reduced, but less so than Dlco, indicating that the capacity to exchange gas is impaired in a lung that has not been destroyed. If there is significant coexisting emphysema, lung volumes will be well preserved in the face of a disproportionately depressed gas transfer measurement in both Dlco and Kco. Forced vital capacity Forced vital capacity is incorrect. Idiopathic pulmonary fibrosis is characterised by a restrictive ventilatory defect of mechanical function, resulting in reduced pulmonary compliance, vital capacity and total lung capacity. Residual volume is usually decreased, unless there is coincident airflow obstruction due to cigarette smoking, and lung recoil pressure is increased. Total lung capacity Total lung capacity is incorrect. Idiopathic pulmonary fibrosis is characterised by a restrictive ventilatory defect of mechanical function, resulting in reduced pulmonary compliance, vital capacity and total lung capacity. Residual volume is usually decreased, unless there is coincident airflow obstruction due to cigarette smoking, and lung recoil pressure is increased. Vital capacity Vital capacity is incorrect. Idiopathic pulmonary fibrosis is characterised by a restrictive ventilatory defect of mechanical function, resulting in reduced pulmonary compliance, vital capacity and total lung capacity. Residual volume is usually decreased, unless there is coincident airflow obstruction due to cigarette smoking, and lung recoil pressure is increased.

Question 859

Topic: 1. General Principles & Basic Science

A 26-year-old female intravenous drug user presents with a productive cough and fever of 2–3 days’ duration. She had flu last week. Other than a leucocytosis and a high C-reactive protein level, her blood results are normal. A chest X-ray shows bilateral cavitating pneumonia. Which of the following types of pneumonia is she most likely to have?

. Fungal pneumonia
. Klebsiella pneumonia
. Pneumococcal pneumonia
. Pneumocystis jirovecii pneumonia
. Staphylococcal pneumonia

Correct Answer & Explanation

. Staphylococcal pneumonia

Explanation

Correct Answer: E- Staphylococcal pneumonia Explanation Staphylococcal pneumonia In general, staphylococcal pneumonia follows a viral infection – usually with flu-like symptoms. This type of pneumonia is often seen in intravenous drug abusers and in patients with a central line. It is also common in patients with an underlying disease, such as leukaemia, lymphoma or cystic fibrosis. X-rays show bilateral cavitating bronchopneumonia. Pneumothorax, effusion and empyema are common. Intravenous antibiotics should be administered properly. The drug of choice is flucloxacillin. Fungal pneumonia Fungal pneumonia is incorrect. Although the history of intravenous drug use indicates an increased risk of HIV infection and therefore fungal infection (which can caue cavitation), the typical pattern of fungal pneumonia is nodular consolidation. Although fungal pneumonias can cavitate, the lack of history to suggest this patient has a likely diagnosis of HIV, combined with the history of flu, make staphylococcal pneumonia more likely. Klebsiella pneumonia Klebsiella pneumonia is incorrect. Klebsiella spp. can cause cavitating pneumonia, particularly of the upper lobes, but the history of flu and intravenous drug use here makes staphylococcal pneumonia more likely. Pneumococcal pneumonia Pneumococcal pneumonia is incorrect. Streptococcus pneumoniae is the commonest cause of pneumonia in the general population; however, it is not associated with cavitation. Furthermore, the history of flu and intravenous drug use here makes staphylococcal pneumonia more likely. Pneumocystis jirovecii pneumonia Pneumocystis jirovecii pneumonia is incorrect. Although the history of intravenous drug use indicates an increased risk of HIV infection and therefore Pneumocystis jirovecii infection, the case described is not consistent with pneumocystis pneumonia, which does not frequently cause cavitation.

Question 860

Topic: 1. General Principles & Basic Science

A 62-year-old woman is brought to the Emergency Department with symptoms of a respiratory tract infection. According to her relatives she has had a cough for the past week, has become progressively more short of breath, and is now confused, convinced that her husband is trying to poison her. On examination she is pyrexial 38.2 °C, pulse is 95/min, her BP is 100/60 mmHg. There are clear signs of a right lower lobe pneumonia and her respiratory rate is 27/min. She tries to hit you during the consultation. Her urea is 5.2 mmol/l on arterial blood gas. Which of the following according to CURB 65 criteria is associated with a worse prognosis?

. Age 62
. Confusion
. Respiratory rate 27/min
. Systolic blood pressure 100 mmHg
. Urea 5.2 mmol/l

Correct Answer & Explanation

. Confusion

Explanation

Correct Answer: B- Confusion Explanation Confusion The CURB-65 criteria include age > 65, BP < 90 mmHg systolic or 60 mmHg diastolic, respiratory rate > 30/min, urea >7 mmol/l. Patients with 3 or more features are at high risk of death, and thus require urgent hospital admission with IV antibiotic therapy the preferred option. Scores of 1 or 2 are associated with increased risk of death and therefore expert assessment with respect to management is recommended. Age 62 Age 62 is incorrect. Age > 65 is associated with a worse prognosis in line with the CURB-65 criteria. Respiratory rate 27/min Respiratory rate 27/min is incorrect. Respiratory rate > 30/min is associated with a worse prognosis in line with the CURB-65 criteria. Systolic blood pressure 100 mmHg Systolic blood pressure is incorrect. Systolic blood pressure < 90 mmHg is associated with a worse prognosis in line with the CURB-65 criteria.Urea 5.2 mmol/lUrea 5.2 mmol/l is incorrect. Urea > 7 mmol/l is associated with a worse prognosis in line with the CURB-65 criteria.

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