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WorksheetsGEM Module 2 Mock
Total questions: 100
Worksheet time: 2hrs 40mins
Name
Class
Date
1.
A 45-year-old man presents with a hoarse voice and a weak cough following a left thyroidectomy for a benign nodule. Direct laryngoscopy reveals his left vocal cord lies in a paramedian position. Which nerve is most likely injured?
a)
Left superior laryngeal nerve, external branch
b)
Left superior laryngeal nerve, internal branch
c)
Left recurrent laryngeal nerve
d)
Right recurrent laryngeal nerve
e)
Glossopharyngeal nerve
2.
A 60-year-old woman with maxillary sinusitis complains of a persistent, sharp pain in her upper molar teeth. This referred pain is mediated by which cranial nerve?
a)
V₁ (Ophthalmic division of Trigeminal)
b)
V₂ (Maxillary division of Trigeminal)
c)
V₃ (Mandibular division of Trigeminal)
d)
VII (Facial)
e)
IX (Glossopharyngeal)
3.
During a tonsillectomy, there is concern about damage to a nerve that provides sensory innervation to the oropharynx and the afferent limb of the gag reflex. Which nerve is this?
a)
Trigeminal Nerve (V₃)
b)
Facial Nerve (VII)
c)
Glossopharyngeal Nerve (IX)
d)
Vagus Nerve (X)
e)
Hypoglossal Nerve (XII)
4.
A patient presents with a total unilateral paralysis of the soft palate, loss of the gag reflex on the same side, and hoarseness. This complex of symptoms suggests a lesion at the base of the skull affecting which structure?
a)
Trigeminal Ganglion
b)
Facial Nerve at the stylomastoid foramen
c)
Glossopharyngeal Nerve at the jugular foramen
d)
Vagus Nerve at the jugular foramen
e)
Hypoglossal Nerve at the hypoglossal canal
5.
A 3-year-old child is diagnosed with Otitis Media with Effusion (OME) or "glue ear." Which of the following anatomical factors primarily predisposes young children to this condition?
a)
Short, wide, and more horizontal Eustachian tube
b)
Long, narrow, and vertical Eustachian tube
c)
Highly developed mastoid air cells
d)
Thick, non-compliant tympanic membrane
e)
Abundant ceruminous glands in the external auditory canal
6.
A patient suffering from chronic laryngopharyngeal reflux complains of a persistent sensation of a "lump in the throat" and earache, despite a normal otoscopic examination. The earache is most likely due to referred pain via which nerve?
a)
Auriculotemporal nerve (V₃)
b)
Chorda Tympani (VII)
c)
Tympanic branch of the Glossopharyngeal (IX)
d)
Auricular branch of the Vagus (X)
e)
Great Auricular nerve (C2, C3)
7.
During an emergency cricothyrotomy, the knife is passed through the median cricothyroid ligament. Which cartilages are being separated?
a)
Thyroid and Hyoid
b)
Two laminae of the Thyroid cartilage
c)
Thyroid and Cricoid
d)
Cricoid and first Tracheal ring
e)
Arytenoid and Cricoid
8.
The only intrinsic muscle of the larynx responsible for abducting the vocal folds is the:
a)
Lateral cricoarytenoid
b)
Transverse arytenoid
c)
Oblique arytenoid
d)
Thyroarytenoid
e)
Posterior cricoarytenoid
9.
A patient has a lung tumour located in the superior segment of the right lower lobe. Which bronchopulmonary segment is affected?
a)
S1
b)
S4
c)
S6
d)
S8
e)
S10
10.
When inserting a chest drain in the "safe triangle" (5th intercostal space, mid-axillary line), the needle is inserted just above the rib to avoid damaging which structure running in the costal groove?
a)
Intercostal Artery and Vein
b)
Intercostal Nerve
c)
Internal Thoracic Artery
d)
Lymphatic Trunk
e)
Azygos Vein
11.
A patient with severe emphysema has a PaO₂ of 55 mmHg and a PaCO₂ of 55 mmHg. Which of the following best describes the primary mechanism of hypoxaemia in this patient?
a)
Hypoventilation
b)
Diffusion impairment
c)
Ventilation-Perfusion (V/Q) mismatch
d)
Right-to-left shunt
e)
Low inspired oxygen
12.
The oxyhaemoglobin dissociation curve is shifted to the right by:
a)
Decreased 2,3-BPG
b)
Alkalosis
c)
Hypothermia
d)
Fetal haemoglobin
e)
Increased CO₂ concentration
13.
A patient is admitted with a panic attack and is hyperventilating. An arterial blood gas shows: pH 7.52, PaCO₂ 28 mmHg, HCO₃⁻ 24 mmol/L. What is the primary acid-base disturbance?
a)
Metabolic Acidosis
b)
Metabolic Alkalosis
c)
Respiratory Acidosis
d)
Respiratory Alkalosis
e)
Mixed Acidosis
14.
The majority of carbon dioxide in the blood is transported as:
a)
Dissolved CO₂ in plasma
b)
Carbaminohemoglobin
c)
Bicarbonate ions in plasma
d)
Bicarbonate ions within red blood cells
e)
Carbonic acid
15.
Which of the following receptors is primarily responsible for the long-term regulation of ventilation in response to changes in PaCO₂?
a)
Peripheral chemoreceptors in the carotid bodies
b)
Peripheral chemoreceptors in the aortic bodies
c)
Central chemoreceptors on the ventral surface of the medulla
d)
Irritant receptors in the airways
e)
Stretch receptors in the lung parenchyma
16.
A patient with chronic bronchitis has a PaO₂ of 49 mmHg and a PaCO₂ of 55 mmHg. Which of the following is the most appropriate initial oxygen therapy target?
a)
SpO₂ 88-92%
b)
SpO₂ 94-98%
c)
SpO₂ 99-100%
d)
SpO₂ 80-84%
e)
SpO₂ 85-89%
17.
The Haldane effect describes:
a)
The binding of oxygen to haemoglobin
b)
The increased capacity of deoxygenated blood to carry CO₂
c)
The shift of the oxygen dissociation curve with changes in pH
d)
The diffusion-limited transport of carbon monoxide
e)
The role of 2,3-BPG in oxygen affinity
18.
In a healthy person standing upright, the Ventilation/Perfusion (V/Q) ratio is highest in which part of the lung?
a)
Apex
b)
Middle zone
c)
Base
d)
Posterior segment
e)
Lingula
19.
Which lung volume cannot be measured by simple spirometry?
a)
Tidal Volume (TV)
b)
Inspiratory Reserve Volume (IRV)
c)
Expiratory Reserve Volume (ERV)
d)
Residual Volume (RV)
e)
Forced Vital Capacity (FVC)
20.
A patient with pulmonary fibrosis would be expected to have:
a)
Increased FEV₁/FVC ratio, decreased TLC
b)
Decreased FEV₁/FVC ratio, increased TLC
c)
Normal FEV₁/FVC ratio, increased FRC
d)
Increased FEV₁/FVC ratio, increased RV
e)
Decreased FEV₁/FVC ratio, normal TLC
21.
A 25-year-old man with asthma is prescribed a SABA (e.g., salbutamol) for acute relief. What is its primary mechanism of action?
a)
Muscarinic M₃ receptor antagonism
b)
Phosphodiesterase inhibition
c)
β₂-adrenergic receptor agonism
d)
Leukotriene receptor antagonism
e)
Mast cell stabilisation
22.
According to NICE guidelines, what is the first-line preventer therapy for a patient with asthma who requires more than a SABA alone?
a)
Long-Acting Beta-Agonist (LABA)
b)
Inhaled Corticosteroid (ICS) - low dose
c)
Leukotriene Receptor Antagonist (LTRA)
d)
Long-Acting Muscarinic Antagonist (LAMA)
e)
Oral Theophylline
23.
A patient with COPD is prescribed Tiotropium. Which receptor does this drug antagonise to produce its bronchodilator effect?
a)
β₁-adrenergic receptor
b)
β₂-adrenergic receptor
c)
Muscarinic M₃ receptor
d)
Histamine H₁ receptor
e)
Leukotriene CysLT₁ receptor
24.
A common local side effect of Inhaled Corticosteroids (ICS) is oral candidiasis. Which of the following is the most effective strategy to prevent this?
a)
Switch to a systemic corticosteroid
b)
Use a spacer device and rinse the mouth after inhalation
c)
Take a prophylactic oral antifungal daily
d)
Discontinue the ICS
e)
Increase the dose of the ICS
25.
Montelukast, a drug used in asthma management, works by:
a)
Inhibiting phosphodiesterase
b)
Blocking the CysLT₁ receptor
c)
Stabilising mast cell membranes
d)
Inhibiting 5-lipoxygenase
e)
Antagonising M₃ receptors
26.
Why are Long-Acting Beta-Agonists (LABAs) like Salmeterol never recommended as monotherapy for asthma?
a)
They cause severe tachycardia
b)
They increase the risk of life-threatening asthma attacks and mortality
c)
They are ineffective as bronchodilators
d)
They cause profound hypokalaemia
e)
They lead to rapid tachyphylaxis
27.
Theophylline has a narrow therapeutic window. A toxic level is most likely to cause:
a)
Bradycardia and hypotension
b)
Seizures and cardiac arrhythmias
c)
Acute renal failure
d)
Hepatic encephalopathy
e)
Pulmonary fibrosis
28.
A patient with anaphylaxis is given intramuscular adrenaline. Which of the following effects is NOT a desired action of adrenaline in this context?
a)
Bronchodilation via β₂-receptor agonism
b)
Vasoconstriction via α₁-receptor agonism
c)
Increased heart rate via β₁-receptor agonism
d)
Reduced mast cell degranulation via β₂-receptor agonism
e)
Increased gastric acid secretion via M₃ receptor agonism
29.
Ipratropium bromide is preferred over atropine for inhaled use because:
a)
It is a more potent bronchodilator
b)
It has a longer duration of action
c)
It is a quaternary ammonium compound with poor systemic absorption
d)
It also has strong β-agonist activity
e)
It is resistant to degradation by plasma esterases
30.
Roflumilast, a drug used in severe COPD, is a Phosphodiesterase-4 (PDE4) inhibitor. Its primary beneficial effect is:
a)
Powerful bronchodilation
b)
Reduction of exacerbations in patients with chronic bronchitis
c)
Mucolytic action
d)
Stimulation of the respiratory centre
e)
Antibiotic prophylaxis
31.
A 4-year-old child presents with a "barking" cough, stridor, and mild fever. The most likely causative agent is:
a)
Rhinovirus
b)
Respiratory Syncytial Virus (RSV)
c)
Human Parainfluenza Virus (HPIV)
d)
Adenovirus
e)
Influenza Virus
32.
The histopathological hallmark of Idiopathic Pulmonary Fibrosis (IPF) is:
a)
Caseating granulomas
b)
Neutrophilic infiltrates with microabscesses
c)
Fibroblast foci and honeycombing
d)
Centriacinar emphysema
e)
Hyaline membranes
33.
A 55-year-old heavy smoker is diagnosed with a central lung tumour that is positive for p40 and shows keratin pearls on histology. The most likely diagnosis is:
a)
Small Cell Lung Carcinoma
b)
Lung Adenocarcinoma
c)
Squamous Cell Carcinoma
d)
Large Cell Neuroendocrine Carcinoma
e)
Carcinoid Tumour
34.
Which of the following is a characteristic feature of a malignant neoplasm as opposed to a benign one?
a)
Well-defined borders
b)
Slow growth rate
c)
Local invasion
d)
Well-differentiated cells
e)
Absence of necrosis
35.
A patient from a high-risk region presents with a chronic cough, weight loss, and night sweats. A Ziehl-Neelsen stain of the sputum reveals red, rod-shaped organisms. Which of the following is the gold standard for confirming active, drug-susceptible tuberculosis?
a)
Tuberculin Skin Test (TST)
b)
Interferon-Gamma Release Assay (IGRA)
c)
Sputum culture on Löwenstein-Jensen medium
d)
Chest X-ray showing a Ghon focus
e)
GeneXpert MTB/RIF assay
36.
A construction worker with a long history of asbestos exposure presents with dyspnoea and bilateral lower-zone fibrosis on CT scan. This is most consistent with:
a)
Mesothelioma
b)
Asbestosis
c)
Silicosis
d)
Sarcoidosis
e)
Berylliosis
37.
The pathological stage of a cancer, which is the most important prognostic factor, is based on:
a)
The degree of cellular differentiation
b)
The mitotic rate
c)
The TNM classification (Tumour size, Node involvement, Metastasis)
d)
The presence of specific genetic mutations
e)
The patient's performance status
38.
A 2-year-old child presents with wheezing, tachypnoea, and hyperinflation on chest X-ray during a winter epidemic. The most likely causative agent is:
a)
Streptococcus pneumoniae
b)
Mycoplasma pneumoniae
c)
Respiratory Syncytial Virus (RSV)
d)
Human Metapneumovirus
e)
Influenza A virus
39.
A patient with COPD has a history of frequent exacerbations and a high peripheral blood eosinophil count. Which add-on therapy is most likely to be beneficial in reducing exacerbations?
a)
Long-Acting Muscarinic Antagonist (LAMA)
b)
Inhaled Corticosteroid (ICS)
c)
Roflumilast
d)
Theophylline
e)
Azithromycin
40.
Which of the following is the most common paraneoplastic syndrome associated with Small Cell Lung Carcinoma?
a)
Hypercalcaemia
b)
Syndrome of Inappropriate ADH Secretion (SIADH)
c)
Cushing's Syndrome
d)
Hypertrophic Pulmonary Osteoarthropathy
e)
Lambert-Eaton Myasthenic Syndrome
41.
A competent 65-year-old patient with metastatic lung cancer refuses chemotherapy, stating he has had a "good life" and wishes to avoid the side effects. The oncologist believes the treatment could extend his life by several months. What is the most appropriate next step?
a)
Admit the patient under the Mental Health Act for assessment
b)
Respect the patient's autonomous decision and discuss palliative care options
c)
Ask the family to convince the patient to accept treatment
d)
Start chemotherapy as it is in his best medical interest
e)
Seek a second opinion from another oncologist
42.
During a clinical trial for a new asthma drug, the results are presented as "the new drug reduced exacerbations by 50% compared to placebo (p=0.06)." How should this p-value be interpreted?
a)
The result is highly statistically significant.
b)
The result is not statistically significant at the conventional 5% level.
c)
The new drug is 94% effective.
d)
There is a 6% chance the null hypothesis is true.
e)
The study was underpowered.
43.
A 70-year-old man with severe COPD is admitted with type 2 respiratory failure. He is confused and unable to give a history. The team decides to start non-invasive ventilation (NIV). In this situation, what legal justification is used for providing this treatment?
a)
The patient has given a valid advance directive.
b)
The treatment is being given under the principle of implied consent.
c)
The team is acting in the patient's best interests.
d)
The Mental Capacity Act requires treatment for all incapacitated patients.
e)
The family has provided consent.
44.
A junior doctor is reviewing a chest X-ray. They see a clear pleural edge with no lung markings beyond it. The trachea is deviated to the opposite side. What is the most likely diagnosis?
a)
Tension pneumothorax
b)
Simple pneumothorax
c)
Pleural effusion
d)
Lung consolidation
e)
Atelectasis
45.
A 40-year-old woman presents with sudden onset shortness of breath and pleuritic chest pain. She has just returned from a long-haul flight. Her Wells Score for PE is 6 (high probability). What is the most appropriate initial imaging investigation?
a)
Chest X-ray
b)
Ventilation-Perfusion (V/Q) Scan
c)
CT Pulmonary Angiogram (CTPA)
d)
Doppler Ultrasound of the legs
e)
D-dimer blood test
46.
The "Ghon complex" in primary tuberculosis consists of:
a)
A cavitary lesion in the upper lobe
b)
A subpleural granuloma and involved hilar lymph nodes
c)
Widespread miliary nodules throughout the lung
d)
A pleural effusion and empyema
e)
A calcified mediastinal mass
47.
A 30-year-old man with asthma is prescribed a SABA and a low-dose ICS. At his review, his peak flow diary shows significant morning dips. He admits he often forgets to take his evening dose of his preventer inhaler. According to the WHO dimensions of adherence, this is best categorised as a problem related to:
a)
The health system
b)
The therapy itself
c)
The patient's condition
d)
Socioeconomic factors
e)
The patient
48.
A 60-year-old patient with a 50-pack-year smoking history undergoes low-dose CT screening as part of a research trial. A 8mm spiculated nodule is found in the right upper lobe. The next most appropriate step is:
a)
Immediate surgical resection
b)
Repeat CT scan in 1 year
c)
Referral for PET-CT and/or biopsy
d)
Treat with broad-spectrum antibiotics
e)
Reassure the patient it is benign
49.
The pathological process in COPD that is primarily responsible for the destruction of alveolar walls and loss of elastic recoil is:
a)
Mucus gland hyperplasia
b)
Smooth muscle hypertrophy
c)
Protease-antiprotease imbalance
d)
Airway fibrosis
e)
Goblet cell metaplasia
50.
A 5-year-old child presents with a runny nose, low-grade fever, and a barking cough that is worse at night. On examination, she has mild stridor but is not cyanosed and is playing with toys. What is the most appropriate initial management?
a)
Immediate intubation
b)
Oral corticosteroids and supportive care
c)
Inhaled bronchodilators
d)
Intravenous antibiotics
e)
Chest physiotherapy
51.
Which cranial nerve provides motor innervation to the stylopharyngeus muscle?
a)
Vagus (X)
b)
Glossopharyngeal (IX)
c)
Facial (VII)
d)
Trigeminal (V)
e)
Hypoglossal (XII)
52.
A shift of the oxygen-haemoglobin dissociation curve to the left would be expected in:
a)
Hyperthermia
b)
Acidosis
c)
Increased 2,3-BPG
d)
Carbon monoxide poisoning
e)
Anaemia
53.
A patient with asthma is started on a LABA/ICS combination inhaler. Which of the following is a recognised systemic side effect of the ICS component?
a)
Tachycardia
b)
Adrenal suppression
c)
Urinary retention
d)
Dry mouth
e)
Tachyphylaxis
54.
The most common cause of community-acquired pneumonia in healthy adults is:
a)
Haemophilus influenzae
b)
Mycoplasma pneumoniae
c)
Streptococcus pneumoniae
d)
Staphylococcus aureus
e)
Legionella pneumophila
55.
A 75-year-old man with severe IPF is admitted with a life-threatening pneumonia. He has an advance decision refusing intubation and mechanical ventilation. His condition deteriorates and he loses capacity. The ICU team should:
a)
Intubate him as it is an emergency
b)
Respect the advance decision and provide non-escalated care
c)
Ask the family for consent to intubate
d)
Seek a court order to treat
e)
Provide NIV as a compromise
56.
The arterial blood gas: pH 7.28, PaCO₂ 60 mmHg, HCO₃⁻ 32 mmol/L indicates:
a)
Acute respiratory acidosis
b)
Chronic respiratory acidosis
c)
Acute metabolic acidosis
d)
Chronic metabolic alkalosis
e)
Mixed acidosis
57.
Omalizumab is a monoclonal antibody used in severe allergic asthma. Its mechanism of action is:
a)
Anti-IgE
b)
Anti-IL-5
c)
Anti-TNF alpha
d)
Anti-CD20
e)
Anti-IL-17
58.
A patient presents with haemoptysis, weight loss, and clubbing. A chest X-ray shows a large central mass with collapse of the right upper lobe. The "Golden S-sign" is likely present. This sign is characteristic of:
a)
Lobar pneumonia
b)
A large pleural effusion
c)
A central tumour causing lobar collapse
d)
Tension pneumothorax
e)
Pulmonary oedema
59.
A patient with a history of TB presents with haemoptysis. A CT scan shows a cavity with a calcified mass inside. This is most suggestive of:
a)
Reactivation TB
b)
A Rasmussen aneurysm
c)
An aspergilloma
d)
Bronchiectasis
e)
Lung carcinoma
60.
The most common primary malignant lung tumour in non-smokers is:
a)
Squamous cell carcinoma
b)
Small cell carcinoma
c)
Large cell carcinoma
d)
Adenocarcinoma
e)
Carcinoid tumour
61.
Which of the following is a direct stimulant of the central chemoreceptors?
a)
Decreased PaO₂
b)
Increased PaO₂
c)
Decreased pH of the CSF
d)
Increased pH of the blood
e)
Decreased HCO₃⁻ in the blood
62.
A patient with COPD develops acute worsening of dyspnoea and a purulent cough. The most appropriate first-line antibiotic according to UK guidelines is:
a)
Co-amoxiclav
b)
Doxycycline
c)
Amoxicillin
d)
Clarithromycin
e)
Levofloxacin
63.
A 25-year-old presents with unilateral wheezing. Bronchoscopy reveals a smooth, rounded tumour obstructing the left main bronchus. Biopsy shows nests of small, uniform cells with salt-and-pepper chromatin. This is most likely a:
a)
Small cell carcinoma
b)
Carcinoid tumour
c)
Squamous cell carcinoma
d)
Mucoepidermoid carcinoma
e)
Hamartoma
64.
The FEV₁/FVC ratio is used to distinguish between obstructive and restrictive lung diseases. A ratio of less than 0.7 typically indicates:
a)
Restrictive lung disease
b)
Obstructive lung disease
c)
Normal lung function
d)
Neuromuscular weakness
e)
Chest wall deformity
65.
A patient's sputum sample shows gram-positive, lancet-shaped diplococci. This is characteristic of:
a)
Staphylococcus aureus
b)
Klebsiella pneumoniae
c)
Streptococcus pneumoniae
d)
Pseudomonas aeruginosa
e)
Mycobacterium tuberculosis
66.
In the UK, the legal framework for assessing a patient's capacity to make a specific decision is provided by the:
a)
Human Rights Act 1998
b)
Mental Health Act 1983
c)
Mental Capacity Act 2005
d)
Equality Act 2010
e)
NHS Constitution
67.
A patient with a large pleural effusion would be expected to have:
a)
Hyperresonance on percussion
b)
Increased vocal fremitus
c)
Stony dullness on percussion
d)
Pulsus paradoxus
e)
Wheeze on auscultation
68.
A patient with asthma is prescribed a high-dose ICS. Which of the following is a recommended monitoring parameter?
a)
Serum potassium
b)
Liver function tests
c)
Bone mineral density
d)
Thyroid function tests
e)
Full blood count
69.
A 50-year-old miner presents with progressive dyspnoea and nodules on CXR. The pathology shows fibrotic nodules with a characteristic "onion-skin" pattern of collagen. This is diagnostic of:
a)
Asbestosis
b)
Silicosis
c)
Berylliosis
d)
Coal Worker's Pneumoconiosis
e)
Siderosis
70.
The most common cause of a pleural effusion in the UK is:
a)
Tuberculosis
b)
Malignancy
c)
Heart Failure
d)
Pneumonia
e)
Pulmonary Embolism
71.
Which of the following is a feature of a typical pneumonia rather than an atypical pneumonia?
a)
Gradual onset
b)
Productive cough with purulent sputum
c)
Extrapulmonary symptoms prominent
d)
Patchy infiltrates on CXR
e)
Causative agent is Mycoplasma pneumoniae
72.
A patient with bronchiectasis has daily production of large volumes of green sputum. The most likely colonising organism is:
a)
Streptococcus pneumoniae
b)
Haemophilus influenzae
c)
Pseudomonas aeruginosa
d)
Mycobacterium avium-intracellulare
e)
Staphylococcus aureus
73.
The primary muscle of inspiration is the:
a)
Internal intercostals
b)
External intercostals
c)
Diaphragm
d)
Scalenes
e)
Sternocleidomastoid
74.
A 60-year-old with COPD has a PaO₂ of 7.0 kPa on room air. According to the MRC trial, he should be assessed for:
a)
No treatment needed
b)
Long-term oxygen therapy (LTOT)
c)
Nocturnal NIV
d)
Lung volume reduction surgery
e)
Palliative care referral
75.
A 3-year-old child inhales a peanut. It is most likely to lodge in the:
a)
Left main bronchus
b)
Right main bronchus
c)
Trachea
d)
Larynx
e)
Oesophagus
76.
A patient with suspected lung cancer has a biopsy showing cells positive for TTF-1. This finding is most characteristic of:
a)
Squamous cell carcinoma
b)
Small cell carcinoma
c)
Adenocarcinoma
d)
Mesothelioma
e)
Large cell carcinoma
77.
The most common site for distant metastasis from lung cancer is the:
a)
Liver
b)
Brain
c)
Bone
d)
Adrenal glands
e)
Skin
78.
A patient with asthma is prescribed a SABA via a Metered-Dose Inhaler (MDI). They are struggling to coordinate inhalation with actuation. The best solution is to:
a)
Switch to a dry powder inhaler (DPI)
b)
Prescribe oral theophylline instead
c)
Add a spacer device to the MDI
d)
Refer for nebuliser therapy
e)
Double the dose of the SABA
79.
A patient with a past medical history of sarcoidosis presents with hypercalcaemia. The mechanism is increased activity of:
a)
Parathyroid hormone (PTH)
b)
1-alpha-hydroxylase in macrophages
c)
Osteoclasts due to bone metastases
d)
Vitamin D receptors in the gut
e)
Calcitonin
80.
A 70-year-old man with severe COPD and cor pulmonale is started on home oxygen. Which of the following is a recognised complication of oxygen therapy in this population?
a)
Hyperkalaemia
b)
Respiratory acidosis
c)
Metabolic alkalosis
d)
Hypoglycaemia
e)
Sinus tachycardia
81.
The blood supply to the main bronchi is derived from the:
a)
Pulmonary arteries
b)
Bronchial arteries
c)
Coronary arteries
d)
Internal thoracic arteries
e)
Aorta directly
82.
A patient with a Pancoast tumour may present with:
a)
Hoarseness
b)
Horner's syndrome
c)
Superior vena cava obstruction
d)
Pericardial effusion
e)
Dysphagia
83.
Which of the following is a key mediator of bronchoconstriction in asthma that is targeted by leukotriene receptor antagonists?
a)
Histamine
b)
Prostaglandin D₂
c)
Tryptase
d)
Leukotriene C₄
e)
Bradykinin
84.
A 45-year-old non-smoker presents with bilateral hilar lymphadenopathy on CXR and erythema nodosum. The most likely diagnosis is:
a)
Tuberculosis
b)
Lymphoma
c)
Sarcoidosis
d)
Silicosis
e)
Coccidioidomycosis
85.
In the UK, the legal duty of candour requires that when a patient suffers moderate or severe harm, the healthcare provider must:
a)
Apologise and offer compensation
b)
Inform the patient, provide an apology, and offer a meeting to discuss
c)
Report the incident to the GMC
d)
Disclose the incident only if the patient asks
e)
Settle any potential claim quickly
86.
A patient with a pleural effusion has an aspirate with a protein content of 45 g/L and LDH of 350 IU/L (serum LDH 200 IU/L). This effusion is best classified as:
a)
A transudate
b)
An exudate
c)
A chylous effusion
d)
An empyema
e)
A haemothorax
87.
A patient with cystic fibrosis is chronically colonised with Pseudomonas aeruginosa. The antibiotic that is often given via nebuliser for its anti-pseudomonal effect is:
a)
Tobramycin
b)
Vancomycin
c)
Ceftazidime
d)
Meropenem
e)
Ciprofloxacin
88.
A 55-year-old woman presents with progressive dyspnoea and a dry cough. High-resolution CT shows ground-glass opacities and traction bronchiectasis predominantly in the subpleural regions. The most likely diagnosis is:
a)
Chronic obstructive pulmonary disease (COPD)
b)
Idiopathic Pulmonary Fibrosis (IPF)
c)
Sarcoidosis
d)
Non-specific Interstitial Pneumonia (NSIP)
e)
Desquamative Interstitial Pneumonia (DIP)
89.
The most common organism causing ventilator-associated pneumonia (VAP) is:
a)
Streptococcus pneumoniae
b)
Haemophilus influenzae
c)
Pseudomonas aeruginosa
d)
Staphylococcus aureus (including MRSA)
e)
Klebsiella pneumoniae
90.
A 30-year-old man is brought to A&E with severe asthma unresponsive to nebulisers. He is agitated, tachycardic, and has a silent chest on auscultation. The most urgent next step is:
a)
Arterial blood gas
b)
Chest X-ray
c)
Intravenous magnesium sulphate
d)
Intravenous aminophylline
e)
Immediate anaesthetic review for intubation
91.
A patient with a history of breast cancer presents with progressive dyspnoea. CT scan shows multiple, randomly distributed nodules of varying sizes throughout both lung fields. This pattern of metastasis is best described as:
a)
Lymphangitis carcinomatosa
b)
Miliary
c)
Cavitating
d)
Cannonball
e)
Endobronchial
92.
The most common cause of upper airway obstruction in an unconscious patient is:
a)
Foreign body
b)
Laryngeal oedema
c)
Tumour
d)
The tongue falling back
e)
Bilateral vocal cord paralysis
93.
A 20-year-old presents with fever, cough, and myalgia. CXR shows bilateral patchy infiltrates. Cold agglutinins are positive. The most likely causative organism is:
a)
Streptococcus pneumoniae
b)
Mycoplasma pneumoniae
c)
Chlamydia pneumoniae
d)
Coxiella burnetii
e)
Legionella pneumophila
94.
In the management of stable COPD, which of the following has been shown to improve survival?
a)
Long-Acting Beta-Agonist (LABA)
b)
Inhaled Corticosteroid (ICS)
c)
Long-Acting Muscarinic Antagonist (LAMA)
d)
Long-term oxygen therapy (LTOT)
e)
Roflumilast
95.
A 65-year-old man with lung cancer develops weakness of the proximal muscles of the limbs and absent reflexes. This is most suggestive of:
a)
Myasthenia Gravis
b)
Lambert-Eaton Myasthenic Syndrome (LEMS)
c)
Polymyositis
d)
Cerebellar metastasis
e)
Spinal cord compression
96.
The sound produced by rubbing the visceral and parietal pleura together in pleurisy is called a:
a)
Wheeze
b)
Rhonchus
c)
Stridor
d)
Pleural rub
e)
Crepitation
97.
A patient with a history of DVT presents with acute dyspnoea and is diagnosed with a massive PE. Thrombolysis is contraindicated due to a recent stroke. An appropriate alternative intervention is:
a)
Surgical embolectomy
b)
Inferior vena cava filter
c)
Catheter-directed thrombectomy
d)
Increasing the dose of heparin
e)
Observation alone
98.
A 40-year-old HIV-positive patient presents with dyspnoea and a dry cough. CXR shows diffuse interstitial infiltrates. A bronchoalveolar lavage shows cysts on silver stain. The causative organism is:
a)
Mycobacterium avium-intracellulare
b)
Cryptococcus neoformans
c)
Pneumocystis jirovecii
d)
Aspergillus fumigatus
e)
Cytomegalovirus
99.
A 50-year-old smoker with chronic bronchitis develops increasing oedema and cyanosis. The most likely underlying mechanism for these new signs is:
a)
Left ventricular failure
b)
Development of cor pulmonale
c)
Nephrotic syndrome
d)
Liver cirrhosis
e)
Hypothyroidism
100.
When discussing a new lung cancer diagnosis with a patient, the doctor should primarily aim to:
a)
Ensure the patient understands the poor prognosis
b)
Provide all information in a single, detailed session
c)
Check for understanding and respond to the patient's concerns
d)
Focus exclusively on the treatment plan
e)
Use complex medical terminology to be precise
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