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CPD
SELF-ASSESSMENT
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 The following physical finding on examination of the chest is a reliable distinguishing sign related to the abnormality paired with it: A
indrawing of the abdominal wall on inspiration lying supine AND pleurisy
B
whispering pectoriloquy and dullness on percussion at the lung base AND pleural effusion
C
mediastinal shift away from the side where there is dullness to percussion and reduced breath sounds AND pleural thickening
D
reduced tactile vocal fremitus in the right upper lobe area AND collapse of the underlying lobe
E
breathing with pursed lips AND severe airflow obstruction in chronic obstructive pulmonary disease
C
it has been superceded by more sophisticated techniques as the first imaging procedure to undertake
D
it is the imaging procedure of choice in an emergency situation to confirm the diagnosis of acute pulmonary embolism
E
it has an important role in staging an already diagnosed lung cancer
4 Regarding pulmonary function tests and their interpretation it is TRUE that:
2 A 55-year-old woman with persistent cough for the past 6 months was assessed and investigated. Examination, chest X-ray and spirometry were all normal. She had been well in the past apart from mild hypertension at the time of her menopause 2 years ago; this had been treated with lisinopril until her GP stopped it 6 weeks ago wondering if it was a contributory factor. Regarding her condition it is TRUE that: if the ACE inhibitor is the cause of her cough it is A not safe to substitute an angiotensin-II receptor blocker, e.g. losartan
A
reduced perfusion in relation to ventilation occurs naturally at the lung bases
B
spirometry measures the volume and rate of flow of expired air after maximal inhalation rather than that of inspired air
C
an FEV1/FVC (forced expiratory volume in 1 second/ forced vital capacity) ratio greater than normal (>70%) excludes restrictive lung disease
D
limitation of gas exchange across the alveolar membrane is a feature of emphysema
E
following pneumonectomy both the measurements of transfer factor (DCLO and KCO) will both be reduced even if the remaining lung is normal
5 Regarding diagnostic flexible bronchoscopy techniques it is TRUE that: A
where imaging by CXR/CT shows a suspected cancer distal to the reach of the bronchoscope ‘beyond vision’, bronchial washings and brushing yield a result in the majority of cases where tumour is present
B
persistence of cough 6 weeks after withdrawal of an ACE inhibitor strongly suggests that it is NOT the cause
C
randomized trials of acid suppression with a proton pump inhibitor confirm improvement of cough in patients with gastro-oesophageal reflux
B
auto-fluorescence bronchoscopy (AFB) involves giving an intravenous porphyrin sensitizer which is taken up selectively by tumour cells
D
when due to eosinophilic bronchitis airways hyperresponsiveness will be present
C
AFB may reveal abnormal tissue not seen with conventional white light bronchoscopy
E
reduction of cough severity after a 6-week trial of inhaled corticosteroids suggests a diagnosis of cough variant asthma
D
conventional transbronchial needle aspiration (TBNA) biopsy has been superceded on account of its high complication rate of pneumothorax, bleeding and mediastinitis and low diagnostic yield
E
endobronchial ultrasound-TBNA has low sensitivity and specificity in the detection of malignant involvement of lymph nodes adjacent to bronchi
3 Regarding the use of chest radiography (CXR) in managing chest disease it is TRUE that: A
an anterior-posterior projection results in a larger cardiac silhouette compared to a posterior-anterior projection
B
it has a lower radiation burden compared to magnetic resonance imaging
MEDICINE 40:4
For the answers and for more questions and answers, go to:
www.medicinecpd.co.uk
221
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 The following physical finding on examination of the chest is a reliable distinguishing sign related to the abnormality paired with it: A
indrawing of the abdominal wall on inspiration lying supine AND pleurisy
B
whispering pectoriloquy and dullness on percussion at the lung base AND pleural effusion
C
mediastinal shift away from the side where there is dullness to percussion and reduced breath sounds AND pleural thickening
D
reduced tactile vocal fremitus in the right upper lobe area AND collapse of the underlying lobe
E
breathing with pursed lips AND severe airflow obstruction in chronic obstructive pulmonary disease
C
it has been superceded by more sophisticated techniques as the first imaging procedure to undertake
D
it is the imaging procedure of choice in an emergency situation to confirm the diagnosis of acute pulmonary embolism
E
it has an important role in staging an already diagnosed lung cancer
4 Regarding pulmonary function tests and their interpretation it is TRUE that:
2 A 55-year-old woman with persistent cough for the past 6 months was assessed and investigated. Examination, chest X-ray and spirometry were all normal. She had been well in the past apart from mild hypertension at the time of her menopause 2 years ago; this had been treated with lisinopril until her GP stopped it 6 weeks ago wondering if it was a contributory factor. Regarding her condition it is TRUE that: if the ACE inhibitor is the cause of her cough it is A not safe to substitute an angiotensin-II receptor blocker, e.g. losartan
A
reduced perfusion in relation to ventilation occurs naturally at the lung bases
B
spirometry measures the volume and rate of flow of expired air after maximal inhalation rather than that of inspired air
C
an FEV1/FVC (forced expiratory volume in 1 second/ forced vital capacity) ratio greater than normal (>70%) excludes restrictive lung disease
D
limitation of gas exchange across the alveolar membrane is a feature of emphysema
E
following pneumonectomy both the measurements of transfer factor (DCLO and KCO) will both be reduced even if the remaining lung is normal
5 Regarding diagnostic flexible bronchoscopy techniques it is TRUE that: A
where imaging by CXR/CT shows a suspected cancer distal to the reach of the bronchoscope ‘beyond vision’, bronchial washings and brushing yield a result in the majority of cases where tumour is present
B
persistence of cough 6 weeks after withdrawal of an ACE inhibitor strongly suggests that it is NOT the cause
C
randomized trials of acid suppression with a proton pump inhibitor confirm improvement of cough in patients with gastro-oesophageal reflux
B
auto-fluorescence bronchoscopy (AFB) involves giving an intravenous porphyrin sensitizer which is taken up selectively by tumour cells
D
when due to eosinophilic bronchitis airways hyperresponsiveness will be present
C
AFB may reveal abnormal tissue not seen with conventional white light bronchoscopy
E
reduction of cough severity after a 6-week trial of inhaled corticosteroids suggests a diagnosis of cough variant asthma
D
conventional transbronchial needle aspiration (TBNA) biopsy has been superceded on account of its high complication rate of pneumothorax, bleeding and mediastinitis and low diagnostic yield
E
endobronchial ultrasound-TBNA has low sensitivity and specificity in the detection of malignant involvement of lymph nodes adjacent to bronchi
3 Regarding the use of chest radiography (CXR) in managing chest disease it is TRUE that: A
an anterior-posterior projection results in a larger cardiac silhouette compared to a posterior-anterior projection
B
it has a lower radiation burden compared to magnetic resonance imaging
MEDICINE 40:4
For the answers and for more questions and answers, go to:
www.medicinecpd.co.uk
221