Q.1 A 25-year-old male presents with sudden shortness of breath after a blunt chest injury. On examination, there is absent breath sounds on the right side. What is the most likely diagnosis?
Asthma attack
Pneumothorax
Pulmonary embolism
Pneumonia
Explanation - Absent breath sounds following chest trauma strongly suggest pneumothorax due to collapsed lung.
Correct answer is: Pneumothorax
Q.2 A 30-year-old asthmatic patient presents with severe wheezing, inability to speak in sentences, and SpO2 of 85%. What is the immediate management?
Start oral steroids
Administer nebulized salbutamol
Order chest X-ray first
Give antibiotics
Explanation - In acute severe asthma, immediate bronchodilator therapy with nebulized salbutamol is life-saving.
Correct answer is: Administer nebulized salbutamol
Q.3 A patient presents with sudden chest pain and hemoptysis. He has a history of prolonged immobilization after surgery. What is the most likely diagnosis?
Pneumothorax
Pulmonary embolism
COPD exacerbation
Asthma
Explanation - Prolonged immobilization predisposes to deep vein thrombosis, which can embolize to lungs and cause pulmonary embolism.
Correct answer is: Pulmonary embolism
Q.4 Which of the following is the first-line treatment in anaphylaxis with respiratory compromise?
Oxygen therapy
Antihistamines
Adrenaline IM injection
Corticosteroids
Explanation - Adrenaline IM is the first-line life-saving drug in anaphylaxis to reverse airway obstruction and shock.
Correct answer is: Adrenaline IM injection
Q.5 A patient is found to have stridor, drooling of saliva, and difficulty swallowing. What is the most likely diagnosis?
Asthma
Epiglottitis
Bronchiolitis
COPD
Explanation - Stridor with drooling indicates upper airway obstruction due to inflamed swollen epiglottis.
Correct answer is: Epiglottitis
Q.6 Which investigation is most useful in confirming pulmonary embolism?
Chest X-ray
ECG
CT Pulmonary Angiography
Spirometry
Explanation - CT pulmonary angiography is the gold standard imaging technique for diagnosis of pulmonary embolism.
Correct answer is: CT Pulmonary Angiography
Q.7 In tension pneumothorax, what is the immediate emergency intervention?
Chest physiotherapy
Needle decompression
Chest X-ray
IV antibiotics
Explanation - Tension pneumothorax requires urgent needle decompression to relieve intrathoracic pressure.
Correct answer is: Needle decompression
Q.8 Which of the following is a classic triad of tension pneumothorax?
Dyspnea, hyperresonance, tracheal deviation
Cough, fever, chest pain
Wheezing, cough, tachypnea
Hemoptysis, fever, chest tightness
Explanation - Tension pneumothorax presents with dyspnea, hyperresonant chest, and tracheal deviation away from the affected side.
Correct answer is: Dyspnea, hyperresonance, tracheal deviation
Q.9 A child presents with sudden onset barking cough and inspiratory stridor. The most likely diagnosis is:
Asthma
Croup
Epiglottitis
Foreign body aspiration
Explanation - Croup is characterized by barking cough and inspiratory stridor due to laryngeal inflammation.
Correct answer is: Croup
Q.10 Which blood gas finding is concerning in a severe asthma attack?
Respiratory alkalosis
Metabolic alkalosis
Normal CO2 levels
Low oxygen saturation
Explanation - In severe asthma, normal CO2 is concerning as it indicates impending respiratory failure due to fatigue.
Correct answer is: Normal CO2 levels
Q.11 A 45-year-old smoker presents with worsening cough, sputum production, and dyspnea. He is diagnosed with COPD exacerbation. What is the first-line treatment?
Nebulized bronchodilators
IV antibiotics
Oral steroids only
Chest physiotherapy
Explanation - Bronchodilators are first-line in acute COPD exacerbation to relieve airflow obstruction.
Correct answer is: Nebulized bronchodilators
Q.12 What is the initial oxygen therapy target saturation in COPD exacerbation?
100%
Above 95%
88-92%
75-80%
Explanation - COPD patients are given controlled oxygen to maintain SpO2 between 88-92% to prevent CO2 retention.
Correct answer is: 88-92%
Q.13 Which sign suggests complete airway obstruction in choking?
Coughing loudly
Stridor
Inability to speak or cough
Wheezing
Explanation - Complete airway obstruction prevents air exchange, leading to inability to cough or speak.
Correct answer is: Inability to speak or cough
Q.14 The definitive management for severe upper airway obstruction due to foreign body is:
Antibiotics
Chest physiotherapy
Heimlich maneuver
Bronchodilator
Explanation - Heimlich maneuver is the emergency life-saving intervention in complete foreign body airway obstruction.
Correct answer is: Heimlich maneuver
Q.15 A patient with massive hemoptysis is best managed initially by:
Positioning on bleeding side
Immediate intubation
Nebulized bronchodilators
IV antibiotics
Explanation - In massive hemoptysis, patient should be positioned on bleeding side to prevent flooding the healthy lung.
Correct answer is: Positioning on bleeding side
Q.16 In anaphylaxis, which airway complication is most dangerous?
Laryngospasm
Tracheitis
Bronchitis
Pharyngitis
Explanation - Laryngospasm causes life-threatening airway obstruction in anaphylaxis.
Correct answer is: Laryngospasm
Q.17 A wheeze that is present during both inspiration and expiration is known as:
Monophonic wheeze
Stridor
Biphasic wheeze
Crepitations
Explanation - Biphasic wheeze occurs when there is a fixed large airway obstruction.
Correct answer is: Biphasic wheeze
Q.18 Which of the following is NOT a risk factor for pulmonary embolism?
Recent surgery
Prolonged immobilization
Oral contraceptive use
Asthma
Explanation - Asthma is not a risk factor for pulmonary embolism, unlike surgery, immobility, and contraceptive use.
Correct answer is: Asthma
Q.19 Which drug is contraindicated in acute severe asthma?
IV aminophylline
Nebulized salbutamol
Oxygen
Beta-blockers
Explanation - Beta-blockers can worsen bronchospasm and are contraindicated in acute asthma.
Correct answer is: Beta-blockers
Q.20 Which clinical finding differentiates pneumonia from asthma?
Wheeze
Productive cough with fever
Breathlessness
Chest tightness
Explanation - Pneumonia typically presents with productive cough and fever, which are not features of asthma.
Correct answer is: Productive cough with fever
Q.21 In severe asthma attack, which sign indicates impending respiratory arrest?
Increased wheezing
Silent chest
Coughing fits
Sweating
Explanation - A silent chest indicates minimal airflow due to severe obstruction and impending arrest.
Correct answer is: Silent chest
Q.22 Which type of pneumothorax is most life-threatening?
Closed pneumothorax
Open pneumothorax
Tension pneumothorax
Spontaneous pneumothorax
Explanation - Tension pneumothorax rapidly compromises venous return and cardiac output, making it life-threatening.
Correct answer is: Tension pneumothorax
Q.23 What is the role of D-dimer in suspected pulmonary embolism?
Confirms diagnosis
Excludes diagnosis when negative
Assesses severity
Guides treatment
Explanation - A negative D-dimer test can effectively rule out pulmonary embolism in low-risk patients.
Correct answer is: Excludes diagnosis when negative
Q.24 In a patient with COPD exacerbation and rising CO2, the next step after oxygen therapy is:
Nebulized bronchodilators
Oral antibiotics
Non-invasive ventilation
Chest physiotherapy
Explanation - Non-invasive ventilation helps reduce CO2 retention and respiratory muscle fatigue in COPD exacerbation.
Correct answer is: Non-invasive ventilation
Q.25 Which clinical sign is most specific for pulmonary embolism?
Dyspnea
Hemoptysis
Chest pain
Tachycardia
Explanation - Hemoptysis, though uncommon, is a specific feature of pulmonary embolism compared to nonspecific dyspnea and tachycardia.
Correct answer is: Hemoptysis