Pulmonary Evaluation — MCQs
Type 3 respiratory failure occurs due to ?
In the immediate post operative period the common cause of respiratory insufficiency could be because of the following, except -
Among the following conditions, laparoscopy carries the highest risk in patients with:
Which one of the following is not a component of THORACOSCORE?
Emergency tracheostomy is not indicated in
The sleep apnea syndrome is defined as -
A person had an accident and came to casualty with contusion on left precordium. There was decrease in breath sounds on left side, trachea deviated to right side and normal heart sounds. Which of the following is the first line of management?
A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?
Proper evaluation of serum calcium level requires estimation of:
An adult male patient presented in the OPD with complaints of cough and fever for 3 months and haemoptysis off and on. His sputum was positive for AFB. On probing it was found that he had already received treatment with RHZE for 3 weeks from a nearby hospital and discontinued. How will you categorize and manage the patient?
Pulmonary Evaluation Indian Medical PG Practice Questions and MCQs
Question 1: Type 3 respiratory failure occurs due to ?
- A. Post-operative atelectasis (Correct Answer)
- B. Kyphoscoliosis
- C. Flail chest
- D. Pulmonary fibrosis
Explanation: ***Post-operative atelectasis*** - **Type 3 respiratory failure**, also known as **perioperative respiratory failure**, is characterized by hypoxemia occurring typically after surgery. - **Atelectasis**, the collapse of lung tissue, is a common cause of hypoxemia in the post-operative period due to shallow breathing, pain, and anesthesia affecting lung volumes. *Kyphoscoliosis* - This condition leads to a **restrictive lung disease** due to chest wall deformity, causing chronic respiratory failure. [1] - It more typically results in **Type 2 respiratory failure** (hypercapnic) due to impaired ventilation over time. [1] *Flail chest* - Flail chest is a severe chest wall injury causing paradoxical movement, leading to **acute respiratory failure**. - It is often associated with **Type 1 (hypoxemic)** or **Type 2 (hypercapnic)** respiratory failure due to trauma-induced lung injury and impaired mechanics. *Pulmonary fibrosis* - This is a progressive interstitial lung disease causing **restrictive ventilatory defect** and impaired gas exchange. - It leads to chronic **Type 1 respiratory failure** (hypoxemic) as the lung tissue becomes stiff and scarred.
Question 2: In the immediate post operative period the common cause of respiratory insufficiency could be because of the following, except -
- A. Mild Hypovolemia (Correct Answer)
- B. Residual effect of muscle relaxant
- C. Overdose of narcotic analgesic
- D. Myocardial infarction
Explanation: ***Mild Hypovolemia*** - While significant **hypovolemia** can lead to systemic complications, *mild hypovolemia* itself does not directly cause *respiratory insufficiency* in the immediate postoperative period without other complicating factors. - Hypovolemia primarily affects **cardiovascular stability** and tissue perfusion, not directly the mechanics or drive of respiration unless it progresses to **shock**. *Residual effect of muscle relaxant* - **Residual neuromuscular blockade** can lead to *diaphragmatic weakness* and impaired accessory muscle function, causing insufficient ventilation and respiratory distress. - This is a common cause of *postoperative respiratory insufficiency*, especially if reversal agents are inadequate or not administered. *Overdose of narcotic analgesic* - **Narcotic overdose** depresses the *respiratory drive* in the brainstem, leading to decreased respiratory rate and depth, which can result in **hypoventilation** and *respiratory insufficiency*. - This is a significant concern in the immediate postoperative period due to pain management requirements. *Myocardial infarction* - A *myocardial infarction* can lead to **cardiogenic pulmonary edema** due to impaired cardiac function, resulting in fluid accumulation in the lungs and *respiratory insufficiency*. - Postoperative myocardial infarction is a serious complication that directly impacts respiratory function through its effect on **pulmonary hemodynamics**.
Question 3: Among the following conditions, laparoscopy carries the highest risk in patients with:
- A. COPD (Correct Answer)
- B. Diabetes
- C. Hypertension
- D. Obesity
Explanation: ***COPD*** - **COPD** patients have severely compromised respiratory function, and the **pneumoperitoneum** from CO2 insufflation causes **diaphragmatic splinting** and reduced lung compliance, leading to dangerous **CO2 retention** and respiratory failure. - The increased **intra-abdominal pressure** significantly impairs ventilation in patients who already have limited respiratory reserve, making laparoscopy extremely high-risk. *Diabetes* - While diabetes increases risks of **poor wound healing** and **infection**, these complications are not specifically worse with laparoscopy compared to open surgery. - **Perioperative glucose management** can effectively control diabetes-related risks, and laparoscopy may actually offer benefits like smaller incisions. *Hypertension* - **Hypertension** requires careful **blood pressure monitoring** during surgery but doesn't pose risks unique to laparoscopic procedures. - Well-controlled hypertension with appropriate **antihypertensive medications** allows for safe laparoscopic surgery. *Obesity* - **Obesity** makes laparoscopy technically challenging due to **thick abdominal walls** and need for higher insufflation pressures. - However, laparoscopy is often **preferred over open surgery** in obese patients due to reduced wound complications and faster recovery.
Question 4: Which one of the following is not a component of THORACOSCORE?
- A. Performance status
- B. Complication of surgery (Correct Answer)
- C. Priority of surgery
- D. ASA grading
Explanation: ***Complication of surgery*** - THORACOSCORE is a **risk prediction model** for thoracic surgery used to estimate the *probability of mortality and significant morbidity*, but it does not account for the complications of surgery itself as a component. - The score uses **pre-operative patient characteristics** and co-morbidities to predict outcomes, not post-operative events. *Performance status* - **Performance status**, such as the **ECOG scale**, is a crucial component of THORACOSCORE, reflecting the patient's general health and functional capacity prior to surgery. - A lower performance status (indicating poorer functional ability) increases the predicted risk in THORACOSCORE. *Priority of surgery* - The **priority of surgery** (e.g., elective, urgent, emergency) is an important factor in THORACOSCORE, as emergency procedures generally carry a higher risk. - This variable helps to capture the urgency and associated physiological stress on the patient at the time of presentation for surgery. *ASA grading* - The **American Society of Anesthesiologists (ASA) physical status classification system** is a component of THORACOSCORE, assessing the patient's overall health status and anesthetic risk. - A higher ASA grade (indicating more severe systemic disease) contributes to a higher predicted risk in the THORACOSCORE model.
Question 5: Emergency tracheostomy is not indicated in
- A. Bilateral vocal cord paralysis
- B. Foreign body larynx
- C. Acute severe asthma (Correct Answer)
- D. Stridor due to laryngeal growth
Explanation: ***Acute severe asthma*** - While life-threatening, acute severe asthma is primarily managed with **bronchodilators**, **steroids**, and potentially **non-invasive or invasive ventilation**. - **Tracheostomy** is generally reserved for situations involving upper airway obstruction that cannot be managed by other means, which is not the primary issue in asthma. *Bilateral vocal cord paralysis* - This condition can cause severe **upper airway obstruction** due to the adduction of both vocal cords. - In an emergency setting, a tracheostomy may be life-saving to bypass the obstructed larynx. *Foreign body larynx* - An obstructing **foreign body in the larynx** can lead to immediate and complete airway compromise. - If efforts like the **Heimlich maneuver** or direct laryngoscopy with removal fail, an emergency tracheostomy might be necessary. *Stridor due to laryngeal growth* - A laryngeal growth causing **stridor** indicates significant airway narrowing, which can acutely worsen and lead to respiratory distress. - In cases of severe or rapidly progressive obstruction, an **emergency tracheostomy** is needed to secure the airway below the level of the growth.
Question 6: The sleep apnea syndrome is defined as -
- A. Apnea-Hypopnea Index (AHI) ≥ 5/hour (Correct Answer)
- B. Apnea-Hypopnea Index (AHI) ≥ 10/hour
- C. Apnea-Hypopnea Index (AHI) ≥ 30/hour
- D. Apnea-Hypopnea Index (AHI) ≥ 15/hour
Explanation: ***Apnea-Hypopnea Index (AHI) ≥ 5/hour*** - The definition of **sleep apnea syndrome** generally requires an **AHI of 5 or more events per hour**, often accompanied by symptoms like excessive daytime sleepiness or cardiovascular complications [1]. - This threshold identifies individuals with clinically significant sleep-disordered breathing that warrants further evaluation and potential treatment [1]. *Apnea-Hypopnea Index (AHI) ≥ 10/hour* - While an AHI of 10/hour indicates sleep apnea, it is a higher severity criterion and does not represent the **minimum threshold** for defining the syndrome [1]. - Patients with an AHI between 5 and 10 also have sleep apnea and can experience significant symptoms. *Apnea-Hypopnea Index (AHI) ≥ 30/hour* - An AHI of 30/hour or more signifies **severe sleep apnea**, which requires aggressive management. - This is far above the **general diagnostic threshold** for sleep apnea syndrome. *Apnea-Hypopnea Index (AHI) ≥ 15/hour* - An AHI of 15/hour is typically classified as **moderate sleep apnea**. - This value is higher than the **lowest AHI threshold** used to define the presence of sleep apnea syndrome.
Question 7: A person had an accident and came to casualty with contusion on left precordium. There was decrease in breath sounds on left side, trachea deviated to right side and normal heart sounds. Which of the following is the first line of management?
- A. Needle thoracocentesis (Correct Answer)
- B. Chest tube thoracostomy
- C. Pericardiocentesis
- D. Open surgery
Explanation: ***Needle thoracocentesis*** - The constellation of **decreased breath sounds** on the left, **tracheal deviation** to the right, and a history of trauma indicates a **tension pneumothorax**. - **Needle decompression** (thoracocentesis) is the immediate, life-saving intervention for tension pneumothorax to relieve pressure and restore cardiorespiratory function. *Chest tube thoracostomy* - While a **chest tube** (tube thoracostomy) is the definitive treatment for pneumothorax, it is not the *first-line* **emergency management** for a **tension pneumothorax** where immediate decompression is critical. - The delay in setting up and inserting a chest tube can be fatal in a **tension pneumothorax**. *Pericardiocentesis* - **Pericardiocentesis** is indicated for **cardiac tamponade**, which would typically present with muffled heart sounds, hypotension, and distended neck veins, none of which are noted here. - The presence of **tracheal deviation** and **decreased breath sounds** specifically points away from isolated cardiac tamponade. *Open surgery* - **Open surgery (thoracotomy)** is a major surgical procedure reserved for cases like massive hemorrhage or major airway injury, and not the initial rapid management for a tension pneumothorax. - Performing open surgery directly for a tension pneumothorax would be too slow and inappropriate as an initial intervention.
Question 8: A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?
- A. History + c/e + routine labs + V/Q scan
- B. History + c/e + routine labs
- C. History + c/e + routine labs + stress test (Correct Answer)
- D. History + c/e + routine labs + angiography to assess graft patency
Explanation: ***History + c/e + routine labs + stress test*** - A **stress test** is crucial in patients with a history of MI and CABG to assess **myocardial ischemia** and functional capacity, guiding perioperative management. - This evaluation helps determine the patient's **cardiac risk** for non-cardiac surgery and the need for further cardiac optimization. *History + c/e + routine labs + angiography to assess graft patency* - **Coronary angiography** is an invasive procedure and is generally not indicated as a routine preoperative assessment unless there are new, significant cardiac symptoms or signs of **graft dysfunction**. - Assessing graft patency through angiography carries risks and would only be justified if there were strong clinical indications suggesting acute or severe **cardiac ischemia**. *History + c/e + routine labs* - While critical for any preoperative assessment, **routine history, physical examination, and basic laboratory tests** are insufficient for a patient with a significant cardiac history like MI and CABG. - This approach would **underestimate the cardiac risk** and might miss undetected ischemia, leading to adverse perioperative cardiac events. *History + c/e + routine labs + V/Q scan* - A **ventilation-perfusion (V/Q) scan** is primarily used to diagnose **pulmonary embolism** or assess regional lung function. - It does not provide information about myocardial ischemia or cardiac functional capacity, making it **irrelevant** for assessing cardiac risk in this clinical scenario.
Question 9: Proper evaluation of serum calcium level requires estimation of:
- A. Urinary output
- B. Serum albumin (Correct Answer)
- C. Serum phosphorus
- D. Serum potassium
Explanation: ***Serum albumin*** - Approximately **40-45% of total serum calcium** is bound to plasma proteins, primarily **albumin** - Changes in albumin levels (e.g., hypoalbuminemia) significantly affect total calcium measurements - A **correction formula** is essential: Corrected Ca = Measured Ca + 0.8 × (4.0 - measured albumin in g/dL) - This allows accurate estimation of the physiologically active **ionized calcium** level - Without albumin correction, hypocalcemia may be falsely diagnosed in hypoalbuminemic states *Incorrect: Urinary output* - While urinary calcium excretion is important for assessing calcium balance, urinary output itself is not directly used to evaluate serum calcium levels - It reflects renal function and fluid status, not calcium-protein binding *Incorrect: Serum phosphorus* - Serum phosphorus is important in calcium-phosphate homeostasis, particularly in kidney disease or parathyroid disorders - However, phosphorus levels do not directly influence calcium binding to albumin - Not required for correcting total serum calcium measurements *Incorrect: Serum potassium* - Serum potassium is a critical electrolyte but does not impact the interpretation or correction of serum calcium measurements - Potassium plays a role in nerve and muscle function, distinct from calcium homeostasis and protein binding
Question 10: An adult male patient presented in the OPD with complaints of cough and fever for 3 months and haemoptysis off and on. His sputum was positive for AFB. On probing it was found that he had already received treatment with RHZE for 3 weeks from a nearby hospital and discontinued. How will you categorize and manage the patient?
- A. Category I: New case, intensive phase (2RHZE) (Correct Answer)
- B. Category II: Relapse, intensive phase (2RHZES)
- C. Category IV: Multi-drug resistant TB, intensive phase (individualized regimen)
- D. Category II: Treatment after default, intensive phase (2RHZE)
Explanation: ***Category I: New case, intensive phase (2RHZE)*** - This patient meets the criteria for a **newly diagnosed TB case** as they have not received more than 4 weeks of anti-TB treatment previously [1]. - The standard intensive phase regimen for new cases is **2 months of Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (2RHZE)** [1]. *Category II: Relapse, intensive phase (2RHZES)* - **Relapse** applies to patients who were previously treated for TB, declared cured, but present again with active disease. This patient had discontinued treatment after only 3 weeks, so it's not a relapse. - The intensive phase for relapse cases typically includes **Streptomycin (S)** in addition to RHZE, which is not indicated here. *Category IV: Multi-drug resistant TB, intensive phase (individualized regimen)* - **Multi-drug resistant TB (MDR-TB)** is diagnosed when the TB bacilli are resistant to at least both Rifampicin and Isoniazid. While treatment discontinuation increases the risk of resistance [2], it cannot be assumed without **drug susceptibility testing (DST)**. - An individualized regimen is appropriate for MDR-TB, but more information (like DST results) is needed before categorizing it as such. *Category II: Treatment after default, intensive phase (2RHZE)* - **Default** usually refers to patients who interrupted their treatment for 2 consecutive months or more. This patient only took treatment for 3 weeks, which does not constitute a default in the context of requiring a re-treatment regimen. - While this option mentions "intensive phase (2RHZE)", the categorization of "Treatment after default" is inaccurate given the short duration of initial treatment.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free