AMC MCQ - Australian Medical Council Multiple Choice Questions Respiratory Medicine Questions and Answers 1 — Questions and Answers
Question 1: A 24-year-old university student presents with a 3-month history of intermittent dry cough and wheezing, particularly after playing soccer. She has no significant past medical history and does not smoke. She uses her friend's salbutamol inhaler once or twice a week with good effect. According to the most recent Australian Asthma Handbook guidelines, which of the following is the most appropriate initial treatment for her mild asthma?
- Regular low-dose inhaled corticosteroid (ICS) with as-needed salbutamol.
- As-needed salbutamol monotherapy.
- As-needed low-dose budesonide-formoterol. (Correct answer)
- A course of oral prednisolone followed by as-needed salbutamol.
Correct answer: As-needed low-dose budesonide-formoterol.
The 2025 Australian Asthma Handbook recommends a significant shift in the management of mild asthma for adults and adolescents. As-needed low-dose budesonide-formoterol is now the preferred initial treatment (anti-inflammatory reliever or AIR therapy). This approach addresses both symptom relief and underlying inflammation, reducing the risk of severe exacerbations compared to using a short-acting beta2 agonist (SABA) like salbutamol alone. SABA-only treatment is no longer recommended due to the risks associated with unmanaged inflammation. Regular low-dose ICS is an alternative but as-needed budesonide-formoterol is the preferred reliever-based approach for initial therapy.
Question 2: A 68-year-old man with a 40-pack-year smoking history presents with progressive dyspnoea and a chronic productive cough. A chest X-ray shows hyperinflation but no focal consolidation. Which of the following investigations is required to confirm a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) according to the COPD-X guidelines?
- High-resolution computed tomography (HRCT) of the chest.
- Post-bronchodilator spirometry. (Correct answer)
- Arterial blood gas (ABG) analysis.
- Six-minute walk test.
Correct answer: Post-bronchodilator spirometry.
The definitive diagnosis of COPD requires the demonstration of persistent airflow limitation. According to the Australian COPD-X guidelines, this is confirmed by post-bronchodilator spirometry showing a fixed ratio of Forced Expiratory Volume in 1 second to Forced Vital Capacity (FEV1/FVC) of less than 0.7. While other tests like HRCT, ABG, and a six-minute walk test are useful for assessing severity, complications, and functional status, they are not the primary diagnostic tool for confirming the presence of COPD.
Question 3: A 22-year-old tall, thin male presents to the emergency department with a sudden onset of right-sided pleuritic chest pain and mild shortness of breath that began 4 hours ago. His vital signs are stable: RR 18/min, SpO2 97% on room air, HR 85/min, BP 125/80 mmHg. A chest X-ray confirms a 4 cm primary spontaneous pneumothorax. He is not in significant distress. What is the most appropriate next step in management?
- Immediate insertion of a large-bore intercostal catheter.
- Urgent video-assisted thoracoscopic surgery (VATS).
- Needle aspiration of the pleural space.
- Observation for 4-6 hours with supplemental oxygen and analgesia. (Correct answer)
Correct answer: Observation for 4-6 hours with supplemental oxygen and analgesia.
For a first presentation of a primary spontaneous pneumothorax (PSP) in a clinically stable patient, current guidelines favour a conservative approach. The size of the pneumothorax is less important than the patient's clinical stability and degree of breathlessness. Since this patient is young, stable, and not in significant distress, a period of observation with supplemental oxygen (to enhance resorption of pleural air) and analgesia is the most appropriate initial step. Invasive procedures like needle aspiration or chest tube insertion are reserved for patients who are clinically unstable, significantly breathless, or fail conservative management.
Question 4: A 55-year-old woman presents to her GP with a 4-day history of cough productive of purulent sputum, fever, and right-sided chest pain. A chest X-ray confirms a right lower lobe consolidation. She has no significant comorbidities, has not been hospitalised recently, and has no known risk factors for atypical pathogens. Which of the following is the most appropriate oral antibiotic for the outpatient management of her non-severe community-acquired pneumonia (CAP)?
- Ciprofloxacin
- Amoxicillin (Correct answer)
- Trimethoprim-sulfamethoxazole
- Doxycycline
Correct answer: Amoxicillin
For non-severe community-acquired pneumonia in an adult without significant comorbidities, Australian therapeutic guidelines recommend amoxicillin as the first-line oral antibiotic. This provides excellent coverage for Streptococcus pneumoniae, the most common causative organism. Doxycycline or a macrolide would be considered if atypical pathogens are suspected or in cases of penicillin allergy. Ciprofloxacin has poor activity against S. pneumoniae and is not recommended for routine CAP management.
Question 5: A 58-year-old male truck driver with a BMI of 34 kg/m² is referred by his wife due to loud snoring, witnessed apnoeas during sleep, and significant daytime somnolence. He has a history of hypertension. His Epworth Sleepiness Scale score is 16/24. Physical examination reveals a crowded oropharynx and a neck circumference of 44 cm. What is the most appropriate next step to confirm the suspected diagnosis?
- Trial of continuous positive airway pressure (CPAP) therapy.
- Referral for a formal in-laboratory or home-based sleep study (polysomnography). (Correct answer)
- Prescription of a mandibular advancement splint.
- Empiric advice on weight loss and sleep hygiene alone.
Correct answer: Referral for a formal in-laboratory or home-based sleep study (polysomnography).
The patient's clinical presentation (obesity, snoring, witnessed apnoeas, daytime sleepiness, hypertension, high Epworth score) is highly suggestive of obstructive sleep apnoea (OSA). A sleep study, either in a laboratory (polysomnography) or a home-based study, is the gold standard investigation required to confirm the diagnosis, determine its severity by measuring the apnoea-hypopnoea index (AHI), and guide subsequent management. While weight loss is important, and CPAP is a primary treatment, a definitive diagnosis must be established first.
Question 6: A 72-year-old man with a known history of severe COPD is brought to the hospital with increased breathlessness, wheeze, and purulent sputum. He appears drowsy. His initial oxygen saturation on room air is 86%. According to the Thoracic Society of Australia and New Zealand (TSANZ) guidelines for acute oxygen use, what is the recommended target oxygen saturation (SpO2) range for this patient?
- 94-98%
- 92-96%
- 88-92% (Correct answer)
- Above 98%
Correct answer: 88-92%
In patients with COPD and other conditions associated with chronic respiratory failure, there is a risk of worsening hypercapnia if excessive oxygen is administered. The Thoracic Society of Australia and New Zealand (TSANZ) guidelines recommend titrating oxygen to a target SpO2 range of 88–92% for these patients. This approach minimises the risk of suppressing the hypoxic respiratory drive and worsening respiratory acidosis, while still providing adequate oxygenation. The higher target of 92-96% is for patients without chronic respiratory failure.
AMC MCQ - Australian Medical Council Multiple Choice Questions Respiratory Medicine Questions and Answers 1
A 24-year-old university student presents with a 3-month history of intermittent dry cough and wheezing, particularly after playing soccer.
She has no significant past medical history and does not smoke.
She uses her friend's salbutamol inhaler once or twice a week with good effect.
According to the most recent Australian Asthma Handbook guidelines, which of the following is the most appropriate initial treatment for her mild asthma?