RESPIRATORY MCQ

1. Asthmatic 48 yrs old, FEV1 1.0L, FVC 2.4 L, predicted 2.6/3.2. Nightly symptoms for a week. Currently not
distressed when examined. On fluticasone 500 mg bd and salmeterol 40 bd. Due for cholecystectomy in 4 weeks.
Her preoperative management would be:

a. admit for iv hydrocortisone

b. prednisone and review in 2/52
c. admit 3/7 prior
d. increase the salmeterol
e. add ipratropium bromide

2. Chest xray, left lung white out and lymph node positive for neuron specific enolase. Bronchoscopy done, left
main tumour. Biopsy = poorly differentiated carcinoma.
Best option for management:

a. chemotherapy
b. radiotherapy
c. palliative
d. surgery
e. bronchoscopic laser

3. Young male, ex-smoker, productive cough. Spirometry FEV1/FVC 1.9/4.6

CT scan = bronchiectasis. Diagnosis is?

Alternative of same Q: A male smoker in his 50's presents with increasing shortness of breath and a productive
cough. A CT chest is shown (consensus is that showed bronchiectatic changes). Spirometry represents obstructive
picture. The most likely diagnosis is?

a. bronchiectasis (ie can you recognise bronchiectasis on CT?)

b. fibrosing alveolitis
c. EAA
d. hypersensitivity pneumonitis
e. ABPA
f. Idiopathic pulmonary fibrosis
g. Asthma

4. Truck driver who keeps falling asleep. BMI 25. Sleep study does show sleep apnoea. Had lots of arousals
(26/hour) and decreased sleep latency. Management:

a. uvuloplasty
b. CPAP
c. sleep hygiene and reassure
d. lose weight
e. methylphenidate.

5. A 30 year old asthmatic male presents with dyspnoea and the following blood gases:
pH 7.20
pCO2 50
pO2 60
HCO3- 18.
He has:

a. Partially compensated metabolic acidosis

b. Partially compensated respiratory acidosis
c. Mixed metabolic and respiratory acidosis
d. Respiratory acidosis
e. Compensated respiratory acidosis
f. FiO2 greater than 0.21
g. Theophylline toxicity

6. A flow volume loop is shown with plateauing of the inspiratory loop only. The most likely cause is:

a. Fixed extra-thoracic obstruction

b. Variable extra-thoracic obstruction
c. Fixed intra-thoracic obstruction
d. Variable intra-thoracic obstruction
e. Small airways narrowing

7. Young male with RLL pneumonia. Sputum shows Gram +ve cocci. Initially responds to treatment with
penicillin, but then worsens over next few days. The most likely explanation for this is:

a. Legionella pneumophila
b. Pleural empyema
c. Resistant pneumococcus
d. Lung abscess

8. A patient with severe COPD enters a respiratory rehabilitation program. This is most likely to improve:

a. ABG's
b. Survival
c. Exercise tolerance
d. Spirometry
e. Diffusion capacity

9. A patient presents with end-stage COPD on maximal bronchodilators and inhaled steroids. He has a raised
JVP and ankle oedema. He complains of increasing shortness of breath. The therapy most likely to improve survival
is:

a. Oral steroids
b. Continuous oxygen therapy
c. IV Ventolin
d. Theophylline
e. Intal

10. A 55 yo obese truck driver presents with increasing daytime somnolence and snoring. A sleep study is
performed and is reported as no apnoeas, no desaturations, but multiple arousals per hour ( ?40). A multiple sleep
latency test shows decreased sleep latency. The most appropriate therapy:

a. Nasal C-PAP
b. Reassurance and advice about sleep hygiene
c. Amphetamine prescription

11. Regarding Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene and glycoprotein:

a. It acts as a sodium channel on the apical membrane

b. At present only 16 alleles of CFTR are recognised
c. Male infertility is caused by reduced sperm motility
d. Stimulates outwardly rectifying chloride channels (ORCs)
e. Abnormal gene is on chromosome 10q

12. Rate of O2 diffusion across lung increased by:

a. anaemia
b. capillary volume
c. inspired O2
d. blood flow
e. acidosis

13. Alveolar macrophages:

a. Constitute 80% of cells in normal BAL

b. Have receptors for C3
c. Have increased activity after viral infections
d. Utilise oxygen free radicals in killing
e. Produce surfactant

14. 35 yo man with asthma. 3/12 Hx of  cough and dyspnoea. CXR shown - left midzone opacity. 
eosinophils. Likely organism:

a. Aspergillus fumigatus
b. Chlamydia psittaci
c. Mycoplasma pneumoniae
d. Mycobacterium avium
e. Nocardia

15. With respect to pleural plaques which of the following statements is INCORRECT?

a. Pleural plaques are discrete raised areas that may be situated in any part of the visceral pleura
b. They are strongly associated with exposure to asbestos although they are also found in subjects from whom no
history of exposure can be elicited.
c. Plaques may occur after slight asbestos exposure
d. The prevalence of plaques correlates with the dose of asbestos inhaled and time after first exposure to asbestos
e. The prevalence of plaques is not related to smoking.

16. With respect to cystic fibrosis transmembrane conductance regulator (CFTR) which of the following statement
is INCORRECT:

a. CFTR functions as a chloride channel regulated by cyclic AMP

b. CFTR functions as a regulator of other ion channels
c. The most frequent mutation, present on approximately 70% of CF chromosomes world-wide, results in the
deletion of a phenylalanine residue at codon 508 (F508).
d. Idiopathic pancreatitis is associated with abnormalities of CFTR that do not cause pulmonary disease
e. The severity and course of the pulmonary disease are predicted solely by the genotype

17. All of the following statements about pleural effusions are true, EXCEPT:

a. 5-10% of malignant pleural effusions are transudates.

b. In malignant pleural effusions, a low pH predicts a shorter survival time.
c. Tuberculous pleural effusions are usually bloody
d. pleural effusion eosinophilia usually indicates a benign process
e. Chylous pleural effusions are most commonly caused by lymphoma

18. Which of the following will most increase arterial O2 delivery?

a. PaO2 from 60 to l00 mmHg

b. Cardiac output from 4 to 4.4 L/min
c. Haemoglobin from 8 to 10
d. Arterial pH from 7.40 to 7.50
e. A, B and C will have the same effect

19. Fatal asthma attacks are best predicted by:

a. onset in childhood
b. increased bronchodilator use
c. smoking
d. multiple hospital admissions
e. atopy

20. During exercise, pulmonary artery pressure is increased in patients with emphysema, in comparison with
controls. What is the mechanism underlying this phenomenon?

a. increased blood viscosity

b. lactic acidosis
c. decreased blood volume
d. decreased pulmonary vascular capacity
e. inability to clear CO2

21. A patient with asthma has the following arterial blood gases:
pH 7.10
pCO2 50
pO2 75
(HCO3 & BE not given)
What best explains this?

a. salicylate toxicity
b. metabolic acidosis
c. partially compensated respiratory acidosis
d. mixed metabolic and respiratory acidosis
e. FiO2 >21%

22. Which of the following is most likely to cause oxygen desaturation in COAD patients during REM sleep?

a. intercostal muscle hypotonia

b. increased PEEP
c. decreased sensitivity to hypoxia and hypercapnia
d. increased nasal obstruction
e. intermittent upper airways obstruction

23. A 70 year old female complains that for the past two years her gentle 72 year old husband wakes her at night
shouting obscenities and has struck her in bed causing bruising. She is not aware whether he snores or has apnoeic
episodes. He is very concerned that he has been having uncharacteristically violent dreams for two years. What is
most likely?

a. He is having typical nocturnal seizures

b. He has a REM sleep behaviour disorder
c. He needs psychiatric evaluation for depression
d. He should be prescribed stimulant medicatiꗬÁGЉ ዄ¿ ዄ Ѐዄ֞
 橢橢ዄዄ Љ 돬 돬 䚗 ዄ ዄ ዄ
] Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ
Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ
ዄ ዄ ዄ $ ዄ Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ
匑 and swelling, and what she describes as “insect bites” over her lower limbs. She has been feeling tired and
generally unwell. On examinations she has diffusely swollen but non-oedematous ankles with apparent synovial
thickening, and several raised indurated purple lesions about 2x2(?) cm over her calves, shins and ankles. RhF, ANA
and ANCA all normal. ESR 24. CXR shows bilateral hilar and paratracheal lymphadenopathy with no parenchymal
changes.
e. ዄዄ ዄዄ ዄዄ ] Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ
Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ
ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ $ ዄ Ǵ ዄ x ዄ ዄ
Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 and swelling, and what she describes as
“insect bites” over her lower limbs. She has been feeling tired and generally unwell. On examinations she has
diffusely swollen but non-oedematous ankles with apparent synovial thickening, and several raised indurated purple
lesions about 2x2(?) cm over her calves, shins and ankles. RhF, ANA and ANCA all normal. ESR 24. CXR shows
bilateral hilar and paratracheal lymphadenopathy with no parenchymal changes.
ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ $ ዄ Ǵ ዄ x ዄ ዄ Ⱥ
ዄ ዄ ዄ ዄ ዄ 匑 and swelling, and what she describes as “insect bites”
over her lower limbs. She has been feeling tired and generally unwell. On examinations she has diffusely swollen but
non-oedematous ankles with apparent synovial thickening, and several raised indurated purple lesions about 2x2(?) cm
over her calves, shins and ankles. RhF, ANA and ANCA all normal. ESR 24. CXR shows bilateral hilar and
paratracheal lymphadenopathy with no parenchymal changes.
ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ $ ዄ Ǵ ዄ x ዄ ዄ Ⱥ
ዄ ዄ ዄ ዄ ዄ 匑 and swelling, and what she describes as “insect bites” over
her lower limbs. She has been feeling tired and generally unwell. On examinations she has diffusely swollen but non-
oedematous ankles with apparent synovial thickening, and several raised indurated purple lesions about 2x2(?) cm over
her calves, shins and ankles. RhF, ANA and ANCA all normal. ESR 24. CXR shows bilateral hilar and paratracheal
lymphadenopathy with no parenchymal changes.
ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ $ ዄ Ǵ ዄ x ዄ ዄ Ⱥ ዄ
ዄ ዄ ዄ ዄ 匑 and swelling, and what she describes as “insect bites” over
her lower limbs. She has been feeling tired and generally unwell. On examinations she has diffusely swollen but non-
oedematous ankles with apparent synovial thickening, and several raised indurated purple lesions about 2x2(?) cm over
her calves, shins and ankles. RhF, ANA and ANCA all normal. ESR 24. CXR shows bilateral hilar and paratracheal
lymphadenopathy with no parenchymal changes.

Which if the following statement is true?

a. biopsy of the skin lesions will avoid the need to further evaluate her hilar lymphadenopathy.
b. she should be reassured that the condition has a favourable prognosis in over 95% of cases
c. mediastinoscopy and lymph node biopsy is essential to rule out TB
d. She is likely to develop granulomatous lesions in the liver.
e. Treatment with corticosteroids at a dose of 0.5 mg/kg should be commenced immediately.

26. With regard to inhaled long acting 2 agonists:

a. Salmeterol xinefoate has a large hydrophilic side chain which facilitates its binding to the cell membrane of
respiratory epithelium
b. Salmeterol xinefoate has a shorter onset of action than Eformoterol fumarate
c. Are ineffective at preventing bronchospasm induced by inhaled allergens
d. Plasma levels are predictive of therapeutic effect
e. Binding to the beta receptor activated adenylate cyclase leading to an increase in intracellular cyclic AMP

27. Each of the following is a risk factor for lung cancer except:

a. Asbestos
b. Radon
c. coal products
d. lead
e. cigarette tar

28. A middle-aged lady has a short history of dry cough and dyspnoea. She was a heavy smoker. CXR is shown
– LLL collapse and left pleural effusion. The next best investigation to make a diagnosis is?

a. CT chest
b. V/Q scan
c. sputum cytology
d. bronchoscopy

29. Regarding allergic rhinitis:

a. Early response is accentuated after repeated allergen challenges

b. Early and late responses are prevented by oral and nasal corticosteroids
c. Treatment of rhinitis has no effect on asthma control
d. Symptoms of allergic rhinitis are less intense in a cold environment
e. nasal steroids are not effective in patients with nasal polyps

30. Regarding the Cystic Fibrosis Transmembrane Conductance Regulator ( CFTR) gene and glycoprotein

a. It acts as a sodium channel on the apical membrane

b. At present only 16 alleles of CFTR are recognised
c. Male infertility is caused by reduced sperm motility
d. Stimulates outwardly-reacting chloride channels (ORCs)
e. Abnormal gene is on chromosome 10q

31. An elderly lady who is and ex-smoker presents for management of dyspnoea. FEV1/FVC is 0.9/2.0, with no
improvement post ventolin. She has worsening RVF. ABGs show pH 7.36, pCO 2 60, pO2 62. She is already on low
dose prednisolone and puffers. The best initial management is:

a. increased steroids
b. change puffers to nebs
c. O2 therapy 19 hours per day
d. GHPS
e. overnight sleep study

32. Concerning lung cancer:

a. In Australia, the incidence in women is falling.

b. The use of chemotherapy in combination with radiotherapy in patients with stage IIIB non-small cell lung
cancer is associated with improved survival.
c. Chemotherapy for metastatic non-small cell lung cancer improves quality of life but not survival.
d. The optimal treatment for limited stage small cell lung cancer is with chemotherapy alone.
e. Paraneoplastic manifestations occur in the majority of patients.

33. A middle-aged lady presents with SOBOE and had a spontaneous PTX six months ago. CXR shows bilateral
hilar adenopathy and diffuse interstitial infiltrates. The next best investigation to establish a diagnosis is?

a. gallium scan
b. serum ACE
c. CT chest
d. open lung biopsy
e. transbronchial biopsy
34. A woman. age 32, presents with increasing dyspnoea on exertion without other significant symptoms. She has
been a smoker of 10-20 cigarettes a day for 13 years. Lung function tests reveal the following:
FEV1 90% pred.
FVC 89% pred.
FEV1/FVC 79%.
FEF 25-75 70% pred.
TLC 102% pred.
FRC 96% pred.
RV 93% pred.
KCO 52% pred. Good single breath estimate of TLC
Hb 142 g/L
FiO2 0.21: pO2 94 mmHg
pCO2 31 mmHg
pH 7.49
BE -2 mmol/L.

The diagnosis most compatible with these findings is:

a. Primary pulmonary hypertension

b. Early emphysema
c. Smoking related small airways disease
d. Asthma
e. Sarcoidosis

35. A 50 year old male who is a heavy smoker is diagnosed with adenocarcinoma after biopsy
ꗬÁGЉ ዄ¿ ዄ Ѐዄ֞
橢橢ዄዄ Љ 돬 돬 䚗 ዄ ዄ ዄ ]
Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø
ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ 勫 勭 勭 勭 勭 勭 勭
$ 徦 Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑
is ventilated in ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the
ventilator is:
Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ
ዄ ዄ 勫 勭 勭 勭 勭 勭 勭 $ 徦 Ǵ ዄ x ዄ ዄ
Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated in ICU. He is on FiO2 0.9, rate 10
b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:
a. Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ
ዄ ዄ ዄ 勫 勭 勭 勭 勭 勭 勭 $ 徦 Ǵ ዄ x ዄ ዄ
Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated in ICU. He is on FiO2 0.9,
rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:
b. , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ 勫 勭 勭
勭 勭 勭 勭 $ 徦 Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ
ዄ ዄ 匑 is ventilated in ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The
best adjustment to the ventilator is:
c. ዄ ዄ ዄ ዄ ዄ 勫 勭 勭 勭 勭 勭 勭 $ 徦 Ǵ ዄ
x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated in ICU. He
is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:
d. 勭 勭 勭 勭 勭 勭 $ 徦 Ǵ ዄ x ዄ ዄ Ⱥ ዄ
ዄ ዄ ዄ ዄ 匑 is ventilated in ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106,
pCO2 65. The best adjustment to the ventilator is:
徦 Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated
in ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:
Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated in
ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:
Ǵ ዄ x ዄ ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 is ventilated in
ICU. He is on FiO2 0.9, rate 10 b/min. pH 7.36, pO2 106, pCO2 65. The best adjustment to the ventilator is:

a.  PEEP
b.  RR
c.  RR
d.  TV
e.  FiO2

37. Increased rate of diffusion of O2 across the alveolar membrane occurs with

a. anaemia
b.  FiO2
c. metabolic acidosis
d.  cardiac output
e.  pulmonary capillary blood flow

38. Small cell lung cancer is associated with

a. hypercalcaemia
b. clubbing
c. ectopic ACTH production
d. Lambert-Eaton myaesthenic syndrome (LEMS)
e. hyponatraemia

39. A man is having chemo for small cell lung Ca. His ECOG score of 1 is least likely to influence:

a. survival
b. quality of life
c. toxicity of chemo
d. the amount/dose of chemo required
e. response to chemo.

40. A young man develops ARDS following trauma. He is intubated but is now breathing spontaneously. He has
a CVL with TPN, and a Swan-Ganz catheter in situ, both for the last 10 days. He is on ceftriaxone for persisting
bilateral pulmonary infiltrates and blood cultures to date have been negative. He becomes very unwell and clinically
septic, with T° 40, BP 70/50. His blood and urine are sent for culture, and his CXR is unchanged. After the initial
resuscitation you should;

a. change all lines and send for culture

b. culture tracheal aspirate
c. perform bronchoscopy +/- transbronchial biopsy
d. echo

41. A middle-aged man presents with sever community-acquired pneumonia. CXR shows LLL, RLL and RML
consolidation. The best treatment would be;

a. erythromycin
b. ceftriaxone and erythromycin
c. cefotaxime
d. penicillin
e. ceftriaxone and gentamicin

42. A steroid-dependent patient with COPD presents with an exacerbation. Gases on room air pH 7.49, pCO 2 50,
pO2 48, HCO3- 32. This is consistent with:

a. metabolic alkalosis secondary to steroids

b. chronic respiratory acidosis with acute hyperventilation
c. salicylate overdose
d. hypercapnia secondary to O2 given in the ambulance
e. acute hypercapnic respiratory failure

43. A middle-aged male presents with bilateral hilar adenopathy and interstitial changes. He has a past history of
PTX. The next best test is;

a. serum ACE
b. gallium scan
c. open lung biopsy
d. transbronchial biopsy

44. The predominant cell responsible for the late phase of asthma is:

a. neutrophils
b. eosinophils
c. basophils
d. monocytes
e. mast cells

45. An HIV+ patient with a CD4+ count of 400 presents with pneumonia. The most likely organism is:

a. TB
b. PCP
c. MAC
d. strep pneumoniae
e. mycoplasma
46. With regard to muscles of respiration, which one of the following statements is most correct?

a. the diaphragm contracts more forcefully in patients with hyperexpanded lungs

b. the abdominal muscles are supplementary muscles of inspiration
c. orthopnoea is experienced in bilateral diaphragm paralysis
d. the scalene muscles do not contribute to normal, quiet inspiration
e. the external intercostal muscles are aligned downwards and backwards

47. In patients with obstructive sleep apnoea, which of the following is correct/

a. systemic hypertension is found in over 8% of cases

b. the usual site of airway obstruction is at the level of the soft palate
c. apnoeas are more likely to occur in stage 3 and stage 4 sleep
d. neck circumference is a better predictor of severity than BMI
e. tracheostomy is the treatment of choice if the SaO 2 dips below 75% on overnight polysomnography

48. A 47 yo ex smoker (35 pack years) presents with a three day history of haemoptysis and SOB. The
expectorated volume of blood is 15-20 mL daily, and it is slightly frothy. He is constitutionally unwell. Examination
reveals him to be mildly febrile (37 5), SOB at rest, and pale. Chest examination is unremarkable apart from a few
crackles at the bases. His CXR reveals patchy consolidation in both lung fields. There is no evidence of hilar
adenopathy or mediastinal widening. Which of the following investigations is most likely to yield the diagnosis/

a. transbronchial biopsy
b. ANCA
c. video-assisted thoracoscopic lung biopsy
d. bronchoscopy
e. anti GBM titre

49. A 26 year old man who has worked as a spray painter for 4 years is referred with a history of intermittent
wheeze, SOB and cough. His symptoms are usually worse at night, but apparently resolve when he is on holidays.
Physical examination and spirometry are normal at the initial visit. Which of the following statements is most correct?

a. CXR will show fleeting linear opacities

b. bronchial reactivity to histamine will be noꗬÁGЉ ዄ¿ ዄ Ѐዄ֞
 橢橢ዄዄ Љ 돬 돬 䚗 ዄ ዄ ዄ
] Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ
Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ 勫 勭 勭 勭
勭 勭 勭 $ 徦 Ǵ 憚 x 匑 ዄ Ⱥ ዄ ዄ ዄ ዄ
ዄ 匑 of daytime hypersomnolence, following an MVA caused by falling asleep at the wheel. On further
questioning his daytime sleepiness has been present for 12-15 years. He has always been obese, but over the last three
years had gained 32 kg in weight. His current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal
measurements are small, and uvula is slightly oedematous. BP 150/100. Which of the following statements is true?
c. ዄ¿ ዄ Ѐዄ֞
 橢橢ዄዄ Љ 돬 돬 䚗 ዄ ዄ ዄ
] Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ
Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ 勫 勭 勭 勭
勭 勭 勭 $ 徦 Ǵ 憚 x 匑 ዄ Ⱥ ዄ ዄ ዄ ዄ
ዄ 匑 of daytime hypersomnolence, following an MVA caused by falling asleep at the wheel. On further
questioning his daytime sleepiness has been present for 12-15 years. He has always been obese, but over the last three
years had gained 32 kg in weight. His current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal
measurements are small, and uvula is slightly oedematous. BP 150/100. Which of the following statements is true?
d. ዄዄ ዄዄ ዄዄ ] Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ Ⱥ
Ɏ Ⱜ Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ
ዄ ዄ 勫 勭 勭 勭 勭 勭 勭 $ 徦 Ǵ 憚 x 匑 ዄ
Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 of daytime hypersomnolence, following an MVA
caused by falling asleep at the wheel. On further questioning his daytime sleepiness has been present for 12-15 years.
He has always been obese, but over the last three years had gained 32 kg in weight. His current BMI is 33.4. O/E
neck circumference 46 cm, oropharyngeal measurements are small, and uvula is slightly oedematous. BP 150/100.
Which of the following statements is true?
e. Ⱜ Ⱜ Ⱜ , ⱘ Ƅ Ɏ 庮 ø ዄ ዄ ዄ ዄ ዄ ዄ ዄ ዄ 勫
勭 勭 勭 勭 勭 勭 $ 徦 Ǵ 憚 x 匑 ዄ Ⱥ ዄ
ዄ ዄ ዄ ዄ 匑 of daytime hypersomnolence, following an MVA caused by falling asleep
at the wheel. On further questioning his daytime sleepiness has been present for 12-15 years. He has always been
obese, but over the last three years had gained 32 kg in weight. His current BMI is 33.4. O/E neck circumference 46
cm, oropharyngeal measurements are small, and uvula is slightly oedematous. BP 150/100. Which of the following
statements is true?
匑 ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 of daytime
hypersomnolence, following an MVA caused by falling asleep at the wheel. On further questioning his daytime
sleepiness has been present for 12-15 years. He has always been obese, but over the last three years had gained 32 kg
in weight. His current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal measurements are small, and
uvula is slightly oedematous. BP 150/100. Which of the following statements is true?
匑 ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 of daytime
hypersomnolence, following an MVA caused by falling asleep at the wheel. On further questioning his daytime
sleepiness has been present for 12-15 years. He has always been obese, but over the last three years had gained 32 kg
in weight. His current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal measurements are small, and
uvula is slightly oedematous. BP 150/100. Which of the following statements is true?
ዄ Ⱥ ዄ ዄ ዄ ዄ ዄ 匑 of daytime hypersomnolence,
following an MVA caused by falling asleep at the wheel. On further questioning his daytime sleepiness has been
present for 12-15 years. He has always been obese, but over the last three years had gained 32 kg in weight. His
current BMI is 33.4. O/E neck circumference 46 cm, oropharyngeal measurements are small, and uvula is slightly
oedematous. BP 150/100. Which of the following statements is true?

a. In a multiple sleep latency test, narcolepsy would be diagnosed if 2 out of 5 naps had a sleep latency of 10
minutes or less
b. If overnight oximetry demonstrates that desaturations are no more than 2% from baseline, then obstructive
sleep apnoea is excluded as a cause of the hypersomnolence
c. Narcolepsy is confirmed if REM sleep occurs in 2 or more naps during a multiple sleep latency test
d. If periodic limb movements are shown to be present on overnight polysomnography, then they are likely to be
the cause of his symptoms
e. a trial of nasal CPAP should be offered, irrespective of the results of polysomnography.

51. During REM sleep all of the following occur except:

a. somnambulism
b. nightmares
c. enuresis
d. penile erection
e. periodic limb movement disorder