Respiratory Practice Questions
Respiratory medicine covers asthma diagnosis, controller therapy, status asthmaticus, and bronchoprovocation testing, which is high-yield on the MCCQE, USMLE Step 2 CK, and PLAB. These four sample questions come from MediLingo's bank of 3,900+ questions across 23 specialties.
Sample questions
Question 1
Which spirometric finding confirms asthma?
a) FEV1/FVC < 0.70 that does not improve with bronchodilator
b) FEV1/FVC < 0.70 with ≥12% and ≥200 mL improvement post-bronchodilator ✓ Correct
c) Normal FEV1/FVC with decreased DLCO and normal lung volumes
d) Increased total lung capacity with decreased FEV1/FVC and reduced DLCO
Key teaching point: Asthma = reversible airflow obstruction: FEV1/FVC <0.70 with ≥12% and ≥200 mL improvement post-bronchodilator.
Question 2
What is the preferred controller therapy for a patient with asthma symptoms >2 days/week or nighttime awakening >1x/week?
a) Short-acting beta-2 agonist (SABA) as needed with no daily controller
b) Low-dose inhaled corticosteroid (ICS) as daily controller therapy ✓ Correct
c) Daily oral corticosteroids (prednisone 5-10 mg) as maintenance
d) Long-acting muscarinic antagonist (LAMA) as monotherapy
Key teaching point: Mild persistent asthma: daily low-dose ICS. SABA is for rescue only. Step up therapy based on control.
Question 3
A patient with severe asthma exacerbation is not responding to repeated salbutamol and ipratropium. What is the next step?
a) Immediate endotracheal intubation and mechanical ventilation
b) IV magnesium sulfate 2 g over 20 minutes ✓ Correct
c) Nebulized epinephrine 5 mg via continuous nebulization
d) Heliox (helium-oxygen 80:20) via non-rebreather mask as first-line
Key teaching point: Refractory severe asthma: IV MgSO4 2 g over 20 min. Consider heliox, IV salbutamol, or NIV. Intubation is last resort (high risk).
Question 4
When is methacholine challenge testing indicated?
a) When spirometry is normal but asthma is still clinically suspected ✓ Correct
b) When FEV1 is 50% predicted to assess severity of obstruction
c) To monitor long-term asthma control and medication response
d) During an acute asthma exacerbation to confirm the diagnosis
Key teaching point: Methacholine challenge: for suspected asthma with normal spirometry. Contraindicated if FEV1 <60% predicted or active wheezing.
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