1) In a patient with lobar pneumonia:

a) Arterial hypoxaemia is a poor prognostic feature

b) Macrolides are of no therapeutic benefit
c) Gentamicin is first line therapy
d) Oxygen therapy is harmful
e) Haemoptysis indicates the presence of thrombocytopenia
2) An 18 years old girl with no significant past medical history developed acute
shortness of breath while taking a class examination. Arterial blood gases
breathing room air showed: pH 7.52; PaO2 100 mm Hg; PaCO2 26 mm Hg.
a) The likely diagnosis is acute severe asthma
b) Patient needs reassurance after which she should be discharged
c) She should be given 80 mg of furosemide intravenously
d) High flow oxygen is immediately indicated
e) A perfusion lung scan should be done urgently
3) Massive haemoptysis typically occurs with:
a) ventricular septal defect.
b) pulmonary aspregilloma.
c) Bronchopneumonia.
d) lung secondaries from uterine cancer.
e) acute myocardial infarction.
4) Which of the following drugs should be used in the treatment of acute severe
asthma:
a) oral theophylline.
b) intravenous magnesium sulphate.
c) intravenous calcium gluconate.
d) Intravenous normal saline.
e) adrenaline infusion.
5) The best investigation to confirm bronchiectasis is:
a) Chest X ray
b) High resolution CT chest
c) Sputum culture
d) Bronchogram
e) Chest ultrasound

6) A 40 year old male presented with a 10 day history of dry cough and mild
dyspnoea this was proceeded by a few days history of fever, anorexia and
headache. He used to smoke heavily for years. O/E fine crackles could be heard
on the right base. Several “target” skin lesions were seen on his arms & trunk.
CBC Hb 9g/dl, reticulocyte 5%, WBC 7.4 ×109/L which of the following
investigations may give a clue to the aetiology of his condition?

a) Blood culture
b) Sputum for AA FB
c) CT scan of the chest
d) Cold agglutinin titre
e) Sputum microscopy for malignant cells.
7) A 60 year old man presented with progressive dyspnoea on exertion. He gave a
history of cigarette smoking and alcohol consumption. investigation showed:
- FEV 1.4 (predicted 2.3 -3.2)
- FVC 3.0 (predicted 3.3 – 4.5)
- Total lung capacity (TLC) 7.0 (predicted 5-7.1)
- Carbon monoxide transfer factor 5.3 mmol/min/KPa (predicted 6.6-9.8)

The most likely diagnosis is:

a) Cryptogenic fibrosing alveolitis
b) chronic bronchitis
c) emphysema
d) bronchial asthma
e) congestive heart failure

8) A 45 year old woman with a history of chronic bronchial asthma and oral
corticosteroid therapy, was seen in the TB contacts clinic. She was asymptomatic
and CXR was clear. Her tuberculin test was 10 mm.
The most appropriate action in this patient management is to consider:

a) standard treatment for tuberculosis

b) INH chemoprophylaxis for 6 months
c) Sputum examination for AAFB
d) Repeating the tuberculin test in 4 weeks
e) Reassuring her with follow up visits

9) In a patient with bilateral end inspiratory crackles and lung honey-combing on

chest X-ray, the most likely mode of presentation is:
a) Dyspnoea
b) Cough
c) Wheeze
d) Chest pain
e) Haemoptysis

10) A 60 years old heavy smoker presented with clubbing, cough and haemoptysis,
Chest X-ray showed a cavitatory lesion in the right lung. The most likely
underlying pathology is:
a) Squamous cell carcinoma
b) Adenocarcinoma
c) Small cell carcinoma
d) Streptococcal pneumonia
e) Asparegilloma
11) The following is useful in the treatment of acute severe asthma:
a) Oral aminopylline
b) Intravenous magnesium sulphate
c) Intravenous normal saline
d) Intravenous calcium gluconate
e) Dobtutamine infusion

12) The following cause exacerbation of asthma regularly:

a) Rhinovirus upper respiratory tract infection
b) Swimming
c) Climbing high altitude
d) Enteric fever
e) Vivax malaria

13) In chronic obstructive pulmonary disease(COPD)

a) there is 25% improvement in FEV1 after inhalation of salbutamol
b) symptoms usually start at the second decade of life
c) cigarette smoking is the commonest risk factor for the development of the
disease
d) influenza vaccine is contraindicated
e) inhaled long acting β2 agonist plays no role in treatment

14) Regarding bronchiectasis:

a) chest physiotherapy should be done only during exacerbations
b) pneumococcal vaccine is indicated
c) prophylactic antibiotics should be given to all patients
d) surgery is the treatment of choice if more than one lobe is affected
e) tuberculosis is the likely cause if the lower lobes were affected

15) A 30 year old female presented with tender erythematous skin lesions over her
shins, which of the following is more likely to be seen in her Chest-X-Ray:
a) Bilateral hilar lymphadenopathy
b) Apical fibro-cavitatory lesions
c) Pleural effusion
d) Basal bronchiectasis
e) Prominent pulmonary arteries
16) A 62 year old farmer presented to the out-patient department with cough &
progressive dyspnoea over the previous six months. On examination he was
cyanosed ,had digital clubbing and bilateral basal inspiratory crackles. The most
likely diagnosis is:
a) Pulmonary tuberculosis
b) Sarcoidosis
c) Chronic obstructive pulmonary disease
d) Idiopathic pulmonary fibrosis
e) Chronic extrinsic allergic alveolitis

17) A 65 year old heavy smoker reported to the hospital with worsening cough and
haemoptysis. He was diagnosed as having lung cancer ; which of the following
contraindicates curative surgery for his lung cancer:
a) FEV1 of 2 liters
b) Hoarseness of voice
c) Histology showing squamous cell carcinoma
d) Hypertrophic pulmonary osteodystrophy
e) A tumor diameter of 5 cm on Chest -X-Ray

18) A36 year old man with pulmonary tuberculosis, was started on Rifinah,
Ethambutol& Pyrazinamide one month previously. H e presented with deep
jaundice, upper abdominal discomfort and vomiting. What is the most
important step in the management of this patient:
a) Reassure the patient and continue anti Tuberculosis drugs
b) Admit the patient for observation and fluids
c) Stop all the anti tuberculosis drugs and wait for full recovery then re- start
the same drugs
d) Stop Pyrazinamide and Rifampicin , but continue with Ethambutol & INH
e) Stop all the anti tuberculosis, and after recovery challenge the patient with
each drug individually to determine the drug causing hepatitis

19) The following is an indicator of poor prognosis in a patient with pneumonia:

a) Age 25 years.
b) Presence of bilateral consolidation.
c) Acute onset.
d) Presence of haemoptyis.
e) Temperature of 390C.
20) A 17-year-old asthmatic patient complained of increasing frequency of
episodes of wheezing and shortness of breath. During last month he woke up
three nights with dyspnea.. What is the best next step in his management

a) Increase frequency of B2 agonist inhalation.

b) Add nocturnal slow release theophylline,
c) Start low- dose inhaled steroid.
d) Start sodium cromoglycate
e) Start long acting B2 agonist.
21) A 62-year-old man with non-small cell lung cancer is being considered for
surgical resection. Which of the followings would be regarded as a
contraindication to curative surgery?

a) FEV1: 1.1L
b) Hyertrophic pulmonary osteoarthropathy
c) Hypercalcaemia
d) Pleural effusion
e) Previous history of myocardial infarction
22) A 56-year-old female presented with a six month history of deteriorating non
productive cough and exertional dyspnoea. On examination she was noted to
be cyanosed, had clubbing of the fingers and there were bilateral basal
crackles. A chest X-ray revealed bilateral basal shadowing what is the most
likely diagnosis?
a) Extrinsic allergic alveolitis
b) Idiopathic pulmonary fibrosis
c) Silicosis
d) Sarcoidosis
e) Tuberculosis
23) A 23 year-old lady with chronic cough was diagnosed as smear positive
pulmonary tuberculosis. She is pregnant in her 24th week. Which of the
following anti tubereculous should be avoided.
a) Rifampicin
b) INH
c) Streptomycin
d) Ethambutol
e) pyrazinamide
24) A patient with Rheumatoid arthritis complains of progressive breathlessness.
Which of the following is the most likely cause?
a) Pulmonary Eosinophilia
b) Asthma
c) Pulmonary nodules
d) Fibrosing alveolitis
e) Pulmonary Embolus
25) Which of the following is associated with cavitations in the chest X-ray?

a) Sarcoidosis.>>> bilaterael hilar lymp

b) Pneumococcal pneumonia. >> herpes infection; URTI; most common
C) Leiginnella pneumonia. >> hyponatremia; water source; GI sympts
d) Klebsiella pneumonia. >>
e) Viral pneumonia.

26) Primary pulmonary tuberculosis:

a) Leads to pleural effusion.

b) Is highly infectious.
c) Commonly leads to miliary tuberculosis.
d) May be totally asymptomatic.
e) Usually produces cavitation.

27) In a patient with lobar pneumonia:

a) Arterial hypoxaemia is a poor prognostic feature

b) Macrolides are of no therapeutic benefit
c) Gentamicin is first line therapy
d) Oxygen therapy is harmful
e) Haemoptysis indicates the presence of thrombocytopenia

28) 18 years old girl with no significant past medical history developed acute
shortness of breath while taking a class examination. Arterial blood gases
breathing room air showed: pH 7.52; PaO2 100 mm Hg; PaCO2 26 mm Hg.

a) The likely diagnosis is acute severe asthma

b) Patient needs reassurance after which she should be discharged
c) She should be given 80 mg of furosemide intravenously
d) High flow oxygen is immediately indicated
e) A perfusion lung scan should be done urgently

29) The best investigation to confirm bronchiectasis is:

a) Chest X ray
b) High resolution CT chest
c) Sputum culture
d) Bronchogram
Chest ultrasound
30) A 56-year-old female, presented with a six month history of deteriorating non-
productive cough and exertional dyspnoea. On examination she was noted to
be cyanosed, had clubbing of the fingers and there were bilateral basal
crackles. A chest X-ray revealed bilateral basal shadowing what is the most
likely diagnosis?
f) Extrinsic allergic alveolitis
g) Idiopathic pulmonary fibrosis
h) Silicosis
i) Sarcoidosis
j) Tuberculosis

31) Regarding the patient in the question above what is the most appropriate next
investigation?
a) Bronchoscopy and BAL
b) Lung function test
c) High resolution CT chest
d) Serum angiotensin converting enzyme level
e) Sputum culture

32) A 62 year old man with non-small cell lung cancer is considered for curative
surgery. Which of the following presentations indicates that the tumour is
definitely incurable by surgery?
a) Cerebellar signs
b) Hypertrophic pulmonary osteoartheropathy
c) Hypercalcemia
d) Horner’s syndrome
e) Peripheral neuropathy

33) Which of the following statements is true regarding primary TB?

a) It usually presents with fever, cough and ill health.
b) Miliary spread is not common in younger age group.
c) Cavitation is known complication of primary complex.
d) Pleural effusion occurs within 6 months of infection
e) A positive tuberculin test develops within two weeks of infection
34) Which one of the following disorders would most likely produce a pleural
effusion that contains less than 3g /dl of protein and very few inflammatory
cells?
a) Congestive heart failure.
b) Acute pancreatitis.
c) Metastatic breast cancer.
d) Pulmonary infarction.
e) Lobar pneumonia.

35) The best way to prescribe chemotherapy for TB in Sudan is through;

a) Hospital admission for the initial phase.
b) Directly Observed Treatment using short course chemotherapy (DOTS)
c) Intermittent chemotherapy throughout the whole period.
d) Standard 12 months home treatment.
e) Sanatorium isolation.

36) The following causes exacerbations of asthma regularly:

a) Rhinovirus upper respiratory tract infection.
b) Swimming.
c) Climbing to high altitude.
d) Enteric fever.
e) Vivax Malaria

37) Regarding chronic obstructive pulmonary disease (COPD):

a) There is more than 25% improvement FEV1 after inhalation of salbutamol.
b) Symptoms usually start at the second decade of life.
c) Cigarette smoking is the commonest risk factor for the development of the
disease.
d) Influenza vaccine is contraindicated.
e) Inhaled long acting B2 agonists play no role in its treatment.

38) Type two respiratory failure in patients with chronic obstructive pulmonary
disease (COPD):
a) Should be treated with high flow oxygen therapy.
b) Is the cause of ischemic heart disease in these patients
c) Is the cause of pulmonary hypertension in these patients
d) Is reversed by the use of intravenous hydrocortisone.
e) Does not increase mortality
39) The following is an indicator of poor prognosis in a patient with pneumonia:
a) Age 25 years.
b) Presence of bilateral consolidation.
c) Acute onset.
d) Presence of haemoptysis.
e) Temperature of 390C
40) The differential diagnosis of chronic cough with a normal chest x ray includes:

a) Gastro oesophageal reflux disease

b) Bronchiectasis
c) Lung cancer
d) Tuberculosis
e) Chronic pancreatitis

41) In chronic obstructive pulmonary disease:

a) Air flow obstruction is fully reversible with treatment
b) Most patients have a combination of chronic bronchitis and emphysema
c) The most important risk factor is industrial environmental pollution
d) Common in those less than thirty years old
e) Does not affect women

42) In a patient with recurrent haemoptysis over five years the likely cause is:
a) Lobar pneumonia
b) Adenocarcinoma of the bronchus
c) Bronchiectasis
d) Fibsosing alveolitis
e) Lung abscess

43) A 17-year-old asthmatic patient complained of increasing frequency of

episodes of wheezing and shortness of breath. During last month he woke up
three nights with dyspnea. What is the best next step in his management?
a) Increase frequency of B2 agonist inhalation.
b) Add nocturnal slow release theophylline,
c) Start low- dose inhaled steroid.
d) Start sodium cromoglycate
e) Start long acting B2 agonist.

44) A 62-year-old man with non-small cell lung cancer is being considered for surgical
resection. Which of the following would be regarded as a contraindication to
curative surgery?

a) FEV1: 1.1L
b) Hyertrophic pulmonary osteoarthropathy
c) Hypercalcaemia
d) Pleural effusion
e) Previous history of myocardial infarction
45) A 56-year-old female presented with a six month history of deteriorating non
productive cough and exertional dyspnoea. On examination she was noted to
be cyanosed, had clubbing of the fingers and there were bilateral basal
crackles. A chest X-ray revealed bilateral basal shadowing. What is the most
likely diagnosis?

a) Extrinsic allergic alveolitis

b) Idiopathic pulmonary fibrosis
c) Silicosis
d) Sarcoidosis
e) Tuberculosis

46) A 23 year-old lady with chronic cough was diagnosed as smear positive
pulmonary tuberculosis. She is pregnant in her 24th week. Which of the following
anti tubereculous should be avoided.
f) Rifampicin
g) INH
h) Streptomycin
i) Ethambutol
j) Pyrazinamide

47) Type two respiratory failure in patients with chronic obstructive pulmonary
disease (COPD):
a) Should be treated with high flow oxygen therapy
b) Mechanical ventilation is indicated in all patients
c) Non-invasive ventilation may benefit some patients
d) Is reversed by the use of intravenous hydrocortisone
e) Does not increase mortality

48) In a patient with lobar pneumonia:

a) Arterial hypoxaemia is a poor prognostic feature
b) Macrolides are of no therapeutic benefit
c) Gentamicin is first line therapy
d) Oxygen therapy is harmful
e) Haemoptysis indicates the presence of thrombocytopenia

49) Regarding Bronchiectasis:

a) Chest physiotherapy should only be performed during exacerbations
b) Prophylactic antibiotics should be given to all patients
c) Surgery is the treatment of choice
d) Pneumococcal vaccine is indicated to all patients
e) If it involves the lower lobe tuberculosis is the most likely cause
50) In a patient with lung abscess:
a) Surgery is first line treatment
b) Fever is usually absent
c) Haemoptysis does not occur
d) Chronic sinusitis is almost always present
e) Antibiotics should be given for six weeks

51) A 50 year old smoker presented with dyspnoea after minimal exertion which
started a few months previously. Examination revealed cyanosis, finger
clubbing and bilateral basal crackles. What is the most likely diagnosis?
a) COPD
b) Carcinoma of the bronchus
c) Bronchiectasis
d) Left ventricular failure
e) Idiopathic pulmonary fibrosis

52) A 26 year old asthmatic was admitted to hospital with acute attack. Which of
the following suggest life threatening attack?
a) Inability to complete sentences
b) Pulse 110/min
c) PEFR 45 L/min
d) RR 30/min
e) Normal PaCO2

53) A 33 year old non-smoking woman, who was previously healthy, was admitted
to hospital with fever and cough. Her temperature was 39°C, WBC count of
18,900/mm3, and her CXR showed right lower lobe consolidation. What is the
most likely cause of her pneumonia?
a) Staphylococcus aureus
b) Streptococcus pneumoniae
c) Escherichia coli
d) Klebsiella pneumoniae
e) Enterococcus

54) Which of the following measures is most likely to decrease the risk of TB spread
in the community?
a) BCG vaccination
b) Isolation of the infectious source
c) Detection and treatment of infectious index cases
d) Health education
e) Tuberculin testing of contacts
55) A 64 year-old ex-smoker presented with hemoptysis and weight loss. His chest
X-ray revealed a mass at the right hilum. What investigation is most useful in
reaching a diagnosis?
a) CT scan of the chest
b) Lung function test
c) Sputum cytology
d) Bone scan
e) Bronchoscopy and biopsy

56) A 24 year old pregnant lady presented with cough and haemoptysis. Her
sputum was found to be positive for acid fast bacilli. Which of the anti-TB drugs
should be avoided?
a) INH
b) Streptomycin
c) Rifampicin
d) Pyrazinamide
e) Ethambutol

57) Which one of the following conditions increases the risk of reactivation of
latent TB infection:
a) Asbestosis
b) Asthma
c) Idiopathic pulmonary fibrosis
d) Diabetes mellitus
e) Bronchiectasis

58) Which of the following is known to occur with a Tuberculous pleural effusion?
a) Peripheral lung lesion on CXR
b) Positive pleural fluid culture
c) Pleural fluid glucose <60 mg/dl
d) Low pleural fluid LDH
e) Spontaneous resolution by 16 weeks
59) A 23 year-old previously healthy man presented with fever and cough. His
pulse was 90/ min, PB 110/75 and had crepitations on the left side of his chest.
CXR showed consolidation of the left lower lobe. What is the most appropriate
antibiotic would you prescribe:
a) Oxytetracycline
b) Amoxicillin-clavulinic acid
c) Ceftriaxone
d) Ciprofloxacin
e) Erythromycin

60) A 62-year-old smoker with long history of productive cough presented to

hospital with shortness of breath and drowsiness. On examination he was
cyanosed, had raised JVP, palpable liver and a systolic murmur at the left sternal
edge. What is the most likely diagnosis:
a) Exacerbation of COPD
b) Infective endocarditis
c) Cor-pulmonale
d) Rheumatic heart disease
e) Pulmonary embolism

61) A 20 year-old man was admitted to the emergency room with severe
acute asthma. What is the most appropriate initial treatment?
a) IV aminophylline
b) IV hydrocortisone
c) Nebulized salbutamol
d) IV magnesium
e) IV cefuroxime

62) In a patient with right lower lobe collapse:

a) Pneumonia is the most likely diagnosis.
b) Fibreoptic bronchoscopy is the investigation of choice to reach the
definitive diagnosis.
c) Sputum cytology if negative excludes the presence of lung cancer
d) If the patient has haemoptysis tuberculosis is the most likely diagnosis
e) If there is no loss of weight lung cancer becomes an unlikely diagnosis

63) The best investigation to confirm bronchiectasis is:

a) Sputum culture
b) Chest X ray
c) Bronchogram
d) High resolution CT chest
e) Chest ultrasound