AMC MCQ Respiratory Questions: 10 Free Practice MCQs
Ten AMC MCQ-style respiratory questions with the answer and the reasoning behind it. They come from the AU.med bank, which has 54 respiratory questions and many more across every topic.
1 / 10
A 66-year-old man with moderate COPD continues to experience daily dyspnea and cough despite using a short-acting beta-agonist (Salbutamol) as needed. He has had no exacerbations in the past year. He is a current smoker and wishes to quit.
What is the most appropriate next step in his long-term management according to the COPD-X Guidelines?
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Answer: D. Provide smoking cessation counseling, offer influenza and pneumococcal vaccination, and initiate dual LAMA/LABA inhaler therapy
Why: The Australian COPD-X guidelines recommend a stepwise approach. Non-pharmacological management (smoking cessation, vaccination, pulmonary rehabilitation) is fundamental. For pharmacotherapy, symptomatic patients are escalated from SABA/SAMA as-needed to dual long-acting bronchodilators (LAMA/LABA). ICS is reserved for patients with features of asthma or frequent exacerbations despite dual bronchodilation.
- A. Oxygen therapy is only indicated for patients with chronic hypoxemia (PaO2 < 55 mmHg or < 59 mmHg with cor pulmonale).
- B. ICS monotherapy is not recommended in COPD due to lack of efficacy and increased risk of pneumonia; it is only used in combination for frequent exacerbators.
- C. Oral corticosteroids are reserved for acute exacerbations and should not be used as maintenance therapy in stable COPD.
Sources: The COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD
2 / 10
A 68-year-old man presents to the clinic with cough, purulent sputum, fever, and dyspnea. On examination, he is alert and oriented, BP is 125/80 mmHg, respiratory rate is 22 breaths per minute, and heart rate is 90 bpm. Chest auscultation reveals right lower lobe bronchial breathing. He has no significant comorbidities and is assessed as having mild community-acquired pneumonia (CAP).
Which of the following is the most appropriate first-line empirical antibiotic regimen according to the Therapeutic Guidelines (eTG)?
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Answer: D. Oral Amoxicillin 1g three times daily (or Doxycycline 100mg twice daily)
Why: In Australia, the empirical antibiotic choice for community-acquired pneumonia is guided by severity. For mild CAP, Streptococcus pneumoniae is the primary target. Oral Amoxicillin 1g eight-hourly is first-line. Doxycycline (100mg twelve-hourly) is an acceptable alternative, particularly if atypical pathogens (e.g. Mycoplasma pneumoniae) are suspected or if there is a penicillin allergy.
- A. Cefalexin has poor activity against Streptococcus pneumoniae and atypical pathogens, making it inappropriate for pneumonia treatment.
- B. Intravenous broad-spectrum cephalosporins are reserved for moderate-to-severe pneumonia requiring hospital admission.
- C. Fluoroquinolones are reserved for confirmed resistant infections or severe penicillin allergy to prevent the development of resistance.
Sources: eTG complete — Infectious Diseases — Community-Acquired Pneumonia; AMH
3 / 10
A 68-year-old male with severe COPD and chronic hypercapnic respiratory failure (CO2 retainer) presents with an acute exacerbation and hypoxic respiratory distress.
What is the target saturation?
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Answer: B. 88-92%
Why: In patients with COPD at risk of hypercapnic respiratory failure (CO2 retainers), controlled oxygen therapy targeting an SpO2 of 88-92% is mandatory. Uncontrolled high-flow oxygen blunts hypoxic drive, worsens V/Q mismatch, and increases dead space ventilation, exacerbating life-threatening hypercapnia.
- A. Incorrect. Administering 100% oxygen to a hypercapnic COPD patient causes severe CO2 retention, narcosis, and respiratory arrest.
- C. Incorrect. Target SpO2 of 94-98% is intended for non-hypercapnic acute medical patients and is excessively high for COPD retainers.
- D. Incorrect. Target SpO2 of 80% is dangerously hypoxic and causes end-organ tissue ischemia and cardiac arrhythmias.
Sources: COPD-X Guidelines
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4 / 10
A 15-year-old adolescent has an acute asthma exacerbation requiring oral corticosteroids. The adolescent weighs 42 kg and has no contraindication.
What dose regimen does the handbook recommend for adolescents?
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Answer: C. Prednisone or prednisolone 1 mg/kg orally once daily, up to 50 mg, for 3 to 5 days
Why: For adolescents, the handbook recommends prednisone or prednisolone 1 mg/kg orally once daily, to a maximum of 50 mg, for 3 to 5 days. Reassess the person's clinical response, risk factors, reliever use and inhaled corticosteroid-containing preventer plan.
- A. A fixed adult dose of 100 mg twice daily is not recommended by the Australian Asthma Handbook for this scenario.
- B. One dose of 1 mg total is not recommended by the Australian Asthma Handbook for this scenario.
- D. Avoid oral corticosteroids in every adolescent is not recommended by the Australian Asthma Handbook for this scenario.
Sources: Australian Asthma Handbook, acute asthma in adults and adolescents
5 / 10
A 28-year-old female presents to an Australian emergency department with acute dyspnoea, wheezing, and inability to complete sentences in one breath. Peak expiratory flow (PEF) is 45% of predicted.
What is the first-line pharmacotherapeutic management to initiate immediately?
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Answer: A. Inhaled short-acting beta-2 agonist (Salbutamol) with Ipratropium bromide and systemic corticosteroids
Why: Severe acute asthma exacerbation is managed with high-dose inhaled short-acting beta-2 agonists (Salbutamol) via spacer or nebuliser, inhaled ipratropium bromide, systemic corticosteroids (oral prednisolone or IV hydrocortisone), and controlled oxygen to maintain SpO2 93-95%.
- B. Incorrect. Sedatives and anxiolytics are strictly contraindicated in acute asthma because they depress the respiratory drive and can precipitate fatal respiratory arrest.
- C. Incorrect. Beta-blockers cause severe bronchoconstriction and can trigger fatal status asthmaticus.
- D. Incorrect. Antibiotics have no role in the acute management of uncomplicated asthma exacerbations, which are typically viral- or allergen-triggered.
Sources: National Asthma Council Australia - Australian Asthma Handbook; Therapeutic Guidelines (eTG): Respiratory
6 / 10
A 34-year-old adult presents to a general practice with a worsening asthma episode and increased work of breathing. The clinician is beginning the initial assessment.
How should the severity of the episode be assessed rapidly?
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Answer: A. Observe the patient and measure oxygen saturation with pulse oximetry
Why: The Australian Asthma Handbook recommends rapid severity assessment by observation and pulse oximetry. Reassess the person's clinical response, risk factors, reliever use and inhaled corticosteroid-containing preventer plan.
- B. Estimate severity from speech alone is not recommended by the Australian Asthma Handbook for this scenario.
- C. Wait for spirometry before treatment is not recommended by the Australian Asthma Handbook for this scenario.
- D. Use a peak flow result as the only assessment is not recommended by the Australian Asthma Handbook for this scenario.
Sources: Australian Asthma Handbook, acute asthma in adults and adolescents
7 / 10
A 45-year-old non-smoking man presents to his general practitioner with a dry cough of 10 weeks' duration. He has no chest pain, hemoptysis, fever, or weight loss. He is not taking an ACE inhibitor. Physical examination is unremarkable.
What is the recommended first-line diagnostic investigation for this patient?
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Answer: B. Chest X-ray (CXR)
Why: In patients presenting with a chronic cough (defined as lasting longer than 8 weeks), the initial diagnostic step is to perform a chest X-ray. A normal CXR helps rule out major structural lung disease (e.g., neoplasm, tuberculosis, bronchiectasis) and directs subsequent evaluation toward common causes such as asthma, GERD, or upper airway cough syndrome.
- A. HRCT is a high-radiation, high-cost test that is not indicated as the initial screening tool for unexplained chronic cough.
- C. Empirical treatment should not be initiated before performing basic structural imaging with a chest X-ray.
- D. Bronchoscopy is an invasive procedure reserved for cases where non-invasive investigations have failed or suggest airway pathology.
Sources: CICADA: Cough in Children and Adults: Diagnosis and Assessment (Australian Guidelines); RACGP Chronic Cough Guidelines
8 / 10
A 72-year-old man with severe COPD presents to his GP with a 3-day history of increased sputum volume, sputum purulence, and worsening dyspnea. His oxygen saturation is 90% on room air, and he has a history of carbon dioxide retention.
Which of the following represents the most appropriate outpatient management for this acute COPD exacerbation according to the Therapeutic Guidelines (eTG)?
Show answer
Answer: C. Prescribe oral Amoxicillin 500mg three times daily (or Doxycycline 100mg daily) for 5 days, oral Prednisolone 30–50mg daily for 5 days, and optimize bronchodilator use
Why: An acute exacerbation of COPD is managed with optimization of short-acting bronchodilators, a short course of oral corticosteroids (Prednisolone 30-50mg daily for 5 days), and antibiotics if the exacerbation is infective (indicated by increased sputum purulence and volume/dyspnea). First-line oral antibiotics in Australia are amoxicillin or doxycycline.
- A. Target oxygen saturation in patients with risk of hypercapnic respiratory failure (such as severe COPD) is 88–92%, not high-flow oxygen.
- B. Long courses of steroids (e.g. 14 days) are associated with adverse effects without clinical benefit; 5 days is sufficient. Prophylactic azithromycin is not used for acute flares.
- D. Mild-to-moderate exacerbations without hemodynamic instability or respiratory failure can be managed safely in the outpatient setting.
Sources: eTG complete — Respiratory — COPD Exacerbation; COPD-X Guidelines
9 / 10
A 62-year-old male smoker presents with progressive exertional dyspnoea, chronic productive cough, and a post-bronchodilator FEV1/FVC ratio of 0.58 on spirometry.
Which finding confirms the diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?
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Answer: A. Post-bronchodilator FEV1/FVC ratio < 0.70 demonstrating persistent airflow limitation
Why: Chronic Obstructive Pulmonary Disease (COPD) is diagnosed by demonstration of persistent airflow limitation on post-bronchodilator spirometry defined as FEV1/FVC < 0.70. Clinical features include smoking history, progressive exertional breathlessness, and chronic cough with sputum production.
- B. Incorrect. Complete reversibility of airflow limitation with normalisation of FEV1/FVC is the hallmark of asthma, not COPD.
- C. Incorrect. A preserved or elevated FEV1/FVC ratio with reduced lung volumes indicates a restrictive ventilatory defect (e.g. pulmonary fibrosis), not COPD.
- D. Incorrect. Normal spirometry with bronchial hyperresponsiveness to methacholine is indicative of bronchial asthma.
Sources: The COPD-X Plan: Australian and New Zealand Guidelines for the Management of COPD; Lung Foundation Australia
10 / 10
A 68-year-old woman is admitted to a regional Australian hospital with fever, productive cough, and shortness of breath. On assessment, her respiratory rate is 24/min, blood pressure is 105/65 mmHg, and she is alert. Chest X-ray reveals left lobar consolidation.
Which of the following is the most appropriate empirical antibiotic regimen according to the Therapeutic Guidelines (eTG) for moderate community-acquired pneumonia?
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Answer: B. Intravenous Benzylpenicillin 1.2g six-hourly plus oral Doxycycline 100mg twice daily
Why: According to the Australian Therapeutic Guidelines (eTG), empirical therapy for moderate community-acquired pneumonia in adults requiring admission is intravenous benzylpenicillin combined with oral doxycycline (or clarithromycin if doxycycline is contraindicated).
- A. Oral amoxicillin alone is appropriate for mild, not moderate, community-acquired pneumonia.
- C. This combination is reserved for severe community-acquired pneumonia or patients with specific beta-lactam hypersensitivity.
- D. Broad-spectrum coverage with antipseudomonal agents is not indicated for uncomplicated community-acquired pneumonia.
Sources: eTG complete — Moderate Community-Acquired Pneumonia
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Exam-style questions written by MedHub for practice. They are not official exam questions.