1. A 25-year-old man with asthma presents with worsening shortness of breath over 24 hours. He is unable to complete full sentences, his respiratory rate is 30 breaths/minute, heart rate is 122 bpm and oxygen saturations are 91% on air.
Which ONE of the following is the most appropriate immediate management?
A. Start montelukast and arrange routine asthma review.
B. Increase inhaled corticosteroid dose and review in 2 weeks.
C. Arrange urgent treatment with high-dose inhaled bronchodilator therapy and oxygen as appropriate.
D. Provide a rescue course of oral prednisolone and advise review if symptoms persist.
E. Check inhaler technique and arrange follow-up with the asthma nurse.
2. A 68-year-old man with COPD develops increased breathlessness, increased sputum volume and purulent sputum over 3 days. He is more wheezy than usual but remains haemodynamically stable.
Which ONE of the following is the most appropriate consideration?
A. Escalate immediately to long-term triple inhaled therapy.
B. Arrange routine spirometry before treating the current episode.
C. Start long-term antibiotic prophylaxis without further review.
D. Treat as stable COPD and continue usual medicines only.
E. Manage as a COPD exacerbation and consider antibiotics if bacterial infection is likely, guided by local guidance.
3. A 52-year-old smoker has chronic cough, exertional breathlessness and recurrent winter chest infections. COPD is suspected.
Which ONE of the following investigation is most appropriate to support the diagnosis?
A. Spirometry showing persistent airflow obstruction.
B. Chest X-ray showing hyperinflation only.
C. Peak flow measurement during one symptomatic episode.
D. Blood eosinophil count alone.
E. Sputum culture during an exacerbation.
4. A 31-year-old woman with asthma uses her salbutamol inhaler several times most days and wakes at night with wheeze twice a week. She is not taking any inhaled corticosteroid.
Which ONE of the following is the most appropriate pharmacist intervention?
A. Advise continuing reliever-only treatment because symptoms improve with salbutamol.
B. Recommend taking salbutamol regularly four times daily.
C. Start an oral antihistamine as the main asthma treatment.
D. Arrange asthma review because frequent reliever use suggests poor control and need for anti-inflammatory treatment.
E. Advise avoiding exercise until symptoms settle.
5. A 74-year-old man with COPD is admitted with an exacerbation. He is known to retain carbon dioxide. His oxygen saturation is 84% on air.
Which ONE of the following oxygen strategy is most appropriate initially?
A. Avoid oxygen unless oxygen saturation falls below 75%.
B. Give controlled oxygen aiming for an appropriate target saturation range while awaiting blood gas assessment.
C. Give high-flow oxygen aiming for saturations of 98–100% in all patients.
D. Give oxygen only after nebulised bronchodilators have failed.
E. Start long-term oxygen therapy immediately without further assessment.
6. A 45-year-old woman using a high-dose inhaled corticosteroid reports a sore mouth and white patches on her tongue. The patches can be scraped off.
Which ONE of the following is the most appropriate advice?
A. Stop the inhaled corticosteroid immediately and use salbutamol alone.
B. Increase the inhaled corticosteroid dose because symptoms suggest poor asthma control.
C. Start an oral antibiotic course for bacterial tonsillitis.
D. Use a nasal corticosteroid spray instead of the inhaler.
E. Review inhaler technique, advise mouth rinsing after use and assess for oral candidiasis.
7. A 60-year-old man with COPD continues to smoke 20 cigarettes daily. He asks what intervention would most reduce his risk of disease progression.
Which ONE of the following is the most appropriate advice?
A. Stop smoking and access behavioural and pharmacological smoking cessation support.
B. Use a short-acting bronchodilator before every cigarette.
C. Start long-term oxygen therapy without formal assessment.
D. Use antibiotics at the start of every winter.
E. Increase inhaled corticosteroid dose regardless of exacerbation history.
8. A 67-year-old woman with COPD becomes breathless after walking 50 metres. She is clinically stable and asks whether any non-drug intervention may improve her function.
Which ONE of the following is the most appropriate recommendation?
A. Restrict activity to prevent further breathlessness.
B. Use a rescue course of prednisolone before planned exercise.
C. Start long-term oxygen therapy based on symptoms alone.
D. Refer for pulmonary rehabilitation if suitable.
E. Replace all inhaled therapy with breathing exercises only.
9. A 58-year-old man with COPD uses a long-acting bronchodilator. He has had two exacerbations requiring oral steroids in the last year. His blood eosinophils are elevated and he has no history of pneumonia.
Which ONE of the following may be considered after review?
A. Stop maintenance bronchodilator therapy because exacerbations have occurred.
B. Escalate to inhaled corticosteroid-containing therapy if benefits outweigh risks.
C. Start long-term oral prednisolone as routine maintenance treatment.
D. Use antibiotics continuously without microbiology review.
E. Step down to short-acting bronchodilator therapy only.
10. A 36-year-old man with asthma is prescribed a long-acting beta₂ agonist inhaler without an inhaled corticosteroid. He has no other asthma medicines.
Which ONE of the following is the most appropriate pharmacist action?
A. Dispense because long-acting beta₂ agonist monotherapy is preferred for persistent asthma.
B. Counsel him to use the long-acting beta₂ agonist only during acute attacks.
C. Query the prescription because long-acting beta₂ agonists should not be used without inhaled corticosteroid therapy in asthma.
D. Suggest replacing it with a short-acting muscarinic antagonist.
E. Advise taking the inhaler only before exercise.
11. A 22-year-old woman with asthma has been using a new dry powder inhaler. She says she exhales into the device before inhaling and sometimes notices the powder clumping.
Which ONE of the following is the most appropriate counselling point?
A. Shake the dry powder inhaler vigorously after loading every dose.
B. Wash the device under running water once weekly.
C. Breathe slowly and gently through the device as with a spacer.
D. Avoid breathing into the device and use the correct inspiratory technique.
E. Store the inhaler in the bathroom to keep the powder moist.
12. A 71-year-old man with COPD has recently started home oxygen therapy. He continues to smoke indoors and asks whether this matters.
Which ONE of the following is the most appropriate advice?
A. Smoking near oxygen is a serious fire and injury risk and must be addressed urgently.
B. Smoking is safe if oxygen is turned down to the lowest flow rate.
C. Smoking is safe if the oxygen tubing is kept behind the patient.
D. The main concern is reduced oxygen effectiveness rather than fire risk.
E. Smoking safety does not need to be discussed if oxygen is prescribed by a specialist.
13. A 49-year-old woman presents with sudden pleuritic chest pain, shortness of breath and haemoptysis. She had knee replacement surgery 10 days ago.
Which ONE of the following is the most appropriate action?
A. Treat as community-acquired pneumonia and arrange routine GP review.
B. Recommend a short-acting bronchodilator and review response.
C. Advise simple analgesia and review if symptoms last more than 48 hours.
D. Arrange outpatient spirometry to investigate underlying COPD.
E. Arrange urgent assessment for possible pulmonary embolism.
14. A 77-year-old man presents with persistent cough for 4 months, weight loss and two episodes of haemoptysis. He has a 50-pack-year smoking history.
Which ONE of the following is the most appropriate management?
A. Trial a proton pump inhibitor for possible reflux-related cough.
B. Recommend an antihistamine for possible post-nasal drip.
C. Refer urgently for suspected lung cancer assessment.
D. Arrange routine spirometry before considering referral.
E. Supply cough suppressants and review in one month.
15. A 39-year-old woman has allergic rhinitis with nasal congestion, sneezing and itchy eyes each spring. She has no red flags and symptoms are affecting sleep.
Which ONE of the following is the most appropriate treatment option?
A. Oral prednisolone as routine seasonal prevention.
B. Intranasal corticosteroid with advice on regular use and technique.
C. Antibiotics for presumed bacterial sinusitis.
D. Short-acting beta₂ agonist inhaler for nasal symptoms.
E. Oral decongestant as continuous long-term treatment.
16. A 5-year-old child with asthma is prescribed a pressurised metered-dose inhaler. The parent says the child struggles to coordinate pressing and breathing in.
Which ONE of the following is the most appropriate advice?
A. Encourage the child to breathe in directly from the inhaler without any device.
B. Switch to a dry powder inhaler without assessing inspiratory flow.
C. Use the inhaler only when symptoms are severe enough to justify treatment.
D. Use a spacer device, with a mask if appropriate, and check technique.
E. Mix the inhaler dose into a drink to improve administration.
17. A 67-year-old man takes theophylline for COPD. He is prescribed ciprofloxacin for a urinary infection.
Which ONE of the following is the most appropriate concern?
A. Ciprofloxacin can increase theophylline levels and toxicity risk.
B. Ciprofloxacin reduces the need for theophylline monitoring.
C. Theophylline prevents ciprofloxacin absorption.
D. Theophylline should be doubled while taking ciprofloxacin.
E. Ciprofloxacin has no clinically relevant respiratory medicine interactions.
18. A 60-year-old man taking theophylline stops smoking abruptly during a hospital admission. He has been on a stable theophylline dose for years.
Which ONE of the following is the most appropriate medicines optimisation issue?
A. Theophylline should be stopped permanently in all patients who stop smoking.
B. Smoking cessation reduces theophylline concentrations, increasing exacerbation risk.
C. Theophylline levels may increase after stopping smoking and monitoring may be needed.
D. Smoking cessation affects inhaled medicines but not oral respiratory medicines.
E. Theophylline dose should be doubled immediately after smoking cessation.
19. A 69-year-old woman with pneumonia is confused, respiratory rate is 32 breaths/minute and blood pressure is 88/54 mmHg. She is febrile and oxygen saturations are 89% on air.
Which ONE of the following is the most appropriate action?
A. Start oral antibiotics and arrange routine follow-up in one week.
B. Supply a short-acting bronchodilator and assess response.
C. Recommend oral fluids and paracetamol with safety-netting.
D. Arrange outpatient chest X-ray before deciding on urgency.
E. Arrange urgent hospital assessment for severe pneumonia or sepsis.
20. A 29-year-old man has a 4-week cough, night sweats, weight loss and haemoptysis. He recently arrived from a country with high tuberculosis prevalence.
Which ONE of the following is the most appropriate action?
A. Start inhaled corticosteroid therapy for presumed asthma.
B. Arrange urgent clinical assessment and infection-control consideration for possible tuberculosis.
C. Provide delayed antibiotics for use if symptoms continue another week.
D. Treat as post-viral cough and advise routine review.
E. Recommend cough suppressant and avoid further investigation unless fever develops.
21. A 55-year-old man with COPD has frequent exacerbations. His inhaler technique is poor and he uses his maintenance inhaler only when breathless.
Which ONE of the following is the most appropriate pharmacist intervention?
A. Escalate to triple therapy without checking technique further.
B. Recommend using the maintenance inhaler only during exacerbations.
C. Add long-term oral corticosteroids before reviewing adherence.
D. Switch all inhalers to nebulised therapy immediately.
E. Review inhaler technique, adherence and understanding before escalating therapy.
22. A 33-year-old woman with asthma uses her reliever inhaler every day and has had two courses of oral prednisolone in the past year.
Which ONE of the following is the most appropriate interpretation?
A. Her asthma is well controlled because she responds to reliever therapy.
B. This suggests increased risk and need for structured asthma review.
C. Regular reliever use should be encouraged to prevent exacerbations.
D. Preventer treatment should be reduced because oral steroids have been used.
E. No review is needed unless she has a hospital admission.
23. A 28-year-old woman with asthma is prescribed montelukast. Two weeks later, her partner reports mood changes, nightmares and agitation.
Which ONE of the following is the most appropriate action?
A. Increase montelukast dose because symptoms suggest poor asthma control.
B. Reassure that neuropsychiatric symptoms are not associated with montelukast.
C. Add regular oral corticosteroids to offset the adverse effects.
D. Review urgently because montelukast can be associated with neuropsychiatric adverse effects.
E. Advise continuing until the next annual asthma review.
24. A 45-year-old man with asthma presents with wheeze after cleaning with bleach. He has repeated symptoms at work and improvement on days away from work.
Which ONE of the following should be considered?
A. Seasonal allergic rhinitis as the only likely diagnosis.
B. Stable COPD requiring routine annual review.
C. Occupational asthma requiring clinical assessment.
D. Community-acquired pneumonia requiring immediate antibiotics.
E. Pulmonary embolism because symptoms occur during activity.
25. A 73-year-old woman with COPD has had pneumonia twice while taking an inhaled corticosteroid-containing regimen. She has low eosinophils and no clear asthma features.
Which ONE of the following is the most appropriate consideration?
A. Review whether ongoing inhaled corticosteroid benefit outweighs pneumonia risk.
B. Increase inhaled corticosteroid dose because pneumonia suggests undertreatment.
C. Stop all bronchodilators and continue inhaled corticosteroid alone.
D. Add long-term oral prednisolone for pneumonia prevention.
E. Start regular antibiotics without reviewing inhaled therapy.
26. A 64-year-old man with COPD is prescribed prednisolone for an acute exacerbation. He asks whether he should continue it long term to prevent all future exacerbations.
Which ONE of the following is the most appropriate advice?
A. Long-term oral prednisolone is first-line maintenance therapy in most COPD patients.
B. Prednisolone should replace maintenance inhalers after an exacerbation.
C. Prednisolone should be stopped immediately after one dose if symptoms improve.
D. Oral corticosteroids for exacerbations are usually short courses and should not be continued indefinitely without review.
E. Prednisolone prevents all future infective exacerbations.
27. A 9-year-old child has asthma symptoms during exercise. He is using his inhaler incorrectly and has not had an asthma review for over a year.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Advise avoiding sport permanently to prevent symptoms.
B. Recommend using another child’s reliever inhaler before exercise.
C. Increase reliever use without checking technique.
D. Treat the symptoms as normal breathlessness from exercise.
E. Arrange asthma review and check inhaler technique and personalised action plan.
28. A 70-year-old man with COPD reports unintentional weight loss, reduced appetite and worsening breathlessness. He has a low BMI and struggles with shopping and cooking.
Which ONE of the following is the most appropriate consideration?
A. Weight loss is expected and beneficial in all COPD patients.
B. Nutritional assessment and support should be considered.
C. Restrict calories further to reduce breathlessness.
D. Stop pulmonary rehabilitation until weight improves.
E. Use antibiotics to improve appetite.
29. A 63-year-old woman with bronchiectasis reports increased sputum volume, sputum purulence and worsening breathlessness. She has a previous sputum result showing Pseudomonas aeruginosa.
Which ONE of the following is the most appropriate management consideration?
A. Assess for infective exacerbation and consider antibiotics guided by previous sputum results and local advice.
B. Treat as uncomplicated asthma and increase inhaled corticosteroid only.
C. Avoid sputum cultures because they do not guide management.
D. Stop airway clearance during any infective symptoms.
E. Use antihistamines as first-line treatment.
30. A 31-year-old man with cystic fibrosis is prescribed pancreatic enzymes and nebulised medicines. He often misses treatments because the regimen is time-consuming.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Advise stopping lower-priority treatments without telling the specialist team.
B. Recommend taking all medicines once daily to simplify the regimen.
C. Explore adherence barriers and support a practical treatment routine with the specialist team.
D. Replace nebulised medicines with over-the-counter cough preparations.
E. Focus only on pancreatic enzymes because respiratory treatment burden is unavoidable.
31. A 40-year-old woman has persistent dry cough for 10 weeks after starting ramipril. She has no fever, weight loss, haemoptysis or abnormal chest examination.
Which ONE of the following is the most appropriate medicines-related consideration?
A. ACE inhibitor-induced cough.
B. Inhaled corticosteroid-associated oral candidiasis.
C. Long-acting beta₂ agonist monotherapy.
D. Theophylline toxicity.
E. Beta-blocker-induced bronchospasm.
32. A 68-year-old man with COPD asks why his inhaler has changed from a metered-dose inhaler to a dry powder inhaler. He has severe arthritis and poor hand strength but good inspiratory flow.
Which ONE of the following is the most appropriate principle?
A. Device choice should be based only on drug cost.
B. All COPD patients should use dry powder inhalers.
C. Device choice should consider inspiratory flow, dexterity, preference and correct technique.
D. Metered-dose inhalers are ineffective in COPD.
E. Device choice matters only for children.
33. A 72-year-old woman with asthma has been prescribed prednisolone for an exacerbation. She also takes warfarin and has a history of peptic ulcer disease.
Which ONE of the following is the most appropriate pharmacist contribution?
A. Stop prednisolone because anticoagulated patients cannot receive corticosteroids.
B. Advise doubling warfarin during prednisolone treatment.
C. Continue treatment but review bleeding risk, interacting medicines and monitoring needs.
D. Replace prednisolone with a proton pump inhibitor only.
E. Delay exacerbation treatment until the next INR result.
34. A 44-year-old man presents with loud snoring, witnessed apnoeas, morning headaches and excessive daytime sleepiness. His partner says he falls asleep while watching television.
Which ONE of the following condition should be considered?
A. Nocturnal asthma alone.
B. Obstructive sleep apnoea.
C. Acute pulmonary embolism.
D. Community-acquired pneumonia.
E. Pneumothorax.
35. A 24-year-old tall, slim man develops sudden pleuritic chest pain and shortness of breath while at rest. Breath sounds are reduced on one side.
Which ONE of the following is the most appropriate action?
A. Treat as reflux-related chest pain and supply antacid.
B. Arrange routine spirometry for suspected asthma.
C. Provide NSAID advice and review in one week.
D. Arrange urgent assessment for possible pneumothorax.
E. Start delayed antibiotics for possible bronchitis.
36. A 62-year-old man with COPD and chronic breathlessness asks about vaccinations that may reduce respiratory infection risk.
Which ONE of the following is the most appropriate advice?
A. Vaccination is unnecessary if he uses inhaled therapy correctly.
B. Vaccines are only useful after an exacerbation has started.
C. Annual influenza vaccination and appropriate pneumococcal vaccination should be encouraged if eligible.
D. Vaccination replaces the need for smoking cessation.
E. Live vaccines are routinely required for all COPD patients.
37. A 57-year-old woman with asthma is prescribed a new inhaled corticosteroid inhaler. She is unsure how often to use it because she only feels breathless twice a week.
Which ONE of the following is the most appropriate counselling point?
A. Use it regularly as prescribed to reduce airway inflammation and exacerbation risk.
B. Use it only when acutely breathless.
C. Use it only after salbutamol fails.
D. Stop it once symptoms improve for 48 hours.
E. Take extra doses before every meal.
38. A 65-year-old man taking high-dose inhaled corticosteroids for COPD has repeated chest infections. He asks whether inhaled steroids can affect infection risk.
Which ONE of the following is the most appropriate response?
A. Inhaled corticosteroids prevent all infective exacerbations.
B. Chest infections prove the inhaled corticosteroid dose is too low.
C. Infection risk is unrelated to respiratory medicines.
D. He should stop all inhalers immediately.
E. Inhaled corticosteroid-containing treatment can increase pneumonia risk in some COPD patients and should be reviewed if infections recur.
39. A 30-year-old woman with asthma is pregnant and has stopped her preventer inhaler because she is worried it may harm the baby. She now has worsening night-time symptoms.
Which ONE of the following is the most appropriate advice?
A. Avoid all asthma medicines until after delivery.
B. Restart appropriate asthma treatment after clinical review because uncontrolled asthma can harm mother and baby.
C. Use only short-acting reliever therapy throughout pregnancy.
D. Treat breathlessness in pregnancy with sedating antihistamines.
E. Delay asthma review unless she requires hospital admission.
40. A 75-year-old man with COPD has worsening dyspnoea despite maximal inhaled therapy. He is anxious, has advanced disease and has had several hospital admissions.
Which ONE of the following is the most appropriate additional consideration?
A. Avoid discussing prognosis because COPD is not life-limiting.
B. Stop all respiratory medicines and focus only on sedation.
C. Use antibiotics continuously to control breathlessness.
D. Consider holistic supportive and palliative care needs alongside optimisation of COPD therapy.
E. Escalate inhaled therapy repeatedly without assessing symptom burden.
41. A 54-year-old man has a persistent cough for 9 weeks after a viral infection. He has no haemoptysis, weight loss, fever, breathlessness or smoking history.
Which ONE of the following is the most appropriate approach?
A. Start empirical antibiotics for 6 weeks.
B. Assess for red flags and consider causes of chronic cough if symptoms persist.
C. Refer urgently for suspected cancer in all cases.
D. Treat as COPD without spirometry.
E. Start long-term oral corticosteroids.
42. A 67-year-old woman with COPD uses a salbutamol metered-dose inhaler. Her technique is poor because she cannot coordinate actuation and inhalation.
Which ONE of the following is the most appropriate pharmacist intervention?
A. Increase the number of puffs to compensate for poor technique.
B. Advise inhaling through the nose after actuation.
C. Continue the device because technique does not affect delivery.
D. Consider a spacer or alternative device and reassess technique.
E. Stop reliever therapy because coordination is poor.
43. A 35-year-old man with asthma has salbutamol inhalers issued every month but rarely collects his preventer inhaler.
Which ONE of the following is the most appropriate interpretation?
A. This may indicate reliever overuse and poor preventer adherence, increasing exacerbation risk.
B. This confirms asthma is well controlled.
C. Preventer therapy can be stopped if salbutamol is collected regularly.
D. Salbutamol collection frequency does not provide useful information.
E. Monthly salbutamol issue is expected in all adults with asthma.
44. A 61-year-old man with COPD is started on a long-acting muscarinic antagonist inhaler. He has narrow-angle glaucoma and severe urinary retention symptoms.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure that inhaled antimuscarinics have no systemic cautions.
B. Advise deliberately spraying the inhaler into the eyes to improve absorption.
C. Add another antimuscarinic to improve bronchodilation.
D. Switch automatically to long-term oral corticosteroids.
E. Review suitability and counsel on antimuscarinic adverse effects.
45. A 47-year-old woman with suspected asthma reports that her symptoms improve when she uses her friend’s salbutamol inhaler. She has never had objective testing or a clinical diagnosis.
Which ONE of the following is the most appropriate advice?
A. Diagnose asthma solely because salbutamol helped.
B. Continue borrowing salbutamol while waiting for symptoms to worsen.
C. Advise clinical assessment and objective testing where appropriate before confirming diagnosis.
D. Start long-term oral corticosteroids without assessment.
E. Avoid preventer therapy permanently because symptoms are intermittent.
46. A 71-year-old man is prescribed oral morphine for refractory breathlessness in advanced COPD. His family are worried it means he is “being overdosed”.
Which ONE of the following is the most appropriate explanation?
A. Opioids should never be used for breathlessness in respiratory disease.
B. Carefully prescribed low-dose opioids may be used for refractory breathlessness in advanced disease with monitoring.
C. Morphine reverses the airflow obstruction in COPD.
D. Morphine replaces the need to assess oxygen requirements.
E. Morphine has no adverse effects at low doses.
47. A 29-year-old woman with asthma presents with worsening wheeze. Her peak expiratory flow is 45% of her best, respiratory rate is 28 and she is too breathless to speak full sentences.
Which ONE of the following is the most appropriate interpretation?
A. Mild asthma symptoms suitable for routine review.
B. Well-controlled asthma with anxiety-related symptoms.
C. Severe asthma attack requiring urgent treatment.
D. Exercise-induced bronchoconstriction only.
E. Upper respiratory tract infection without asthma deterioration.
48. A 74-year-old man with COPD is discharged after an exacerbation. He is given a rescue pack of antibiotics and steroids. He asks when to use it.
Which ONE of the following is the most appropriate counselling point?
A. Take both medicines every month to prevent exacerbations.
B. Use antibiotics whenever breathlessness increases, even without sputum change.
C. Use the rescue pack only if oxygen saturations are normal.
D. Use according to an agreed COPD action plan and seek help if symptoms are severe or not improving.
E. Share the rescue pack with household members who develop cough.
49. A 66-year-old woman with bronchiectasis has thick sputum and struggles to clear her chest. She has not seen a respiratory physiotherapist.
Which ONE of the following is the most appropriate non-pharmacological consideration?
A. Airway clearance techniques taught by a specialist physiotherapist.
B. Restrict fluid intake to reduce sputum volume.
C. Stop coughing to prevent airway irritation.
D. Use loperamide to reduce sputum production.
E. Avoid all physical activity.
50. A 59-year-old man with COPD has an FEV₁ of 28% predicted and oxygen saturations of 91% at rest. He asks whether he should buy oxygen online.
Which ONE of the following is the most appropriate advice?
A. Buy oxygen and use it when breathless.
B. Use oxygen only at night without formal assessment.
C. Borrow oxygen from someone with similar COPD.
D. Increase inhaler doses instead because oxygen is never used in COPD.
E. Long-term oxygen therapy requires formal specialist assessment and should not be self-started.
Respiratory Questions
Answers and Rationale
1. C
The patient has features of a severe asthma attack, including inability to complete full sentences, tachypnoea, tachycardia and low oxygen saturation. This requires urgent treatment with bronchodilators and oxygen as clinically appropriate, not routine review.
2. E
Increased breathlessness, sputum volume and sputum purulence suggest a COPD exacerbation with possible bacterial infection. Antibiotics may be appropriate depending on severity, sputum features and local guidance.
3. A
COPD diagnosis is supported by spirometry demonstrating persistent airflow obstruction. Chest X-ray and sputum culture may help assess complications or infection but do not confirm COPD alone.
4. D
Frequent reliever use and night-time symptoms suggest poor asthma control. The patient requires structured asthma review, inhaler technique assessment and consideration of anti-inflammatory treatment.
5. B
Hypoxic COPD patients should receive oxygen, but those at risk of carbon dioxide retention need controlled oxygen with an appropriate target saturation range while blood gases are assessed.
6. E
Inhaled corticosteroids can cause oral candidiasis, particularly at higher doses. Mouth rinsing, spacer use where appropriate and inhaler technique review reduce future risk.
7. A
Smoking cessation is the most effective intervention to slow COPD progression. Behavioural support plus pharmacological treatment improves the chance of successful quitting.
8. D
Pulmonary rehabilitation improves exercise capacity, breathlessness and quality of life in suitable COPD patients. It is a key non-pharmacological intervention for function-limiting breathlessness.
9. B
In COPD patients with frequent exacerbations and raised eosinophils, inhaled corticosteroid-containing therapy may reduce exacerbation risk. Benefits should be weighed against harms such as pneumonia.
10. C
Long-acting beta₂ agonists should not be used alone in asthma because they do not treat airway inflammation and may increase risk without inhaled corticosteroid cover.
11. D
Breathing into a dry powder inhaler can introduce moisture and affect dose delivery. The patient should exhale away from the device and use the correct inspiratory technique.
12. A
Smoking near oxygen is a major fire and burn risk. This needs urgent safety counselling and communication with the oxygen service or clinical team.
13. E
Sudden pleuritic chest pain, haemoptysis and recent surgery are concerning for pulmonary embolism. This requires urgent clinical assessment.
14. C
Persistent cough, haemoptysis, weight loss and heavy smoking history are red flags for lung cancer. Urgent suspected cancer referral is appropriate.
15. B
Intranasal corticosteroids are effective for persistent or moderate allergic rhinitis symptoms, especially nasal congestion. Correct technique and regular use are important.
16. D
Young children often struggle to coordinate a pressurised metered-dose inhaler. A spacer, with a mask if needed, improves lung delivery and should be supported by technique checks.
17. A
Ciprofloxacin can inhibit theophylline metabolism and increase toxicity risk. Symptoms may include nausea, tremor, tachycardia, arrhythmias and seizures, so the combination should be reviewed.
18. C
Smoking induces theophylline metabolism. When smoking stops, theophylline concentrations can rise, so monitoring and dose review may be needed.
19. E
Confusion, tachypnoea, hypotension and hypoxia suggest severe pneumonia or sepsis. This patient requires urgent hospital assessment rather than routine outpatient treatment.
20. B
Chronic cough, night sweats, weight loss, haemoptysis and epidemiological risk factors suggest possible tuberculosis. Urgent assessment and infection-control precautions are needed.
21. E
Before escalating COPD therapy, inhaler technique, adherence and understanding should be reviewed. Poor technique or using maintenance inhalers only when breathless can mimic treatment failure.
22. B
Daily reliever use and repeated oral steroid courses suggest poor asthma control and increased exacerbation risk. A structured asthma review is required.
23. D
Montelukast has been associated with neuropsychiatric adverse effects, including mood changes, nightmares and agitation. New symptoms should prompt urgent review.
24. C
Symptoms triggered by workplace exposure and improving away from work suggest occupational asthma. Early identification and clinical assessment are important.
25. A
In COPD, inhaled corticosteroid-containing therapy can increase pneumonia risk. Recurrent pneumonia with low eosinophils should prompt review of whether the benefit still outweighs the risk.
26. D
Oral corticosteroids are commonly used as short courses for COPD exacerbations. They are not normally continued indefinitely because of significant long-term adverse effects.
27. E
Exercise symptoms, poor inhaler technique and lack of recent review suggest suboptimal asthma management. A personalised action plan and technique review are important.
28. B
Unintentional weight loss and low BMI in COPD are associated with poorer outcomes. Nutritional assessment and support may improve function and resilience.
29. A
In bronchiectasis, increased sputum volume, purulence and breathlessness suggest an infective exacerbation. Previous sputum microbiology can guide antibiotic selection.
30. C
Cystic fibrosis treatment burden can be high. Exploring adherence barriers and agreeing a practical routine with the specialist team can improve treatment use and outcomes.
31. A
A persistent dry cough that starts after ramipril is consistent with ACE inhibitor-induced cough. Treatment should be reviewed if the cough is troublesome.
32. C
Inhaler device selection should consider inspiratory flow, dexterity, cognition, patient preference and ability to demonstrate correct technique.
33. C
Prednisolone may be needed for the asthma exacerbation, but warfarin use and ulcer history mean bleeding risk, gastroprotection and monitoring should be reviewed.
34. B
Loud snoring, witnessed apnoeas, morning headache and daytime sleepiness are typical features of obstructive sleep apnoea. Clinical assessment is appropriate.
35. D
Sudden pleuritic chest pain, dyspnoea and unilateral reduced breath sounds suggest pneumothorax. This requires urgent assessment.
36. C
COPD increases the risk of complications from respiratory infections. Influenza and pneumococcal vaccination should be encouraged when the patient is eligible.
37. A
Inhaled corticosteroids reduce airway inflammation and exacerbation risk when taken regularly as prescribed. They should not be used only as acute relievers.
38. E
Inhaled corticosteroid-containing therapy can increase pneumonia risk in some COPD patients. Recurrent infections should prompt review of the ongoing risk-benefit balance.
39. B
Stopping asthma preventer therapy in pregnancy can worsen control. Poorly controlled asthma may harm both mother and baby, so treatment should be reviewed and optimised.
40. D
Advanced COPD can cause refractory breathlessness, anxiety and repeated admissions. Supportive and palliative care needs should be considered alongside disease optimisation.
41. B
A cough lasting more than 8 weeks is chronic. Red flags should be assessed, and persistent symptoms may require evaluation for causes such as asthma, reflux, ACE inhibitor use or malignancy.
42. D
Poor coordination with a metered-dose inhaler reduces lung delivery. A spacer or alternative device may improve effectiveness and should be accompanied by technique reassessment.
43. A
Frequent salbutamol collection with poor preventer collection suggests reliever overuse and poor preventer adherence. This increases the risk of exacerbations and should prompt review.
44. E
Long-acting muscarinic antagonists can worsen urinary retention and may be problematic in narrow-angle glaucoma. Suitability and counselling should be reviewed.
45. C
Asthma diagnosis should not rely only on symptom improvement with borrowed salbutamol. Clinical assessment and objective testing are important before confirming diagnosis and long-term treatment.
46. B
In advanced respiratory disease, carefully prescribed low-dose opioids may be used for refractory breathlessness when other measures are optimised. Monitoring for sedation, constipation and respiratory effects is important.
47. C
Peak flow below 50% of best with inability to speak full sentences indicates a severe asthma attack. Urgent treatment and escalation are required.
48. D
COPD rescue packs should be used according to an agreed action plan. Severe symptoms, uncertainty or lack of improvement should prompt medical help.
49. A
Airway clearance is central in bronchiectasis management. A specialist respiratory physiotherapist can teach techniques to help clear sputum and reduce exacerbation risk.
50. E
Long-term oxygen therapy requires formal specialist assessment, often including oxygen saturations and blood gas assessment. It should not be purchased or self-started without review.
Here are 50 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.