Free Specialty Certificate Examination in Respiratory Medicine Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Specialty Certificate Examination in Respiratory Medicine practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 32-year-old has episodic wheeze and nocturnal cough. Blood eosinophils are within the reference range. Under the 2024 joint guideline, what is the minimum FeNO level that can confirm asthma in this clinical context?

   1. A.25 ppb
   2. B.35 ppb
   3. C.50 ppbCorrect answer: C
   4. D.20 ppb

   Explanation: The guideline states: "Diagnose asthma if the eosinophil count is above the laboratory reference range or the FeNO level is 50 ppb or more." The adult threshold is 50 ppb; 35 ppb is the child threshold, and the lower values do not meet this rule-in criterion.

   Reference: BTS/NICE/SIGN asthma guideline 2024 – Healthcare Improvement Scotland — 1.2.1

2. 2An adult with suspected fibrotic interstitial lung disease has an abnormal chest X-ray. Which imaging investigation is used next to look for lung scarring?

   1. A.Chest CT scanCorrect answer: A
   2. B.Ventilation-perfusion scan
   3. C.Echocardiography
   4. D.PET-CT scan

   Explanation: The source states: "a chest X-ray, followed by a chest CT scan to look for scarring in your lungs" CT characterises pulmonary scarring; the other tests target perfusion, cardiac function or metabolic activity.

   Reference: NHS – Idiopathic pulmonary fibrosis — How IPF is diagnosed

3. 3A stable adult has primary spontaneous pneumothorax with minimal symptoms and no physiological compromise. Under BTS 2023 guidance, how does pneumothorax size affect whether conservative management may be considered?

   1. A.It may be considered regardless of sizeCorrect answer: A
   2. B.It may be considered only below 1 cm
   3. C.It may be considered only below 2 cm
   4. D.It may be considered only below 3 cm

   Explanation: BTS states: "Conservative management can be considered for the treatment of minimally symptomatic (ie, no significant pain or breathlessness and no physiological compromise) or asymptomatic primary spontaneous pneumothorax in adults regardless of size." Clinical stability and minimal symptoms permit consideration of conservative care; size alone does not mandate an invasive approach.

   Reference: British Thoracic Society Guideline for pleural disease — Acute management for spontaneous pneumothorax

4. 4An adult begins treatment for uncomplicated active pulmonary TB. What is the usual minimum total antibiotic duration stated by NHS guidance?

   1. A.3 months
   2. B.6 monthsCorrect answer: B
   3. C.9 months
   4. D.12 months

   Explanation: The source states: "The main treatment for tuberculosis (TB) is to take antibiotics, usually for at least 6 months." Six months is the usual minimum; this question does not cover extended regimens for special sites or resistant disease.

   Reference: NHS – Tuberculosis — Treatment for tuberculosis

5. 5A patient starts anticoagulation for confirmed pulmonary embolism. What minimum treatment duration is stated by current NHS guidance?

   1. A.1 month
   2. B.2 months
   3. C.3 monthsCorrect answer: C
   4. D.6 months

   Explanation: The source states: "You'll need to have anticoagulant treatment for at least 3 months." Three months is the minimum; longer treatment may be indicated after assessment.

   Reference: NHS – Pulmonary vascular disease — Treatment for a pulmonary embolism

6. 6A sleep study gives an adult an apnoea–hypopnoea index of 22. How is this severity categorised in NHS guidance?

   1. A.Normal
   2. B.Mild
   3. C.ModerateCorrect answer: C
   4. D.Severe

   Explanation: NHS states: "AHI of 15 to 30 = moderate" An AHI of 22 lies in the moderate range.

   Reference: NHS – Sleep apnoea — Understanding your AHI score

7. 7CT shows a suspected lung cancer in the central airways. Which investigation may be offered to inspect the airway and obtain a biopsy?

   1. A.Flexible bronchoscopyCorrect answer: A
   2. B.Percutaneous needle biopsy
   3. C.Medical thoracoscopy
   4. D.Mediastinoscopy

   Explanation: NHS Wales states: "If a CT scan shows there might be cancer in the central part of your chest, you may be offered a bronchoscopy." Bronchoscopy permits central airway inspection and sampling. The other procedures obtain tissue by different access routes and do not directly inspect the central airway lumen.

   Reference: NHS 111 Wales – Cancer of the lung — Bronchoscopy and biopsy

8. 8After an hour of optimised medical therapy for a COPD exacerbation, which repeat arterial blood gas pattern meets the NHS Lanarkshire guideline's biochemical criteria for considering acute NIV?

   1. A.pH 7.28, PaCO2 8.0 kPaCorrect answer: A
   2. B.pH 7.38, PaCO2 8.0 kPa
   3. C.pH 7.30, PaCO2 4.0 kPa
   4. D.pH 7.44, PaCO2 5.0 kPa

   Explanation: The guideline states: "NIV should be considered if a repeat ABG still shows H+ >45 (pH<7.35),PaCO2 >6.5kPA." Only pH 7.28 with PaCO2 8.0 meets both conditions. The other patterns show compensated hypercapnia, non-hypercapnic acidosis, or neither criterion.

   Reference: NHS Lanarkshire – Acute NIV guideline — COPD

9. 9Asthma remains suspected in an adult after non-confirmatory eosinophil and FeNO tests. Which investigation is the next recommended step?

   1. A.Spirometry with bronchodilator reversibilityCorrect answer: A
   2. B.Total serum IgE with allergy testing
   3. C.Methacholine bronchial challenge testing
   4. D.Serial chest radiography during symptoms

   Explanation: The guideline states: "If asthma is not confirmed by eosinophil count or FeNO level, measure bronchodilator reversibility (BDR) with spirometry." Spirometric reversibility is the next step; challenge testing follows if preceding investigations remain non-confirmatory. IgE testing and radiography do not replace this step.

   Reference: BTS/NICE/SIGN asthma guideline 2024 – Healthcare Improvement Scotland — 1.2.2

10. 10A patient with IPF is considering nintedanib. What is the intended disease-related effect described by NHS guidance?

    1. A.Reverse established pulmonary scarring
    2. B.Reduce pulmonary scarring progressionCorrect answer: B
    3. C.Eradicate persistent pulmonary infection
    4. D.Dilate obstructed conducting airways

    Explanation: NHS states: "There are 2 medicines that may be prescribed to some people with IPF, to help slow down scarring in the lungs: pirfenidone (Esbriet) nintedanib (Ofev)" Nintedanib aims to slow further scarring. It does not reverse established fibrosis, eradicate infection or act as a bronchodilator.

    Reference: NHS – Idiopathic pulmonary fibrosis — Medicines for IPF