COVID-19 practice exam questions and answers

1. A 60-year-old male is admitted from home with suspected COVID-19 infection due to fever and dyspnoea. He has otherwise been well and has no other medical history of note. He is being assessed in the admissions unit and COVID-19 infection is probable. He complains of a 5-day history of progressive fever and more recently has been concerned by dyspnoea. Examination reveals a temperature of 38.5 °C, a pulse rate of 98 bpm regular, blood pressure of 112/78 mmHg, respiratory rate of 18/min and his oxygen saturations are 92% on room air. His chest is clear on examination. Investigations return with normal FBC and a CRP of 30 mg/l (normal range <5). Which of the following would prompt his admission rather than discharge?

CRP of 30 mg/l

Oxygen saturations of 92% on room air

Pulse 98 bpm regular

Respiratory rate of 18/min

Temperature of 38.5 °C

A oxygen saturation level of 92% on room air indicates that the patient is not receiving enough oxygen, which is concerning for respiratory distress. This is a significant finding that would prompt admission rather than discharge, as the patient may require supplemental oxygen or further interventions to improve their oxygenation.

Explanation

A oxygen saturation level of 92% on room air indicates that the patient is not receiving enough oxygen, which is concerning for respiratory distress. This is a significant finding that would prompt admission rather than discharge, as the patient may require supplemental oxygen or further interventions to improve their oxygenation.

2. A 23-year-old female physiotherapist presents with symptoms of fatigue and anosmia. She has no other symptoms and her temperature is 36.7°C. As she works with patients, she is tested for COVID-19 infection and is found to be positive through RT-PCR testing of pharyngeal and nasal swabs. Anosmia is an increasingly recognised sign of COVID-19 infection. What is considered to be the underlying mechanism for anosmia?

Apoptosis of frontal lobe neurones related to viral infection

Viral injury of nasal respiratory epithelium

Viral injury of nasal sensory olfactory epithelium

Viral injury of the olfactory bulbs

Rhinosinusitis

The correct answer is viral injury of nasal sensory olfactory epithelium. Anosmia, or loss of smell, is a common symptom of COVID-19 infection. This is believed to be caused by the viral injury to the nasal sensory olfactory epithelium, which is the tissue responsible for detecting smells. The SARS-CoV-2 virus can directly invade and damage these cells, leading to a loss of smell sensation. This mechanism is supported by the findings of RT-PCR testing of nasal swabs, which confirmed the presence of the virus in the nasal passages.

Explanation

The correct answer is viral injury of nasal sensory olfactory epithelium. Anosmia, or loss of smell, is a common symptom of COVID-19 infection. This is believed to be caused by the viral injury to the nasal sensory olfactory epithelium, which is the tissue responsible for detecting smells. The SARS-CoV-2 virus can directly invade and damage these cells, leading to a loss of smell sensation. This mechanism is supported by the findings of RT-PCR testing of nasal swabs, which confirmed the presence of the virus in the nasal passages.

3. A 45-year-old male presents with deterioration of breathlessness. His initial symptoms began 7 days ago with a dry cough and fever. He has more recently developed dyspnoea. RT-PCR of throat and nasal swabs returned 2 days ago confirming COVID-19 infection. His symptoms of breathlessness have progressed over the last 2 days. On examination, his temperature is 37.9 °C, pulse 90 bpm reg, blood pressure 112/80 mmHg, oxygen saturations are 90% at rest on room air and he has a respiratory rate of 26/min. Which of the following signs would define this patient as severe infection?

BP 112/80 mmHg

Pulse 90 bpm

Respiratory rate 26/min

Saturations 90% at rest

Temperature 37.9 °C

The patient is defined as having severe infection based on the saturation level of 90% at rest. This indicates that the patient is not able to maintain adequate oxygen levels in their blood, which can be a sign of respiratory distress and severe illness. The other vital signs (blood pressure, pulse, respiratory rate, and temperature) are within normal ranges and do not necessarily indicate severe infection.

Explanation

The patient is defined as having severe infection based on the saturation level of 90% at rest. This indicates that the patient is not able to maintain adequate oxygen levels in their blood, which can be a sign of respiratory distress and severe illness. The other vital signs (blood pressure, pulse, respiratory rate, and temperature) are within normal ranges and do not necessarily indicate severe infection.

4. You are called by a neighbour to attend to his wife who is 78-years-old and has collapsed in their house. She has been ill and has had flu-like symptoms. She has had breathlessness, which has rapidly deteriorated and culminated in her collapse. She collapsed about 3 minutes ago and the neighbour knows you are a medic and has sought your help. You enter the room and find the patient unresponsive, with no respiratory effort and she is pulseless. You suspect that she has arrested as a consequence of COVID-19 infection. The neighbour has dialled 999 and an ambulance has been dispatched. How do you resuscitate this patient?

Do not give CPR and try and get a defibrillator from a park nearby

Provide chest compressions only

Provide CPR at a ratio of 15 chest compressions : 1 breath

Provide CPR at a rate of 30 chest compressions : 2 breaths

In this scenario, the correct approach is to provide chest compressions only. This is because the patient is suspected to have COVID-19 infection, and performing rescue breaths can increase the risk of aerosolization and transmission of the virus. Providing chest compressions alone can still help maintain blood circulation and increase the chances of survival until the ambulance arrives.

Explanation

In this scenario, the correct approach is to provide chest compressions only. This is because the patient is suspected to have COVID-19 infection, and performing rescue breaths can increase the risk of aerosolization and transmission of the virus. Providing chest compressions alone can still help maintain blood circulation and increase the chances of survival until the ambulance arrives.

5. A 72-year-old female is admitted with severe COVID-19 infection having developed fever and progressive breathlessness 7 days earlier. She has a history of hypertension, for which she takes ramipril 10 mg daily and amlodipine 10 mg daily. Her clinical condition deteriorates despite high flow of oxygen. The critical care team is called, and it is decided to transfer the patient to ITU for ventilation. Roughly, what is the crude mortality rate amongst such patients requiring mechanical ventilation?

1%

10%

20%

50%

70%

The crude mortality rate among patients requiring mechanical ventilation in this case is 70%. This means that out of all the patients who require mechanical ventilation, 70% do not survive. This high mortality rate suggests that the patient's condition is severe and that the chances of survival are low despite the intervention of mechanical ventilation.

Explanation

The crude mortality rate among patients requiring mechanical ventilation in this case is 70%. This means that out of all the patients who require mechanical ventilation, 70% do not survive. This high mortality rate suggests that the patient's condition is severe and that the chances of survival are low despite the intervention of mechanical ventilation.

6. A 55-year-old female is admitted to the hospital with fever and dyspnoea. On initial examination, her temperature is 38.3 °C, pulse 88 bpm, blood pressure 112/80 mmHg and oxygen saturations are 94% on 5 L of oxygen. She is suspected to have COVID-19 infection. As part of the investigations, a chest x-ray is performed which shows the following:

Bilateral pleural effusions

Hilar lymphadenopathy

Lobar collapse

Lobar consolidation

Peripheral ground glass opacification

The presence of peripheral ground glass opacification on the chest x-ray suggests the possibility of COVID-19 infection. Ground glass opacification is a radiological finding commonly seen in viral pneumonia, including COVID-19. It appears as hazy opacities in the lungs, often with a patchy or peripheral distribution. This finding is consistent with the patient's symptoms of fever and dyspnea, as well as the suspected diagnosis of COVID-19. The other findings on the chest x-ray such as bilateral pleural effusions, hilar lymphadenopathy, lobar collapse, and lobar consolidation may also be seen in severe cases of COVID-19, but the peripheral ground glass opacification is the most specific finding for this infection.

Explanation

The presence of peripheral ground glass opacification on the chest x-ray suggests the possibility of COVID-19 infection. Ground glass opacification is a radiological finding commonly seen in viral pneumonia, including COVID-19. It appears as hazy opacities in the lungs, often with a patchy or peripheral distribution. This finding is consistent with the patient's symptoms of fever and dyspnea, as well as the suspected diagnosis of COVID-19. The other findings on the chest x-ray such as bilateral pleural effusions, hilar lymphadenopathy, lobar collapse, and lobar consolidation may also be seen in severe cases of COVID-19, but the peripheral ground glass opacification is the most specific finding for this infection.

7. A 42-year-old female calls her GP surgery for a telephone consultation. She has a two-day history of fever, sore throat and dry cough. She has a past history of Addison's disease for which she takes hydrocortisone 10 mg bd. She is suspected to have COVID-19 infection. She has mild symptoms presently and doesn't feel too bad. Her call is to enquire how to best manage her steroid replacement. She is speaking in full sentences and explains that her temperature is currently 37.5 °C. Last week her husband, who is a healthcare assistant, was diagnosed with COVID-19 following a positive throat swab. Which of the following is the most appropriate approach to the management of her steroid replacement therapy?

Advise her to half the dose of her hydrocortisone

Continue on the current dose of hydrocortisone

Double the dose of the hydrocortisone for the duration of the illness

Switch hydrocortisone to once daily dexamethasone as evidence suggests that hydrocortisone may be associated with a worse prognosis

Switch hydrocortisone to once daily prednisolone

Given that the patient is suspected to have a COVID-19 infection and she has mild symptoms, it is most appropriate to double the dose of hydrocortisone for the duration of the illness. This is because during times of illness or stress, individuals with Addison's disease may require increased steroid replacement therapy. By doubling the dose, it helps to ensure adequate cortisol levels in the body to manage the stress of the illness.

Explanation

Given that the patient is suspected to have a COVID-19 infection and she has mild symptoms, it is most appropriate to double the dose of hydrocortisone for the duration of the illness. This is because during times of illness or stress, individuals with Addison's disease may require increased steroid replacement therapy. By doubling the dose, it helps to ensure adequate cortisol levels in the body to manage the stress of the illness.

8. An 81-year-old female is seen with a 7-day history of fever, cough and dyspnoea. She was confirmed to have COVID-19 infection on RT-PCR. Her dyspnoea had deteriorated during her admission and her oxygen saturations are now 80% on 10 L of face mask-delivered oxygen. Critical care has reviewed the patient and feels that she would not be a suitable candidate for ventilatory support, as prior to this acute infection she had become increasingly frail over the last 1-2 years. Following a discussion with the family, a palliative approach was elected. She is struggling for breath and is distressed. Which of the following would be the most appropriate approach to relieve breathlessness in this patient?

Glycopyrronium

Lorazepam

Oral morphine sulphate immediate release

Salbutamol nebuliser

SC morphine sulphate

The most appropriate approach to relieve breathlessness in this patient would be to administer SC morphine sulphate. This patient is experiencing severe dyspnea and distress, and a palliative approach has been elected due to her frailty and inability to tolerate ventilatory support. SC morphine sulphate is commonly used in palliative care to provide symptomatic relief for breathlessness and distress in patients with advanced illness. It acts as a potent analgesic and also has sedative effects, which can help alleviate the patient's symptoms and improve her comfort.

Explanation

The most appropriate approach to relieve breathlessness in this patient would be to administer SC morphine sulphate. This patient is experiencing severe dyspnea and distress, and a palliative approach has been elected due to her frailty and inability to tolerate ventilatory support. SC morphine sulphate is commonly used in palliative care to provide symptomatic relief for breathlessness and distress in patients with advanced illness. It acts as a potent analgesic and also has sedative effects, which can help alleviate the patient's symptoms and improve her comfort.

9. A 72-year-old man was admitted 3 days ago with dyspnoea and fever. Throat swab confirmed COVID-19 infection. His breathlessness has been treated with 10% oxygen via face mask and he has maintained oxygen saturations of around 95%. He has a past history of ischaemic heart disease, having been treated with stent insertion 5 years ago. He has become rather agitated and slightly confused, which has made things difficult to manage. The nurses also explain it has been increasingly difficult to get him to take his oral treatments due to his delirium. Non-pharmacological approaches have been implemented but still, he remains agitated and confused, endeavouring to climb out of bed or pull his lines. On examination, he appears confused, has a temperature of 37.8 °C, pulse of 88 bpm regular, blood pressure of 122/88 mmHg and oxygen saturations of 95% on 10 L of oxygen. Which of the following would be the most appropriate approach to managing his agitation/delirium?

IM haloperidol

Oral lorazepam

SC levomepromazine

SC midazolam

SC morphine

The most appropriate approach to managing the patient's agitation/delirium would be to administer SC levomepromazine. This medication is an antipsychotic that can help to calm the patient and reduce their agitation and confusion. It is often used in the management of delirium and can help to improve the patient's overall comfort and ability to participate in their care.

Explanation

The most appropriate approach to managing the patient's agitation/delirium would be to administer SC levomepromazine. This medication is an antipsychotic that can help to calm the patient and reduce their agitation and confusion. It is often used in the management of delirium and can help to improve the patient's overall comfort and ability to participate in their care.

10. You are called to the arrest of a patient on the medical ward. The patient is a 63-year-old male with a 9-day history of deteriorating breathlessness, fever and dry cough. His throat swab on admission returned positive for COVID-19. He has a background history of hypertension for which he takes ramipril and amlodipine. He has had deteriorating breathlessness but has just arrested on your ward. You attend with a surgical mask, gloves and a plastic apron. You quickly check ABC and there is no pulse, no respiratory effort and his airway appears clear. The nurse has connected him to the defibrillator pads, which show the trace below, and he has a venflon inserted into his left antecubital fossa. A crash call has gone out to the resuscitation team, but they are not expected to arrive quickly. Which of the following is the most appropriate approach to the management of the patient?

Commence chest decompressions and use an oxygen mask with bag for ventilation

Give a precordial thump and commence chest decompressions only

Give an initial DC shock and, if rhythm is not restored, commence full CPR with chest compressions and bagged ventilation

Give an initial DC shock and, if unsuccessful, commence chest compressions only

Give an initial DC shock and up to 2 further DC shocks. Do not undertake chest compressions or bagging

The most appropriate approach to the management of the patient is to give an initial DC shock and up to 2 further DC shocks. This is because the patient is in cardiac arrest, as evidenced by the absence of a pulse and respiratory effort. The defibrillator pads show a shockable rhythm, indicating that the patient's heart may be successfully restarted with defibrillation. Chest compressions and bagged ventilation are not recommended in this scenario, as they are not indicated for shockable rhythms. The resuscitation team is not expected to arrive quickly, so immediate defibrillation is the best course of action.

Explanation

The most appropriate approach to the management of the patient is to give an initial DC shock and up to 2 further DC shocks. This is because the patient is in cardiac arrest, as evidenced by the absence of a pulse and respiratory effort. The defibrillator pads show a shockable rhythm, indicating that the patient's heart may be successfully restarted with defibrillation. Chest compressions and bagged ventilation are not recommended in this scenario, as they are not indicated for shockable rhythms. The resuscitation team is not expected to arrive quickly, so immediate defibrillation is the best course of action.