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Resp module 3rd year > 2011 end of module exam > Flashcards

2011 end of module exam Flashcards

1
Q

Which of the following bones is involved in the deviation of the nasal septum?

A

Vomer

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2
Q

Which of the following is involved in asthma?

A

Bronchiole

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3
Q

Which of the following structures transits (passes thru) the aortic hiatus with the aorta in the diaphragm?

A

Thoracic duct

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4
Q

What will be paralyzed if the dorsal ramus of a spinal nerve is injured?

A

Levator costarum

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5
Q

Which muscle is involved in forced inspiration?

A

Scalenus anterior

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6
Q

Which structure does the internal laryngeal nerve pass thru?

A

Thyrohyoid membrane

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7
Q

Which of the following is responsible for congenital high airway obstruction?

A

Laryngeal atresia

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8
Q

From which structure does the central tendon of the diaphragm develop?

A

Septum transversum

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9
Q

Which of the following is most vulnerable to injury in trauma above the clavicle?

A

Cervical pleura

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10
Q

Paralysis of which muscle results in loss of the kite-shaped Rima glottides?

A

Posterior cricoarytenoid

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11
Q

Which of the following is used as a guide to separate bronchopulmonary segments?

A

Pulmonary vein

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12
Q

Which structure is most affected by immotile cilia syndrome?

A

Trachea

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13
Q

Which cell is a part of the blood-air barrier?

A

Pneumocyte I

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14
Q

Which of the following synthesizes surfactant?

A

Pneumocyte II

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15
Q

From which structure does the parietal pleura develop?

A

Somatopleuric mesoderm

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16
Q

The upper free margian of which structure forms the vocal fold?

A

Conus elasticus

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17
Q

What provides extra space for expanding vessels?

A

Pulmonary ligament

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18
Q

A 17 year old male who is atopic, smokes, and has a family history of asthma. Which of the following would most strongly predispose him to asthma?

A

Atopy

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19
Q

How long will it take for the risk of heart disease in a smoker to go down to the risk level of a non-smoker?

A

15 years

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20
Q

In a randomized controlled trial to test the effectiveness of a drug in treatment of lung cancer, study participants were placed in two groups, and the result was evaluated by performing a CT scan. What problem might generate if the radiologist weren’t blinded about the groups while doing the CT scan?

A

It will generate the idea that the treatment is better than it actually is

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21
Q

Which of the following cancers is least associated with smoking?

A

Mesothelioma (It is NOT associated, thus it is the least associated)
Adenocarcinoma

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22
Q

A 30-year-old male presents with fever, productive cough, chest pain. Gram positive diplococcic were isolated from a sputum sample. What is the diagnosis?

A

Typical lobar pneumonia

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23
Q

a 69-year-old male smoker presented with dyspnea. H.infleunzae was isolated. What is the diagnosis?

A

Acute exacerbation of chronic bronchitis

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24
Q

Which of the following attract cells to the site of inflammation?

A

Chemokines

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25
Q

Which of the following digests the bacterial cell wall?

A

Lysozymes

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26
Q

What antibiotic is given to a 5-year old child with strep throat?

A

Amoxicillin

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27
Q

To which of the following drugs is extremely drug resistant TB resistant to?

A

Isoniazid, rifampin, ciprofloxacin, capreomycin

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28
Q

How does M. tuberculosis resist killing by macrophages?

A

Inhibition of phago-lysosomal fusion

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29
Q

What are the components of the specific protective immune response against TB?

A

Antigen, antigen specific lymphocyte and macrophages

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30
Q

Which of the following is part of the adaptive immunity of the respiratory tract?

A

IgA

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31
Q

What constitutes the protective vaccine against TB?

A

Attenuated mycobacterium bovis
Bacilli-Calmette-Guerin
(Both answers are correct. We asked the doctors about this question. Dr. Rajaa said that the answer is BCG but the choices she put for the question did not include attenuated M.bovis. Dr.Iqbal said the answer is attenuated M.bovis)

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32
Q

Which of the following causes the clinical symptoms of asthma?

A

IgE cross-linkage on the surface of mast cells

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33
Q

How does lung damage progress to fibrosis in interstitial lung disease?

A

Cytokines produced my macrophages

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34
Q

What is the function of the J-chain?

A

Transport IgA to the lumen of the airways

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35
Q

A child with cystic fibrosis develops pneumonia. What is the causative organism?

A

Pseudomonas aeruginosa

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36
Q

A patient who was involved in a car accident had to be placed on a ventilator. A few days later he developed pneumonia with Gram-positive cocci arranged in clusters isolated from a blood culture. What is the causative organism?

A

Staphylococcus aureus

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37
Q

What are the culture characteristics of streptococcus pneumoniae?

A

Alpha hemolytic Gram-positive cocci in chains, optochin sensitive

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38
Q

A 1-year-old child developed a severe illness with high fever. A whitish membrane was found on his tonsils. His vaccination record was missing. What is the causative organism?

A

Corynebacterium diphtheriae

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39
Q

A 20-year old bird handler developed pneumonia. What is the causative organism?

A

Chlamydia psittaci

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40
Q 
Which of the following atypical mycobacteria causes pulmonary disease?
M.kansasii
M.scrofulaceum
M.smegmatus
M.ulcerans M.marinum
A

M.kansasii

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41
Q

Which of the following atypical mycobacteria is responsible for a disseminated disease in immune-compromised individuals?

A

M.avium complex

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42
Q

A 1-year-old child developed fever and a refusal to eat. On examination his tonsils were red and inflamed. What is the causative organism?

A

Streptococcus pyogenes

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43
Q

What is the age of onset of croup in children?

A

6 months to 5 years

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44
Q

Which of the following is the commonest cause of acute otitis media? (strep. Pneumo wasn’t in the choices)
Staphylococcus aureus
Adenovirus

A

Staphylococcus aureus

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45
Q

What is the mechanism of type III hypersensitivity?

A

Immune complex mediated damage to the lung tissue

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46
Q

What is the principle behind immunotherapy in allergy?

A

Induction of IgG antibodies

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47
Q

Which of the following will present as an air bronchogram on a chest radiograph?

A

Consolidation

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48
Q

How will lung cancer present on a CT scan?
Cavitary nodule
Dimishing nodule with calcification

A

Cavitary nodule

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49
Q

A child was diagnosed with leukemia. The mother went to 7 doctors for a different diagnosis but all gave the same diagnosis. She still was not convinced that her child has leukemia. In what stage of the grief cycle is she?

A

Denial

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50
Q

How does aflatoxin B1 cause cancer?

A

By conversion to aflatoxin M1 and then damaging the DNA

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51
Q

How do polycyclic aromatic hydrocarbons damage the DNA?

A

By forming DNA adducts

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52
Q

How does surfactant lower the surface tension?

A

By forming a surface monolayer

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53
Q

-Which of the following is a direct product of LOX-5?

A

HPETE

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54
Q

What is the most common lipid component of surfactant?

A

Glycerophosphlipids

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55
Q

Why would aspirin cause an exacerbation of asthma?

A

Because it increases leukotriene levels (upregulation of leukotrienes)

56
Q

In the Bohr effect, what produces a change in the affinity of hemoglobin for oxygen?

A

Production of acid

57
Q

How would red blood cells respond to hypoxia in tissues?

A

They release ATP

58
Q

What is the effect of alpha-1-antitrypsin deficiency?

A

Increased activity of neutrophil elastase

59
Q

Why is the loss of lung tissue accelerated in smokers with alpha-1- antitrypsin deficiency?

A

Because smoking induces inflammation

60
Q

How does histamine mediate bronchoconstriction?

A

By calcium release

61
Q

Which of the following substances directly stimulates cough receptors?

A

Substance P

62
Q

What is the relationship between pulmonary vascular resistance and lung volume?

A

The lowest pulmonary vascular resistance is at the functional residual capacity

63
Q

What is the most important feature of obstructive sleep apnea?

A

Hemoglobin desaturation

64
Q

What increases hemoglobin affinity for oxygen?

A

Increased intracellular pH

65
Q

A 10-year old boy had a bean lodged in the right main bronchus. He developed severe cyanosis and dyspnea. What is the pathophysiology?

A

Large intrapulmonary shunt
(Obstruction of the bronchus would cause no air to get into the lung i.e. no ventilation. However perfusion is still maintained. Thus this constitutes an intrapulmonary shunt, where blood “bypasses” the respiratory zones of the lungs and then mixes with arterial blood to lower the PaO2)

66
Q

What affects static compliance of the lungs?
Lung volume
Pleural pressure
Shallow breathing Resistance in the airways

A

Lung volume

67
Q

What results in a decrease in the dynamic compliance?

A

Shallow breathing

68
Q 
Arterial and venous blood gas samples were taken from a dyspnoic 60-year old patient while breathing air and 100%O2.
Air:
Hb 170 g/L
PaO2 60 mmHg 
Hb saturation (a) 80%
PaCO2 38 mmHg
PvO2 30 mmHg
Hb saturation (v) 38%
DLCO 25ml/min/mmHg (predicted > 20 ml/min/mmHg)
100%:
PaO2 453 mmHg 
Hb saturation (a) 99%
PaCO2 38 mmHg
PvO2 45 mmHg
Hb saturation (v) 38%

What does he have?

A

Shunt

69
Q

What causes an increase in DLCO?

A

Left to right cardiac shunt

70
Q

A patient with high PaCO2 and low PaO2. What does he have?

A

Hypoventilation

71
Q

A patient with normal pH, low PaO2, low PaCO2, high Hemoglobin. What is the cause?

A

High altitude for 2 months

72
Q

A patient with an arterial oxygen content of 180 mlO2/L and a venous oxygen content of 110 mlO2/L. What does he have?

A

Congestive heart failure

73
Q

What changes the sensitivity of the DRG neurons to changes in the level of CO2?
Metabolic acidosis
Chronic airway obstruction

A

Metabolic acidosis

74
Q

What causes hypoxemia without a change in AaDO2?

A

Hypoventilation

75
Q

A patient has a lung compliance of 0.8L/cmH2O while the normal value is 0.2L/cmH2O. What is the cause for his increased compliance?

A

Destruction of lung tissue

76
Q

calculate the content of O2 (CaO2) (We don’t remember the exact values he gave in the question. However it was very direct and if you remember the equation he gave in the lecture you will solve this question)

A

-

77
Q

What would cause a high AaDO2 with low oxygen?

A

Interstitial lung disease

78
Q

High residual volume. Normal TLC. Low FEV50%. Low PEFR. What does the patient have?

A

Lower airway obstruction

79
Q

At which lung volume would you find the lowest resistance?

A

TLC

80
Q

What mediates vasoconstriction after a drop in alveolar oxygen?

A

Decreased potassium current (closure of potassium channels/decreased potassium permeability)

81
Q

An HIV infected individual presented with a dry cough, fever, and diffuse bilateral infiltrates. Crescent-shaped organisms in silver stain were demonstrated in the alveolar spaces and alveolar wall in a lung biopsy. What is the diagnosis?

A

Pneumocystis jirovecii infection

82
Q

An alcoholic man was found unconscious. He then developed fever of 39.2 degrees. A lesion in the chest x-ray with an air-fluid level was found on the chest X-ray. What is the diagnosis?

A

Lung abscess

83
Q

A smoker presents with a central cancer lesion and hypercalcemia. What is the diagnosis?

A

Squamous cell carcinoma

84
Q

Which of the following is affected in chronic bronchitis?

A

Intermediate-sized airways

85
Q

A farmer presents with progressive dyspnea of 15 years duration. Tissue biopsy showed lymphocyte and plasma cell infiltration with small granulomas. What is the pathogenesis?

A

Hypersensitivity to inhaled spores of thermophilicactinomycetes (fungal spores)

86
Q

Which type of emphysema occurs in smokers and is associated with a black pigment?

A

Centriacinar

87
Q

A patient with alpha-1-antitrypsin deficiency, liver lesions, and uniform enlargement of acini. Which type of emphysema is this?

A

Panacinar

88
Q

What is the Reid index?

A

Ratio of the thickness of mucous glands to the thickness of the bronchial wall

89
Q

What is the gross appearance of the Ghon focus?

A

Subpleural lesion above or below the interlobar fissure

90
Q

in a granuloma, what would a cell with nuclei arranged in a horse- shoe shap be called?

A

Langhan’s giant cell

91
Q

A patient presents with productive cough, fever, and weight loss of 3 months duration. Tissue biopsy reveals the presence of a granuloma with a center of structureless necrosis. What is the diagnosis?

A

Tuberculosis

92
Q

A patient who was previously sensitized to tuberculosis presents with a cavitary lesion on the apex of the left lung. What is the diagnosis?

A

Secondary tuberculosis

93
Q

-Diffuse involvement of the lungs with lesions <2mm. What is the diagnosis?

A

Military tuberculosis

94
Q

Which of the following represents stage I of ssarcoidosis on X-ray?

A

Bilateral hilar lymphadenopathy

95
Q

Which of the following is a common feature of all manifestations of pneumoconiosis?
Interstitial fibrosis
They all confer increased risk to tuberculosis

A

Interstitial fibrosis

96
Q

A 55-year-old woman with progressive dyspnea for 18 months. Her X-ray shows basal bilateral reticular patterns and honeycombing of the lungs. Examination revealed fine crackles. What is the diagnosis?

A

Idiopathic pulmonary fibrosis

97
Q

a patient presented with cough and weight loss. Tissue biopsy showed mucinous growth along the alveolar wall. What is the diagnosis?

A

Bronchogenic carcinoma

98
Q

A 70-year-old man who used to work in a shipyard and then in insulation presented with dyspnea and pleural effusion on the chest X-ray. Following his death, post-mortem examination revealed a thick brown layer encasing the lungs. What is the diagnosis?

A

Mesothelioma

99
Q

Which tumor is characterized by neuroendocrine secretions?

A

Small cell carcinoma

100
Q

A person presents with acute symptoms of respiratory distress and hyaline membranes. What is the diagnosis?

A

Adult respiratory distress syndrome (ARDS)

101
Q

A 65-year-old man with presented with productive cough, dyspnea, and chest pain. His chest radiograph showed consolidation. He was trated with antibiotics and his symptoms subsided. Following treatment you found a small lesion on the chest X-ray. Trans-bronchial biopsy showed malignant cells growing along the alveolar walls. What is the diagnosis?

A

Bronchogenic carcinoma

102
Q

Which type of emphysema is associated with dilation of the distal part of the acinus with the proximal part relatively unaffected?

A

Paraseptal

103
Q

How does phenylephrine work in nasal congestion?

A

Activates alpha-1 receptors on nasal blood vessels

104
Q

Which drug inhibits mycolic acid synthesis?

A

Isoniazid

105
Q

Which of the following drugs inhibits protein synthesis?

A

Capreomycin

106
Q

Which drug is not given with streptomycin because of their combined effect on the eighth cranial nerve?

A

Capreomycin

107
Q

What inhibits phosphodiesterases?

A

Theophylline

108
Q

How does ipratropium work to cause bronchodilation and decreased mucus secretion?

A

Anti-muscarinic action

109
Q

What is the mechanism of resistance to rifampin?

A

Decreased affinity of RNA polymerase for the drug

110
Q

Which of the following anti-cancer drugs is characterized by cardiotoxicity?

A

Doxorubicin

111
Q

Which of the following drugs is a plant derivative that stabilizes tubulin in its polymerized state?

A

Paclitaxel

112
Q

Which cough suppressant stimulates mucus secretion, inhibits ciliary function, and causes constipation?

A

Codeine

113
Q

Which drug inhibits protein synthesis by competing with t-RNA for the A-site?

A

Tetracycline

114
Q

Which drug inhibits bacterial cell wall synthesis?

A

Cefotaxime

115
Q

Which of the following is an intravenous drug given in the case of status asthmaticus?

A

Hydrocortisone

116
Q

What is the mechanism of action of disodium cormoglycate?

A

Stabilization of mast cells

117
Q

What is the result of the combination of trimethoprim and sulfamethoxazole?

A

Inhibition of the sequential steps in folate synthesis

118
Q

What is the most common cancer in a middle-aged male who is a smoker?

A

Squamous cell carcinoma
(The most common cancer overall is adenocarcinoma, however it is more common in women who are non-smokers, thus from the history it is excluded. The second most common overall is squamous cell carcinoma, and it is the most common amongst male smokers)

119
Q

The peak expiratory flow rate for a 20-year-old female who was 165cm was 370 L/min. What is the percentage of the measured value to her predicted value? (there should be a figure here)

  • 85%
  • 90%
A

85%

This was from the second clinical skills lab, just learn how to use the figure and you should be fine

120
Q

What is the most probable cause of sudden chest pain in a 20-year- old smoker male?
Tension pneumothorax
Angina
Acid reflux

A

Tension pneumothorax

121
Q

A 45-year-old diabetic woman was diagnosed with hypertension. She recently developed wheezing and chest tightness. What is the cause?

A

Beta-blocker treatment for her hypertension

122
Q

A person has reduced FEV1, reduced FVC, normal FEV1/FVC ratio, reduced TLC and RV. What is the diagnosis?

A

Restrictive lung disease

123
Q

A woman suffers from nighttime choking as reported by her husband and is tired during the day. What does she have?

A

Obstructive sleep disorder

124
Q

What is the gold standard test for diagnosing sleep disorders?

A

Polysomnography

125
Q

Which of the following is a reliable test for the diagnosis of sleep disorders that requires interpretation with the patient’s history and physical examination?

A

Overnight oximetry

126
Q

A patient presents with fever, non-productive cough, and chest pain. His cough became productive of rusty-colored sputum when he took a mucolytic. Physical examination revealed dullness and crackles throughout inspiration and expiration. What is the cause?

A

Streptococcus pneumoniae

127
Q

A 65-year old smoker was admitted to the hospital after his son noticed his lips were cyanosed. He was severely dyspnic. He has low PO2, high PCO2 and low pH. What could be the cause of the patient’s dyspnea?
Exacerbation of his COPD
tachypnea

A

Exacerbation of his COPD

128
Q

What is the initial management of a patient with COPD who comes in with severe dyspnea?
Bronchodilators (beta-2 agonists)
Oxygen entertainment
Immune suppressants steroids

A

Bronchodilators (beta-2 agonists)

129
Q

Which mode of treatment should you be careful with when administering it to a patient with COPD? (we don’t know the answer) same choices as above, both were EMQ

A

-

130
Q

What would you most likely find in the physical examination of a patient who has an opacity in the area of the middle lobe without tracheal deviation?

A

Dullness at the right axilla
(axilla=area that corresponds to the middle lobe. opacity without tracheal deviation=consolidation. So he has middle lobe consolidation, and consolidation would present as dullness in percussion.)

131
Q

A patient’s chest X-ray showed a meniscus sign at the right costophrenic angle. What would you find in the physical examination?

A

Dullness at the base of the lung

132
Q

A patient who is dyspnic with high CO2, low O2 and low pH. Loss of drive to which of the following resulted in the respiratory dysregulation? Hypercapnia
hypercarbia
Respiratory alkalosis

A

Hypercapnia

133
Q

A lorry driver with dry cough for 2 months, night sweats, weight loss of 5 kg. He also has chest pain. (there was something about a chest x- ray but we don’t remember). What does he have?
Mycobacterium tuberculosis
Viral pleurisy

A

Mycobacterium tuberculosis

134
Q

Which of the following sounds is heard with whispering pectoriloquy?

A

Bronchial breathing (consolidation is associated with whispering pectoriloquy, and also bronchial breathing)

135
Q

A patient presented with dry cough and dyspnea for 6 months duration. His physical examination revealed bilateral fine inspiratory crackles at the base of the lungs. What is the diagnosis?

A

Idiopathic pulmonary fibrosis

Resp module 3rd year (8 decks)

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