2011 end of module exam Flashcards
Which of the following bones is involved in the deviation of the nasal septum?
Vomer
Which of the following is involved in asthma?
Bronchiole
Which of the following structures transits (passes thru) the aortic hiatus with the aorta in the diaphragm?
Thoracic duct
What will be paralyzed if the dorsal ramus of a spinal nerve is injured?
Levator costarum
Which muscle is involved in forced inspiration?
Scalenus anterior
Which structure does the internal laryngeal nerve pass thru?
Thyrohyoid membrane
Which of the following is responsible for congenital high airway obstruction?
Laryngeal atresia
From which structure does the central tendon of the diaphragm develop?
Septum transversum
Which of the following is most vulnerable to injury in trauma above the clavicle?
Cervical pleura
Paralysis of which muscle results in loss of the kite-shaped Rima glottides?
Posterior cricoarytenoid
Which of the following is used as a guide to separate bronchopulmonary segments?
Pulmonary vein
Which structure is most affected by immotile cilia syndrome?
Trachea
Which cell is a part of the blood-air barrier?
Pneumocyte I
Which of the following synthesizes surfactant?
Pneumocyte II
From which structure does the parietal pleura develop?
Somatopleuric mesoderm
The upper free margian of which structure forms the vocal fold?
Conus elasticus
What provides extra space for expanding vessels?
Pulmonary ligament
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?
Atopy
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?
15 years
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?
It will generate the idea that the treatment is better than it actually is
Which of the following cancers is least associated with smoking?
Mesothelioma (It is NOT associated, thus it is the least associated)
Adenocarcinoma
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?
Typical lobar pneumonia
a 69-year-old male smoker presented with dyspnea. H.infleunzae was isolated. What is the diagnosis?
Acute exacerbation of chronic bronchitis
Which of the following attract cells to the site of inflammation?
Chemokines
Which of the following digests the bacterial cell wall?
Lysozymes
What antibiotic is given to a 5-year old child with strep throat?
Amoxicillin
To which of the following drugs is extremely drug resistant TB resistant to?
Isoniazid, rifampin, ciprofloxacin, capreomycin
How does M. tuberculosis resist killing by macrophages?
Inhibition of phago-lysosomal fusion
What are the components of the specific protective immune response against TB?
Antigen, antigen specific lymphocyte and macrophages
Which of the following is part of the adaptive immunity of the respiratory tract?
IgA
What constitutes the protective vaccine against TB?
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)
Which of the following causes the clinical symptoms of asthma?
IgE cross-linkage on the surface of mast cells
How does lung damage progress to fibrosis in interstitial lung disease?
Cytokines produced my macrophages
What is the function of the J-chain?
Transport IgA to the lumen of the airways
A child with cystic fibrosis develops pneumonia. What is the causative organism?
Pseudomonas aeruginosa
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?
Staphylococcus aureus
What are the culture characteristics of streptococcus pneumoniae?
Alpha hemolytic Gram-positive cocci in chains, optochin sensitive
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?
Corynebacterium diphtheriae
A 20-year old bird handler developed pneumonia. What is the causative organism?
Chlamydia psittaci
Which of the following atypical mycobacteria causes pulmonary disease? M.kansasii M.scrofulaceum M.smegmatus M.ulcerans M.marinum
M.kansasii
Which of the following atypical mycobacteria is responsible for a disseminated disease in immune-compromised individuals?
M.avium complex
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?
Streptococcus pyogenes
What is the age of onset of croup in children?
6 months to 5 years
Which of the following is the commonest cause of acute otitis media? (strep. Pneumo wasn’t in the choices)
Staphylococcus aureus
Adenovirus
Staphylococcus aureus
What is the mechanism of type III hypersensitivity?
Immune complex mediated damage to the lung tissue
What is the principle behind immunotherapy in allergy?
Induction of IgG antibodies
Which of the following will present as an air bronchogram on a chest radiograph?
Consolidation
How will lung cancer present on a CT scan?
Cavitary nodule
Dimishing nodule with calcification
Cavitary nodule
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?
Denial
How does aflatoxin B1 cause cancer?
By conversion to aflatoxin M1 and then damaging the DNA
How do polycyclic aromatic hydrocarbons damage the DNA?
By forming DNA adducts
How does surfactant lower the surface tension?
By forming a surface monolayer
-Which of the following is a direct product of LOX-5?
HPETE
What is the most common lipid component of surfactant?
Glycerophosphlipids
Why would aspirin cause an exacerbation of asthma?
Because it increases leukotriene levels (upregulation of leukotrienes)
In the Bohr effect, what produces a change in the affinity of hemoglobin for oxygen?
Production of acid
How would red blood cells respond to hypoxia in tissues?
They release ATP
What is the effect of alpha-1-antitrypsin deficiency?
Increased activity of neutrophil elastase
Why is the loss of lung tissue accelerated in smokers with alpha-1- antitrypsin deficiency?
Because smoking induces inflammation
How does histamine mediate bronchoconstriction?
By calcium release
Which of the following substances directly stimulates cough receptors?
Substance P
What is the relationship between pulmonary vascular resistance and lung volume?
The lowest pulmonary vascular resistance is at the functional residual capacity
What is the most important feature of obstructive sleep apnea?
Hemoglobin desaturation
What increases hemoglobin affinity for oxygen?
Increased intracellular pH
A 10-year old boy had a bean lodged in the right main bronchus. He developed severe cyanosis and dyspnea. What is the pathophysiology?
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)
What affects static compliance of the lungs?
Lung volume
Pleural pressure
Shallow breathing Resistance in the airways
Lung volume
What results in a decrease in the dynamic compliance?
Shallow breathing
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?
Shunt
What causes an increase in DLCO?
Left to right cardiac shunt
A patient with high PaCO2 and low PaO2. What does he have?
Hypoventilation
A patient with normal pH, low PaO2, low PaCO2, high Hemoglobin. What is the cause?
High altitude for 2 months
A patient with an arterial oxygen content of 180 mlO2/L and a venous oxygen content of 110 mlO2/L. What does he have?
Congestive heart failure
What changes the sensitivity of the DRG neurons to changes in the level of CO2?
Metabolic acidosis
Chronic airway obstruction
Metabolic acidosis
What causes hypoxemia without a change in AaDO2?
Hypoventilation
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?
Destruction of lung tissue
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)
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What would cause a high AaDO2 with low oxygen?
Interstitial lung disease
High residual volume. Normal TLC. Low FEV50%. Low PEFR. What does the patient have?
Lower airway obstruction
At which lung volume would you find the lowest resistance?
TLC
What mediates vasoconstriction after a drop in alveolar oxygen?
Decreased potassium current (closure of potassium channels/decreased potassium permeability)
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?
Pneumocystis jirovecii infection
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?
Lung abscess
A smoker presents with a central cancer lesion and hypercalcemia. What is the diagnosis?
Squamous cell carcinoma
Which of the following is affected in chronic bronchitis?
Intermediate-sized airways
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?
Hypersensitivity to inhaled spores of thermophilicactinomycetes (fungal spores)
Which type of emphysema occurs in smokers and is associated with a black pigment?
Centriacinar
A patient with alpha-1-antitrypsin deficiency, liver lesions, and uniform enlargement of acini. Which type of emphysema is this?
Panacinar
What is the Reid index?
Ratio of the thickness of mucous glands to the thickness of the bronchial wall
What is the gross appearance of the Ghon focus?
Subpleural lesion above or below the interlobar fissure
in a granuloma, what would a cell with nuclei arranged in a horse- shoe shap be called?
Langhan’s giant cell
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?
Tuberculosis
A patient who was previously sensitized to tuberculosis presents with a cavitary lesion on the apex of the left lung. What is the diagnosis?
Secondary tuberculosis
-Diffuse involvement of the lungs with lesions <2mm. What is the diagnosis?
Military tuberculosis
Which of the following represents stage I of ssarcoidosis on X-ray?
Bilateral hilar lymphadenopathy
Which of the following is a common feature of all manifestations of pneumoconiosis?
Interstitial fibrosis
They all confer increased risk to tuberculosis
Interstitial fibrosis
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?
Idiopathic pulmonary fibrosis
a patient presented with cough and weight loss. Tissue biopsy showed mucinous growth along the alveolar wall. What is the diagnosis?
Bronchogenic carcinoma
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?
Mesothelioma
Which tumor is characterized by neuroendocrine secretions?
Small cell carcinoma
A person presents with acute symptoms of respiratory distress and hyaline membranes. What is the diagnosis?
Adult respiratory distress syndrome (ARDS)
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?
Bronchogenic carcinoma
Which type of emphysema is associated with dilation of the distal part of the acinus with the proximal part relatively unaffected?
Paraseptal
How does phenylephrine work in nasal congestion?
Activates alpha-1 receptors on nasal blood vessels
Which drug inhibits mycolic acid synthesis?
Isoniazid
Which of the following drugs inhibits protein synthesis?
Capreomycin
Which drug is not given with streptomycin because of their combined effect on the eighth cranial nerve?
Capreomycin
What inhibits phosphodiesterases?
Theophylline
How does ipratropium work to cause bronchodilation and decreased mucus secretion?
Anti-muscarinic action
What is the mechanism of resistance to rifampin?
Decreased affinity of RNA polymerase for the drug
Which of the following anti-cancer drugs is characterized by cardiotoxicity?
Doxorubicin
Which of the following drugs is a plant derivative that stabilizes tubulin in its polymerized state?
Paclitaxel
Which cough suppressant stimulates mucus secretion, inhibits ciliary function, and causes constipation?
Codeine
Which drug inhibits protein synthesis by competing with t-RNA for the A-site?
Tetracycline
Which drug inhibits bacterial cell wall synthesis?
Cefotaxime
Which of the following is an intravenous drug given in the case of status asthmaticus?
Hydrocortisone
What is the mechanism of action of disodium cormoglycate?
Stabilization of mast cells
What is the result of the combination of trimethoprim and sulfamethoxazole?
Inhibition of the sequential steps in folate synthesis
What is the most common cancer in a middle-aged male who is a smoker?
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)
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%
85%
This was from the second clinical skills lab, just learn how to use the figure and you should be fine
What is the most probable cause of sudden chest pain in a 20-year- old smoker male?
Tension pneumothorax
Angina
Acid reflux
Tension pneumothorax
A 45-year-old diabetic woman was diagnosed with hypertension. She recently developed wheezing and chest tightness. What is the cause?
Beta-blocker treatment for her hypertension
A person has reduced FEV1, reduced FVC, normal FEV1/FVC ratio, reduced TLC and RV. What is the diagnosis?
Restrictive lung disease
A woman suffers from nighttime choking as reported by her husband and is tired during the day. What does she have?
Obstructive sleep disorder
What is the gold standard test for diagnosing sleep disorders?
Polysomnography
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?
Overnight oximetry
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?
Streptococcus pneumoniae
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
Exacerbation of his COPD
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
Bronchodilators (beta-2 agonists)
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
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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?
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.)
A patient’s chest X-ray showed a meniscus sign at the right costophrenic angle. What would you find in the physical examination?
Dullness at the base of the lung
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
Hypercapnia
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
Mycobacterium tuberculosis
Which of the following sounds is heard with whispering pectoriloquy?
Bronchial breathing (consolidation is associated with whispering pectoriloquy, and also bronchial breathing)
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?
Idiopathic pulmonary fibrosis
