2013 end of module exam Flashcards by Susan w

What is the most common source of TB infection in old people in developing countries?
A. Crowded households
B. Active TB infection
C. Reactivation of latent TB infection
D. Unavailability of anti-TB drugs

C. Reactivation of latent TB infection

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A cohort study was done to compare the efficacy of 2 drugs in the treatment of hypertension. Some hypertensive patients received drug A and some received drug B. BP was measured before and 4 months after follow-up. Which of the following measures of association is the best to know which drug is more effective?
A. Comparing the risk of hypertension between the 2 groups
B. Comparing the rate of hypertension between the 2 groups
C. Comparing the odds ratio between the 2 groups
D. Comparing the difference between BP measurements in the beginning and the end of the study in the two
groups
E. 2 Kaplan-Maier curves

D. Comparing the difference between BP measurements in the beginning and the end of the study in the two
groups

Note: This is exactly how the question was stated (it was not an RCT). KM-curve is wrong because it is used to get time-to-event data. Both risk (CI) and rate are wrong because here we are not studying disease occurrence. Odds ratio is not used in cohort studies. D is the correct answer because it would really reflect the efficacy of the drugs.

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A patient with TB was admitted to your hospital. What is the most effective way to prevent the spread of TB to others?
A. Identifying the patient’s contacts and treat those who are PPD positive
B. Washing hands before and after contact with the patient
C. Isolation in a negative pressure room
D. Wearing gloves, masks, and gowns

C. Isolation in a negative pressure room

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A 45 year old smoker wants to quit smoking. He asked you “Doctor, if I stop smoking now, when will my risk to develop cardiovascular diseases be the same as a non-smoker?” what will be you answer?
A. Yes, in 1 year
B. Yes, in 8 years
C. Y es, in 15 years
D. Yes, In 25 years
E. No, this can never happen

C. Y es, in 15 years

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A randomized control trial was done to assess a new drug for reducing COPD-related deaths. Two groups were selected; one group took the new drug and the other group took the old one. Calculate the relative risk reduction in mortality.

possibility of death for Treated group: 11.8
possibility of death for Placebo group: 15.2

A. 10-15%
B. 20-25%
C. 75-80%
D. 60-65%

B. 20-25%

Note: “Probability of death at 3 years” means cumulative incidence (probability of death after following the patients for 3 years).
RR= Risk of death among the treated group/ Risk of death among the placebo groupRR=11.8/15.2= 78% RRR=1-78= 22%

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Which bone will be deviated due to fracture of the nasal septum?
A. Vomer
B. Maxillary bone
C. Palatine
D. Ethmoid

A. Vomer

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Which part is affected the most in primary ciliary dyskinesia?
A. Alveoli
B. Trachea
C. Segmented bronchi
D. Lobar bronchi
Note: The trachea has the maximum number of cilia.

B. Trachea

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Which cell is part of the blood-air barrier?
A. Pneumocyte 1
B. Pneumocyte 2
C. Clara cell
D. Brush cell
E. Goblet cell

A. Pneumocyte 1

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Which cell secretes material involved in the protection of the terminal bronchioles?
A. Pneumocyte 1
B. Pneumocyte 2
C. Clara cells

C. Clara cells

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Which cell divides by mitosis to replace other cells and secretes material that has a bactericidal effect?
A. Pneumocyte 1
B. Pneumocyte 2
C. Clara cells
D. Ciliated columnar cells
E. Bipolar neurons

B. Pneumocyte 2

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Which structure will be affected by Trauma above the clavicle?
A. Cervical pleura
B. Diaphragmatic pleura
C. Mediastinal pleura
D. Costal pleura

A. Cervical pleura

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Infection of which paranasal sinus will cause toothache?
A. Anterior ethmoidal cells
B. Posterior ethmoidal cells
C. Sphenoidal sinus
D. Frontal sinus
E. Maxillary sinus

E. Maxillary sinus

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Relaxation of which muscle increases the thoracic pressure (or decreases the vertical diameter during expiration)?
A. Diaphragm
B. Internal intercostal muscles
C. External intercostal muscles

A. Diaphragm

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What allows expansion of vessels?
A. Pulmonary artery
B. Pulmonary ligament

B. Pulmonary ligament

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What component encodes forming the lung buds?

TBX4

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Which lymph nodes drain the left lower lung margin (or cancer in the left lower lobe first metastasizes to which lymph nodes)?
A. Right broncho-mediastinal
B. Inferior tracheo-bronchial
C. Right tracheo-bronchial
D. Left tracheo-bronchial

C. Right tracheo-bronchial

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Which structure is insensitive to pain?
A. Parietal pleura
B. Visceral pleura

B. Visceral pleura

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The superior free margin of which structure makes the vocal ligaments?
A. Quadrangular membrane
B. V estibular ligament
C. Ary-epiglottic ligament
D. Conus elasticus

D. Conus elasticus

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Injury to which nerve causes hoarseness of voice?
A. Glossopharyngeal
B. Inferior laryngeal

B. Inferior laryngeal

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The internal laryngeal nerve pierces which membrane?
A. Thyrohyoid membrane
B. Thryoepiglottal membrane

A. Thyrohyoid membrane

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What structure has to be identified and carefully isolated in the separation of 2 bronchopulmonary segments from each other?
A. Pulmonary artery
B. Pulmonary vein
C. Pulmonary ligament

B. Pulmonary vein

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Which laryngeal muscle is an abductor of the vocal ligaments?
A. Lateral crico-arytenoids
B. Oblique arytenoids
C. Thyro-arytenoids
D. Transverse arytenoids
E. Posterior crico-arytenoids

E. Posterior crico-arytenoids

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Which of the following muscles contracts/relaxes during inflating a balloon?
A. Diaphragm relaxes and intercostal muscles contract
B. Intercostal and abdominal muscle contract
C. Intercostal muscles relax and diaphragm contracts

B. Intercostal and abdominal muscle contract

Note: The concept is to understand the type of action you use to inflate a balloon, which is forced expiration. Intercostal muscles contract to provide rigidity to the intercostal space, and since it is “forced” expiration, accessory muscles, such as abdominal muscles, will contract as well.

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What happens when there is injury to intercostal nerves 9, 10, and 11 on one side?
A. Paralyzed diaphragm
B. Paradoxical movement
C. Inspiration will continue normally
D. Sensation will be lost from the peripheral part of the diaphragm

D. Sensation will be lost from the peripheral part of the diaphragm

Note: We had the same question in the OSPE. The pointer was at the peripheral part of the diaphragm and the question was “Which nerve is responsible for the sensation of structure X?”

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Ultrasound imaging of the lungs of a fetus showed honeycomb cysts. Dilatation of which structure is the reason for this appearance? A. Trachea B. Primary bronchus C. Terminal bronchioles

C. Terminal bronchioles

``` A subject was found to have a DLCO 160% of the predicted value for his height, weight, and age (normally 75% to 125%). What could be a possible cause for this high value? A. Obstructive lung disease B. Compression of the pulmonary artery C. Pulmonary hypertension D. Bleeding in the lungs ```

D. Bleeding in the lungs

Why do NSAIDs exacerbate asthma? A. Promote the synthesis of prostaglandin E2 B. Prostacyclin I2 C. Increase the production of Leukotrienes D. Produce Lipoxin A4

C. Increase the production of Leukotrienes

Which of the following is a natural anti-inflammatory substance? A. LXA4 B. LTA4

A. LXA4

``` Which of the following is a powerful chemo-attractant lipid mediator of inflammation? A. LTA4 B. LTB4 C. LTC4 D. LXA4 E. PGI2 ``` Note: The names of these mediators were mentioned in short forms. LT=leukotriene – LX = lipoxin

B. LTB4

``` What is the cytokine produced by Tuberculosis-specific activated CD4+ T cells? A. IL-4 B. IL-6 C. IL-3 D. INF-gamma ```

D. INF-gamma

Which medium is used to diagnose TB in the CSF? A. LJ medium B. Middlebrooke 7H11 agar C. BioFM liquid medium

C. BioFM liquid medium

``` Transbronchial biopsy taken from a cigarette-smoker showed nests of cells that are larger than lymphocytes with little cytoplasm and nuclear molding. What type of lung carcinoma does this patient have? A. Squamous cell carcinoma B. Small cell carcinoma C. Mesothelioma D. Adenocarcinoma ```

B. Small cell carcinoma Note: SCLC is a neuroendocrine tumor characterized by nests or clusters of small round cells that are 2 to 2.5 times larger than lymphocytes. Tumor cells show scant cytoplasm, nuclear molding, apoptotic bodies, smearing, and salt- and-pepper chromatin.

What is the action of streptomycin that is responsible for its bacterial selectivity? A. Mammalian cells do not contain peptidoglycan B. Eukaryotic cells do have cell wall C. It acts on 30S ribosomal subunit D. Eukaryotic cells have their own way of retrieving folate

C. It acts on 30S ribosomal subunit

What constitutes the protective vaccine against TB? A. Attenuated Mycobacterium bovis B. BCG

A+B Note: We argued with the medical education department regarding this question, and both answers were considered correct.

A blood clot got tapped in one of the right pulmonary arteries, causing obstruction of that artery of the subject, who soon became severely dyspneic. What is the main cause of his dyspnea? A. Diffusion limitation B. Abnormally large right-to-left shunt C. Abnormally large functional dead space D. Free fluid in the alveoli

C. Abnormally large functional dead space

Which of the following is the most likely histological change seen in viral pneumonia? A. Neutrophil-rich intra-alveolar exudate B. Eosinophilic foamy exudate C. Interstitial mononuclear infiltrate D. Hyaline membrane along the alveolar wall

C. Interstitial mononuclear infiltrate

What causes cavitation in progressive pulmonary tuberculosis? A) The action of the bacteria themselves B) Drainage of the caseous material to the eroded bronchioles

B) Drainage of the caseous material to the eroded bronchioles

``` which of the following conditions the sensitivity of the DRG neuron to PaCO2 increases? A) Sleep B) Obstruction C) Anesthesia D) Metabolic acidosis ```

D) Metabolic acidosis

``` What condition will cause the most significant increase in DLCO? A. Chronic bronchitis B. Emphysema C. Chest wall deformities D. Left-to-right intra-cardiac shunt ```

D. Left-to-right intra-cardiac shunt

In the suppressive action of cough, why is dextromethorphan better than codeine? ``` A. It can be taken orally B. It also has an expectorant effect C. It also has analgesic effects D. It doesn’t inhibit ciliary activity E. It doesn’t penetrate the CNS ```

D. It doesn’t inhibit ciliary activity Note: Many students chose “E” because they mixed between addiction and CNS penetration. Both drugs penetrate the CNS to suppress the cough center. Codeine is an opiate that’s why it has some analgesic effect and liability for addiction, while dextromethorphan doesn’t have these properties.

``` What is the routine test that is used to detect structural abnormalities of the cilia? A. TEM B. NO measurement C. Isoelectric focusing D. High speed video microscopy E. Immunofluorescent analysis ```

A. TEM Note: HVMA is used to detect ciliary movement not ultra-structural defects.

What is the name of the syndrome of PCD that is characterized by a triad of bronchiectasis, sinusitis, and situs inversus? A. GoodPasture's syndrome B. Kartagener syndrome C. Heterotaxy

B. Kartagener syndrome

Which definition generally characterizes emphysema? A. Dilation of air spaces and destruction of the alveolar wall without scarring B. Dilation of air spaces and destruction of the alveolar wall with fibrosis C. Obstructed air way with mucus plugging

A. Dilation of air spaces and destruction of the alveolar wall without scarring

What is the main site for the synthesis of alpha one antitrypsin? A. Liver B. Pancreas C. Intestine

A. Liver

What forms the hyaline membrane in adult respiratory distress syndrome? A. Lipids and necrotic material B. Fibrin & necrotic material

B. Fibrin & necrotic material

What initiates the immune response during a second exposure? A. Macrophages B. Mast cells C. Memory cells

C. Memory cells

``` Which Immune cell is deficient in a patient with recurrent bacterial infections? A. T cell B. B cell C. Phagocyte D. Eosinophil ```

B. B cell Note: Recurrent bacterial infections are very characteristic of B cell-deficiency states. I confirmed the answer with the medical education department.

``` A peanut got trapped in the pulmonary bronchus of a subject while he was swallowing. What would happen to his lungs? A. Abnormally large dead space B. Diffusion limitation C. Abnormally large shunt D. Collapse ```

C. Abnormally large shunt

What causes increased pulmonary vascular resistance? A. COPD B. Compression of the pulmonary artery

A. COPD Note: COPD causes chronic hypoxia leading to hypoxic vasoconstriction. Eventually, this will increase the thickness of the VSMCs and thus the vascular resistance. Pulmonary arteries are low resistant highly compliant vessels so compression of one artery won’t increase the resistance that much.

``` A 5 year-old child presented with pharyngitis and rash on the chest and abdomen sparing the palms and soles. What is the causative organism? A. Streptococcus pneumoniae B. adenovirus C. Fusobacterium necrophorum D. S. pyogenes ```

D. S. pyogenes

A military outbreak of fever, conjunctivitis, pharyngitis, and cough. What is this syndrome called? A. Lemierre syndrome B. Pharyngoconjuctival syndrome

B. Pharyngoconjuctival syndrome

``` What is the most common bacterial etiology of acute bronchitis? A. S. pneumoniae B. H. influenzae C. S. aureus D. Mycoplasma pneumoniae ```

D. Mycoplasma pneumoniae

``` What anti-asthmatic drug causes adrenal suppression in children? A. Corticosteroids B. Xanthine derivatives C. Leukotriene inhibitors D. B2 agonists ```

A. Corticosteroids

What characterizes S. pneumoniae? A. Beta-hemolytic colonies B. Optochin sensitive C. Fried-egg colonies

B. Optochin sensitive

What characterizes M. Pneumoniae? A. Beta hemolytic B. Optochin sensitive C. Fried-egg colonies

C. Fried-egg colonies

What is the main component of surfactant? A. SP-A B. Cholesterol C. SP-B D. Dipalmitoylphosphatidylcholine E. SP-C

D. Dipalmitoylphosphatidylcholine

Which of the following decreases surfactant function when increased? A. SP-A B. Cholesterol C. SP-B D. Dipalmitoylphosphatidylcholine E. SP-D

B. Cholesterol

What helps in the expansion of the baby’s lung for the first time? A. DPPC B. Sphingomyelin C. cholesterol

A. DPPC

Which of the following is released from RBCs in local hypoxia? A. ATP B. 2,3 BPG

A. ATP

``` A 65 year-old woman presented with cough and fever for 3 days and was diagnosed with lobar pneumonia. Her sputum grows alpha hemolytic gram positive diplococci. What is the most likely causative organism? A. S. aureus B. Streptococcus pneumoniae C. Hemophilus influenza D. Mycobacterium Tuberculosis E. Pseudomonas aeruginosa ```

B. Streptococcus pneumoniae

Helium dilution underestimates TLC in which of the following diseases? A. Bullous emphysema B. Chronic bronchitis C. Restrictive lung disease

A. Bullous emphysema

Which of the following is not an obstructive airway disease? A. Laryngo-trachio-bronchitis (croup) B. Exercise-induced asthma C. Compression of the bronchus by a tumor

A. Laryngo-trachio-bronchitis (croup)

What signs or symptoms are strongly suggestive to diagnose obstructive sleep apnea? A. Short fat neck with excessive snoring B. Right ventricular enlargement C. Frequent episodes of hemoglobin desaturation D. Pulmonary hypertension

C. Frequent episodes of hemoglobin desaturation Note: It’s true that having a short fat neck is a risk factor to develop OSA, but that is not enough for the diagnosis.

Which of the following is against the diagnosis of asthma? A. Low DLCO B. The patient doesn’t have allergic rhinitis C. Lack of wheezing D. Late-onset asthma

A. Low DLCO Note: DLCO in asthma can be normal or high but not low. Also, it’s not necessary to have a history of allergic rhinitis because not all cases of asthma are allergic.

``` What is the treatment of choice for a 40-yearold male with influenza virus? A. Palivizumab B. Zanamavir C. Oseltamivir D. Cidofovir E. Ribavirin ```

C. Oseltamivir

``` Which of the following is given prophylactically to new born infants to prevent RSV during its season? A. Palivizumab B. Zanamavir C. Oseltamivir D. Cidofovir E. Ribavirin ```

A. Palivizumab

``` What is the side effect of second generation anti histamines? A. Hypersensitivity B. Sedation C. Hallucination D. Long QT interval ```

D. Long QT interval

``` Which of the following activates cough reflex through airway epithelial receptors? A. Substance P B. Angiotensin converting enzyme C. Natural endopeptidase D. general anesthetic ```

A. Substance P

``` What is the pathogenesis of end stage interstitial lung disease? A. Calcification B. Replacement by fibrosis C. Inflammation D. Formation of hyaline membrane ```

B. Replacement by fibrosis

Which of the following statements describes chronic bronchitis? A. It's a short-term condition B. Doesn't require regular medication C. Results from long term exposure to second hand smoke D. Inhalation is longer than exhalation

C. Results from long term exposure to second hand smoke

``` A 30 year old woman presented with dyspnea and persistent cough for 3 months after sore throat, and malaise and then these symptoms subsided but the cough persisted. Physical examination and PFTs were normal but you're still suspecting bronchial asthma, what is your next method of investigation? A. Measure residual volume and TLC B. Chest radiography C. Methacholine challenge test D. Skin prick test for common allergens E. Pre and post exercise spirometry ```

C. Methacholine challenge test

``` Which cancer is characterized by intercellular bridges and keratinized pearls? A. Squamous cell carcinoma B. Adenocarcinoma C. Small cell carcinoma D. Large cell carcinoma ```

A. Squamous cell carcinoma

A 6 year old child presented with cough, fever and feels unwell. His symptoms decreased significantly after he saw his physician. His mother said that his father had active TB. What is the best pathological finding in this case? A. Pleural effusion B. Ghon focus C. Miliary pattern on chest radiograph D. Apical cavitation surrounded by consolidation E. Tuberculin test F. T spot test (INF gamma)

B. Ghon focus Note: E and F are immunological tests, and they basically mean the same thing.

``` A 25 year old bird handler presented with pneumonia, what is the most likely causative organism? A. Legionella pneumophila B. S. pneumoniae C. Mycoplasma pneumoniae D. Chlamydia psittaci E. Aspergillosis Niger ```

D. Chlamydia psittaci

``` What is the location of secondary Tb lesion? A. Apical B. Basal C. Tracheobronchial D. Close to the hilum ```

A. Apical

What is the function of 2, 3 -BPG? A. Decreases the affinity of hemoglobin to oxygen B. Increases the affinity of hemoglobin to oxygen C. Produces A TP D. Decreases NO

A. Decreases the affinity of hemoglobin to oxygen

``` Gross appearance of the lungs showed yellow-white firm areas of consolidation that are several millimeters in diameter. What is the diagnosis? A. Primary pulmonary TB B. Secondary pulmonary TB C. Tuberculous bronchopneumonia D. Miliary TB ```

D. Miliary TB

``` Diffuse consolidation throughout large areas of the lung parenchyma in an immunocompromised patient. What is the diagnosis? A. Primary pulmonary TB B. Secondary pulmonary TB C. Tuberculous bronchopneumonia D. Miliary TB ```

C. Tuberculous bronchopneumonia

``` What is the mechanism of action of Desloratidin in the treatment of urticaria A. Block H1 receptors B. Block H2 receptors C. Block alpha 1 receptors D. Block alpha 2 receptors ```

A. Block H1 receptors

Which of these drug regimens is the most appropriate one to treat multi-bacillary lepromatous leprosy? A. Dapsone and ethambutol for 2 years. B. Dapsone, rifampicin, and clofazimine for at least 2 years C. Isoniazid, rifampicin, and ethambutol for 6 months. D. Dapsone and rifampicin for 6 months.

B. Dapsone, rifampicin, and clofazimine for at least 2 years

What defines multidrug resistant TB? A. Resistance to rifampicin, isoniazid, capreomycin, and ciprofloxacin B. Resistance to rifampicin and isoniazid C. Resistance to isoniazid and pyrazinamide

B. Resistance to rifampicin and isoniazid

What defines poly-resistant TB? A. Resistance to rifampicin, isoniazid, capreomycin, and ciprofloxacin B. Resistance to rifampicin and isoniazid C. Resistance to isoniazid and pyrazinamide

C. Resistance to isoniazid and pyrazinamide

What defines extensively resistant TB? A. Resistance to rifampicin, isoniazid, capreomycin, and ciprofloxacin B. Resistance to rifampicin and isoniazid C. Resistance to isoniazid and pyrazinamide

A. Resistance to rifampicin, isoniazid, capreomycin, and ciprofloxacin

``` Which of the following drugs is cell-cycle nonspecific and used in the regimen of Cyclophosphamide + Vincristine in treating small cell lung carcinoma? A. Etoposide B. Paclitaxel C. Topotecan D. Doxorubicin ```

D. Doxorubicin

``` What increases static compliance of the lung? A. Airway resistance B. Lung volume C. Shallow breathing D. Exercise ```

B. Lung volume

What results in a decrease in the dynamic compliance of the lung? A. Sighing and yawning B. Exercise C. Shallow breathing

C. Shallow breathing

What is the mechanism of action of disodium cromogylcate? A. Prevents histamine release from mast cell B. Increases cAMP leading to SMC relaxation C. B2-receptor agonist D. 5-HT antagonist

A. Prevents histamine release from mast cell

``` B lactam antibiotics e.g. penicillin bind to penicillin-binding proteins. What is PBP? A. Topoisomerase B. B lactamase C. Peptidoglycan D. Transpeptidase ```

D. Transpeptidase

What is the mechanism of ipratropium in treating asthma? A. B2 receptor agonist B. Inhibitor of PDE C. Prevents histamine release from mast cells D. Blocks muscarinic receptors of bronchial smooth muscles causing relaxation

D. Blocks muscarinic receptors of bronchial smooth muscles causing relaxation

``` Which drug causes yellowish discoloration of children's teeth? A. Tetracycline B. Amikacin C. V ancomycin D. Ciprofloxacin ```

A. Tetracycline

``` Which drug inhibits bacterial cell wall synthesis? A. Streptomycin B. Clavulanic acid C. Cefotaxime D. Tetracycline E. Co-trimoxazole ```

C. Cefotaxime

A 42 year old smoker female had a polypoidal mass projecting into the lumen of the main bronchus. How would you be able to tell if it has metastasised or not (or how would you differentiate primary from secondary lung tumours)? A. Cytokeratin LMW B. Cytokeratin HMW C. TTF-1

C. TTF-1 Note: TTF1 is a nuclear stain that is used to differentiate primary lung adenocarcinomas from metastatic adenocarcinomas e.g. breast carcinoma. Some students were confused by the description of the tumour which doesn’t fit adenocarcinoma so they chose cytokeratin. Cytokeratin stain has several types (ex: CK7, CK20 ...) and not all of them stain lung cells.

``` Transbronchial biopsy shows intrabronchial polypoidal mass. Histologically, uniform small round cells with moderate cytoplasm are seen. What is the most likely diagnosis? A. Squamous cell carcinoma B. Small cell carcinoma C. Large cell carcinoma D. Bronchial carcinoid ```

D. Bronchial carcinoid

``` What is the most potent outdoor allergen? A. Cat dander B. Molds C. Pollen D. Dog hair ```

C. Pollen

What is the primarily affected structure in emphysema? A. Alveoli B. Terminal bronchiole

A. Alveoli

What increases the shift volume? A. Increased resistance of airways B. Increased lung compliance

A. Increased resistance of airways

A 21 year old patient diagnosed with pneumonia that progressed and occupied the two lungs. Crepitations were heard on auscultation at the lung bases. He is still dyspnic even though he is on O2 supplementation (his PaO2 is only 92%). What is essential to best predict his arterial O2 content (or his oxygenation state)? A. Alveolar ventilation B. Minute ventilation C. Ratio of dead space to minute ventilation D. Perfusion to the affected lobes.

C. Ratio of dead space to minute ventilation

At which point the contraction of diaphragm is maximal? (a flow (L/sec) and an alveolar pressure curve (cm H2O)) https://i.ibb.co/kKJ7dt6/fullsizeoutput-bd.jpg A. A B. B C. C D. D

B. B Note: The contraction of the diaphragm follows the alveolar pressure. At point C the diaphragm relaxes. Many students chose “C” because it’s the point of maximal air volume inside the lungs (FRC+0.5L). (This is because the chest expands increasing the negative pressure allowing for air entry; however, this doesn’t reflect the state of the diaphragm.)

What physiological parameter should we check if we suspect stagnant hypoxia? A) Difference between CaO2 and CvO2 B) Nitrogen washout

A) Difference between CaO2 and CvO2

``` The ventilation to perfusion ratio is maintained at 0.8 -1; however, it's not equal throughout the lung. What part of the lung usually has a high V/Q ratio? A. Apical part in supine position B. Basal part is supine position C. Apical part in upright position D. Basal part in upright position ```

C. Apical part in upright position Note: The effect of the anatomy of the lung and gravity on V/Q ratio disappears in supine position.

``` PFT results were provided: High RV, reduced PEFR and FEF 75%, normal TLC. What is the most likely diagnosis? A. Broken ribs B. Obstructive disease of large airways C. Obstructive disease of small airways D. Tumor ```

C. Obstructive disease of small airways

What is the main cause of low hydrostatic pressure in the pulmonary arteries? A. Low compliance in the pulmonary arteries B. Low resistance in the pulmonary arteries C. High compliance in the systemic circulation D. Low CO of the right ventricle compared to the left

B. Low resistance in the pulmonary arteries

Which antibiotic inhibits folate synthesis? A. Co-trimoxazole B. Amikacin C. Ciprofloxacin

A. Co-trimoxazole

What is the characteristic of adult respiratory distress syndrome? A. Alveolar exudate B. Granulomas C. Hyaline membrane

C. Hyaline membrane Note: DAD --> There is damage to endothelial cells and epithelial cells (pneumocytes) --> Necrotic cells + fibrin = hyaline membrane.

Which muscle is innervated by the dorsal rami of spinal nerves? A. Levator constarum B. External intercostal muscles C. Serratus posterior superior

A. Levator constarum

``` What decreases significantly in anemic patients? A. CaO2 B. O2 delivery to tissues C. PaO2 D. O2 utilization by the tissues ```

A. CaO2

``` A table was provided: Low CO2, low O2, and high Hemoglobin. What could be the cause of such results? A. Anemia B. Diffusion limitation C. V/Q mismatch D. Hypoventilation E. Being at high altitude for 2 months ```

E. Being at high altitude for 2 months Note: At high altitude, the inspired O2 has low tension (low O2 in the results). As a compensation, the person will start to hyperventilate trying to get more O2, washing out CO2 in the process (low CO2 in the results), and also the body will increase the amount of hemoglobin (polycythemia in the results).

Which cell produces cytokines to activate MQs and CD8+ T cells for the protection against TB? A. Th1 cell B. Th2 cell C. NK cell

A. Th1 cell

What are the cellular events in the smooth muscle cells of the pulmonary arterioles that cause vasoconstriction when local PO2 decreases?

Activation of AMPK --> Closure of K+ channels by phosphorylation --> depolarization --> Ca++ entry Note: This is not exactly how the answer was phrased but that’s the mechanism in summary.

``` Which one of the following diseases will increase the arterial alveolar difference? A. Acute bronchitis B. Pulmonary hemorrhage C. COPD D. Barbiturates overdose E. Interstitial lung disease ```

E. Interstitial lung disease

``` Which of the following will increase DLCO? A. Acute bronchitis B. Pulmonary hemorrhage C. COPD D. Barbiturates overdose E. Interstitial lung disease ```

B. Pulmonary hemorrhage

``` Which disease will increase the pressure in the pulmonary artery? A. Acute bronchitis B. Pulmonary hemorrhage C. COPD D. Barbiturates overdose E. Interstitial lung disease ```

C. COPD

``` What will always increase in hypoventilation? A. Alveolar pressure of oxygen B. Arterial pressure of oxygen C. Arterial pressure of carbon dioxide D. Arterial Content of oxygen ```

C. Arterial pressure of carbon dioxide

``` A 67 year old patient with IPF is on supplemental oxygen. He developed gastrointestinal bleeding. His hemoglobin changed from 140 to 90, what is the cause of his dyspnea? A. Low Pao2 B. Low Cao2 C. Less hemoglobin saturation D. Tissue extracts less O2 ```

B. Low Cao2

``` A 75 year old man presented with dyspnea and these are his PFT findings: TLC (55%), FEV1 (1.2), FVC (1.45), DLCO (51%). What is the most likely diagnosis? A. IPF B. Asthma C. Emphysema D. Chronic bronchitis E. Pleural effusion ```

A. IPF

A patient with COPD smokes every day. He lives in a highly polluted area and has some pits at home. As a physician, what is the most important advice you would give to such patient? A. Change his residential area B. Get rid of the pits C. Quit smoking

C. Quit smoking

PFT results show: High TLC, low FEV1/FVC ratio, and low DLCO. What is the most likely diagnosis? A. Interstitial lung disease B. Emphysema C. asthma

B. Emphysema

A patient appeared to be dyspnic. He is on supplemental oxygen. His arterial blood showed low pH, low PaO2, low PaCO2 and low HCO3. What would be the best parameter to know the reason of hypoxia? A. AaDO2 B. pH C. PaCO2

A. AaDO2