2014 end of module exam Flashcards
1
Q
Which of the following is a co stimulatory factor required for b cell activation in type 1 hypersensitivity reaction?
A
CD40 L on basophil and CD40 on b cell
2
Q
What causes an increase in DLCO?
a) Chronic bronchitis
b) Emphysema
c) Pulmonary hemorrhage
A
c) Pulmonary hemorrhage
3
Q
A 49-year-old patient diagnosed with pneumonia due to strep pneumonia what is a laboratory finding?
a) Bile soluble
b) Gram positive cocci in chains
c) Gram negative diplococci d) Egg shaped colonies
A
a) Bile soluble
4
Q
Which cell is part of the blood-air barrier?
A
Pneumocyte 1
5
Q
Which of the following is a natural anti-inflammatory substance?
A
LXA4
6
Q
Which of the following syndromes of primary cell dyskinesia is characterized by bronchiectasis, sinusitis, and situs inverses?
A
Kartagener syndrome
7
Q
What is the side effect of first generation anti histamines?
A
Sedation
8
Q
What mostly affects the shift volume?
A) an increase in airway resistance
B) a decrease in airway resistance C) an increase in compliance
D) a decrease in compliance
A
A) an increase in airway resistance
9
Q
At which point is the contraction of the Diaphragm maximal?
a) A
b) B
c) C
d) D
A
b) B
10
Q
What are the cellular events in the smooth muscle cells of the pulmonary arterioles that cause vasoconstriction when local PO2 decreases?
a) Reduced K+ permeability by phosphorylation
b) Reduced Ca++ uptake into sarcoplasmic reticulum
A
a) Reduced K+ permeability by phosphorylation
11
Q
What is the mechanism of action of ipratropium?
A
Blocks acetylcholine receptors
12
Q
A blood clot got trapped in one of the right pulmonary arteries, causing obstruction of that artery of the subject, who soon became dyspneic. What is the main cause of dyspnea? (A previously healthy old patient was severely dyspneic and found that he had a clot in one of the pulmonary arteries, what is the cause of his dyspnea)?
a) Increased functional dead space
b) Increased anatomical dead space
c) Increased shunt
A
a) Increased functional dead space
13
Q
Which of the following is innervated by the cervical plexus?
A
Diaphragm
14
Q
) Which of the following strongly indicates obstructive sleep apnea?
a) Pulmonary hypertension
b) Short and fat neck
c) recurrent episodes of hemoglobin desaturation
A
c) recurrent episodes of hemoglobin desaturation
15
Q
What is the function of 2,3-BPG?
A
Decreases the affinity of hemoglobin to oxygen
16
Q
Which of the following physiological parameter will be increased in case of stagnant hypoxia?
A
Difference between CaO2 and CvO2
17
Q
Graph of lung compliance, chest wall compliance and whole respiratory system compliance, what can you conclude (what is the most logical relation)?
A) compliance of chest wall > than lung
B) trans lung pressure is 0 at RV
C) at FRC the chest wall compliance is directed outward
D) the pressure across the respiratory system is close to 0 at RV
A
C) at FRC the chest wall compliance is directed outward
18
Q
What is a characteristic feature of latent TB?
a) Patient is infectious
b) Lung x-ray show lesion
c) Interferon gamma assay test is positive
d) Caused by atypical mycoplasma
A
c) Interferon gamma assay test is positive
19
Q
What test is most appropriate method to diagnose latent TB? a) Sputum smear B) IGRA C) PCR D) Elisa against TB antibodies
A
B) IGRA
20
Q
Which of the following mediate the class switch of B cells to IgE production?
A
IL-4
21
Q
In a rural environment, a study was conducted to find the correlation between drinking milk every day and growth rate of children in school. The teachers were asked to choose the children who will receive the milk. The students were followed for six-months the results show that the growth of the student who were given milk was worse that the student who did not drink milk. Which of the following is most likely caused this result?
a) There was no masking, which resulted in bias of the results.
b) The teachers gave the milk to children with poor growth
c) The poor quality of the milk
A
b) The teachers gave the milk to children with poor growth
22
Q
What is the most dangerous outdoor allergen?
Pollen
A
Pollen
23
Q
Required to get isotype switching to IgE
a) IL-2
b) IL-3
c) IL-4
d) IL-5
e) IL-6
f) IL-7
g) IL-8
h) IL-10
A
c) IL-4
24
Q
Required for eosinophil maturation
a) IL-2
b) IL-3
c) IL-4
d) IL-5
e) IL-6
f) IL-7
g) IL-8
h) IL-10
A
d) IL-5
25
produced upon up-regulation of Treg
a) IL-2
b) IL-3
c) IL-4
d) IL-5
e) IL-6
f) IL-7
g) IL-8
h) IL-10
h) IL-10
26
A 67-year-old man developed ventilator associated pneumonia in the ICU. Test showed oxidase positive bacteria which produces green pigmentation. What is the causative agent? a) strept pneumonia
b) pseudomonas aeruginosa
c) Moraxella cattarhalis d) H.influenza
b) pseudomonas aeruginosa
27
What are the peripheral chemoreceptors (carotid bodies) most sensitive to?
a) PaCO2
b) PaO2
c) pH
d) blood pressure
b) PaO2
28
What is the predominant cell type infiltrating in arthus reaction?
a) Macrophages
b) eosinophils
c) neutrophils
d) mast cells
c) neutrophils
29
The presence of Restrictive lung disease
a) TLC
b) FEV1
c) FEV1/FVC
d) FVC
e) RV
f) DLCO
g) FEF50%
a) TLC
30
The presence of an obstructive lung disease
a) TLC
b) FEV1
c) FEV1/FVC
d) FVC
e) RV
f) DLCO
g) FEF50%
c) FEV1/FVC
31
What causes gray baby syndrome?
Chloramphenicol
32
Which nerve is responsible for innervating the tip of the nose?
a) Ophthalmic nerve
b) Maxillary nerve
c) facial nerve
a) Ophthalmic nerve
33
Which disease is marked by diffuse pulmonary hemorrhage and progressive glomerulonephritis?
a) Goodpasture syndrome
b) Wegners granulamotous
c) Takayasu vascularitis d) Radiation pneumonitis
a) Goodpasture syndrome
34
An entire lobe is usually involved in the lung by an exudate containing neutrophils and red cells
a) lobar pneumonia
b) Intestinal pneumonia
c) Chronic bronchitis
d) Acute bronchitis
e) Bronchiectasis
h) Abscess
F) Fibrinous pleuritis
G) Pleural effusion
a) lobar pneumonia
35
What is the main chemical messenger involved in immediate hypersensitivity reaction?
a) Interleukines
b) Lymophokines
c) Chemokines
d) Histamine
d) Histamine
36
What does an air bronchogram on CXR indicates?
Consolidation
37
A CXR shows a nodule with air-fluid level, which of the following is most likely the cause? Or (an alcoholic man was found unconscious. He then developed high fever. A lesion in the chest x-ray with an air-filled level was found on the chest x-ray. What is the diagnosis)?
Lung abscess
38
A patient with lung opacity and ipsilateral tracheal deviation, which of the following is the cause?
a) Collapse of the Lungs
b) Tension pneumothorax
c) Consolidation of that lung d) Pleural effusion
a) Collapse of the Lungs
39
What is the major lipid component of surfactants?
a) Glycophospholipids
b) Sphingolipid
c) Cholestrol
a) Glycophospholipids
40
What will cause a congenital high airway obstructive disease?
Laryngeal atresia
41
The lung is “hanging” in the chest, making the trans lung pressure in the apical alveoli larger that the alveoli in the base, what is the functional (physiological) consequence of this phenomenon?
a) The apical alveoli receive less proportion of new fresh air in inspiration than the alveoli in the base
b) The apical alveoli receive more proportion of new fresh air in inspiration than the alveoli in the base
c) The basal alveoli receive relatively less blood than the alveoli in the apex
d) The basal alveoli receive relatively more blood than the alveoli in the apex
a) The apical alveoli receive less proportion of new fresh air in inspiration than the alveoli in the base
42
A patient was instructed to take a full inspiration (reach TLC) and then full expiration (reach RV), at which point the pulmonary vascular resistance is the most?
a) TLC
b) FRC
c) RV
d) 50% TLC
c) RV
43
What is the best approach to cause a nerve block in an intercostal space of a patient?
a) In the middle of the intercostal space
b) Two to four intercostal spaces
c) Bilaterally in the intercostal space
d) In the intervertebral/spinal nerve foramen
b) Two to four intercostal spaces
44
A young patient presented with difficulty breathing and pleural rub. Later on she complained of stabbing chest pain that radiates from the thorax to the anterior wall of the abdomen, which of the following is most likely involved?
a) Costal pleura
b) Diaphragmatic Pleura c) Visceral pleura
d) Mediastinal pleura
a) Costal pleura
45
Which of the following is involved in drainage of fluid from the pleural space?
Costodiaphragmatic recess
46
A patient was injured by a knife near the clavicle, which of the following will most likely be injured?
a) Cervical pleura
b) Diaphragmatic Pleura
c) Visceral pleura
d) Mediastinal pleura
a) Cervical pleura
47
In which case the hilum dilution method will underestimate the lung volume?
a) Sever obstructive lung disease
b) Advanced emphysema
b) Advanced emphysema
48
Which of the following you will most likely find in a patient with high extrapulmonary shunt?
a) Increased Pao2
b) Increased Paco2
c) Increased PAco2
d) Increased AaDO2
d) Increased AaDO2
49
Which of the following is responsible for increasing the vertical diameter of the thoracic cavity?
Diaphragm
50
A blood gas analysis of a patient before and after pure oxygen. The table shows that the patient was hypoxic and the PaO2 before was 68 and after pure 100% Oxygen PO2 was 370 mmhg. What is the cause?
a) Hypoventilation
b) Anemia
c) Diffusion limitation
d) Ventilation-perfusion mismatch
e) Abnormal shunt
e) Abnormal shunt
51
What causes an increased pulmonary vascular resistance?
a) COPD
b) Compression of the pulmonary artery
a) COPD
52
Which of following characterizes adult respiratory distress syndrome?
Necrotic cells and fibrin (Hyaline membrane)
53
What decreases significantly in anemia patients?
CaO2
54
What immunoglobulin plays a role in humoral immunity of the respiratory system?
IgA
55
Employees at a bakery shop are at increased risk of occupational asthma because of inhaling flour particles. What kind of secondary prevention can the bakery implement? a) Increase employees salary to afford health insurance
b) Perform PFT to screen for asthma annually
c) Install advanced ventilation to get rid of flour particles d) Rotate employees around different areas of the bakery
b) Perform PFT to screen for asthma annually
56
A 65-year-old male presented with fever and cough with rusty sputum. X-ray showed lobar pneumonia. Microscopically, the organisms showed to be alpha hemolytic and optochin sensitive. What is most likely cause of this condition?
Streptococcus pneumonia
57
Which of the following is an anti-asthmatic drug that inhibits the synthesis of leukotriene?
Zileutin
58
Which of the following is affected in acute asthmatic attack?
Bronchiole
59
What is the embryological origin of visceral pleura?
Splanchnic mesoderm
60
what is the pathophysiology of pressure-dependent obstruction in a severe case of emphysema?
a) Septal destruction and dilation of air spaces
b) Septal dilation and destruction of the terminal bronchioles
a) Septal destruction and dilation of air spaces
61
What is the mechanism of action of mucolytics?
Cleaves the disulphide bonds cross-linking glycoproteins
62
Which of the following does not change in hypoventilation?
Alveolar-arterial difference (AaDO2)
63
What is the function of disodium cromoglycate?
Stabilization of mast cells
64
What channel will be affected due to a mutation of the gene responsible for cystic fibrosis?
Chloride channels
65
A 65-year-old man presented with a peripheral tumor and gland formation. What is the most likely diagnosis?
Adenocarcinoma
66
From which structure does the central part of the diaphragm develops?
a) Septum transversum
b) Dorsal mesentery of esophagus
a) Septum transversum
67
Which structure does the internal laryngeal nerve pass through?
Thyrohyoid membrane
68
A 17 years old boy who is atopic, smokes, and has a family history of asthma, what would strongly predispose him to asthma?
a) Being a male
b) Atopy
c) Family history
d) Smoking
b) Atopy
69
Which of the following causes the clinical symptoms of asthma?
IgE cross-linkage on the surface of a mast cell and Th2 priming
70
Which of the following is characterized by sensory hyper-responsiveness?
a) Cough-variant asthma
b) Obstructive sleep apnea
c) nonasthmatic eosinophilic bronchitis
a) Cough-variant asthma
71
TRP channels are expressed in almost every tissue and cell type and play an important role in mediating cough responses. Which TRP channels are responsible for inhibiting cough?
TRPM8
72
A 6-year-old boy presented with hoarseness, croaking cough, and stridor. What is the most likely diagnosis?
Croup
73
In the case of injury of the recurrent laryngeal nerve, innervation of which of the following is lost first?
a) Abductors
b) Adductors
a) Abductors
74
Presence of carbon-Leiden Macrophages is an indicator of?
a) Anthracosis
b) Asbestosis
a) Anthracosis
75
benzopyrene metabolite covalently bind with?
a) Thymine
b) Cytosine
c) Guanine
d) Adenine
c) Guanine
76
A 30-year-old man presented with increasing dyspnea and airflow limitation, is diagnosed with emphysema. Genotyping of the pi gene showed homozygous Z allele. What is the primary cellular mechanism underlying this patients emphysema?
A) Decreased antioxidants mechanisms
B) protease-anti protease imbalance
C) increased lysosomes production
B) protease-anti protease imbalance
77
What is skin prick test used for?
Bronchial asthma
78
What is the recommended specimen to diagnose TB in a 2 year old child?
a) Sputum
b) Blood
c) Gastric aspirate
d) Broncho-alveolar lavage
c) Gastric aspirate
79
Which structure plays the major role in the contraction of the diaphragm?
a) Dorsal respiratory group
b) Ventral respiratory group
c) pneumotaxic center
a) Dorsal respiratory group
80
What characterizes the immune response in TB?
a) INF-gamma dominate Th1 response
b) Activation of complement
c) Down regulation of T-cell activation
d) Isotype switch
a) INF-gamma dominate Th1 response
81
What is necessary for lungs to inflate in premature infants?
a) SP-A
b) SP-b
c) SP-c
d) SP-D
e) DPPC
f) Sphingomyelin
g) Cholesterol
e) DPPC
82
Major protein component of surfactant
a) SP-A
b) SP-b
c) SP-c
d) SP-D
e) DPPC
f) Sphingomyelin
g) Cholesterol
a) SP-A
83
What is the major component of surfactant?
a) Sphingolipid
b) cholesterol
c) Triacylglycerol
d) glycerophospholipid
d) glycerophospholipid
84
Which of the following secretes a material to protect the terminal bronchioles?
Clara cells
85
What is the mechanism by which alpha 1 antitrypsen inactivate elastase?
Substrate suicide
86
Produces the ethmoidal bulla
Middle meatus
87
Why the aorta is not compressed when the diaphragm contracts? (why does the aorta radius not change when diaphragm contracts)?
Because it passes posterior to the diaphragm at the level of T12
88
The leading IgE-mediated disease worldwide?
a) Bronchial asthma
b) Atopic dermatitis
c) Seasonal allergic rhinitis
a) Bronchial asthma
89
What is characteristic of granuloma in TB?
a) Lymphocytes
b) Epithelioid histocytes
c) neutrophils
b) Epithelioid histocytes
90
What is the pathway of sensitization for Derp1?
Cleavage of the tight junctions of the airway epithelium mediates the presentation and Th2 priming.
91
Which drug inhibits cell wall synthesis?
Cefotaxime
92
Which of the following is used to check if the treatment for TB is working?
a) Sputum smear cytology
b) Chest X ray
c) IGRA
a) Sputum smear cytology
93
How will lung cancer present on a CT scan?
a) A cavitary nodule
b) A nodule surrounded by fat c) A calcified nodule
a) A cavitary nodule
94
What is the end stage result of chronic interstitial lung diseases?
a) Calcification
b) Inflammation
c) Replacement by fibrosis
d) Formation of hyaline membrane
c) Replacement by fibrosis
95
What is the most common cause of acute bronchitis?
a) Herpes simplex virus
b) Influenza virus
b) Influenza virus
96
What is the most likely microorganism to cause acute exacerbation of chronic bronchitis?
(not sure of the answer)
a) Moraxella caterhallis
b) Mycoplasma pneumonia
b) Mycoplasma pneumonia
97
A 68 year old male presented with otitis externa, what is the most probable cause? (not sure of the answer)
a) Pseudomonas areguinosa
b) Streptococcus pyogens
a) Pseudomonas areguinosa
98
What will come first in the atopy march?
Atopic dermatitis
99
A 27-year-old football player suddenly collapsed during a match. He was brought to the hospital where he had severe dyspnea and chest pain. Chest x-ray showed radiolucency across his right lung. What is the most likely cause of this condition?
paraseptal emphysema
(the idea is that this patient had paraseptal emphysema which ruptured during the match causing his symptoms and showed these findings on the CXR)
100
) What forms the Epithelial lining of lower respiratory tract?
Lung bud
101
what does this flow-volume loop indicate? (flow volume loop with a concavity in it)
a) increase resistance of airways
b) increase compliance of lung
a)increase resistance of airways
102
Spirometry shows a non-reversible obstructive pattern?
COPD
103
What is the most common cause of panacinar emphysema?
Alpha 1 antitrypsin deficiency
104
What opens to the most anterior part of semilunar hiatus?
a) Frontal sinuses
b) Ethmoidal air spaces
a) Frontal sinuses
105
Which of the following immunohistochemically markers helps you differentiate between small cell and squamous cell carcinoma?
a) Epithelial membrane protein
b) Vimentin
c) P63
c) P63
106
tables of blood gas analysis and all the normal ranges were given:
PaO2: 60 (N:95-100)
PCO2: 50 (N:38-42)
HB: 155 (N:150-175)
DLCO: 105% predicted
```
Choices:
a) Hypoventilation
b) Hyperventilation
c) Anemia
d) Polycythemia
e) Left to right shunt
f) Diffusion limitation
g) Ventilation to perfusion non-uniform
(normal reference values are between brackets)
```
a) Hypoventilation
107
PaO2: 80 (N:95-100)
PCO2: 39 (N:38-42)
HB: 160 (N:150-175)
DLCO: 158% predicted
```
Choices:
a) Hypoventilation
b) Hyperventilation
c) Anemia
d) Polycythemia
e) Left to right shunt
f) Diffusion limitation
g) Ventilation to perfusion non-uniform
(normal reference values are between brackets)
```
e) Left to right shunt
108
PaO2: 40 (N:95-100)
PCO2: 38 (N:38-42)
HB: 160 (N:150-175)
DLCO: 62% predicted
```
Choices:
a) Hypoventilation
b) Hyperventilation
c) Anemia
d) Polycythemia
e) Left to right shunt
f) Diffusion limitation
g) Ventilation to perfusion non-uniform
(normal reference values are between brackets)
```
f) Diffusion limitation
109
PaO2: 84 (N:95-100)
PCO2: 28 (N:38-42)
HB: 178 (N:150-175)
DLCO: 110% predicted
```
Choices:
a) Hypoventilation
b) Hyperventilation
c) Anemia
d) Polycythemia
e) Left to right shunt
f) Diffusion limitation
g) Ventilation to perfusion non-uniform
(normal reference values are between brackets)
```
b) Hyperventilation
110
108) How does Mycobacterium Tuberculosis resist killing by macrophages?
Inhibition of phago-lysosmal fusion
111
Which tumor is characterized by neuroendocrine secretions?
Small cell carcinoma
112
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?
S pyogens
113
In achest x-ray ,the left border of the heart corresponds to which part of the left lung?
a) Apex of lung
b) lingular lobe
b) lingular lobe
114
during a thyroid surgery upon the ligation of an artery a nerve was damaged which lead to hoarseness of the voice and monotonous speech, which of the following nerve was most likely damaged?
a) External laryngeal
b) internal laryngeal
c) recurrent laryngeal
a) External laryngeal
115
what does the above figure show? (the polysomnography from mechanism of sleep apnea)
a) Obstructive sleep apnea
b) Central sleep apnea
b) Central sleep apnea
116
A cohort study was conducted to demonstrate the association between age, smoking and respiratory diseases. The chart above shows the result of this study (as the age goes up, the resp diseases go up as well), which of the following criteria of causation does this chart show?
a) Temporal relationship, dose response, biological plausibility
b) Temporal relationship, dose response, consistency
c) temporal relationship, Strength of association, dose response
c) temporal relationship, Strength of association, dose response
117
a young female was diagnosed with a specific type of cancer, which of the following must be found in the patient so we can treat her with tyrosine kinase inhibitor?
a) KRAS (Kirsten rat sarcoma viral oncogene)
b) EGFR (Epidermal growth factor receptor)
c) cMET (tyrosine-protein kinase Met)
b) EGFR (Epidermal growth factor receptor)
