2015 end of module exam Flashcards
What affects PH the most?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
A) paco2
What doesn’t change with hypoventilation?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
C) AaDO2
What increases with hypoventilation?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
A) paco2
Which of these parameters is most affected in anemia?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
D) CaO2
What increases in stagnant hypoxia?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
G) AV difference at rest
Which of the following affect the tone of the pulmonary arterioles?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
B) pao2
What is sensed by carotid body?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
B) pao2
Largely depends on the concentration of hb?
A) paco2 B) pao2 C) AaDO2 D) CaO2 E) CvO2 F) PAO2 G) AV difference at rest H) Hb saturation
D) CaO2
Trans-lung pressure (PL) depends on pleural pressure and alveolar pressure. Pleural pressure is 8 less than alveolar pressure, alveolar pressure is like barometric pressure. What is PL?
+8 (PL= 0 – (- 8))
Airway dilatation from the level of the respiratory bronchiole to the alveoli,
predominantly affecting lower zones of the lung?
Pan-acinar emphysema
What Ig plays a role in humoral immunity of the respiratory system?
A) IgA
B) IgM
C) IgD
D) IgE
A) IgA
What is seen in a tumor of the lung?
a) Small calcified nodule
b) Cavitating nodule
c) Nodule that disappears in successive films
b) Cavitating nodule
What characterizes asthma vs emphysema?
a. Expiration in emphysema is worse than in asthma
b. Inspiration of both is equally bad
c. Expiration of both is equally bad
a. Expiration in emphysema is worse than in asthma
A 9-year-old girl was admitted to the hospital with one day of malaise, anorexia, and low-grade fever. Her immunization status was incomplete. On physical examination, she had acute pharyngitis with overlying white adherent membrane. What is the most likely cause?
A) Gram +ve cocci
B) Gram –ve cocci
C) Gram +ve bacilli
D) Gram –ve bacilli
C) Gram +ve bacilli
What produces surfactants?
A) Pnemocyte type I
B) Pnemocyte type II
C) Basal cells
D) Brush cells
B) Pnemocyte type II
Surgery for goiter in anterior triangle of the neck. Patient experienced monotonous voice and unable to increase pitch. Sensation to the vestibule was intact. What nerve was damaged?
A) External laryngeal
B) Recurrent laryngeal
C) Internal laryngeal
A) External laryngeal
Internal laryngeal nerve lesion in a 60 years old patient with lung cancer. What action is lost first?
A) Abduction
B) Adduction
C) Relaxers
D) Tensors
A) Abduction
Right heart border on chest x-ray corresponds to what part of the lung?
Medial border of middle lobe
In allergic bronchial asthma, what do TH2 cells release to activate effector
cells?
A) IL4,5,9,13
B) IL 4, 12, 15, 23
A) IL4,5,9,13
What occurs in allergic bronchial asthma?
A) Upregulation of FCeR1 receptors by IL-4
B) IL-5 preventing eosinophils from exiting bone marrow
C) RANTES
D) MCP 1 causing release of histamine from basophils
A) Upregulation of FCeR1 receptors by IL-4
A 39-year-old female with fever and weight loss and cervical
lymphadenopathy?
A)Node with multiple well-formed epithelioid without necrosis
B) Lysosomal release by leukocytes
C) Induction of class complement
D) Type 4 hypersensitivity
D?
Hypersensitivity lung reaction?
A) Allergic bronchopulmonary aspergillosis (ABPA) B) Aspergilloma C) allergic aspergillus sinusitis D) pulmonary aspergillosis E) invasive pulmonary aspergillosis
A) Allergic bronchopulmonary aspergillosis (ABPA)
Fungal ball in the lung?
A) Allergic bronchopulmonary aspergillosis (ABPA) B) Aspergilloma C) allergic aspergillus sinusitis D) pulmonary aspergillosis E) invasive pulmonary
B) Aspergilloma
Hypersensitivity pneumonitis?
A) IgG precipitin antibodies B) Total serum IgE C) Allergen specific IgE D) Serum tryptase E) Intradermal test F) Eosinophil cationic protein G) Prick to prick test H) Methacholine challenge test
A) IgG precipitin antibodies
Allergic bronchopulmonary aspergillosis (ABPA)?
A) IgG precipitin antibodies B) Total serum IgE C) Allergen specific IgE D) Serum tryptase E) Intradermal test F) Eosinophil cationic protein G) Prick to prick test H) Methacholine challenge test
B) Total serum IgE
What is the guideline for bronchopulmonary segment removal?
Pulmonary vein
What decreases the resistance of airways?
A) Adrenaline
B) Histamine
C) Ach
D) Substance P
A) Adrenaline
What do you measure in anaphylaxis?
Serum tryptase
Older male Patient with inspiratory crackles, chronic dry cough, dyspnea, and clubbing. He stopped smoking 15 years ago, what is the diagnosis?
A) COPD
B) Bronchial asthma
C) Interstitial lung disease
C) Interstitial lung disease
What produces mucus?
A) Pneumocyte type I B) Pneumocyte type II C) Clara cells D) Goblet cells E) Ciliated cells F) Small neuro-endocrine cells
D) Goblet cells
On gross examination, we found dilated near the subpleural area, with mucus
and purulent substance. what is the pathology?
A) Bronchiectasis B) Chronic bronchitis C) Pneumonia D) Central emphysema E) Panacinar emphysema
A) Bronchiectasis
Patient, middle aged male with productive cough for 10 years, smoker, with
hypoventilation (high co2, low o2, ph low) what is the likely diagnosis?
A) Submucosa mucus gland hypertrophy
B) Loss of elastic recoil
A) Submucosa mucus gland hypertrophy
Type of emphysema that leads to pneumothorax?
Paraseptal emphysema
Which of the intercostal spaces is approached in the mid-axillary line with a
needle to drain the costo-diaphragmatic recess?
A) 6th
B) 7th
C) 8th
D) 9th
D) 9th
FV loop of emphysema given: What is the diagnosis? Or what is the underlying
process?
Decreased elastic recoil
What kills MTB?
A) Macrophages
B) NK cells
A) Macrophages
A 6-year-old boy diagnosed with bronchopneumonia, his sputum culture yielded an organism that only grows on chocolate agar. What is the most likely organism?
A) S. pyogenes
B) M. pneumonia
C) H. influenza
C) H. influenza
What is activated in type IV hypersensitivity (or what is activated by TH1 cells in MTB infection?) A) Cytotoxic T cells B) Eosinophils C) Mast cells
A) Cytotoxic T cells
Pancytopenia, Hepatospleenomegaly, ground glass appearance of lung?
Miliary TB
Hepatospleenomegaly, ground glass lung – sample showed epithelioid granulomas. What is the underlying pathological process causing this?
Type IV hypersensitivity
Chest x-ray of a 29 years old male with fever & night chills showed ground glass appearance. Physical examination showed splenomegaly. Blood test showed pancytopenia. Bronchial biopsy showed two epitheloid granuloma. Which of the following organisms is implicated In this pathology?
A) Mycobacterium avium intravellulare
B) k.pneumonia
C) MTB
D) P.argenosa
C) MTB
Which type of cells control MTB in the infected cell? A) Th2 B) Mast cells C) Esinophiols D) CD8+
D) CD8+
What is the gold standard test to diagnose food allergy?
A) Skin prick test for major proteins
B) Intradermal prick test for major proteins
C) Prick to prick test for fresh food
D) Double blinded food challenge test
D) Double blinded food challenge test
A 65-year-old female presented to the ER with cough and fever for 3 days duration. She was diagnosed as a case of lobar pneumonia. What is the most likely causative organism? A) Staph. Aureus B) Strept. Pneumonia C) MTB D) Haemophilus influenzae
B) Strept. Pneumonia
The alveoli should be dry for proper gas diffusion across the respiratory membrane. Which of the following factors play a key role in preventing the net fluid drainage from pulmonary capillaries?
Hydrostatic pressure is low in pulmonary capillaries, thus favors reabsorption of fluid
What allows the expansion of blood vessels in the lung? A) Pulmonary artery B) Pulmonary ligament C) Cervical pleura D) Costal pleura E) Diaphragmatic pleura F) Endothoracic fascia G) Hilum H) Primary bronchus
B) Pulmonary ligament
A 49-year-old man with long standing pulmonary TB is recently discovered to have massive proteinuria associated with ascites and lower limb edema. Lab tests showed marked hypoalbuminemia? A) Systemic amyloidosis B) Miliary TB C) adrenal TB D) pott’s disease
A) Systemic amyloidosis
What tells you about the population size in Kaplan-meyers graph?
a. Size of steps
b. Cumulative incidence of the two groups
c. Median survival rate of the two groups
a. Size of steps
What percent of smokers die of smoking-related diseases? A) 50%
B) 60%
C) 100%
A) 50%
Chart to calculate RRR: In an RCT, the table with the outcomes and exposures was given then we had to calculate cumulative incidence and then RR then RRR.
-
What drug wouldn’t you give to a pregnant woman?
A) Tetracycline
B) streptomycin
C) disodium crom
A) Tetracycline
Young patient with pneumonia caused by mycoplasma pneumonia?
Fried egg colonies
Patient with pneumonia caused by S. pneumonia?
A) Bile soluble
B) gram positive cocci in chains
C) gram negative coccobacilli D) fried egg colonies
A) Bile soluble
Pharyngitis with white (or grey) membrane (and enlarged cervical lymph nodes?) what is seen? A) Gram negative bacilli B) Gram positive bacilli C) Gram negative coccobacilli D) Gram positive cocci in pairs
B) Gram positive bacilli
Patient with Enlarged tonsils with exudate with cervical lymph node enlargement. Culture showed gram positive cocci in chains?
A) S. Pyogenes
B) C. Diptheria
C) Strep. Pneumonia
A) S. Pyogenes
Unvaccinated child presents with stridor (or epiglottitis). Organism grows on chocolate agar only?
A) Gram positive cocci
B) Gram negative coccobacilli
B) Gram negative coccobacilli (or maybe the choices were micro-organisms
and the answer was hemophilus influenza)
What is depicted here? (the polysomnography from mechanism of sleep apnea, slide 5)
A) Central sleep apnea
B) Obstructive sleep apnea
A) Central sleep apnea
What is true about the above graph? (pressure volume loop)
A) Surface area tension in alveoli play an important role in decreasing lung
compliance
B) Pressure of saline increase elasticity in lung connective tissue
C) Air-filled lung expands more readily than saline
A) Surface area tension in alveoli play an important role in decreasing lung
compliance
What is predominant cell in Arthus reaction?
A) Neutrophils
B) Mast cells
C) Eosinophils
A) Neutrophils
Where would you see hyaline membrane formation in the lungs? (ARDS was not an option) A) Sarcoidosis B) W egners granulomatosis C) Idiopathic pulmonary fibrosis D) caplan syndrome
C) Idiopathic pulmonary fibrosis
A 55 years old comatose woman on ventilator in ICU experienced pneumonia, what is the most likely pathogen? A) MRSA B) bacteriodes fragilis C) M. Catarrahlis D) S. Pneumoniae E) chlamydia psittaci F) legionella pneumophilus
A) MRSA
Multiple patients with (disseminated?) pneumonia/ resp. distress caused by organism spread through air conditioning? A) Legionella pneumophilus B) MRSA C) bacteriodes fragilis D) M. Catarrahlis E) S. Pneumoniae F) chlamydia psittaci
A) Legionella pneumophilus
Growth seen through trans-bronchial bronchoscopy central and obstructing bronchus. Histology shows small round cells with low mitotic activity that were chromogranin positive. What is the type of cancer? A) SCLC B) Adenocarcinoma C) Squamous cell carcinoma D) Carcinoid tumor
D) Carcinoid tumor
A transbronchial biopsy of a 67 years old man showed a high-grade malignancy. Staining showed +ve P40, and –ve TTF1. what is the type of cancer?
A) Squamous cell carcinoma
B) Adenocarcinoma
C) small cell carcinoma
A) Squamous cell carcinoma
Pathological examination on lung showed +ve TTF1 and amplification on EGFRH?
adenocarcinoma
70-year-oldmale,witha30-packyearhistoryofsmoking,whatishismost important risk factor for lung cancer?
A) Male gender
B) Smoking
C) Age
C) Age
What is the diagnosis? (flow volume loop with concavity)
A) COPD/emphysema
B) Bronchial asthma
C) Chronic bronchitis
A) COPD/emphysema
Whatisusedtoseetheultrastructure ofcilia? ((a test that is used to check the cilia motion))
A) TEM
B) IF
C) High speed video
A) TEM
What directly causes mast cell degranulation and release of mediators?
a. Cross linking of IgE on mast cells by allergen
b. Production of IgE by allergen
c. Allergen binding to antibody
a. Cross linking of IgE on mast cells by allergen
What is commonly seen in mild asthma?
A) Low co2 with low o2
B) Low co2 with normal or close normal o2
C) lowco2withlowo2
B) Low co2 with normal or close normal o2
In metabolic alkalosis, why does not co2 increase beyond a specific point with hypoventilation?
Hypoxemia develops
Air bronchogram on a chest x-ray shows what?
Consolidation
What is the most common cause of lung abscess? A) Post-pneumonic B) Post- obstructive C) Metastasis D) Aspiration of foreign particles
D) Aspiration of foreign particles
suppurative destruction of lung parenchyma within a central area of cavitation? A) Lung abscess B) Bronchopneumonia C) Viral pneumonia D) Aspiration pneumonia E) Atypical pneumonia F) Chronic pneumonia G) interstitial pneumonia H) Lobar pneumonia
A) Lung abscess
Foreign body reaction leading to pneumonia?
Aspiration
What do polyaromatic hydrocarbons do to DNA?
A) Form a DNA adduct
B) Break DNA strand
A) Form a DNA adduct
A 28-year-old man presented with a colorless fluid draining from his nose.
Which bone would be fractured in his case?
A) Nasal bone
B) Ethmoid bone
C) Lacrimal bone
B) Ethmoid bone
What passes through the aortic hiatus? A) Thoracic duct B) Sympathetic chain C) Vagus nerve D) IVC
A) Thoracic duct
What happens when you give aspirin to asthmatics (or why does aspirin worsen
symptoms in asthmatics?
Increases leukotriene synthesis
What drug causes grey baby syndrome?
Chloramphenicol
Which drug works by inhibiting 5-LOX enzyme?
Zileutin
A 62 years old man who quitted smoking 10 years ago presented with cough and showed signs of RHF with these ABGs [High arterial CO2 + Low arterial O2] What is the cause?
A) Destroyed alveolar wall & dilated air spaces
B) Sarcoidosis with a non-caseating granuloma
C) COPD
C) COPD
Child that was hypersensitive (allergic) to penicillin presented with strep throat caused by gram +ve cocci in chains, sensitive to bacitracin. what drug would you use? A) Erythromycin B) Cefotaxime C) Amoxicillin D) Clavulanic acid
A) Erythromycin
What is damaged with a stab wound above clavicle?
Cervical pleura
Where does the central part of the diaphragm develop from? A) Pleuroperitoneal membranes B) Septum transversum C) Mesentry of esophagus D) Pericardiopleural membranes
B) Septum transversum
What does binding of low concentrations of Carbon monoxide do to
Hemoglobin?
A) Decreases affinity of hemoglobin to O2
B) Increases affinity of hemoglobin to O2
B) Increases affinity of hemoglobin to O2
What is important to inflate lungs in newborns?
A) DPCC
B) Sphingomyelin
A) DPCC
What will decrease surfactant function if its high in adults?
Cholesterol
Major lipid component of surfactant?
DPCC
Weight loss, hemoptysis, night sweats. what is the diagnosis?
A) MTB
B) Moraxella caterhalis
A) MTB
Where is the main source of production of Alpha -1- antitrypsin?
Liver
What type of enzyme is AAT (or what is the mechanism of AAT)?
Suicide substrate
Patient presents with dyspnea, what will get better with 100% O2?
A) Shunt
B) Diffusion limitation
C) V/Q mismatch with no ventilation and V/Q = 0,
D) Anemia
B) Diffusion limitation
What keeps the thorax rigid in forced expiration?
Internal intercostal
What is enervated by dorsal spinal rami?
Levator costarum
Former heroin addict was on methadone for one year. He was then diagnosed with TB, taking the typical 4 drug regimen for 4 days, then came to the doctor with complaints of “withdrawal symptoms” Which drug is responsible for this?
A) streptomycin
B) Ethambutol
C) Rifampicin
D) Isoniazid
C) Rifampicin
What drug activates liver enzymes (or induces CYP450)? A) Rifampicin
B) Isoniazid
A) Rifampicin
blebs seen, voluminous almost covering the lung, causing pneumothorax? A) Bullous emphysema B) Paraseptal emphysema C) Centriacinar emphysema D) Panacinar emphysema
A) Bullous emphysema
Patient with typical presentation of COPD and was a smoker, what is the type of emphysema? A) Centriacinar emphysema B) Bullous emphysema C) Paraseptal emphysema D) Panacinar emphysem
A) Centriacinar emphysema
What is the condition if the alveoli are affected from the terminal bronchioles to the alveolar sac with lower lobe predominance? A) Panacinar emphysema B) Bullous emphysema C) Paraseptal emphysema D) Centriacinar emphysema
A) Panacinar emphysema
What forms middle ethmoidal bulla? A) Middle ethmoidal air sinus B) Frontal air sinus C) Anterior ethmoidal sinus D) Posterior ethmoidal sinus E) Nasolacrimal duct F) Maxillary air sinus G) Sphenoidal sinus
A) Middle ethmoidal air sinus
What drains into anterior-most part of hiatus semilunaris? A) Frontal air sinus B) Middle ethmoidal air sinus C) Anterior ethmoidal sinus D) Posterior ethmoidal sinus E) Nasolacrimal duct F) Maxillary air sinus G) Sphenoidal sinus
A) Frontal air sinus
Left lower lobe of lung drains into what Lymph node in cancer?
A) Right tracheobronchial lymph nodes
B) Right brochomediastinal lymphnodes
A) Right tracheobronchial lymph nodes
which of the following is the predominant histological finding in community acquired viral pneumonia?
A) PMN in alveolar spaces
B) Alveoli filled with lymphocytes
C) Alveolar wall (interstitial) widening/thickening due to lymphocytic
infiltration
D) Alveolar wall (interstitial) widening/thickening due to neutrophilic
infiltration
C) Alveolar wall (interstitial) widening/thickening due to lymphocytic
infiltration
What muscle tenses the vocal fold?
Cricothyroid
What adducts the inter-ligamentous part of the rima glottidis? A) Lateral crico-arytenoid B) Oblique arytenoid C) aryepiglottic D) posterior crico-arytenoid E) thyroarytenoid F) cricothyroid G) vocalis
A) Lateral crico-arytenoid
Chest x-ray with opaque hemithorax with ipsilateral shift of the trachea, what is the most likely cause?
A) Massive lung collapse
B) Pleural effusion
A) Massive lung collapse
Inhibits synthesis of leukotrienes?
Zileutin
Disodium cromoglycate?
Stabilizes mast cells
What is the most common cancer in males, both smokers and non-smokers? A) Adenocarcinoma B) Squamous cell carcinoma C) small cell carcinoma D) large cell carcinoma E) adeno-squamous carcinoma
A) Adenocarcinoma
A young woman experienced coughing with low amount of cigarette smoke in the air and when eating pepper spice. She also felt a tickling sensation in the throat. What is the underlying mechanism?
Upregulation of TRV1 and TRPA1
A man is standing upright. Why do the apical areas have a higher V/Q ratio?
A) Apical parts receive less fresh air
B) Apical parts are hypo-perfused
B) Apical parts are hypo-perfused
What is the mechanism of action of mucolytic drugs?
Cleaving the disulfide bonds of the glycoproteins
How do surfactants reduce the surface tension of alveoli?
A) Add monolayer lipid surface
B) Add bilayer lipid surface
A) Add monolayer lipid surface
What is a risk factor for OSA?
Low facial index
Which drug causes dry mouth a side effect?
Diphenhydramide
A kid visited a zoo and developed an asthma attack that got severe after few minutes. What could help in relieving his bronchoconstriction if he was brought to the ER?
Inhaled salbutamol
What is the effect of increased 2,3-BPG on red blood cells?
Decreases the affinity of hemoglobin to O2
The lung is hanging in the chest making the trans pressure in the apical alveoli larger than the base, what is the main consequence for that?
A) The apical alveoli receive less proportion of fresh air during inspiration than the alveoli in the base
B) The basal alveoli receive less proportion of fresh air during inspiration than the alveoli in the apex
C) The apical alveoli are more hypo-perfused than the alveoli in the base
D) The basal alveoli are more hypo-perfused than the alveoli in the apex
A) The apical alveoli receive less proportion of fresh air during inspiration than the alveoli in the base
Older man with hyponatremia, weight loss, and previously diagnosed with TB. What could be the problem he is presenting with?
Adrenal TB
