2016 end of module exam Flashcards by Susan w

A patient came in the ER from a motorcycle accident and clear fluid was dribbling from his nose. Which bone was fractured?

A. Lacrimal
B. Sphenoid
C. Ethmoid
D. Maxilla

C. Ethmoid

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What forms middle ethmoidal bulla?

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

B (middle ethmoidal air sinus)

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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)

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parietal pleura develops from this

A- foregut endoderm
B- septum transversum
C- somatopleural mesoderm
D- pleuroperitoneal membrane 
E- splanchnic mesoderm

D- pleuroperitoneal membrane

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from where the fluid is withdrawn ?

A- 7th intercostal space midclavicular line
B- 7th intercostal space midaxillary line
C- 9th intercostal space midclavicular line
D- 9th intercostal space midaxillary line

D- 9th intercostal space midaxillary line

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replaces lost respiratory cell

a-brush cell
b-basal cell
c-ciliated cells
d-small granule cells

b (basal cell)

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Secrete serotonin

a-brush cell
b-basal cell
c-ciliated cells
d-small granule cells

d (small granule)

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act as receptors

a-brush cell
b-basal cell
c-ciliated cells
d-small granule cells

a (brush cell)

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affected when stab injury to clavicle.

a-Cervical pleura
b-Costal pleura
c-Visceral pleura

a (cervical pleura)

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Insensitive to pain

a-Cervical pleura
b-Costal pleura
c-Visceral pleura

c ( visceral pleura)

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60-year-old lung cancer patient suffer from progressive lesion in right recurrent laryngeal nerve, which laryngeal muscle is affected first?

A) Abduction
B) Adduction
C) Relax
D) Tensor

A) Abduction

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A young boy with Respiratory distress syndrome and on x-ray he showed intestinal coils in the right thoracic cavity, what malformations results in this disorder?

A - pleuroperitoneal membrane
B- dorsal mesentery of esophagus
C- septum transversum
D- pericardioperitoneal canal

A - pleuroperitoneal membrane

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Origin of central tendon?

a-Septum transversum

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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 likely damaged?

A- External laryngeal
B- Internal laryngeal
C- recurrent laryngeal

C- recurrent laryngeal (confirmed by the doctor)

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A patient showed low plasma level of alpha anti trypsin, high liver enzymes, have a lung disease and history of smoking.
smoking causes high level of which?

A-Elastase 
B-Trypsin
C- Chymotrypsin 
D- Elastin
E- Heme

A (Elastase)

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A patient showed low plasma level of alpha anti trypsin, high liver enzymes, have a lung disease and history of smoking.
smoking causes high damage to which component?

A-Elastase 
B-Trypsin
C- Chymotrypsin 
D- Elastin
E- Heme

D (Elastin)

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Which of the following nucleic base is mostly affected with the exposure of aromatic hydrocarbon?

A- adenine
B- Guanine
C- thymine
G- cytosine

B- Guanine

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what does Aspergillus flavus produce to cause lung cancer?

A) aflatoxin B1
B) aflatoxin M1
C) aflatoxin M2
D) aflatoxin Q1

A) aflatoxin B1

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How does A1AT inactivates elastase?

allosteric inhibitor

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what is released by RBC in response to hypoxia in the peripheral…

a- 2,3 BPG
b- glucose
c- ATP
d-lactate

c- ATP

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What do erythrocytes produce in response to peripheral hypoxia?

ATP

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Usually in the periphery of the Lung

A. squamous cell carcinoma
B. small cell carcinoma
C. carcinoid tumors
D. adenocarcinoma
E. mesothelioma

D. adenocarcinoma

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What are the microscopic changes seen in the trachea of an asthmatic patient

a- Decrease in goblet cells
b- Decrease in thickness of smooth muscle cells layer
c- Increase in basal cells
d- Increase in the thickness of the basement membrane

d- Increase in the thickness of the basement membrane

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a CT scan of a 50-year-old woman showed a nodular infiltrate and a hilar lymphadenopathy. Something about a biopsy from erythematous patch on the chest wall. What’s the cause?

A) Sarcoidosis
B) Goodpasture Syndrome
C) Collagen Vascular Disease
D) Wegener’s granulomatous

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what stage of labor pneumonia there is disintegration of red cell and persistence fibrinosuppurative exudate? A-stage of congestion B-stage of red hepatization C-stage of gray hepatization

C-stage of gray hepatization

``` Misfold mutation in CFTR? a-Class I b-Class II c-Class III d-Class IV e-Class V ```

b-Class II

What is the cytoplasmic protein involved in pre-assembly of dynein components into the axoneme? a. CCDC40 b. RSPH9 c. LRRC50

c.LRRC50

What causes infertility in cystic fibrosis? a- immotile flagella b- bilateral congenital absence of vas deferens

b- bilateral congenital absence of vas deferens

What is associated with cystic fibrosis, immotile cilia syndrome,...?

Bronchiectasis

The pathophysiology of bullous formation?

destruction of alveolar walls and fusion of adjacent alveoli.

which of these interstitial lung diseases progress fibrosis into non-caseating granulomas A) berylliosis B) asbestosis C)silicosis D)anthracosis

A) berylliosis

Patchy consolidation of neutrophil-rich exudate in bronchi, bronchioles, and adjacent alveolar spaces A- lobar pneumonia B- viral pneumonia C- lung abscess D- pneumonia in immunocompromise

A- lobar pneumonia

Young immigrant presented w/fever and swelling, on chest x-ray fibro-parenchymal changes predominantly in the upper zone of lung A-lung cancer B-tb C-pneumothorax D-bronchopneumonia

B-tb

a 36-year-old man changed the place he lived in to a higher altitude, what is the consequence? a-pulmonary vasodilation b-left heart hypertrophy c-depolarization of the pulmonary artery Smooth muscle cell membrane d-decrease in the pulmonary artery cytosolic ca+2

c-depolarization of the pulmonary artery Smooth muscle cell membrane Explanation: hypoxia induced pulmonary vasoconstriction is the result, and membrane depolarization is the mechanism of which

What causes the pressure independent area in pressure volume loop? (picture) a-The diameter of the large airways which acts as a bottle neck b-increasing effort causes the plural pressure to increase. This narrows the airways

b-increasing effort causes the plural pressure to increase. This narrows the airways (not sure about the wording, the idea is about equal pressure point)

N2 wash out shown, what is the interpretation? (picture, similar to first seminar question) a- normal lung b- ventilation is uneven c- High dead spaces

b- ventilation is uneven

Which of the following would be a typical finding in a patient with an interstitial lung disease? A- Increased airway resistance B- Decreased airway resistance C- Increased functional residual capacity D- Decreased residual volume

D- Decreased residual volume

Which of the following causes the severest reduction in the oxygen transfer across respiratory membrane? a-anemia b-emphysema c-left to right extrapulmonary shunt d-compression of the pulmonary artery

b-emphysema

What is affected by partial pressure of CO2? ``` a-Arterial alveolar difference b-Hb O2 saturation c- CvO2 d- CaO2 e- difference between artery and vein content ```

b-Hb O2 saturation

What is reduced when the Krebs cycle is abnormal? ``` a-Arterial alveolar difference b-Hb O2 saturation c- CvO2 d- CaO2 e- difference between artery and vein content ```

e- difference between artery and vein content abnormal kreb cycle = not adequate oxidative phosphorylation which is the function of the mitochondria ( kreb cycle provide mediators for the electron transport chain) From that you will conclude that oxygen is not used so: CvO2 will be increased and the difference between arterial and venous content will be decreased the question asked about the one which is decreased so option e is the correct answer (note* this is my explanation and it is not confirmed by the doctor)

stimulations of This TRP inhibit cough

TRPM8

Patient with dyspnea at rest, results are shown below, what is the diagnosis? PaO2: (Blood gas = 65) (Normal range = >95) (With 100% o2 = 380) PaCO2: (Blood gas = 37) (Normal range = 38-42) (With 100% o2 = 40) CaO2: (Blood gas = 18) (Normal range = >1.3) Cv02: (Blood gas = 130) (With 100% o2 = 175) HCO3: (Blood gas = 22) (Normal range = 22-26) Hb: (Blood gas = 170) (Normal range = 132-172) Hb saturation: (Blood gas = 82%) (Normal range = >95%) (With 100% o2 = 100%) DLCO: (Blood gas = 28(127%)) (Normal range = 22) a) hypoventilation B) diffusion ventilation C) anemia D) abnormal shunt

D) abnormal shunt

metabolic alkalosis, hypoventilation is not fully compensated because PaCO2 cannot increase enough to compensate for the increased HCO3-. What is the limitation? A) alkaline plasma stimulates resp center B) increased Paco2 reduces sensitivity of resp center to pH C) hypoxemia limits hypoventilation D) hypoxemia reduces sensitivity of resp center to pH

C) hypoxemia limits hypoventilation

What is the most likely diagnosis for the picture below? (flow volume curves picture) A) normal lung B) obstruction of the small airways C) extrathoracic obstruction of the large airways D) intrathoracic obstruction of the large airways

C) extrathoracic obstruction of the large airways

what factor play a role in preventing fluid drainage from pulmonary capillaries to the alveoli? A) low hydrostatic pressure B) high oncotic pressure C) low protein concentrations D) high airway resistance

B) high oncotic pressure

hypoxia is relieved when the patient receives pure oxygen via a mask in which of the following cases? a-anemia b-bronchopneumonia

What is sensed by carotid body? A- PaO2 B- PAO2

A (PaO2)

Which of the following affect the tone of the pulmonary capillaries? A- PaO2 B- PAO2

B (PAO2) confirmed by the doctor

which of these is characteristic of acute mild asthma? (LT) A. Low PaO2 & low PaCO2 B. Normal/slightly low PaO2 & low PaCo2

B. Normal/slightly low PaO2 & low PaCo2

what cellular mechanism causes vasoconstriction in low partial pressure of O in lungs (hypoxic vasoconstriction)? a- decrease K+ conduction b- decrease Ca+ conduction

a- decrease K+ conduction

Ventilation to perfusion ratio in a person who stands upright is lower in the basal area compared to the apical. What is the main reason for this difference?

ventilation in apical alveoli is lower than basal alveoli why? A) apical alveoli remain distended at end of expiration C) apical alveoli expand less due to high surface tension D) basal alveoli expand more due to reduced airway resistance

A) apical alveoli remain distended at end of expiration

Drug given intravenously for status asthmaticus patient a-hydrocortisone b-predisalone c-salmatrol d-cromolyn

a-hydrocortisone

Former heroin addict was on methadone for one day. he was then diagnosed with TB, taking the typical 4 drugs regimen for 4 days, then came to the doctor with complaints of “withdrawal symptoms” which drug is responsible of this? a-rifampicin b-isoniazid c-streptomycin d-ethambutol

a-rifampicin

What drug is administered IV in status asthmaticus?

hydrocortisone

MOA for budesonide (anti-histamine)?

which medication is contraindicated in pregnancy a- Tetracycline b- Cefotaxime c- Streptomycin

a- Tetracycline

Which drug can cause Cushing syndrome?

Prednisolone

seizure as a side effect?

Theophylline

How does diphenhydramine cause dry mouth.

Inhibition of muscarinic receptors

What is the adverse effect of second generation of antihistamine? A- dry mouth B- sedation C- elongation of cardiac Q-wave

C- elongation of cardiac Q-wave

what is the method used to identify airway hyper responsive?

Methacholine

Boy have bilateral tonsils enlargement and pain with swallowing, what test do we use to know the causative agent? a- bacitracin test b-Novobiocin test

a- bacitracin test

-Tuberculosis avoids being killed by which mechanism?

blocking Phagolysosomal fusion

What is secondary TB resistance?

Resistance after therapy

what happens at secondary allergic reaction?

allergen with IgE and cross links and activates tyrosine kinase

What are common characteristics of outdoor allergens? a-Small insoluble protein carry on dry particles such as pollen grain and mite feces b-Small insoluble proteins that are common in season change c-A protein that need high dose of sensitization to form a strong TH2 response d-Protein need small dose of sensitization to form a strong TH2 response

d-Protein need small dose of sensitization to form a strong TH2 response

A 2-year-old diagnosed with bronchopneumonia, sputum culture grew gram negative coccobacilli, what is the diagnostic feature of this bacteria? a. Beta hemolytic b. Factor x and v dependent c. Bacitracin sensitive

b. Factor x and v dependent

after TB exposure, how long does it take before TB infection can be detected by TST? a. 48 - 72 hrs. b. 7 - 10 days c. 2 - 8 weeks d. 6 months or more

c. 2 - 8 weeks

a 3-year-old boy suffered from earache and his ear drum was bulging, gram stain of pus shows many neutrophils and gram-negative coccobacilli: A) S. aurues B) H. influenza C) S. Pneumonia D) s. pyogenes

B) H. influenza

What is the treatment of lepromatous leprosy?

dapsone, clofazimine, and rifampicin for 2 years

What’s is the characteristic of lepromatous leprosy?

lepretin test negative, many organisms in the lesion

The appropriate test do diagnose ABPG? ``` A- specific IgE B- total serum IgE C- serum tryptase D- Eosinophil Cationic Protein E- Precipitin IgG antibody ```

B (total serum IgE)

The appropriate test do diagnose hypersensitivity pneumonitis? ``` A- specific IgE B- total serum IgE C- serum tryptase D- Eosinophil Cationic Protein E- Precipitin IgG antibody ```

E (Precipitin IgG antibody)

The appropriate test do diagnose anaphylaxis? ``` A- specific IgE B- total serum IgE C- serum tryptase D- Eosinophil Cationic Protein E- Precipitin IgG antibody ```

C (serum tryptase)

Which pathogen/disease is associated with birds? a- Chlamydia psittaci b- MERS CO c- corona virus

A (Chlamydia psittaci)

Which pathogen/disease is associated with camels? a- Chlamydia psittaci b- MERS CO c- corona virus

B (MERS)

Part of adaptive immunity?

What is the class of drugs used to treat mycoplasma pneumonia? a- Aminoglycosides b- Glycopeptides c- Macrolides

c- Macrolides (not sure if this is the correct answer but the doctor mentioned it during the lecture)

Pt with hypercalcemia and has x-ray shows tumor? what is the next diagnostic method would u do? A- ask pt to drink fluids and check calcium levels again B- check for liver enzymes? C- check for thyroid levels

What does the appearance of air bronchogram indicate? a) lobar pneumonia b) hemothorax c) emphysematous bulla d) pneumothorax

a) lobar pneumonia

young female present with recent onset of high fever. Chest x-rays show right paracardial opacity obliterating the right heart border

Silhouette sign (cant remember the choices but this what the question described)

RCT was done to assist to different therapies on asthmatic patients, what is the role of randomization in this study? A-to match cases and controls B-reduce selection bias in the exposure assessment C- reduce information bias in the outcome

B-reduce selection bias in the exposure assessment

You successfully assist a 45-year-old smoker to quit smoking since he stopped smoking will his risk for heart disease ever decrease to that of a non-smoker? a- yes in 1 year b- yes within 8 years c- yes within 15 years d- yes within 25 years

c- yes within 15 years

what study design has a characteristic/feature of an “experiment”? a-RCT b- Prospective cohort

a-RCT

what's the best method to prevent the spread of TB? a- isolation in a negative pressure room b- washing hands after contact with someone with TB c. following those who are in contact with the patient & treating those with a positive PPD test

(Graph) The graph shows a study that was conducted to assess the effectivity of a new intensive drug for diabetic retinopathy. What is the study design and which group is doing better? A) Cohort -- Intensive treatment B) Cohort – Placebo C) RCT – Intensive treatment D)RCT -- Placebo

D)RCT -- Placebo