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Respiratory module Exams > 2018 end of module exam > Flashcards

2018 end of module exam Flashcards

1
Q

The lacrimal fluid from lacrimal sac goes into which space of nasal cavity?

  1. Atrium of middle meatus
  2. Middle meatus
  3. Inferior meatus
  4. sphenoethmoidal recess
A
  1. Inferior meatus
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2
Q

Which air sinus drainage is against gravity in anatomical position?

  1. Maxillary air sinus
  2. Sphenoidal air sinus
  3. Ethmodial air sinus
A
  1. Maxillary air sinus
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3
Q

Which structure is most abundant with smooth muscle fibers?

  1. Bronchioles
  2. trachea
  3. alveoli
  4. bronchi
A
  1. Bronchioles
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4
Q

Which nerve supplies sensory innervation of the laryngeal mucous membrane above the vocal fold?

  1. internal laryngeal nerve
  2. inferior laryngeal nerve
  3. external laryngeal nerve
  4. recurrent laryngeal nerve
A
  1. internal laryngeal nerve
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5
Q

Which muscle opens the vocal cord after full adduction?/Which of the following muscles abduct the larynx/airway after being fully adducted?

  1. Posterior cricoarytenoid
  2. Lateral cricoarytenoid
  3. Aryepiglottic Thyroarytenoid
A
  1. Posterior cricoarytenoid
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6
Q

A young patient presented with difficulty breathing and pleural rub. Later on she complained of stabbing pain especially at the root of her neck, which of the following is most likely involved?

  1. Cervical pleura
  2. Diaphragmatic Pleura
  3. Visceral pleura
  4. Mediastinal pleura
A
  1. Cervical pleura
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7
Q

What cells secrete pulmonary surfactant?

  1. Pneumocyte type 1
  2. Dust cells
  3. Pneumocyte type 2
  4. Goblet cells
A
  1. Pneumocyte type 2
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8
Q

A young boy with respiratory distress and on x-ray he showed what seems to be intestinal coils in the right thoracic cavity, malformation of which structure results in this condition?

  1. Pleuroperitoneal membrane
  2. dorsal mesentery of esophagus
  3. septum transversum
  4. pericardioperitoneal canal
A
  1. Pleuroperitoneal membrane
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9
Q

A bullet pierces the 6th intercostal space next to sternum, what structure will it miss (not injure)?

  1. internal intercostal muscle
  2. external intercostal membrane
  3. innermost intercostal muscle
  4. endothoracic fascia and skin
  5. parietal pleura
A
  1. innermost intercostal muscle
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10
Q

Which of the following is mostly associated with adenoid?

  1. Nasopharyngeal tonsil
  2. Palatine tonsil
  3. Lingual tonsil
A
  1. Nasopharyngeal tonsil
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11
Q

Which muscle is relaxing during forced inspiration?

  1. diaphragm
  2. external intercostal
  3. Interchondral part of internal intercostal
  4. interosseous part of internal intercostal
  5. innermost intercostal
A
  1. interosseous part of internal intercostal
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12
Q

A doctor inserted a needle near lower border of right 8th rib at anterior axillary line. Next day patient complains of tingling & numbness of skin of the chest below the 8th rib extending into abdominal wall into umbilical on the right side, which nerve is injured?

  1. 8th intercostal nerve
  2. 8th collateral intercostal nerve
  3. 8th lateral cutaneous intercostal nerve
  4. 7th intercostal nerve
  5. 9th intercostal nerve
A

8th intercostal nerve* or 8th lateral cutaneous intercostal nerve*

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13
Q

What muscle elevates the larynx?

  1. Mylohyoid
  2. Omohyoid
  3. Sternohyoid
  4. Sternothyroid
A
  1. Mylohyoid
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14
Q

Which is described as alveolar collapse?

  1. resorption atelectasis
  2. compression atelectasis
  3. contraction atelectasis
  4. segmental atelectasis
A
  1. resorption atelectasis
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15
Q

What is the mechanism of inhibition of Cyclooxygenase by aspirin?

  1. Assisting arachidonic acid binding to the active site C
  2. ompetitive binding of aspirin to the active site
  3. Binding of aspirin on an allosteric site on the enzyme
  4. Irreversible modification of a serine residue in the active site
A
  1. Irreversible modification of a serine residue in the active site
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16
Q

What is the function of FLAP protein in leukotriene synthesis?

  1. An anti inflammatory lipid mediator
  2. conjugates leukotriene to glutathione
  3. Brings arachidonic acid to 5-lipooxygenase
  4. Stimulates the migration of 5-lipooxygenase to plasma membrane
A
  1. Brings arachidonic acid to 5-lipooxygenase*
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17
Q

What will decrease surfactant function if it’s high in adults?

  1. Sphingomyelin
  2. DPPC
  3. Cholesterol
A
  1. Cholesterol*
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18
Q

Which organ produces α1-antitrypsin?

  1. Spleen
  2. Thyroid
  3. Lung
  4. Liver
A

Liver

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19
Q

How does α1-antitrypsin inhibit elastase?

  1. Acts as a substrate to form an inactive complex
  2. Reduce elastase production
A
  1. Acts as a substrate to form an inactive complex
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20
Q

What type of DNA damage is caused by polycyclic aromatic hydrocarbon?

  1. form a DNA adduct
  2. break DNA strand
A
  1. form a DNA adduct
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21
Q

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

  1. adenine
  2. guanine
  3. thymine
  4. cytosine
A
  1. guanine
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22
Q

What’s the feature of cytokine syndrome in Covid-19?

  1. release multiple cytokines that help in lung epithelial cell regeneration.
  2. release multiple cytokines and chemokines leading to prolonged survival of lung epithelial cell and endothelial cell.
  3. release multiple cytokines and chemokines leading to lung epithelial cell and endothelial cell apoptosis
  4. release multiple cytokines that help in endothelial cell regeneration.
A
  1. release multiple cytokines and chemokines leading to lung epithelial cell and endothelial cell apoptosis
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23
Q

What is the feature seen in acute respiratory distress syndrome (ARDS) in covid 19 ?

A

impaired function of type 2 pneuomcytes

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24
Q

What’s the cytokine needed for B cell Class switch to IgE?

  1. IL-2
  2. IL-4
  3. IL-6
  4. IL-10
A
  1. IL-4
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25
Q

What is the most appropriate test for diagnosing allergic broncho pulmonary aspergillosis?

  1. Allergen specific IgG
  2. Total serum IgE
  3. Serum tryptase
  4. Precipitin IgG antibody
A
  1. Total serum IgE
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26
Q

Which cytokine is produced by T-reg?

  1. IL-4
  2. IL-10
  3. IL-2
  4. IL-13
A
  1. IL-10
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27
Q

Which is a live attenuated vaccine?

  1. rabies
  2. rubella
  3. polio (salk)
  4. hepatitis A
A
  1. rubella

[Salk vaccine contains killed viruses]

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28
Q

What is the gold standard test to diagnose food allergy?

  1. skin prick test for major proteins
  2. intradermal prick test for major proteins
  3. prick to prick test for fresh food
  4. double blinded food challenge test
A
  1. double blinded food challenge test
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29
Q

What constitutes subunit vaccine?

  1. live, attenuated infectious agent
  2. killed the whole agent
  3. antigen and specific/purified parts
  4. T-independent Ag bind to T-depandant
A
  1. antigen and specific/purified parts
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30
Q

A 8 year old boy presented with a 3-day history of worsening sore throat, pharyngitis, (and one other clinical manifestation that i cant remember), enlarged anterior cervical lymph nodes. Culture grew B hemolytic gram +ve cocci in chains. What is the preferred treatment?

  1. ciprofloxacin
  2. penicillin
  3. vancomycin
  4. tetracycline
A
  1. penicillin

[Streptococcus is the caustive agent]

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31
Q

A 70 year old obese diabetic patient presented with foul smelling ear discharge for two months. The CT exam showed an aggressive infection of the external auditory canal, middle ear, and mastoid bone. What’s the most likely organism?

  1. Gram negative bacilli
  2. Gram positive bacilli
  3. Gram negative cocci
A
  1. Gram negative bacilli
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32
Q

A 8 year old child presented with malaise, fever, his immune profile was not completed, and there was a thick membrane w/ gray color.

  1. S. Pneumonia
  2. Diphtheria
  3. P. Aeruginosa
A
  1. Diphtheria
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33
Q

What is the diagnostic test for latent Tb?

  1. Sputum microscopy
  2. Tuberculin test
  3. PCR
  4. Sputum culture
A
  1. Tuberculin test
34
Q

How long does it takes for cellular immunity and tissue hypersensitivity to appear in tb infection?

  1. 2-3 days
  2. 3-8 weeks
  3. 1-2 weeks
  4. 3-6 months
35
Q

What is the gold standard therapy in TB?

A

Isoniazid and rifampicin for 6 months, and pyrazinamide and ethambutol for 2 months.

36
Q

What is the gold standard method for diagnosis of bronchiectasis?

  1. Sputum culture
  2. Blood culture
  3. High resolution CT
  4. PCR
A
  1. High resolution CT
37
Q

What is the best method of diagnosis of lepromatous leprosy?

  1. culture of skin and nerve biopsy on lowenstein jensen medium
  2. culture of skin and nerve biopsy on blood agar
  3. acid fast staining of skin and nerve biopsy
  4. nucleic acid amplification
A
  1. acid fast staining of skin and nerve biopsy
38
Q

What is the anomaly that cause cough when the baby sucking milk?

  1. trachesophageal fistula
  2. lung hypoplasia
  3. trachea diverticulm
  4. congenital diaphram hernia
A
  1. trachesophageal fistula
39
Q

An 8 year old boy had epiglottitis, and the organism was Haemophilus influenzae On which agar does this organism grow?

  1. blood agar
  2. chocolate agar
  3. nutrient media
A
  1. chocolate agar
40
Q

53 yo, obese, chronic smoker presented with *acute exacerbation of chronic bronchitis*, what’s the most likely agent?

  1. Klebsiella pneumonia
  2. Moraxella catarrhalis
  3. Mycoplasma pneumonia
A
  1. Moraxella catarrhalis
41
Q

A man came into the ER with cough, fever, and confusion. He recently had a kidney transplant. X-Ray shows heavy interstitial infiltration. What could be the cause ?

  1. birds droppings
  2. cooling towers
  3. animals
  4. drinking contaminated water
A
  1. cooling towers

(legionella which is transferred through inhalation of contaminated water, not drinking it)

legionella: interstitial inflammation, usually legionella is severe in immunosuppressed individuals like this patient, and it causes intrapulmonary manifestations including confusion!

42
Q

What are the mediators of tuberculin-type hypersensitivity?

  1. IL4, IL10, IFN gamma
  2. IL5, TGF beta, TNF alpha
  3. IL8, IFN gamma, TNF alpha
  4. IL17, TGF beta, TNF alpha
A
  1. IL8, IFN gamma, TNF alpha
43
Q

How can Mycobacteria tuberculosis degrade the collagen around a granuloma?

A

matrix metalloproteinase

44
Q

A 54 year man with dyspnea and cough. his PFT results show? I don’t remember the numbers but they gave us [FEV1, FVC, FEV1/FVC ratio]

And the post-bronchodilator results show improvement in both FEV1 and FVC more than 12%

  1. Tracheal stenosis
  2. emphysema
  3. lung fibrosis
  4. Pneumonia Asthma
A
  1. Pneumonia Asthma
45
Q

What is the most important risk factor that accounts for high incidence of tuberculosis in Africa?

  1. poor awareness of the disease
  2. malnutrition
  3. HIV infection
  4. no BCG vaccination
A
  1. HIV infection
46
Q

What is cause of confusion for people diagnosed with small cell lung cancer?

  1. Syndrome of inappropriate ADH
  2. Hypoparathyroidism
  3. Anemia
  4. Ectopic production of parathormone
A
  1. Syndrome of inappropriate ADH
47
Q

What is the percentage of smokers among COPD patients?

  1. 70-95%
  2. 35-50%
48
Q

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?

  1. Increase employees salary to afford health insurance
  2. Perform PFT to screen for asthma annually
  3. Install advanced ventilation to get rid of flour particles
  4. Rotate employees around different areas of the bakery
A
  1. Perform PFT to screen for asthma annually
49
Q

What is compatible from pulmonary functional test to confirm interstitial lung disease with shortness of breath and dry cough?

  1. reduced FRC - reduced FEV1 - reduced FEV1/FRC - reduced DLCO
  2. reduced FRC - reduced FEV1 - normal FEV1/FRC - reduced DLCO
  3. increased FRC - reduced FEV1 - reduced FEV1/FRC - normal DLCO
  4. reduced FRC - reduced FEV1 - normal FEV1/FRC - normal DLCO
A
  1. reduced FRC - reduced FEV1 - normal FEV1/FRC - reduced DLCO
50
Q

56 year old man presents with 5 days history of fever, shortness of breath, and left side chest pain, arterial blood gas obtained shows

Normal ph Normal HCO3 Low Pco2 = 3.2 Low Po2

What is the best physiological basis that explains Pco2 values?

  1. increased alveolar ventilation
  2. increased dead space ventilation
  3. increased perfusion to the lung
  4. increased ventilation perfusion matching
A
  1. increased alveolar ventilation
51
Q

What is the characteristics X-ray pattern of idiopathic pulmonary fibrosis?

  1. Reticulonodular pattern in the apex
  2. Reticular pattern in the basal and peripheral parts
  3. hilar lymphadenopathy
  4. centrilobular fibrosis
A
  1. Reticular pattern in the basal and peripheral parts
52
Q

Gas A diffuses readily through the alveolar membrane, dissolves poorly in water, has lower solubility than O2, and binds very poorly to Hb.
What is the rate-limiting step?

  1. alveolar ventilation
  2. Diffusion through respiratory membrane
  3. Lung perfusion
  4. Hb binding
A
  1. Lung perfusion
53
Q

Person with bronchial asthma. What is the role of Eosinophils in the pathogenesis of the disease?

  1. Secrete IL-5 attracts inflammatory cells
  2. Release histamine to cause bronchoconstriction
  3. Induce collagen synthesis
  4. Release leukotrienes to cause bronchoconstriction
A
  1. Release leukotrienes to cause bronchoconstriction
54
Q

50 year old woman post transplant with fever of 38.5°C and weight loss. X-ray shows bilateral diffuse consolidation. What is the most likely cause?

A

Pneumocytis pneumonia

55
Q

What inhibits DNA topomerase II?

A

Ciprofloxacin

56
Q

By what mechanism does carbocistenine produce its expectorant action?

  1. breaking of intra-molecular disulfide bonds of glycoproteins of mucus
  2. inducting secretion of water by epithelial cells to liquify mucus
  3. enhancing ciliary movement to facilitate easy removal of mucus
  4. blockade of intracellular transport of glycoproteins in epithelial cells
A

breaking of intra-molecular disulfide bonds of glycoproteins of mucus

57
Q

Which of the following anti-asthmatic drugs can cause adrenal suppression in children?

  1. Ipratopium
  2. Prednisolone
  3. Zafirlukast
  4. Theophyllin
A
  1. Prednisolone
58
Q

Adverse effect of Clofazimine?

  1. Peripheral neuropathy
  2. Discoloration of body fluids
  3. Renal impairment
  4. Jaundice
A
  1. Discoloration of body fluids
59
Q

What is the action of isoniazid?

  1. inhibition of mycolic acid synthesis
  2. inhibition of RNA polymerase
A
  1. nhibition of mycolic acid synthesis
60
Q

What is most likely cell type infiltrating the site of an Arthus Reaction?

  1. Neutrophils
  2. eosinophils
  3. macrophages
  4. Dendritic Cells
A
  1. Neutrophils
61
Q

How do inflammatory mediators increase the tendency for cough?

  1. direct contact with TRPV1
  2. GPCR activation
  3. TRPM8 activation
A
  1. GPCR activation
62
Q

Which parameter stays almost the same during cough compared to normal breathing ?

  1. Inspiratory volume
  2. Expiratory volume
  3. Inspiratory phase duration
  4. Expiratory phase duration
A
  1. Inspiratory phase duration
63
Q

they gave us a graph of VO2max.

  • the Predicted VO2 max was 4
  • Reached anaerobic threshold at 0.9
  • The respiratory reserve was normal.
  • Did not reach MVV. Did not reach VO2 max

What could be the cause of this?

  1. Normal subject
  2. Weak heart
  3. Respiratory problem
  4. Unfit
A
  1. Weak heart
64
Q

At which lung volume is the compliance highest?

  1. Residual volume
  2. Total lung capacity
  3. 86% FRC
  4. FRC
65
Q

In which of the following obstructive lung diseases DLCO may increase?

  1. COPD/ emphysema
  2. Acute bronchitis
  3. Chronic bronchitis
  4. Asthma
66
Q

Patient with high DLCO (%180), what’s the reason/cause?

  1. compressed pulmonary artery
  2. pulmonary hemorrhage
  3. right to left cardiac shunt
  4. pulmonary edema
A
  1. pulmonary hemorrhage
67
Q

A 70 yo woman w/ emphysema, What consistent with this disease?

A

FEV1 is low, FVC is low or normal, FEV1/FVC ratio low, DLCO low, and TLC and RV could be high due to air trapping

They were all pulmonary function test results. We don’t remember exactly but here is what you should know about emphysema:

68
Q

What does this figure represent?

  1. Central sleep apnea
  2. Obstructive sleep apnea
A
  1. Central sleep apnea

(The lines for rib cage and abdomen effort had small wave and airflow was 0. But in comparison to when the airflow was normal the waves were much larger, which is why central sleep apnea is the answer. Effort in the respiratory muscles should be high during period of no airflow in order to be classified as obstructive sleep apnea)

69
Q

Which one is decreased in pulmonary hypertension?

  1. Nitric oxide
  2. Endothelin-1
  3. Angiotensin
  4. Thromboxane A2
A
  1. Nitric oxide
70
Q

What cellular mechanism causes vasoconstriction in low partial pressure of O2 in lungs (hypoxic vasoconstriction)?

  1. Decrease K+ conduction
  2. decrease Ca+ conduction
A
  1. Decrease K+ conduction
71
Q

What change in pattern would occur in peak expiratory flow and forced expiratory flow 50-75% upon maximal effort compared to normal expiratory effort?

  1. PEFR No change , FEF50-75% no change
  2. PEFR No change, FEF50-75% increase
  3. PEFR Increase, FEF50-75% no change
  4. PEFR Increase, FEF50-75% increase
A
  1. PEFR Increase, FEF50-75% no change
72
Q

What causes an increase in airway resistance?

  1. increase lung volume above FRC
  2. sympathetic stimulation
  3. cholinergic agonist acetylcholine
A
  1. cholinergic agonist acetylcholine
73
Q

In the figure shown, given that the two alveoli contain the same amount of surfactant, which has higher pressure and what’s the direction of air flow?

A

Higher pressure: A

Direction of flow A to B

74
Q

Which of the following causes the intrapleural pressure to become more positive?

  1. Exhalation of volume (3L)
  2. Inhalation of volume (3L)
A
  1. Exhalation of volume (3L)
75
Q

As a person takes a deep breath, the compliance of the respiratory system changes with the volume. At what lung capacity or volume does the respiratory system have the greatest compliance?

  1. Total lung capacity
  2. 86% of vital capacity
  3. Functional residual capacity
  4. Residual volume
A
  1. Functional residual capacity
76
Q

What is the most common CFTR mutation in Caucasians?

77
Q

What structural gene in primary ciliary dyskinesia causes abnormality (or is abnormal?) in arabs?

  1. DNAH5
  2. RSPH9
  3. CCDC40
  4. LRRC50
78
Q

What is the primary defense against TB?

  1. IgG
  2. IgM
  3. IgE
  4. NK cells
  5. T cells
79
Q

A 58-year-old man presented with a history of weight loss, malaise, night sweats and back pain. Radiography revealed a collapse in L1 vertebrae and decreased intervertebral space along with a right pleural effusion.

What is the most appropriate investigation to perform?

  1. Sputum culture
  2. CT scan of the chest
  3. Pleural aspiration & biopsy
  4. Chest xray
  5. Bronchoscopy & bronchial aspirate
A
  1. Pleural aspiration & biopsy
80
Q

53-year-old female smoker that has a mass near the left hilum that had small round cells and scant cytoplasm, what is a feature of this tumor?

  1. Can undergo surgical resection
  2. ACTH secreting
  3. Grows slowly
A
  1. ACTH secreting
81
Q

A 60 y/o male, a chronic smoker, presented with pain in his right shoulder. Physical exam showed ptosis in his right upper eyelid, constriction in his right pupil, and lack of sweating in his right side of his face
What is the most likely tumor?

  1. Squamous cell carcinoma involving the right main bronchus
  2. Small cell carcinoma involving the right hilum
  3. Adenocarcinoma in the apex of the right lung
  4. Mucinous adenocarcinoma in the right hilum
  5. Endo-bronchial carcinoid in the right main bronchus
A
  1. Adenocarcinoma in the apex of the right lung

[apical tumor = Horners syndrome]

82
Q

Whats the immunological status of a person after M.tb infection and activated adaptive immunity?

    • IGRA, - TST
    • IGRA, + TST
    • IGRA, - TST
    • IGRA, + TST
A
    • IGRA, + TST

Respiratory module Exams (10 decks)

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