Internal medicine - Pulmonology Flashcards
INT - 4.1
The factor that mostly effects the prognosis of a COPD patient is:
A) The continuation of smoking
B) The reversibility of obstruction when using steroids
C) The degree of hypoxia
D) The value of FEV1
E) The presence of hypercapnia
ANSWER
D) The value of FEV1
EXPLANATION
Numerous international studies have confirmed that the prognosis of COPD is mainly determined by the FEV1 values. The degrees of the severity (prognosis) were determined by the decline of FEV1.
INT - 4.2
In case of suspected chronic obstructive pulmonary disease, the most important examination that can confirm the diagnosis is:
A) The determination of the daily amount of sputum
B) Physical examination
C) Chest radiograph
D) Pulmonary function testing
E) Blood gas analysis
ANSWER
D) Pulmonary function testing
EXPLANATION
The diagnosis of COPD cannot be made without detectable airway obstruction proved by pulmonary function testing, as airway obstruction (O) is the most important criteria.
INT - 4.4
From the following symptoms which one is the most typical for bronchiectasis?
A) Cough
B) Large amount of (>50-100 ml/day), often purulent expectoration
C) Hemoptysis
D) Chest pain
E) Dyspnea
ANSWER
B) Large amount of (>50-100 ml/day), often purulent expectoration
EXPLANATION
Although in bronchiectasis both hemoptysis and dyspnea may be present, the most typical symptom that draws the attention to bronchiectasis is the large amount of expectoration, the “full-mouth” spit after targeted cough. In bronchiectasis phlegm stasis serves as an ideal substrate for bacteria, so the sputum is often purulent. It should be noted that bronchiectasis can be permanently asymptomatic as well, especially in the case of even cylindrical dilation.
INT - 4.5
From the following medication groups which one can significantly inhibit the production of mucus?
A) Theophylline
B) β2-adrenergic receptor agonists
C) Non-selective β2-blockers
D) Anticholinergics
E) Furosemide
ANSWER
C) Non-selective β2-blockers
EXPLANATION
The non-selective β-adrenergic agonists prevent the movement of the cilia on the columnar cells found on the surface of the bronchial mucous membrane and thus the mucus transport, contrary to theophylline and β2-adrenergic agonists which enhance the functions of the mucociliary clearence. Anticholinergics and furosemide do not inhibit the clearence, in larger doses they even help it.
INT - 4.6
Medications for the rapid treatment of asthma attacks:
A) Sedatives
B) Bronchodilators
C) Antihistamines
D) Corticosteroids
E) Chromoglycate
ANSWER
B) Bronchodilators
EXPLANATION
The asthma attack can be eased in a short time by bronchodilators (bronchial smooth muscle relaxants). The bronchodilator effect of antihistamines - that competitively inhibit the bronchoconstrictor effect of histamine released in a significant amount during mast cell degranulation - is irrelevant. In fast evolving asthma attack the spasm of the bronchial smooth muscles is dominant. The bronchial mucous membrane inflammation that later might become dominant can be eased slowly with corticosteroids. The use ofUsing chromoglycate does not end the asthma attack and sedatives are not antiasthmatic drugs.
INT - 4.8
Which of the following answers is not correct?
A) Regular administration of a short-acting β2-receptor agonist bronchodilator is preferred to administration as needed.
B) Inhaled β2-agonists reach their maximal bronchodilator effect within minutes (in 5-15 minutes).
C) The efficiency of inhalation bronchodilator aerosols can be enhanced, if the patient inhales them through an inhalation piece (nebuhaler).
D) The duration of effect of long-acting inhaled β2-receptor agonist products is between 10-12 hours.
E) The most effective medications in case of bronchoconstriction are β-receptor stimulant bronchodilators.
ANSWER
A) Regular administration of a short-acting β2-receptor agonist bronchodilator is preferred to administration as needed.
EXPLANATION
Short acting β-adrenergic agonists are used as “risk-drugs” in long-term medical adjustment or without it, reducing airway caliber narrowing (bronchospasm) that evolves acutely. In long-term asthma control treatment, their usage – e.g. application in asymptomatic periods – is unnecessary. So, statement A is not correct.
INT - 4.9
In case of a 56-year-old, alcoholic, heavy smoker male patient with recurrent fever and cough, followed by large amount of purulent expectoration, weight loss, chest pain and poor general condition has occured. His chest x-ray shows a right upper lobe shadow with fissure formation. The most likely pathogen that caused the pneumonia with above-described clinical picture is:
A) Streptococcus pneumoniae
B) Mycoplasma pneumoniae
C) Staphylococcus aureus
D) Klebsiella pneumoniae
E) Mycobacterium tuberculosis
ANSWER
D) Klebsiella pneumoniae
EXPLANATION
Pneumonia caused by Mycoplasma pneumoniae and Staphylococcus is not lobar pneumonia. The pneumatic form of Streptococcus pneumonie and M. tuberculosis do not cause putrid sputum, and more than average amount of expectoration occurs rarely. So Klebsiella remains, that can be associated with lobar pneumonia with fissure formation and a large amount of sputum.
INT - 4.10
The size of the hyperergic tuberculin reaction among the vaccinated population is (the largest diameter perpendicular to the longitudinal axis of the induration):
A) > 10 mm
B) > 15 mm
C) > 20 mm
D) > 25 mm
E) > 30 mm
ANSWER
B) > 15 mm
EXPLANATION
Regarding international agreement, hyperergic tuberculin reaction means larger than 15mm reaction (induration). A reaction larger than that namely appears only after BCG-vaccination as a rare exception.
INT - 4.11
In case of newly discovered lesion, which is the size of an infant’s palm, inhomogeneous, right apical, clinically considered as TB, but is negative to Mycobacterium with direct sputum test and with PCR, which one is the recommended sufficient drug combination?
A) INH + RAMP + PZA
B) INH + RAMP
C) INH + PZA
D) INH + PZA + RAMP + EMB
E) INH + EMB
ANSWER
A) INH + RAMP + PZA
EXPLANATION
Based on international and national recommendation and practical experiences, beside the rare national occurrence of primary multiresistance (1-2%, at most) the triple combination of isoniazid (INH) + rifampicin (RAMP) + pyrazinamide (PZA) is sufficient.
NT - 4.12
Which antibiotic from the followings is most likely to cause hepatitis?
A) INH
B) PZA
C) RAMP
D) PAS
E) EMB
ANSWER
B) PZA
EXPLANATION
Although INH and RAMP can lead to liver damage, yet the occurrence of hepatitis is the most common during PZA application.
INT - 4.13
Principles used in the treatment of multidrug-resistant TB patients, except:
A) At least three drugs to which the isolated bacteria are sensitive should be used.
B) First-line antituberculotic treatment should be used primarily.
C) The medication is supplemented with secondary antituberculotics to achieve a combination of four drugs.
D) At least 3-3 microscopic examinations and culture tests should be performed every three months during treatment.
E) A resistance test is need to be performed from the cultures.
F) After bacterial testing came back negative, the treatment must be continued for at least one more year.
G) Surgical solution must be considered.
ANSWER
D) At least 3-3 microscopic examinations and culture tests should be performed every three months during treatment.
EXPLANATION
During the treatment until culture results become negative, performing microscopic and culture tests are necessary for three months. After that if the radiological regression is persistent the number of these tests can be decreased.
INT - 4.14
Which treatment is contraindicated in the treatment of pulmonary embolism during pregnancy?
A) O2 addition
B) bedrest
C) early mobilization
D) administration of Syncumar
E) administration of heparin
ANSWER
D) administration of Syncumar
EXPLANATION
Syncumar is contraindicated in pregnancy. Given in the 2nd and 3rd trimester it may cause chondrodysplasia puncata, central nervous system abnormalities or abortion. In late pregrancy it may cause fetal bleeding.
INT - 4.16
Characteristics of acute cor pulmonale, except:
A) consequence of pulmonary embolism
B) consequence of severe acute asthma
C) echocardiography shows dilated, thin walled right ventricle
D) echocardiography shows hypertrophic dilated right ventricle
E) the consequence of acute increase of right ventricular pressure
ANSWER
D) echocardiography shows hypertrophic dilated right ventricle
EXPLANATION
In acute cor pulmonale there is not enough time to develop rigth ventricular hypertrophy.
INT - 4.17
In which condition could ’Birbeck’s granulomas’ be typically detected from bronchoalveolar lavage by electron microscopy or may be the ratio of CD1-positive cells above 3%?
A) alveolar microlithiasis
B) Goodpasture syndrome
C) Hamman-Rich syndrome
D) histiocytosis X
E) alveolar proteionosis
ANSWER
D) histiocytosis X
EXPLANATION
Birbeck’s granulomas also known as x-bodies, or more than 3% of CD1 positive cell ratio in BAL are diagnostic for histiocytosis X.
INT - 4.19
In which condition is pleural exudate most likely expected?
A) heart failure
B) nephrosis
C) cirrhosis hepatis
D) peritoneal dialysis
E) pulmonary embolism
ANSWER
E) pulmonary embolism
EXPLANATION
According to literature, the correct answer is pulmonary embolism.
NT - 4.20
All of the following conditions may cause mediastinal lymph node enlargement, except:
A) Hodgkin’s disease
B) Non-Hodgkin’s lymphomas
C) Toxoplasma gondii infection
D) Sarcoidosis
E) Pneumonia
ANSWER
E) Pneumonia
EXPLANATION
Pneumonia does not cause mediastinal lymph node enlargement.
INT - 4.21
Symptoms of superior vena cava syndrome, except:
A) swelling of the head
B) cyanosis
C) development of thoracic collateral circulation
D) arrhythmia
E) heavy breathing
ANSWER
D) arrhythmia
EXPLANATION
Superior vena cava syndrome results from significant lumen narrowing or total obstruction of this vessel. Its most important features are swelling of the head and neck due to obstruction of venous reflux, cyanosis due to venous congestion and the development of thoracic collaterals. Swelling of the cervical soft tissues causes narrowing of the airways in the case of compression of the trachea (mediastinal tumor), which may lead to heavy breathing even without cerebral hypoxemia. Arrhytmia is not typical in superior vena cava syndrome.
INT - 4.22
Characteristic of respiratory failure based on hypoventilation, except:
A) May be a consequence of neuromuscular disease
B) The degree of hypoxia is not similar to the degree of hypercapnia
C) May be caused by chest deformity
D) Ventilation pulmp failure
E) May be a consequence of obesity
ANSWER
B) The degree of hypoxia is not similar to the degree of hypercapnia
EXPLANATION
Not only does arterial O2 tension decrease in hypoventilation, but also the elimination of CO2 is inadequate, thus increases arterial CO2 tension.
INT - 4.23
In the following conditions respiratory failure is predominantly due to diffusion failure, except:
A) fibrotic alveolitis
B) sarcoidosis
C) alveolar cell carcinoma
D) COPD
E) irradiation damage
ANSWER
D) COPD
EXPLANATION
In COPD the main cause of respiratory failure is an abnormal change in the ventilation/perfusion rate caused by airway obstruction and ventilation distribution failure caused by the uneven regional lung distensibility. In the case of COPD-related obstructive emphysema it is not the reduction in diffusion that plays a decisive role, but rather the above mentioned factors. In the other diseases listed above, the prolongation of the diffusion pathway and the reduction of the diffusion surface play the major role.
INT - 4.24
Characteristic of trachea dyskinesis:
A) predispose to barking cough
B) common cause of cough
C) usually curable by surgery
D) precancerosis
E) relieved by antihistamines
ANSWER
A) predispose to barking cough
EXPLANATION
In tracheadyskinesia during coughing intrathoracic pressure increases, so the abnormally loose parietal membrane of the trachea bulges into the lumen and often slams against the anterior wall of the trachea, which may make the cough barking like. Deep breathing (cold air), inhalation of irritants stimulate the nerve endings of the often inflamed, hyperaemic tracheal mucosa causing cough or coughing attacks. However trachea dyskinesia is by far not the most common cause of cough.
INT - 4.25
Which one of the following clinical signs is not characteristic of sleep apnea?
A) daytime sleepiness
B) intellectual- and personality changes
C) loud snoring at night
D) elevated blood glucose level
E) hypertonia
F) obesity
ANSWER
D) elevated blood glucose level
EXPLANATION
Elevated blood glucose level does not play a causal role in sleep apnea and neither is it a sequelae of it.
INT - 4.26
Tuberculosis infections can occur in the following ways, with one exception. Mark the exception.
A) trough airways
B) alimentary infection (by the consumption of contaminated food)
C) percutaneous (contact with the skin)
D) transplacental (through the placenta)
E) genital contact
ANSWER
D) transplacental (through the placenta)
EXPLANATION
Tuberculosis bacteria doesn’t cross the placenta.
INT - 4.27
Which one of the following can lead to chronic cor pulmonale?
A) lobar pneumonia
B) pulmonary venous thromboembolism
C) pulmonary edema
D) chronic obstructive pulmonary disease
E) bronchopneumonia
ANSWER
D) chronic obstructive pulmonary disease
EXPLANATION
In chronic obstructive pulmonary disease alveolar hypoxia, consequential vasoconstriction, pulmonary vascular resistance, pulmonary hypertension and chronic right heart strain leads to cor pulmonale. In the other listed diseases cor pulmonale either doesn’t develop at all, or there isn’t enough time for it to develop – those being acute diseases.
INT - 4.28
Symptoms of Goodpasture-syndrome, except:
A) focal glomerulonephritis
B) septic spleen
C) pulmonary fibrosis, induration
D) cutaneous purpura
E) Prussian blue staining in lung parenchyma
ANSWER
B) septic spleen
EXPLANATION
Goodpasture-syndrome is not an infectious disease, therefore septic spleen is not part of the sypmtoms.
INT - 4.29
All the followings are possible complications of chronic obstructive pulmonary disease (COPD), except:
A) cor pulmonale
B) polycythaemia
C) respiratory failure
D) left ventricular dysfunction
E) bronchogenic carcinoma
ANSWER
D) left ventricular dysfunction
EXPLANATION
COPD causes strain on the right side of the heart, not on the left. Altough polycythaemia caused by hypoxaemia increases blood viscosity, thus straining the left side of the heart, but that usually doesn’t lead to left ventricular failure all by itself.
INT - 4.30
Depending on the pathological changes in the lung, chronic obstructive pulmonary disease (COPD) can manifest as emphysema or bronchitis. Although these two COPD-syndromes rarely manifest as independent diseases, by definition they can be separated based on the clinical features. Which one of the following symptomes is common in both COPD’s bronchitic and emphysematous phenotype?
A) polycythaemia
B) airflow improvement with bronchodilators
C) dyspnoea
D) chronic cough
E) hypercapnia
ANSWER
C) dyspnoea
EXPLANATION
Dyspnea caused by airway obstruction is typical for both obstructive emphysema and obstructive bronchitis. Polycythaemia, airflow improvement after using bronchodilators and chronic cough are not characteristic for emphysema. In emphysema alone, significant hypoxaemia doesn’t occur, and hypercapnia never happens because of hyperventilation. (Except for in very severe emphysema when exhaustion of the respiratory muscles cause hypoventilation.)
INT - 4.31
Which statement is not true about the autonomic innervation of the respiratory tract?
A) Parasympathetic nerves control the main mechanisms of bronchoconstriction.
B) Sympathetic nerves control the main mechanisms of bronchodilatation.
C) Acetylcholine is the primary mediator of parasympathetic postganglionic neurons.
D) Noradrenaline is the primary mediator of sympathetic postganglionic neurons.
E) Slightly increased cholinergic resting bronchial tone is physiological.
ANSWER
B) Sympathetic nerves control the main mechanisms of bronchodilatation.
EXPLANATION
Sympathetic postganglionic neurons innervating the respiratory tract – which are mediated primary by noradrenaline – play a fundamental role only in regulating the bronchial blood flow. Airway smooth muscles don’t have sympathetic innervation, therefore sympathetic nerves don’t mediate bronchodilation. Bronchoconstriction is mainly regulated by respiratory parasympathetic nerves, which are primary mediated by acetlycholine. Acetylcholine activates the M3-receptors of bronchial smooth muscle cells, triggering bronchoconstriction. Tonic acetylcholine release from the parasympathetic nerves is responsible for the slightly increased, physiological resting bronchial tone.
INT - 4.32
Inhalation of non-selective cholinergic antagonists can paradoxically provocate bronchoconstriction. Inhibition of which receptor is responsible for this rare reaction?
A) M1
B) M2
C) M3
D) NA
E) Beta2-adrenergic
ANSWER
B) M2
EXPLANATION
Activation of M2-receptors of parasympathetic postganglional nerves inhibits acetylcholine release. Pharmacological inhibition of postganglional nerve’s inhibitory M2-receptors leads to more acetylcholine release during cholinergic stimulation. This decreases the effect of the non-selective cholinergic antagonist or, paradoxically, can trigger bronchoconstriction. Bronchoconstriction caused by cholinergic antagonists is not related to the other listed receptors.
INT - 4.33
How do anticholinergic bronchodilators exert their bronchial smooth muscle relaxing effect?
A) by facilitating sympathetic neuromuscular transmission
B) by inhibiting sympathetic neuromuscular transmission
C) by facilitating parasympathetic neuromuscular transmission
D) by inhibiting parasympathetic neuromuscular transmission
E) by direct effect
ANSWER
D) by inhibiting parasympathetic neuromuscular transmission
EXPLANATION
Cholinergic antagonist bronchodilators are competitive antagonists of acetylcholin, which inhibit activation of the muscarinic cholinergic receptors by acetylcholin. This mechanism is responsible for inhibiting the parasympathetic neuromuscular transmission, therefore decreasing the bronchial smooth muscle’s tone, indirectly causing bronchodilation. Sympathetic innervation of the airways doesn’t play a considerable role in regulating bronchial tone.
INT - 4.34
Which one of the following function is not characteristic of pulmonary surfactant?
A) stabilizing alveoli and bronchi during exspiration (anti-atelectasis)
B) maintaining the alveolo-bronchial clearance
C) enhancing alveolar macrophage function
D) enhancing the colonisation of particular viruses and bacteria
E) increasing bronchial clearance by reducing the adhesion between sol and gel phase of the fluid covering the bronchial walls
ANSWER
D) enhancing the colonisation of particular viruses and bacteria
EXPLANATION
Surfactant inhibits (and not enchances) bacterial and viral colonisation. The other answers are correct.
INT - 4.35
Which statement is not true?
A) Alveoli can be found on the walls of bronchioles distal to the terminal bronchioles.
B) The terminal bronchiole is divided into two respiratory bronchioles.
C) The third-generation of respiratory bronchioles are divided into alveolar ducts.
D) Alveolar ducts can also originate from first-generation respiratory bronchioles.
E) Airways distal to the terminal bronchioles are called conductive airways.
ANSWER
E) Airways distal to the terminal bronchioles are called conductive airways.
EXPLANATION
The respiratory tract up to the respiratory bronchioles leads (“conducts”) the air to the alveolar region where gas exchange occurs. The latter region contains respiratory bronchioles, the distal airways and alveoli. So E statement is not true, but the other statements are true.
INT - 4.36
Which statement is not true?
A) The average diameter of terminal bronchiole is 0,6 mm.
B) The wall of the bronchioles do not contain cartilage.
C) The lung unit provided by terminal bronchioles is called acinus.
D) The basis diameter of acinus is 0,5–1 cm.
E) The unit provided by the third-generation respiratory bronchioles is the terminal respiratory unit.
F) An acinus contains 8-10 lobules.
G) The average airspace of an acinus is 0,2 ml.
ANSWER
F) An acinus contains 8-10 lobules.
EXPLANATION
The difference between bronchioles and bronchi is that the bronchioles do not contain cartilage. Their average diameter is 0.6 mm. A lung unit belonging to the terminal bronchioles is the acinus and the diameter of the acinus is 0.5 to 1 cm at its base. The lung unit belonging to the 3rd generation of respiratory bronchioles is now called the “terminal respiratory unit”. Lung acinus consists of 3-5 (and not 8-10) lobules. The airspace of the acinus is 0.2 ml. So all statements are true, except of F.
INT - 4.37
The main features of cells, which cover airways, except for:
A) Clara cells are secretory cells, which do not contain cilium and are predominantly presented in the terminal bronchioles.
B) Kulchitsky cells produce biogenic amines.
C) Type I pneumocytes produce surfactant.
D) The number of goblet cells in the bronchi decreases towards the periphery.
E) In case of chronic irritation goblet cells may also appear in the bronchioles.
ANSWER
C) Type I pneumocytes produce surfactant.
EXPLANATION
Surfactant is produced by type II pneumocytes and not type I pneumocytes. The other answers are true. Kulchinsky cells, also known as paracrine or APUD cells, are presented in relatively small numbers in the epithelium and the submucosal glands. They can produce biogenic amines (including 5-hydroxytryptamine, dopamin and noradrenaline) and peptide hormones (for example calcitonin). Endocrin tumours called „apudomas” can be formed from these cells.
INT - 4.38
Which statement is not true?
A) The average ventilation/perfusion ratio is 0,8.
B) Ventilation of basal areas is low compared to the perfusion.
C) Perfusion of apical areas is very low compared to the ventilation.
D) The normal alveolar ventilation is 8 l.
E) Alveolar hypoventilation is characterized by the elevation of CO2 in the arterial blood.
ANSWER
D) The normal alveolar ventilation is 8 l.
EXPLANATION
Alveolar ventilation is smaller than minute ventilation, because it is the amount of air that in terms of its gas tension is balanced with the gas tension of arterial blood. Thus, alveolar ventilation is the minute ventilation reduced with anatomical and functional dead space ventilation. It is not characterized by a fixed value. It depends primarily on body size but is also influenced by other factors (for example metabolic rate etc.). If the value of the minute ventilation (at rest) is 6-8 l, then the 8 l alveolar ventilation is unrealistically high. The other statements are true.
INT - 4.39
Which of the following metabolic functions does not occur in the lungs?
A) Production of prostaglandins
B) Production of arylsulphatase-B
C) Production of leukotrienes
D) Hormone production
E) Conversion of angiotensin I to angiotensin II
F) Hypoxaemia-induced erythropoietin production
G) Deamination of serotonine
H) Production of thromboplastin
ANSWER
F) Hypoxaemia-induced erythropoietin production
EXPLANATION
Hypoxaemia-induced erythropoietin production is located in the kidney and not in the lungs. The other statements are true.
INT - 4.40
Which of the following cells plays a central role in the pathogenesis of bronchial asthma?
A) neutrophil granulocyte
B) eosinophil granulocyte
C) monocyte
D) histiocyte
E) plasma cell
ANSWER
B) eosinophil granulocyte
EXPLANATION
Bronchial asthma is characterized by the chronic eosinophilic cell inflammation in bronchial airways. Almost all other types of inflammatory cells play role in the activation of eosinophilic cells.
INT - 4.42
The most common stimulus which triggers exercise-induced asthma is:
A) running in cold air
B) using stationary bicycle
C) swimming
D) hall football
E) hall aerobic
ANSWER
A) running in cold air
EXPLANATION
Practical experiences have shown that running in cold air most commonly provokes asthmatic attack in exercise-induced asthma. Swimming is a well-tolerated sport for asthmatics. Noteworthy, sulfuric or heavily chlorinated water can increase BHR (bronchial hyperresponsiveness) and cause asthma attacks.
INT - 4.43
Which of the following cells is the most important antigen presenting cell in asthma?
A) T-lymphocyte
B) alveolar macrophage
C) dendritic cell
D) epithel cell
E) endothel cell
ANSWER
C) dendritic cell
EXPLANATION
Bone marrow dendritic cell is the most important antigen presenting cell in asthma.
INT - 4.45
Which parameter goes first to normal range in case of the adequate treatment of community-acquired pneumonia?
A) fever
B) cough
C) auscultation
D) CRP
E) leukocytosis
ANSWER
D) CRP
EXPLANATION
The decrease of CRP, it occurs 1-3 days after. The other parameters will be normalized in 3-4 days.
INT - 4.46
Which virus can be the cause of pneumonia in transplanted patients and which one of the risk factors of rejection?
A) CMV
B) adenovirus
C) flu virus
D) EBV
E) RSV
ANSWER
A) CMV
EXPLANATION
Immunsuppressive treatment is predisposed to CMV-infection after the transplantation. The mostly endangered patients are CMV seronegative patients, who gets their organ from a CMV positive donor.
INT - 4.47
The features of aspiration pneumonia are:
A) Community-acquired aspiration pneumonia is most commonly caused by aerob bacterias.
B) The clinical manifestation includes pneumonitis, necrotising bronchopneumonia and pulmonary abscess.
C) Leukocytosis is not a characteristic feature.
D) In diagnostic, the hemoculture has a main role because of its good sensitivity and specificity.
E) The first choice is aminoglycoside antibiotic treatment.
ANSWER
B) The clinical manifestation includes pneumonitis, necrotising bronchopneumonia and pulmonary abscess.
EXPLANATION
The aspiration pneumonia is mostly caused by mixed aerob and anaerob bacterias. The clinical manifestation depends on the invasivity and patogenicity of the bacterias.
INT - 4.48
Which bacteria is NOT the cause of pulmonary gangraena?
A) Klebsiella pneumoniae
B) Anaerob bacterias
C) Mycobacterium marinum
D) Hemophilus influenzae
E) Staphylococcus aureus
ANSWER
C) Mycobacterium marinum
EXPLANATION
The most common causes of pulmonary gangrene are Klebsiella pneumoniae, then S. aureus, S. pneumoniae, H. influenzae and anaerobic bacteria.
INT - 4.49
Which one of the followings is an exclusion criteria in lung transplantation?
A) idiopathic, non-treated, end-stage pulmonary disease
B) confused psychical status, unsettled severe social status
C) significantly reduced life expectancy without the surgery
D) acceptable nutritional status
E) severe pulmonary arterial hypertension
ANSWER
B) confused psychical status, unsettled severe social status
EXPLANATION
The indications of lung transplantation are untreatable end-stage pulmonary diseases of known or unknown etiology including progressive severe pulmonary arterial hypertension. The surgery is indicated if the life expectancy without transplantation is worse. The conditions of the surgery are the acceptable nutritional, emotional and psychical status.
INT - 4.50
Which one of the followings is NOT the indication of lung transplantation?
A) end-stage pulmonary fibrosis
B) pulmonary sepsis
C) severe emphysema due to α-1 antitrypsin deficiency
D) pulmonary arterial hypertension
E) severe COPD with pulmonary hypertension
ANSWER
B) pulmonary sepsis
EXPLANATION
(A kérdésben nincs szó egyoldali tüdőtranszplantációról. PAH-ban kétoldali transzplantáció indokolt. Így nem jó) The indications of single lung transplantation are: end-stage pulmonary fibrosis, severe emphysema, severe pulmonary arterial hypertension, various pulmonary diseases, including eosinophil granuloma, sarcoidosis. Pulmonary sepsis is against lung transplantation until the signs of sepsis exist.
INT - 4.51
Which disease is not solved by lung transplantation alone?
A) Eisenmenger-syndrome
B) severe bilateral bronchiectasis with severe symptoms
C) pulmonary arterial hypertension
D) secundery pulmonary hypertension
ANSWER
A) Eisenmenger-syndrome
EXPLANATION
The indication of lung transplantation are: severe emphysema (including alfa-1-antitrypsin deficiency), pulmonary arterial hypertension, various diseases including eosinophil granuloma, sarcoidosis. In Eisenmenger-syndrome the initial left-to-right shunt may result in elevated pulmonary vascular resistance and right-to-left/bidirectional shunt causing cyanosis. This is a point at which the pulmonary vascular disease is irreversible with contraindication against closure of the shunt lesion. Transplantation, either combined heart–lung transplantation or lung transplantation with concomitant cardiac repair, remain the only definitive treatment options.
INT - 4.52
What situation can be an indication for combined heart and lung transplantation, if the adequate severity criteria are present?
A) congenital heart defect combined with Eisenmenger-syndrome
B) cystic fibrosis
C) severe emphysema caused by α-1 antitrypsin deficiency
D) end-stage pulmonary fibrosis
E) pulmonary arterial hypertension
ANSWER
A) congenital heart defect combined with Eisenmenger-syndrome
EXPLANATION
The indications of heart-lung transplantation are: parenchymal lung disorder with severe independent heart disease, congenital heart disease with Eisenmenger-syndrome, so the answer A is the correct. In case of tuberculosis transplantation is not indicated. In case of end-stage pulmonary fibrosis, single lung transplantation is indicated. In case of emphysema caused by severe α-1 antitrypsin deficiency single or dual lung transplantation is indicated.
INT - 4.53
What is the chance of CMV pneumonia among lung transplanted patients without specific drug therapy?
A) 25%
B) 18%
C) 50%
D) 80%
E) 90%
ANSWER
C) 50%
EXPLANATION
CMV infection is the second most common infection in lung-transplanted patients, after bacterial infections. It starts 2-12 weeks after the transplantation. The most severe infection develops in case if a seronegative recipient gets a seropositive graft. The diagnosis is made by BAL, if positive, a transbronchial biopsy is also needed. After heart or heart-lung transplantation the prevalence of CMV infection can reach 50 % without specific drug treatment.
INT - 4.54
When does the bacterial pneumonia occurs the most commonly after lung transplantation?
A) 0–3 months
B) 2–12 weeks
C) 1–3 months
D) 9 days –2 months
E) the first 2 weeks
ANSWER
A) 0–3 months
EXPLANATION
The most common disease after lung transplantation is the bacterial pneumonia, which occurs usually in the first 3 months. Among Gram-negative bacteria Enterobacter and Pseudomonas infection, fro other bacteria Haemophilus influenzae and Staphylococcus aureus are the most common causes of the disease.
INT - 4.55
How often do fungal infections occur after a lung transplantation?
A) 30%
B) 10–22%
C) 23–30%
D) less, than 5%
E) 50%
ANSWER
B) 10–22%
EXPLANATION
Fungal infections are frequent as a consequence of the immunosupressive therapy. They usually occur in the first two months after the transplantation, with an incidence of approx. 10-22%. They’re caused by Candida and Aspergillus spp. Candida infections usually occur right after the transplantation, because the colonisation takes place from the donor’s airways. Aspergillus spp. can lead to invasive, acute, fulminant infections. Fungal infections have a high mortality, around 40-70%. They’re mostly successfully treatable with amphotericin B, although Aspergillus spp. are hard to eradicate, and often could lead to lethal infections.
