LE4 Flashcards
- The underlying mechanism of anti-hypertensive drug-induced chronic cough (as above) is:
a. drug allergy
b. All of the above
c. None of the above
d. Sensitization of sensory nerve ending to accumulated bradykinin
d. Sensitization of sensory nerve ending to accumulated bradykinin
Anti-hypertensive drug-induced chronic cough:
This is often associated with ACE inhibitors, a class of antihypertensive drugs. ACE inhibitors can lead to the accumulation of bradykinin in the respiratory tract because they inhibit the enzyme that normally breaks it down. This accumulation can sensitize the sensory nerve endings in the respiratory tract, leading to a persistent cough.
- True or false: Edema can cause localized hypoxia
a. True
b. false
a. True
Edema, or the accumulation of fluid in tissues, can lead to localized hypoxia (a deficiency in the amount of oxygen reaching the tissues). This is because the excess fluid can interfere with the diffusion of oxygen from blood vessels to the tissues.
- To address massive hemoptysis, the treatment of choice is
a. bronchial artery embolization
b. endotracheal intubation with double lumen endotracheal tube
c. surgical resection
d. photocoagulation and cautery
a. bronchial artery embolization
This procedure is often the first-line treatment for controlling massive hemoptysis. It involves the selective catheterization of the bronchial artery and the introduction of substances to block the artery and stop the bleeding.
- The cough center in the brain is located at the:
a. Nucleus tractus solitarius
b. Afferent nerves
c. Corpus callosum
d. Pineal gland
a. Nucleus tractus solitarius
This nucleus in the medulla oblongata is a part of the brainstem that plays a crucial role in the cough reflex and other respiratory processes.
- A patient with dyspnea should also have the abdomen examined for paradoxical inward movement of the abdomen during inspiration. This abnormal abdominal finding indicates:
a. Bronchiectasis
b. Abdominal aneurysm
c. Accelerated gastrointestinal peristalsis
d. Diaphragmatic weakness
d. Diaphragmatic weakness
Paradoxical inward movement of the abdomen during inspiration is a sign of diaphragmatic weakness. Normally, the diaphragm contracts and moves downward during inspiration, causing the abdomen to move outward.
- Cyanosis present since birth with clubbing is usually due to:
a. Venous occlusion
b. Congenital heart disease with right-to-left shunting
c. Raynaud’s phenomenon
d. Peripheral arterial occlusion
b. Congenital heart disease with right-to-left shunting
Cyanosis that is present from birth and accompanied by clubbing is typically indicative of congenital heart disease where there is a right-to-left shunt, such as Tetralogy of Fallot. This shunting allows deoxygenated blood to bypass the lungs and enter the systemic circulation, leading to cyanosis.
- Supplemental oxygen should only be given to patients with dyspnea if:
a. All patients regardless of O2 saturation
b. Opioids and anxiolytics do not alleviate dyspnea
c. O2 saturation drops <95% at baseline or with activity or sleep
d. O2 saturation is ≤88% with activity or sleep
d. O2 saturation is ≤88% with activity or sleep
Supplemental oxygen is typically recommended for patients with chronic respiratory diseases who have an oxygen saturation of 88% or less either at rest, with activity, or during sleep. This is because maintaining an oxygen saturation above this level helps to prevent complications associated with chronic hypoxia.
- Infectious agents that can cause hemoptysis:
a. Staphylococcus aureus, Klebsiella pneumoniae
b. Nocardia and Aspergillus and endemic fungi
c. AOTA
d. NOTA
c. AOTA
- Hemoglobin-oxygen dissociation curve SHIFT TO THE LEFT means:
a. Greater quantities of oxygen is released at any level of tissue PO2
b. NOTA
c. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
d. AOTA
c. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia.
A leftward shift in the hemoglobin-oxygen dissociation curve indicates that hemoglobin has a higher affinity for oxygen. As a result, oxygen is less readily released to the tissues at any given partial pressure of oxygen, which can contribute to tissue hypoxia.
- Hypertensive patient complained of a chronic cough. Chest x-ray was normal. The most common causative of anti-hypertensive is:
a. diuretics
b. ACE inhibitors
c. Nitrates
d. Calcium channel blockers
b. ACE inhibitors
As mentioned earlier, ACE inhibitors are known to cause a persistent dry cough in some patients. This side effect is due to the accumulation of bradykinin in the respiratory tract, which sensitizes the cough reflex.
- To diagnose asthma using spirometry, the expected is:
a. Non-reversibility in response to bronchodilators
b. NOTA
c. Reversibility in response to bronchodilators
d. Variable response to bronchodilators
c. Reversibility in response to bronchodilators
A key feature of asthma is the reversibility of airway obstruction. In spirometry, this is demonstrated by a significant improvement in lung function (usually measured as an increase in FEV1, or forced expiratory volume in 1 second) after the administration of a bronchodilator. This reversibility helps to distinguish asthma from other respiratory conditions like chronic obstructive pulmonary disease (COPD), where the obstruction is typically not fully reversible.
- it is the leading cause of massive hemoptysis and subsequent death
a. bronchitis
b. bronchiectasis
c. tuberculosis
d. rasmussen’s aneurysm
b. bronchiectasis
While bronchiectasis and Rasmussen’s aneurysm are also causes of hemoptysis, TB is historically and globally a more common cause, especially in areas where TB is prevalent.
- A 40 year old male complained of breathing discomfort after walking 100 meters on level ground. Based on the Modified Medical Research Council Dyspnea Scale, the grade of dyspnea is:
a. 0-1
b. 2
c. 3
d. 4
c. 3
According to the Modified Medical Research Council (MMRC) Dyspnea Scale, a grade of 3 is assigned to patients who experience breathlessness after walking a short distance on level ground. In this case, the patient’s discomfort after walking 100 meters fits this description.
- A patient at the ER complaining of dyspnea, was seen with decreased breath sounds on the left lung field to the mid base, with dullness on percussion. The most likely cause of dyspnea:
a. Pleural effusion
b. emphysema
c. interstitial edema
d. none of the above
a. Pleural effusion.
Decreased breath sounds and dullness to percussion, particularly if localized to one area of the lung, are classic signs of pleural effusion, which is the accumulation of fluid in the pleural space. This can significantly impair breathing and cause dyspnea.
- Chronic cough is defined as:
a. cough that lasts more than 12 weeks
b. cough that lasts more than 2 weeks
c. cough that last between 3-8 weeks
d. cough that is more than 8 weeks
d. cough that is more than 8 weeks
Objective finding of exaggerated fall in the systolic blood pressure by more than 10mmHg during inspiration:
a. pulsus paradoxus
b. Quincke’s sign
c. orthostatic hypotension
d. pulsus alternans
a. pulsus paradoxus
Pulsus paradoxus is characterized by an exaggerated decrease in systolic blood pressure (more than 10 mmHg) during inspiration. It is often associated with conditions like cardiac tamponade, severe asthma, or pericarditis.
Cough that lasts between 3-8 weeks is commonly seen in:
a. neoplasm
b. emphysema
c. residuum of tracheobronchitis
d. post nasal drip
c. residuum of tracheobronchitis
A cough that lasts between 3-8 weeks is often categorized as a subacute cough. This duration of cough is commonly seen as a residuum (or lingering effect) of tracheobronchitis, which is an inflammation of the trachea and bronchi, often following an upper respiratory tract infection.
A male patient with shortness of breath was referred to your clinic because of BP fluctuations during inspiration. The systolic blood pressure was reported to decrease from 120-100 mmHg. The possible causes include:
a. All of the above
b. None of the above
c. Pericardial disease
d. Chronic obstructive pulmonary disease or
asthma exacerbation
a. All of the above
The described symptom of a significant decrease in systolic blood pressure during inspiration (known as pulsus paradoxus) is a hallmark of pericardial disease, particularly cardiac tamponade. It can also be seen in severe cases of asthma or COPD exacerbations, but pericardial disease is a more direct cause of this specific symptom.
Acute cough that lasts for less than 3 weeks is due to:
a. Emphysema
b. All of the above
c. Inhalation of noxious smoke or chemicals
d. Neoplasm
c. Inhalation of noxious smoke or chemicals
Acute cough, which typically lasts less than 3 weeks, is most commonly due to viral upper respiratory infections, but it can also be caused by the inhalation of irritants like noxious smoke or chemicals. Neoplasm and emphysema are more likely to cause chronic cough.
- Treatment for cough variant asthma
a. Intermittent use of inhaled beta-agonist bronchodilators
b. All of the above
c. Inhaled glucocorticoids
d. None of the above
b. All of the above
Cough variant asthma is a type of asthma where the predominant symptom is a chronic cough. Inhaled glucocorticoids are the mainstay of treatment for controlling inflammation and preventing the cough. While inhaled beta-agonists may be used for quick relief of symptoms, they are not the primary treatment.
- Possible causes of dyspnea in the upright position but relieved in the supine position:
a. Left atrial myxoma and hepatopulmonary syndrome
b. Pleural effusion and cardiac tamponade
c. Congestive heart failure and cardiorenal syndrome
d. Chronic bronchitis and emphysema
a. Left atrial myxoma and hepatopulmonary syndrome
This pattern of dyspnea, known as platypnea, is unusual and can be seen in conditions like left atrial myxoma (a type of heart tumor) and hepatopulmonary syndrome (a complication of liver disease). The other options listed typically cause dyspnea that worsens in the supine position.
- True or False: Clinical picture of acute hypoxia resembles acute alcohol intoxication.
a. True
b. False
a. True
Acute hypoxia can indeed resemble acute alcohol intoxication in its clinical presentation. Symptoms like confusion, disorientation, and impaired judgment are common to both conditions. This similarity can sometimes lead to misdiagnosis in emergency situations.
- Objective physical findings indicative of increased airway resistance or lung and chest wall stiffness:
a. Tripod position
b. Supraclavicular retractions and use of accessory muscles of ventilation
c. All of the above
d. None of the above
c. All of the above
Both tripod positioning and supraclavicular retractions/use of accessory muscles of ventilation are indicative of increased work of breathing, which can be due to increased airway resistance or lung and chest wall stiffness. These are compensatory mechanisms to increase the efficiency of breathing.
- Central cyanosis is caused by
a. Venous obstruction
b. Acquired sulfhemoglobinemia
c. Arterial obstruction
d. Reduced cardiac output
b. Acquired sulfhemoglobinemia
- Subjective breathing discomfort perceived during upright position but relieved during spine position is known as
a. dyspnea
b. hypoxemia
c. hypoxia
d. platypnea
d. platypnea
Platypnea refers to the unusual condition where a person experiences shortness of breath (dyspnea) in the upright position, which is relieved by lying down (supine position).
- The cyanosis of the skin and mucous membrane is due to
a. Reduced quantity of all hemoglobin
b. Reduced quantity of white blood cells
c. Reduced quantity of hematocrit
d. Increased quantity of reduced hemoglobin or of hemoglobin derivatives
d. Increased quantity of reduced hemoglobin or of hemoglobin derivatives.
Cyanosis occurs when there is an increased amount of deoxygenated (reduced) hemoglobin in the blood, which gives the blood and the skin a bluish color. It’s not directly related to the total quantity of hemoglobin, white blood cells, or hematocrit levels.
- A patient sought consultation due to recurrent shortness of breath. Lung examination showed hyperresonance on both lung fields. The most likely cause is
a. Interstitial edema
b. emphysema
c. Pleural effusion
d. Interstitial fibrosis
b. emphysema
Hyperresonance on percussion of the lung fields is a classic finding in emphysema, a type of chronic obstructive pulmonary disease (COPD). Emphysema involves the destruction of the alveoli and results in overinflated lungs, which produce the hyperresonant sound on percussion. Interstitial edema, on the other hand, would more likely produce dullness on percussion due to fluid accumulation.
- To address expectoration of blood, the first thing to do is
a. Give tranexamic acid 500mg 1 capsule every 8 hours
b. Ascertain whether bleeding is from the respiratory tract or GI tract
c. Do sputum AFB and gene X-pert
d. Use nasal packing
b. Ascertain whether bleeding is from the respiratory tract or GI tract
When a patient presents with expectoration of blood, it is crucial to first determine the source of the bleeding. This differentiation is important because the management of gastrointestinal bleeding differs significantly from that of respiratory tract bleeding.
- Treatment for chronic eosinophilic bronchitis
a. Inhaled glucocorticoids
b. Intermittent use of inhaled beta agonist bronchodilators
c. AOTA
d. NOTA
a. Inhaled glucocorticoids
Chronic eosinophilic bronchitis, which is often associated with cough, is effectively treated with inhaled glucocorticoids. These medications help reduce airway inflammation and eosinophilic infiltration in the bronchial walls.
- Hemoglobin - oxygen dissociation curve SHIFT TO THE RIGHT means:
a. Oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
b. None of the above
c. All of the above
d. Greater quantities of oxygen is released at any level of tissue PO2
d. Greater quantities of oxygen is released at any level of tissue PO2
A rightward shift in the hemoglobin-oxygen dissociation curve indicates that hemoglobin has a lower affinity for oxygen. As a result, oxygen is more readily released to the tissues at any given partial pressure of oxygen, which can be beneficial in conditions where tissues require more oxygen.
- True or false: Cough alone as a manifestation of asthma is common among children but not among adults:
a. True
b. False
a. True
Cough alone as a manifestation of asthma is common among children but not among adults. Cough due to asthma in the absence of wheezing, shortness of breath, and chest tightness is referred to as “cough-variant asthma.”
- The parasite that can mimic tuberculosis common in Southeast Asia and China causing hemoptysis:
a. Loa loa
b. Diphyllobothrium latum
c. Paragonimus westermani
d. Enterobius vermicularis
c. Paragonimus westermani
Paragonimus westermani, a lung fluke, is known to cause paragonimiasis, which can present with symptoms similar to tuberculosis, including hemoptysis. It is endemic in certain parts of Southeast Asia and China.
- The hemoptysis that is cyclical that occurs with menstrual bleeding is:
a. Catamenial hemoptysis
b. Hemoptysis from Kaposi’s sarcoma
c. Aspergillosis hemoptysis
d. Pulmonary asbscess
a. Catamenial hemoptysis
Catamenial hemoptysis is a rare condition where a woman experiences lung bleeding that coincides with her menstrual cycle. It is thought to be related to endometrial tissue deposits in the lung, which respond to hormonal changes during the menstrual cycle.
- Massive hemoptysis is defined as:
a. 100-150mL blood loss at one time
b. All of the above
c. None of the above
d. Blood loss of 400mL in 24 hours
b. All of the above
Massive hemoptysis is typically defined as the expectoration of a significant amount of blood, usually around 300-600 mL within 24 hours, but the threshold can vary. A loss of 400 mL in 24 hours is commonly used as a criterion.
- Ineffective coughing leading to serious infections may be due to:
a. All of the above
b. Tracheobronchomalacia
c. IV sedation and anesthesia
d. Severe kyphoscoliosis
a. All of the above
Ineffective coughing can be due to various causes, including tracheobronchomalacia (weakening of the tracheal and bronchial walls), IV sedation and anesthesia (which can suppress cough reflex), and severe kyphoscoliosis (which can impair respiratory muscle function).
- Cyanosis of extremities from cold-induced vasospasm is:
a. High altitude hypoxia
b. Carboxyhemoglobinemia
c. Methemoglobinemia
d. Raynaud’s Phenomenon
d. Raynaud’s Phenomenon
Raynaud’s phenomenon is characterized by episodic vasospasm in the extremities, often in response to cold or stress, leading to color changes in the skin of the fingers and toes, including cyanosis.
- Poisons such as cyanide cause hypoxia that tissues are unable to use oxygen and venous blood tends to have high oxygen tension. This is called:
a. Eisenmenger’s syndrome
b. Central hypoxia
c. Shunting
d. Histotoxic hypoxia
d. Histotoxic hypoxia
Histotoxic hypoxia occurs when tissues are unable to utilize oxygen effectively. Poisons like cyanide inhibit cellular respiration, leading to high oxygen tension in venous blood because oxygen cannot be utilized by the tissues.
- Most hemoptysis is due to vessels in the:
a. None of the above
b. Bronchial arteries
c. All of the above
d. Pulmonary arteries
b. Bronchial arteries
Most cases of hemoptysis originate from the bronchial arteries, not the pulmonary arteries. The bronchial arteries have systemic pressure and can be a source of significant bleeding in conditions like bronchiectasis, lung infections, and lung cancer.
- True or false: Chronic eosinophilic bronchitis causes chronic cough with a normal chest radiograph
a. True
b. False
a. True
Chronic eosinophilic bronchitis is a common cause of chronic cough and is characterized by an eosinophilic infiltration of the bronchial walls without airway hyperresponsiveness. It typically presents with a chronic cough but with a normal chest radiograph.
- In carbon monoxide intoxication, the hemoglobin-oxygen dissociation shifts to the:
a. AOTA
b. left
c. right
d. NOTA
b. left
In carbon monoxide (CO) poisoning, the hemoglobin-oxygen dissociation curve shifts to the left. CO binds to hemoglobin with a much higher affinity than oxygen, reducing the amount of oxygen that hemoglobin can transport. This shift to the left indicates that hemoglobin holds onto the remaining oxygen more tightly, making it less available to tissues.
- Exercise increases oxygen requirements and the hemoglobin-oxygen dissociation curve shifts to the:
a. AOTA
b. left
c. right
d. NOTA
c. right
During exercise, the hemoglobin-oxygen dissociation curve shifts to the right. This shift is due to factors like increased carbon dioxide, decreased pH (acidosis), and higher temperatures in the muscles during exercise, all of which enhance oxygen unloading to the tissues.
- True or false: Clubbing is seen only in patients with congenital heart disease.
a. True
b. False
b. False
Clubbing is not exclusive to congenital heart disease. It can be seen in a variety of conditions, including lung diseases (like lung cancer, bronchiectasis, and interstitial lung disease), gastrointestinal diseases, and other systemic conditions.
- Disease causing cough that may be missed on chest x-ray:
a. Tumors and atypical tuberculosis
b. Bronchiectasis and early interstitial lung disease
c. None of the above
d. All of the above
d. All of the above
Both tumors and atypical tuberculosis, as well as bronchiectasis and early interstitial lung disease, can cause a cough and may be missed on a standard chest X-ray, especially in their early stages.
- Peripheral cyanosis is caused by:
a. Cold exposure
b. Carboxyhemoglobinemia
c. Acquired sulfhemoglobinemia
d. Decreased atmospheric pressure in high altitude
a. Cold exposure
Peripheral cyanosis is often caused by cold exposure, which leads to vasoconstriction and reduced blood flow to the extremities. This results in an increased extraction of oxygen from the blood in these areas, leading to cyanosis. Carboxyhemoglobinemia and acquired sulfhemoglobinemia typically cause central, not peripheral, cyanosis.
- High altitude hypoxia leads to pulmonary arterial and venous constriction causing capillary leakage and high altitude pulmonary edema.
a. TRUE
b. FALSE
a. TRUE
High altitude hypoxia can lead to pulmonary arterial and venous constriction, which in turn can cause capillary leakage and high altitude pulmonary edema. This is a response to the low oxygen levels at high altitudes and can be a serious and potentially life-threatening condition.
- Cough is Always a reflex to prevent retention of airway secretions
a. TRUE
b. FALSE
b. FALSE
While coughing is often a reflex to clear the airways of secretions, irritants, or foreign objects, it is not always for this purpose. Cough can also be a symptom of various medical conditions where airway secretions are not the primary issue, such as in cough-variant asthma or gastroesophageal reflux disease (GERD).
- Most common cause of chronic cough with normal chest x-ray
a. Asthma and post-nasal drip
b. Gastroesophageal reflux disease
c. AOTA
d. Use of angiotensin enzyme inhibitors
c. AOTA
Asthma, post-nasal drip (upper airway cough syndrome), gastroesophageal reflux disease (GERD), and the use of angiotensin-converting enzyme (ACE) inhibitors are all common causes of chronic cough in the presence of a normal chest X-ray.
- With persistent respiratory failure resulting to persistent hypoxia, the hemoglobin-dissociation curve shifts to the
a. Right
b. All of the above
c. None of the above
d. Left
a. Right
In conditions of chronic hypoxia, such as persistent respiratory failure, the hemoglobin-oxygen dissociation curve shifts to the right. This shift facilitates the release of oxygen to the tissues, which is beneficial in a state of reduced oxygen availability.
- Blood supply from the lungs is from
a. The pulmonary arteries
b. The bronchial circulation
c. All of the above
d. None of the above
c. All of the above
The lungs receive blood supply from both the pulmonary arteries and the bronchial circulation. The pulmonary arteries carry deoxygenated blood from the heart to the lungs for oxygenation, while the bronchial arteries, part of the systemic circulation, provide oxygenated blood to the lung tissue itself.
- The most common cause of respiratory hypoxia is
a. Ventilation-perfusion mismatch
b. Intrapulmonary right-to-left shunting
c. High altitude hypoxia
d. Hypoventilation
a. Ventilation-perfusion (V/Q) mismatch.
A V/Q mismatch, where there is an imbalance between the air reaching the alveoli (ventilation) and the blood flow in the pulmonary capillaries (perfusion), is the most common cause of hypoxia. This mismatch can occur in various lung diseases, such as chronic obstructive pulmonary disease (COPD), pneumonia, and pulmonary embolism.
- Treatment for chronic eosinophilic bronchitis
a. inhaled glucocorticoids
b. intermittent use of inhaled beta-agonist bronchodilators
c. all of the above
d. none of the above
a. inhaled glucocorticoids
- A patient with dyspnea should also have the abdomen examined for paradoxical inward movement of the abdomen during inspiration. This abnormal abdominal finding indicates:
A. bronchiectasis
B. pulmonary fibrosis
C. diaphragmatic weakness
d. Diaphragmatic weakness
Paradoxical inward movement of the abdomen during inspiration is a sign of diaphragmatic weakness. Normally, the diaphragm contracts and moves downward during inspiration, causing the abdomen to move outward.
- To diagnose asthma using the spirometry, the expected is:
A. non-reversibility in response to a bronchodilator
B. reversibility in response to a bronchodilator
B. reversibility in response to a bronchodilator.
A key feature of asthma is the reversibility of airway obstruction. In spirometry, this is demonstrated by a significant improvement in lung function (usually measured as an increase in FEV1, or forced expiratory volume in 1 second) after the administration of a bronchodilator.
- Subjective breathing discomfort perceived during upright position but relieved during supine position is known as:
A. Dyspnea
B. Platypnea
C. Hypoxia
D. Hypoxemia
B. Platypnea
Platypnea refers to the unusual condition where a person experiences shortness of breath (dyspnea) in the upright position, which is relieved by lying down (supine position).
5.Objective finding of exaggerated fall in the systolic pulsus alternans blood pressure by more than 10mmHg during inspiration:
A. Pulsus alternans
B. Quincke’s sign
C. Pulsus paradoxus
D. Corrigan’s pulse
C. Pulsus paradoxus
Pulsus paradoxus is characterized by an exaggerated decrease in systolic blood pressure (more than 10 mmHg) during inspiration. It is often associated with conditions like cardiac tamponade, severe asthma, or pericarditis.
6 Ineffective coughing leading to serious infections may be due to:
a. severe kyphoscoliosis
b. tracheobronchomalacia
c. IV sedation and anesthesia
d. all of the above
d. all of the above
Ineffective coughing can be due to various causes, including severe kyphoscoliosis (which can impair respiratory muscle function), tracheobronchomalacia (weakening of the tracheal and bronchial walls), and IV sedation and anesthesia (which can suppress cough reflex). All these conditions can lead to an inability to effectively clear airway secretions, increasing the risk of serious infections.
- it is the leading cause of massive hemoptysis and subsequent death
a. bronchitis
b. bronchiectasis
c. tuberculosis
d. rasmussen’s aneurysm
b. bronchiectasis
- A patient sought consultation due to recurrent shortness of breath. Lung examination showed hyperresonance on both lung fields. The most likely cause is
a. Interstitial edema
b. emphysema
c. Pleural effusion
d. Interstitial fibrosis
b. emphysema
Hyperresonance on percussion of the lung fields is a classic finding in emphysema, a type of chronic obstructive pulmonary disease (COPD). Emphysema involves the destruction of the alveoli and results in overinflated lungs, which produce the hyperresonant sound on percussion. Interstitial edema, on the other hand, would more likely produce dullness on percussion due to fluid accumulation.
- To address massive hemoptysis, the treatment of choice is:
A. bronchial artery embolization
B. photocoagulation and cautery
C. surgical resection
D. endotracheal intubation with double lumen endotracheal tube
a. bronchial artery embolization
This procedure is often the first-line treatment for controlling massive hemoptysis. It involves the selective catheterization of the bronchial artery and the introduction of substances to block the artery and stop the bleeding.
Most common cause of chronic cough with normal chest x-ray:
A. asthma and post-nasal drip
B. gastroesophageal reflux disease
C. use of angiotensin-converting enzyme inhibitors
D. all of the above
c. AOTA
Asthma, post-nasal drip (upper airway cough syndrome), gastroesophageal reflux disease (GERD), and the use of angiotensin-converting enzyme (ACE) inhibitors are all common causes of chronic cough in the presence of a normal chest X-ray.
- The parasite that can mimic tuberculosis common in Southeast Asia and China causing hemoptysis:
A. Paragonimus westermanii
B. Loa loa
C. Diphylobothrium latum
D. Enterobius vermicularis
A. Paragonimus westermanii
- Infectious agent/s that can cause hemoptysis:
A. none of the above
B. Nocardia and Aspergillus and endemic fungi
C. Staphylococcus aureus, Klebsiella pneumoniae
D. all of the above
C. all of the above
- True or false: Clubbing is seen only in patients with congenital heart disease.
A. True
B. False
b. False
Clubbing is not exclusive to congenital heart disease. It can be seen in a variety of conditions, including lung diseases (like lung cancer, bronchiectasis, and interstitial lung disease), gastrointestinal diseases, and other systemic conditions.
- Cough that lasts between 3-8 weeks is commonly seen in:
A. neoplasm
B. emphysema
C. residuum of tracheobronchitis
D. none of the above
c. residuum of tracheobronchitis
A cough that lasts between 3-8 weeks is often categorized as a subacute cough. This duration of cough is commonly seen as a residuum (or lingering effect) of tracheobronchitis, which is an inflammation of the trachea and bronchi, often following an upper respiratory tract infection.
Most hemoptysis is due to vessels in the:
A. pulmonary arteries
B. bronchial arteries
C. all of the above
D. none of the above
B. bronchial arteries
- True or false: Edema can cause localized hypoxia.
A. True
B. False
A. True
17.Disease causing cough that may be missed on chest x-ray:
A. bronchiectasis and early interstitial lung disease
B. tumors and atypical tuberculosis
C. none of the above
D. all of the above
D. all of the above
- With persistent respiratory failure resulting to persistent hypoxia, the hemoglobin-dissociation curve shifts to the:
A. right
B. left
C. no change
D. none of the above
A. right
9.Treatment for cough-variant asthma:
A. inhaled glucocorticoids
B. intermittent use of inhaled beta-agonist bronchodilators
C. all of the above
D. none of the above
C. all of the above
- True or false: Clinical picture of acute hypoxia resembles acute alcohol intoxication
A. True
B. False
C. Maybe
D. all of the above
A. True
21.Poisons such as cyanide cause hypoxia that tissues are unable to use oxygen and venous blood tends to have high oxygen tension. This is called:
A. central hypoxia
B. histotoxic hypoxia
C. eisenmenger’s syndrome
D. shunting
B. histotoxic hypoxia
22.Massive hemoptysis is defined as:
A. blood loss of 400 ml in 24 hours
B. 100-150ml blood loss at one time
C. all of the above
D. none of the above
C. all of the above
23.True or false: Chronic eosinophilic bronchitis causes chronic cough with a normal chest radiograph.
A. True
B. False
A. True
- Hemoglobin-Oxygen dissociation curve SHIFT TO THE LEFT means:
A. oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
B. greater quantities of oxygen is released at any level of tissue PO2
C. none of the above
D. all of the above
A. oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
- Possible causes of dyspnea in the upright position but relieved in the supine position:
A. left atrial myxoma and hepatopulmonary syndrome
B. congestive heart failure and cardiorenal syndrome
C. chronic bronchitis and emphysema
D. pleural effusion and cardiac tamponade
A. left atrial myxoma and hepatopulmonary syndrome
- True or false: High altitude hypoxia leads to pulmonary arterial and venous constriction causing capillary leakage and high-altitude pulmonary edema.
A. True
B. False
C. Maybe
D. all of the above
A. True
- A male patient with shortness of breath was referred to your clinic because of BP fluctuations during inspiration. The systolic blood pressure was reported to decrease from 120 to 100 mmHg. The possible causes include:
A. chronic obstructive pulmonary disease or asthma exacerbation
B. pericardial disease
C. all of the above
D. none of the above
C. all of the above
- To address expectoration of blood, the FIRST THING to do is:
A. do sputum AFB and gene X-pert
B. ascertain whether bleeding is from the respiratory tract or GI tract
C. give tranexamic acid 500 mg 1 capsule every 8 hours
D. use nasal packing
B. ascertain whether bleeding is from the respiratory tract or GI tract
- The “cough center” in the brain is located at the:
A. afferent nerves
B. corpus callosum
C. nucleus tractus solitarius
D. pineal gland
C. nucleus tractus solitarius
- In carbon monoxide intoxication, the hemoglobin-oxygen dissociation shifts to
A. right
B. Left
C. none of the above
D. All of the above
B. Left
31.Cyanosis of extremities from cold-induced vasospasm is:
A. Raynaud’s phenomenon
B. high altitude hypoxia
C. methemoglobinemia
D. carboxyhemoglobinemia
A. Raynaud’s phenomenon
- True or False: Cough is always a reflex to prevent retention of airway secretions.
A. True
B. False
B. False
- Exercise increases oxygen requirements and the hemoglobin-oxygen dissociation curve shifts to the
A. right
B. Left
C. none of the above
D. All of the above
A. right
- Objective physical findings indicative of increased airway resistance or lung and chest wall stiffness.
A. Supra clavicular retractions and use of accessory muscles of ventilation
B. Tripod position
C. All of the above
D. None of the above
C. All of the above
- Blood supply to the lungs is from
A. the pulmonary arteries
B. the bronchial circulation
C. all of the above
D. none of the above
C. All of the above
- The hemoptysis that is cyclical that occurs with menstrual bleeding is:
A. hemoptysis from Kaposi’s sarcoma
B. catamenial hemoptysis
C. Aspergillosis hemoptysis
D. pulmonary abscess
B. catamenial hemoptysis
- Supplemental oxygen should only be given to patients with dyspnea
A.O2 saturation is < 88% at baseline or drops to <88% with activity or sleep
B. O2 saturation drops <95% at baseline or with activity or sleep
C. all patients regardless of 02 saturation
D. opioids and anxiolytics do not alleviate dyspnea
A.O2 saturation is < 88% at baseline or drops to <88% with activity or sleep
- Cyanosis present since birth with clubbing is usually due to:
a. peripheral arterial occlusion
b. venous occlusion
c. congenital heart disease with right-to-left shunting
c. congenital heart disease with right-to-left shunting
39.Central cyanosis is caused by:
A. acquired sulfhemoglobinemia
B. reduced cardiac output
C. arterial obstruction
D. venous obstruction
A. acquired sulfhemoglobinemia
- Peripheral cyanosis is caused by:
a. decreased atmospheric pressure in high altitude
b. cold exposure
c. acquired sulfhemoglobinemia
d. carboxyhemoglobinemia
b. cold exposure
- A patient at the ER complaining of dyspnea, was seen with decreased breathe sounds on the left lung field to the mid base, with dullness on percussion. The most likely cause of dyspnea:
A. Pleural effusion
B. emphysema
C. interstial edema
D. none of the above
A. Pleural effusion
42.Hemoglobin-Oxygen dissociation curve SHIFT TO THE RIGHT means:
A. oxygen is unloaded only at lower tensions further contributing to tissue hypoxia
B. greater quantities of oxygen is released at any level of tissue PO2
C. none of the above
D. all of the above
B. greater quantities of oxygen is released at any level of tissue PO2
43.The cyanosis of the skin and mucous membrane is due to?
A. Increased quantity of reduced hemoglobin or hemoglobin derivatives
B. Reduced quantity of all hemoglobin
C. Reduced quantity of hematocrit
D. Reduced quantity of white blood cells
A. Increased quantity of reduced hemoglobin or hemoglobin derivatives
Cyanosis occurs when there is an increased amount of deoxygenated (reduced) hemoglobin in the blood, which gives the blood and the skin a bluish color. It’s not directly related to the total quantity of hemoglobin, white blood cells, or hematocrit levels.
- A hypertensive patient complained of chronic cough. Chest x-ray was normal.
The most common causative anti-hypertensive is:
A. angiotensin-converting enzyme inhibitors
B. calcium channel blockers
C. diuretics
D. nitrates
A. angiotensin-converting enzyme inhibitors
45.A 40 year old male complained of breathing discomfort after walking 100 meters on level ground. Based on the Modified Medical Research Council Dyspnea Scale, the grade of dyspnea is:
A. 0-1
B. 2
C. 3
D. 4
C. 3
- True or false:
Cough alone as a manifestation of asthma is common among children but not among adults.
A. True
B. False
A. True
- Chronic cough is defined as:
a. cough that last between 3-8 weeks
b. cough that is more that 8 weeks
c. cough that lasts more than 2 weeks
d. cough that lasts more than 12 weeks
b. cough that is more that 8 weeks
- The underlying mechanism of anti-hypertensive drug-induced chronic cough (as above) is:
A. sensitization of sensory nerve ending to accumulated bradykinin
B. drug allergy
C. all of the above
D. none of the above
A. sensitization of sensory nerve
- The most common cause of respiratory hypoxia
A. ventilation-perfusion mismatch
B. hypoventilation
C. intrapulmonary right-to-left shunting
D. high altitude hypoxia
A. ventilation-perfusion mismatch
- Acute cough that lasts for less than three (3) weeks is due to:
A. emphysema
B. inhalation of noxious smoke or chemical
C. neoplasm
D. all of the above
B. inhalation of noxious smoke or chemical
