LE4

Question 1

1. 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

Answer 1

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.

Question 2

2. True or false: Edema can cause localized hypoxia
   a. True
   b. false

Answer 2

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.

Question 3

3. 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

Answer 3

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.

Question 4

4. The cough center in the brain is located at the:
   a. Nucleus tractus solitarius
   b. Afferent nerves
   c. Corpus callosum
   d. Pineal gland

Answer 4

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.

Question 5

5. 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

Answer 5

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.

Question 6

6. 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

Answer 6

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.

Question 7

7. 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

Answer 7

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.

Question 8

8. Infectious agents that can cause hemoptysis:
   a. Staphylococcus aureus, Klebsiella pneumoniae
   b. Nocardia and Aspergillus and endemic fungi
   c. AOTA
   d. NOTA

Answer 8

c. AOTA

Question 9

9. 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

Answer 9

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.

Question 10

10. 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

Answer 10

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.

Question 11

11. 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

Answer 11

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.

Question 12

12. it is the leading cause of massive hemoptysis and subsequent death
    a. bronchitis
    b. bronchiectasis
    c. tuberculosis
    d. rasmussen’s aneurysm

Answer 12

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.

Question 13

13. 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

Answer 13

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.

Question 14

14. 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

Answer 14

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.

Question 15

15. 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

Answer 15

d. cough that is more than 8 weeks

Question 16

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

Answer 16

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.

Question 17

Cough that lasts between 3-8 weeks is commonly seen in:
a. neoplasm
b. emphysema
c. residuum of tracheobronchitis
d. post nasal drip

Answer 17

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.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

20. 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

Answer 20

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.

Question 21

21. 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

Answer 21

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.

Question 22

22. True or False: Clinical picture of acute hypoxia resembles acute alcohol intoxication.
    a. True
    b. False

Answer 22

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.

Question 23

23. 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

Answer 23

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.

Question 24

24. Central cyanosis is caused by
    a. Venous obstruction
    b. Acquired sulfhemoglobinemia
    c. Arterial obstruction
    d. Reduced cardiac output

Answer 24

b. Acquired sulfhemoglobinemia

Question 25

25. Subjective breathing discomfort perceived during upright position but relieved during spine position is known as a. dyspnea b. hypoxemia c. hypoxia d. platypnea

Answer 25

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).

Question 26

26. 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

Answer 26

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.

Question 27

27. 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

Answer 27

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.

Question 28

28. 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

Answer 28

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.

Question 29

29. Treatment for chronic eosinophilic bronchitis a. Inhaled glucocorticoids b. Intermittent use of inhaled beta agonist bronchodilators c. AOTA d. NOTA

Answer 29

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.

Question 30

30. 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

Answer 30

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.

Question 31

31. True or false: Cough alone as a manifestation of asthma is common among children but not among adults: a. True b. False

Answer 31

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."

Question 32

32. 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

Answer 32

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.

Question 33

33. 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

Answer 33

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.

Question 34

34. 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

Answer 34

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.

Question 35

35. 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

Answer 35

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).

Question 36

36. Cyanosis of extremities from cold-induced vasospasm is: a. High altitude hypoxia b. Carboxyhemoglobinemia c. Methemoglobinemia d. Raynaud’s Phenomenon

Answer 36

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.

Question 37

37. 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

Answer 37

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.

Question 38

38. Most hemoptysis is due to vessels in the: a. None of the above b. Bronchial arteries c. All of the above d. Pulmonary arteries

Answer 38

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.

Question 39

9. True or false: Chronic eosinophilic bronchitis causes chronic cough with a normal chest radiograph a. True b. False

Answer 39

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.

Question 40

40. In carbon monoxide intoxication, the hemoglobin-oxygen dissociation shifts to the: a. AOTA b. left c. right d. NOTA

Answer 40

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.

Question 41

41. Exercise increases oxygen requirements and the hemoglobin-oxygen dissociation curve shifts to the: a. AOTA b. left c. right d. NOTA

Answer 41

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.

Question 42

42. True or false: Clubbing is seen only in patients with congenital heart disease. a. True b. False

Answer 42

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.

Question 43

43. 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

Answer 43

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.

Question 44

44. Peripheral cyanosis is caused by: a. Cold exposure b. Carboxyhemoglobinemia c. Acquired sulfhemoglobinemia d. Decreased atmospheric pressure in high altitude

Answer 44

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.

Question 45

45. High altitude hypoxia leads to pulmonary arterial and venous constriction causing capillary leakage and high altitude pulmonary edema. a. TRUE b. FALSE

Answer 45

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.

Question 46

46. Cough is Always a reflex to prevent retention of airway secretions a. TRUE b. FALSE

Answer 46

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).

Question 47

47. 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

Answer 47

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.

Question 48

48. 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

Answer 48

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.

Question 49

49. 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

Answer 49

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.

Question 50

50. The most common cause of respiratory hypoxia is a. Ventilation-perfusion mismatch b. Intrapulmonary right-to-left shunting c. High altitude hypoxia d. Hypoventilation

Answer 50

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.

Question 51

1. 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

Answer 51

a. inhaled glucocorticoids

Question 52

2. 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

Answer 52

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.

Question 53

3. To diagnose asthma using the spirometry, the expected is: A. non-reversibility in response to a bronchodilator B. reversibility in response to a bronchodilator

Answer 53

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.

Question 54

4. Subjective breathing discomfort perceived during upright position but relieved during supine position is known as: A. Dyspnea B. Platypnea C. Hypoxia D. Hypoxemia

Answer 54

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).

Question 55

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

Answer 55

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.

Question 56

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

Answer 56

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.

Question 57

7. it is the leading cause of massive hemoptysis and subsequent death a. bronchitis b. bronchiectasis c. tuberculosis d. rasmussen's aneurysm

Answer 57

b. bronchiectasis

Question 58

27. 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

Answer 58

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.

Question 59

9. 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

Answer 59

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.

Question 60

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

Answer 60

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.

Question 61

11. 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

Answer 61

A. Paragonimus westermanii

Question 62

12. 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

Answer 62

C. all of the above

Question 63

13. True or false: Clubbing is seen only in patients with congenital heart disease. A. True B. False

Answer 63

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.

Question 64

14. Cough that lasts between 3-8 weeks is commonly seen in: A. neoplasm B. emphysema C. residuum of tracheobronchitis D. none of the above

Answer 64

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.

Question 65

Most hemoptysis is due to vessels in the: A. pulmonary arteries B. bronchial arteries C. all of the above D. none of the above

Answer 65

B. bronchial arteries

Question 66

16. True or false: Edema can cause localized hypoxia. A. True B. False

Answer 66

A. True

Question 67

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

Answer 67

D. all of the above

Question 68

18. 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

Answer 68

A. right

Question 69

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

Answer 69

C. all of the above

Question 70

20. True or false: Clinical picture of acute hypoxia resembles acute alcohol intoxication A. True B. False C. Maybe D. all of the above

Answer 70

A. True

Question 71

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

Answer 71

B. histotoxic hypoxia

Question 72

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

Answer 72

C. all of the above

Question 73

23.True or false: Chronic eosinophilic bronchitis causes chronic cough with a normal chest radiograph. A. True B. False

Answer 73

A. True

Question 74

24. 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

Answer 74

A. oxygen is unloaded only at lower tensions further contributing to tissue hypoxia

Question 75

25. 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

Answer 75

A. left atrial myxoma and hepatopulmonary syndrome

Question 76

26. 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

Answer 76

A. True

Question 77

27. 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

Answer 77

C. all of the above

Question 78

28. 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

Answer 78

B. ascertain whether bleeding is from the respiratory tract or GI tract

Question 79

29. The "cough center" in the brain is located at the: A. afferent nerves B. corpus callosum C. nucleus tractus solitarius D. pineal gland

Answer 79

C. nucleus tractus solitarius

Question 80

30. In carbon monoxide intoxication, the hemoglobin-oxygen dissociation shifts to A. right B. Left C. none of the above D. All of the above

Answer 80

B. Left

Question 81

31.Cyanosis of extremities from cold-induced vasospasm is: A. Raynaud's phenomenon B. high altitude hypoxia C. methemoglobinemia D. carboxyhemoglobinemia

Answer 81

A. Raynaud's phenomenon

Question 82

32. True or False: Cough is always a reflex to prevent retention of airway secretions. A. True B. False

Answer 82

B. False

Question 83

33. 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

Answer 83

A. right

Question 84

34. 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

Answer 84

C. All of the above

Question 85

35. 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

Answer 85

C. All of the above

Question 86

36. 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

Answer 86

B. catamenial hemoptysis

Question 87

37. 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

Answer 87

A.O2 saturation is < 88% at baseline or drops to <88% with activity or sleep

Question 88

38. 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

Answer 88

c. congenital heart disease with right-to-left shunting

Question 89

39.Central cyanosis is caused by: A. acquired sulfhemoglobinemia B. reduced cardiac output C. arterial obstruction D. venous obstruction

Answer 89

A. acquired sulfhemoglobinemia

Question 90

40. Peripheral cyanosis is caused by: a. decreased atmospheric pressure in high altitude b. cold exposure c. acquired sulfhemoglobinemia d. carboxyhemoglobinemia

Answer 90

b. cold exposure

Question 91

41. 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

Answer 91

A. Pleural effusion

Question 92

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

Answer 92

B. greater quantities of oxygen is released at any level of tissue PO2

Question 93

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

Answer 93

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.

Question 94

44. 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

Answer 94

A. angiotensin-converting enzyme inhibitors

Question 95

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

Answer 95

C. 3

Question 96

46. True or false: Cough alone as a manifestation of asthma is common among children but not among adults. A. True B. False

Answer 96

A. True

Question 97

47. 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

Answer 97

b. cough that is more that 8 weeks

Question 98

48. 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

Answer 98

A. sensitization of sensory nerve

Question 99

49. The most common cause of respiratory hypoxia A. ventilation-perfusion mismatch B. hypoventilation C. intrapulmonary right-to-left shunting D. high altitude hypoxia

Answer 99

A. ventilation-perfusion mismatch

Question 100

50. 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

Answer 100

B. inhalation of noxious smoke or chemical