Pulmonology

Question 1

Which of the following is believed to be the major source of mediators driving the chronic inflammation of asthma?
a) T-lymphocytes
b) Mast Cells
c) Neutrophils
d) Eosinophils
e) Airway epithelial cell

Answer 1

e) Airway epithelial cell

Question 2

A 19 y/o, female, sought consultation because of high grade fever, she claims that her problem started 8 days prior to consultation as stuffy nose, sore throat and dry cough; and one day prior to consultation she has high grade fever and chills. She denies any difficulty breathing. On physical examination vital signs are normal. Denies any other illness. Official report of chest X-ray done one day prior to consultation reveal pneumonia. Base on this information. What is the drug of choice?
a) Co-Amoxiclav 625mg 3x/day
b) Amoxicillin 1 g 3x/day
c) Clarithromycin 500mg 2x/day
d) Cefuroxime 500 mg 3x/day
e) Levofloxacin 500mg one a day

Answer 2

b) Amoxicillin 1 g 3x/day

Question 3

A 38 y/o, female, is suspected to have pneumonia vital sign was normal except for temperature of 5 C. She denied any concomitant illness but claim to have received antibiotic about 4 weeks ago because of skin
infection. Which of the following is the appropriate antimicrobial?
a) Beta lactam plus macrolide
b) Extended macrolide
c) Respiratory fluoroquinolone
d) Amoxicillin
e) 2nd generation cephalosporin

Answer 3

a) Beta lactam plus macrolide

Question 3

Which of the following mediators causes airway
smooth muscles constriction leading to an asthmatic attack?
a) Histamine
b) TNF
c) IL4
d) Nitric oxide
e) IL13

Answer 3

a) Histamine

Question 4

40 y/o female, known diabetic, admitted for fever & cough. BP= 110/80, CR= 100, RR= 29, T= 38.5. CXR= consolidation RLL. CBG= 120mg%. WBC= 16,000, 80% Segmenters. Diagnosis?
a) CAP moderate risk
b) CAP low risk
c) CAP high risk
d) HCAP

Answer 4

b) CAP low risk

Question 5

Possible common pathogens causing pneumonia in patients with decreased level of consciousness:
a) Hemophilus influenza and Pseudomonas
b) Klebsiella and Mycobacterium tuberculosis
c) Streptococcus and Staphylococcus
d) Legionella sp.
e) Anaerobes and Gram-negative Enterobacter

Answer 5

e) Anaerobes and Gram-negative Enterobacter

Question 5

The most common cause of exudative effusion in the Philippines is:
a) Malignant effusion
b) Pulmonary embolism
c) Parapneumonic effusion
d) Tuberculous pleuritis
e) Viral infection

Answer 5

d) Tuberculous pleuritis

Question 6

Predisposing factors to obstructive sleep apnea
EXCEPT:
a) Obesity
b) Male, 40-65 years old
c) Shortened mandible
d) Hyperthyroidism

Answer 6

d) Hyperthyroidism

Question 7

Triggers of asthma attack that generally does not evoke any long-term sequelae is:
a) Exposure to allergens
b) Exposure to toluene di-isocyanide
c) Food like eggs or nuts
d) Exercise
e) Respiratory tract infections

Answer 7

d) Exercise

Question 8

The single most important PE finding suggestive of severe pneumonia among patient without other respiratory problem is:
a) Temperature of 40°C
b) Respiratory rate ~ 30/min
c) Heart rate of ~125/ min
d) Bilateral rales
e) Diffuse wheezes

Answer 8

b) Respiratory rate ~ 30/min

Question 9

The most common risk factor for development of ARDS:
a) Aspiration
b) Sepsis
c) Acute pancreatitis
d) Trauma

Answer 9

b) Sepsis

Question 10

Hypoxemia is expected among COPD patient if their FEV1 is less than or equal to:
a) 50%
b) 40%
c) 60% of predicted normal
d) 35%

Answer 10

a) 50%

Question 11

Which of the following play an important role in
initiating acute broncho-constriction response to allergens and other stimuli?
a) T-lymphocytes
b) Eosinophils
c) Neutrophils
d) Mast Cells
e) Airway epithelial cells

Answer 11

d) Mast Cells

Question 12

Which of the following pathologic changes of the airway is usually present during an asthma attack?
a) Denudation of surface epithelium
b) Hyperplasia of mucosal and submucosal
blood vessel
c) Thickening of basement membrane
d) Mucus glands hyperplasia
e) Smooth muscles hypertrophy

Answer 12

e) Smooth muscles hypertrophy

Question 13

Cornerstone in the treatment of COPD is:
a) Anti-cholinergic agent
b) Smoking cessation
c) inhaled steroid
d) pulmonary rehabilitation

Answer 13

b) Smoking cessation

Question 14

Which of the following finding on Pulmonary function test is compatible emphysema?
a) Dec. TLC
b) Dec. FVC
c) Dec. FEV1
d) Dec. RV
e) Dec. DLCO

Answer 14

e) Dec. DLCO

Question 15

An Evidence based recommendation A in ventilator management of ARDS:
a) Prone position
b) ECMO
c) PEEP
d) Tidal volume of s 6 ml/ kg BW

Answer 15

d) Tidal volume of s 6 ml/ kg BW

Question 16

Obstructive sleep apnea hypoventilation syndrome:
a) AHI >5 per hour
b) No daytime sleepiness
c) Regular snoring
d) 5 or more apneas per hour of sleep

Answer 16

d) 5 or more apneas per hour of sleep

Question 17

A 60 y/o, male, diagnosed to have COPD about 6 years ago, he has chronic cough and sputum
production, and he have exacerbation of his cough about 2x/year. He was rushed to the ER few hours ago, because of fever and worsening of cough. Chest X-ray done revealed pneumonia. Which of the following antibiotic will give this patient?
a) Ampicillin-sulbactam 2 g/ iv every 8 hours
b) Ceftriaxone 1 g/ iv every 12 hours
c) Ertapenem 1 g/ iv every 24 hours
d) Levofloxacin 750 mg/ iv every 24 hours

Answer 17

b) Ceftriaxone 1 g/ iv every 12 hours

Question 18

Severe asthmatic attack is more commonly triggered by:
a) Exercise
b) Respiratory tract infections
c) Food like eggs or nuts
d) Exposure to toluene di-isocyanide
e) Exposure to allergens

Answer 18

b) Respiratory tract infections

Question 19

65 y/o male, known CAD patient, admitted for
pneumonia. BP= 80/ 50, CR= 130, RR= 32, T= 35.4. ECG sinus tachycardia, ABG severe hypoxemia with metabolic acidosis. WBC= 4.0, 90% neutrophils. Diagnosis?
a) CAP low risk
b) CAP moderate risk
c) CAP high risk
d) HCAP

Answer 19

c) CAP high risk

Question 20

Which of the following condition causes exudative effusion with low level of pleural fluid glucose?
a) Dressler’s’ syndrome
b) Pulmonary embolism
c) Viral infection
d) Malignant effusion
e) Tuberculous pleuritis

Answer 20

d) Malignant effusion

Question 20

When COPD patient develop respiratory failure, it is usually:
a) Type Ill
b) Type I
c) Type II
d) Type IV

Answer 20

c) Type II

Question 21

Which one of the following effects of PEEP (Positive End-Expiratory Pressure) enhances Oxygenation in the management of ARDS?
a) Decreases pulmonary capillary wedge
pressure
b) Increases intra-alveolar pressure at end exhalation
c) Increases pleural pressure at end expiration
d) Decreases venous blood return to right
ventricle during expiratory phase

Answer 21

d) Decreases venous blood return to right
ventricle during expiratory phase

Question 22

50 y/o male, CKD patient, on bi-weekly dialysis was admitted for fever & productive cough. Previous antibiotics taken for acute bronchitis a week ago. Crackles with increased fremitus on LLF. Diagnosis?
a) CAP moderate risk
b) CAP low risk
c) CAP high risk
d) HCAP

Answer 22

a) CAP moderate risk