Samplex 2014 Flashcards
1
Q
Congenital Cystic Adenomatoid Malformation
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
A
B
2
Q
Congenital Diaphragmatic Hernia
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
A
B
3
Q
Tracheoesophageal fistula, distal type
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
A
A
4
Q
Lung agenesis
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
A
A
5
Q
Lobar emphysema
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
A
C
6
Q
This phase of lung development coincides with the closure of the pleuroperitoneal cavity:
A. Embryonic Phase B. Pseudoglandular Phase C. Canalicular Phase D. Saccular Phase E. Alveolar Phase
A
B
7
Q
This phase of lung development involves the flattening and early sacculation of respiratory epithelium and the formation capillary network from angioblastic cells:
A. Embryonic Phase B. Pseudoglandular Phase C. Canalicular Phase D. Saccular Phase E. Alveolar Phase
A
C
8
Q
This congenital lung malformation is characterized by the absence of lung parenchyma and nondevelopment of bronchus:
A. Pulmonary agenesis
B. Pulmonary aplasia
C. Pulmonary hypoplasia
A
A
9
Q
This congenital lung malformation is characterized by the presence of developed bronchus and the absence of lung parenchyma:
A. Pulmonary agenesis
B. Pulmonary aplasia
C. Pulmonary hypoplasia
A
B
10
Q
This congenital lung malformation is characterized by the presence of developed lung parenchyma and a decreased lung parenchyma:
A. Pulmonary agenesis
B. Pulmonary aplasia
C. Pulmonary hypoplasia
A
C
11
Q
With the given history and PE findings, one might consider the following pulmonary diseases as main impression except:
a. pneumonia
b. Tuberculosis
c. malignancy
d. COPD
e. NOTA
A
E
12
Q
On PE, a dull area was found on percussion. All the following are considerations except:
A. Consolidation
B. Pneumothorax
C. Mass
D. Pleural effusion
A
B
13
Q
Egophony may be appreciated over the (R) mid lung field in case of the following, except:
a. pleural effusion
b. consolidation
c. pulmonary mass
d. loculated pneumothorax
A
D
14
Q
The following data may be important in making one consider a respiratory disease more over a primary cardiac problem:
a. he feels better after a nitroglycerine patch was placed over third ICS
b. he sits up a few minutes after lying supine to relieve the dyspnea
c. strong history of smoking around 200 pack years
d. he has exertional dyspnea
A
C
15
Q
A chest radiograph was done revealing a dense opacification of the (R) basal lung field area. This finding in addition to the above PE data may strengthen the diagnosis of the following, except:
a. pneumothorax
b. pleural effusion
c. pulmonary mass
d. lobar pneumonia
A
A
16
Q
Which of the following is a test of respiratory function?
a. Arterial blood gas
b. MRI
c. Chest CT scan
d. PET scan
A
A
17
Q
The following can be measured in SPIROMETRY:
a. total lung capacity
b. residual volume
c. oxygen saturation
d. forced expiratory volume
A
D
18
Q
condition where pulmonary function test is contraindicated:
a. thoracic aneurysm
b. preoperative evaluation
c. smoker
d. urinary tract infection
A
A
19
Q
Polysomnography involves monitoring of ___________ during sleep:
a. Eye movements
b. Expired carbon dioxide
c. Temperature
d. Tidal volume
A
A
20
Q
What should be the first diagnostic test to be ordered in a patient suspected with PTB?
a. chest Xray
b. MRI
c. Sputum AFB
d. ABG
A
C
21
Q
which of the following is a possible complication of thoracocentesis
a. pulmonary embolism
b. pneumothorax
c. carcinogenesis
d. mediastinitis
A
B
22
Q
light’s criteria for diagnosis of exudative effusion
a. LDH< 40 mg %
d. serum and LDH ratio >0.6
A
D
23
Q
what should be the first diagnostic test to evaluate parenchymal lung disease
a. chest CT scan
b. chest xray
c. MRI
d. PET scan
A
B
24
Q
which of the following is an adequate specimen collection
a. SEC 25/HPF
b. SEC > 10 / LPF, PMN > 25/HPF
c. SEC 25/LPF
A
D
25
what diagnostic test is done to evaluate hemoptysis, stridor and lung cancer staging
a. pleuroscopy
b. MRI
c. Bronchoscopy
d. thoracoscopy
C
26
functions of the upper respiratory tract
a. filtration
b. warming
c. humidification
d. aota
D
27
function of the respiratory system which is mist reflected by PaO2 values
a. ventilation
b. gas exchanghe
c. metabolism
d. defense
A
28
function of the respiratory system which is most reflected by Pa CO2
a. ventilation
b. gas exchanghe
c. metabolism
d. defense
C
29
airway resistance is
a. inversely proportional to airway length
b. directly proportional to airway diameter
c. highest in the large lung airways
d. highest in the airways with laminar airflow
C
30
he following is true regarding normal distribution of ventilation and perfusion in the human upright lung
a. ventilation decrease from apex to base
b. perfusion increase from apex to base
c. ventilation perfusion ratio increase from apex to base
d. ventilation and perfusion do not change form apex to base
C
31
Interstitial lung diseases commonly lead this gas exchange abnormality
A. Ventilation
B. Perfusion
C. Ventilation/perfusion mismatch
D. Shunting
C
32
The most common cause of secondary pulmonary arterial hypertension is:
A. Embolism
B. Idiopathic
C. Hypoxemia
D. Systemic hypertension
A
33
A significant hemothorax can lead to this physiologic abnormality
A. Obstructive ventilatory pattern
B. Restrictive ventilatory pattern
C. Shunting
D. Early onset hypercarbia
B
34
The Philippine tobacco Regulations Act of 2003 includes this tobacco control measure:
A. Place pictorial and graphic warnings on cigarette packs
B. Restrict access to cigarettes to those 15 years old and above only
C. Ban the planting of tobacco starting 2015
D. Reimburse 100% the usage of smoking cessation medications
A
35
The most common associated risk factor for COPD in the rural areas of the Philippines is:
A. Tobacco use
B. Biomass fuel exposure
C. Tuberculosis
D. Poverty
B
36
A 55 year old male, current smoker, executive, consults at your clinic for a 6-week history of non-productive cough accompanied by a sensation of throat fullness. He denies any other complaints. He has been diagnosed with hypertension and diabetes for which he has been taking enalapril, glibenclamide, and simvistatin regularly. Physical examination is unremarkable. Chest radiograph reveals no significant findings.
What is the most likely cause of his cough?
```
A. Congestive heart failure
B. Chronic bronchitis
C. Bronchiectasis
D. ACEi-induced cough
E. Bronchiectasis
```
D
37
A 24 year old medical clerk from PGH complains of a cough productive of whitish sputum, occasional hemoptysis, fever, malaise, and anorexia of 3 weeks’ duration. He has no other complaints. Physical examination reveals a weak-looking, mildly underweight patient. There are no other remarkable findings.
Which lab test will you prioritize to determine the diagnosis of this patient’s condition?
```
A. Chest X-ray
B. CBC
C. Sputum AFB smears
D. Sputum, GS, CS
E. Spirometry
```
C
38
A 60 y.o. female who has repeated history of pneumonia wand was previously adequately treated for PTB, now consults for a 1-month history of cough productive of white, think sputum which was difficult to expectorate. She has no fever or dyspnea. Lung findings revealed occasional crackles in the right lower lung field. Her chest imaging studies revealed bronchiectasis. What medication will you recommend for this patient at this time?
```
A. Levodropropizine
B. Erdosteine
C. Codeine
D. Dextrometorphan
E. Tranexamic Acid
```
B
39
Which procedure can provide both diagnostic and therapeutic utility for a patient with significant hemoptysis?
```
A. Chest imaging studies
B. Sputum induction studies
C. Bronchoscopy
D. Spirometry
E. None of the above
```
B
40
A 30 y.o. teacher, non-smoker, with a strong atopic family history consults you for an on-and-off cough productive of white, occasionally yellow, phlegm, since 6 months ago, often occurring at night and early in the morning. She recalls that her cough has become worse since 2 weeks ago when the classroom computer broke down and she had to write on the blackboard with chalk. She has no other complaints, except for occasional chest tightness. The rest of her clinical history and physical examination are unremarkable. A chest radiograph done 1 month ago was normal.
Basing your clinical decision on the chronic cough algorithm, what will be your next step?
A. Repeat the chest x-ray
B. Do sputum AFB smears
C. Start empiric antibiotic with atypical coverage
D. Start empiric oral antihistamine and decongestant
E. Start empiric inhaled steroid-beta agonist combination
E
41
Mortality from massive hemoptysis is usually attributed to:
```
A. Asphyxiation
B. Exsanguination
C. Fatal arrythmia
D. Hypovolemic shock
E. The severity of the underlying condition
```
A
42
Features suggesting a pulmonary, rather than a GI source of oral bleeding, EXCEPT:
```
A. Foaminess
B. Bright red appearance
C. Acidic pH
D. Presence of pus
E. None of the above
```
C
43
Which is TRUE of hemoptysis occuring in a patient with pulmonary tuberculosis?
A. It invariably heralds active disease.
B. It can be seen in patients with non-cavitary involvement.
C. A TB cavity will likely contain a fungus ball.
D. A true aneurysm of the feeding bronchial arteries often develops in the TB lesion.
E. It invariably heralds bronchioectatic complications.
NA
44
The most important factor for the function of cough
A. Glottic closure
B. Compressive phase
C. Expiratory phase
D. NOTA
C
45
Which is not true regarding the complex reflex arc of cough?
A. It begins with the stimulation of an irritant receptor.
B. The trigeminal nerve serves the afferent limbs in the diaphragm.
C. The central cough center integration is in the medulla oblongata.
D. An effecive cough depends on the ability to achieve high gas flows and intrathoracic pressures.
E. none of the above
B
46
Unacceptable interpretation for dyspnea:
A. shortness of breath
B. breathlessness
C. tachycardia
D. not getting the air all the way down
C
47
Which of the following can be seen as an objective manifestation of dyspnea?
A. Slow breathing
B. Stammering speech
C. Alar flaring
D. Flushed face
C
48
The sense of respiratory effort is believed to arise from a signal transmitted from the motor cortex to this structure coincidently with the outgoing motor command to the ventilatory muscles:
A. sensory cortex
B. medulla
C. cerebellum
D. anterior horn cells of the spinal cord
A
49
All of the following situations will produce breathlessness, EXCEPT:
A. Metabolic alkalosis
B. Heightened ventilatory demand
C. Respiratory muscle abnormalities
D. Abnormal ventilatory impedance
A
50
Which of the following statements is TRUE regarding dyspnea in respiratory distress?
A. Dyspnea usually arises from a single mechanism specific for a particular disease.
B. Establishing the etiology of acute severe dyspnea takes precedence over immediate treatment
C. Specific language descriptors have been associated with certain mechanisms of dyspnea.
D. Being subjective, dyspnea cannot be measured nor compared.
C
51
In lung fibrosis, which of the following breathing patterns is expected?
A. rapid, shallow breathing
B. rapid, deep breathing
C. slow, shallow breathing
D. slow, deep breathing
A
52
When the intrapulmonary airways are significantly obstructed,
A. compliance work is increased
B. tachypnea increases further the work of breathing
C. inspiratory stridor becomes evident
D. alveoli are likely to deflate
B
53
Which of the following breathing patterns is characteristic of severe metabolic acidosis?
A. Cheyne-Stokes breathing
B. apneustic breathing
C. Biot’s breathing
D. Kussmaul breathing
D
54
True cyanosis always indicates
A. hypoxemia
B. reduced Hb of >3 or 4 gms/dl
C. arterial blood desaturation
D. sluggish peripheral circulation
B
55
Which of the following is TRUE regarding central cyanosis?
A. central cyanosis + dyspnea = respiratory or CVS disease
B. central cyanosis with no dyspnea rules our respiratory or CVS disease
C. central and peripheral cyanosis cannot occur simultaneously
D. central cyanosis + clubbing indicates recent catastrophic onset illness
A
56
The airway branching in human lung is regularized dichotomy from trachea to alveolar ducts and sacs. How many generations are purely conducting?
A. 16
B. 20
C. 21
D. 23
A
57
Which of the following statement is true regarding airway wall structure? EXCEPT
A. Epithelial layer gradually becomes reduced from stratified to cuboidal and to squamous
B. Smooth muscle layer disappears in the alveoli
C. Fibrous coat contains cartilage only in bronchi
D. Fibrous coat gradually becomes thinner as the alveolus is approached
B
58
Which of the following statement is true regarding bronchial epithelium? EXCEPT
A. Ciliated cells dominate the bronchioles
B. Clara cells progressively decrease distally along the airways
C. Goblet cells and serous cells decrease distally and are absent in terminal bronchioles
D. Basal cells and especially Kulchitsky cells are uncommon in distal airways
B
59
Which of the following respiratory disorders cause loss of cilia or abnormal function?
```
A. chronic bronchitis
B. asthma
C. cystic fibrosis
D. AOTA
E. NOTA
```
D
60
Which of the following statement is TRUE regarding alveolar macrophage? EXCEPT
A. derived from precursors of the bone marrow
B. regulator of tissue repair
C. has adaptations for aerobic environment of the lungs
D. AOTA
E. NOTA
D
61
Which of the following medical illnesses affect host defenses?
```
A. Diabetes mellitus
B. Congestive heart failure
C. Aspergillus infection
D. All of the above
E. None of the above
```
D
62
In patients with pneumonia, which of the following inflammatory mediators causes fever?
```
A. Granulocyte CSF
B. Interleukin-1
C. Tumor necrosis factor
D. Both a and c
E. Both b and c
```
E
63
Which of the viruses are causes of bronchiectasis in association with lower respiratory tract infection?
```
A. Adenovirus
B. Parainfluenza
C. Coxsackie virus
D. All of the above
E. None of the above
```
B
64
The diagnosis of lung abscess is based on which of the following?
```
A. Clinical symptoms
B. Identification of predisposing conditions
C. Chest radiographic findings
D. All of the above
E. None of the above
```
D
65
Which of the following laboratory results indicate the likely need for a procedure more invasive than a thoracentesis?
A. Pleural fluid pH > 7.0
B. Pleural fluid glucose
D
66
[T/F] A 28 year old housewife consults you for fever and diarrhea. On prodding, she also admits to having cough that is dry. PE is normal except for a 38.2 Temperature with stable vital signs. A chest radiograph reveals interstitial pneumonitis. She should be advised to have a fecalysis done, start azithromycin as outpatient and return three days for reevaluation.
F
67
[T/F] A 45-year old smoker with no other past medical history was brought to the emergency room for shortness of breath. The wife says he has been having cough and fever for 3 days. On initial assessment, he was dyspneic, tachypneic with cyanosis, and has decreased breath sounds. He was immediately intubated. He should be admitted to the intensive care unit and be managed as high risk CAP with anti-pseudomonal agents.
F
68
[T/F] Your 55 year-old dad asks you regarding vaccination to prevent pneumonia. He is otherwise well with regular exercise and follows a healthy lifestyle. You should recommend him to have annual vaccination of the influenza and pneumococcal vaccines.
F
69
[T/F] Severe pneumonia has a predicted mortality rate of over 30% and should be managed aggressively with the correct empiric antibiotics and properly timed diagnostic tests to determine the etiology.
T
70
[T/F] The value of doing chest radiograph in the diagnosis of CAP is to help assess severity, differentiate pneumonia from other conditions and for prognostication.
T
71
[T/F] A patient with two day history of chills, fever and cough productive of yellow phlegm, found to have crackles at the left lung on PE; but a normal chest radiograph. He cannot possibly have CAP.
F
72
[T/F] A 24 year-old medical student presents to the UPHS for evaluation of one day of fever and cough. He has no comorbid illnesses. On examination he had RR 40/min, BP 90/60, HR 140. He should be advised to start amoxicillin-clavulanate and excused from school to rest at home.
F
73
[T/F] Sputum culture is an important diagnostic procedure to determine etiologic agents of pneumonia. One needs to wait for the final results before antibiotic therapy is started for better and a more cost-effective approach.
F
74
[T/F] Good history and physical examination result in findings which are non-specific making physicians’ clinical judgement regarding the diagnosis of CAP only between 30-50%.
F
75
[T/F] Physicians are usually able to distinguish between typical and atypical pneumonia based on physical examination.
T
76
Which of the following fungal infections of the lungs that is characterized by growth of fungal mycelia within the pre-existing lung cavities
```
A. Histoplasmosis
B. Aspergillosis
C. Cryptococcosis
D. Mucormycosis
E. Candidiasis
```
B
77
True of emphysema associated with prolonged cigarette smoking
```
A. Panacinar emphysema
B. Centrilobular emphysema
C. Focal emphysema
D. Distal acinar emphysema
E. None of the above
```
B
78
The Reid index is increased in the disease, usually in proportion to the severity and duration of the disease:
```
A. Bronchiectasis
B. Bronchial asthma
C. Emphysema
D. Chronic bronchitis
E. None of the above
```
A/D
79
Obstruction and infection are the predisposing factors in the development of which of the following?
```
A. Chronic bronchitis
B. Emphysema
C. Adult respiratory distress syndrome
D. Bronchiectasis
E. None of the above
```
D
80
The following viruses may be associated with cytopathic effect of the bronchial epithelium:
```
A. Herpes simplex
B. Varicalla zoster
C. Adenovirus
D. Cytomegalovirus
E. All of the above
```
E
81
False statement about streptomycin:
A. It inhibits protein synthesis
B. It has excellent activity against intracellular mycobacteria
C. It must be admistered parenterally
D. It may be used for the treatment of streptococcal endocarditis in combination with other beta-lactams
B
82
Which is a TRUE statement about Isoniazid?
A. It inhibits RNA polymerase
B. Once weekly treatment is acceptable
C. It is bactericidal against growing mycobacteria
D. It causes ototoxicity
C
83
Which is a FALSE statement about pyrazinamide?
A. It is bactericidal against intracellular mycobacteria
B. It is given during the maintenance or continuation phase of treatment
C. Adverse effects include hepatotoxicity and hyperuricemia
D. It inhibits mycolic acid synthesis
B
84
Combination therapy is necessary for TB treatment because:
A. Natural resistance to first-line drugs exist in patients
B. There are different populations with different metabolic activity
C. All of the above
D. None of the above
C
85
The following Quinolones have good anti-mycobacterial activity EXCEPT:
A. Ciprofloxacin
B. Levofloxacin
C. Nalidixic acid
D. Moxifloxacin
C
86
A 2-month-old infant was brought to the emergency room due to difficulty of breathing. History revealed tha the patient developed cough and colds for 1 week and was given nasal decongestants. On the dy of consult, the infant had increased respiratory rate associated with intercostal retractions. Physical examination showed wheezing on both lung fields. Which of the following respiratory viruses is most likely involved?
A. Rhinovirus
B. Adenovirus
C. Influenza virus
D. Respiratory Syncitial Virus
D
87
The adenovirus can have a single serotype that causes different clinical syndromes. Which triad of manifestations is characteristic of an adenoviral infection?
A. nasal congestion, diarrhea and vomiting
B. coryza, cough, sore throat
C. cough, fever, headache
D. pharyngitis, non-purulent conjunctivitis, lymphadenopathy
D
88
The novel flu virus that caused the pandemic in 2009 is a combination of genes from
A. human and pig
B. human and bird
C. human, bird, and pig
D. unknown
C
89
The most preferred specimen for the diagnosis of viral respiratory diseases:
A. Nasal swab
B. Pharyngeal swab
C. Nasopharyngeal aspirate
D. Serum
C
90
The development of a fungus ball or aspergilloma is associated with certain predisposing conditions. Which of the following will most likely develop this health problem?
A. A 60 y.o. diabetic previously treated for pulmonary TB
B. A 20 y.o. smoker
C. A 10 y.o. undergoing cardiac catheterization
D. A 30 y.o. female athelete with known bronchial asthma.
A
91
The gold standard for the diagnosis of paragonimiasis is
A. Stool examination
B. Sputum examination
C. Serologic test
D. None of the above
B
92
True of lung fluke EXCEPT
A. It is a hermaphrodite
B. Molluscs are 1st intermediate hosts
C. Crustaceans are 2nd intermediate hosts
D. None of the above
D
93
Pathology of lung fluke infection includes the following, EXCEPT:
A. Tubercle-like abscess
B. Granuloma formation
C. Both a and b
D. Neither a nor b
D
94
Lung flukes may invade the following organs EXCEPT:
A. Brain
B. Spinal cord
C. Peritoneal organs
D. None of the above
D
95
The drug/s of choice for paragonimiasis is/are:
A. Praziquantel
B. Triclabendazole
C. Either A or B
D. Neither A nor B
C
96
Which is found in the first intermediate host of Paragonimus?
A. cercaria
B. metacercaria
C. cysticerus
D. miracidium
D
97
The following are the characteristics of the lung fluke ova EXCEPT:
A. flattened operculum
B. thickened abopercular end
C. easily found on concentrated stool examination
D. NOTA
D
98
Metacercariae of lung flukes may be found in:
A. Antemelania
B. Oncomelania
C. Sundathelphusa
D. NOTA
C
99
Known paragonimiasis endemic provinces in the Philippines include:
A. Basilan and Cebu
B. Sorsogon and Bohol
C. Davao Oriental and Leyte
D. Zamboanga del Norte and Bataan
C
100
Highest rates of lung fluke infection have described in:
A. Leyte
B. Samar
C. Davao Oriental
D. Basilan
C
