Samplex 2015 Set A Flashcards
1
Q
Fremitus is increased in which of the following condition/s:
A. COPD
B. pleural effusion
C. consolidation
D. pneumothorax
A
C
2
Q
A patient came to you for second opinion regarding chest radiographic findings. To sufficiently read the chest radiograph, you check first for the acceptability of the film. Which of the following criteria indicates a good chest PA radiograph?
A. All of the thoracic vertebrae are virtualized
B. At least nine posterior ribs are above the diaphragm
C. Scapulae are symmetrically positioned overlying the upper lobes
D. Clavicles should be above the first ribs
A
B
3
Q
Which best describes the main function of the lungs?
A. Foreign body expulsion
B. Gas exchange
C. Mucociliary clearance
D. Ventilation
A
B
4
Q
The _______ divides the upper respiratory tract from the lower respiratory tract.
A. false vocal cords
B. true vocal cords
C. Trachea
D. carina
A
B
5
Q
Conducting zone is up to what generation?
A. 19
B. 18
C. 17
D. 16
A
D
6
Q
Which of the following is/are chief site/s of airway resistance?
A. Small sized bronchioles
B. Medium sized bronchioles
C. Main bronchus
D. None of the above
A
B
7
Q
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 E. None of the above
A
A
8
Q
The function(s) of the upper respiratory tract includes:
A. Filtration
B. Warming
C. Humidification
D. All of the above
A
D
9
Q
Which of the following statement is NOT true regarding airway wall structure?
A. Smooth muscle layer disappears in the alveoli
B. Fibrous coat contains cartilage only in the bronchi
C. Epithelial layer gradually becomes reduced from stratified to cuboidal and to squamous
D. Fibrous coat gradually becomes thinner as the alveolus is approached
E. None of the Above
A
C
10
Q
Increase in PaCO2 in patients with shunt is mainly due to:
A. Central hypoventilation
B. Increase in dead space ventilation
C. Decrease in tidal volume
D. increase in residual volume
A
B
11
Q
Which of the following statement is NOT true regarding bronchial epithelium?
A. Clara cells progressively decrease distally along the airways
B. Goblet cells and serous cells decrease distally and are absent in terminal bronchioles
C. Basal cells and especially Kulchitsk cells are uncommon in distal airways
D. Ciliated cells dominate the bronchioles
E. None of the Above
A
D
12
Q
Which function of respiratory system is most reflected by PaO2 values:
A. Gas exchange
B. ventilation
C. metabolism
D. Defense
A
A
13
Q
Function of respiratory system which is most reflected by PaCO2 values
A. Gas ventilation
B. Gas Exchange
C. Metabolism
D. Defense
A
A
14
Q
The following are true regarding anatomy of the pleura:
A. the pleural membranes include both visceral and parietal pleura
B. The pleural space occupies 12 to 20 cm width
C. the pleural is composed of 3 layers
D. A and C only
A
D
15
Q
Which of the following causes hypoxemia?
a. hypoventilation
b. shunt
c. V/Q mismatch
d. All of the above
A
D
16
Q
Interstitial lung diseases commonly lead this gas exchange abnormality:
a. V/Q Mismatch
b. Ventilation
c. shunting
d. Perfusion
e. All of the above
A
A
17
Q
A significant hemothorax can lead to which of the following physiologic abnormality?
a. Obstructive ventilator pattern
b. restrictive ventilator pattern
c. shunting
d. early onset hypercarbia
A
B
18
Q
The most common cause of secondary pulmonary arterial hypertension is:
a. Pulmonary embolism
b. hypoxemia
c. chronic obstructive Pulmonary disorder
d. systemic hypertension
A
B
19
Q
The most common mechanism causing hypoxemia among pulmonary disorders
a. ventilator abnormality
b. perfusion abnormality
c. diffusion abnormality
c. ventilation-perfusion mismatch
d. shunting
A
D
20
Q
The Philippine Tobacco Regulations Act of 2003 includes this tobacco control measure:
a. restrict access to cigarettes to those 15 years old and above only
b. place pictorial and graphic warnings on cigarette packs
c. ban the planting of tobacco starting 2015
d. reimburse 100% usage of smoking cessation medications
A
B
21
Q
In COPD, the equal point pressure on forced expiration is _______________ compared to a person with no COPD.
a. more proximal
b. more distal
c. at the same point
d. not evaluable
A
B
22
Q
Case. A 60-year old male consults for persistent shortness of breath. He is a previous 60- pack-year smoker with occasional cough. Chest x-ray done this year was normal and cardiac work-ups were normal. PE was normal except for wheezes at the mid-lung field area. Oxygen saturation was at 98%. The symptom of dyspnea among COPD patients is best correlated with
a. number of pack years smoking
b. FEV1
c. FVC
d. FEV1/FVC
e. dynamic lung hyperinflation
A
E
23
Q
The phase of a cough is characterized by a rapid deceleration of gas flow rates:
a. Inspiratory
b. glottis closure
c. Compressive
d. expiratory
e. recovery
A
D
24
Q
Which nerve subserves both the afferent and efferect limbs of the cough reflex pathway
a. vagus
b. trigeminal
c. glossopharyngeal
d. superior laryngeal
e. spinal motor
A
A
25
A 25 year old male call center agent complains of chronic cough, nasal congestion, sneezing, postnatal drip, itchy throat and watery eyes, Physical examination reveals congested nasal mucosa and “cobblestone” appearance of the posterior pharyngeal mucosa. Following the anatomic diagnostic protocol in the evaluation of cough, which afferent limbs of the reflex pathway are most likely involved?
a. phrenic and vagus nerves
b. trigeminal and glossopharyngeal nerves
c. spinal motor and recurrent laryngeal nerves
d. trigeminal and phrenic nerves
e. none of the above
B
26
40 F form Paco complains of cough productive of whitish, blood tinged sputum, fever, malaise, anorexia for 4 weeks duration. Self-medication of paracetamol and lagundi provided relief. PE is essentially normal. What lab test should be done to confirm the diagnosis of the patient?
```
A. Sputum AFB smears
B. CBC
C. Spirometry
D. Chest radiography
E. Sputum GS, CS
```
A
27
Pulmonary and airway lesions causing hemoptysis are usually supplied by the:
```
A. aortic circulation
B. bronchial circulation
C. pulmonary circulation
D. alveolar capillary shunts
E. pulmonary arteriovenous anastomoses
```
B
28
Mortality from hemoptysis is usually attributed to:
A. Hypovolemic shock due to exsanguination
B. Acute respiratory failure
C. Disseminated Intravascular Coagulation
D. All of the above
B
29
All of the following suggest a source of oral bleeding except:
```
A. acidic pH
B. Dark red appearance
C. Presence of food particles
D. Foaminess
E. none of the above
```
D
30
Which of the following is the LEAST acceptable equivalent description of dyspnea?
A. Shortneness of breath
B. Breathlessness
C. Palpitations
D. “Not getting the air all the way down”
C
31
Which of the following sign/s is are associated with dyspnea
A. slow breathing
B. Stammering
C. Alar flaring
C
32
Which of the following is/are true when the intrapulmonary airways are obstructed?
A. inspiratory stridor becomes evident
B. alveoli are likely to deflate
C. tachypnea increases further the work of breathing
D. compliance work is increased
A
33
Which of the following breathing patterns characterizes severe metabolic acidosis?
A. Apneustic breathing
B. Cheyne-Strokes breathing
C. Kussmaul breathing
D. Biot’s breathing
D
34
Cyanosis always indicates
A. Arterial blood desaturation
B. Sluggish peripheral circulation
C. Hypoxemia
D. reduced Hb of >3 or 4 mgs/dL
D
35
Which of the following is true regarding central cyanosis?
A. Central Cyanosis with no dyspnea is a common respiratory or CVS
B. Central or peripheral cyanosis cannot occur simultaneously
C. Central cyanosis + clubbing indicates recent catastrophic recent illness
D. none of the above
D
36
This stage of development is characterized by ventral outpouching
a. embryonic phase
b. pseudoglandular phase
c. canalicular phase
d. saccular phase
e. alveolar phase
A
37
During which phase of development does diaphragmatic hernia develop?
a. embryonic phase
b. pseudoglandular phase
c. canalicular phase
d. saccular phase
e. alveolar phase
B
38
Which of the following describes a mature alveolus?
a. It is line up with Type 2 cells in intimate contact with a capillary
b. Each capillary is exposed to 5 alveoli
c. It is connected to an alveolar duct
d. The Type I cells produce adequate surfactant
e. All of the above
C
39
The following are true of lung development:
a. The first 28 weeks of gestation is characterized by anatomical lung development
b. Lung maturation consists of functional as well as biochemical development
c. All alveoli are present at birth so that postnatal growth is characterized only in the lumen and size of the alveoli
d. All of the above are true.
e. Only a and b are true.
E
40
This type of lung development is characterized by the absence of mainstem lung tissue:
a. lung agenesis
b. lung aplasia
c. lung hypoplasia
d. lung dsyplasia
e. lung dysgenesis
A
41
Laryngotracheomalacia
```
A. Streptococcus pneumoniae
B. Staphyloccus aureus
C. Parainfluenza virus
D. Hemophilus Influenza Type B
E. Respiratory Syncitial Virus
F. Mycoplasma pneumoniae
```
C
42
Epiglotitis
```
A. Streptococcus pneumoniae
B. Staphyloccus aureus
C. Parainfluenza virus
D. Hemophilus Influenza Type B
E. Respiratory Syncitial Virus
F. Mycoplasma pneumoniae
```
D
43
Bacterial tracheitis
```
A. Streptococcus pneumoniae
B. Staphyloccus aureus
C. Parainfluenza virus
D. Hemophilus Influenza Type B
E. Respiratory Syncitial Virus
F. Mycoplasma pneumoniae
```
B
44
Pneumonia
```
A. Streptococcus pneumoniae
B. Staphyloccus aureus
C. Parainfluenza virus
D. Hemophilus Influenza Type B
E. Respiratory Syncitial Virus
F. Mycoplasma pneumoniae
```
A
45
Bronchiolitis
```
A. Streptococcus pneumoniae
B. Staphyloccus aureus
C. Parainfluenza virus
D. Hemophilus Influenza Type B
E. Respiratory Syncitial Virus
F. Mycoplasma pneumoniae
```
E
46
A 5 - year old male developed high grade fever and sore throat. A few hours after, the patient appeared toxic with difficulty in swallowing and labored breathing. Physical examination revealed a patient in respiratory distress who is seen sitting upright and leaning forward. He was also noted to have stridor and drooling.
Your immediate impression for the above case should be:
A. Laryngrotracheomalacia
B. Bacterial Tracheitis
C. Acute Epiglotitis
D. Acute Laryngotracheomalacia
C
47
A 5 - year old male developed high grade fever and sore throat. A few hours after, the patient appeared toxic with difficulty in swallowing and labored breathing. Physical examination revealed a patient in respiratory distress who is seen sitting upright and leaning forward. He was also noted to have stridor and drooling.
The attending physician of the above patient requested for a neck STL. What radiographic finding should you look for in this case?
A. steeple sign
B. Thumb sign
C. Silhouette sign
D. Sail sign
B
48
The attending physician of the above patient requested for a neck STL. What radiographic finding should you look for in this case?
A. steeple sign
B. Thumb sign
C. Silhouette sign
D. Sail sign
C
49
The “steeple sign” is most commonly associated with:
A. Rhinitis
B. Tonsillopharyngitis
C. Lanryngotracheobronchitis
D. Epiglotitis
C
50
The physical examination finding that is most sensitive and specific for pneumonia in children is:
A. Retractions
B. Tachypnea
C. Rales
D. Wheezing
B
51
The following is/are true regarding the PPD skin test EXCEPT:
A. It should be positive in patients with TB exposure.
B. It should be positive in patients with TB infection.
C. IT should be positive in patients with TB disease
D. It should be positive in patients after successful treatment of TB disease.
A
52
The diagnosis of TB disease in a pediatric patient can be ascertained for the following cases EXCEPT:
a. Fine needle aspiration biopsy of patient’s cervical lymph node positive for Langhan’s giant cells
b. Mother recently diagnosed to have sputum AFB (+) smear
c. Patient with positive gastric aspirate AFB smear
d. PPO positive result in an adolescent patient with apical cavitary lesion on chest xray
B
53
True regarding the transmission of tuberculosis in pediatric patients EXCEPT:
a. An adolescent or adult household member with untreated disease is the usual source of the child’s infection
b. The classmate of a pre-schooler diagnosed to have latent TB infection/”Primary complex” can be a source of infection
c. Amniotic fluid aspirated during delivery to a mother with TB endometritis can cause congetital TB
d. Ingestion of unpasteurized milk can lead to GI tuberculosis
B
54
Which of the following statements is true about TB in children?
a. Casual contacts are an important source of infection
b. Children under 5 years in exposure stage should be treated to prevent rapid development of disseminated or meningeal TB
c. Extrapulmonary tuberculosis occurs more often in adults than in children
d. Children harbor a significant bacillary lead in their endobronchial secretions
B
55
According to Wallgren’s timetable of tuberculosis:
a. Miliary or meningeal TB occurs as early as 2-6 weeks after infection
b. Interval between infection and chronic TB is shorter in adolescents compared to infants
c. Bone and joint involvement develops around 5 years after infection
d. Renal lesions can be expected 5-25 months after infection
B
56
What is the most common way for microorganisms to gain access to the lower respiratroy tract?
a. Inhalation of contaminated droplets
b. Contiguous extension from an infected pleural or mediastinal space
c. Aspiration from the oropharynx
d. Hematogenous spread
e. None of the above
C
57
Which of the following statements is TRUE regarding mechanical factors in host defense? EXCEPT:
a. Hairs and turbinates of the nares catch both large and small inhaled particles before they reach the lower respiratory tracts
b. Branching architecture of the tracheobronchial tree traps particles on the airway lining
c. Mucociliary clearance and local antibacterial factors kill the potential pathogen
d. Gag reflex provides critical protection from aspiration
e. Normal flora adhering to mucosal cells of the oropharynx prevents pathogenic bacteria from binding
A
58
Which of the following host inflammatory response triggers the clinical syndrome of pneumonia? EXCEPT:
a. Interleukin (IL) 1
b. Interleukin (IL) 6
c. Interleukin (IL) 8
d. tumor necrosis factor (TNF)
e. Granulocyte colony-stimulating factor
B
59
The following are the pathophysiologic events that follow after an inflammatory response, EXCEPT:
a. Bacterial pathogens interfere with the hypoxic vasoconstriction that can result in severe hypoxemia
b. Increased respiratory drive in the systemic inflammatory response syndrome (SIRS) leads to metabolic acidosis
c. Decreased compliance lead to dyspnea
d. Reductions in lung volume and compliance and the intrapulmonary shunting of blood may cause the patient’s death
B
60
What is the most common causes of lung abscess?
a. Esophageal dysmotility
b. Aspiration
c. Seizure disorder
d. Bulbar dysfunction
B
61
What is the duration of treatment of lung abscess?
a. 1-2 weeks
b. 2-4 weeks
c. 4-6 weeks
d. 8-12 weeks
e. None of the above
C
62
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
63
The following are differential diagnosis for exudative pleural effusion, EXCEPT:
a. Tuberculosis
b. Uremia
c. Pulmonary embolization
d. Urinothorax
e. Esophageal perforation
D
64
The following are the pathophysiologic events that follow after an inflammatory response, EXCEPT:
a. Bacterial pathogens interfere with the hypoxic vasoconstriction that can result in severe hypoxemia
b. Increases respiratory drive in the systemic inflammatory response syndrome (SIRS) leads to metabolic acidosis
c. Decreased compliance lead to dyspnea
d. Reductions in lung volume and compliance and the intrapulmonary shunting of blood may cause the patient’s death
B
65
Treatment for TB meningitis
a. 2HR/ 7-10 HRZE
b. 2HRZE/ 7-10 HR
c. 2HRZES/ 1HRZE/ 5HRE
d. 2HRZE/4HR
B
66
The criteria for the diagnosis of sputum negative PTB are the following except
a. Sputum culture negative for M. tuberculosis
b. At least two negative sputum smears (including at least one early specimen)
c. Lack of response to broad spectrum antimicrobial agents
d. CXR findings consistent with TB
A
67
A 52 year old male, vendor, cigarette-smoker, came to our OPD clinic with a chief complaint of productive cough of three weeks duration associated with night sweats and intermittent fever. Patient has no known co-morbidities, claimed to have no previous history of PTB treatment.
PE: (+) bilateral supraclavicular lymphadenopathies
C/L: SCE, rales on both apical lung fields
Labs: CXR- PA hyperaerated lung fields, apicolordotic view suggested
AFB 1, 2, 3: (+) 1/ (-)/ (+)
The above patient can be classified as
a. Smear negative pulmonary TB
b. Extrapulmonary TB
c. New, smear positive PTB
d. Possible MDR-TB
C
68
A 52 year old male, vendor, cigarette-smoker, came to our OPD clinic with a chief complaint of productive cough of three weeks duration associated with night sweats and intermittent fever. Patient has no known co-morbidities, claimed to have no previous history of PTB treatment.
PE: (+) bilateral supraclavicular lymphadenopathies
C/L: SCE, rales on both apical lung fields
Labs: CXR- PA hyperaerated lung fields, apicolordotic view suggested
AFB 1, 2, 3: (+) 1/ (-)/ (+)
The above patient would warrant what treatment regimen
a. 2HRZES/ 1HRZE/ 5HRE
b. 2HRZE/4HR
c. 4HRZE/2HR
d. 2HRZE/4HRE
B
69
A 52 year old male, vendor, cigarette-smoker, came to our OPD clinic with a chief complaint of productive cough of three weeks duration associated with night sweats and intermittent fever. Patient has no known co-morbidities, claimed to have no previous history of PTB treatment.
PE: (+) bilateral supraclavicular lymphadenopathies
C/L: SCE, rales on both apical lung fields
Labs: CXR- PA hyperaerated lung fields, apicolordotic view suggested
AFB 1, 2, 3: (+) 1/ (-)/ (+)
The best way to monitor the patient’s response would be to
a. Repeat CXR at the end of 6 months
b. Assess clinically at the end of 6 months
c. Request for sputum smear by the end of the 2nd and 4th month of treatment
d. Do FNAB of lymph node at the end of the treatment
C
70
Which of the following viruses is/are common cause of lower respiratory tract infection
a. Rhinovirus
b. Adenovirus
c. Influenza virus
d. Poliovirus
e. None of the above
E
71
The Rhinovirus is similar in most properties with other members of the family Picornaviridae. Which of the following characteristics is unique for the Picornaviridae?
a. inability to grow in alkaline conditions
b. survives in body temperature
c. low optimum temperature for growth
d. easily deactivated by drying
C
72
Which of the following describes the pathophysiology of the common cold?
a. The ICAM-1 is a major human receptor and facilitates the spread of the adenoviruses
b. Individuals who lack the immunity against the adenovirus can be infected by inhalation of as low as 5 virions in a droplet nuclei
c. The mutation of the hemagglutinin antigen on the surface of the Rhinovirus prevents the development of long-lasting protection
d. The Rhinovirus is an enveloped virus which is relatively stable in adverse environmental conditions
B
73
Which surface glycoprotein is primarily responsible for the occurrence of influenza epidemics?
a. Hemagglutinin
b. Neuraminidase
c. Matrix protein
d. Fusion protein
A
74
The changing pattern in the influenza virus is caused by its ability to mutate. The reassortment process is also known as
a. antigenic drift
b. antigenic shift
c. viral mutation
d. viral fusion
B
75
. A 2 month old infant was brought to the emergency room due to difficulty of breathing. History revealed that the patient developed cough and colds for two weeks and as given nasal decongestants. On the day of consult the infant had increased respiratory rate associated with intercostal retractions. Physical examination revealed wheezing in bilateral lung fields.Which of the following respiratory viruses is most probably involved?
a. Rhinovirus
b. Adenovirus
c. Influenza virus
d. Respiratory syncytial virus
D
76
The development of a fungus ball or aspergilloma is associated with certain predisposing condition. Which of the following is most likely to develop this health problem?
a. A 60 year old diabetic previously treated for PTB
b. A 20 year old smoker
c. A 10 year old undergoing cardiac catheterization
d. A 30 year old athlete with known bronchial asthma
A
77
Histoplasmosis can mimic pulmonary tuberculosis. Which of the following is similar to both infections?
a. In the susceptible host, the microorganism deactivated inside the alveoli
b. They can survive within macrophages
c. Pulmonary infection can lead to acute respiratory distress syndrome
d. They can be treated with rifampicin, azithromycin and pyrazinamide
B
78
Gram positive cocci are commonly associated with respiratory infections. The finding of a gram positive cocci in clusters and catalase test positive is suggestive of
a. Staphylococcus aureus
b. Streptococcus pneumoniae
c. Klebsiella pneumoniae
d. Aspergillus fumigatum
A
79
Which of the following statements is CORRECT for RSV
a. The fusion (f) protein is responsible for cell surface attachment
b. RSV in adults is manifested as lower repiratory tract infection such as pneumonia
c. Antibody detection tests are needed to confirm diagnosis
d. RSV in children as manifested as Acute Bronchiolitis
D
80
In the laboratory, the microscopic examination of a cultured Aspergillus spp will show
a. Non-septated hyphae
b. Tuberculate macroconidia
c. Fruiting body appearance
d. Filamentous growth with microconidia
C
81
Fungi are widespread in the environment. The inhalation of the conidia of some of these fungi may cause respiratory infections. If the microscopic appearance reveals dichotomous branching hyphae, what is the most probable etiologic agent?
a. Pneumocytis carini
b. Candida albicans
c. Aspergillus spp.
d. Cryptococcus neoformans
C
82
Histoplasmosis, the microscopic examination of its culture will reveal:
a. Tuberculate macronidia
b. Mariner’s wheel
c. Broad based bud
d. Acid fast bacilli
A
83
In the community setting, widely used method to identify Mycobacterium tuberculosis in sputum examination is
a. Auramine Rhodamine stain
b. Gram staining
c. Modified Kinyoun method
d. Ziehl Neelsen Stain
C
84
A 60 year old female, smoker was admitted for high grade fever, pleuritic chest pain, and productive cough of rusty sputum for 1 week. Sputum examination showed numerous PMN’s with extracellular Gram positive cocci in pairs. The most probable infection is caused by:
a. Streptococcus pneumoniae
b. Klebsiella pneumoniae
c. Staphylococcus aureus
d. Bordatella pertussis
A
85
Which of the following has/have been identified as risk factors for lung cancer?
a. Advanced age
b. Cigarette smoking
c. Asbestos exposure
d. All of the above
D
86
Which of the following is true regarding the epidemiology of lung cancer?
a. Primary lung cancer affects more men than women each year
b. Lung cancer is the second leading cause of cancer death in both sexes worldwide
c. Smoking cessation efforts have failed to lower lung cancer-related mortality in males.
d. The death rate for lung cancer has nearly doubled over the past 30 years
A
87
Which of the following lung cancers is usually peripherally located?
a. Small cell carcinoma
b. Squamous cell cacinoma
c. Adenocarcinoma
d. Large cell carcinoma
C
88
Which histology is characterized with the greatest propensity to metastasize?
a. Small cell carcinoma
b. Squamous cell carcinoma
c. Adenocarcinoma
d. bronchoalveolar carcinoma
A
89
Which of the following signs or symptoms DO NOT point to a metastatic disease?
a. Bone pains
b. Right hemiplegia
c. Jaundice
D. Hemoptysis
D
90
Which of the following paraneoplastic syndromes is most commonly associated with lung cancer?
a. Dermatomyositis
b. Hypercalcemia
c. Jaundice
D. Nephrotic Syndrome
B
91
Hoarseness in lung cancer patients is usually caused by:
a. Pulmonary hypertension
b. Laryngeal edema associated with pursed breathing
c. Compression of the recurrent laryngel nerve
d. Obstructive pneumonia
C
92
Disease staging can be used in all of the following EXCEPT:
a. Determining the extent of the disease
b. Determining prognosis
c. Selecting treatment options
d. Predicting response to treatment
D
93
Which of the following is a case of stage IV disease?
A. 60-year old female with a 5 x 5 cm right lower lung mass with no lymph nodes or distant metastases
B. 39-year old woman with a 1 x 1 cm nodule in the left upper lung lobe with no lymph nodes but with a small nodule in the left adrenal gland
C. 58-year old male with a 2 x 2 cm mass in the left upper lobe and a single subcarinal lymph node with no other lesions
D. 45-year old man with a 1 x 1 cm mass in the right upper lobe and several right peribronchial nodes
B
94
A patient with histologic evidence of lung cancer R middle lobe, obtained via CT aspiration biopsy, was initially deemed to have resectable disease. He prepared for the operation, but on follow-up a month later, he presented with pleural effusion and new mediastinal nodes on the R. A pleural fluid cytology in this case is:
A. not needed; planned surgery should proceed
B. not needed; the patient should be treated as advanced disease
C. needed; this may be a predictor of response to chemotherapy
D. needed; cytology is needed to determine if effusion is malignant or not
D
95
A 24-year old male consults for productive cough of yellowish phlegm and fever of 5 days duration. What is the recommended initial diagnostic examination?
A. Chest X-ray
B. CT scan of the chest
C. MRI of the chest
D. Ultrasound of the chest
A
96
A 64-year old male is suspected to have a lung mass. Past history reveals that the patient has a 40 pack year smoking history. He underwent surgery of a cerebral aneurysm using a metal clip 2 years ago. Which diagnostic test should he NOT undergo to evaluate the mass?
A.MRI of the chest
B. Chest X-ray
C. CT scan of the chest
D. Ultrasound of the chest
A
97
Pleural fluid analysis shows the following: LDH 300 IU/L, Total protein 40 g/dL. Glucose 216 mg/dL. Serum analysis shows: LDH 400 IU/L, Total protein 50 g/dL, glucose 300 mg/dL. The pleural fluid is best described as a/an:
A. Transudate
B. Malignant
C. Exudate
D. Indeterminate
C
98
Uncontrolled diabetes may result into a false negative test with:
A. Ultrasound
B. MRI
C. CT scan
D. Pet scan
D
99
An adequate sputum for culture sensitivity and gram stain is:
A. Polymorphonuclear cells 10/hpf
C. Polymorphonuclear cells >25/hpf, Squamous epithelial cells 25/hpf, Squamous epithelial cells >10/hpf
C
100
Aspiration fluid from the pleural space using a syringe is called:
A. Bronchoscopy
B. Thoracocentesis
C. VATS
D. Mediastinoscopy
B
101
The diagnostic procedure allows direct visualization of the airways:
A. Thoracotomy
B. Mediastinoscopy
C. VATS
D. Bronchoscopy
D
102
The following are indications of Pulmonary Function Tests EXCEPT:
A. Scheduled for clipping of the cerebral aneurysm
B. Chronic Obstructive lung disease
C. Bronchial Asthma
D. Interstitial Lung Disease
A
103
Which of the following is/are monitored during polysomnography:
A. Heart Rate
B. Respiratory rate
C. Blood Pressure
D. Temperature
B
104
The following measures the gas exchange functions:
A. Pulmonary Function Test
B. Sputum gram stain
C. Arterial Blood Gas
D. Chest X-ray
C
105
CASE: MP, 43/male, taxi driver, smoker, sought consult due to on and off cough
History of present illness revealed cough of one month duration associated with yellowish phlegm and occasional low grade fever which was undocumented. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, there was persistence of cough and was now associated with episodes of dyspnea. Patient self-medicated with terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
```
PE:
BP: 140/09 RR: 24 HR: 88
note of 1 x 1 cm movable node at (R) supraclavicular area; use of neck accessory muscles
Lungs: decreased BS over (R) base
Heart: regular rhythm, no murmur
Soft abdomen, NASS
Full pulses
```
Given the above history and PE finding, one might consider the following pulmonary diseases as main impression EXCEPT:
```
A. Pneumonia
B. Tuberculosis
C. Malignancy
D. COPD
E. None of the above
```
E
106
CASE: MP, 43/male, taxi driver, smoker, sought consult due to on and off cough
History of present illness revealed cough of one month duration associated with yellowish phlegm and occasional low grade fever which was undocumented. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, there was persistence of cough and was now associated with episodes of dyspnea. Patient self-medicated with terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
```
PE:
BP: 140/09 RR: 24 HR: 88
note of 1 x 1 cm movable node at (R) supraclavicular area; use of neck accessory muscles
Lungs: decreased BS over (R) base
Heart: regular rhythm, no murmur
Soft abdomen, NASS
Full pulses
```
On further physical examination, there was note of dullness on percussion over the (R) base and no adventitious sound noted. One may consider the following entities EXCEPT:
A. pneumothorax
B. pleural effusion
C. pneumonia
D. empyema
A
107
CASE: MP, 43/male, taxi driver, smoker, sought consult due to on and off cough
History of present illness revealed cough of one month duration associated with yellowish phlegm and occasional low grade fever which was undocumented. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, there was persistence of cough and was now associated with episodes of dyspnea. Patient self-medicated with terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
```
PE:
BP: 140/09 RR: 24 HR: 88
note of 1 x 1 cm movable node at (R) supraclavicular area; use of neck accessory muscles
Lungs: decreased BS over (R) base
Heart: regular rhythm, no murmur
Soft abdomen, NASS
Full pulses
```
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
D
108
CASE: MP, 43/male, taxi driver, smoker, sought consult due to on and off cough
History of present illness revealed cough of one month duration associated with yellowish phlegm and occasional low grade fever which was undocumented. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, there was persistence of cough and was now associated with episodes of dyspnea. Patient self-medicated with terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
```
PE:
BP: 140/09 RR: 24 HR: 88
note of 1 x 1 cm movable node at (R) supraclavicular area; use of neck accessory muscles
Lungs: decreased BS over (R) base
Heart: regular rhythm, no murmur
Soft abdomen, NASS
Full pulses
```
The following data may be important distinguishing respirator disease more over a primary cardiac problem:
A. He feels better after a nitroglycerine patch was placed over his chest.
B. He sits up a few minutes after lying supine to relieve the dyspnea
C. Strong history of smoking around 20 pack years.
D. He has exertional dyspnea.
A
109
CASE: MP, 43/male, taxi driver, smoker, sought consult due to on and off cough
History of present illness revealed cough of one month duration associated with yellowish phlegm and occasional low grade fever which was undocumented. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, there was persistence of cough and was now associated with episodes of dyspnea. Patient self-medicated with terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
```
PE:
BP: 140/09 RR: 24 HR: 88
note of 1 x 1 cm movable node at (R) supraclavicular area; use of neck accessory muscles
Lungs: decreased BS over (R) base
Heart: regular rhythm, no murmur
Soft abdomen, NASS
Full pulses
```
A chest radiograph showed a dense opacification on 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
110
If there is atelactasis of the right middle lobe, the chest radiograph would show
A. decrease in the intercostals spaces in the left
B. depression of the minor fissure
C. ipsilateral shift of the trachea
D. displacement of the mediastinal structures to the left
B
111
Infiltrates radiating from the hila which are bilateral and symmetric are common radiologic findings in:
A. viral pneumonia
B. asthma
C. bronchiectasis
D. emphysema
A
112
Bronchiectasis can be seen in CT scan as:
A. bronchial opacities
B. saccular dilatation of the bronchioles
C. thin-walled lucencies
D. interstitial thickening
B
113
Multiple cannon ball nodules in the lungs may be the radiologic manifestation of:
A. pulmonary tuberculosis
B. bronchiectasis
C. secondary malignancy
D. consolidation
B
114
Presence of diffuse tiny nodules in the lungs which are bilateral and symmetric suggests the diagnosis of:
A. miliary tuberculosis
B. secondary pulmonary malignancy
C. tuberculous endobronchial spread
D. viral pneumonia
A
115
The diagnostic tool of choice for pulmonary tuberculosis
A. sputum culture for M. tuberculosis
B. chest radiograph
C. direct sputum microscopy
D. a well-done history and PE
C
116
Patients with PTB would usually present with the following except:
```
A. cough of more than weeks
B. weight loss
C. fever
D. all of the above
E. none of the above
```
E
117
Which of the following fungal infection of the lungs that is characterized by growth of the fungal mycelia within the preexisting lung cavities?
```
A. Histoplamosis
B. Aspergillosis
C. Cryptococcus
D. Mycomycosis
E. Candidiasis
```
B
118
Which of the following statements is/are TRUE regarding pneumonia?
A. Lungs of patients with bronchopneumonia show patchy consolidation as opposed to that with lobar pneumonia which reveals consolidation of large portions of the lung
B. In terms of appearance/distribution of consolidation, there is no difference between bronchopneumonia vs lobar pneumonia
C. The arrows in the illustration points to patchy consolidation characteristic of bronchopneumonia
D. Either A or C is true
A, D
119
Which of the following is/are considered complications of pneumonia
A. cavity formation
B. empyema
C. lung abscess
D. B and C only
D
