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[OS 213] Respiratory E2 > Samplex 2015 Set B > Flashcards

Samplex 2015 Set B Flashcards

1
Q

Components of pulmonary lobule

A. Bronchioles, terminal bronchioles, acinus
B. Respiratory bronchiles, alveolar ducts, alveolar sacs
C. 3 to 5 terminal bronchioles, respective acinus
D. Bronchus, lung lobe, bronchioles

A

C

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2
Q

Oligohydramnios may cause pulmonary HTN by

A. Compression of lung tissue
B. Impede lung expansion
C. Predisposed to diaphragmatic hernia
D. Being associated with cardiac and renal anomalies

A

B

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3
Q

True of congenital lobar emphysema

A. Primarily affects the lower lobes
B. Bronchi at the involved site may be devoid of cartilage
C. Results from abnormal detachment of the primitive foregut
D. Hamartamous proliferation of cysts

A

B

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4
Q

Common source of pulmonary emboli

A. Superficial by vein thrombosis
B. Deep vein thrombosis
C. Right atrium
D. left atrium

A

B

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5
Q

True of septic infarcts

A. Common in large emboli
B. results in respiratory compromise but not hemodynamic compromise
C. With accompanying neutrophilic inflammatory reaction
D. White Infarcts

A

C

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6
Q

OSA predisposes to pulmonary HTN by this mechanism:

A. Recurrent thromboemboli
B. Chronic hypoxemia- induced changes
C. Destruction of lung parenchyma
D. Idiopathic mechanisms

A

B

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7
Q

Which of the ff diffuse pulmonary hemorrhage syndromes involves both kidneys and lungs?

A. Wegener Granulomatosis
B. Idiopathic Pulmonary Fibrosis
C. Familial Pulmonary ARterial Hypertension
D. Goodpasture Syndrome

A

D

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8
Q

Which of the following thymic lesions preserve the thymic architecture?

a. Thymic dysplasia
b. True thymic hyperplasia
c. Thymic follicular hyperplasia
d. Thymoma

A

B

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9
Q

True of invasive thymomas

A. Mixed with sparse lymphocytes
B. Always exhibit cytologic atypia
C. composed mostly of cortical epithelial cells
D. Most common histologuc subtype in SCC

A

C

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10
Q

Which of the ff neuroendocrine tumors has the best prognosis?

A. Carcinoid Tumor
B. Undifferentiated Carcinoma
C. Small cell neuroendocrine carcinoma
D. large cell neuroendocrine carcinoma

A

A

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11
Q

Which of the ff is the most common primary tumor of metastatic tumors to the mediastinum?

A. invasive ductal carcinoma

b. malignant melanoma
c. undifferentiated carcinoma of the nasopharynx
d. small cell undifferentiated carcinoma of the lung

A

D

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12
Q

Obstruction and infection are predisposing factors for the development of which of the following:

a) chronic bronchitis
b) emphysema
c) ADRS
d) Bronchiectasis
e) NOTA

A

D

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13
Q

Hallmark of ARDS

A. hyaline membrane and cappilaritis
B. Organizing fibromyxoid tissue
C. Atelectasis
D. Interstitial fibrosis

A

A

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14
Q

The basic pathology of ARDS

a. diffuse alveolitis with shunting
b. endothelial damage
c. epithelial damage
d. AOTA

A

D

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15
Q

Acute mediastinitis commonly affects this compartment of the mediastinum:

a. Anterior mediastinum
b. Posterior mediastinum
c. Superior mediastinum
d. Middle mediastinum

A

B

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16
Q

True of smoking as a significant RF for the devt of lung cancer:

A. Use of filters reduce tar within inhaled smoke resulting in less deposition of carcinogens deeper in the lungs
B. Lung cancer risk depends more on duration rather than intensity
C. Passive smokers inhale tobacco carcinogens at levels equal to that of active smokers
D. Risk in former smokers approaches the risk of non smokers after 5 years of smoking cessation

A

B

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17
Q

Best modality of choice to obtain a tissue biopsy for diagnosis of a peripherally located lung mass

A. sputum cytology
B. bronchoscopy guided endobronchial biopsy
C. CT guided aspiration biopsy
D Video assisted biopsy

A

C

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18
Q

Recommended treatment for stage 2 Non small cell CA?

a. Surgery
b. Radiotherapy
c. Concurrent chemo radio therapy
d. Chemotherapy

A

A

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19
Q

Type of lung cancer most often occurs in nonsmokers or former smokers and typically presents as peripheral lesions within a high propensity to metastasize

A. Adenocarcinoma
B. Lung Cell CA
C. Small Cell CA
D. Squamous cell CA

A

A

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20
Q

Limited stage small cell lung CA is characterized by:

A, Unilateral pleural effusion
B. Disease extent safely encompassed within a tolerable radiation field
C. Metastasis to a solitary distant site
D. Contralateral supraclavicular lymphadenopathy

A

B

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21
Q

Lung cancer staging is used for the ff purposes, EXCEPT:

A. defining extent of disease
B. determination of prognosis
C. predicting prognosis
D. selecting treatment options
D. Prediction of response to chemotherapy
A

D

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22
Q

A 60 year old smoker with cough of 4 mos history, associated with hemoptysis, lower back pain and progressive dyspnea. On PE, there in decreased breath sounds on the left lung and wheezing.

If the px initially came to you, what imaging modality would you first request?

A. Chest X-ray
B. CT Scan
C. MRI
D. NOTA

A

A

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23
Q

A 60 year old smoker with cough of 4 mos history, associated with hemoptysis, lower back pain and progressive dyspnea. On PE, there in decreased breath sounds on the left lung and wheezing.

Bronchoscopy guided CT revealed squamous cell CA. Work up revealed: Chest xray showed right hilar homogenous opacity, chest CT had findings of a right hilar mass 6x4x5 cm with moderate right pleural effusion, Bone scan with multiple bone metastasis

Staging by TNM would indicate that px has what stage of disease:

A. I.
B. II
C. III
D. IV

A

D

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24
Q

A 60 year old smoker with cough of 4 mos history, associated with hemoptysis, lower back pain and progressive dyspnea. On PE, there in decreased breath sounds on the left lung and wheezing.

What is the best treatment for the patient would be

A. Surgery
B. radiotherapy alone
C. Concurrent chemo/radiotherapy
D. systemic chemotherapy

A

C

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25
Q

A 60 year old smoker with cough of 4 mos history, associated with hemoptysis, lower back pain and progressive dyspnea. On PE, there in decreased breath sounds on the left lung and wheezing.

Role of chemotherapy for this patient:

A. Neo-adjuvant
B. adjuvant
C. Palliative
D. Curative

A

C

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26
Q

The high molecular-weight compounds are considered important agents that can induce occupation related asthma, EXCEPT:

a. metal salts
b. wood and vegetable dusts
c. pharmaceutical agents
d. enzymes

A

A

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27
Q

FALSE about streptomycin

a) inhibits protein synthesis
b) active against intracellular bacteria
c) must be given parenterally
d) given as prophylaxis against endocarditis

A

B

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28
Q

Apart from H. influenzae, what other predominant organism can be found in sputum of a patient with bronchiectasis?

A. S. pneumoniae
B. P. aeruginosa
C. M. tuberculosis
D. S. aureus

A

B

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29
Q

Which is TRUE about isoniazid?

a. inhibits RNA polymerase
b. treatment once a week is ok
c. bactericidal against actively growing mycobacterium
d. ototoxic

A

C

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30
Q

FALSE about Pyrazinamide?

a. bactericidal against active TB
b. given in maintenance
c. adverse effect is hepatotoxicity
d. inhibits mycolic acid

A

B

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31
Q

During the early 1900’s, the recommended treatment for patients with TB is

A. Bed Rest
B. Fresh air
C. Sunlight
D. AOTA

A

A

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32
Q

First anti-TB drug discovered in 1943 by Selmann Waksman

A. Isoniazid
B. Rifampicin
C. Streptomycin
D. Ethambutol

A

C

33
Q

Which synthetic anti-tb drug was synthesized in 1936, but was tested for TB treatment only in the 1980’s?

A. Ethambutol
B. Pyrazinamide
C. Thiacetazone
D. Ofloxacin

A

B

34
Q

Which of the following statement/s is/are true regarding the treatment of PTB?

A. treatment depends on the prevailing resistance patterns of the country
B. treatment depends on location of the disease
C. monotherapy is encourageed in the treatment of PTB
D. the maintenance phase lasts for 6 months regardless of the location and severity of TB infection

A

A

35
Q

In acute hypoxemic respiratory failure, the alveolar-arterial oxygen gradient is

A. the A-a gradient cannot be determined
B. less than 20
C. greater than 20
D. None of the above

A

C

36
Q

In acute hypercapnic respiratory failure as in narcotic overdose, the Alveolar-arterial gradient is:

A. Greater than 20
B. Less than 20
C. the A-a gradient cannot be determined
D. none of the above

A

B

37
Q

Snoring is the most common observed event in:

A. Central sleep apnea
B. Cheyne-Stokes respiratopm
C. Obesity hypoventilation syndrome
D. Obstructive Sleep Apnea

A

D

38
Q

In patients with ARDS, the PO2/FiO2 ratio is:

A. Greater than 500
B. Less than 200
C. Greater than 200 but less than 500
D. It cannot be calculated

A

B

39
Q

A 20-year old male fell from his bike and hit his neck on the pavement. he was brought to the ER awake but has shallow respiration. His ABG showed a PCO2 of 80 and a PO2 of 45. The increase in the PCO2 is due to:

A. A dec in tidal volume due to a possible spinal injury
B. an inc in dead space ventilation due to a rib fracture
C. a dec in minute ventilation due to dec signals from the central medullary centers
D. an inc in tidal volume due to hyperventilation secondary to his anxious state

A

A

40
Q

In patients with OSA, a respiratory event is considered abnormal if it last for

a. at least 30 s
b. at least 20 s
c. at least 10 s
d. at least 5 s

A

C

41
Q

One can deliver 100% FiO2 to a patient on:

A. Venturi Mask
B. Partial Rebreathing Mask
C. Nonbreathing Mask with bag reservoir
D. Mechanical ventilator

A

D

42
Q

Of the following non-invasive O2 delivery system, which device can the clinician titrate the FiO2 more accurately compared to the other devices?

a. partial rebreathing mask
b. Venturi mask
c. nonbreathing mask with bag reservoir
d. nasal cannula

A

B

43
Q

The only intervention which has significantly improved outcomes in ARDS (aside from treating the underlying cause) is to:

A. Give IV steroids within the first 48 hours
B. Ventilate with low tidal volumes to avoid overstretching the lungs
C. Hydrate with high amounts of fluid to keep the patient on the “wet” side
D. Give Anti-Tumor Necrosis Factor to dampen the inflammatory response

A

B

44
Q

Cornerstone for therapy in patients with OSA

A. Surgery
B. CPAP
C. use of progesterone and theophylline as respiratory stimulants
D. use of oral-dental appliances such as mandibular advancement devices

A

B

45
Q

Pulmonary edema that is cardiogenic in cause can be differentiated from noncardiogenic edema by the presence of

A. PaO2/FiO2 18cm H2O

A

D

46
Q

In acute respiratory distress syndrome, the initial and basic lesion is:

a. increased capillary permeability
b. diffuse damage to the alveolar wall
c. interstitial and intraalveolar edema
d. formation of hyaline membranes

A

B

47
Q

Polysomnography is indicated for subjects suspected to have:

a. Asthma
b. Obstructive sleep apnea
c. Parasomnia
d. Cataplexy
A

B

48
Q

Pulmonary vasculitis should be considered in the presence of:

a. Alveolar hemorrhages
b. Multiple lung nodules
c. Mononeuritis complex
d. All of the above

A

D

49
Q

The most common pulmonary manifestation of microscopic polyangitis (MPA) is:

a. Pulmonary nodules
b. Asthma
c. Alveolar hemorrhage
d. Thromboembolic disease

A

C

50
Q

Churg-Strauss Vasculitis is most commonly associated with:

a. Sinus ulcerations
b. Pulmonary cavities
c. COPD
d. Asthma

A

D

51
Q

Thromboembolic disease is most commonly found in:

a. Wegener granulomatosis
b. Microscopic polyangitis
c. Churg Strauss vasculitis
d. Pulmonary embolism

A

D

52
Q

The gold standard in the diagnosis of pulmonary vasculitis is

A. HRCT scan of the chest
B. Pulmonary angiography
C. Surgical lung biopsy
D. ANCA testing for antiproteinase-3 (PR3)

A

C

53
Q

Cor Pulmonale usually show an enlarged main pulmonary artery segment on chest Xray of:

a. >10mm
b. >12mm
c. >14mm
d. >16mm

A

D

54
Q

The most common cause of Cor pulmonale in more than 80% of cases is:

a. Chronic interstitial lung disease
b. COPD
c. Sleep disordered breathing
d. Chronic exposure to high altitude

A

B

55
Q

The best predictor of survival in Cor pulmonale is:

a. FEV1
b. paO2
c. paCO2
d. pulmonary artery pressure

A

D

56
Q

Cardiovascular findings in Cor pulmonale include the following EXCEPT:

a. P pulmonale on ECG
b. RVH on ECG
c. Poor RV contractility with low EF
d. None of the above

A

D

57
Q

The presence of asbestos bodies in respiratory secretions:

a. Indicates previous asbestos exposure
b. Is an early marker for asbestosis
c. Is associated with an increased risk of lung cancer
d. Is assoc with the development of mesothelioma, specially in the presence of pleural plaques
e. May only be an incidental finding and is of no clinical relevance.

A

A

58
Q

The ff inorganic dusts are known to cause occupation exposure related to ILD’s EXCEPT

a. Coal dust (coal worker’s pneumoconiosis)
b. Beryllium (beryllosis)
c. Thermophilic actinomycetes (farmer’s lung)
d. Iron (arc welder’s lung)
e. None of the above

A

C

59
Q

The most sensitive test to demonstrate the pathophysiologic effect of ILD on gas exchange is:

a. Pulmo function testing
b. Resting DLCO
c. High resolution CT scan
d. Exercise oximetry
e. ABG’s

A

B

60
Q

What is the pulmonary manifestation of SLE?

a. Pulmonary fibrosis
b. Diffuse alveolar hemorrhage
c. Pleural disease
d. Pulmonary hypertension
e. Shrinking lung syndrome
A

C

61
Q

On the average, which of the following idiopathic interstitial has the worst prognosis

a. usual interstitial pneumonia
b. Bronchiolitis obliterans organizing pneumonia (BOOP)
c. Acute Interstitial Pneumonia
d. Non-specific interstitial pneumonia
A

C

62
Q

Which of the folliwing feature/s indicate a more favorable prognosis in IPF?

a. Younger onset
b. Familial type, among females
c. Presenceof diffuse fibroblastic foci
d. Presence of honeycombing
e. None of the above
A

B

63
Q

The following idiopathic ILD’s are responsive to steroid EXCEPT

a. BOOP
b. Acute interstitial pneumonia
c. Deaquamative interstitial pneumonia
d. Non-specific interstitial pneumonia
A

B

64
Q

The most common clinical manifestation of interstitial lung disease is

a. cough
b. Dyspnea
c. Chest tightness
d. Wheezes
e. Hemoptysis
A

B

65
Q

The gold standard in the diagnosis of Idiopathic Pulmonary Fibrosis is:

a. Open lung biopsy
b. Chest CT scan
c. Bronchoalveolar lavage
d. Spirometry
e. Pulmonary angiography
A

A

66
Q

In Interstitial Fibrosis, the cell that is activated by an antigen or immune complex and starts the cascade of events leading to fibrosis is:

a. T lymphocyte
b. Neutrophil
c. Alveolar macrophage
d. Mast cell
e. Eiosinophil
A

C

67
Q

Which of the following statements regarding IPF is correct?

a. A restrictive pattern on lung function distinguishes it from other IIPs
b. Bibasilar inspiratory crackles on auscultation are uncommon
c. The insidious onset of symptoms differentiates it from other types of IIPs
d. The 5-year mortality rate is 80%
A

D

68
Q

The parameters(s) tat is is/are useful in monitoring response to therapy is/are:

a. Chest x-rays
b. forced vital capacity
c. HRCT scan
d. Oxygen saturation
A

B

69
Q

Which environmental/occupational lung disease increases the risk for acquiring both Mycobacterium tuberculosis and atypical mycobacterium infections?

a. Asbestosis
b. Coal worker's pneumonia
c. Silicosis
d. Capilan's Syndrome
e. Berylliosis
A

C

70
Q

Which of the folowing occupational lung diseases is associated with lung cancer?

a. Silicosis
b. Asbestosis
c. Berylliosis
d. Coal workker's penumoconiosis
e. Byssinosis
A

B

71
Q

TRUE of interstitial lung diseases:

a. This is a homogenous group of disorders with similar clinical, roentgenographic, physiologic and pahtologic manifestations
b. The two major histopathologicpatters are a granulomatous pattern, an a pattern in which necrosis an atrophy predominate
c. The development of interstitial fibrosis in some ILD's is often progressive and leads to significant derangement of ventilatory function and gas exchange.
d. The radiographic finding of a bibasilar reticular pattern correlates with the pathologic finding of small cystic spaces and progressie fibrosis, and portends a poor prognosis
e. Most forms of ILC produce an obstructive defect on pulmonary function testing.
A

C

72
Q

This condition results from exposure to moldy hay containing spores of thermophilic actinomycetes that produce a hypersensitivity pneumonities

a. Coal worker's pneumoconiosis
b. Byssinosis
c. Farmer's lung
d. Berryliosis
e. Caplan's Syndrome
A

C

73
Q

Which of the following is/are try regarding parapneumonic effusions:

a. If free fluid separates the lung from the chest wall by more that 5 mm on the decubitus radiograph, a therapeutic thoracentesis should be performed
b. Pleural fluid pH more than 7.5 indicate the likely need for chest tube insertion
c. Empyema refers to a grossly bloody effusion
d. Presence of free pleural fluid can be demostrated with a lateral decubitus radiograph
e. none of the above
A

D

74
Q

A 40 year-old female with pneumonia underwent thoracentesis. Pleural fluidanalysis revealed
pleural fluid protein/serum protein = 0.7, pleural fluid LDH/serum LDH = 0.3,
pleural fluid pH below 7.8,
gram positive organisms on gram stain.

Which of the following is/are true?

a. The patient should undergo closed tube thoracostomy
b. The pleural fluid is a transudate
c. Empyema refers to a grossly bloody effusion
d. The patient should undergo CT-scan to rule out pulmonary embolism
e. all of the above
A

A

75
Q

Which of the following is true regarding pleural effusion?

a. Best treatment for pleural effusion secondary to heart failure is CTT insertion
b. Exudates have pleural fluid protein/serum ratio > 0.5
c. transudates are secondary to local factors such as malignancy or infection
d. mostcommon cause of exudative pleural effusion is renal failure
A

B

76
Q

In patients with a congestive heart failure and pleural effusion, diagnostic thoracentesis should be done in the presence of he following except:

a. Bilateral effusion
b. Febrile
c. Pleuritic chest pain
d. Non-resolution despite diuretic therapy
A

A

77
Q

Which of the following is/are clinical manifestation/s of tension pneumothorax?

a. enlarged pneumothorax
b. absent breath sounds
c. mediastinal shift to contralateral side
d. all of the above
A

D

78
Q

True regarding pleural effusions:

a. Pleural fluid is removed via the lymphatics situated in the parietal pleura
b. in transudative pleural effusions local factors that influence the formation and absorption of pleural fluid are altered
c. Left ventricular failure, pulmonary embolism, and cirrhosis are causes of exudative pleural effusion
d. all of the above
e. none of the above
A

A

79
Q

The diagnosis of TB pleuritis is established by:

a. Lymphocytic predominant effusion
b. culture of the pleural fluid
c. high pleural fluid glucose
d. typical CT scan findings
e. none of the above
A

B

[OS 213] Respiratory E2 (4 decks)

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