Samplex 2017 Flashcards
In patients with emphysema, the equal point pressure moves upstream in the airways because the lung elastic recoil:
a. Increases b. Decreases c. Stays the same d. Is erratic
B
In adult respiratory distress syndrome (ARDS), the severe lung injury depletes lung surfactant so that:
a. Lung hysteresis is widened
b. Lung compliance increases
c. The closing volume of the lung increases
d. Type 2 alveolar cells predominate over Type 1 alveolar cells
C
The lung compliance in patients with pulmonary fibrosis is:
a. Increased b. Decreased c. Unchanged d. Not evaluable
B
In patients with hypopnea due to massive cerebral strokes, the blood gasses will show:
a. Increased PaCO2 b. Increased PaO2 c. Widened alveolar arteriolar O2 gradient d. Increased bicarbonate
B
The most common gas exchange abnormality encountered is:
a. Obstructive ventilation problem b. Restrictive ventilation problem c. Lung perfusion abnormality d. Lung diffusion abnormality e. Ventilation perfusion mismatch
E
In patients with pulmonary embolism, hypoxemia happens due to:
a. Shunting that results from lack of perfusion and continued ventilation
b. Alveolar dead space ventilation from lack of perfusion and continued ventilation
c. Hemodynamic collapse from lack of perfusion
d. Airway obstruction from the vascular obstruction
B
A COPD patient who came in to the ER with dyspnea with an initial oxygen saturation of 85% was inadvertently given high flow oxygen 6 L/minute. The patient suddenly became very drowsy despite oxygen saturation improving to 94%. Respiratory rate, initially 26/ minute became 10/minute.
The sudden hypoventilation after excessive oxygen administration was due to:
a. Loss of the respiratory drive stimulation from the peripheral chemoreceptors that was previously stimulated by the hypoxia
b. Loss of the respiratory drive stimulation from the central chemoreceptors that was previously stimulated by the hypoxia
c. Sudden increased airway resistance from the high-flow oxygen administration
d. Sudden increase in lung hyperinflation from the high flow oxygen administration
A
Carbon monoxide poisoning would:
a. Decrease dissolve O2 b. Decrease Oxygen-Hemoglobin saturation c. Decrease PaCO2 d. Increase pH
B
Pursed lip breathing helps COPD patients by creating an external resistance against breathing so that the dissipation of the driving alveolar pressure is not as rapid. This has the effect of:
a. Decreasing end expiratory volume b. Increasing end expiratory volume c. Increasing elastic recoil pressure in the lungs d. Decreasing elastic recoil pressure in the lungs
A
An effective mucolytic agent would be able to:
a. Decrease chloride transport to the airway lumen b. Decrease the sol and increase the gel layer of the mucus c. Break the disulfide bond of the mucoprotein strands d. Increase parasympathetic stimulation to decrease mucus production
C
Among patients with pulmonary complaints, which of the following is considered a subjective parameter?
a. Clubbing b. Use of accessory respiratory muscles c. Dyspnea d. Cyanosis e. Tachypnea
C
Which of the following signs DOES NOT collaborate with dyspnea?
a. alar flaring b. supraclavicular retractions c. stammering speech d. subcostal retractions e. intercostal retractions
C
Which of the following refers difficulty of breathing occurring during supine position?
a. Bradypnea
b. Orthopnea
c. Platypnea
d. Tropopnea
e. Pleurisy
B
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 inhibitory muscles:
a. Sensory cortex
b. medulla
c. pons
d. cerebellum
e. anterior horn cells of the spinal cord
A
Which of the following describes a respiratory pattern characterized as regularly irregular with progressive increase in depth and sometimes frequency in a crescendo-decrescendo manner that ends in apnea?
a. apneustic breathing b. biots respiration c. cheyne-stokes respiration d. kussmaul respiration e. agonal respiration
C
Which of the following respiratory patterns can be a finding among patients with severe sepsis?
a. ataxic breathing b. biots respiration c. cheyne-stokes respiration d. kussmaul respiration e. apneustic respiration
D
Which of the following breathing patterns is expected in lung fibrosis?
a. rapid, shallow breathing b. rapid, deep breathing c. slow, shallow breathing d. slow, deep breathing
A
Which of the following is NOT considered a first line diagnostic modality in investigating dyspnea in the primary care setting?
a. CBC b. Spirometry c. chest radiography D. ECG e. Lung biopsy
B, D
Which of the following is NOT a cause of dyspnea?
a. obstruction to airflow
b. resistance to expansion of the lungs
c. respiratory muscles are placed at a subcostal disadvantage
d. wasted ventilation from large vessel obstruction
e. respiratory acidosis
E
Symptomatic treatment of dypnea include the following EXCEPT;
a. respiratory muscle stimulation such as invasive mechanical ventilation
b. oxygen therapy
c. sedation
d. exercise training
e. none of the above
E
Which phase in the process of cough is characterized by a rapid rise in subglottic pressure?
a. inspiratory b. expiratory c. recovery d. compressive e. glottic closure
D
The efferent limb of the cough reflex arc includes receptors within the sensory distribution of the following nerves, except;
a. vagus b. trigeminal c. glossopharyngeal d. superior laryngeal e. spinal motor
E
Which nerve subserves both the afferent and efferent limbs of the cough reflex pathway?
a. vagus b. trigeminal c. glossopharyngeal d. superior laryngeal e. spinal motor
A
Factors contributing to cough insufficiency, except;
a. altered mucociliary function b. expiratory muscle weakness c. inspiratory muscle weakness d. reduced mucus secretion e. increased luminal mucus
D
Which of the following is NOT TRUE of the laboratory workup for cough?
a. a chest radiograph can rule out chest wall or pleural lesion
b. a sputum gram stain is necessary for pneumonic phlegm
c. spirometry is useful in ruling out cough persistent asthma
d. sputum eosinophils is supportive of asthma
e. high resolution ct scan is indicated for interstitial lung disease
C
A 20 year old male complains of chronic cough, nasal congestion, sneezing, postnasal drip, itchy throat, and watery eyes. Physical examination reveals congested nasal mucosa with ‘’cobblestone’’ appearance of posterior pharyngeal mucosa.
Following the diagnostic protocol in the evaluation of cough, which afferent limbs of the reflex pathway are most likely involved?
a. phrenic and vagus nerves b. spinal motor and recurrent laryngeal nerves c. trigeminal and phrenic nerves d. trigeminal and glossopharyngeal nerves e. all of the above
D
A 50 year old male, chronic smoke, bank employee, from Manila consults your clinic with a week history of nonproductive cough accompanied by sensation of throat fullness. He has been noncompliant with his medications. Something months ago, he has been taking chu chu, chu chu, and chu chu SORRY DI MABASA, BASTA ANTI HPN’s malamang ang mga to, regularly for his co-morbid medical problems. Physical examination is unremarkable. Chest radiograph reveals no significant findings.
What is the most likely cause of his cough?
a. ACE-I induced cough b. congestive heart failure c. chronic bronchitis d. bronchiectasis e. tuberculosis
A
A 20 year old female with a history of prior PTB complication of chronic cough with whitish, viscoid sputum that causes precordial chest pain when forcefully expectorated. She is unable to sleep at night due to the cough. At present, she has no other complaints. She has inspiratory crackles in the right upper lung field. Sputum AFB smear, and TB culture are negative. Chest x-ray shows residual TB scars, and bronchiectatic change in the upper lung field area.
Which type of medication will you prescribe to improve the quality of this patient and reduce her symptoms?
a. an antitussive b. a protussive c. an anti-leukotiene d. an inhaled corticosteroid e. a broad spectrum antibiotic
B
A 30 year old teacher, non smoker, consults you for an on-off cough productive occasionally with yellow phlegm since 6 months ago often occurring at night and during the morning. 3 days prior to consult, cough has become bothersome. She has difficulty breathing and noted blood-streaking of the sputum. She has previously with consulted their physician twice. She was told she had bronchitis and was given antibiotic
Raising your clinical suspicion on chronic cough algorithm, what will be your next step?
a. repeat chest x-ray b. do sputum AFB smear c. start inhaled steroid therapy d. start empiric antibiotic with atypical coverage e. start oral antihistamine and decongestant
C
Pulmonary and airway lesions causing hemoptysis are usually supplied by the:
a. aortic circulation b. pulmonary circulation c. intercostal circulation d. bronchial circulation d. azygos circulation
D
Mortality from massive hemoptysis is usually attributed to
a. asphyxiation b. hypovolemic shock due to exsanguination c. fetal arrhythmia d. disseminated intravascular coagulation e. the severity of the underlying condition
A
Features suggesting a gastrointestinal, rather than a pulmonary source of oral bleeding, EXCEPT:
a. acidic pH b. foaminess c. dark red appearance d. presence of food particles e. none of the above
B
What is are the mechanism/s of hemoptysis in a patient with bronchiectasis
a. bronchial artery hypertrophy
b. expansion of peribronchial and submucosal bronchial arterial apparatus
c. augmentation of anastomoses with the pulmonary arterial bed
d. destruction of cartilaginous support
e. all of the above
E
The ff are the possible mechanisms of hemoptysis in Pulmonary Tuberculosis, EXCEPT:
a. bronchial ulceration with necrosis of adjacent vessels and alveoli
b. rupture of erosive pulmonary artery pseudoaneurysm in the cavity walls
c. expectoration of broncholiths
d. systemic derangements in the coagulation cascade
e. erosion of bronchial arteries by calcific hilar lymph nodes
D
A 50 year old female, former smoker, company executive from Makati, coughed out 3 tablespoons of fresh blood admixed with mucus on the morning of consult. She reports that this is her 1st episode of hemoptysis but has had on and off cough productive___phleghm in the past 3 years. She has no fever or dyspnea. Physical examination is unremarkable.
What initial laboratory test will you recommend?
a. CBC with platelet count, prothrombic time, and other tests of bleeding parameters
b. sputum AFB smears
c. chest ct scan
d. chest xray
e bronchoscopy
D
Which of the following surface anatomical landmarks is FALSE?
a. the inferior tip of the scapula usually lies at the level of the 7th rib or interspace
b. the sternal angle is the best guide to count the ribs and interspaces, and it marks the 2nd rib and costal cartilage
c. the 11th and 12th ribs are floating ribs and have no anterior attachments
d. on inspiration, the lower border of the lung crosses the 6th rib at the midclavicular line, the 8th rib at the midaxillary line and lies at the level of T10 spinous process posteriorly
e. the trachea bifurcates into the mainstem bronchi at the levels of the sternal angle anteriorly and the T4 spinous process posteriorly
D
Complaints of chest pain raise the risk of heart disease, but often arise from structures in the thorax and lung as well. Sources of chest pain include EXCEPT:
a. myocardium
b. pericardium
c. aorta
d. visceral pleura
e. extrathoracic structures such as the neck, gallbladder and stomach
D
Which statement about dyspnea is NOT TRUE:
a. dyspnea from left sided heart failure arises from transudation of fluid onto the interstitial space and alveoli, and is generally relieved by sitting up
b. dyspnea from COPD arises from overdistention of air spaces distal to terminal bronchioles and is aggravated by exertion
c. dyspnea from bronchial asthma arises from airway inflammation leading to increases secretions and bronchoconstriction and is generally acutely episodic, separated by symptom-free periods
d. dyspnea from chronic bronchitis arises from excessive mucus production in the bronchi and is often relieved by expectoration
e. none of the statement are false
E
Which percussion note is NOT properly matched with its normal location and its pathologic example?
a. flatness - thigh - large pleural effusion b. dullness - liver - lobar pneumonia c. resonance - normal lung - simple chronic bronchitis d. hyperresonance - trachea - emphysema e. tympany - stomach - pneumothorax
D
Which breath sound is NOT properly described?
a. vesicular breath sounds have longer lasting inspiratory sounds and are heard over most of both lungs
b. bronchiovesicular breath sounds have equal inspiratory and expiratory sounds and are heard often in the 2nd and 3rd interspaces anteriorly and between the scapulae
c. bronchial breath sounds have longer lasting expiratory sounds, separated from the inspiratory sounds by a short silence, and are heard over the manubrium, if at all
d. tracheal breath sounds have equal inspiratory and respiratory sounds separated by a short silences and are heard over the trachea in the neck
B
Which statement on adventitious lung sounds and transmitted voice sounds is NOT TRUE?
a. crackles results from a series of tiny explosions when small airways, deflated during expiration, pop open during inspiration
b. wheezes occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure
c. rhonchi suggest secretions in the large airways
d. pleural rub occurs when inflamed and roughened pleural surfaces grate against each other and are typically heard best when there is fluid in the pleural space
e. clearing of crackles, wheezes or rhonchi after cough suggests that secretions caused them
D
JB, 35/M, taxi driver, heavy smoker, sought consult due to cough
Pertinent Hx: one month episode of cough with yellowish phlegm and occasional low grade fever. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, cough was persistent and quite progressive associated with some episodes of dyspnea. He took terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
PE: BP 140/90 RR 24 HR 88
2x1cm movable node at R supraclavicular area; use of neck accessory muscles
lungs: decreased breath sounds over R base
heart: regular rythm, no murmur
soft abdomen, normoactive bowel sounds
full pulses
With the given history and PE findings, one might consider the following pulmonary disease as main impression except:
a. pneumonia b. tuberculosis c. Malignancy d. COPD e. none of the above
E
JB, 35/M, taxi driver, heavy smoker, sought consult due to cough
Pertinent Hx: one month episode of cough with yellowish phlegm and occasional low grade fever. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, cough was persistent and quite progressive associated with some episodes of dyspnea. He took terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
PE: BP 140/90 RR 24 HR 88
2x1cm movable node at R supraclavicular area; use of neck accessory muscles
lungs: decreased breath sounds over R base
heart: regular rythm, no murmur
soft abdomen, normoactive bowel sounds
full pulses
Additional PE maneuvers were done revealing dullness on percussion over the R base and no adventitious sounds noted. One may consider the following entities except:
a. pneumothorax b. pleural effusion c. pneumonia d. empyema
A
JB, 35/M, taxi driver, heavy smoker, sought consult due to cough
Pertinent Hx: one month episode of cough with yellowish phlegm and occasional low grade fever. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, cough was persistent and quite progressive associated with some episodes of dyspnea. He took terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
PE: BP 140/90 RR 24 HR 88
2x1cm movable node at R supraclavicular area; use of neck accessory muscles
lungs: decreased breath sounds over R base
heart: regular rythm, no murmur
soft abdomen, normoactive bowel sounds
full pulses
A chest radiography 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. lobar pneumonia c. pulmonary mass d. pleural effusion
A
JB, 35/M, taxi driver, heavy smoker, sought consult due to cough
Pertinent Hx: one month episode of cough with yellowish phlegm and occasional low grade fever. He self-medicated with ibuprofen and ambroxol which provided only temporary relief of symptoms. 2 weeks before consult, cough was persistent and quite progressive associated with some episodes of dyspnea. He took terbutaline tablets which provided only temporary relief. His wife noted some weight loss and easy fatigability on walking two flights of stairs.
PE: BP 140/90 RR 24 HR 88
2x1cm movable node at R supraclavicular area; use of neck accessory muscles
lungs: decreased breath sounds over R base
heart: regular rythm, no murmur
soft abdomen, normoactive bowel sounds
full pulses
On a right lateral decubitus film, the noted opacification was noted to later at the lateral aspect of the right hemithorax. This may make one consider:
a. pleural fluid b. empyema c. airway secretions d. pulmonary mass e. a and b only
E
Typical features of dyspnea due to asthma, EXCEPT:
a. more prominent when lying on the side of the chest b. often induced by triggers c. can be induced by exercise d. relieved by a bronchodilator e. episodic
A
A mechanism involved in airway limitation in asthma:
a. loss of elastic recoil b. inflammatory destruction of medium sized bronchi c. airway mucosal edema d. tracheal edema e. all are correct
C
The single largest risk factor for the development of asthma:
a. family history of asthma b. maternal smoking c. early house dust mite exposure d. genes predisposing to airway hyperresponsiveness e. atopy
E
The following is/are true of asthma pathology, EXCEPT:
a. denuded mucosa b. hypertrophied airway smooth muscles c. thinned basement membrane d. inflammatory cell
C
The triad of asthma includes the following EXCEPT:
a. dyspnea b. cough c. sputum production d. wheezing
C
The following are tests to confirm or suggest asthma EXCEPT:
a. spirometry b. bronchoprovocation test c. peak flow d. chest radiograph
D
A confirmatory diagnostic test for asthma:
a. an increase of at least 12% or an absolute increase of 200mL in FEV1 after 2-4 puffs of a short acting bronchodilator
b. a reduction in DLCD with exercise
c. hyperinflation on chest x-ray
d. a 20% drop in FEV1 after an inhalational challenge with a low dose of metacholine
e. all are correct
D
The most effective controller medication for asthma:
a. inhaled glucocorticosteroid b. oral glucocorticosteroid c. long-acting beta-agonist d. leukotriene modifier e. long-acting anti-muscarinic agent
A
An asthma reliever medication:
a. tamoxifen b. nedocromil c. montelukast d. fluticasone e. albuterol
E
A 40 year old asthmatic is maintained on inhaled Fluticasone 500 ug/day. On her clinic follow-up, she reports that she has occasional daytime symptoms and uses inhaled Salbutamol about 4x a week. She has no nocturnal symptoms and can perform her regular activities without difficulty. On physical examination, she has no wheezing. Her clinic PEFR is 90% of her personal best.
How will you assess the level of control of this patient’s asthma?
a. controlled b. partially controlled c. uncontrolled d. in exacerbation e. information is insufficient for adequate assessment
B
The cytokine that promotes differentiation and maturation of eosinophils is:
a. IL-7 b. IL-4 c. IL-5 d. IL-10 e. IL-12
C
Allergic asthma can be triggered by cross-linking of IgE receptors on:
a. lymphocytes b. mast cells c. plasma B cells d. neutrophils e. macrophages
B
The basic mechanism underlying a Type I hypersensitivity reaction is:
a. IgG bound to lymphocytes reacting with allergen leading to release of mediators
b. IgG bound to basophils reacting with allergen leading to release of mediators
c. IgE bound to mast cells reacting with allergen leading to release of mediators
d. IgE bound to lymphocytes reacting with allergen leading to release of mediators
e. IgE bound to neutrophils reacting with allergen leading to release of mediators
C
The immunoglobulin responsible for the immediate type of hypersensitivity reaction:
a. IgG b. IgA c. IgM d. IgE e. IgD
D
Cysteinyl leukotrienes have the following effects EXCEPT:
a. bronchoconstriction b. vascular congestion c. epithelial cell damage d. decreased mucus transport e. decreased mucus secretion
E
Allergen immunotherapy is considered for the following conditions EXCEPT:
a. Allergic rhinitis b. Atopic dermatitis c. Adverse food restrictions d. Bronchial asthma e. Chronic urticaria
C
- Which is NOT a benefit of allergen immunotherapy?
a. Reduction of rhinitis symptoms scores and medication use
b. Improved quality of life among asthmatics
c. Reduction of asthma symptoms scores
d. Prevents sensitization to new allergens
e. Prevent asthma if given to those with allergic rhinitis alone
B
Which of the following is one of the proposed mechanisms of allergen immunotherapy?
a. Reduction of IgG antibodies specific to the allergens
b. Recruitment of effector cells in the respiratory epithelia
c. Induction of regulatory T cells
d. Upregulation of IgE antibodies
e. Shift from TH1 to TH2 cytokine profile
C
Factors that predisposes to a TH2 phenotype are the following EXCEPT:
a. Western lifestyle b. Widespread use of antibiotics c. Early exposure to day care d. Urban environment e. Diet
C
Which of the following statements which describes COPD is/are true?
a. It is a common and preventable disease
b. Although COPD is progressive, it can be treated with pharmacologic and non-pharmacologic therapies
c. Prolonged exposure to noxious particles or gases is an important risk factor
d. Many non-pulmonary co-morbidities can accompany COPD which contributes to seriousness
e. All of the above
E
The greatest risk factor for the development of COPD is
a. Air pollution b. Indoor pollution c. Industrial emissions d. Smoking e. Genetic Predispositions
D
This is the most common type of parenchymal destruction in COPD patients.
a. Panacinary emphysema b. Distal acinar emphysema c. Centrilobular emphysema d. Focal emphysema e. Bronchiectasis
C
The mechanism/s underlying airflow limitations in COPD includes the following EXCEPT:
a. Small airways disease b. Airway inflammation and fibrosis c. Increased airway resistance d. Increased elastic recoil e. Parenchymal destruction
D
All of the following cells play an important role in COPD pathogenesis EXCEPT:
a. Mast cell b. Macrophages c. Neutrophils d. Lymphocytes e. Epithelial cells
A
Which of the following statements related to the combined assessment of COPD is true?
a. More than one COPD exacerbations in a 12 month period is an indicator of higher risk COPD
b. The modified Medical Research Council score (mMRC) can be used in lieu of spirometry for the diagnosis of COPD
c. The CAT questionnaire should be accomplished every 2 weeks to detect any changes
d. An mMRC score of 3 is the boundary to delineate more symptomatic COPD
e. An FEV1 of less than 60% predicted in a patient with FEV/FVC
A
