Samplex 2017 Flashcards
1
Q
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
A
B
2
Q
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
A
C
3
Q
The lung compliance in patients with pulmonary fibrosis is:
a. Increased b. Decreased c. Unchanged d. Not evaluable
A
B
4
Q
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
A
B
5
Q
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
A
E
6
Q
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
A
B
7
Q
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
A
8
Q
Carbon monoxide poisoning would:
a. Decrease dissolve O2 b. Decrease Oxygen-Hemoglobin saturation c. Decrease PaCO2 d. Increase pH
A
B
9
Q
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
A
10
Q
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
A
C
11
Q
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
A
C
12
Q
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
A
C
13
Q
Which of the following refers difficulty of breathing occurring during supine position?
a. Bradypnea
b. Orthopnea
c. Platypnea
d. Tropopnea
e. Pleurisy
A
B
14
Q
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
A
15
Q
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
A
C
16
Q
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
A
D
17
Q
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
A
18
Q
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
A
B, D
19
Q
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
A
E
20
Q
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
A
E
21
Q
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
A
D
22
Q
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
A
E
23
Q
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
A
24
Q
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
A
D
25
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
26
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
27
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
28
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
29
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
30
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
31
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
32
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
33
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
34
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
35
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
36
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
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
The triad of asthma includes the following EXCEPT:
a. dyspnea
b. cough
c. sputum production
d. wheezing
C
51
The following are tests to confirm or suggest asthma EXCEPT:
a. spirometry
b. bronchoprovocation test
c. peak flow
d. chest radiograph
D
52
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
53
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
54
An asthma reliever medication:
a. tamoxifen
b. nedocromil
c. montelukast
d. fluticasone
e. albuterol
E
55
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
56
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
57
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
58
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
59
The immunoglobulin responsible for the immediate type of hypersensitivity reaction:
a. IgG
b. IgA
c. IgM
d. IgE
e. IgD
D
60
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
61
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
62
63. 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
63
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
64
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
65
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
66
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
67
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
68
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
69
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
70
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
71
The recommended first choice of maintenance treatment for COPD Group C is:
a. Short-acting beta-agonists
b. Long-acting beta-agonists + inhaled corticosteroids
c. Long-acting anticholinergics
d. B and C
e. All of the above
D
72
Which of the following statements about acute exacerbations of COPD is/are true?
a. Exacerbations are indicative of increased risk among COPD patients
b. Spirometry is necessary to confirm the diagnosis of acute exacerbation of COPD
c. Hypersensitivity of the airway without increased inflammation is typical of patients with acute exacerbations
d. The decline in lung function of COPD patients is independent of exacerbation rates
e. All of the above
A
73
Which of the following statements describes the most important pathology is bronchiectasis?
a. Reversible bronchoconstriction after a post-bronchodilator test on spirometry
b. An impairment of mucociliary drainage in one or both of the lungs
c. Bronchiectasis may involve any isolated lung segment of may be spread throughout the respiratory tree
d. The elastic and muscular components of the bronchial walls may be destroyed
e. All of the above
B
74
Which of the following statements describe/describes the treatment of bronchiectasis?
a. The timely and appropriate use of antibiotics is key during exacerbations
b. Surgery with resection of localized affected areas may be considered
c. Hemoptysis must be closely monitored and remedied before it can lead to severe patient compromise
d. Postural drainage has been shown to significant improve the symptoms of patients
e. All of the above
E
75
Inward movement of the chest wall during inspiration
a. Kussmaul’s respiration
b. Periodic breathing
c. Forced inspiration
d. Paradoxical breathing
D
76
Normal respiratory rate in a newborn infant:
a.<30/min
A
77
Normal respiratory rate in a 3 year old child
a.<30/min
C
78
The following are examples of Restrictive Lung Disease EXCEPT:
a. Pneumonia
b. Pleural Effusion
c. Asthma
d. Pneumothorax
e. NOTA
C
79
This is a benign condition in premature infants characterized by short apneic episodes not associated with cyanosis or bradycardia
a. Apnea of Prematurity
b. Periodic Breathing
c. Kussmaul’s breathing
d. Cheyne Stoke’s breathing
e. Transient Tachypnea of the Newborn
B
80
Patients with ‘bad breath’ could have which of the following pulmonary disease?
a. bronchiectasis
b. lung abscess
c. nasal foreign body
d. adenoidal infection
e. AOTA
E
81
Is an attempt by the patient to increase intra-alveolar pressure by breathing against a closed glottis:
a. Stridor
b. Wheeze
c. Rhonchi
d. Grunting
e. Stertor
D
82
Chest findings of equal chest expansion with decreased breath sounds and increased tactile and vocal fremitus at the right mid to apical lung fields is highly suggestive of which underlying condition:
a. Pleural effusion
b. Atelectasis
c. Pneumothorax
d. Consolidation
e. NOTA
C
83
Musical continuous sounds usually caused by the development of turbulent flow in narrow airways:
a. Stridor
b. Rhonchi
c. Wheeze
d. Crackles
e. NOTA
C
84
High-pitched, interrupted sounds found during inspiration and more rarely during early expiration which denote opening of previously closed air spaces:
a. Stridor
b. Rhonchi
c. Wheeze
d. Crackles
e. NOTA
D
85
Which of the following is true about the development of the lungs?
a. The left main bronchus is more in line with the trachea.
b. The left main bronchus is more vertical.
c. The right lung bud gives rise to three branches.
d. The respiratory system is an outgrowth from the dorsal wall of the foregut.
C
86
Which of the following is correctly matched?
a. Pulmonary lobule = 3-5 terminal bronchioles + respective acini
b. Bronchiole = alveolar ducts + alveolar sacs
c. Respiratory bronchiole = terminal bronchioles + acinus
d. Acinus =alveolar ducts + alveolar sacs
A
87
Which of the following is NOT a cell of the bronchial mucosa?
a. Neuroendocrine cells
b. Goblet cells
c. Columnar ciliated cells
d. Type I and Type II pneumocytes
D
88
What is the type of congenital anomaly in which there is incomplete development of the lungs such as there are rudimentary bronchi but no lung tissue?
a. Agenesis
b. Aplasia
c. Hypoplasia
d. Sequestration
B
89
What is the most common type of foregut cyst?
a. Esophageal
b. Bronchogenic
c. Enteric
d. Intestinal
B
90
Which histological type of Congenital Pulmonary Airway Malformation has the best prognosis?
a. Congenital lobar emphysema
b. Microcystic
c. Solid
d. Cystic
A
91
The presence of a discrete mass of lung tissue without normal connection to airway system:
a. Congenital lobar emphysema
b. Pulmonary sequestration
c. Congenital Pulmonary Airway Malformation
d. Foregut cyst
B
92
Which of the following is true about pulmonary hypoplasia?
a. Polyhydramnios is an identified cause
b. The decrease in the weight of the lungs is proportional to the gestational age and body weight
c. There is abnormal communication between the trachea and the esophagus
d. One lung may be more affected than the other
D
93
This type of emphysema is strongly associated with alpha-1 antitrypsin deficiency:
a. paraseptal emphysema
b. Irregular emphysema
c. Centriacinar emphysema
d. Panacinar emphysema
D
94
Possible sequelae of ruptured bulla:
a. pleural effusion
b. pleural thickening
c. pneumonitis
d. pneumothorax
D
95
Microscopic morphology of bronchial asthma:
a. smooth muscle hyperplasia
b. bronchial narrowing
c. decreased mucosa
d. only a and b are correct
e. all are correct
D
96
A chronic necrotizing infection of bronchi and bronchioles leading to abnormal permanent dilatation:
a. Bronchopneumonia
b. Bronchiectasis
c. Bronchitis
d. Emphysema
B
97
Which of the following is true about the pathogenesis of bronchiectasis?
a. Inflammation of the bronchial walls is non-contributory
b. Destruction of elastic and muscular components is antecedent
c. The surrounding undamaged lung exerts an expansile force
d. End result is characteristic narrowing of bronchi
B
98
Which of the following types of emphysema involves all airway and alveoli?
a. Saccular and cystic
b. Centriacinar
c. Centrilobular
d. Panacinar
D
99
Which of the following best describes bullous emphysema?
a. Large, air-filled spaces, usually subpleural
b. Basal and posterior subpleural regions are usually affected
c. Not associated with weakness of alveolar walls or negative pleural pressure
d. With no identified association with inflammatory disease
A
100
Which of the following is true about the developmental anatomy of the lungs?
a. The respiratory system is an outgrowth from the dorsal wall of the foregut.
b. The midline trachea develops two lateral outpocketings
c. The right lung bud develops into two branches.
d. The left lung bud develops into three branches.
B
101
An acinus is composed of which of the following:
a. Bronchioles + terminal bronchioles
b. 3-5 terminal bronchioles
c. Respiratory bronchioles + alveolar ducts +alveolar sacs
d. Alveolar ducts + alveolar sacs
C
102
Which of the following is correct organization of the bronchial epithelium?
a. Pseudostratified columnar cells + neuromuscular cells + goblet cells
b. Squamous cells + neuromuscular cells + goblet cells
c. Pseudostratified columnar cells + squamous cells + goblet cells
d. Pseudostratified columnar cells + squamous cells+neuromuscular cells
A
103
Which of the following is correctly matched?
a. Aplasia- incomplete development of the lungs
b. Agenesis- rudimentary bronchi
c. Pulmonary hypoplasia- decreased weight, volume and size of both lungs, equally affected
d. Metaplasia- disordered maturation of bronchial epithelial lining
A
104
True of pulmonary sequestration:
a. Intralobar sequestration are often associated with recurrent infections
b. Extralobar sequestration is usually found in older children
c. Extralobar sequestration are prone to bronchiectasis more than intralobar sequestration
d. Intralobar sequestration presents as lung lesions in infants
A
105
What radiographic view is the routine chest examination?
a. Chest AP
b. Chest apicolordotic view
c. Chest lateral decubitus view
d. Chest PA
D
106
What is the primary use of the chest apicolordotic group?
a. To better visualize the lung apices
b. To confirm the presence of pleural fluid
c. To diagnose pneumothorax
d. To diagnose pulmonary tuberculosis
A
107
Which statement is true?
a. In the frontal projection, the radiolucency of the lung decreases from superior to inferior
b. The complete hemidiaphragm in the chest lateral view is the left hemidiaphragm
c. In the lateral projection, the retrocardiac space is radiopaque
d. In the lateral view of the chest, the trachea lies posterior to the esophagus
A
108
Which of the following structures can be seen in a normal chest x-ray?
a. Air bronchogram
b. Hilar lymph node
c. minor fissure
d. visceral pleura
C
109
Chest PA examination of a 60-year-old male shows too blurry diaphragm. What is your most likely diagnosis?
a. Atelectasis
b. Bronchiectasis
c. Pleural effusion
d. Pulmonary emphysema
D
110
Single pulmonary nodule with spiculated margins suggests
a. Primary pulmonary malignancy
b. Loculated pleural effusion
c. Round pneumonia
d. Tuberculoma
A
111
Multiple cannon ball nodules in the lungs may be the radiologic manifestation of
a. Pulmonary tuberculosis
b. Primary pulmonary malignancy
c. Metastatic malignancy
d. Consolidation
C
112
Which imaging modality is most often used for pulmonary biopsies?
a. Fluoroscopy
b. MRI
c. CT Scan
d. Ultrasound
C
113
The following are contraindications to the use of non-invasive ventilation, EXCEPT:
a. Facial burns
b. Facial trauma
c. Fixed upper airway obstruction
d. Pneumonia
e. Recent facial surgery
D
114
By definition, Long Term Oxygen Therapy means that the patient is on oxygen support for how many hours/day?
a. 8 hours
b. 10 hours
c. 25 hours
d. 20 hours
e. 24 hours
C
115
Drug that is considered to be a specific Phosphodiesterase-4 inhibitor?
a. theophylline
b. doxofylline
c. montelukast
d. sildenafil
e. roflumikast
E
116
Single drug of choice as controller in asthma?
a. inhaled glucocorticoid
b. inhaled long-acting beta agonist
c. inhaled long-acting muscarinic antagonist/ anticholinergic
d. leukotriene receptor antagonist
e. oral glucocorticoid
A
117
The only mucolytic with some evidence of efficacy in improving clinical outcomes
a. carboxysteine
b. lagundi
c. bromhexine
d. n-acetylcysteine
e. ambroxol
D
118
The recommended first choice of maintenance treatment for COPD Group C is:
a. Short-acting beta-agonists
b. Long-acting beta-agonists + inhaled corticosteroids
c. Long-acting anticholinergics
d. B and D
e. All of the above
NA
119
Which of the following is NOT a bronchodilator
a. roflumikast
b. theophylline
c. formoterol
d. ipartropium bromide
e. salbutamol
A
120
The only long acting muscarinic antagonist that is currently available in the market
a. ipatropium bromide
b. tiotropium
c. montelukast
d. doxofylline
e. oxitropium
B
121
The drug of choice in maintenance therapy in COPD is
a. Inhaled glucocorticoids
b. Oral glucocorticoids
c. Long acting inhaled beta-antagonists
d. Methylxanthines
e. Short acting inhaled anti-cholinergics
C
122
Omalizumab works by
a. burst and taper
b. inhibits IgE binding to mast cells and basophils
c. Competes with histamine for specific receptor sites
d. Inhibits the synthesis of leukotrienes
e. all of the above
B
123
Anticholinergics have which of the following respiratory effects
a. prevent bronchodilation
b. increase respiratory secretions
c. increase bronchoconstriction
d. all of the above
e. none of the above
E
124
The following is true about theophylline EXCEPT
a. It is a nonselective adenosine receptor antagonist
b. It is a nonselective phosphodiesterase inhibitor
c. It causes tachycardia and jitteriness as side effect
d. It may be taken orally or intravenously
e. All of the above statements are true
E
125
Alveoli first appear
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
D
126
Lung buds
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
A
127
Blood gas barrier thins
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
C
128
Expansion of surface area
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
E
129
Alveolar number increases
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
F
130
Conducting airways formed
```
A. Embryonic Stage
B. Pseudoglandular
C. Cannalicular
D. Saccular
E. Alveolar
F. Postnatal
```
B
131
Surfactant formation
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
D
132
Well differentiated cells to support gas exchange
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
E
133
Lung bud
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
A
134
Terminal bronchiole
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
B
135
Type I and II cell differentiation
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
C
136
Respiratory distress syndrome
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
C
137
Pulmonary agenesis
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
A
138
Bronchial malformation
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
B
139
Pulmonary hypoplasia
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
E
140
Pulmonary sequestration
```
A. Embryonic Phase
B. Pseudoglandular Phase
C. Canalicular Phase
D. Saccular Phase
E. Alveolar Phase
```
B
141
What is the most common cause of hypoxemia?
a. Hypoventilation
b. Shunt
c. V/Q mismatch
d. Diffusion defect
e. Decreased inspired oxygen
C
142
Phase of cough process where there is rapid deceleration of flow?
```
A. Inhalation phase
B. Expiratory phase
C. Compressive phase
D. Glottis closure
E. Recovery phase
```
B
143
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
144
Obstructive sleep apnea is caused by a damage where?
Neural
145
Function of the respiratory system
Gas exchange
146
What is the hallmark of alveolar hypoventilation?
CO2 is increased
147
What is the most common pulmonary clinical presentation?
Cough or Dyspnea
148
When does the first cough sound occur?
Expulsive phase
149
When is the subglottic pressure highest?
Compressive phase
150
A 30 year old female consults you for on-and-off cough of 8 weeks duration and production of white mucoid sputum. She also complains of nasal congestion and sneezing. Physical examination reveals nasal mucosal edema and cobblestone appearance of the posterior pharyngeal mucosa.
What is the most likely cause of her chronic cough?
```
A. Upper airway cough syndrome
B. Cough variant asthma
C. GERD
D. Chronic bronchitis
E. Information is insufficient to form a meaningful diagnosis
```
A
151
A 40 year old laundry woman from Paco complains of cough productive of whitish blood-tinged sputum, fever, malaise and anorexia of 4 weeks duration. Self-medication with paracetamol and lagundi tablets provide some relief. Physical examination is unremarkable.
Which laboratory test will you prioritize to determine the diagnosis of this patient’s condition?
```
A. CBC
B. Spirometry
C. Chest radiograph
D. Sputum GS, CS
E. Sputum AFB
```
E
152
Woman taking captorpil and enalopril for a few years develops acute cough and chest pain sometime after an operation
A. ACE-i induced cough
B. MI
C. Congestive heart failure
D. Acute Pulmonary Embolism
D
153
Pulmonary airway lesions cause hemoptysis. Where does the blood come from?
Bronchial circulation
154
The procedure of choice if one suspects bronchiectasis
CT Scan
155
Case: 70 year old male, smoker, severe dyspnea with occasional cough for 2 years. Months ago he had an xray but was only given maintenance medications. Started as dyspnea during physical activity but slowly progressed. At present he has dyspnea even at rest.
Given the information above, which of the following is likely to be considered?
```
A. TB
B. Emphysema
C. Asthma
D. Chronic Bronchitis
E. AOTA
```
E
156
Case: 70 year old male, smoker, severe dyspnea with occasional cough for 2 years. Months ago he had an xray but was only given maintenance medications. Started as dyspnea during physical activity but slowly progressed. At present he has dyspnea even at rest.
On palpation, what PE findings would you expect?
a. bilateral chest lag, bilateral decreased tactile fremitus
b. bilateral chest lag, equal tactile fremitus
c. unilateral chest lag, bilateral decreased tactile fremitus
d. normal chest expansion and tactile fremitus
e. bilateral chest lag, but one side might have decreased tactile fremitus
A
157
Number one cause of chronic cough
```
A. Asthma
B. Tuberculosis
C. Post-nasal drip
D. GERD
E. Acute rhinitis
```
A, C
158
Most common way for microorganisms to reach the lower respiratory tract?
A. Inhalation
B. Metastasis
C. Aspiration
D. Hematogenous Spread
C
159
Cause of acute rhinosinusitis
Nasal steroids
160
Which of the following is false of the etiologies of acute pharyngitis?
A. Majority of the cases (30%) have no identifiable cause.
B. Rhinoviruses are the most common viral cause.
C. Streptococcus pyogenes is the most common bacterial cause.
D. Formation of exudates, ulcers, and vesicles are characteristic of HSV.
E. Exudative pharyngitis with generalized lymphadenopathy is characteristic of EBV.
A
161
What is the most common presenting symptom of pneumonia?
```
A. Cough
B. Malaise
C. Difficulty of Breathing
D. Fever
E. Chills
```
A
162
False of pneumonia
A. Inflammation of lung parenchyma with abnormal fluid in alveolar space
B. Caused by viral, bacterial, fungal, parasitic infection
C. Major cause of hospitalization worldwide
D. Risk factors include >65 years of age, malnutrition, asplenia, previous pneumonia…
E. None of the above
E
163
Which of the ff is false about pneumonia?
A. CAP develops within a patient not hospitalized or residing in a long-term health facility at least 14 days before onset of symptoms
B. HAP develops within 48 hours after admission to a hospital and not incubating at the time of admission
C. VAP arises at least 48-72 hours after endotracheal intubation
D. HCAP occurs within 90 days of receiving any form of health care
E. None of the above
E
164
78 yr old male, unconscious brought to PGH ER. Palpatory BP and head to be intubated. CXR multilobular densities
A. Low risk CAP
B. Mod Risk Cap
C. High RIsk CAP
D. Hospital acquired CAP
C
165
Where was the first case of SARS recorded?
A. Hong Kong
B. China
C. Some other country
D. Yet another country
B
166
Common finding in children with pneumonia
Tachypnea
167
Child with no known immunizations was admitted with fever, a notable pharyngeal membrane cough and bull neck
A. Retro Pharyngeal Abscess
B. Peritonsilar Abscess
C. Diptheria
D. Tonsilar Exudates
C
168
Which of the ff. signs and symptoms will best predict the presence of pneumonia in children
C
169
In a child with viral pneumonia, the following ancillary measures are NOT routinely implemented, except:
```
A. Herbal medicines
B. NSS nebulizations
C. Steam inhalation
D. Oxygen inhalation is needed
E. Chest physiotherapy
```
D
170
Best diagnostic tool for PTB
AFB Smear
171
Influenza virus cause lower respiratory infections. Which of the following describes this virus?
A. The only negative sense ssRNA virus that needs an intermediate nuclear step before transcription.
B. The 3 different types contain 5 genomes each encoding a specific protein.
C. All types have the potential to undergo reassortment.
D. Influenza C is genetically and morphologically similar to influenza A and B.
A
172
What viral component is a hydrolytic enzyme responsible for acting on Sialic acid residues found in respiratory epithelium?
A. Hemagglutinin
B. Neuraminidase
C. Fusion Protein
B
173
One of the subgroups of influenza A viruses that normally circulate among birds but recently, human infections were detected. What is this influenza virus?
A. A(H1N1)
B. A(H3N2)
C. A(H7N9)
D. A(H5N1)
C
174
Which of the ff. will be detected in sputum microscopy? (Paragonimus)
A. Egg
B. Miracidia
C. Cercaria
D. Metacercaria
A
175
histopathology of PTB
a. noncaseating granulomatous formation
b. caseating necrosis with langhans type giant cells
B
176
True of respiratory development
A. Respiratory system outgrowth of dorsal wall of foregut
B. Trachea divides into lung buds
C. Left lung has two lobes
D. Right lung has three lobes
B
