Samplex 2017 Flashcards
(165 cards)
1
Q
Function of respiratory system which is most reflected by PaO2 values:
a. ventilation b. perfusion c. body metabolism d. gas exchange e lung defense
A
D
2
Q
Function of respiratory system most reflected by paCo2 values
a ventilation b. perfusion c. body metabolism d. gas exchange e. lung defense
A
A
3
Q
what is the most common cause of hypoxemia?
a hypoventilation b. shunt c. v/q mismatch d. diffusion defect e. decrease inspired oxygen
A
C
4
Q
the use of non invasive ventilation in respiratory failure associated with what disease entity has led to a decrease in mortality and length of hospital stay amongst patients with this disease process?
a. severe pneumonia b. status asthmaticus c. COPD in exacerbation d. post operative respiratory failure e. ARDS
A
C
5
Q
Which of the following is not a consideration to non-invasive ventilation
A. Acute respiratory failure B. Hemodynamic instability C. Severe agitation or uncooperability D. obtunded or unresponsive patient E. facial trauma
A
A
6
Q
Which is not part of the berlin definition of acute respiratory distress syndrome?
A. respiratory failure within 1 week of a known clinical insult
B. Bilateral parenchymal opacities on chest radiographs that are not fully explained by effusion, lung collapse or nodules
C. Respiratory failure not fully explained by cardiac failure of fluid overload
D. paO2/FaO2 ratio of less than 300mmHg
E. Need for oxygen support of at least 51/min to maintain an O2 sat of 95%
A
E
7
Q
According to the berline definition of Acute respiratory distress syndrome, which is severe ARDS?
A. PaO2/FI O2 of 200mmhg to 300mmhg B. PaO2/FI O2 of 100 mmhg to 150 mmhg C. PaO2/Fi O2 of 300 mmhg to 200 mmhg D. PaO2/FI O2 of 100 mmhg or less E. PaO2/FI O2 of 50 mmhg or less
A
D
8
Q
Low tidal volume as a ventilatory strategy has been found to decrease mortality in ARDS by preventing inflammation in the lungs. This means the ventilator’s tidal volume should be set at?
A. 3 ml/kg B. 4 ml/kg C. 5ml/kg D. 6ml/kg E 7ml/kg
A
D
9
Q
Respiratory strategies employed by infants who are hypoxemic?
a. decreasing tidal volume by the use of accessory muscles
b. slowing expiration through laryngeal narrowing during expiration or grunting
c. decreasing respiratory rate
d. NOTA
A
B
10
Q
True of persistent pulmonary hypertension
a. more of a cardiovascular rather than a pulmonary disease
b. characterized by elevated systemic hypertension
c. characterized by shunting of blood from the systemic circulation to pulmonary circulation through the foramen ovale or ductus arteriosus
d. NOTA
A
C
11
Q
True of meconium aspiration syndrome?
A. the pathophysiology includes pulmonary obstruction, surfactant inactivation and chemical pneumonitis
B. affects infants more often than term infacts
C. Is self-limiting and resolves within 24-48 hours
D. None of the above
A
A
12
Q
True of cardiac causes of respiratory distress
A. Characterized by cyanosis
B. Characterized by left to right shunt causing pulmonary congestion
C. Hypoxia is reversed by the administration of oxygen
D. None of the above
A
B
13
Q
True of Hyaline Membrane Disease
A. A disease of primary surfactant deficiency
B. Involves only preterm infants
C. Treated only by surfactant replacement therapy
D. None of the above
A
A
14
Q
True of transient tachypnea of the newborn
A. A disease of primary surfactant deficiency
B. Involves only term infants
C. Self-limiting and resolves within 24-48 hours
D. None of the above
A
C
15
Q
True of apnea
A. Defined as cessation of respiration for 10 seconds with or without desaturations or
bradycardia
B. Occurs more often among term infants compared to preterm infants
C. Is a manifestation among infants who may be hypoxemic as a result of a lung
pathology
D. None of the above
A
C
16
Q
True of neonatal pneumonia
A. May be caused by bacteria, virus, protozoan or fungal agents
B. Affects both term and preterm infants with the same frequency
C. The x-ray may resemble HMD, TTN or meconium aspiration syndrome
D. None of the above
A
A
17
Q
What is the most common way for microorganisms to gain access to the lower respiratory tract?
A. Inhalation of contaminated droplets B. Aspiration from the oropharynx C. Contiguous extension from an infected pleural or mediastinal space D. Hematogenous spread E. All of the above
A
B
18
Q
Which of the following is NOT TRUE of lung defense?
A. The turbinates and nares form the first mechanical defense by filtering the inhaled air.
B. The mucociliary apparatus exists from the trachea to the lobar bronchus.
C. Normal flora are nonpathogenic bacteria that bind the mucosal cells.
D. Alveolar macrophages protect at the alveolar level.
E. Surfactant proteins A and B/D (not clear enough in pic) have antibacterial activity.
A
B
19
Q
Which of the following medical illnesses affect host defenses?
A. diabetes mellitus B. congestive heart failure C. renal failure D. A and B E. All of the above
A
E
20
Q
Which of the following is NOT TRUE of nonspecific URIs?
A. Has a median duration of 1 week
B. Common reason for physician consults
C. Majority are bacterial in origin
D. Diagnosis is made mostly on clinical grounds.
E. Antibiotics do not play a prominent role during treatment.
A
C
21
Q
Which is TRUE of acute rhinosinusitis?
A. Most commonly involves the frontal sinuses
B. Most common bacterial causes (50-60%) are Haemophilus influenzae andStreptococcus pyogenes.
C. Characterized by pain over the sinus involved
D. Nasal steroids are indicated for treatment.
E. Antibiotics are indicated when there is no improvement after 3 days.
A
C
22
Q
Which of the following is FALSE of etiologies of acute pharyngitis?
A. Majority of causes (30%) have an identifiable cause.
B. Rhinoviruses are the most common viral etiology.
C. Streptococcus pneumoniae is the most common bacterial etiology.
D. Formation of exudates, vesicles and ulcers are characteristic of rhinoviruses.
E. Exudative pharyngitis with generalized lymphadenopathy is characteristic of HSV.
A
B
23
Q
Which of the following is FALSE of lung abscesses?
A. Aspiration from alcoholism is a common cause of lung abscesses.
B. Anaerobic bacteria are common organisms in immunocompromised hosts.
C. Pulmonary sequestration and infected bullae are differential diagnoses.
D. Clindamycin for 4-6 weeks is an effective treatment regimen.
E. Surgery is an option if there is refractory hemoptysis.
A
B
24
Q
What is the most common cause of lung abscess?
A. Alcoholism B. Bulbar dysfunction C. Esophageal dysmotility D. Aspiration E. Seizure disorders
A
D
25
The major human receptor of Rhinovirus is
A. polymorphonuclear cells
B. intracellular adhesion molecules
C. macrophages
D. epithelial cells
B
26
The most common type of influenza circulating in the community and responsible for the occurrence of pandemic is
a. Type A
b. Type B
c. Type C
d. Type D
A
27
A 70 y/o male was admitted for fever, shaking chills, pleuritic chest pain, and productive cough of rusty sputum for six days. He was diagnosed to have pneumonia. Microscopic examination of the sputum showed numerous PMN’s with extracellular Gram-positive cocci in pairs. Further test showed catalase (-), alpha hemolytic colonies. What other test result will confirm the etiologic agents?
a. Coagulase positive
b. Lactase fermenter
c. Susceptibility to optochin
d. Novobiocin resistant
D
28
A 5y/o male was brought to the ER due to cyanosis. Hx revealed he had chronic cough of 3 weeks with characteristic paroxysmal attacks that terminates in a high pitched sound. This condition is clinically consistent with whooping cough. The most probable agent is best cultured in which media
a. Blood agar plate
b. Loeffer’s slant
c. Chocolate agar
d. Bordet Gengou agar
D
29
A3 y/o consulted the OPD due to cough and fever of 5 days. On PE, there was note of fast breathing and “noisy” lung fields. She was diagnosed to have community-acquired pneumonia. Immunization of this child was all done at the local health center. Lab work-up included demonstration of satellite phenomenon to observe the growth of Hemophilus influenzae. This test needs a organism streaked on blood agar plate to provide the V growth factor:
a. Streptococcus pneumoniae
b. Mycoplasma pneumoniae
c. Staphylococcus aureus
d. Bordetella pertussis
C
30
A 4 y/o child came in due to cough and throat pain associated with fever. She was given cough syrup by the mother with no relief. On PE, it was noted that her neck was slightly enlarged and the tonsillar wall had adherent whitish plaque. The child did not receive any immunization. If you suspect that lesion to be a pseudomembrane caused by diphtheria and decide to do further lab workup, what medium will you use to culture your throat swab?
a. Bordet Gengou agar
b. Blood agar plate
c. Lowenstein Jensen agar
d. Loeffler’s agar slant
D
31
Hemolytic activity is observed in several respiratory microorganizms that contributes to the identification. Which of the following has the correct relationship?
a. alpha hemolysis: complete lysis
b. beta hemolysis: partial lysis
c. gamma hemolysis: no lysis
d. kappa hemolysis: partial lysis
C
32
The Quellung test is used to demonstrate the capsule of bacteria Which of the following will show a positive reaction to the anti-capsular serum?
a. Hemophilus influenzae type b
b. Streptococcus epidermidis
c. Mycobacterium tuberculosis
d. Enterococcus
A
33
Paragoniums is
a. A lung nematode
b. A lung trematode
c. A lung fluke
d. A lung protozoan
B, C
34
True about Paragonimus:
a. The infective stage is the metacercaria
b. Fish serve as intermediate hosts.
c. Definitive diagnosis of the disease caused by this organism is through CXR
d. The disease caused by this organism can be diagnosed through an AFB smear
A
35
A characteristic of the Paragonimus egg:
a. Embryonated upon deposition
b. Hatch in the human stomach.
c. Operculated
d. Serves as the infective stage for humans
C
36
A behavior that places a person at risk for paragonimiasis:
a. Eating raw or undercooked aquatic vegetation
b. Eating raw or undercooked fish
c. Eating raw or undercooked snails
d. Eating raw or undercooked crabs
D
37
Mechanism by which the Paragonimus larvae reaches the human lungs
a. Carried by a reflux mechanism from the stomach upward to the esophagus and pharynx, reaching the trachea, and descending into the bronchi and lungs
b. Penetrated through the small intestinal wall into the peritoneal cavity, then through the abdominal wall and diaphragm into the lungs
c. Penetrate through the small intestinal wall, reaching the mesenteric venules and the arterial circulation, becoming deposited to the lungs
d. Penetrate through the rectal wall and perianal skin, reaching the capillaries and then the arterial circulation, becoming deposited in the lungs
B
38
A reasonable initial test for a patient suspected of having Paragonimus infection:
a. bronchoscopy with bronchoalveolar lavage
b. chest CT scan
c. Lung biopsy
d. stool exam
D
39
Drug of choice for the treatment of paragonimiasis
a. Praziquantel
b. Mebendazole
c. Sulfamethoxazole
d. Pyraquantel
A
40
Prevention and control measure against Paragonimus:
a. Inspection of crustaceans being sold in wet markets
b. Periodic mass drug administration in endemic areas
c. Proper food preparation
d. Snail control through the use of molluscicides
D, C
41
Mycobacterium tuberculosis infections are difficult to treat because the bacteria:
a. Multiply extremely fast
b. Are easily penetrated by beta-lactam antibiotics
c. Lie dormant for long periods
d. All are extracellular
e. Necessitates one weeks therapy.
C
42
Isoniazid
a. inhibits cell wall synthesis
b. promotes cell wall destruction
c. inhibits ribosomal protein syntehsis
d. inhibits mitochondrial ATP function
e. inhibits DNA synthesis
A
43
Adverse effects of isoniazid include the following EXCEPT:
a. Hepatotoxicity
b. Nephrotoxicity
c. Peripheral neuropathy
d. Seizures
e. Hemolytic anemia in G6PD deficiency
B
44
Which is a TRUE statement about both Ethambutol and Streptomycin
a. both drugs are nephrotoxic
b. both drugs have good oral absorption
c. both drugs are metabolized by the liver.
d. both drugs are given throughout TB treatment
e. both have poor penetration in the CSF
A
45
Which folic acid antagonist has anti-tb activity
a. Folinic acid
b. Para-aminosalysylic acid
c. para-hydroxybenzoic acid
d. Para-aminobenzoic acid
e. Para-aminohippuric acid
B
46
Indications for 2nd line anti-TB drugs include the ff except:
a. Documented resistance to 1st line agents
b. Failure of clinical response to 1st line agents
c. Serious ADRs to 1st line drugs
d. Non-tolerance of first line drugs
e. presence of concomitant bacterial infection
E
47
monotherapy with isoniazid
a. may be used for Hiv-positive patients who have evidence of infection but are asymptomatic
b. May be used for HIV-positive patients who also have symptoms of TB disease
c. May be used for children with evidence of TB disease
d. May be used fo post-exposure prophylaxis for healthy patients with history of TB
e. may be used for pre-exposure prophylaxis for healthy patients who are high risk for exposure
A
48
Combination therapy is necessary for TB treatment because:
a. natural resistance to isonaizid exists in patients
b. There are different bacterial populations with different metabolic acitivity
c. Intracellular and extracellular populations of bacteria provide different susceptibilities
d. all of the above
e. none of the above
D
49
Which of the following is FALSE of pneumonia?
a. An abnormal condition of the lung characterized by inflammation of the lung parenchyma with abnormal alveolar filling with fluid
b. An infection of the pulmonary parenchyma caused by bacteria, virus, parasites, or fungi
c. Major cause of hospital admission in many countries worldwide
d. Risk factors include age > 65 yrs old, alcoholism, asplenia, malnutrition, and previous history of pneumonia
e. None of the above
E
50
Which of the following etiologies of pneumonia are true?
a. Measles is an important pathogen causing pneumonia in the elderly and debilitated
b. Typical pneumonia is usually caused by bacteria such as Streptococcus pyogenes, Heamophilus influenzae, and Moraxella catarrhalis
c. Atypical pneumonia is usually attributed to Mycoplasma pneumonia, Chlamydophilia pneumonia, and legionella spp
d. Staphylococcus epidermidis is an important pathogen causing pneumonia in the ICU
e. None of the above
C
51
Sputum studies are part of the diagnostic armamentarium for pneumonia. What are the minimum requirements of a good sputum speicmen?
a. The Gram stain must have >10 polymorphonuclear cells and 25 polymorphonuclear cells and 10 polymorphonuclear cells and 25 polymorphonuclear cells and
D
52
The etiologic agent/s most commonly seen in low risk CAP
a. Streptococcus pneumonia
b. Hemophilus influenza
c. Moraxella catarrhalis
d. Mycoplasma pneumonia
e. AOTA
E
53
Which of the following is TRUE for the empiric treatment of pneumonia in adults?
a. Low-risk CAP with no comorbidities - Co-amoxiclav
b. Low risk CAP with stable comorbidities - amoxicillin
c. Moderate risk CAP - 2nd or 3rd generation cephalosporins and macrolide
d. High risk CAP with no risk for Pseudomonas - meropenems and macrolide
e. Moderate risk CAP - ertapenem and macrolide
C
54
A 62y/o male admitted for complicated acute pancreatitis. His initial CXR was normal. On the 5th HD, he developed fever and increase in yellowish respiratory secretions, CXR now showed lung infiltrations in both bases. He rapidly deteriorates and needed to be on mechanical ventilation. This case can be best described as:
a. Low risk CAP
b. Moderate risk CAP
c. High risk CAP
d. Nosocomial pneumonia
e. Ventilator-associated pneumonia
D
55
Etiologic agents for nosocomial pneumonia include:
a. Pseudomonas aeruginosa
b. Staphylococcus aureus
c. Streptococcus aureus
d. All except C
e. AOTA
E
56
Which of the following is TRUE for preventive measures for pneumonia
a. The pneumococcal vaccine is indicated for smokers and asthmatics persons
b. The influenza vaccine is indicated for patients with chronic medical illnesses
c. Smoking cessation should be advised to all patients
d. Handwashing is the most important measure in preventing nosocomial pneumonia.
e. AOTA
E
57
Common pathogens of CAP in children 1-12 months of age:
a. streptococcus pneumoniae
b. haemophilus influenzae
c. respiratory viruses
d. A and C only
e. AOTA
E
58
A patient with no previous history of immunization with fever, membranous pharyngitis with sore throat, cervical lymphadenopathy, and edema of the surrounding soft tissues (bull-neck appearance). The management of this patient consists of:
a. steroids and nebulized epinephrine
b. iv antibiotics
c. iv antibiotics and surgical drainage
d. iv antibiotics and antitoxin
e. intubation and suctioning
D
59
A 4-year old boy with a one-day history of high grade fever, throat pain and a muffled voice was brought to the ER due to respiratory distress. He appears toxic, refused to lie down and preferred to sit with his head forward, neck extended and mouth open. He is observed to have stridor and drooling of saliva.
a. give oxygen support and intubate
b. give oxygen and administer Paracetamol for fever
c. have the patient lie down to better examine the oral cavity
d. give oxygen and suction the mouth to clear the oral secretions
e. do cbc and start iv antibiotics
A
60
Which of the following signs and symptoms will BEST predict the presence of pneumonia in children less than 5 yrs old and has cough?
a. fever and crackles on auscultation
b. high fever and tachypnea
c. tachypnea and/or chest indrawing
d. recurrent cough and colds
e. high fever and chest indrawing
C
61
The following should NOT be routinely given to prevent community acquired pneumonia, EXCEPT:
a. vitamin C
b. vitamin A
c. vaccines against measles, varicella, mumps, influenza, Heamophilus
d. probiotics
e. A and C
C
62
The following are true for Acute Laryngotracheobronchitis, EXCEPT:
a. it is the msot common infectious cause of acute upper airway obstruction in children
b. it is commonly caused by respiratory viruses
c. a gray adherent membrane can be found in the larynx
d. There is subglottic narrowing and on radiograph of the neck, the “steeple sign” can be seen.
e. Management is supportive and steroids can be beneficial
C
63
The following are TRUE for Acute Bronchiolitis, EXCEPT:
a. Mostly caused viruses
b. Can present with tachypnea, chest retractions and wheezing
c. Treatment is supportive and consists of humidified oxygen, adequate hydration and bronchodilators in the presence of wheezing
d. Chest radiograph would usually reveal areas of consolidation and pneumoatocoeles.
e. More common in children less than 2 years of age.
D
64
Antibiotic Therapy is indicated in the following Acute Upper Airway Infections, EXCEPT:
a. Epiglottis
b. Tracheitis
c. Diphtheria
d, Laryngotracheobronchiolitis
e. Retropharyngeal Abscess
D
65
According to the 2009 International Standards for Tuberculosis CAr, what is the best diagnostic test for tuberculosis?
a. Chest radiograph taken in two views
b. Sputum AFB smear
c. SPutum culture for TB
d. Biopsy of affected tissue
e. Molecular probe for TB
B
66
34/F, came to you for chronic cough with hemoptysis. He had a CXR taken a year ago for which she was diagnosed to have PTB. She was started with unrecalled meds from a health center and was advised monthly follow-up She felt better after 2 months and she was subsequently lost to follow-up. What is your best next step?
a. admit her to ensure good compliance to anti-TB meds
b. resume first-line anti-TB meds from where she discontinued
c. refer her to centers which can cater for MDR TB
d. refer to a pulmonologist or infectious disease specialist
e. start fluoroquinolone with first line anti-TB drugs:
C
67
the two most potent first line anti-TB drugs:
a. Pyrazinamide and rifampicin
b. Isoniazid and pyrazinamide
c. Rifampicin and isoniazid
d. Isoniazid and streptomycin
e. Rifampicin and ethambutol
C
68
A 40/M had chronic cough. He had two sputum smears done revealing results of negative and +1. What regimen will you recommend?
a. 9HR
b. 2HRZ/4HZ
c. 2HRZE/4HRE
D. 2HRZ/4HR
E. 2HRSE/4HR
D
69
The criteria for the initial diagnosis of sputum negative PTB are the following except?
a. at least 2 negative sputum smears (including at least 1 early morning specimen)
b. lack of response to trial of broad spectrum antimicrobial agents
c. CXR finding consistent with TB
d. Sputum culture negative for M TB
e. response to empiric treatment with anti-tb medication
D
70
In an asymptomatic HIV positive individual with a PPD reaction of 12mm and a normal CXR, what will you offer?
a. Advice annual CXR for monitoring
b. advise healthy and safe lifestyle
c. isoniazid for 9 months
d. start 2HRZE/4HR
e. give trimethoprim/sulfamethazole for prophylaxis
C
71
The following individuals are priority for contact investigation?
a. children especially less than 5 years old
b. adults living with a smear (+) patients
c. adults living with patients on a 6 months standard treatment
d. foreigners living with filipinos
e. those in crowded living conditions
A
72
according to the 2009 international standards for TB care. what is the most reliable test to diagnose TB pleural effusion?
a. pleural effusion cytology
b. pleural effusion TB PCR
c. pleural effusion AFB smear
d. pleural effusion TB CS
e. pleural effusion adenosine deaminase
D
73
the following statements are true regarding the PPD skin test except?
a. it should be positive in immunocompetent patients after successful treatment of TB disease
b. it should be positive in patients with TB exposure
c. it should be positive in patients with TB infection
d. it should be positive in patients with TB disease
B
74
a pediatric patient can be considered to have TB disease in the following clinical settings, except
a. fine needle aspiration biopsy of patient’s cervical lymph nodes positive for Langhan’s giant cell
b. mother recently diagnosed to have sputum AFB (+) smear
c. patient has positive gastric aspirate AFB smear
d. PPD positive result in an adolescent patient with apical respiratory lesion on CXR.
B
75
Which of the following treatment regimens is appropriate?
a. INH for 6 months for latent TB infection
b. INH for 6 months for TB disease
c. INH for 9 months for latent TB infection
d. INH and Rifampicin for 6 months as tx for PTB
C
76
True regarding the transmission of TB in pedia 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 congenital TB
d. ingestion of unpasteurized milk can lead to GI TB
B
77
Which of the following statements is true about about TB in children?
a. Casual contacts are an important sources of infection
b. Children under 5 years in exposure stage should be treated to prevent rapid dev‘t of disseminated or meningeal TB
c. Extrapulmonary TB occurs more often in adults than in children
d. Children harbor a significant bacillary load in their endobronchial secretions.
B
78
Treatment of TB infection in children is important because of the following, EXCEPT:
a. the child infected with TB constitutes a long lasting reservoir in the population
b. the child with TB infection contributes significantly to transmission to his household members
c. TB infection can progress to disease, thus prophylaxis is required
d. Partially healed by dormant infections can be reactivated when the child is exposed to stressful condition
B
79
According to Wallgren’s timetable of TB:
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
80
For the treatment of TB in children:
a. Pulmonary TB is usually treated with a 6 months course
b. Bone and joint is usually treated with a 9 months course
c. TB meningitis responds well to a 12 month course
d. AOTA are correct
D
81
most common type of lung CA that most often occurs to nonsmokers or former smokers and typically presents as peripheral lesions with a high propensity to metastasize.
a. Small Cell CA
b. Non-small Cell CA
c. Adenocarcinoma
C
82
Hoarseness in lung cancer patients is usually caused by:
a. Compression of the recurrent laryngeal nerve
b. Compression of the laryngeal folds
c. Laryngeal edema associated with pursed breathing
d. obstruction of the trachea
e. Compression of a main bronchus
A
83
Which diagnostic modality is best to obtain tissue for a peripherally located lung mass
a. Sputum cytology
b. Bronchoscopy
c. CT guided aspiration biopsy
d. MRI assisted biopsy
e. Video-assisted thoracoscopy
C
84
Which of the following is a case of Stage IV disease?
a. 60 year old female with a 3x4 cm right lower lung mass with no lymph nodes or distant metastases
b. 60-year old male with 2x2 mass in the left upper lobe and a single subcarinal lymph node with no other lesions
c. 65 year old man with a 2x2 cm mass in the right upper lobe and several right peribronchial nodes
d. 65 year old male with a 1x1 cm nodule in the left upper lung lobe with no lymph nodes but with a small nodule in the right lower lobe
e. 60-year old female with a 6x4 cm mass on the right upper lobe and a 4x2 right supraclavicular lymph node.
D
85
Recommended treatment for Stage I non-small cell lung cancers:
a. Radiotherapy
b. Concurrent chemo-radiotherapy
c. Chemotherapy
d. Surgery
e. Surgery with adjuvant chemotherapy
D
86
Limited stage small cell lung cancer is characterized by
a. contralateral pleural effusion
b. disease extent safely encompassed within a tolerable radiation field
c. metastasis to a solitary distant site
d. ipsilateral supraclavicular lymphadenopathy
e. pericardial effusion
B
87
Treatment objectives for stage II lung cancer
a. cure
b. control local disease
c. increase length of survival
d. palliation
A
88
Treatment objective for Stage IV Lung Cancer
a. Cure
b. Control local disease
c. Increase length of survival
d. palliation
e. Better quality of life
D, E
89
Which of the following is a component of Light’s criteria in diagnosing an exudative pleural effusion?
A. Pleural Fluid albumin / Serum albumin > 0.5
B. Pleural fluid LDH more than 1000 mg/dl
c. Pleural fluid more than two-thirds the upper limit of normal
d. Pleural fluid protein / serum protein > 0.5
e. Pleural fluid LDH / serum LDH > 0.5
C
90
Which of the following is an etiology for an exudative pleural effusion?
a. Cirrhosis
b. Nephrotic Syndrome
c. Hypoalbuminemia
d. Peritoneal dialysis
e. Pneumonia
E
91
A 60y/o F consulted for 1 wk Hx of fever, cough and dyspnea. Her CXR showed pleural effusion on the right. Chest CT scan showed the fluid to be occupying half of the chest cavity. A thoracentesis was done which yielded purulent fluid. The correct management should be:
a. Give antibiotics and observe patient
b. Perform tube thoracostomy
c. Perform VATS (Video Assisted thoracoscopic surgery)
d. Perform open thoracostomy
e. None
B
92
The following are chest PE findings CONSISTENT with tension pneumothorax
a. Ipsilateral chest lag, decreased ipsilateral breath sounds, trachea midline
b. ipsilateral chest lag, decreased ipsilateral breath sounds, trachea shifted contralaterally
c. ipsilateral chest lag, decreased ipsilateral breath sounds, trachea shifted ipsilaterally
d. Contralateral chest lag, decreased ipsilateral breath sounds, trachea shifted contralaterally
e. Contralateral chest lag, decreased ipsilateral breath sounds, trachea shifted ipsilaterally
B
93
A 20y/o M complained of sudden dyspnea and chest pain prompting consult at the ER. His CXR showed a pneumothorax on the right amounting to around 30%. The correct management should be:
a. Observe patient
b. Perform tube thoracostomy
c. Perform VATS
d. Perform open thoracostomy
e. Needle Aspiration
B
94
Which of the following anterior mediastinal tumors is benign?
a. Seminoma
b. Mature teratoma
c. Endothelial sinus tumor
d. Yolk sac tumor
e. None
B
95
The tumor Alpha Feto Protein may be positive in which of the following anterior mediastinal tumors?
a. Mature teratoma
b. Choriocarcinoma
c. Endothelial Sinus Tumor
d. Thymoma
e. Intrathoracic Goiter
C
96
Pulmonary Hypertension is defined as a pulmonary arterial systolic pressure of:
a. >10mmHg
b. > 15 mm Hg
c. > 20 mm Hg
d. > 25 mm Hg
e. > 30mm Hg
E
97
Cor pulmonale usually show as enlarged pulmonary segment on chest xray of:
a. > 14mm
b. > 16mm
c. > 18mm
d. > 20mm
e. > 22mm
B
98
The most common cause of Cor pulmonale
a) Congenital heart disease
b) Chronic obstructive pulmonary disease
c) Chronic interstitial lung disease
d) Sleep disordered breathing
e) Chronic exposure to high altitude
B
99
Which of the following is NOT a strategy for the management of Cor pulmonale?
a) oxygen therapy
b) Anticoagulation
c) Low salt diet
d) Low fat diet
e) Avoidance of pregnancy
D
100
Which of the following is a risk factor for venous thromboembolism?
a) Ankle fracture
b) Bed rest
C
101
Which of the following in the management of pulmonary embolism is TRUE?
a) Treatment should be considered in patients with a high clinical suspicion of pulmonary embolism prior to awaiting results of diagnostic workup.
b) D-dimer is an excellent screening tool for patients with high clinical suspicion of pulmonary embolism because it has excellent sensitivity.
c) D-dimer is used in patients with a high clinical suspicion of pulmonary embolism because it has excellent specificity.
d) Ventilation/Perfusion Scanning is the preferred imaging modality for patients with a high clinical suspicion for pulmonary embolism.
e) Pulmonary angiography is indicated in all patients with high clinical suspicion for pulmonary embolism.
A
102
True of the management of pulmonary embolism
a) Fluid administration and vasopressors are indicated in hemodynamically unstable patients
b) Insertion of an IVC filter is indicated in all cases to prevent further embolism
c) Anticoagulation cannot be resumed once contraindications to its use have resolved
d) Thrombolytic therapy is indicated if there are contraindications to anticoagulant use
e) Surgical embolectomy is foremost in the management of patients with right ventricular dysfunction
A
103
Which is TRUE in the prophylaxis for venous thromboembolism
a) A single prophylactic dose of LMWH is indicated in patients with high risk for VTE taking flights >8 hours.
b) Most patients in the ICU will need prophylaxis against VTE.
c) Mechanical prophylaxis is primarily used in patients with high bleeding risk.
d) Properly fitted, below the knee, graduated compression stockings with a pressure of 15-30 mm Hg at the ankle is the primary method of mechanical prophylaxis recommended.
e) All are true.
E
104
Which of the following is TRUE regarding interstitial Lung Diseases
a) Interstitial lung disease is a homogenous group of disorders classified together because of their similar clinical, radiologic, and pathologic manifestations.
b) Symptoms include episodic dyspnea or non-productive cough
c) A complete history reliably provides the diagnosis.
d) Spirometry may be normal or may reveal a restrictive ventilatory pattern
e) Physical examination shows prominent wheezes.
D
105
Which of the following is TRUE on the workup of Interstitial Lung Diseases
a) Lung biopsy is a key element in the diagnosis of some ILDs
b) Transbronchial biopsy may be performed and may be useful in centrilobular diseases
c) It is preferable to biopsy the unaffected lung
d) Biopsy may not be necessary when clinical assessment and HRCT features are characteristic of a particular disease
e) All are true
E
106
The following are risk factors for idiopathic Pulmonary Fibrosis EXCEPT
a) Cigarette smoking
b) Exposure to birds
c) Exposure to dust from metals
d) Farming
e) All are true
E
107
Which of the following is NOT involved in the pathogenesis of Idiopathic Pulmonary Fibrosis?
a) Repeated stimulus leads to sequential lung injury
b) Sequential lung injury induces inflammation
c) Environmental and genetic factors influence the inflammatory response
d) TH1 and TH2 imbalance leads to aberrant wound healing
e) Inflammation leads to fibrosis
E
108
Which is/are needed in eliciting a good occupational history?
a) Cumulative exposure
b) Timing of exposure
c) Physical nature of exposure
d) Additional sources of exposure
e) All of the above
E
109
Which of the following is NOT a common characteristic of occupational lung diseases?
a. They are caused by a workplace exposure
b. They are aggravated by a workplace exposure
c. They are characterized by normal physical findings
d. They are not preventable
e. They are potentially compensable
D
110
What is the most common malignancy associated with asbestos exposure?
a. lung carcinoma
b. malignant mesothelioma
c. pleural plaques
d. rounded atelectasis
e. diffuse pleural thickening
A
111
Which of the following are criteria for the diagnosis of coal worker’s pneumoconiosis
a. a consistent CXR
b. a work history with sufficient exposure to coal
c. a history with sufficient latency after exposure
d. absence of other illness with may explain patients presentation
e. AOTA
E
112
Most potent stimulus for wakefulness
a. music
b. Light
d. noise
d. emotion
B
113
The sleep center of the brain regulates sleep and wakefulness during night and day and is located at the
a. suprachiasmatic nucleus
b. supraoptic nucleus
c. paraventricular nucleus
d. red nucleus
A
114
To have a restorative sleep, one must go through which phases of sleep?
a. N1 and N2
b. N2 and N3
c. N1 and REM
d N3 and REM
D
115
An Epsworth Sleepiness Scale score of ___ is associated with excessive daytime sleepiness.
a. 8
b. 9
c. 10
d. 11
C, D
116
What does AHI mean?
a. Apnea-hypopnea index
b. Apnea-hypercapnic index
c. Asleep- Hypopnea index
d. Apnea- hyperpnea
A
117
What AHI score reliably diagnosis sleep disordered breathing
a. 3
b. 5
c. 8
d. 10
B
118
what is the modality that reliably diagnose Obstructive sleep apnea
a. Epsworth Sleepiness Scale
b. Electroencephalogram
c. Pulse oxymetry
d. Polysomnograph
D
119
What is the treatment of choice for obstructive sleep apnea?
a. Continuous Positive Pressure Ventilation
b. Uvulopaltopharyngoplasty
c. Oral airway devices
d. Tonsillectomy
A
120
53 yo male, hypertensive came in for chest pain dyspnea BP 180/100 HR 105, RR 28/min with neck vein engorgement and crackles all over, CXR one showed pulmonary edema. what is the main mech causing his p. edema?
a. leaky alveolocapillary membrane
b. increased plasma oncotic pressure
c. increased capillary hydrostatic pressure
d. increased lymphatic circulation
C
121
What radiologic finding is expected due to edema at the interlobular septa?
a. peribronchial cuffing
b. Kerley B lines
c. azygos vein dilatation
d. parihilar haziness
e. increased proportion in West’s zone 1
B
122
Pleural effusion experienced by patients with chronic kidney disease is
a. directly related to the level of serum creatinine
b. of urinary consistency
c. mainly due to cardiogenic pulmonary edema
d. lessened with regular dialysis
D
123
The most common non-infectious complication among patients with SLE is?
a. Pleuritis
b. diffuse alveolar damage
c. pulmonary hemorrhage
d. venous thromboembolism
e. alveolitis
A
124
A normal pregnancy usually causes the following normal physiologic changes, EXCEPT:
A. increased vital capacity
B. increased functional residual capacity
C. increased minute ventilation
D. increased tidal volume
A
125
Increased serum progesterone during pregnancy causes the following physiologic changes, EXCEPT:
A. increased central respiratory drive
B. increased minute ventilation
C. increased respiratory rate
D. increased sensitivity to PaCO2
C
126
Hepatopulmonary syndrome is a difficult disease to diagnose and is…
A. diagnosed when significant hypoxemia occurs in a cirrhotic patient with congenital heart failure
B. noted for the prominent peripheral vasoconstriction of the pulmonary vasculature
C. due to portosystemic shunting and increased nitric oxide circulation
D. deadly and irreversible even with liver transplantation
C
127
The hallmark for diffuse alveolar damage:
A. granuloma
B. nonspecific fibrosis
C. hyaline membrane
D. fluid-filled cavity
C
128
Histopathology of Desquamative Interstitial Pneumonitis:
A. diffuse alveolar damage
B. hyaline membrane formation
C. marked fibrosis
D. diffuse intra-alveolar macrophage accumulation
D
129
Histopathology of Cryptogenic Organizing Pneumonia:
A. plugs of granulation tissue in bronchioles
B. hyaline membrane formation
C. alveolar septal thickening
D. type II pneumocyte hyperplasia
A
130
True of Nonspecific Interstitial Pneumonias (NSIP):
A. changes are temporarily uniform
B. heterogenous appearance of inflammation
C. poor response to steroids
D. honeycomb common
A
131
Histologic type of malignancy usually seen in non-smokers:
A. small cell carcinoma
B. squamous cell carcinoma
C. bronchoalveolar carcinoma
D. large cell neuroendocrine carcinoma
C
132
Horner’s syndrome:
A. apical lung cancers in the superior pulmonary sulcus
B. enophthalmos, ptosis, miosis (blurring of vision) and ipsilateral anhidrosis (foreign body sensation)
C. prominent neck veins, edema of face and right upper extremity due to obstruction of the SVC
D. ectopic ACTH secretion
B
133
Which of the following is true of Squamous Cell Carcinoma of the Lung?
A. majority are peripherally located
B. majority have an endobronchial component
C. most are well-differentiated tumors
D. slower growth compared to adenocarcinomas
B
134
Which of the following is true of Pulmonary Adenocarcinomas?
A. they tend to metastasize early
B. most are centrally located
C. not commonly seen in non-smokers
D. grow rapidly
A
135
Neuroendocrine tumor with the worst prognosis:
A. typical carcinoid
B. small cell carcinoma
C. atypical carcinoid
D. papillary adenocarcinoma
B
136
This form of atelectasis occur when the pleural space is expanded by fluid or air:
A. contraction atelectasis
B. compressive atelectasis
C. reversible atelectasis
D. retraction atelectasis
B
137
Morphology of diffuse alveolar damage:
A. fibrin rich edema fluid
B. lipid remnants of necrotic epithelial cells
C. mucus material lining the alveolar walls
D. only A and B are correct
E. all are correct
D
138
A liver-like gross appearance of the lung with community acquired pneumonia is seen in this stage:
A. resolution
B. grey hepatization
C. red hepatization
D. congestion
C
139
Morphology of atypical pneumonia include:
```
A. patchy or lobar areas of congestion without consolidation
B. mononuclear infiltrates
C. fibrosis in the interstitium
D. all are correct
E. only B and C are correct
```
D
140
Which of the following is not a bronchodilator?
```
A. Theophylline
B. Salmeterol
C. Montelukast
D. Ipatropium bromide
E. Doxyfelline
```
C
141
The most common sleep disorder leading to chronic hypoventilations
a. Narcolepsy
b. Obstructive sleep apnea
c. COPD in somethin
d. Insomnia
e. Parasomnia
B
142
Which of the following presents with dyspnea Unilateral Dullness upon percussion?
```
A. Pneumonia
B. CHF
C. ILD
D. Pneumothorax
E. COPD
```
A
143
Which of the ff findings indicate a patient with COPD?
A. FEV1/FVC 70%, FEV1 decreased, FVC decreased, TLC increased, (-) response to bronchodilators
D.FEV1/FVC > 70%, FEV1 increased, FVC increased, TLC decreased, (-) response to bronchodilators
E. FEV1/FVC
B
144
The only lung acting muscarinic antagonist that is currently available in the market?
```
A. Ipratropium bromide
B. Montelukast
C. Doxatyline
D. Tiotropium
E. Oxitropium
```
D
145
Which is a false statement about both rifampicin and isoniazid
A. Both hepatotoxic
B. Both given during the intensive phas
C. Both penetrate the blood brain barrier well
D. Both may cause hyperuricemia
E. Both are active against intracellular bacteria
D
146
Patients who present with the ff sign are most likely to develop respiratory distress:
```
A. Wheezing
B. Tachypnea
C. Retractions
D. Normal or elevate PCO2 levels in a patient in severe distress
E. Tachycardia
```
D
147
What is the most common radiographic presentation of viral pneumonias?
A. Bilateral parahilar infiltrates
B. Lower lobe consolidation
C. Middle lobe atelectasis
D. Upper lobe nodular infiltrates
A
148
Which radiologic manifestation of primary PTB is seen in majority of cases
A. Ghon’s Focus
B. Lymphadenopathy
C. Lymphangitis
D. Pleural Effusion
B
149
Single pulmonary nodule with spiculated margins
A. Localized pleural effusion
B. Primary pulmonary malignancy
C. Round pneumonia
D. Tuberculoma
B
150
COPD combined assesment… is most related to?
A. 2 or more COPD exacerbations in 12 month span is an indicator
B. MMR(British Scoring) is > 10
C. CAT must be regularly taken to determine changes in COPD function
D. COPD is FEV
A
151
Which of the following is a case of stage IV disease?
a. 60F, 5x5 cm R lower lung mass, N0 or distant metastases
b. 39M, 1x1 cm nodule in the left upper lung lobe, N0 but with a small nodule in the left adrenal gland
c. 58M, 2x2 cm mass in the leeft upper lobe and a single subcarinal lymph node with no other lesions
d. 45M, 1x1 cm right upper lobe and several right peribronchial nodes
e. 30F, 6x4 cm, right upper lobe and a 4x2 right supraclavicular lymph node
B
152
The normal respiratory rate of a 4 year old child?
A. < 30 breaths/min
B. < 50 breaths/min
D. <60 breaths/min
B
153
The most common cause of cor pulmonale in more than 80% of cases is
```
A. Chronic Idiopathic Lung Disease
B. Sleep disordered breathing
C. COPD
D. Chronic exposure to high altitude
E. Congenital heart disease
```
C
154
Histopathology of desquamative Interstitial pneumonitis
A. Diffuse Alveolar Damage
B. Hyaline Membrane formation
C. Marked fibrosis
D. Diffuse Alveolar Macrophage accumulation
D
155
Histopathological finding of Cryptogenic
```
Organizing Pneumonia
a. Plugs of granulation tissue
b. Hyaline membrane formation
C. Alveolar septal wall thickening
D. Type II pneumocyte hyperplasia
```
A
156
Non-specific interstitial pneumonia
A. Changes are temporally uniform
B. Heterogenous appearance of infiltrates
C. Poor response to steroids
D. Honeycomb formation
A
157
Histological type usually seen in non-smokers
A. Small cell lung carcinoma
B. Squamous cell carcinoma
C. Bronchoalveolar carcinoma
D. Large cell neuroendocrine carcinoma
C
158
True of squamous cell carcinoma:
A. Most are peripheral
B. Most have endobronchial involvement
C. Majority are well-differentiated
D. Slower growth compared to adenocarcinoma
B
159
True of adenocarcinoma:
A. Metastasize early
B. Not common to non-smoker
C. Grow rapidly
A
160
True of septic infarcts:
A. Common in large emboli
B. Result in respiratory compromise but not hemodynamic compromise
C. With accompanying neutrophilic inflammatory reaction
D. White infarcts
C
161
Acute Mediastinitis
a. Anterior
B. Posterior
C. Superior
D. Middle
B
162
Mutations in this gene allow for Pulmonary hypertension to occur
A. TGF-Beta
B. BMPR2
C. Modifier gene
D. COX
B
163
Which thymic lesion has preserved thymic architecture?
A. Thymic dysplasia
B. True thymic hyperplasia
C. Thymic follicular hyperplasia
D. Thymoma
B
164
Most common mediastinal tumor
A. invasive ductal CA
B. Malignant Melanoma
C. Undifferentiated CA of the NP?
D. Small cell undifferentiated ca of the lung
D
165
The most commonly done chest X-ray, routine
A. Chest PA
B. Apicolordotic
C. Lateral decubitus
D. Chest AP
A
