Samplex 2017 Flashcards
Function of respiratory system which is most reflected by PaO2 values:
a. ventilation b. perfusion c. body metabolism d. gas exchange e lung defense
D
Function of respiratory system most reflected by paCo2 values
a ventilation b. perfusion c. body metabolism d. gas exchange e. lung defense
A
what is the most common cause of hypoxemia?
a hypoventilation b. shunt c. v/q mismatch d. diffusion defect e. decrease inspired oxygen
C
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
C
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
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%
E
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
D
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
D
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
B
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
C
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
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
B
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
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
C
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
C
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
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
B
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.
B
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
E
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.
C
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.
C
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.
B
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.
B
What is the most common cause of lung abscess?
A. Alcoholism B. Bulbar dysfunction C. Esophageal dysmotility D. Aspiration E. Seizure disorders
D
The major human receptor of Rhinovirus is
A. polymorphonuclear cells
B. intracellular adhesion molecules
C. macrophages
D. epithelial cells
B
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
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
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
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
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
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
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
Paragoniums is
a. A lung nematode b. A lung trematode c. A lung fluke d. A lung protozoan
B, C
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
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
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
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
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
Drug of choice for the treatment of paragonimiasis
a. Praziquantel b. Mebendazole c. Sulfamethoxazole d. Pyraquantel
A
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
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
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
Adverse effects of isoniazid include the following EXCEPT:
a. Hepatotoxicity b. Nephrotoxicity c. Peripheral neuropathy d. Seizures e. Hemolytic anemia in G6PD deficiency
B
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
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
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
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
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
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
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
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
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
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
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
Etiologic agents for nosocomial pneumonia include:
a. Pseudomonas aeruginosa b. Staphylococcus aureus c. Streptococcus aureus d. All except C e. AOTA
E
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
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
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
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
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
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
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
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
Antibiotic Therapy is indicated in the following Acute Upper Airway Infections, EXCEPT:
a. Epiglottis b. Tracheitis c. Diphtheria d, Laryngotracheobronchiolitis e. Retropharyngeal Abscess
D
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
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
