Internal Medicine/ Respiratory
I.
Common Respiratory Presentations.
1. Clubbing.
***) All
of the following are the causes of clubbing of fingers, except:
A.
Subacute bacterial endocarditis
B.
Pulmonary abscess
C.
Emphysema
D.
Hepatic cirrhosis
E.
Ulcerative colitis
Answer: C* Emphysema
***) All
of the following are the causes of clubbing of fingers, except:
A.
Bronchiectasis
B.
Crohn's disease
C.
Pulmonary embolism
D.
Infective endocarditis
E.
Fibrosing alveolitis
Answer: C* Pulmonary embolism
***) All
of the following are the causes of clubbing of fingers, except:
A.
Bronchogenic carcinoma
B.
Rheumatoid arthritis
C.
Tetralogy of Fallot
D.
Lung fibrosis
E.
Mesothelioma
Answer: B* Rheumatoid arthritis
***) Finger
clubbing is a recognized feature of all the following, except:
A.
Bronchiectasis
B.
Aortic aneurysm
C.
COPD
D.
Infective endocarditis
E.
Crohn's disease
Answer: C* COPD
2. Hemoptysis.
***) Hemoptysis
is commonly associated with all of the following, except:
A.
Bronchiectasis
B.
Bronchial carcinoma
C.
Uncomplicated bronchial asthma
D.
Mitral stenosis
E.
Pulmonary infarction
Answer: C* Uncomplicated bronchial
asthma
***) All
of the following can cause hemoptysis, except:
A.
Pneumonia
B.
Mitral prolapse
C.
Tuberculosis
D.
Lung trauma
E.
Goodpasture's syndrome
Answer: B* Mitral prolapse
***) Hemoptysis
may be seen in all of the following, except:
A.
Bronchial adenoma
B.
Mitral stenosis
C.
Bronchogenic carcinoma
D.
Uncomplicated bronchial asthma
E.
Tuberculosis
Answer: D* Uncomplicated bronchial
asthma
***) Hemoptysis
may result from all of the following, except:
A.
Pulmonary tuberculosis
B.
Aspergilloma
C.
Cryptogenic fibrosing alveolitis
D.
Bronchial adenoma
E.
Pulmonary infarction
Answer: C* Cryptogenic fibrosing
alveolitis
***) Hemoptysis
is not a feature of:
A.
Bronchitis
B.
Idiopathic pulmonary hemosiderosis
C.
Cystic fibrosis
D.
Goodpasture's syndrome
E.
Asbestosis
Answer: B* Idiopathic pulmonary
hemosiderosis
***) All
of the following diseases are well known causes of massive hemoptysis, except:
A.
Tuberculosis
B.
Bronchiectasis
C.
Idiopathic pulmonary fibrosis
D.
Acute pneumonia
E.
Mitral stenosis
Answer: C* Idiopathic pulmonary
fibrosis
II.
Respiratory Investigations.
1. Lung Anatomy.
***) Regarding
the right main bronchus, all the following are correct, except:
A.
It is longer and wider than the left bronchus
B.
It extends from the carina down to the origin of middle lobe bronchus
C.
Its structure is identical of trachea
D.
The right upper lobe bronchus leaves the main bronchus outside the
hilum
E.
It is more vertical than the left
Answer: A* It is longer and wider than
the left bronchus
2. Chest X-Rays.
***) Regarding
chest X-Ray all are true except:
A.
Routine CXR is done in A-p view with full inspiration
B.
Right done of diaphragm is seen at the level of 6th anterior
rib
C.
Visceral pleura cover the lung
D.
Right hilum is usually lower than the left
E.
Pneumothorax appears radiolucent
Answer: A* Routine CXR is done in A-p
view with full inspiration
3. Arterial Blood Gases.
***) Which
of the following ranges of hemoglobin saturation in arterial blood:
A.
40 – 97 %
B.
26 – 75 %
C.
75 – 97 %
D.
40 – 75 %
E.
60 – 90 %
Answer: C* 75 – 97 %
III.
Respiratory Diseases.
1. Pneumonia.
***) Rusty
sputum is characteristic of: Q2012
A.
Pneumococcal
pneumonia
B.
Lung
abscess
C.
Tuberculosis
D.
Coal
worker pneumoconiosis
E.
Lung
cancer
Answer: A* Pneumococcal pneumonia
***) The
most common cause of pneumonia is:
A.
Staphylococcus aureus
B.
Mycoplasma pneumonia
C.
Haemophilus influenza
D.
Streptococcus pneumonia
E.
Influenza A virus
Answer: D* Streptococcus pneumonia
***) The
most common cause of pneumonia in children is:
A.
Adenovirus
B.
Staphylococci pneumonia
C.
Streptococci pneumonia
D.
H.influenza type B
E.
Mycoplasma
Answer: B* Streptococci pneumonia
***) All
of the following conditions may cause aspiration pneumonia, except:
A.
Gastroesophageal reflux
B.
Achalasia
C.
Phrenic nerve palsy
D.
Werdnig-Hoffman disease
E.
Tracheo-esophageal fistula
Answer: D* Werdnig-Hoffman disease
***) Clinical
signs consistent with lobar pneumonia include all the following, except:
A.
Reduced chest movement
B.
Whispering pectoriloquy
C.
Pleural rub
D.
Deviation of the trachea
E.
Bronchial breathing
Answer: D* Deviation of the trachea
***) Regarding
viral pneumonia, one of the following is correct:
A.
Influenza virus group C can cause epidemics in human
B.
Amantadine is an effective medication for swine flue
C.
H1N1 virus is transmitted mainly through milk
D.
Viral pneumonia is more common than bacterial pneumonia
E.
Specific radiological findings is characteristic for viral pneumonia
Answer: A* Influenza virus group C can
cause epidemics in human
***) Regarding
atypical pneumonia all are true except:
A.
The organism is mycoplasma pneumonia
B.
Treatment with clarithromycin
C.
Positive cold agglutination test
D.
Presence of cell wall responsible for resistance of penicillin
E.
More common in school age children
Answer: D* Presence of cell wall responsible
for resistance of penicillin
2. Empyema & Lung Abscess.
***) The
most common complication of lung abscess is:
A.
Pneumothorax
B.
Empyema
C.
Broncho-pleural fistula
D.
Brain abscess
E.
Osteomyelitis of a rib
Answer: B* Empyema
***) All
of the following may be causes of empyema, except:
A.
Osteomyelitis of rib
B.
Pneumonia
C.
Perforation of the esophagus
D.
Subphrenic abscess
E.
Primary
Answer: E* Primary
3. Bronchiectasis.
***) Any
of the following may be commonly found in patients with bronchiectasis, except:
A.
Clubbing of fingers
B.
Lung crepitations
C.
Absence of sputum
D.
Hemoptysis
E.
Pulmonary hypertension
Answer: C* Absence of sputum
4. Cystic Fibrosis (CF).
***) Routine
management in cystic fibrosis includes all of the following, except:
A.
Gluten free diet
B.
Pancreatic preparations
C.
Regular physiotherapy
D.
Vitamins supplementation
E.
Low fat diet
Answer: A* Gluten free diet
5. Lung Tumors.
***) The
commonest symptom of bronchial carcinoma is:
A.
Cough
B.
Chest pain
C.
Cough and pain
D.
Coughing blood
E.
Weight loss
Answer: A* Cough
***) Concerning
carcinoma of bronchus, one of the following is not true:
A.
It may lead to recurrent laryngeal nerve palsy
B.
Cigarette smoking is predisposing factor
C.
Squamous cell carcinoma is the most common type
D.
Clubbing is not a feature of bronchial carcinoma
E.
Pancoast tumor is a peripheral type occurring at the apex of the lung
Answer: D* Clubbing is not a feature of
bronchial carcinoma
***)
Pancoast tumor arises in:
A.
Apex of the lung
B.
Isthmus of the thyroid gland
C.
Body of the pancreas
D.
Appendix
E.
Pituitary gland
Answer: A* Apex of the lung
6. Asthma.
***) One of
the following differentiates the asthma from COPD: Q2012
A.
Hyperreactive
airways
B.
Variability
C.
Wheezes
D.
Hyperinflation
E.
Cough
Answer: B* Variability
***) All of
the following are signs of severe asthma, except: Q2012
A.
Silent
chest
B.
Low
PO2
C.
Loud
wheezy chest
D.
Pulsus
paradoxus
E.
Cyanosis
Answer: C* Loud wheezy chest
***) All of
the following are found in patient with bronchial asthma, except: Q2012
A.
Hyperinflated
chest
B.
Wheezing
C.
Dyspnea
D.
Clubbing
E.
Cough
Answer: D* Clubbing
***) All
of the following are components of airway obstruction in asthma, except:
A.
Mucous plugging
B.
Laryngospasm
C.
Inflammation of airways
D.
Bronchospasm
E.
Edema of airways
Answer: B* Laryngospasm
***) All
the following are typical components of bronchial asthma, except:
A.
Bronchospasm
B.
Stridor
C.
Edema of airways
D.
Mucus production
E.
Feeling of suffocation
Answer: B* Stridor
***) Acute
asthmatic attack may be precipitated by all of the following, except:
A.
Exercise
B.
Sudden change of air temperature
C.
Infection
D.
Paracetamol injection
E.
Crying
Answer: E* Crying
***) The
commonest symptom of bronchial asthma is:
A.
Cough
B.
Chest pain
C.
Coughing blood
D.
Chest infection
E.
Weight loss
Answer: A* Cough
***) Typical
attack of bronchial asthma consists of each of the following, except:
A.
Marked dyspnea
B.
Attacks of cough
C.
Expiratory wheezes
D.
Bradycardia
E.
Restlessness
Answer: D* Bradycardia
***) All
of the following are signs of severe asthma, except:
A.
CO2 retention
B.
Silent chest
C.
Respiratory alkalosis
D.
Pulsus paradoxus
E.
Cyanosis
Answer: C* Respiratory alkalosis
***) All
of the following are features of severe asthma, except:
A.
Tachycardia (more than 130 per min)
B.
Pulsus paradoxus (more than 30mm Hg)
C.
Hypercapnia
D.
Low PEEP (below 100 per min)
E.
Pulsus alternans
Answer: E* Pulsus alternans
***) All
of the following are signs of severe asthma, except:
A.
Inability to speak
B.
Tachycardia more or equal 120 beats per minute
C.
Silent chest
D.
Pulsus alternans
E.
PEEF below 150liters
Answer: D* Pulsus alternans
7. Management of Asthma.
***) The
following are useful in the treatment of a severe asthmatic attack, except:
A.
IV Aminophyllin
B.
Intravenous hydrocortisone
C.
Sodium cromoglycate
D.
Oxygen
E.
Inhaled Salbutamol
Answer: C* Sodium cromoglycate
***) All
of the following medications can be used in first step in the management of
bronchial asthma as a reliever therapy, except:
A.
Salbutamol
B.
Salmeterol
C.
Beclomethasone
D.
Fluticasone
E.
Leukotriene antagonist
Answer: E* Leukotriene antagonist
***) following
are considered as controller medications in Bronchial asthma management,
except:
A.
Inhaled gluco-corticosteroids
B.
Leukotriene modifiers
C.
Short-acting inhaled B2-agonists
D.
Systemic gluco-corticosteroids
E.
Theophylline
Answer: B* Leukotriene modifiers
***) All
of the following drugs could be used in controlling acute attacks of bronchial
asthma, except:
A.
Adrenaline
B.
Aminophyllin
C.
Ketotifen (Zaditen)
D.
Ephedrine sulfate
E.
Salbutamol
Answer: C* Ketotifen (Zaditen)
***) All
of the following drugs could be used in controlling acute attacks of bronchial
asthma, except:
A.
Aminophyllin
B.
Ketotifen (Zaditen)
C.
Adrenaline
D.
Salbutamol
E.
Corticosteroids
Answer: B* Ketotifen (Zaditen)
***) Substances
thought to normally mediate the bronchospasm in asthma include all of the
following, except:
A.
Prostaglandines
B.
Histamine
C.
Slow reacting substance of anaphylaxis
D.
Sodium cromoglycate
E.
Eosinophilic chemotactic factor of anaphylaxis
Answer: D* Sodium cromoglycate
8. Chronic Obstructive Pulmonary Disease COPD.
***) Treatment
of COPD patient includes all the followings except: Q2012
A.
Ipratropium
bromide
B.
Salbutamol
C.
Steroid
D.
O2
mask 100%
E.
Aminophylline
Answer: D* O2 mask 100%
***) Total
lung capacity is increased in:
A.
Asthma
B.
Emphysema
C.
Congestive failure
D.
Cystic fibrosis
E.
Respiratory distress syndrome
Answer: B* Emphysema
***) All
of the following complications of chronic obstructive pulmonary disease,
except:
A.
Cor pulmonale
B.
Polycythemia
C.
Respiratory failure
D.
Left ventricle failure
E.
Bronchogenic carcinoma
Answer: E* Bronchogenic carcinoma
***) All
of the following changes occur in COPD, except:
A.
Lung inflammation
B.
No alveolar wall destruction
C.
Loss of elasticity
D.
Destruction of pulmonary capillary bed
E.
Increase in inflammatory cells macrophages
Answer: B* No alveolar wall destruction
9. Respiratory Failure.
***) Blood
gas analysis in type 1 respiratory failure shows: Q2012
A.
High
PCO2 and normal PO2
B.
Low
PCO2 and normal PO2
C.
Normal
PCO2 and high PO2
D.
High
PCO2 and low PO2
E.
Normal
PCO2 and low PO2
Answer: E* Normal PCO2 and low
PO2
***) The
usual causes of low arterial oxygen tension (PaO2) include all of
the following, except:
A.
Right to left shunt
B.
Ventilation perfusion mismatch
C.
Impaired diffusion capacity
D.
Hyperventilation
E.
Hypoventilation
Answer: D* Hyperventilation
***) Signs
of hypercapnia include all of the following, except:
A.
Confusion
B.
Papilledema
C.
Cold extremities
D.
A large pulse volume
E.
Coma
Answer: D* A large pulse volume
***) The
following are signs of respiratory failure, except:
A.
Warm hands
B.
Flapping tremors
C.
Small volume pulse
D.
Papilledema
E.
Altered level of consciousness
Answer: C* Small volume pulse
***) Hyperventilation
may be found in all of the following, except:
A.
Narcotic overdose
B.
Diabetic ketoacidosis
C.
Acute attack of bronchial asthma
D.
Hysterical reaction
E.
Pulmonary embolism
Answer: A* Narcotic overdose
10.
Pulmonary
Embolism.
***) The
most common symptoms after major pulmonary embolism is:
A.
Cough
B.
Hemoptysis
C.
Dyspnea
D.
Pleural pain
E.
Chest pain
Answer: C* Dyspnea
***) All
of the following clinical findings are seen in patients with pulmonary
embolism, except:
A.
Hypoxia
B.
Right heart failure
C.
Cyanosis
D.
Deep vein thrombosis
E.
Bradycardia
Answer: E* Bradycardia
***) All
of the following are clinical evidence of pulmonary embolism, except:
A.
Hypoxia
B.
Pleural friction rub
C.
Hypercapnia
D.
Right ventricular failure
E.
Deep venous thrombosis
Answer: C* Hypercapnia
***) The
following are characteristics of pulmonary embolus, except:
A.
Normal or low PCO2
B.
Hypoxia
C.
Collapsing pulse
D.
Pleuritic chest pain
E.
Raised jugular venous pressure
Answer: C* Collapsing pulse
***) The
definitive diagnosis of pulmonary embolism is best made by:
A.
Arterial blood gas analysis
B.
Chest X-ray
C.
ECG
D.
Lung scan
E.
Pulmonary arteriography
Answer: E* Pulmonary arteriography
11.
Pneumothorax.
***) A
3 years old boy with staphylococcal pneumonia suddenly develops increasing
respiratory distress. The possible diagnosis requiring urgent action is:
A.
Pneumatocele formation
B.
Pleural effusion
C.
Tension pneumothorax
D.
Progression of pneumonia
E.
Lung abscess formation
Answer: C* Tension pneumothorax
***) In
patient who is receiving assisted ventilation with positive end expiratory
pressure (PEEP). The sudden occurrence of hypotension most likely caused by:
A.
Hypovolemia
B.
Acute congestive cardiac failure
C.
Haemothorax
D.
Massive atelectasis
E.
Tension pneumothorax
Answer: E* Tension pneumothorax
12.
Pleural
Effusions.
***) The
following conditions may cause transudate type of pleural effusion, except:
A.
Nephrotic syndrome
B.
Hypothyroidism
C.
Liver cirrhosis
D.
Congestive cardiac failure
E.
Empyema
Answer: E* Empyema
***) An
exudative pleural effusion may be due to all of the following, except:
A.
Pulmonary tuberculosis
B.
Congestive cardiac failure
C.
Bronchogenic carcinoma
D.
Acute pancreatitis
E.
Mesothelioma
Answer: B* Congestive cardiac failure
***) Signs
of pleural effusion include all of the following, except:
A.
Stony dullness on percussion
B.
Diminished or absent breath sound
C.
Deviation of trachea to opposite side
D.
Increased tactile vocal fremitus
E.
Bronchial breathing above effusion
Answer: D* Increased tactile vocal
fremitus
***) One
of the following is aspirated from the pleural cavity in chylothorax:
A.
Fresh blood
B.
Lymph
C.
Serous fluid
D.
Saliva
E.
Bile
Answer: B* Lymph
13.
Sarcoidosis.
***) 40
years old woman presented with 2 months history of dry cough, nasal blockage,
low grade fever, the CXR showed enlarged both right and left hilum. All of the
following are in favor of the sarcoidosis diagnosis, except: Q2012
A.
Presence
of right paratracheal lymphadenopathy
B.
Increased
lymphocytes by bronchoscopic bronchioalveolar lavage
C.
Disappearance
of the radiological findings after 3 months without treatment
D.
Presence
of deforming arthritis
E.
Negative
PPD test
Answer: D* Presence of deforming arthritis
***) All
of the following are features of sarcoidosis, except:
A.
Hypocalcemia
B.
Lupus pernio
C.
Erythema nodosum
D.
Anterior uveitis
E.
Hepatosplenomegaly
Answer: A* Hypocalcemia
***) All
of the following are features of sarcoidosis, except:
A.
Erythema multiforme
B.
Lupus pernio
C.
Bilateral hilar lymphadenopathy
D.
Uveitis
E.
Hypercalcemia
Answer: A* Erythema multiforme
***) All
of the following about sarcoidosis are true, except:
A.
It is a granulomatous condition
B.
Causes bilateral hilar lymphadenopathy
C.
Steroid therapy is helpful in the treatment
D.
Hypercalcemia is a feature
E.
Tuberculin test is usually positive
Answer: E* Tuberculin test is usually
positive
***) In
sarcoidosis all are true, except:
A.
Hepatomegaly is a feature
B.
There is usually a hypergammaglobulinemia
C.
Bilateral hilar lymphadenopathy is a feature
D.
Steroid therapy is helpful in the treatment
E.
It is common in those over 60 years of age
Answer: E* It is common in those over
60 years of age
***) In
sarcoidosis which of the following is true:
A.
It is commonest in those over 60 years of age
B.
It should always be treated with steroids
C.
It is presenting with erythema nodosum has good prognosis
D.
Tuberculin test is usually positive
E.
It is usually responds to antituberculous therapy
Answer: B* It should always be treated
with steroids
14.
Interstitial
lung Disease.
***) All
the following are associated with decreased diffusion lung carbon monoxide
except:
A.
Pulmonary edema
B.
Pulmonary hemorrhage
C.
Pulmonary resection
D.
Anemia
E.
Interstitial lung disease
Answer: E* Interstitial lung disease
***) All
the following are causes of airspace disease except:
A.
Right middle lobe pneumonia
B.
Pulmonary edema
C.
Lung contusion
D.
Bronchogenic carcinoma
E.
Lymphoma
Answer: D* Bronchogenic carcinoma
15.
Extrinsic
Allergic Alveolitis.
***) A
large round mass in a chest X-ray might be due to all of the following, except:
A.
Hydatid cyst
B.
Bronchogenic carcinoma
C.
Tuberculoma
D.
Bronchogenic cyst
E.
Extrinsic allergic alveolitis
Answer: E* Extrinsic allergic
alveolitis
16.
Industrial
Dust Diseases.
***) In
silicosis all of the following statements are true, except:
A.
It predisposes the patient to pulmonary tuberculosis
B.
Chest X-ray shows discrete rounded opacities in both lung fields
C.
It may predispose the patient to lung cancer
D.
Potters and masons are liable to get this disease
E.
Acute silicosis is usually fatal within a year of the first appearance
of symptoms
Answer: E* Acute silicosis is usually
fatal within a year of the first appearance of symptoms
17.
Obstructive
Sleep Apnea Syndrome.
***) All of
the following are provocative factors for obstructive sleep apnea, except: Q2012
A.
Sleep
deprivation
B.
Alcohol
use
C.
Tobacco
abuse
D.
CNS
depressant medications
E.
Diuretic
use
Answer: E* Diuretic use
***) Features
of the Pickwickian syndrome may include all of the following, except:
A.
Obesity
B.
Somnolence
C.
Hypocapnia
D.
Polycythemia
E.
Hypoxia
Answer: C* Hypocapnia
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