150 - respiratory system mcqs - part 9

71q: which one of the following is not correct regarding silicosis ?

a. egg shell calcification is seen on chest X ray
b. it is more marked in the lower zone
c. may lead to progressive massive fibrosis
d. the disease may progress even after the exposure has ceased

answer: b .

72q: a person who has high fever,tachycardia,hemoptysis and a lobar consolidation on CXR has ?

a. bronchopneumonia
b. lobar pneumonia
c. pulmonary edema
d. pulmonary infarction

answer: b . lobar pneumonia .

73q: which one of the following organisms causes pneumatocele ?

a. klebsiella
b. hemophilus influenza
c. staphylococcus aureus
d. streptococcus pneumoniae

answer: c . staphylococcus aureus .

74q: kartagener's syndrome is not associated with ?

a. situs inversus
b. subluxation of lens
c. bronchiectasis
d. sinusitis

answer: b .

75q: with reference to cystic fibrosis , which one of the following statement is not correct ?

a. gene is located in the long arm of chromosome 7
b. lung function is grossly impaired at birth
c. pseudomonas infection is very common
d. diabetes is more commonly encountered than in normal population

answer: b . lung function is not actually grossly impaired at birth and hence b is the wrong statement .

76q: cystic fibrosis characteristically has all of the following features except ?

a. low levels of sodium and chloride in sweat
b. pancreatic insufficiency
c. biliary cirrhosis
d. bronchial obstruction

answer: a .

77q: a patient presents with breathlessness . he has bilateral basal crepitations. lung function tests reveal decrease in total lung capacity and vital capacity with normal FEV1/VC ratio. the most likely diagnosis is ?

a. chronic bronchitis
b. idiopathic pulmonary fibrosis
c. cystic fibrosis
d. allergic bronchopulmonary aspergillosis

answer: b . idiopathic pulmonary fibrosis .

78q: interstitial pulmonary fibrosis is associated with the following except ?

a. sarcoidosis
b. asbestosis
c. carcinoid lung
d. radiation exposure

answer: c . carcinoid lung .

79q: all the following are features of alveolitis ( interstitial lung disease ) except ?

a. exertional dyspnea
b. early productive cough
c. digital clubbing
d. coarse crepitations during inspiration

answer: b . early productive cough .

80q: pleural effusion in rheumatoid arthritis is typically associated with the following features except ?

a. glucose greater than 60 mg/dl
b. protein greater than 3gm/ml
c. pleural fluid to serum protein ratio greater than 0.6
d. pleural fluid to serum LDH ratio greater than 0.6

answer: a. rheumatoid arthritis is one of the causes of conditions with low glucose , other causes of pleural fluid low in glucose are mesothelioma ,empyema,malignant pleural effusion . tuberculosis and dressler syndrome are conditions with high glucose in pleural fluid .

149 - respiratory system mcqs - part 8

66q: use of disodium cromoglycate as a preventive measure has been found to be useful in ?

a. intrinsic asthma
b. exercise induced asthma
c. chronic bronchitis
d. farmer's lung

answer: both a and b .

67q: in bronchial asthma glucocorticoids

a. act as potent bronchodilators
b. reduce airway inflammation
c. inhibit degranulation of mast cells
d. block the action of humoral mediators

answer: b . reduce airway inflammation .

68q: farmer's lung is caused by exposure to ?

answer: thermophilic actinomyces .

69q: the diagnostic criteria for allergic bronchopulmonary aspergillosis would include all of the following except ?

a. peripheral eosinophilia
b. central bronchiectasis
c. bronchial asthma
d. culture of aspergillus fumigatus from the sputum

answer: d . culture of aspergillus fumigatus from the sputum is not a diagnostic criteria .

70q: recognised features of asbestosis does not include ?

a. calcification of pleura
b. egg shell calcification of hilar lymph nodes
c. clubbing of features
d. restrictive pattern of ventilatory defect shown by pulmonary function

answer: c . clubbing of fingers .

148 - respiratory system mcqs - part 7

61q: study the results of the pulmonary function tests shown below ?

predicted FEV1 of 3.5-4.3 but actual FEV1 is 1.2
predicted FVC of 4.6-5.4 but the actual FVC is 4.1
predicted FEV1/FVC is 72-80 % but the actual value is 29 %
predicted PEF is 440-540 but the actual value is 80

the above results are consistent with the disease of ?

a. chronic bronchitis
b. interstitial lung disease
c. pneumonia
d. pneumothorax

answer: a . chronic bronchitis . the parameters indicate that the disease is an obstructive disease and so the answer is chronic bronchitis .

62q: a previously healthy factory worker was found unresponsive in his workplace .he is afebrile anicteric , tachypnoiec , drowsy and blue all over with
clear lung field and hyperdynamic cardiovascular findings.his ABG with 100 % oxygen after intubation was

pH = 7.30
pO2 = 80 mm of Hg
pCO2 = 30 mm of Hg
SaO2 = 50 %

what is the most likely diagnosis

a. methhemoglobinemia
b. adult respiratory distress
c. carbon monoxide poisoning
d. organophosphorous poisoning

answer: c . carbon monoxide poisoning . ( can anyone explain this - please post in comments ) .

63q: consider the following statements . life threatening features of acute severe asthma in children include

1. altered sensorium
2. pulsus paradoxus
3. audible wheeze in both inspiration and expiration
4. oxygen saturation 92-95 %

a. 1 is only correct
b. 1 and 2 are correct
c. 2 and 4 are correct
d. all are correct

answer: b . altered sensorium and pulsus paradoxus .

64q: poor prognostic indicators in acute severe asthma include all of the following except ?

a. pulsus paradoxus
b. hypocarbia
c. use of accessory muscles of respiration
d. PEFR less than 20 % of previous value

answer: b . hypocarbia .

65q: consider the following statements :

early onset extrinsic episodic asthma is characterised by ?

1. family history of eczema or rhinitis
2. development of an early and late asthamtic reaction mediated by mast cells
3. T lymphocytes that release cytokine like interleukin-4

which of the above statements are ture

a. 1,2 and 3 are true
b. 1 and 2 are true
c. 2 and 3 are true
d. 1 and 3 are true

answer: a . all the three statements are true .

147 - respiratory system mcqs - part 6

51q: FEV1/FVC ratio is decreased in all except ?

a. bronchiectasis
b. emphysema
c. chronic bronchitis
d. tuberculosis

answer: d . tuberculosis .

52q: drug of choice in asthma with heart disease ?

a. rimiterol
b. terbutaline
c. ipratropium
d. cromolyn sodium

answer: c . ipratropium .

53q: an exacerbation of farmer's lung ?

a. is commoner in summer
b. is characterised by intense wheeze
c. produces eosinophilia in the peripheral blood
d. is excluded by the absence of precipitating antibodies
e. disseminated intravascular coagulation

answer: ( if u know the answer please post in comments )

54q: sino bronchial infection is most commonly seen in ?

a. pneumoconiosis
b. kartagener's syndrome
c. uremia
d. down's syndrome

answer: b . kartagener's syndrome .

55q: features of fibrocystic disease include all except ?

a. meconium ileus
b. obstructive emphysema
c. pancreatic insufficiency
d. decreased Na and Cl in sweat

answer: d .

56q: chronic fibrosing mediastinitis is seen in all except ?

a. tuberculosis
b. histoplasmosis
c. plague
d. sarcoidosis

answer: c . plague .

57q: transudative type of pleural effusion is a feature of ?

a. variceal sclerotherapy
b. coronary artery bypass
c. radiation
d. peritoneal dialysis

answer: d . peritoneal dialysis .
other causes of the transudative pleural effusion are congestive heart failure, cirrhosis, nephrotic syndrome , meig's syndrome and hydronephrosis .

58q: external cardiac massage is usually done in ?

a. lower one third of sternum
b. xiphisternum
c. middle of sternum
d. manubrium

answer: a. lower one third of sternum .

59q: pulmonary edema due to narcotic overdose is mostly seen with ?

a. cocaine
b. heroin
c. morphine
d. methadone

answer: b . heroin .

60q: tubular breathing is seen in ?

a. pleural effusion
b. consolidation
c. pleurisy
d. tuberculous cavity

answer: b . consolidation .

145 - respiratory system mcqs - part 4

31q: a patient with spontaneous pneumothorax involving more than 50 % of the hemithorax is best treated with ?

a. needle aspiration
b. closed drainage by tube in underwater seal
c. let spontaneous remission occur
d. open thoracotomy

answer: b . closed drainage by tube in underwater seal .

32q: hamman's crunch is seen in ?

a. caries tooth
b. fracture mandible
c. mediastinal emphysema
d. niemann-pick's disease

answer: c . mediastinal emphysema.

33q: the organism most frequently related to mediastinal fibrosis ?

a. actinomyces
b. histoplasma
c. hansen bacillus
d. staphylococcus

answer: b . histoplasma .

34q: hypercapnea at rest is most indicative of ?

a. hypoventilation
b. right to left shunt
c. impaired diffusion
d. CO poisoning

answer: a . hypoventilation .

35q: about systemic inflammatory response syndrome ( SIRS ) all are true except ?

a. leukopenia
b. hyperthermia
c. hypoxia
d. tachycardia

answer: c . hypoxia .

36q: lung abscesses are least likely to be caused by ?

a. histoplasma
b. staphylococcus
c. metastatic malignancy
d. primary carcinoma

answer: c . metastatic malignancy .

37q: primary disease causing raised PCO2 manifests as ?

a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

answer: a . respiratory acidosis .

38q: the following are CNS findings of CO2 narcosis except ?

a. excitement
b. increased pH of CSF
c. decreased pH of CSF
d. papilloedema

answer: b . acidosis results due to CO2 narcosis therefore decreasing the pH .

39q: respiratory acidosis is seen with ?

a. DKA
b. pneumonia
c. emphysema
d. phenytoin

answer: c . emphysema .

40q: respiratory acidosis is seen with ?

a. starvation
b. hyperventilation
c. muscular dystrophy
d. vomiting

answer: c . muscular dystrophy .

135 - lung diseases diagnosis mcqs

For each set of patients below, select the most likely diagnosis.

a. Laryngeal carcinoma
b. Small cell carcinoma of the lung
c. Large cell carcinoma of the lung
d. Beryliosis
e. Sarcoidosis
f. Laryngeal papilloma
g. Bronchial adenoma
h. Cystic fibrosis
i. Hodgkin’s disease
j. Chronic obstructive lung disease
k. Acute bronchitis

135. A 20-year-old male has a cough and history of bronchitis with thick
greenish sputum. There is no history of cigarette smoking. The patient has
also been treated for abdominal cramping and malabsorption.

136. A 60-year-old black male who has a long history of cigarette smoking
and alcohol abuse complains of pain on swallowing. Pain is also
referred to the ear. The patient speaks with a hoarse voice.

137. A 55-year-old women, who began smoking cigarettes as a teenager,
has been losing weight for 3 months and complains of hemoptysis and
cough. She has also had 1 week of severe leg and back pain. Routine laboratory
data shows hyponatremia and anemia.

138. A 40-year-old electronics worker has noted increasing shortness of
breath and cough over many years, which he attributes to working conditions.
On physical exam there is dermatitis of the face and bilateral inspiratory
crackles. Chest x-ray shows hilar adenopathy and bilateral
interstitial markings.

139. A 42-year-old male is evaluated for fever, night sweats, and pruritus.
There is a 2-cm fixed supraclavicular node on physical exam as well as
bilateral axillary nodes. Chest x-ray shows mediastinal lymphadenopathy.

The answers are 135-h, 136-a, 137-b, 138-d, 139-i.

(Kasper, pp 506–516, 654, 1489, 1524, 1543–1546.) The 20-year-old male
has evidence of chronic airway infection not associated with cigarette
smoking. Cystic fibrosis is a multisystem disease with signs and symptoms
usually beginning in childhood. However, 7% of patients are diagnosed as
adults. This is an autosomal recessive disease with a gene mutation on
chromosome 7. In addition to respiratory tract infection, there are intesti-
nal complications and exocrine pancreatic insufficiency. This results in
malabsorbtion with bulky stools.

The 60-year-old black male presents with symptoms of laryngeal carcinoma.
The disease is closely correlated with smoking. Alcohol is also an
important risk factor, and the disease is more common in blacks than
whites. Symptoms depend on the anatomic region of the cancer. Pain on
swallowing is the most common symptom, sometimes with dysphagia or a
mass sensation. For glottic and subglottic tumors, hoarseness is often
present. Pain may also be referred to the ear by the recurrent laryngeal
nerve.

The incidence of small cell carcinoma of the lung is increasing in
women. The 55-year-old woman suggests the diagnosis of small cell carcinoma
because symptoms have developed quickly and there is evidence for
early metastatic disease. In addition, the syndrome of hyponatremia caused
by inappropriate ADH secretion is more likely to occur with small cell carcinoma.

The 40-year-old electronics worker is an example of environmental
lung disease. Berylliosis occurs in the high-tech electronics field as well as
in the manufacture of alloys, nuclear material, and ceramics. Usually, 2 to
15 years of exposure are required before becoming symptomatic. Dermatitis
may be present, along with nonspecific respiratory symptoms. This is a
granulomatous disease presenting in a manner similar to sarcoidosis. Tissue
levels of beryllium can be measured for definitive diagnosis.

The 42-year-old with fever, night sweats, and pruritus gives symptoms
very characteristic of Hodgkin’s disease. Most patients present with palpable
lymphadenopathy, and more than half will have mediastinal lymphadenopathy
on presentation. About half will have symptoms of fever,
night sweats, or weight loss. There may be unexplained itching as well as
cutaneous lesions such as erythema nodosum, or icthyosis.