Pulmonology

Topic 1- COPD

1. The sputum in COPD contains:

a. The cells of the bronchial epithelium, leucocytes
b. Basophilic leukocytes
c. Atypical cells
d. Macrophages
e. A large number of eosinophils

2. The most common physical signs in patients with COPD

(severe course) are all except one:
a. Barrel chest
b. Prolonged expiration
c. Vesicular breathing
d. Weakening of respiratory sounds
e. Distant wheezing

3. The indication for corticosteroid therapy in COPD is:

a. Severe symptoms of COPD
b. Stage III-IV of severity
c. All of the above
d. Intolerance to bronchodilators
e. The ineffectiveness of treatment by bronchodilators

4. Expectorants, which also possess antiseptic properties are:

a. Herb Thermopsidis
b. Acetylcysteine
c. Bromhexine
d. Herb Althea officinalis
e. Herb Thyme

5. The main symptom of chronic bronchitis, caused by the

primary lesion of the mucous membrane of small bronchi is:
a. Chest pain
b. Severe dry cough
c. Edema of the lower extremities
d. Shortness of breath
e. Cough with sputum
6. Which drugs are mucolytics:
a. Salbutamol
b. Ephedrine
c. Codeine
d. Acetylcysteine

7. The treatment of chronic obstructive bronchitis should be

done:
a. Only on inpatient basis
b. Continuously
c. Only at exacerbation of the disease
d. At exacerbation of the disease and as prevention courses
e. Only on outpatient basis

8. Which drugs can not be combined with expectorants:

a. Antibiotics
b. Antitussives
c. Mucolytics
d. Multivitamins
e. Decongestants

9. The clinical manifestations of chronic obstructive bronchitis

are all, except one:
a. Small amount of sputum
b. Cough
c. Respiratory failure
d. Shortness of breath
e. Large amount of sputum

10. The vital lung capacity (VLC) is all of the above, EXCEPT one:
a. Functional residual capacity of the lungs
b. Residual volume
c. Exhalation reserve volume
d. Respiratory capacity
e. Respiratory volume

11. The drug which improves expectoration of sputum by

increasing its turnover due to stimulation of lung surfaktant
system is:
a. Bromhexine
b. Herb Ivy extract
c. Acetylcysteine
d. Herb althea officinalis
e. Trypsin

12. What does Tiffeneau index help to determine?

a. The effectiveness of ventilation
b. Functional residual capacity
c. State of bronchial obstruction
d. A total lung capacity
e. Maximum oxygen consumption

13. Complications of COPD are all of mentioned below, except:

a. Hemoptysis
b. Cor pulmonale
c. Pneumonia
d. Spontaneous pneumothorax and thromboembolism
e. Respiratory failure
14. Factors, that contribute to the exacerbation of chronic
obstructive bronchitis:
a. Industrial fumes and gases
b. Alcoholism
c. Tobacco smoking
d. Climatic and weather factors
e. Infectious factors

15. Complications of chronic obstructive bronchitis are:

a. Cor pulmonale
b. Pulmonary embolism
c. Lung fibrosis
d. Mediastenitis
e. Spontaneous pneumothorax

16. The most common auscultative sound in chronic obstructive

bronchitis is:
a. The weakening of vesicular breathing
b. Dry wheezing
c. Prolonged inhalation
d. Amphoric breathing
e. Moist rales

17. When prescribing antibacterial drugs for a patient with

chronic bronchitis, the following details should be considered:
a. The nature of the microflora of tracheobronchial secretions
b. Sensitivity of the microflora to antibiotics
c. Tolerability of the drug by patient
d. The concentration of the selected drug, which must be
achieved in the bronchial mucus
e. Everything listed above

18. The common etiological factors for chronic obstructive

bronchitis are all, EXCEPT:
a. Chemicals
b. Allergic
c. Stress
d. Physical
e. Infectious

19. Dry cough in COPD is caused by:

a. Hypersensitivity of reflex zones of the mucous membrane of
large bronchi
b. Inflammation of the mucous lining of small bronchi
c. Inflammation of the mucosal lining of large bronchi
d. Atrophy of the bronchial mucosa
e. Hypertrophy of bronchial mucosa

20. The main symptom of chronic bronchitis with a primary

lesion of the mucous membrane of the large bronchi is:
a. Sore throat
b. Severe dry cough
c. Chest pain
d. Shortness of breath
e. Cough with sputum production

Topic 2- Asthma

1. Auscultation most complete picture of an exacerbation of

asthma presented:
a. Weakened breath wheezing and whistling
b. Brash vesicular breathing with prolonged exhalation and
mainly dry whistling wheezing
c. Brash vesicular breathing with prolonged exhalation
d. Bronchial wheezing breath and wet
e. Brash vesicular breathing and humming, wheezing

2. In mild persistent asthma should:

a. Take treatment only during exacerbations of the disease
b. Continuously, regardless of the disease, take inhaled
medicines
c. Constantly, regardless of the disease, take bronchodilating
drugs
d. In remission conduct courses supporting desensitizing
therapy
e. Take medical treatment mucolitics 1 every 3-4 months

3. The most information on presence of bronchial obstructive

changes make the following indicators of external breathing:
a. Reserve inspiratory volume
b. Evaluation of all these indicators together
c. Forced expiratory volume in the first second (FEV1)
d. Vital capacity
e. Respiratory volume

4. The leading risk factors for asthma are:

a. Contact with domestic animals, birds, mold, yeast fungi and
other allergens
b. Inefficiently treated bronchitis, pneumonia
c. The work in dusty, gassed
d. Burdened regarding asthma and other allergic diseases
heredity
e. All of the above

5. What preparations have anti-inflammatory effect:

a. Budesonide
b. Beklofort
c. None of these drugs
d. All of the drugs
e. Flyksotyd

6. In bronchial asthma in sputum are:

A. Atypical cells. B. Eosinophils, Charcot-Leyden crystals,
spiral of Kurshman. C. Erythrocytes as coin columns. D. A
 large number of elastic fibers. E. Neutrophils, alveolar
epithelium.
a. Eosinophils, Charcot-Leyden crystals, spiral of Kurshman
b. A large number of elastic fibers
c. Atypical cells
d. Neutrophils, alveolar epithelium
e. Erythrocytes as coin columns

7. What preparations have Bronchodilation action:

a. All of the drugs
b. Beklofort
c. Budesonide
d. None of these drugs
e. Flyksotyd

8. The immunological mechanisms of asthma include all of

these, except one:
A. Activation basophilic leukocytes. B. Hypereosinophilia. C.
Activation synthesis reagin. D. Glucocorticoid deficiency. E.
Hypersensitivity reaction negative type.
a. Hypersensitivity reaction negative type.
b. Activation synthesis reagin.
c. Hypereosinophilia
d. Glucocorticoid deficiency
e. Activation basophilic leukocytes.

9. The basic mechanisms of wheezes in asthma patients are:

a. Dyscrinia
b. Defeat alveoli.
c. Spasm of small bronchi
d. Obturation of the bronchi of small caliber
e. Obturation small bronchi

10. The main complaint for patients with asthma are:

A. Cough with a large amount of phlegm. C. Frequent
unproductive cough. C. Expiratory dyspnea. D. Periodic
bouts of breathlessness. E. Inspiratory dyspnea.
a. Inspiratory dyspnea
b. Frequent unproductive cough
c. Periodic bouts of breathlessness
d. Expiratory dyspnea
e. Cough with a large amount of phlegm
11. What preparations have bronchodilation action:
a. Salbutamol
b. Serevent
c. All of the drugs
d. Ventolyn
e. None of these drugs

12. Use a peak flow meter cannot:

a. Bronchial hyperreactivity diagnose.
b. Predict exacerbation
c. Evaluate variability of bronchial obstruction
d. Plan basic therapy.
e. Evaluate the effectiveness of the bronchodilator drug

13. For a long planned treatment patient with asthma drugs

most expedient to appoint the following groups:
a. Inhaled β2-agonists
b. Prolonged theophylline
c. Systemic glucocorticoids
d. Inhaled glucocorticosteroids
e. Membranostabilizer

14. “Asthma – a chronic inflammatory disease of the airways in

which development involving mast cells, T lymphocytes,
macrophages.” This definition should be supplemented:
A. “And that is characterized by reversible variable bronchial
obstruction.” B. “And that is characterized by bronchial
hyperreactivity.” C. “And what is the genetic
predisposition.” D. All of the above. E. There is no need in
addition, because the definition is complete.
a. All of the above
b. There is no need in addition, because the definition is
complete
c. “And what is the genetic predisposition”
d. “And that is characterized by reversible variable bronchial
obstruction”
e. “And that is characterized by bronchial hyperreactivity”

15. Selectiveβ2-stimulants include:

a. Ephedrine
b. Platifillin
c. Eufillina
d. Zaditen
e. Salbutamol

16. In the course well controlled asthma rates peak expiratory

flow rate:
a. A should be as in the morning and gradually decline evening
b. There should be almost the same in the morning and evening
c. In the morning should be much higher than in the evening
d. There should be minimal in the morning and gradually
increase the evening
e. In the evening should be much higher than in the morning

17. The conventional monitoring the clinical course of asthma

at this time are:
a. Setting provocation tests with histamine
b. Learning curve parameters “flow-volume”
c. Setting provocative tests with acetylcholine
d. The test with bronchodilators.
e. Study expiratory flow rate (PEF) using a peak flow meter
18. In any pathological condition in patients with asthma
obstructive changes are irreversible:
a. In mucosal swelling of the airways
b. When sclerotic changes in the bronchial wall
c. When bronchial smooth muscle spasm
d. When all of these
e. The formation of viscous secretion and obstruction of small
bronchi

19. Development is possible complication in patients with

asthma:
a. Gangrene of the lungs
b. Empyema
c. Lung abscess
d. Pleural effusion
e. Asthmatic status

20. Bronchial obstruction in asthma is caused by:

a. Dyskrynia
b. Swelling of bronchial mucosa
c. The functional instability of the airways
d. Bronchial smooth muscle spasm
e. With all these factors

21. Patient N., 30 years, complains stuffy nose, asthma attacks

at night once a week. Ill after a respiratory infection, which was
treated with acetylsalicylic acid alone.In the analysis of blood
and. Sputum eosinophilia detected. What is the most likely
diagnosis?
a. Asthma aspirin
b. Eosinophilic infiltration of the lungs
c. Asthma physical exercises
d. Asthma, endogenous form
e. Bronchial asthma, exogenous form

22. Patient A., 43 years old, complained of shortness of breath

during exercise. OBJECTIVE: body temperature – 36,4 ° C. BH –
20 for 1 min, pulse – 78 for 1 min, blood pressure 125/80
mmHg Forms barrel chest. Above the lungs auscultated
vesicular breathing weakened. What research is necessary to
the patient in an outpatient setting to address the effectiveness
of bronchodilators intended?
a. Spirography
b. Bronchoscopy
c. Peakflowmetria
d. Analysis of sputum (number and flora)
e. ECG monitoring overload right heart

23. A woman, 25 years old, 1.5 years is at the dispensary on

bronchial asthma. Recently asthma attacks occur 4-5 times a
week, night attacks – 2-3 times a month. For relief applies
salbutamol. Skaryfikations test antigen positive domestic mites.
OBJECTIVE: relatively satisfactory state, BH – 20 for 1 min,
CHSS- 76 for 1 min, blood pressure – 120/80 mmHg In the lungs
vesicular breathing. Dult cardiac rhythm correct. What
mechanism is leading in the development of bronchial
obstruction in a patient?
a. Increased tone of the parasymp
b. Adrenergic imbalance
c. Bronchial hyperreactivity
d. Tracheobronchial dyskinesia
e. Arahidonic acid metabolism

24. Patient G., 42 years old, patients with bronchial asthma

appointed theophylline. If a drug whose concentration in the
blood can hope for improvement in pulmonary function with
no toxic effect?
a. 31 – 40 mg / l
b. 41 – 45 mg / l
c. 26 – 30 mg / l
d. 5-20 mg / l
e. 21- 25 mg / l

25. Patient P., 39 years old, suffering from asthma for about 5
years. The attacks of breathlessness lightweight, removable
tablet of Eufillin or two breaths dosed sympathomimetic night
between 4th and 5th hour there is difficulty breathing, which
removed dosed sympathomimetic. What bronchodilators
appropriate to recommend to the patient before bedtime to
prevent nighttime symptoms?
a. Eufillin
b. Salbutamol
c. Teopek
d. Berotek
e. Antrovent

26. The patient entered the clinic O., 55 years after the attack
of asthma. For 20 years with the pharmaceutical factory and
engaged tableting chlorpromazine, sulfanilamide. For 10 years,
notes the frequent respiratory infections. Later there was
shortness of breath, occasionally – subfebrile. While working in
a dusty room and out of the warm room on a cold appear
asthma attack. Signs of cardiac decompensation available.
What is the most likely diagnosis?
a. Chronic obstructive bronchitis
b. Chronic non-obstructive bronchitis
c. Bronchial asthma, infectious-allergic form
d. Cardiac asthma
e. Occupational asthma, atopic form

27. Patient suffering from asthma for over 20 years, against

attacks of breathlessness suddenly appeared constant cough
without phlegm, chest pain, increased shortness of breath.
ECG: overload right heart. Treatment of β-adrenergic agents
has no effect. What possible complications developed in this
patient?
a. Pneumothorax
b. Thromboembolism pulmonary artery branches
c. Pulmonary edema
d. Cardiac asthma
e. Status asthmaticus
28. Patient K., 50, suffers from bronchial asthma 20 years.
Developing asthma 2-3 times a week. Takes inhaled
corticosteroids, salbutamol as needed. Do not tolerate
ibuprofen. Notes the constant feeling of fullness in the nose.
ENT discovered polyps in the nose. OBJECTIVE: rhinorrhea, BH –
22 for 1 min. CHSS- 88 for 1 min, blood pressure – 120/80
mmHg In the lungs vesicular breathing weakened, scattered dry
wheezing. Which option is most likely originated asthma
patient?
a. “Aspirin” asthma
b. Infectious-allergic asthma
c. Asthma physical effort
d. Cholinergic asthma
e. Atopic asthma

29. Patient L., 35, 14 years suffer from asthma. Recently asthma
attacks occur 4-5 times a week, night attacks – 2-3 times a
month. For cupping uses salbutamol. Objectively: state is
satisfactory. BH – 20 for 1 min, heart rate – 76 for 1 min, blood
pressure – 120/80 mm Hg. Art. In the lungs vesicular breathing.
Heart sounds are muffled rhythm correct. What preparation is
to be assigned for the prevention of asthma attacks in the first
stage?
a. Corticosteroids tablets
b. Inhaled corticosteroids
c. Regular use of salbutamol
d. Cromoglycate sodium
e. Corticosteroids injected

30. The patient, 48 years old, over the last 10 years suffering
from asthma. While working on their summer cottage feel
shortness of breath, cough, wheezing distance began to grow
short of breath. The drug whose pharmacological group to
recommend the best patient to relieve breathlessness such
attacks?
a. Inhaled glucocorticoid
b. Blocker β 2 adrenergic
c. Membrane stabilizer of mast cells
d. Methylxanthine
e. β2-adrenergic stimulator

Topic 3- Pneumonia

1. The most common causative agent of community-acquired

pneumonia is:
a. Chlamydophyla pneumoniae
b. Mycoplasma pneumoniae
c. Str. Pneumoniae
d. Moraxella cattaralis
e. Haemophilus influence

2. Biochemical blood test shows the following changes in

patients with pneumonia:
a. Hyperalbuminemia
b. Hypercholesterolemia
c. Dysproteinemia
d. Hyperbilirubinemia
e. Hyperenzymemia

3. Which of the following criteria is an indication for

hospitalization of the patient?
a. Tachypnea, hypothermia
b. Only if all mentioned above indications are present
c. Disturbance of consciousness
d. Unstable hemodynamics
e. Any of the above
4. Which of the following objective signs is the most
informative for diagnosis of pneumonia:
a. Dull percussion sound
b. The presence of intraalveolar infiltration, that has been
confirmed radiologically
c. Crepitation
d. Leukocytosis, increase of ESR against the background of
cough and intoxication syndrome
e. Moist small-bubble rales

5. What is the nature of the sputum in patients with focal

pneumonia:
a. Purulent
b. Mucopurulent or liquid mucous
c. Rusty
d. Bloody
e. Three-layer

6. Shortness of breath in pneumonia can be caused by:

a. Pleural lesions
b. Mucosal edema of bronchi and mucus hypersecretion
c. Large area of affected lung tissue
d. Intoxication syndrome
e. All of the above reasons

7. The cause of blood appearance in the sputum may be:

a. Lobar pneumonia
b. All of the above pathological conditions
c. Viral lesion of the mucous membrane of the tracheobronchial
tree
d. Mitral stenosis
e. Bronchiectasis

8. Which of the definitions of pneumonia is correct:

a. Pneumonia is an acute infectious disease, mainly of bacterial
etiology, which is characterized by focal lesions of the
respiratory parts of the lungs and the presence of intraalveolar
exudation, which is confirmed radiologically
b. Pneumonia is an acute infectious disease of bacterial
etiology, characterized by the presence of moist rales,
crepitation
c. Pneumonia is an inflammatory disease of the respiratory
parts of lungs of any origin, and is confirmed radiologically
d. All of the above answers are not true
e. All of the above answers are true

9. Which of the following conditions commonly misdiagnosed

as pneumonia has the most serious outcomes?
a. Acute bronchitis
b. Heart failure
c. Airway obstruction
d. Pulmonary embolism

10. Mortality rates in patients with pneumonia are highest in

which of the following scenarios?
a. Patient is < 50 years of age
b. Pathogen is gram-negative bacteria
c. Pathogen is gram-positive bacteria
d. Pathogen is atypical bacteria

11. Pain in the chest in pneumonia is caused by:

a. Increased pressure in the pulmonary circulation because of
frequent coughing
b. Involvement of pleura into pathological process
c. Hypoxia of respiratory muscles
d. Obstruction of the bronchial tree
e. All above mentioned reasons

12. Antibacterial drugs of which group should be prescribed to

the patient of 30 years old, who had been diagnosed with
community-acquired pneumonia caused by Mycoplasma
pneumoniae:
a. Cephalosporins of the II generation
b. Aminoglycosides
c. Macrolides
d. Semi-synthetic aminopenicillins
e. Protected aminopenicillins

13. What criteria should be followed when deciding whether to

admit a patient to the hospital:
a. Age over 50 years
b. The above criteria are not enough to address the issue
c. Previous outpatient treatment wasn’t effective
d. All the above criteria in the sum give the right to hospitalize
the patient
e. The patient has concomitant chronic diseases
14. Cough in pneumonia can not be associated with:
a. Irritation of reflexogenic zones located in the costo-
diaphragmatic sinuses
b. Lesions of the segmental bronchi
c. None of the above reasons
d. Lesion of the pleura
e. Accumulation of sputum in the large bronchi

15. What is the name of sharply increased respiration

(auscultatory):
a. Bronchial
b. Amphoric
c. Mixed
d. Vesicular
e. Harsh

16. The most common etiological factor for community-

acquired pneumonia is:
a. Mycobacteria
b. Fungi
c. Streptococcus pneumoniae
d. E.coli
e. Viruses

17. Which of the following changes in respiration during lung

auscultation is the most characteristic for focal pneumonia?
a. Amphoric breathing
b. Harsh vesicular breathing
c. Bronchial breathing
d. Harsh vesicular breathing with prolonged exhalation
e. Weakened vesicular breathing

18. Cough can occur when there is:

a. Irritation of pleural receptors
b. Irritation of n. Vagus due to mediastinal tumor, aortic
aneurysm
c. None of the above pathological conditions
d. In all of the mentioned above pathological conditions
e. Irritation of airway receptors

19. The course of pneumonia can be complicated by:

a. Hepatic coma
b. Myocardial infarction
c. Gastrointestinal bleeding
d. Status asthmaticus
e. Infectious-toxic shock

20. The radiological sign of the hepatization phase in lobar

pneumonia is:
a. Uneven spotted and indistinctly outlined darkening
b. Mesh deformation and enhancement of the pulmonary
pattern
c. Enhancement of the pulmonary pattern
d. Enhancing the transparency of the pulmonary fields
e. Intense darkening of inflammatory genesis

21. The presence of how many leukocytes and epithelial cells in

the vision field suggests to stop any further study of sputum
because the material that is studied is the contents of the oral
cavity:
a. All the above results should not be investigated
b. Leukocytes 30-50, epithelium cells 5-8
c. Leukocytes 50-70, epithelium cells 5-7
d. Leukocytes 10-15, epithelium cells more than 10-20
e. All of the above results can be investigated

22. According to modern classification, the following types of

pneumonia exist:
a. Pneumonia in immune-compromised patients
b. Community-acquired pneumonia
c. Hospital-acquired pneumonia
d. All of the above are true
e. Aspiration pneumonia

Topic 4- Pleurisy, Pleural effusion

1. What is the best way to start the treatment of exudative
pleurisy:
a. Pleural puncture
b. Administration of gentamicin
c. Administration of sulphonamides
d. Administration of aminocaproic acid
e. Administration of amoxicillin

2. What is the most typical location of dull percussion sound in

exudative pleurisy?
a. Under the Damuazo line
b. Above the triangle of Garland
c. Above the space of Troyes
d. Above the Rauchfuss-Groco triangle
e. Above the Damuazo line

3. What are the characteristics of pleural friction rub?

a. Decreases after coughing
b. It can be heard during inspiration only
c. It can be heard at a distance
d. It can be heard during expiration only
e. It can be heard during both inhalation and exhalation

4. The main principles of treatment of pleurisy include:

a. Detoxication therapy
b. Dehydration therapy
c. Antibacterial therapy
d. Expectorants
e. Broncholytic therapy
5. The most common cause of pleurisy of non-infectious
etiology is:
a. Primary tumors of the pleura
b. Hemorrhagic vasculitis
c. Meigs syndrome
d. Coronary heart disease
e. Myxedema

6. The clinical manifestation of pleurisy is:

a. Pressing chest pain in the precardiac area
b. Increased fremitus vocalis
c. Small-bubble wet rales
d. Chest lag on the affected side
e. Amphoric breathing

7. Pain in dry pleurisy is getting worse:

a. In the supine position
b. With a deep breath
c. During the day
d. When fever drops
e. When leaning body in the opposite direction

8. What type of pleurisy is characterized by the presence of

pain:
a. Diaphragmatic pleurisy
b. Intercostal pleurisy
c. Intralobular
d. Apical

9. The mechanisms of pathogenesis of dry pleurisy do not

include:
a. Hematogenous spread
b. Disorder of the integrity of the pleural cavity
c. Contact path of penetration
d. Lymphogenic infection
e. Influence of allergens

10. Urgent pleural puncture is performed in case:

a. The level of fluid reaches IV rib
b. The level of fluid reaches II rib
c. The level of fluid reaches V rib
d. The level of fluid reaches VI rib
e. The level of fluid reaches III rib

11. The predominance of which blood cells in the pleural

effusion is characteristic for acute inflammatory process:
a. Eosinophils
b. Lymphocytes
c. Monocytes
d. Erythrocytes
e. Neutrophils

12. The main distinguishing symptom of dry pleurisy is:

a. Cough
b. Pain in the trapezius muscles
c. The association of pain with breathing
d. Shortness of breath
e. Pleural friction rub

13. The most common feature of pain in pleurisy:

a. The pain is short-term
b. The pain is long-term
c. Pain is accompanied by hemoptysis
d. Pain is associated with coughing, breathing
e. Pain is relieved by nitroglycerin

14. The most common etiological factor for exudative pleurisy

is:
a. Diabetes mellitus
b. Hemophilia
c. Tuberculosis
d. Systemic connective tissue diseases
e. Chest injury

15. Which type of pleurisy is characterized by predominance of

lymphocytes in the pleural fluid:
a. Allergic pleurisy
b. Thromboembolism of pulmonary artery
c. Uremia
d. Pneumonia
e. Tuberculosis and tumors
16. Complete blood count data of a patient with pleurisy:
a. Leukocytosis, increased ESR
b. Erythrocytosis
c. Neutropenia
d. Leukopenia, decreased ESR
e. Eosinophilia

17. The differential diagnosis of pleurisy is usually made with:

a. Intercostal neuralgia
b. Lobar pneumonia
c. Spine osteochondrosis
d. Spontaneous pneumothorax
e. Myositis

18. Which instrumental method is the most informative in

exudative pleurisy:
a. Bronchoscopy
b. Spirometry
c. Bronchography
d. Radiography of the thoracic cavity
e. Tomography

19. Chest X-ray is able to visualize effusion reliably when its

volume is not less than:
a. 200 ml
b. 400 ml
c. 500 ml
d. 100 ml
e. 300 ml

20. Verification of the diagnosis of dry pleurisy is based on:

a. Auscultatory data
b. Chest radiography
c. Examination of sputum
d. Carefully collected history
e. Bronchography

21. Male 42 years old, complains of paroxysmal cough with

sputum yellow-brown, pain in the right side, associated with
deep breathing, sweating. Sick 6 days after hypothermia.
OBJECTIVE: T 39.6 0C. BH – 26 per min., Pulse – 110 per min.,
Blood pressure – 110/70 mmHg Right in the lower lung – wet
sounding wet wheezing. Radiological findings: right at the
bottom of the lungs – a massive infiltration of inhomogeneous
areas enlightenment sine differentiated. What is the most likely
complication developed in a patient?
a. Abscess formation
b. Empyema
c. Spontaneous pneumothorax
d. Fibrinous pleurisy
e. Lung atelectasis

22. Male 28 years old, acutely ill two days ago when having
headache, weakness, cough with a “rusty” sputum. OBJECTIVE:
flushing of the face, BH – 36 per min. Above the lungs
percussion – dull sound right below the angle of the blade,
auscultation – bronchial breath. Heart rate – 98 per min., Blood
pressure – 110/70 mmHg Body temperature – 38 0C. In a blood
test: A – 17h109 / l, ESR – 32 mm / h. Radiological findings:
homogeneous darkening in the lower part of the right lung.
Which of these is most likely diagnosis?
a. Bronchiectasis
b. Pleural effusion
c. Acute bronchitis
d. Pneumonia
e. Pulmonary tuberculosis

23. Patient V., 40, complains increase temperature to 39.5 0C,

cough with “rusty” sputum, shortness of breath, herpetic
lesions on the lips. BH – 32 per min. Right under the shoulder
blade strengthening voice trembling, there blunting percussion
sound, against the background auscultation bronchial breath –
crackling. Blood test: A – 14h109 / l, ESR – 35 mm / h. Your
preliminary diagnosis?
a. Acute bronchitis
b. Pneumonia
c. Bronchiectasis
d. Pulmonary tuberculosis
e. Pleural effusion

24. Patient A., 44 years, 4 days after surgery cyst right ovary
suddenly developed pain in the right half of the chest with a
discharge sputum pink, fever up to 37.7 0C. An examination of
the lungs revealed blunting of pulmonary sound in the lower
right, listen in the same single wet wheezing. What is the most
likely complication?
a. Pulmonary infarction
b. Pleural effusion
c. Pneumothorax
d. Pneumonia
e. Lung abscess

25. Patient ’35 suddenly appeared sharp pain in the right side
of the chest. Quickly intensified shortness of breath. Objectively
– pronounced acrocyanosis. The patient’s condition heavy.
Determined subcutaneous emphysema in the neck and upper
chest. Above right lung box sound, no breath. HR – at 85-110
min., Pressure – 110/60 mm Hg. Art. What disease is most likely
the patient?
a. Spontaneous pneumothorax
b. Myocardial infarction
c. Pulmonary infarction
d. Pleural effusion
e. Pneumonia

26. Patient A., 38 years old, complained of shortness of breath,

feeling of compression in the right half of the chest, the
temperature rose to 38.7 0C, cough with small amounts of
mucous-purulent sputum. Ill more than a week. Complaints
connects with hypothermia. On examination: easy acrocyanosis
lips, rhythmic pulse, 90 per min, blood pressure 140/85 mmHg
The right half of the chest behind the act of breathing.
Percussion – right below the angle of the blade dullness is
heard from below to the top. In this section respiration sharply
weakened absent. What is the most likely diagnosis?
a. Atelectasis of the right lung
b. Abscess of right lung
c. Pleural effusion
d. Right-sided pleuropneumonia
e. Bronchiectasis

27. Patient P., 46 years, of unidentified provisionally diagnosed

by clinical and radiographic parameters recommended pleural
puncture. As a result of a puncture obtained 1000 ml of liquid
that has the properties: transparent, density – 1010, protein
content – 1%, Rivalta test – negative, ER. – 2-3 in ar. For what
disease is characterized by the data?
a. Pleural mesothelioma
b. Pulmonary tuberculosis
c. Lung cancer
d. Heart failure
e. Pleural effusion
28. The patient A. Observed against the background of fever,
dry cough, shortness of breath increases. Most of the time lying
on one side. Auscultation and percussion data allowed
suspected pleural effusion. What method of research confirm
the diagnosis?
a. Bronchoscopy
b. Tomography
c. Spirometry
d. Radiography of the chest cavity
e. Bronchography

29. A 64-year-old woman is found to have a right-sided pleural

effusion on chest x-ray. Analysis of the pleural fluid reveals
pleural fluid to serum protein ratio of 0.38, a lactate
dehydrogenase (LDH) level of 110 IU (normal 100-190), and
pleural fluid to serum LDH ratio of 0.46. Which of the following
disorders is most likely in this patient?
a. Congestive heart failure
b. Systemic lupus erythematosus
c. Sarcoidosis
d. Pulmonary embolism
e. Bronchogenic carcinoma
30. A 76-year-old woman presents with worsening dyspnea for
the past 4 weeks. She has noticed fatigue, 10-lb weight loss,
and occasional night sweats. On examination, she is in mild
respiratory distress. Her RR is 22, and her BP is 134/76. She has
mild generalized lymphadenopathy, with the largest node
measuring 1.5 cm. Lung examination reveals bibasilar dullness
without rales or wheezes. Her neck veins are not distended.
CXR shows moderate left-sided pleural effusion. A
thoracentesis is performed, revealing milky fluid. Pleural fluid
protein and LDH demonstrate an exudative effusion. The
pleural fluid cell count is 4800/mm3 with 14% neutrophils, 12%
mesothelial cells, and 74% lymphocytes. Pleural fluid
triglyceride is 170 mg/dL. What is the likely cause of this
patient’s illness?
a. Pneumonia with parapneumonic effusion
b. Congestive heart failure
c. Tuberculosis
d. Lymphoma
e. Lung cancer

Topic 5- Bronchiectasis. Lung Abscess

1. A typical radiological presentation of lung abscess is :

a. Fluid accumulation in the pleural cavity
b. All of the above
c. Focal compaction of lung tissue
d. Formation of a cavity in the lungs
e. None of the above

2. What additional investigation method is the most

informative in lung abscess:
a. Study of the function of external respiration (spirography,
spirometry)
b. Radiological
c. Clinical (complete blood count, general urine test, sputum
test)
d. Cytological examination of sputum
e. Bacteriological examination of sputum

3. The main clinical symptom of pulmonary gangrene is:

a. Intense chest pain when breathing
b. Dry cough
c. Cough with a full mouth purulent sputum in the morning
d. Asthma attacks
e. Cough with layered sputum
4. Treatment of a patient with a lung abscess should begin with:
a. Detoxication therapy only
b. Antibiotics and bronchodilators
c. Antibacterial therapy only
d. Antibacterial and detoxication therapy
e. Antibiotics and sulfonamides

5. Which stage of lung abscess is characterized by discharge of

sputum with a full mouth:
a. Stage of convalescence
b. Stage of cavity formation in the lungs
c. All of the above
d. Stage of breakthrough into the draining bronchus
e. None of the above

6. Characteristic changes of sputum test in pulmonary

gangrene:
a. When settling, three layers are formed
b. The presence of Charcot-Leyden crystals
c. True A + B
d. True A + C
e. Purulent sputum of dirty gray color

7. The obstructive type of respiratory failure is formed due to:

a. Decreased ability of the lungs to expand and collapse
b. The presence of anemia
c. Decreased oxygen proportion in the inhaled air
d. Airway obstruction
e. Circulatory disorders

8. Which of the sputum elements indicates the destruction of

lung tissue:
a. Leukocytes
b. Charcot-Leyden crystals
c. Elastic fibers
d. Erythrocytes
e. Kurshman’s spirals

9. The clinical syndromes of lung gangrene are all of the

following, except:
a. Syndrome of general inflammatory changes
b. Intoxication syndrome
c. Hepatolienal syndrome
d. Syndrome of inflammatory changes of lung tissue
e. Respiratory failure syndrome

10. Restrictive type of respiratory failure is formed due to:

a. Airway obstruction
b. The presence of anemia
c. Decreased oxygen proportion in the inhaled air
d. Decreased ability of the lungs to collapse and expand
e. Circulatory disorders

11. The main method of diagnosing lung gangrene is:

a. Fluorography
b. Chest radioscopy
c. Spirography
d. Bronchography
e. Clinical sputum test

12. A differential diagnosis of lung abscess is made first of all

with:
a. Gangrene of the lungs
b. Infectious endocarditis
c. Emphysema of the lungs
d. Chronic bronchitis
e. Bronchial asthma

13. The main task for treatment of respiratory failure is:

a. Support of external respiration function
b. Ensuring adequate gas exchange
c. All of the above is true
d. None of the above
e. Treatment of the underlying disease that has caused
respiratory failure

14. Cor pulmonale is characterized by:

a. None of the above
b. Total heart failure
c. Right ventricular failure
d. Left ventricular failure
e. Disorders of rhythm and conduction
15. The clinical manifestations of infectious lung destruction
include all of the following signs, except:
a. Cough with a large amount of purulent sputum
b. Respiratory failure
c. Disorders of heart rhythm and conduction
d. Intoxication syndrome
e. Pain syndrome

16. The clinical signs of respiratory failure include all of the

above except:
a. Cyanosis
b. Crepitation
c. Tachycardia
d. Feeling of lack of air
e. Shortness of breath

17. The clinical and pathogenetic periods of lung abscess

development include everything mentioned below, except:
a. The period of convalescence
b. The period of imaginary well-being
c. Period of infiltration
d. The period of drainage of the abscess in the bronchus

18. The most common complication of infectious lung

destruction is:
a. Spontaneous pneumothorax
b. Infectious and toxic shock
c. Hemorrhagic stroke
d. Myocardial infarction
e. Status asthmaticus

19. The syndrome of cavity formation in the lungs is typical for:

a. Bronchial asthma
b. Bronchiectasis
c. Pulmonary infarction
d. Pneumonia
e. Lung abscess

20. The typical changes of the sputum test in lung abscess

include:
a. True A + B
b. Purulent sputum with unpleasant odor
c. Sputum splits into two layers when settled down
d. True A + C
e. Kurshman’s spirals

Topic 6- Respiratory Failure

1. All the following are pathophysiological mechanisms for

respiratory failure except
a. Hypoventilation
b. V/Q mismatch
c. Shift of O2-Hb dissociation curve to the left
d. Diffusion deficit

2. Which one of the following conditions causes respiratory

failure primarily by hypoventilation ?
a. Pulmonary fibrosis
b. Pulmonary embolism
c. Myaesthenia gravis
d. Pneumonia

3. Pulmonary shunt occurs when

a. Arterial blood mixes with venous blood (left to right)
b. A combination of both conditions above
c. Venous blood mixes with arterial blood (right to left)
d. None of the mentioned

4. Ventilation/Perfusion mismatch is
a. Both ventilation without perfusion and perfusion without
ventilation
b. Ventilation without perfusion
c. Perfusion without ventilation
d. A cardiac output higher than minute ventilation

5. All the following are common causes of respiratory failure

except
a. Pulmonary haemorrhage
b. ARDS
c. Pneumonia
d. Pulmonary embolism

6. Non-invasive ventilation is most useful for which one of the

following condition
a. Pneumonia with CO2 retention
b. Acute exacerbation of COPD with CO2 retention
c. Left ventricular failure with CO2 retention
d. Pulmonary embolism with CO2 retention

7. Investigation to confirm the diagnosis of respiratory failure

a. Echocardiography
b. Arterial blood gases
c. Chest radiography
d. Bronchoscopy

8. Complication of excessive oxygen therapy

a. Ketoacidosis
b. Lactate acidosis
c. Respiratory alcalosis
d. Oxygen toxicity

9. Complication of respiratory failure

a. Stress ulcer
b. Heart failure
c. All of the mentioned
d. Brain damage

10. Respiratory failure is a clinical syndrome which occurs when

a. PaO2 lower than 60 mmHg and/or PaCO2 higher than 50
mmHg
b. PaO2 lower than 90 mmHg and/or PaCO2 higher than 30
mmHg
c. PaO2 lower than 70 mmHg and/or PaCO2 higher than 40
mmHg
d. PaO2 lower than 30 mmHg and/or PaCO2 higher than 60
mmHg

11. Type 1 (hypoxemic) respiratory failure is characterized by

a. PaO2 < 50 mmHg and disorders of the respiratory controllers
in the central nervous system
b. PaO2 < 70 mmHg and disorders of the respiratory muscles
c. PaO2 < 60 mmHg and disorders of lung tissue
d. PaO2 < 90 mmHg and disorders of alveolo-capillary
membrane

12. Type 2 (hypercapnic) respiratory failure is characterized by

a. PaCO2 > 30 mmHg and pulmonary oedema
b. PaCO2 > 70 mmHg and failure of the alveolar-capillary
membrane
c. PaCO2 > 50 mmHg
d. PaCO2 > 50 mmHg and respiratory pump failure

13. The main physiological mechanisms of respiratory failure is

a. Hypoventilation
b. A shunt – when deoxygenated blood bypasses the alveoli
c. All of the mentioned mechanisms
d. Ventilation/perfusion mismatch

14. Extra-pulmonary causes of the respiratory failure include

a. Lower airways obstruction
b. Cardiogenic pulmonary edema
c. Abnormalities of the alveoli
d. CNS causes

15. What is the cause of ventilatory pump failure?

a. All the variants are correct
b. Diseases of the respiratory muscles
c. Severe hyperinflation of the lungs
d. Respiratory centres are insufficient for the demand

16. Mechanism of acute respiratory failure in severe

exacerbation of bronchial asthma?
a. Severe hyperinflation of the lungs
b. Alveolar hypoventilation
c. All of the mentioned
d. Reduced mechanical action of the inspiratory muscles

17. Indication for mechanical ventilation

a. Disturbed consciousness level or coma
b. Tachypnea with respiratory rate >30 breaths per minute
c. Hemodynamic instability
d. All of the mentioned

18. The goals of ventilatory support in respiratory failure

a. Correction of acute respiratory acidosis
b. Correction of hypoxemia
c. Giving rest for respiratory muscles
d. All of the mentioned

19. Indication for mechanical ventilation

a. Hypotension
b. Tachypnea with respiratory rate >30 breaths per minute
c. All of the mentioned
d. Alcalosis

20. A 38-year-old woman with severe asthma presents to your

clinic complaining that for the past 2 days, she has been
experiencing progressive shortness of breath. She now
experiences shortness of breath while at rest. She reports little
relief of her symptoms with the use of her albuterol inhaler.
She says that she is feeling tired. On examination, the patient’s
respiratory rate is 18 breaths/min; oxygen saturation on room
air is 86%. She has few expiratory wheezes with very little air
movement. Results of arterial blood gas measurements are as
follows: pH, 7.2; PaO2, 62 mm Hg; and PCO2, 63 mm Hg. On the
basis of the arterial blood gas measurements, which of the
following best describes this patient’s condition?
a. Chronic hypercapnic respiratory failure
b. Acute hypoxemic respiratory failure
c. Acute hypercapnic respiratory failure
d. Mixed hypoxemic and hypercapnic respiratory failure

21. A 73-year-old man with hypertension, coronary artery

disease, and diabetes mellitus presents to your office
complaining of cough and shortness of breath. He reports
progressive dyspnea on exertion for the past 3 or 4 days, now
has mild dyspnea at rest. He also states having fevers, chills,
purulent sputum production over this period. He denies having
come into contact with anyone who was sick. Results of
physical examination: blood pressure, 124/87 mm Hg; heart
rate, 95 beats/min; respiratory rate, 26 breaths/min;
temperature, 101.3° F (38.5° C); and oxygen saturation on room
air, 88%. The patient exhibits tachypnea without the use of
accessory muscles. Bronchial breath sounds are noted over the
right lower lung zones consistent with consolidation. A chest
radiograph in the office confirms a right lower lobe infiltrate.
You plan to admit the patient to the hospital for intravenous
antibiotics and further monitoring. Which of the following is a
likely cause of this patient’s low oxygen saturation?
a. Ventilation-perfusion mismatch
b. Alveolar hypoventilation
c. Low mixed venous oxygen content
d. Low inspired concentration of oxygen
e. Intrapulmonary shunting

22. A 64-year-old man with moderate COPD is complaining of

worsening shortness of breath for the past 5 days. He denies
having fevers or chills, but he does report increasing purulent
sputum production. He visited his 6-year-old grandson this past
weekend, and the child had symptoms of an upper respiratory
infection. The patient’s vital signs are normal except that
oxygen saturation on room air is 88%. Examination reveals
bilateral expiratory wheezing. A chest radiograph is normal.
Results of laboratory testing are as follows: white blood cell
count, 12,500/mm3; arterial blood gas pH, 7.35; arterial oxygen
tension (PaO2), 65 mm Hg; and carbon dioxide tension (PCO2),
60 mm Hg. Which of the following is the most appropriate step
to take next for this patient after he is admitted to the hospital?
a. Supplemental oxygenation via nasal cannula
b. Continuous oxygen saturation monitoring
c. Noninvasive positive-pressure ventilation
d. Mechanical ventilation

23. An 82-year-old patient has been increasingly confused and

lethargic for the past few days. The patient has stage IV breast
cancer with widespread bone metastases and requires long-
and short-acting narcotics for pain control. Her daughter
reports that the patient has been taking increasing doses of her
long-acting morphine to control the pain. Results of physical
examination are as follows: blood pressure, 98/62 mm Hg;
heart rate, 63 beats/min; respiratory rate, 8 breaths/min;
temperature, 98.2 F (36.8 C); and oxygen saturation on room
air, 95%. Arterial blood gas measurement reveals an acute
respiratory acidosis. Because of the patient’s altered
continuousness, she is admitted to the intensive care unit for
mechanical ventilation. Which of the following conditions
would place this patient at risk for acute hypercapnic
respiratory failure?
a. Large pulmonary embolism
b. Guillain-Barre syndrome
c. Pulmonary edema
d. Acute respiratory distress syndrome

24. A 66-year-old man, an asthmatic, presented with symptoms

suggestive of an acute exacerbation of asthma. His arterial
blood gas revealed PaO2 55 mm Hg with normal PaCO2 with a
compensated lactic acidosis. He was treated for an asthma
exacerbation and sepsis. Despite treatment, his respiratory rate
remained elevated although his hypoxaemia improved. There
was progressive worsening of the lactic acidosis. Treatment for
sepsis was augmented. Peak flow measurements were not used
to assess the severity of his exacerbation nor his response to
treatment. An alternate diagnosis of acute coronary syndrome
with acute pulmonary oedema was made and his asthma
treatment was stopped. This coincided with a decline in his
serum lactate. A diagnosis of salbutamol-induced lactic acidosis
(SILA) was made. SILA is a relatively common complication of
salbutamol therapy in moderate/severe asthma exacerbations.
It is caused by a mechanism different from the lactataemia that
is associated with septic shock and life-threatening asthma.
Which type of respiratory failure did he have?
a. Mixed hypoxemic and hypercapnic respiratory failure
b. Chronic hypercapnic respiratory failure
c. Acute hypoxemic respiratory failure
d. Acute hypercapnic respiratory failure

25..A 21-year-old man with a past medical history of well-

controlled intermittent asthma presented with acute worsening
shortness of breath overnight. Chest X-ray performed showed
bilateral large pneumothorax with significantly compressed
mediastinum. Chest tubes were placed bilaterally with
immediate clinical improvement. However, the chest tubes
continued to have an air leak without full lungs expansion.
Computed tomography scan without contrast of the chest
revealed subpleural blebs in both upper lobes. The patient
underwent bilateral video-assisted thoracoscopic surgery
(VATS) with apical bleb resection, bilateral pleurectomy, and
bilateral doxycycline pleurodesis. Biopsy of the apical blebs and
parietal pleura of both lungs were negative for any atypical cells
suspicious for malignancy or Langerhans cell histiocytosis. The
patient had been doing well six months following surgery with
no recurrence of pneumothorax. Pathophysiology of acute
respiratory failure in this patient?
a. Alveolar hypoventilation
b. Ventilation-perfusion mismatch
c. Severe hyperinflation
d. Acute respiratory distress syndrome

26. A 34-year-old female presented with sudden onset chest

pain and nonproductive cough. The patient had been smoking
cigarettes (1 pack·per day) for the last 14 years and reported
the use of oral contraceptive in the last 10 years. Any
suggestion of respiratory symptoms, including cough, shortness
of breath or physical limitations during exercise were denied.
On admission, the patient had no dyspnoea, and physical
examination demonstrated a slight decrease in breath sounds
over the left hemithorax. Heart sounds were normal and there
was no cyanosis, clubbing or oedema. The abdomen was
nondistended, nontender, and without bruits,
hepatosplenomagaly or masses. There were no focal
neurological findings. The patient had normal body
temperature with normal values of blood pressure, pulse and
respirations and transcutaneous blood gas determination in
room air showed normal arterial oxygen and carbon dioxide
tension. A chest radiograph demonstrated the presence of a
left-sided pneumothorax. Blood tests were within normal
values. After successful chest drainage, the patient was
discharged. Which additional examination should have been
done?
a. Echocardiography
b. D-dimer
c. CT scan of the chest
d. Spirometry