1.What is the most COMMON type or category of respiratory diseases?

(1/1 Point)
Restrictive lung disease
Pulmonary Vascular disease
Obstructive lung disease
Infectious lung disease
2.The most common presenting symptom for respiratory diseases, include the
following?
(1/1 Point)
Cough and dyspnea
Cough and chest pain
Hemoptysis
Sputum production
3.Common causes of hemoptysis include the following, EXCEPT:
(1/1 Point)
Pneumothorax
Pulmonary Tuberculosis
Pulmonary Embolism
Bronchogenic Carcinoma
4.Which of the following lung diseases present with DECREASED breath sounds
with HYPERRESONANCE in percussion?
(1/1 Point)
Pleural Effusion
Pneumothorax
Pneumonia
Pulmonary Embolism
5.This is high-pitched, focal inspiratory wheeze, usually heard over the neck as
manifestation of upper airway obstruction?
(1/1 Point)
Wheeze
Rhonchi
Stridor
Crackles
6.Egophony - auscultation of the sound “AH” instead of “EEE” when a patient
phonates “EEE" is a finding that may be noted in?
(1/1 Point)
Pneumothorax
Pleural Effusion
Consolidation Pneumonia
Pulmonary Edema
7.Clubbing may be seen in the following diseases, except?
(1/1 Point)
Pneumonia
Cystic Fibrosis
Idiopathic Pulmonary Fibrosis
Lung Cancer
8.Blunting of the constophrenic angles on chest x-ray is indicative of what
respiratory disease?
(1/1 Point)
Pneumonia
Pleural Effusion
Pneumothorax
Pulmonary embolism
9.The following tests are helpful in the diagnosis of lung diseases
(1/1 Point)
Chest Ultrasound
Arterial Blood Gas
Sputum Evaluation
All of the above
10.True or False: Patients with Emphysema may sometimes present with a quiet
chest with diffusely decreased breath sounds
(1/1 Point)
True
False
1.What is the most common pathogenetic mechanism for the production of
pneumonia?
(1 Point)
Inhalation of infectious aerosols
Aspiration of pulmonary pathogens from the oropharynx
Hematogenous dissemination from extrapulmonary sites
None of the above
2.The following are risk factors strongly associated with Pseudomonas aeruginosa
healthcare -associated pneumonia, except:
(1 Point)
Chronic dialysis
Nursing home residence
Hospitalization for >48 hrs
Previous antibiotic therapy
3.Which pathologic phase of pneumonia is characterized by predominance of
neutrophils and fibrin deposition?
(1 Point)
Edema
Red hepatization
Gray hepatization
Resolution
4.The following are true of pneumonias, except:
(1 Point)
In Ventilator-associated Pneumonia, respiratory bronchiolitis may precede the development of a
radiologically apparent infiltrate
A bronchopneumonia pattern is more common in nosocomial pneumonia
Lobar pattern is seen more in CAP
Viral and Pneumocystis pneumonias represent interstitial rather than alveolar process
5.The following are ATYPICAL microorganisms causing CAP, except:
(1 Point)
Legionella
Klebsiella
Chlamydia pneumoniae
 Mycoplasma
6.The usual respiratory pathogen that complicates influenza infection:
(1 Point)
Staphylococcus aureus
Mycobacterium tuberculosis
Legionella spp.
Pneumocystis jiroveci
7.Most likely pathogens causing CAP in patients with COPD and/or smoking
history, except:
(1 Point)
Moraxella catarrhalis
Hemophilus influenzae
Anaerobes
Pseudomonas aeruginosa
8.CAP developing in a patient after exposure to bats or birds suggests which
organism:
(1 Point)
Chlamydophila psitacci
Francisella tularensis
Histoplasma capsulatum
Hantavirus
9.To be adequate for culture, a sputum sample should have:
(1 Point)
> 25 polymorphonuclears/lpf
< 10 squamous epithelial cells/ lpf
Both A and B
None of the above
10.The most important risk factor for antibiotic-resistant pneumococcal infection:
(1 Point)
Extremes of age
HIV infection
Recent hospitalization or residence in a nursing care facility
Use of a specific antibiotic within the previous 3 months
1.The following disease commonly present with hemoptysis, EXCEPT:
(1/1 Point)
Goodpasture's syndrome
LAM
Granulomatous Polyangitis
Idiopathic Pulmonary Fibrosis
2.TRUE about diffuse parenchymal lung diseases, EXCEPT
(1/1 Point)
Heterogenous conditions that affect the lung parenchyma with varying degrees of inflammation
and fibrosis
Most patients come to medical attention for progressive exertional dyspnea or a persistent dry
cough
ILDs can be associated with high rates of morbidity and mortality
Lung biopsy is required in all cases for definitive diagnosis
3.Idiopathic pulmonary fibrosis presents most commonly at this age group:
(1/1 Point)
20-30 years old
30-40 years old
40-50 years old
>60 years old
4.These ILDs are more commonly seen in women, EXCEPT:
(1/1 Point)
Idiopathic Pulmonary Fibrosis
Lymphangioleiomyomatosis [LAM]
Connective Tissue Disease Related-ILDs
All are correct
5.This is the most common complaint in patients presenting with an ILD:
(1/1 Point)
Cough
Dyspnea on exertion
Hemoptyis
Chest Pain
6.This is a late finding in patients with ILD and is indicative of ADVANCED disease.
(1/1 Point)
Cough
Wheeze
Crackles
Clubbing
7.Which pulmonary function test result may be seen as an earlier manifestation of
ILD?
(1/1 Point)
Increased FEV1 to FVC ratio
Low diffusing capacity of the lung for carbon monoxide (DLCO)
Increased total lung capacity (TLC)
Reduced FEV1 to FVC ratio
8.Which is the most common type of ILD secondary to an unknown cause?
(1/1 Point)
Idiopathic Pulmonary Fibrosis
Cryptogenic Organizing Pneumonia
Pulmonary Langerhans Cell Histiocytosis
Connective Tissue Related-ILD
9.Which radiographic finding in chest CT scan is suggestive of an advanced
disease?
(1/1 Point)
basilar reticular pattern
small cystic spaces
honeycombing
emphysema
10.ILD with a KNOWN cause include all of the following diseases, EXCEPT:

(1/1 Point)
Asbestosis
Granulomatosis with Polyangitis
SIlicosis
Langerhan's Cell Histiocytosis
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PULMO - Pleural Diseases
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Points:
5/5
1.Which of the following diseases causes a TRANSUDATIVE type of PLEURAL
EFFUSION?

(1/1 Point)
Tuberculosis
Urinothorax
Esophageal perforation
Meigs' syndrome
2.All of the following criteria indicate an EXUDATIVE pleural effusion, EXCEPT:
(1/1 Point)
pleural fluid protein/serum protein > 0.5
pleural fluid LDH/serum LDH > 0.6
pleural LDH less than 2/3 the normal upper limit for serum
all are correct
3.All are true about tuberculous pleural effusion, EXCEPT:
(1/1 Point)
Primarily due to a hypersensitivity reaction to mycobacterium protein in the pleural space
The pleural fluid is a transudate with predominantly small lymphocytes
Diagnosis may be established by demonstrating high levels of TB markers in the pleural fluid like
adenosine deaminase >40 IU/L or interferon γ >140 pg/mL
Patients with tuberculous pleuritis present with fever, weight loss, dyspnea, and/or pleuritic chest
pain
4.In hemothorax, thoracoscopy or thoracotomy is considered when pleural
hemorrhage exceeds:
(1/1 Point)
>50 mL/hour
>100 mL/hour
>150 mL/hour
>200 mL/hour
5.Which type of pneumothorax occurs without antecedent trauma to the thorax
in a patient with no underlying lung disease?
(1/1 Point)
Primary spontaneous pneumothorax
Secondary pneumothorax
Traumatic pneumothorax
Tension pneumothorax
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1.Common mediastinal masses located in the ANTERIOR mediastinum include the
following, EXCEPT:
(1/1 Point)
Lymphoma
Thymoma
Bronchogenic cyst
Thyroid masses
2.The most valuable imaging technique for evaluating mediastinal masses
(1/1 Point)
Chest CT scan
Barium studies
I-131 scan
Mediastinoscopy
3.True or False: Mortality rates for acute mediastinitis post sternotomy still
exceeds 20% despite immediate drainage, debridement and antibiotics
(1/1 Point)
True
False
4.The main causes of pneumomediastinum to occur include the following,
EXCEPT:
(1/1 Point)
Alveolar rupture with dissection of air into the mediastinum
Perforation or rupture of the esophagus, trachea, or main bronchi
Dissection of air from the neck or the abdomen into the mediastinum
Acute rupture of an apical plueral bleb
5.Tension pneumothorax is treated as a medical emergency. What area in the
anterior chest should a large-bore needle be inserted to relieve patient of his
symptoms while awaiting chest tube insertion?
(1/1 Point)
2nd intercostal space midclavicular line
3rd intercostal space midclavicular line
4th intercostal space posterior axillary line
5th intercostal space posterior axillary line
6.Which of the following ventilatory alarms will indicate the diagnosis of a
possible Tension Pneumothorax?
(1/1 Point)
High plateau pressures
High exhaled tidal volume
High peak inspiratory pressures
Reverse inspiratory:expiratory (I:E) ratio
7.This compartment of the mediastinum is bounded by the pericardium and
trachea anteriorly and the vertebral column posteriorly
(1/1 Point)
Anterior mediastinum
Middle mediastinum
Posterior mediastinum
8.Common mediastinal masses located in the MIDDLE mediastinum include the
following, EXCEPT:
(1/1 Point)
Vascular masses
Pleuropericardial cysts
Bronchogenic cysts
Neurogenic Tumors
9.Which factor indicates the likely need for a procedure MORE INVASIVE than a
thoracentesis (e.g. chest tube insertion)?

(1/1 Point)
Pleural fluid pH <7.20
Non-loculated pleural fluid
Pleural fluid glucose >3.3 mmol/L (>60mg/dl)
Negative Gram stain or culture of the pleural fluid
10.The most common tumors causing malignant pleural effusion include the
following, EXCEPT:

(1/1 Point)
Lung CA
Lymphoma
Hepatocellular CA
Breast CA
Occupational Lung Diseases
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Points:
10/10
1.This occupational lung disease is characterized by progressive pulmonary
fibrosis, “eggshell” pattern of hilar lymphadenopathy, and a high risk of acquiring
tuberculosis:

(1/1 Point)
Asbestosis
Berylliosis
Bysinnosis
Silicosis
2.This risk factor for lung cancer is obtained from significant indoor exposure to
gas that emanates from decay of uranium 238 to radium 226
(1/1 Point)
Ozone exposure
Sulfur dioxide exposure
Diazomethane exposure
Radon gas exposure
3.This is the second leading environmental hazard, behind unsafe water,
sanitation and hygiene, and is 3.5x larger than the burden attributed to outdoor
air pollution, it may come from wood, dung, or charcoall:
(1/1 Point)
Acid fumes
Ozone
Biomass smoke
Phosgenes
4.Which of the following occupational lung disease shows irregular opacities first
noted in the lower lung fields, indistinct heart border or a "ground-glass"
appearance as its hallmark?
(1/1 Point)
Silicosis
Asbestosis
Berylliosis
Hypersensitivity Pneumonitis
5.True or False: Water-soluble gases are absorbed in the lining of the upper &
proximal airways and tend to produce irritative & bronchoconstrictive responses.
(1/1 Point)
True
False
6.Caplan’s syndrome is characterized by a combination of pnuemoconiotic
nodules in association with which disease?
(1/1 Point)
Churg Strauss vasculitis
Polyarteritis nodosa
Rheumatoid arthritis
Sjögren’s syndrome
7.A 57-year-old cotton dust farmer complains of occasional chest tightness
toward the end of the first day of the week (Monday chest tightness) associated
with a significant drop in FEV1 over the course of a Monday workshift. What is
the likely diagnosis?
(1/1 Point)
Byssinosis
Asbestosis
Coal Worker's Pneumoconiosis
Farmer's Lung
8.The following are true of mesotheliomas due to asbestos exposure, EXCEPT:
(1/1 Point)
Strongly associated with smoking
Generally locally invasive
May involve the peritoneum
 Mediastinal shift is uncommon
9.Biomass fuel exposure in women in developing countries is related to which of
the following respiratory disease?
(1/1 Point)
Idiopathic Pulmonary Fibrosis
Intersitial Pneumonia
Asthma
COPD
10.Which of the following size of particles are considered as coarse-mode
fractions like silica, aluminum or iron and usually deposit high up in the
tracheobronchial tree?
(1/1 Point)
>10-15 micrometer
2.5-10 micrometer
<2.5 micrometer
<0.1 micrometer
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PULMO POST TEST - Hypersensitivity
Pneumonitis
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Points:
10/10
1.True about Hypersensitivity Pneumonitis, EXCEPT:
(1/1 Point)
Also known as extrinsic allergic alveolitis
Occurs due to inhalational exposure
Increased risk in smokers
IgG antibodies is necessary for development
2.Acute HP usually manifests as follows, except?
(1/1 Point)
Occurs 4–8 h following exposure to the inciting antigen
Mild in nature
Systemic symptoms, including fevers, chills, and malaise
Symptoms resolve within hours to days
3.True about the chest Imaging features of HP:
(1/1 Point)
Ill-defined micronodular opacities
hazy ground-glass airspace opacities in subacute HPOption 2
subpleural honeycombing
All of the above
4.This presents with transient pulmonary infiltrates w/ eosinophilia that occurs in
response to passage of helminthic larvae through the lungs most commonly
Ascaris species
(1/1 Point)
Loffler syndrome
 Strongyloides Infection
Allergic bronchopulmonary Aspergillosis
Eosinophilic Granulomatosis
with Polyangiitis (EGPA)
5.True about the histologic features of HP:
(1/1 Point)
presence of caseating granuloma in the vicinity of small airways
Granulomas are well-defined as compared in Sarcoidosis
Within alveolar spaces & interstitium, a mixed cellular infiltrate w/ a lymphocytic
predominance in patchy pattern
Bronchiolitis, fibrosis, honeycombing is not seen
6.The following are significant predictors of HP, EXCEPT:
(1/1 Point)
Presence of serum precipitins
non-recurring symptoms
symptoms 4-8H after antigen exposure
crackles on inspiration
7.Which of the following examples of Hypersensitivity Pneumonitis are correctly
matched to their appropriate antigen or exposure?
(1/1 Point)
Malt worker's lung - wheat flour
Miller's lung - Barly
Bagassosis - sugar cane
Farmer's lung - animal furs
8.What is the mainstay of treatment for HP?
(1/1 Point)
Antigen avoidance
Nindetanib
Prednisone
Lung Transplantation
9.This has been hypothesized to play an etiologic role for the development
of Pulmonary eosinophilic syndromes.
(1/1 Point)
 Interluekin 8
Interleukin 5
Tumor necrosis factor
CD8+ cells
10.Pathognomonic Chest Imaging feature of CHRONIC Eosinophilic Pneumonia
(1/1 Point)
Honeycombing
Subplueral thickening
Photographic negative pulmonary edema
Septal line thickening
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1.This area in the medulla acts as the initial integration site for many of the
afferent nerves relaying information about Pao2, Paco2, pH, and blood pressure
from the carotid and aortic chemoreceptors and baroreceptors to the CNS:

(1/1 Point)
Dorsal Respiratory Group (DRG)
Ventral Respiratory Column (VRC)
Pre-Bötzinger Complex
Pneumotaxic center
2.In the balance between respiratory system strength and load, which
abnormality arises if normal respiratory muscle strength is coupled with excessive
respiratory drive which then alveolar hyperventilation ensues, leading to
_________?
(1/1 Point)
Normal gas exchange
Hypercapnia
Hypocapnia
Hypoventilation
3.Which of the following is considered a sign and symptom of hypoventilation?
(1/1 Point)
Dyspnea during activities of daily living
Night-time hypersomnolence
Late-night headaches
Active cough reflex in neuromuscular disease
4.The clinical course of patients with chronic hypoventilation from neuromuscular
or chest wall disease follows a characteristic sequence including ALL of the
following, EXCEPT:
(1/1 Point)
Asymptomatic Stage - daytime PaO2 and Pa CO2 are norma
Nocturnal Hypoventilation – initially during REM sleep and later in non-REM sleep
Daytime Hypercapnia - when vital capacity drops further
Obstructive ventilatory defects - wheezing with shortness of breath especially at night
5.Treatment of choice for hypoventilation and apneas, both central and
obstructive, in patients with neuromuscular and chest wall disorders which
improves daytime hypercapnia, prolong survival and improve health-related
quality of life:
(1/1 Point)
Nocturnal Noninvasive Positive-Pressure Ventilation (NIPPV)
Invasive mechanical ventilation
Bi-level positive airway pressure (BiPAP)
Oxygen supplementation
6.Treatment options for Obesity Hypoventilation Syndrome:
(1/1 Point)
Weight reduction
NIPPV
Continuous positive airway pressure (CPAP)
All are treatment options
7.TRUE about Ondine’s curse or Congenital Central Hypoventilation Syndrome
(CCHS):
(1/1 Point)
secondary to abnormalities in gene encoding PHOX2b
good respiratory response to hypoxia or hypercapnia
May normalize Paco2 during exercise and non-REM sleep
Markedly elevated PaCO2 during REM sleep
8.This is defined as the EXCESS in ventilation of metabolic requirements leading
to a reduction in Paco2:
(1/1 Point)
Hypoventilation
Hyperventilation
Metabolic Alkalosis
Respiratory Acidosis
9.True about Phrenic nerve or diaphragm pacing in the treatment of
hypoventilation:
(1/1 Point)
It is a potential therapy for patients with hypoventilation from high thoracic spinal cord lesions
nerve conduction studies are done prior to procedure to ensure normal bilateral phrenic
nerve function
 diaphragmatic pacing has not been shown to improve quality of life
All are TRUE
10.True about the treatment of hyperventilation:
(1/1 Point)
Breathing exercises and diaphragmatic retraining are beneficial for some patients
Beta-blockers can be given to patients with sympathetically mediated symptoms such as
palpitations and tremors
Identifying and eliminating habits that perpetuate hypocapnia, such as frequent yawning or sigh
breathing, can be helpful
All are TRUE