Respiratory NLE

14 y.o. girl with painless mass at neck PE: cystic

mass at midline located just below hyoid bone and
moving upward with protrusion of tongue. What is
the embryonic origin of the mass?
• A. 1st pharyngeal groove
• B. 2nd pharyngeal pouch
• C. Third pharyngeal pouch
• D. pharyngeal pouch
• E. endoderm foramen caecum
15 y.o. boy with epistaxis and hemoptysis PE
swelling pf nasal septum, bleeding is from
nasopharynx. Which artery must be ligated?
• A. anterior ethmoidal
• B. posterior ethmoidal
• C. Lesser palatine
• D. greater palatine
• E. sphenopalatine
5 y.o. girl with severe dyspnea and cough for 1
hour. PE BT 37.2 RR40 PR110 BP 132/65 expiratory
wheezing both lungs. What is the most
appropriate symptomatic treatment?
• A. oral montelukast
• B. inhaled cromolyn
• C. inhaled salbutamol
• D. inhaled ipratropium
• E. intravenous dexamethasone
A newborn was diagnosed with Digeorge’s
syndrome which arise from malformation of
pharyngeal arch 3 and 4. Which of the following
structure would be absent in this patient?
• A. Lingual tonsil
• B. parathyroid gland
• C. thyroid gland
• D. aortic arch
• E. common carotid artery
A 30 y.oo. Man was adviced to stop smoking but
he does not seem to care. Which stage of
addiction overcoming stage is he in?
• A. Action
• B. prepare
• C. contemplation
• D. maintain
• E. precontemplation
A woman is on a hiking trip in the desert. PE BT 39.
relative humidity is 67%. What type of heat loss is
the most prominent way in this patient?
• A. radiation
• B. air convention
• C. water convention
• D. conduction
• E. evaporation
Which of the following substances is the most
prominent during bronchial tree relaxation?
• A. Acetylcholine
• B. epinephrine
• C. norepinephrine
• D. morphine
• E. dopamine
Which of the following diagnosis best fit the
patient who has this spirometry result?
bronchiectasia : pseudomonas aerogenosa -> ceftazidime,piperazidin -tazobactam
• A. Kyphoscoliosis
• B. Bronchiectesis
• C. Pneumoconiosis
• D. pulmonary edema
• E. pulmonary tuberculosis
A 20 years old man was found comatose on the
ground. His arms have multiple injection wound.
PE BP 100/70 HR 60 RR 8 Heroin overdose was
suspected. Which of the following arterial blood
gas best fit this patient?
• A.

• B.

• C.

• D.

• E.
A 55 y.o. man just undergone a cardiac bypass
surgery 3 hours ago. His arterial blood gas has pH
7.31 O2sat 90% paO2 62% PaCO2 63. What is the
cause of his arterial blood gas abnormality?
• A. V/Q mismatch
• B. hypoventilation
• C. left to right shunt
• D. dead space
• E. diffusion defect
25 year old man had hyperventilation attack. PE
shows carpopedal spasm. Which of the following
is increased in this man?
• A. arterial PaO2
• B. arterial PaCO2
• C. Hb O2 affinity
• D. serum bicarbonate
• E. serum CO2
A patient with severe persistent asthma was
treated with an IL-5 inhibitor. Which of the
following cell or substance was inhibited by this
medication?
• A. IgE activity
IgE activity : omalizumab

• B. Eosinophil activity IL-5 : mepolizumab

• C. Th2 helper cell

• D. mast cell degradation
• E. neutrophil activity
A woman with allergic rhinitis has been using
intranasal decomgestant for more than 10 days.
Which of the following adverse event might be
found?
• A. anosmia
• B. epistaxis
• C. rebound congestion
• D. nasal septum perforation
• E. mucosal membrane atrophy
60 y.o. man presented with nonproductive cough
with bloody sputum for 2 months. CXR reveals a 5
cm mass at hilar of left lung. Sputum examination
is as follow. Which diagnosis best fit our patient?
• A. sarcoidosis
• B. lung cancer
• C. mesothelioma
• D. cryptococcosis
• E. tuberculosis
A 20 year old primigravida with diabetes has the
onset of premature labour at the 30th week of
gestation. Which of the following medications
administered may prevent occurrence of acute
respiratory distress syndrome of her premature
newborn?
• A. thiamine
• B. surfactants
• C. terbutaline
• D. indomethacin
• E. dexamethasone
A 40 years old woman was admitted with bacterial
pneumonia. She starts coughing blood streaked
sputum today. Which stage of pulmonary tissue
does she have?
• A. Red hepatization
• B. Grey hepatization
• C. Blue hepatization
• D. Honeycomb
• E. Resolution
ชาย 40 ปี pneumonia มั้ง มานอนรพ แล้ว acute
diarrhea เป็ นกันทั้งวอร์ด ถามวิธีป้องกัน
• 1.ใส่แมสก์
• 2. ใส่กาวน์
• 3. ใส่ face shield
• 4. Aseptic กับทุกเครื่องมือ
• 5. ล้างมือก่อนและหลังสัมผัสผูป้ ่ วย
A newborn baby เกิดที่ 28 week เกิดมาแล้ว develop
respiratory distress CXR: bilateral ground glass
appearance infiltration What's the most likely
feature found in this patient?
• A. Diffuse alveolar hemorrhage
• B. Interstitial lymphocytic infiltration
• C. Neutrophilic exudate
• D. Pulmonary fibrosis with dilated airspace
• E. Poorly developed saccular alveoli
ชาย 50 ปี ทางาน automobile brake pad มา 20 ปี
diffused interstitial lung with calcification
• 1. aspergilloma
• 2. mesothelioma
• 3. bron...
• 4. Pulmonary embolism
• 5. pulmonary tuberculosis
เด็กเป็ นards อะไรผิดปกติ
• a. phosphatidylcholine
• b. phosphatidylserine
• c. phosphatidylinositol
runner force inspiration
• a. anterior scalene
• b. subcostal
• c. external intercostal
• d. serratus ant
• e. innermost intercostal
A 60-year-old heavy smoking man presents with
difficult breathing and profound coughing. The
dysfunction of which structure is responsible for
his ineffective coughing?
• A. Cilia
• B. Clara cell
• C. Goblet cell
• D. Seromucous gland
• E. Type II pneumocyte
เด็กกินpeanutไอรัวๆ+difficult breathing ติดที่ไหน
most common สุ ด
• A. Larynx
• b. Trachea
• c. Bronchus
• d. Bronchiole
interstitial pneamonia Cold agglutination+ เชื้อ
อะไร
• a. Mycoplasma pneumoniae
Follow up of 55-years-old man blood pressure is
170/105 mmHg. He was have blood pressure
175/110 mmHg on routine check up 1 month ago.
He did’t take any action because he felt fine. If
don’t treat his condition. What is the greatest risk
will occur?
• A. Pulmonary effusion
• B. Pulmonary hypertension
• C. Tricuspid insufficiency
• D. Cardiac concentric hypertrophy
• E. Interstital lymphocytic miocarditis
Heavy smoker , pursed lip , barrel chest ถาม
CXRพบอะไร
• A. Diffuse bronchiolar infiltrates
• B. Dilated air way with damaged alveolar wall
50 year old man, heavy smoker, chronic dyspnea
with barrel shape chest, what respiratory
parameter will be found in him?
• a) Decrease lung compliance
• b) Decrease chest wall compliance
• c) Increase inspiratpry residual volume
• d) Increase expiratpry residual volume
• e) Increase residual capacity
newborn distress which decrease
• A. Phosphatidylserine
• B. Phosphatidylcholne
• C. Phosphatidylinositol
• D. Phosphatidylglycerol
70 YO male heavy smoker , difficult to breath , face
swelling , jugular venous drainage , upper limb
edema , no lower limb edema CXR : right upper
lung mass. What is diagnosis
• a) SVC obstruction
• b) Atelectasis
Patient take isoniazid. Which supplement
drug should be prescribed?
• a) Thiamine
• b) Niacin
• c) Cobalamine
• d) Pyridoxine
• e) Riboflavin
55 year old man วินิจฉัยว่ามีrespiratory distress หลังผ่าตัด
ใส่ เครื่ องช่วยหายใจ หลังจากนั้น 3วัน เริ่ มหายใจเหนื่อย CXR พบ
increase opacification both lung
• A.pulmonary infarction
• B.total lung atelectasis
• C.necrotizing pneumonia
• D.Acute pulmonary emboliam
• E.Acute respiratory distress syndrome
เด็กอายุ28weekคลอดมาพบภาวะ respiratory disstress
CXR:bilateral ground glass ถาม feature
• A.massive ... hemorrhage
• B.infiltrate lymphocyte
• C.neutrophilic exudate in alveoli
• D.fibroblast
• E.minimal alveolar saccular development
ชาย 35 ปี dyspnea, tachypnea, sternal retraction
Asthmatic Attack, hyperventilation,
intercostal retraction, pH 7.5, PaO2 = 60,
PaCO2 = 30 จะพบอะไรเพิRม
• a) %FEV/FVC
• b) serum [HCO3-]
• c) renal net acid excretion
• d) expiration reserve volume
• e) pulmonary vascular resistant
30 y.o. male patient presented with acute dyspnea
และ deep inspiration + pleuritis chest pain for 6
hour. CXR found complete left lung
collapse.Blood gas shown hypercapnia and
hypoxemia. What is decreased in this patient.
• a) Hb O2 affinity
• b) Pulmonary vascular resistanse
• c) plasma HCO3- concentration
• d) plasma 2,3DpG comcentration
• e) stimulation form Chemoreceptor reflex
A man was stabbed in the right 3rd intercostal
space. x Ray พบatelectasis. Dyspnea does not
improve eventhough the patient force more
inspiration. What is the cause of his dyspnea?
• a) decreased pulmonary compliance
• b) decreased chest wall compliance
• c) loss of intrapleural negative pressure
• d) loss of intraalveolar negative pressure
35-year old man come with deep laceration on
right chest wall from motorcycle accident ,
right lung collapse , and cannot reexpand during
attempted inspiration. Which abnormal
respiratory mechanism occur?
• ) Decrease lung compliance
• b) Decrease chest wall compliance
• 64 สหพันธ์นิสิตนักศึกษาแพทย์แห่งประเทศไทย ในพระอุปถัมภ์ฯ (สพท.)
• c) Loss air resistant
• d) Loss intrapleural negative pressure
• e) Loss alveolar negative pressure
คนไข้โดนแทงเข้า chest wall ทางหน้าอกด้านซ้าย แล้วดึงมีดออกทันที
ไม่กีนาทีต่อมา เกิด อาการdypnea และตาย ผลตรวจศพพบว่า รอยแผลที
R chest wall ขนาด 3 cm lung intact คาถาม pressure
ในข้อใดต่อไปนียงั คงเป็ นลบ

• a) Intra-abdominal pressure
• b) Right intra-pulmonary pressure
• c) Right intra-pleural pressure
• d) Left intra-pulmonary pressure
• e) Left intra pleural pressure
A man presented with Hemoptysis มา 3 เดือน, มี
cervical lymphadenopathy. Which of the following
pathology will be found in his lungs?
• a) Fribrinoid necrosis
• b) Aggegration Epitheloid cell
• c) Forming Granulation tissue
5. Preterm newborn RDS มีอาการหายใจลาบากจนมีซีโR
ครงบุ๋ม อาการดังกล่าวเกิดจากความผิดปกติของอะไร
• a) type1 alveolar cell
• b) type2 alveolar cell
• c) respiratory epithelial cell
• d) olfactory epithelial cell
• e) Interstitial
A man post lumbar surgery -> bedridden ->
dyspnea, pleuritic chest pain ตรวจเจอ V/Q mismatch
นอนโรงพยาบาล7วัน what is the cause of pulmonary
finding
• a) fat emboli
• b) red infarction
• c) pneumothorax
• d) pulmonary edema
• e) pulmonary thrombosis
60 yrs old man cigarette smoking 30-pack-year,
produtive cough, dypnea on exertion, low
PaO2 ถามว่า factors mainly determine gas effusion?

• a) Alveolar surface area

• b) Pulmonary blood flow
• c) Pulmonary surfactant
• d) Constant CO2 effusion
• e) Fluid accumulation in alveoli
Which of the following has Hb-O2 dissociation
curve similar to strenuous exercise?
• a) Hyperthermia
• b) Cyanide poisoning
• c) Metabolic alkalosis
• d) Voluntary hyperventilation
• e) Carbon monoxide poisoning
• f) Decrease of 2,3-BPG
ผูป้ ่ วยอายุ 25 ปี มาด้วยdyspnea lung crepitation fever
มาด้วยอาการ pneumonia มีoxygen sat 90 % ใสtube
cannula oxygen sat 95% สาเหตุทาให้เกิดhypoxia คือ

• a) Low v/q mismatch

• b) Left to right shunt
• c) Hypoventilation
คนไข้อายุ 25 ปี เดิมเป็ น asthma รักษาด้วยยาICS มา 5 ปี ต่อมาผูป้ ่ วย
เป็ น rhinorrhea & cold แพทย์ จึง supportive treatment
ต่อมาผูป้ ่ วยมี palpitation ถามว่าเป็ นผลจากยาใด
• a) Sulbutamol
• b) Bromhexine
• c) Muntelukast
• d) Chlorpheniramine
• e) Dextromethorphan