DCTD Screening Exam -2008 July

1. Tuberculin skin test

a. Read after 24 hrs

b. Transverse diameter of erythematous area measured
c. Mantoux helpful for diagnosis in high prevalence TB country
d. Use tuberculin bacilli
e. If Mantoux >20mm PTB diagnosed

2. Milliary TB
a. Normal CXR Excludes diagnosis
b. Mantoux is usually positive
c. Sputum AFB positive
d. Hematogeous spread in all possible cases
e. Cavitation can be seen

3. TB Pleural effusion
a. High prevalence in young pt with immune competence
b. AFB culture is most of the time positive
c. TB pleural effusion is always treated with steroids

4. Incidence of TB in Sri Lanka

a. 40 per 100,000 is the prevalence
b. 8000 per year sputum +ve cases seen
c. During last decade diagnosed cases of TB is gradually decreasing
d. Commoonly seen in old age

5. MDR TB
a. Resistance to two of any ATT
b. Sould treat for one year after sputum culture negative
c. Quinalone plays a role
d. Common in HIV patients
e. Irregular treatment is a causative factor

6. WOF T/F
a. DOT provider is always a health care worker
b. Cure rate in Sri Lanka is over 80%
c. For TB meningitis with Neurological manifestations the initiation phase should be
extended
d. Post primary TB patient can present without clinical signs
e. A patient presenting after 2 weeks of not taking treatment after commencement can be
 given CAT 1

7. Risk factor for TB

a. Old age
b. Uncontrolled hypertension
c. Malnutrition
d. Diabetes mellitus
e. Epilepsy
f. Chronic alcoholism
g. Malignancy

8. Post primary TB
a. Localized wheezing can be heard
b. Daily drugs are as effective as 3days/week drugs
c. Pyrazinamide acts on extracellular bacteria
d. TB pleural effusion
e. Plural effusion with cavitation may indicate long period of diseas

1. BA differ from COPD

a. Nocturnal cough
b. FEV1/FVC reduced
c. Develop cor pulmonale
d. Peripheral blood eosinophilia
e. History of Atopy

2. Bronchial asthma
a. Breast feeding is a way of primary prevention of bronchial asthma
b. Long acting Theophyllin can be given in 2 nd stage
c. Nocturnal cough can be treated with Salmetrol
d. Exercise should be discouraged

3. Community acquired pneumonia

a. Streptococcal pneumonia is commonly spread in hospital
b. Amoxicillin has no place a s resistance to penicilin has developed
c. Can present without cough
d. Sputum culture mandatory
e. Viral pneumonia accounts for 35%

4. Properly done CXR-PA Telechest

a. Transverse processes of T1,T2,T3 can be seen
b. R/S anterior end of the 5th rib can be seen
c. Upper lobe lesion can be masked by the clavicle
 d. Hypertranslucency cannot be attributed to the rotation
e. CT ratio of >0.5 indicate cardiomegaly

5. Pulmonary embolism
a. Long air travel is a known cause
b. Doppler scan of the lower limb is an ancillary Ix
c. CT angiogram is the choice of Ix
d. If V/Q mismatch normal can exclude PE
e. Left Vent strain pattern seen in ECG

6. WOF T/F
a. Leigenella pneumonia treated with amoxicillin
b. In Mycoplasma pneumonia neutrophil leukocytosis can be seen
c. Sarcoid can obstruct bronchi
d. Iv Mg sulphate can be used in acute severe asthma

7. Residual Volume
a. Increased in old age
b. Increased with exercise
c. Is the remaining amount after a comfortable breath
d. 25% of the total lung capacity

8. B/L Lower lobe opacities seen in

a. Sarcoidosis
b. Silicosis
c. Cystic bronchiectasis
d. Idiopathic pulmonary fibrosis

9. These two are present together,

a. L/S small pneumothorax with 2nd sound click
b. Acute pancreatitis with pleural effusion
c. Post MI syndrome with pleural effusion
d. Nalidicxic acid and lung fibrosis
e. Ankylosing spondylosis with pulmonarty fibrosid

10. Reactive lung disease

a. COPD
b. BA

DTCD Selection exam – 2010

1. Aspirin induced asthma
a. 20% of bronchial asthma
b. Predominant in males
c. Increased Interleukins
d. Associated with conjunctivitis

2. Increased translucency in CXR

a. Mastectomy
b. Rotation
c. Pneumonia
d. Pneumothorax

3. Intracavitatory bodies seen in

a. Mycitema
b. Hydatid cyst
c. Resolving pneumonia
d. Malignancy
e. Pnemocycistis carini

4. COPD
a. Stage II – inhaled steroids can be used
b. FEV1/FVC <70% diagnostic (prebronchodilator)
c. Main treatment is bronchodilators
d. Oral steroids is used in treatment

5. Asthma
a. Main apthology is due to smooth muscle hypertrophy
b. Hyperresponsiveness
c. Salmetrol alone can be used

6. T/F
a. Rifampicin can cause ARF
b. Ethambutol nephrotoxic
c. Ethambutol optic neuritis is dose dependant
d. Streptomycin can be given in pregnancy
e. Pirezinamide can cause foetal hepatotoxicity

7. Oxygen dissociation curve right shift

a. Acidosis
b. Alkalosis
c. High altitude
d. Hyperthermia
8. ATT taken for 6/52 and defaulted for 10/52 and then smear +ve,
a. CXR is not useful in treatment regimen
b. AFB culture is not useful
c. Atypical mycobacteria is likely
d. Change the regimen – CAT 2

9. Pneumothorax
a. Emphysema pts can get primary spontaneous pneumothorax
b. Divers at risk
c. Mechanical ventilation
d. Smokers can get
e. In 2ry pneumothorax most patients need IC tube insertion

10. Mycobacterium avium intercellulare with HIV

a. Can get when CD4 count is high
b. Sputum culture is a must
c. Mantoux test – 6mm is positive
d. ART and TB drugs should be started quickly

11. Uncomplicated pleural effusion

a. Fluid – clear
b. Aseptic
c. Plt < 7.2
d. Protein < 2/3 of serum protein

12. Causes for Transudate

a. Eosinophilic pneumonia
b. Nephrotic syndrome

13. DPLD (Diffuse parenchymal Lung Disease)

a. Extrinsic allergic alveolitis – upper lobe
b. Fibrosing alveolitis – lower lobe
c. Sarcoidosis – middle and upper lobe
d. NSIP can be treated with steroids (Non specific interstitial pneumonia)

14. Functional residual capacitFunctional residual capacitis increased in

a. Exacerbation of BA
b. COPD
c. Exercise

15. Lung CA
 a. Adeno Ca – common in smokers
b. FVC – 900ml can go for surgery
c. Pleural effusion – contraindicated for surgery
d. Early stage of lung ca can be curable

DTCD Selection Examination 2007

1. Predominantly upper lobe of lung involvement in lesions is seen in

a. Histoplasmosis
b. Silicosis
c. Ankylosing spondylosis
d. TB
e. Rheumatoid arthritis

2. Bronchiectasis is associated with

a. Asbestosis
b. Nail dystrophy
c. Rheumatoid arthritis
d. Inflammatory bowel disease
e. Allergic bronchopulmonary aspergillosis

3. Aniticholinergic in COPD
a. Should not combine with β agonist
b. Has a shorter half-life than that of β agonists
c. Only inhaled form is available
d. Acts on muscarinic receptors of the lung
e. Aatropine- like side effects are common

4. Lung volume
a. Emphysema caused increased lung volume
b. Restrictive lung diseases reduces all lung volumes
c. Residual lung volume is measured by helium dilution method
d. With increasing age FRC is reduced

1. Cuses of hypercapnia
a. Pneumonia
 b. Motor neuron disease
c. Ankylosing spondylosis
d. Central sleep apnoea
e. Poliomyelitis

2. T/F
a. Right lung has 10 segments
b. Left lung has 10 segments
c. Visceral pleura is sensitive to pain
d. Parital pleura is sensitive to pain
e. L/Upper lobe has 4 segments

3. DOT strategy
a. Political commitment
b. Sputum smear examination
c. Accountability
d. BCG vaccination
e. DOT therapy

4. Second line ATDs

a. Kanamycin
b. Ethionamide
c. Ciprofloxacin
d. Amikacin
e. Azithromycin

5. In following patients, MDR TB is suspected

a. HIV positive pt
b. Pt who has failed to respond to CAT 1
c. Attendant at medical ward
d. Pt who has defaulted and smear positive
e. Pt who is taking CAT1 at 4th month

6. Upper lobe fibrosis is commonly seen in

a. TB
b. Sarcoidosis
c. Bronchiectasis with post nasal drip
d. Cryptogenic fibrosing alveolitis
e. Asbestosis

7. Differentiate asthma from COPD

a. Nocturnal cough
 b. Eosinophilia
c. Signs of cardiac failure
d. FEV1 < 70%

8. TB pleural effusion
a. Smear for TB is often positive
b. PCR 80% is positive
c. Neutrophil count may be high

9. T/F
a. Sputum culture should be done in pts who fail to be smear negative at 3 rd month CAT1
b. Dark colured urine is due to drug induced …………..
c. Rifampicin is predominantly acting against bacilli inside macrophages
d. Omission of pyrazinamide necessitate to continue total of 9 months

10. Asbestos related lung dis

a. Bronchial ca can occur
b. Mesothelioma in peritoneum
c. Predispose to GIT malignancy
d. Pleural plaques predispose to malignancy
e. Upper lobe fibrosis > lower lobe fibrosis

11. TB is associated with

a. Acnathosis nigiricans
b. Apergilloma
c. Polyarteritis nodosa
d. Erythema nodosum
e. Silicosis

12. BCG vaccination

a. 0.05 ml is given intradermally
b. Is a heat killed vaccine
c. Prevents children getting pulmonary TB
d. Can get complicated with TB adenitis

13. Extrapulmonary TB
a. Cervical LN enlargement is the commonest in SL
b. Is always non infectious

14. Regarding surgery in Lung Ca

a. Can be curable
 b. Pleural effusion indicate inoperability
c. Pt at stage I with a FEV of 900 ml can undergo surgery

15. Pulmonary embolism

a. Is known to occur in air travel
b. Normal V/Q exclude the diagnosis
c. Duplex scan of LL is a supportive Ix
d. CT Pulmonary Angio is the choice of Ix
e. Lt ventricular strain pattern seen

16. Pleural effusion

a. Post MI synd
b. Pancreatitis

17. ARDS
a. Known to occur with acute pancreatitis

18. Community acquired pneumina

a. 33% due to virues
b. Amoxicillin as the first line drug should not be used due to resistance to Penicillin
c. Confusion is a poor prognostic feature
d. Can present without cough
e. Always culture should be done

19. Complete opacification of one hemithorax may be due to

a. Pneumonectomy
b. Large pleural peffusion
c. Upper lobe collapse
d. Lower lobe consolidation
e. Elevation of hemidiaphragm

20. T/F regarding TB

a. Bacilli load in sputum becomes 50% after starting Rifampicin 48hrs
b. Milliary TB treated with intensive phase for 3 months and continuation phase 5 months
c. L/S small pneumothorax caused a click in heart sound

21. Etiology of bronchiectasis is evidenced by

a. Haemoptysis
b. Clubbing
c. Eosinophilia
d. Intestinal obstruction
 DTCD Selection Exam 2009

1. TB in Sri Lanka
a. Defaulter rate is not more than 45%
b. Colombo district has the highest number of cases
c. Nearly 8000 new TB cases found annually

2. MDR TB in Sri lanka

a. Said when TB is resistant to both INAH and Rifampicin
b. Levofloxacin is the choice of Rx
c. Aminoglycoside has no major role in Rx
d. Initiation phase should be at least 4 months
e. Total case detection is > 2%

3. Bronchiectasis is caused by
a. Karigeners syndrome
b. TB
c. Lobar pneumonia

4. DOTS strategy
a. Not affected by short supply of ATT
b. Supervision by a family member not accepted

5. In Pneumonitis Jeruvesi pneumonia of HIV infected pt

a. Prophylaxis is give with Ziduvidan
b. Co-trimoxasole is the mode of prophylaxis
c. All HIV infected pts should be given prophylaxis for above

6. In community acquired pneumiona

a. ….clearance completion takes 4-6 weeks
b. Commonest cause is influenza
c. Can be complicated with pleural effusion commonly

7. In atypical pneumonia
a. Have mild symptoms but prolonged prodromal period
b. Constitutional symptoms like myositis/ arthralgia are rare
c. Has predominantly neutrophil leukocytosis
8. Lymphocytic pleural effusion found in
a. Ca bronchus
b. TB
c. Mesothelioma
d. Lymphoma

9. Predominantly upper lobe opacities found in

a. Extrinsic allergic alveolitis
b. Asbestosis
c. Ankylosing spondylosis
d. TB
e. Klebsiella pneumonia

10. In HIV –TB co-infection

a. Generalized lymphadenitis is most likely due to TB
b. Priority should be given to treat TB
c. When CD4 count 400/ml
d. ATT should be given for 9 months

11. Following are more in favor towards COPD

a. Onset of symptoms in 3rd decade
b. Episodic ecxertion
c. Not improving FEV1 by 20% bronchodilator reversibility
d. 3rd decade

12. Regarding nosocomial pneumonia

a. Gram Negative enterobacteria are commonly involves
b. Staph aureus is important in pathogenesis
c. Pseudomonas is common in ICU pts
d. Tx with Erythromycin + Cefuroxime is adequate
e. Oraganism colonized in the URT is a common cause

13. Coal workers pneumoconiosis

a. Simple coal workers pneumoconiosis is often asymptomatic
b. Predispose to Lung Ca
c. Can have Caplan,s synd. In a pt with Rhu. Arthritis
d. Progression will stop after cessation of exposure
e. Can lead to chronic bronchitis even with simple pneumoconiosis

14. Lung Ca
a. Squamous Cell Ca is the commonest
b. Is the most common Ca of the developed world
 c. Small cell Ca can spread to loal LNs
d. Adeno Ca rapidly metastasize than Squamous cell Ca
e. Cryptogenic fibrosing alveolitis is a predisposing condition

15. The honeycomb lung is recognized in

a. Neurofibromatosis
b. Tuberous sclerosis
c. Cryptogenic fibrosing alveolitis
d. Hereditary haemorrhagic taelangectasia
e. Good Pasture’s syndrome
f. Sarcoidosis

16. Regarding pleural fluid examination

a. Glucose is reduced in Rhu. Arthritis
b. Presence of Amylase is diagnostic of Pancreatitis
c. LE cells found in pts with SLE
d. Increased levels of complement found in SLE
e. Increased CRP is pathognomonic of SLE
f. In TB ADA ( Adenosisne De Aminase) is increased
 DTCD Selection Examination 2006 Oct

1. Regarding COPD
a. Papillodema is a feature
b. Unregulated O2 therapy can worsen hypoxia
c. Respiratory acidosis is an indication for ventilation
d. Cannot use bronchodilators

2. Acute severe asthma is indicated by

a. Hypotension
b. Bradycardia
c. PEFR 50-70% than expected

3. Regarding respiratory physiology

a. Alveolar O2 onc is equal to the atmospheric O2 conc
b. After quite expiration lung volume is 3000ml
c. Normal individual Tidal Volume is 400ml
d. Dead space volume is not included in tidal volume
e. In expiration 1st removed air is dead space volume

4. WOF are associated with acute respiratory failure

a. Methyl alcohol
b. OPmpoisoning
c. Kaneru poisoning
d. PCM poisoning
e. Dialantin Na toxicity

5. Features of long lasting COPD

a. Increased AP diameter than lateral diameter
b. Obtuse costo-phrenic angle
c. Coin sign
d. Pectus excavatum
e. Clubbing is a recognized feature