Sir Syed College of Medical Sciences for Girls

FIRST YEAR MBBS

RESPIRATORY MODULAR EXAM, 2021

Dated: 09- 08- 2021 Total Marks = 100

SELECT SINGLE BEST

Q.1. Which one of the following structures passes posterior to the root of the right lung?
A. Hemiazygos vein.
B. Right phrenic nerve.
C. Right vagus nerve.
D. Right recurrent laryngeal nerve.
Q.2. Which of the following is the most superficial structure in the thoracic inlet?
A. Brachiocephalic vein.
B. Subclavian artery.
C. Thoracic duct.
D. Vagus nerve.
Q.3. The trachea bifurcates into right & left bronchi at the level of:
A. First rib
B. Plane of sternal angle
C. Seventh cervical vertebra
D. Supra sternal notch
Q.4. A patient came to emergency with a history of stab wound in right 3rd intercostal space
just lateral to right sternal border after resistance in road side robbery. Which of the
following structure is be pierced by knife:
A. External Intercostal muscle.
B. Internal Intercostal muscle.
C. Internal intercostal membrane.
D. Serratus anterior.
Q.5. Through which of the following azygos vein ascends into thorax?
A. Caval opening
B. Left dome of diaphragm
C. Aortic opening
D. Esophageal opening
Q.6. Fracture of the rib commonly occurs at:
A. Angle of the rib
B. Head of the rib
C. Mid shaft of the rib
D. Neck of the rib
Q.7. Which of the following lymph nodes are found in the hilum of lungs?
A. Bronchomediastinal lymph nodes
B. Bronchopulmonary lymph nodes
C. Pulmonary lymph nodes
D. Tracheobronchial lymph nodes
Q.8. A wrestler's chest is compressed during a match, causing a posterior displacement of the
clavicle at the sterno-clavicular joint. Which of the following structures would be mostly at risk?
A. Aorta
B. Esophagus
C. Superior vena cava
1
 D. Trachea
Q.9. Which of the following structure’s aperture/ opening lies in the central tendon of diaphragm?
A. Abdominal aorta
B. Esophagus
C. Inferior vena cava
D. Thoracic duct
Q.10. Transverse diameter of thoracic cage is increased by which of the following?
A. Bucket handle movement of ribs
B. Caliper movement of ribs
C. Contraction of diaphragm
D. Pump handle movements of ribs
Q.11. During a procedure to harvest lymph nodes in the posterior mediastinum, the thoracic duct
is accidentally cut. The resulting accumulation of lymph in the pleural cavity is referred to as:
A. Chylothorax
B. Hemothorax
C. Pleurisy
D. Pyothorax
Q.12. Structure winding around the root of left bronchus is
A. Aortic arch
B. Azygos vein
C. Recurrent laryngeal nerve
D. Vagus nerve
Q.13. A surgical procedure is performed in a patient to remove a thymic tumor. Which of the
following structures must be avoided during the surgery that is directly posterior to the
thymus in the superior mediastinum?
A. Arch of the aorta
B. Esophagus
C. Left brachiocephalic vein
D. Trachea
Q.14. Which part of the left lung might partially fill the Costomediastinal recess in full inspiration?
A. Apex
B. Cupola
C. Hilum
D. Lingula
Q.15. The oblique fissure of the right lung separates which structures?
A. Lower lobe from both upper and middle lobes
B. Lower lobe from middle lobe only
C. Lower lobe from upper lobe only
D. Upper from middle
Q.16. Which of the following is related to superior surface of first rib?
A. Axillary vein
B. Subclavian artery
C. Upper trunk of brachial plexus
D. Ventral ramus of T1
Q.17. A 57-year-old man, who has smoked cigarettes for 40 years, has a lung cancer which
invades his left third intercostal space at the mid-axillary line. If cancer cells were carried in
the venous drainage of that intercostal space, they would travel first to which of the
following intrathoracic veins?
A. Accessory hemi-azygos vein
B. Azygos vein
C. Hemiazygos vein
D. Left brachiocephalic vein
2
Q.18. A physician is demonstrating the correct technique for inserting a sub-clavian central
venous line. He has a medical student palpating the clavicle, then the chest wall below it.
The first bony structure that can be palpated below the inferior margin of the medial portion
of the clavicle is the:
A. Acromion
B. Atlas
C. First rib
D. Second rib
Q.19. During a pneumectomy the surgeon started operating anterior to the right hilum of the lung.
Which of the following structures will be incised (cut) first?
A. Pulmonary artery
B. Pulmonary vein
C. Right bronchus
D. Thoracic duct
Q.20. The enlargement of which of the following group of lymph nodes is most likely to compress
left recurrent laryngeal nerve?
A. Bronchopulmonary nodes
B. Pulmonary nodes
C. Thoracic duct
D. Tracheobronchial nodes
Q.21. A medical student inserting an intercostal drain for the first time forgets her anatomy and
passes it at the lower border of the rib. The structure most likely to be damaged is the:
A. Intercostal artery
B. Intercostal nerve
C. Intercostal vein
D. Internal intercostal muscle
Q.22. During routine cadaveric dissection, a medical student attempted to pass his index finger
posterio-inferior to the root of the lung, but he found that the passage was blocked. Which
structure would most likely be responsible for this?
A. Costo-diaphragmatic recess
B. Inferior vena cava
C. Left pulmonary vein
D. Pulmonary ligament
Q.23. Which of the following describes a characteristic of left lung?
A. 3 lobar (secondary ) bronchi
B. A groove for the superior vena cava
C. Horizontal fissure
D. Lingua of lung
Q.24. The crura of diaphragm develop from:
A. Body wall.
B. Dorsal mesentry of oesophagus.
C. Pleura peritoneal membrane.
D. Septum transversum.
Q.25. The terminal saccular period of maturation of lung begins at which of the following weeks?
A. 16th week.
B. 26th week.
C. 6th week.
D. 34th week
Q.26. In which of the following conditions posterolateral diaphragmatic defect occurs?
A. Congenital hiatal hernia
3
 B. Costodiaphragmatic recess
C. Pericardioperitoneal canal
D. Pleuroperitoneal membrane
Q.27. A young mother brings her recently born infant into your office and complains that the
infant gags and chokes after swallowing milk. A physical examination indicates excessive
saliva and mucus around the mouth and nose, abdominal distention, pneumonitis, and
radiographs indicate air in the infant’s stomach. What is the most likely cause?
A. Congenital lobar emphysema
B. Pulmonary hypoplasia
C. Respiratory distress syndrome
D. Tracheoesophageal fistula
Q.28. Accessory ribs are most commonly found attached to which of the following?
A. Cervical vertebrae
B. Lumbar vertebrae
C. Sterne brae
D. Thoracic vertebrae
Q.29. Septal cells of the lung alveoli are involved in which of the following states?
A. Allergic reaction
B. Blood-air barrier
C. Phagocytosis
D. Production of surfactant
Q.30. Which of the following type of capillary is found in the wall of alveoli?
A. Continuous capillary.
B. Fenestrated capillary.
C. Sinusoidal capillary.
D. Sinusoids.
Q.31.Which of the following structural characteristics enables the distinction between terminal
and respiratory bronchioles?
A. Alveoli
B. Cilia
C. Cuboidal epithelial lining
D. Mucous glands in the lamina propria
Q.32. The pulmonary (functional) and bronchial (nutrient) arterial systems enter the lungs
separately through the hilus but anastomose into a single system at which of the following
levels?
A. Bronchioles
B. Respiratory bronchioles
C. Tertiary bronchi
D. Terminal bronchioles
Q.33. Which one of the following is lined by Pseudostratified columnar respiratory epithelium?
A. Lingual surface of epiglottis
B. Nasopharynx
C. Oropharynx
D. Vestibule
Q.34. A six year old child came in emergency with a history of inhaling a bead, on bronchoscope
the bead most likely to be located in which of the following?
A. Left main bronchus
B. Left superior segmental bronchus
C. Right lobar bronchus
D. Right superior segmental bronchus
Q.35. Aspiration of left pleural cavity is usually done in which space?
4
 A. 2nd intercostal space
B. 4th intercostals space
C. 5th intercostals space
D. 8th intercostal space

Q.36. A physician orders a barium swallow with fluoroscopy and an esophagogram for a 61- year
old male patient with a chief complaint of difficulty in swallowing. The esophagogram
revealed compression of anterior wall of the esophagus in the mid thorax. Which one of the
following structures is causing this compression:
A. Left atrium
B. Left ventricle
C. Right atrium
D. Right ventricle
Q.37. A 50 years old male patient with cancer of lower end of esophagus, operated for removal of
lower end of esophagus, the stomach, the spleen and upper part of duodenum. In which of
the following lymph nodes does the lymph from lower end of esophagus drain:
A. Bronchomediastinal lymph nodes
B. Celiac nodes
C. Sub diaphragmatic lymph nodes
D. Tracheobronchial lymph nodes.
Q.38. Which one of the following are the characteristics of thoracic duct?
A. Arches across the apex of the right lung.
B. Enters the thorax in company with the esophagus.
C. Lies anterior to the trachea in the superior mediastinum.
D. Lies in the posterior mediastinum.
Q.39. Which of the following is characteristic of chest wall?
A. Intercostal artery is more superficial than the vein
B. Intercostal artery lies between the nerve and vein
C. Neurovascular bundle lies between the external and internal intercostals
D. Transversus muscle lies between the internal and external intercostals
Q.40. A 59 yr. old man complains of recurrent attacks of pain in the region of left shoulder
radiating to sternum & pit of stomach. The attacks of pain came at lengthy intervals until the
last 2 days when it became continuous. The physician diagnosed it as angina pectoris. In
this case the pain pathway from the heart is carried by:
A. Middle & inf. cervical cardiac n.
B. Sup. cervical cardiac n.
C. Thoracic splanchnic n.
D. Vagus n.
Q.41. Which of the following is the muscle of inspiration?
A. Diaphragm
B. External oblique
C. Rectus abdominis
D. Transverses abdominis
Q.42. Which one of the following is characteristic of left main bronchus:
A. Is usually wider than the right main bronchus.
B. Lies posterior to the left vagus nerve.
C. Lies within the concavity of the arch of the aorta.
D. Receives branches from the internal thoracic artery.
Q.43. While lying supine in the bed a child aspirates a peanut, in which one of the following
bronchopulmonary segments would this foreign object most likely enter:
A. Apical segment of the right lower lobe
B. Medial segment of the right lower lobe

5
 C. Posterior basal segment of the left lower lobe
D. Superior segment of the right lower lobe

Q.44.The bulk of CO2 is transported in arterial blood as:

A. Dissolved CO2
B. Carbonic acid
C. Carbaminohemoglobin
D. Bicarbonate
Q.45. An infant born prematurely has respiratory distress syndrome. Which of the following is
expected in this infant?
A. Arterial PO2 of 100 mm Hg
B. Increased lung compliance
C. Collapse of small alveoli
D. Normal breathing rate
Q.46. During inspiration, how does alveolar pressure compare to atmospheric pressure?
A. Alveolar pressure is greater than atmospheric.
B. Alveolar pressure is less than atmospheric.
C. Alveolar pressure is the same as atmospheric.
D. Alveolar pressure is not dependent on atmospheric pressure changes.
Q.47. If a patient had a progressive lung disease that required an ever-increasing pressure to fill
the same volume of lung, how would the lung's compliance be affected?
A. It would increase it.
B. It would stay the same.
C. It would decrease it.
D. These variables do not affect lung compliance
Q.48. A shift in O2-Hb dissociation curve in the right ward direction:
A. Can be caused by a decrease in temperature
B. Favours O2 delivery to the tissues
C. Favours O2 uptake from the lungs by alveolar capillary blood
D. Occurs in pulmonary capillaries
Q.49. If an area of the lung is not ventilated because of bronchial obstruction, the pulmonary
capillary blood serving that area will have a PO2 that is:
A. Equal to mixed venous PO2
B. Equal to normal systemic arterial PO2
C. Higher than inspired PO2
D. Lower than mixed venous PO2
Q.50. Venous admixture:
A. Occurs at the level of pulmonary artery
B. Occurs due to venous drainage of lung by pulmonary vein
C. Decreases the systemic arterial PO2 to 95mmHg
D. Increases the systemic arterial PO2 to 104mmHg
Q.51. Which of the following is the first branching of the bronchial tree that has gas exchanging
capabilities?
A. Alveoli
6
 B. Respiratory bronchioles
C. Segmental bronchi
D. Terminal bronchioles
Q. 52. Which of the following represents the pressure difference that acts to distend the lungs?
A. Alveolar pressure
B. Airway opening pressure
C. Transthoracic pressure
D. Transpulmonary pressure
Q.53. Which of the following is the primary regulating variable of the central chemoreceptors?
A. PaO2
B. PaCO2
C. Arterial pH
D. Rate of alveolar ventilation
Q.54. If the left sided heart failure causes increase in atrial pressure to 20 mm Hg, what will be the
effect on pulmonary circulation?
A. Complete cessation of blood flow leading to pulmonary edema
B. Decrease in pulmonary capillary pressure
C. Movement of flow in opposite direction
D. No change in blood flow
Q.55. With pulmonary capillary pressure = 8mmHg, plasma colloid osmotic pressure = 28mmHg,
interstitial colloid osmotic pressure = 15mmHg and negative interstitial fluid pressure =
9mmHg. The mean filtration pressure for fluid will be:
A. 1 mm Hg
B. 2 mm Hg
C. 3 mm Hg
D. 4 mm Hg
Q.56. In restrictive lung disease, there will be:
A. Decreased Vital Capacity, Total lung capacity, Increased Residual volume, Functional residual
capacity
B. Decreased Vital Capacity, Total lung capacity, Residual volume, Functional residual capacity:
C. Increased Vital Capacity, Total lung capacity, Residual volume, Functional residual capacity
D. Increased Vital Capacity, Total lung capacity, decreased Residual volume, Functional residual
capacity
Q.57. Vital capacity can be calculated by the following formula:
A. IC+FRC
B. RV+ERV
C. TLC – RV
D. VT+IRV
Q.58. The PO2 must drop below what level in order to stimulate the peripheral chemoreceptors for
increased ventilation?
A. 40 mm Hg
B. 60 mm Hg
C. 80 mm Hg
D. 100 mm Hg
Q.59. Which of the following gas is released out during the process of respiration?
A. Oxygen
B. Hydrogen
C. Carbon dioxide
D. None of the above
Q.60. Which of the following functions by filtering and keeping the mucus and dirt away from our
lungs?
A. Cilia
7
 B. Bronchioles
C. Hairs in the lungs
D. All of the above
Q.61. The maximum volume of air contained in the lung by a full forced inhalation is called ______.
A. Tidal volume
B. Vital capacity
C. Ventilation rate
D. Total lung capacity

Q.62. Which of these statements is true about internal respiration?

A. Production of ATP
B. Exchange of gases between the bloodstream and tissue cells
C. Exchange of gases between alveoli and the bloodstream
D. Breathing between the atmosphere and the alveoli
Q.63. The exchange of gases between the external environment and the lungs______.
A. Respiration
B. External respiration
C. Cellular respiration
D. None of the above
Q.64. Which of the following is correct for the partial pressure of oxygen in alveoli?
A. Less than carbon dioxide
B. Less than the blood
C. More than the blood
D. Equal to that of the blood
Q.65. The gaseous exchange in alveoli is a type of
A. Simple diffusion
B. Osmosis
C. Active transport
D. Passive transport
Q.66. Which of the following parts of the brain regulates the respiratory process?
A. The vagus nerve
B. Cerebral peduncle
C. Medulla oblongata
D. Cerebellum
Q.67. Which of the following is the first branching of the bronchial tree that has gas exchanging
capabilities?
A. Terminal Bronchiole
B. Respiratory bronchiole
C. Alveoli
D. Alveolar ducts
Q.68. Pulmonary ventilation movements are due to __________
A. Intercostal muscles and diaphragms
B. Diaphragm
C. Wall of lungs
D. Intercostal muscles
Q.69.The factor which does not affect the diffusion rate across Respiratory membrane is:
A. Solubility of gas
B. Reactivity of gas
C. Thickness of membrane
D. Concentration gradient

8
Q.70. Ascent of high mountains may cause altitude sickness in men. Prime cause for this is _____
A. Decreased proportion of oxygen in the air
B. Decreased partial pressure of oxygen
C. Decreased efficiency of hemoglobin
D. Excess CO2 in blood
Q.71. In which part of the respiratory system, gaseous exchange takes place?
A. Alveoli
B. Pharynx
C. Larynx
D. Trachea

Q.72. Respiration involves one of the following sets of processes:

A. Inspiration, exchange of gases, Expiration
B. Aspiration, Inspiration, Expiration
C. External, Internal and Expiration
D. None of the above
Q.73. Oxygenated blood from lungs is carried to heart by:
A. Pulmonary artery
B. Pulmonary vein
C. Coronary vein
D. Pre-caval
Q.74. When the oxygen supply to the tissues is inadequate, the condition is:
A. Hypoxia
B. Asphyxia
C. Pleurisy
D. Anoxia
Q.75. During inspiration, air passes into lungs due to:
A. Increase in volume of thoracic cavity and fall in lung pressure
B. Fall in pressure inside the lungs
C. Increased volume of thoracic cavity
D. Muscular expansion of lungs
Q.76. Phospholipid acting as surfactant is:
A. Cephalin
B. Phosphatidyl inositol
C. Lecithin
D. Phosphatidyl serine.
Q.77. Niemann-Pick disease results from deficiency of:
A. Ceramidase
B. Sphingomyelinase
C. Arylsulphatase A
D. Hexosaminidase A.
Q.78. Lecithin contains a nitrogenous base named as:
A. Ethanolamine
B. Choline
C. Inositol
D. Lysine
Q.79. Sphingomyelins are composed of fatty acids, phosphoric acid and:
A. Sphingosine and choline
B. Glycerol and sphingosine
9
 C. Glycerol and Serine
D. Glycerol and Choline.
Q.80. Phospholipase A2 is an enzyme which removes a fatty acid residue from lecithin to form:
A. Lecithin fragments
B. Phosphotidic acid
C. Glyceryl phosphate
D. Lysolecithin.
Q.81. Sphingomyelins are composed of fatty acids, phosphoric acid and:
A. Sphingosine and choline
B. Glycerol and sphingosine
C. Glycerol and Serine
D. Glycerol and Choline.
Q.82. Phospholipase A2 is an enzyme which removes a fatty acid residue from lecithin to form:
A. Lecithin fragments
B. Phosphotidic acid
C. Glyceryl phosphate
D. Lysolecithin.
Q.83. High “Anion Gap metabolic acidosis” is seen in all of the following except:
A. Diarrhea
B. Renal Failure
C. None of above
D. Hepatic Acidosis\
Q.84. A man comes to the emergency department with complaint of repeated vomiting for 5 days.
The most likely description of his acid/base disturbance is:
A. Metabolic alkalosis
B. Respiratory acidosis
C. Respiratory alkalosis
D. Hyperchloremic metabolic acidosis
Q.85. Regarding acid buffering, the first line of defense is:
A. Plasma Buffers
B. Immune system
C. Liver conjugation
D. Kidney mechanism
Q.86. Lab data of a male patient shows:
Na+ = 150mEq/L, HCO- 3=25, K+=06, CI-= 95. His anion gap is:
A. Normal
B. Reversed
C. Increased
D. Decreased
Q.87. The mechanism involved in renal regulation of pH is:
A. Excretion of NH3
B. Excretion of lactate
C. Excretion of H+ ions
D. Excretion of titrable acid
Q.88. The electrolyte abnormality more likely to be present in acidosis is:
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypernatremia
Q.89. An analysis of arterial blood from a patient provided pH=7.31, pCO2=35mmHg,
10
 HCO- 3=17mmHg.It can be concluded from this information that the patient has:
A. uncompensated metabolic acidosis
B. uncompensated respiratory alkalosis
C. mixed respiratory and metabolic acidosis
D. partially compensated metabolic acidosis
Q.90. At the normal physiologic pH of plasma H+ion concentration is:
A. None of the above
B. 0.00,000,4 moles/L
C. 0.00,000,01 moles/L
D. 0.00,000,14 moles/L

Q.91. A patient of hysteria presented with hyperventilation. Her ‘Arterial Blood Gas’ analysis
showed; pH=7.5, CO2=30mm Hg, HCO3=20. She is having:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Q.92. Salicylate poisoning can cause:
A. Respiratory acidosis
B. Metabolic acidosis
C. Respiratory alkalosis
D. Metabolic alkalosis
Q.93. The H of the buffer solution depends upon the concentration of:
A. Acid (H+)
B. Conjugate base (OH-)
C. Salt
D. Acid (H+) and Conjugate base (OH-)
Q.94. pH can be kept constant with the help of:
A. Saturated solution
B. Unsaturated solution
C. Buffer solution
D. Supersaturated solution
Q.95. Buffers react with:
A. Hydrogen, hydroxyl
B. Magnesium, calcium
C. Potassium
D. Sodium
Q.96. Carbonic acid and bicarbonate ions buffer which of the following?
A. Cytosol
B. Cytoplasm
C. Blood
D. Lymph
Q.97. Buffers are mixtures of:
A. Strong acid and strong base
B. Strong acid and weak base
C. Weak acid and their conjugate base
D. Weak base and their conjugate acid
Q.98. The electrolyte abnormality more likely to be present in acidosis is:

11
 A. Hypokalemia
B. Hyponatremia
C. Hypernatremia
D. Hypernatremia
Q.99. An analysis of arterial blood from a patient provided pH=7.31, pCO2=35mmHg,
HCO- 3=17mmHg. It can be concluded from this information that the patient has:
A. Uncompensated metabolic acidosis
B. Uncompensated respiratory alkalosis
C. Mixed respiratory and metabolic acidosis
D. Partially compensated metabolic acidosis
Q.100. A presented presented with hypoventilation. Her ‘Arterial Blood Gas’ analysis showed;
pH=6.0 CO2=25mm Hg, HCO3=19. She is having:
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

12