17th March 2024 – Respiratory

Dr S Rishikesavan – 8:30am – 10:30am

1. Which of the following statements about CPAP treatment in OSAS is/are true?

a. CPAP is currently the most effective treatment for severe OSAS.

b. The CPAP therapeutic principle in OSAS is the application of positive pressure to splint
the pharyngeal lumen.
c. The nasal pressure required for treatment of OSAS depends on the number of respiratory
events.
d. The nasal pressure required for treatment of an OSAS patient depends on factors such
as body posture, alcohol ingestion or drug treatment.

2. Regarding Pneumocystis jiroveci pneumonia in HIV-infected patients, which of the following

statement(s) is/are correct?

a. Most patients have CD4 counts <200 cells per μL at the time of diagnosis of their first
episode of P. jiroveci pneumonia.
b. Most patients with P. jiroveci pneumonia will have an elevated serum lactate
dehydrogenase level.
c. Arterial blood gases in patients with P. jiroveci pneumonia frequently reveal respiratory
alkalosis and a widened alveoloarterial oxygen tension difference
d. A normal chest radiograph rules out the diagnosis.
e. Normal oxygen saturation on rest can exclude diagnosis of PJP

3. Which of the following statements concerning the use of supplemental oxygen in patients
with COPD is/are correct?

a. Long-term oxygen therapy improves survival in patients with stable COPD with severe
hypoxaemia.
b. Continuous oxygen therapy decreases pulmonary vascular resistance in patients with
stable hypoxaemic COPD.
c. Continuous oxygen therapy decreases the level of polycythaemia in patients with stable
hypoxaemic COPD.
d. Oxygen administration increases V′E in patients with acute hypoxaemic exacerbations of
COPD.
e. 10 – 12 hours of therapy is adequate for COPD patients
4. A 45-year-old female is admitted to the hospital because of severe dyspnoea and acute chest
pain. Fever and cough are not present on admission. The patient reports mild dyspnoea on
exertion for the past 2 years and an episode of pneumothorax 6 months ago. On admission,
her blood pres- sure is 130/80 mmHg, her heart rate is 100 beats per min and regular, and
her respiratory rate is 32 breaths per min. Chest radiography reveals small bilateral
pneumothoraces. CT shows multiple round cysts involving the whole parenchyma; three
micronodules, enlargement of axillary lymph nodes and a renal mass were also detected.
Which of the following statements about this case is/are correct?

a. The diagnosis requires lung histology.

b. Lung cysts are the hallmark lesion.
c. Echocardiography is recommended in the follow-up.
d. There is a strong association with female gonadotropic hormones.
e. Pneumothorax is a rare complication.

5. Which of the following statements concerning exudative pleural effusions is/are true?

a. In parapneumonic effusions, a pH ≤7.0 suggests a complicated or loculated effusion,

which may progress to empyema.
b. In contrast to low pleural fluid pH, pleural fluid glucose is usually normal in complicated
para- pneumonic effusions.
c. Lymphocytosis on pleural fluid differential cell counting often occurs in malignant or
tuberculous effusions.
d. Adenosine deaminase levels of pleural fluid are often elevated in tuberculous effusions.
e. Pleural fluid eosinophile make the diagnosis of TB pleural effusion less likely

6. A 46-year-old nonsmoking patient suffers from recurrent purulent bronchitis. He complains of

increased sputum production but is otherwise well. A CT scan shows bilateral, mainly lower
lobe tubular bronchiectasis.
Which of the following investigation(s) is/are important for treatment decisions?

a. Search for nontuberculous mycobacteria in sputum

b. α1-antitrypsin serum level
c. IgG and subclasses levels in serum
d. Bacterial sputum cultures

7. Regarding diffusing TLCO, which of the following statement(s) is/are correct?

a. Among routine pulmonary function tests, single-breath TLCO is the most sensitive
method to detect abnormalities in pulmonary gas exchange.
b. Broadening of the alveolar–capillary membrane is the most common cause of decreased
TLCO.
c. Measured TLCO is significantly dependent on the available surface area for gas
exchange.
d. Anaemia alone can cause a reduction in the measurement of TLCO, even in patients with
normal lungs.
e. Normal spirometry with low TLCO can be due to pulmonary vascular disease T
8. Which of the following statements about symptoms and signs of lung cancer is/are correct?

a. Horner syndrome indicates extrathoracic metastases.

b. Cushing syndrome includes hyperkalaemic acidosis and hyperglycaemia.
c. Lambert–Eaton myasthenic syndrome may be worse in the morning and improve during
the day.
d. The severity of neurologic paraneoplastic syndromes is related to tumour bulk.
e. Hypercalcemia common with small cell lung carcinoma

9. Which of the following statements about central sleep apnoea, Cheyne–Stokes respiration
and periodic breathing is/are correct?

a. Circulatory delay contributes to the development of Cheyne–Stokes respiration.

b. In Cheyne–Stokes respiration, during sleep, PaCO2 transiently falls below the critical
PaCO2 required for respiratory rhythm generation.
c. Periodic breathing at altitude is associated with a low PaCO2.
d. Cheyne–Stokes respiration can trigger sympathetic nervous activation and, thereby, exert
a secondary deleterious effect on the underlying cardiac disorder.

10. Which of the following statements concerning pleural effusion is/are true?

a. Pulmonary embolism may cause exudative or transudative pleural effusions.

b. Benign asbestos pleural effusions are transudates.
c. Effusions after coronary bypass surgery are most frequently bilateral.
d. Hepatic hydrothorax is more often located in the left hemithorax than in the right.
e. Eosinophils are compatible with previous blood or air entering the pleural space.

11. Which of the following statements is/are correct concerning asbestos-related malignancies?

a. Asbestos exposure is associated with an increased incidence primarily of small cell lung
cancer.
b. Asbestos exposure in cigarette smokers multiplies the risk of lung cancer.
c. The risk for developing malignant mesothelioma is independent of the history of cigarette
smoking.
d. Latency between asbestos exposure and lung cancer peaks at 10 years.

12. Which of the following statement(s) concerning non-cystic fibrosis bronchiectasis in

adults is/are true?

a. Male infertility suggests primary ciliary dyskinesia.

b. Measurement of serum immunoglublin IgG, IgA and IgM levels should be performed.
c. Sputum culture should be performed.
d. Inhaled corticosteroids should be prescribed.
13. Which of the following diseases is/are associated with upper lobe fibrosis on chest
radiography?

a. Sarcoidosis
b. Hypersensitivity pneumonitis
c. Langerhans cell histiocytosis
d. Rheumatoid arthritis
e. Ankylosing spondylitis

14.Which of the following conditions warrants/warrant preventive therapy for patients known to
have latent tuberculosis infection?

a. Treatment with tumour necrosis factor-α blocking agents

b. Patients on an organ transplant list
c. Pregnancy
d. Chronic renal failure scheduled for dialysis
e. Patient awaiting for anti-retroviral treatment

15. Which of the following statements regarding manifestations and treatment of rheumatoid
arthritis (RA) is/are correct?

a. Pleural involvement is more common than parenchymal manifestations.

b. RA-associated interstitial lung disease is more common in females than in males.
c. Patients with anticyclic citrullinated peptide antibodies are at increased risk for the
development of extra-articular RA.
d. Adalimumab therapy of RA may cause interstitial pneumonia.
e. Pleural fluid analysis shows low LDH and low PH

16. Regarding mediastinal tumors (T/F)

a. Thyroid tumours are the most common tumors in the anterior mediastinum.
b. Most of them are diagnosed incidentally.
c. Are rarely malignant in infants and children.
d. Are best assessed by CT scanning.
e. The most common symptoms are non-specific

17. Concerning the obstructive sleep apnoea syndrome (T/F)

a. Hyperthyroidism is a recognized predisposing condition

b. Uvulopalatoplasty is indicated in patients with severe disease ( e. g. apnoea / hypopnoea
index >30%)
c. The main reason for treatment is to reduce long-term cardiovascular mortality
d. Domiciliary oxygen is indicated if polycythemia occurs
e. Duration of sleep is important than the sleep architecture
18. In pulmonary embolism (T/F)

a. A pleural effusion occurs up to 50% of patients

b. Transudative effusions may occur in pulmonary embolism
c. A blood-stained pleural effusion is a contraindication for anticoagulants
d. Anticoagulants dissolve the clots
e. Thrombolytics can be given within 14 days

19. Reduced DLCO with normal lung volumes and spirometry found in

a. Asthma
b. Chronic recurrent pulmonary emboli
c. Pulmonary arterial hypertension
d. Obesity
e. Anaemia