WEEK 3 (20-24 MAY 2012) MODULE: RESPIRATORY SYSTEM __________________________________________________________________________________ BIOCHEMISTRY OF LUNG SURFACTANT 1.

Choose the correct statement about the biophysical properties of the lung surfactant A. B. C. D. Improves mucocilliary function Prevents alveolar collapse during respiration Prevents pulmonary oedema by balancing hydrostatic force All of the above

2. Which of the following statement is not true about the pulmonary surfactant protein? A. B. C. D. About 10% of surfactant consist of protein There are four surfactant protein which is SP-A,SP-B,SP-C and SP-D SP-A and SP-D mediate the host-defence function of the pulmonary surfactant SP-B and SP-C are hydrophilic surfactant protein

3. All of the following statement are true about the pulmonary surfactant except A. Pulmonary surfactant is a lipopolysaccharide mixture of phospholipid, carbohydrate, and calcium ions B. It is produced by pneumocyte type 2 C. It maintain minimal surface tension within the lung D. It also functions in the pulmonary host defence as immune mediator 4. Which of the following answer is false about the immunological properties of pulmonary surfactant? A. Surfactant phospholipid inhibit proliferation, immunoglobulin production and cytotoxicity of lymphocytes B. SP-D and SP-A regulate phagocytosis, chemotaxis and oxidative burst of alveolar macrophages C. SP-A and SP-D facilitate opsonisation of various microorganisms and particles and also able to capture bacterial toxins D. Surfactant phospholipid stimulate cytokine release from activated macrophages 5. Choose the correct answer about the pulmonary surfactant lipids A. Surfactant lipids are mostly phospholipid that are essential for reducing surface tension within the lungs together with neutral lipids such as triglycerides and cholesterol B. The most abundant surfactant phospholipid is phosphatidylcholine C. The surfactant lipid plays an important role in decreasing the surface tension D. All of the above

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SURFACTANT AND WORK OF BREATHING 6. All of the following is TRUE regarding surfactant EXCEPT: A. B. C. D. Its a surface tension lowering agent Its produce by Pneumocyte type II which present in the alveoli Its secreted into alveolar lumen by endocytosis SP-A is responsible to regulate uptake of surfactant

7. Which of the following are FALSE regarding mechanism of action of surfactant? A. The particles spread at the interface between air and fluid lining the alveoli B. Hydrophilic head dissolve in the fluid, whereas hydrophobic tail doesn't. C. The hydrophobic tail scatters the fluid molecules decreasing the attraction between them thus lowering the surface tension D. Its particles spread as monomolecular layer 8. Choose the correct statements regarding the functions of the surfactant? I. II. III. IV. A. B. C. D. Increases lung compliance thus reduces the work needed for expansion. Equalize the pressure inside the pulmonary alveoli Prevents transudation of the fluid from the capillaries into the alveolar spaces It prevent atelectasis tendency to occur I,II II,III I,III,IV All of the above

9. Choose the CORRECT pair regarding factors affecting formation of the surfactant: I. II. III. IV. A. B. C. D. Thyroid hormones (stimulate) Smoking ( stimulate) Glucocorticoid hormones (stimulate) Inhalation of pure O2 ( stimulate) I,II I,III III,IV II,IV

10. Which is FALSE regarding work of breathing? A. Compliance work is increases in all condition associated with decreased lung compliance B. Tissue resistance work decrease in disease affecting thoracic cage and respiratory muscle C. Airway resistance work depends on the diameter of the passage ways D. At rest the amount of work of breathing is 1-2% in heavy exercise 3-5%

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STREPTOCOCCUS PNEUMONIAE & CORYNEBACTERIA 11. Which of the following is not the morphology of streptococcus pneumonia? A. B. C. D. Gram + diplococci non-sporing non-capsulated polysaccharides Has specific antisera

12. All of the following are true about streptococcus pneumonia except? A. B. C. D. Commonest pathogens in lobar and broncho-pneumonia Produce disease through multiplying in the tissue Capsule inhibits its phagocytosis produce toxins

13. Which of the following is not the morphology of corynebacterium diphtheriae? A. B. C. D. Resemble like “ Chinese letter writings” Gram negative rods show clubbing at one or both ends Contain volutin (metachromatic) granules

14. The entire following are true about pathogenesis of Diphtheria except? A. B. C. D. Produce disease by multiplying in the tissue Infection usually occurs in the soft part of the fauces produces a false membrane at part infected incubation period is 2 to 5 days

15. All the following tests are used for detecting toxigenicity or virulence of Diphtheria except? A. B. C. D. Polymerase chain reaction Elek’s Test Enzyme-Linked immunosorbent assays Mcleod’s tellurite plate

DISEASE OF UPPER RESPIRATORY TRACT 16. All of the following are the acute infection of upper respiratory tract EXCEPT A. B. C. D. Common cold Acute pharyngitis Acute bacterial epiglottitis Alveolar cysts

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17. Choose the CORRECT characteristics regarding Nasopharyngeal Carcinoma I. II. III. IV. A. B. C. D. Endemic in southern China Consists of 3 histologic variant Tend to grow silently May spread through lymphatic, blood and local invasion I,II I,II,IV I,II,III All of the above

18. All of the following are TRUE regarding Laryngeal Masses EXCEPT A. B. C. D. Non neoplastic type occurs among heavy smokers and singer Vocal cord nodule is due to chronic irritation and abuse of voice Papilloma is multiple in adult, single in children(Juvenile Laryngeal Papillomatosis) Carcinoma of laryngeal masses appear pearly gray wrinkled

19. Choose the FALSE statements regarding congenital anomalies of the lung A. Congenital bronchogenic cysts cases is extremely rare and mainly single B. Alveolar cysts appear as multiple large air spaces and centrally located especially in upper lobe C. Rupture of congenital bronchogenic cysts lead to haemoptysis, pneumothorax or interstitial emphysema D. Alveolar cysts lead to decrease vital capacity of the lung 20. Choose the CORRECT statements regarding Atelectasis I. II. III. IV. A. B. C. D. Neonatorum atelectasis occurs in premature infants or born with diabetic mother or with caeserian sections Neonatorum atelectasis ends in Respiratory Distress Syndrome Acquired atelectasis may presence as obstruction/absorption,compression,contraction/traction,microatelectasis Their morphology includes, appear reddish,float in water and rubbery subcrepitant I,II I,II,IV I,II,III All of the above

REGIONAL DIFFERENCE IN VENTILATION 21. Which of the following is TRUE? A. IPP at base are more negative than apex in upright position B. In supine position, no difference in ventilation between anterior and posterior part of lung C. Capillaries are relatively empty of blood at the top of lung in vertical position D. Gravity has no effect on ventilation. QMU RESPIRATORY STSTEM 2012 ©

22. Which of the following statement is TRUE regarding apex of the lung? IIIIIIIVA. B. C. D. Large change in volume during inspiration Small resting volume and alveoli are less expanded Large expanding pressure Less ventilated under resting condition I and II III and IV I, II and III II, III and IV

23. Partial pressure of O2 in expired air is A. B. C. D. 40 100 120 150

24. The following can increase thickness of respiratory membrane EXCEPT A. B. C. D. Pulmonary edema Pulmonary emphysema Pulmonary fibrosis Pulmonary congestion

25. Which of the following is TRUE regarding rate of diffusion through respiratory membrane? A. B. C. D. The thicker the membrane, the higher the rate of diffusion. CO2 is more soluble than O2 Surface area increased in emphysema Diffusion coefficient for CO2 is about 10 times more than O2

COPD: EMPHYSEMA & CHRONIC BRONCHITIS 26. The following statements are true EXCEPT A. Increase resistance limits air flow -is the main characteristic of obstructive lung disease B. Total lung capacity is decreased in restrictive lung diseases C. Emphysema is the permanent enlargement of air spaces distal to the terminal bronchioles with limited walls destruction D. Both bronchiectasis and bronchial asthma patients show dyspnea 27. The following are correct EXCEPT A. Centriacinar emphysema is associated with chronic bronchitis B. Panacinar emphysema affects lower zones of lungs more than the upper part C. Smoke from cigarettes has the role of stimulating proteolytic activity of neutrophils and macrophages in lung, also causing antitrypsin to take upper hand D. Irregular and distal acinar emphysema share the same pathogenesis

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28. The following are the clinical features and complications of emphysema EXCEPT I. II. III. IV. V. A. B. C. D. E. F. Dyspnea and chronic cough leading to barrel-shaped chest Hypoxemia leading to polcythemia Rupture of bullae leading to pyothorax Cor pulmonale is caused by chronic dyspnea Patient may die from respiratory alkalosis due to high CO 2 I II I and II III IV III, IV and V

29. The following are true EXCEPT A. Chronic bronchitis-persistent productive cough for at least 3 months in at least 2 consecutive years with higher frequency in middle aged men regardless of smoking habit B. Cigarette smoking cause chronic irritation which then cause different effects between trachea-bronchi and bronchioles C. Mononuclear inflammatory cells mixed with neutrophils are present in the mucosa of bronchi D. The gross appearance of chronic bronchitis shows typical inflammation signs added with mucopurulent secretions 30. The following are true about the complications of chronic bronchitis EXCEPT A. B. C. D. Squamous metaplasia and dysplasia may lead to bronchogenic carcinoma Emphysema in areas with incomplete obstruction Atelectasis in the areas where obstruction is complete Death from emphysema

PULMONARY CIRCULATION 31. The followings are true regarding the pulmonary artery and its branch EXCEPT A. B. C. D. Walls are distensible Have abundant smooth muscle Have thin wall Arising from the right ventricle

32. The mean pulmonary venous pressure is A. B. C. D. 8 mmHg 15 mmHg 5 mmHg 25 mmHg

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33. In order to prevent pulmonary oedema, it is important to maintain ______ low. A. B. C. D. Pulmonary capillary pressure Pulmonary systolic pressure Pulmonary diastolic pressure Mean pulmonary venous pressure

34. Cardiac shunt is A. B. C. D. One of the congenital defect Holes may present in atria or ventricle Is an example of pathological shunt Decrease the partial pressure of oxygen to about 95 mmHg

35. Which of the following factors involve in reducing the pulmonary blood flow? I. II. III. IV. A. B. C. D. Hypoxia Increase in carbon dioxide Increase in nitric oxide Sympathetic stimulation I, II and III I, II and IV I,III and IV II, III and IV

36. All following are TRUE about pulmonary circulation EXCEPT : A. B. C. D. Starts at pulmonary artery which receives oxygenated blood Consists of bronchial arteries and pulmonary artery Pulmonary artery branches successively like airway system Walls of pulmonary artery are thin and contain little smooth muscle

State TRUE or FALSE: 37. Pulmonary capillary pressure is very low 38. Hydrostatic force distends the vessel at base of lung and narrow those at the apex 39. In mild exercise, lung blood flow decreases linearly from the bottom to the top

40. Which of the following are TRUE matches? I. II. III. IV. A. B. C. D. Zone I –Pv> Pa > PA Zone II – Pa> PA>Pv Zone III – Pa >Pv> PA Zone IV – PA > Pa >Pv I AND II II AND III III AND IV I AND III QMU RESPIRATORY STSTEM 2012 ©

BRONCHIOECTASIS AND BRONCHIAL ASTHMA 41. All of the following are included in the definition of bronchiectasis EXCEPT A. B. C. D. Permenant abnormal dilatation of small bronchi and bronchioles Due to destruction of their muscles and elastic tissue Resulting from chronic necrotizing infection Associated with small bronchi and bronchioles obstruction

42. Regarding to bronchiectasis, which of the following is the CORRECT statement A. B. C. D. E. Predisposing factors are bronchial obstruction, hereditary condition and meningitis Pathogenesis : obstruction and acute infection Usually lower lobes of lungs Microscopically, lining epithelium and submucosa show desquamation, ulceration or squamous metaplasia Even in moderate case, fibrosis and lung abscess can be seen

43. Regarding to bronchial asthma, all of the following is TRUE EXCEPT A. B. C. D. Characterized by episodic reversible bronchospasm Shows the morphology of Curschmann spirals Cannot be considered as a chronic inflammatory disorder of airways Non-immunologic asthma mostly triggered by respiratory tract infections, chemical irritants, air pollution, aspirin, cold, exercise and psychogenic factor

44. Bronchiectasis and bronchial asthma have same clinical features which are I. II. III. IV. V. A. B. C. D. Status asthmaticus Dyspnea Attacks of cough Wheezing Clubbing of finger II and III II, III and IV I, IV and V All of the above

45. What are the complications for both bronchiectasis and bronchial asthma? I. II. III. IV. V. A. B. C. D. Emphysema Bronchopneumonia Squamous metaplasia Cor pulmonale Brain abscess I and II I and IV I, II an IV All of the above QMU RESPIRATORY STSTEM 2012 ©

PHARMACOLOGY APPROACH TO TREATMENT OF BRONCHIAL ASTHMA 46. All of the following are correct regarding the prevention of exposure approaches EXCEPT: A. The first step is to determine the causative agents B. Specific immunotheraphy is applied if only if the avoidance of causative allergen is impossible or appropriate medications failed to control asthma C. Identification of causative allergens can be achieved through skin prick test D. Administration of controller medicines 47. Choose the correct pathophysiology characteristics of asthma: IIIIIIIVA. B. C. D. Obstruction due to bronchospasm, mucous secretion and oedema Acute and chronic inflammation Airway hyper-responsiveness Airway wall remodelling I & II ONLY I, II, III III & IV ONLY All of the above

48. All of the following are correct regarding bronchial asthma, EXCEPT: A. Bronchospasm is a chronic symptoms which can be treated by anti-inflammatory drugs B. Acute and chronic inflammation can enhances the susceptibility to bronchospasm C. The development of chronic inflammation may lead to permanent alteration in the airway structure D. The asthmatic patient cannot fully respond to currently available treatment if there is airway remodelling 49. Choose the correct long term anti-inflammatory drugs: IIIIIIIVA. B. C. D. Inhaled glucocorticosteroids (ICS) Sustained release theophylline Anti-cholinergic drug Short acting beta2 agonist (SABAs) I & II ONLY I,II,& III III & IV ALL of the above

50. All of the following are correct about symphatomimetics drug with its action, EXCEPT: A. SABAs can treat acute asthma symptoms and for preventing exercise induced asthma (EIB) B. LABAs used in combination with Inhaled glucococorticoids for long term control and prevention of symptoms in severe and persistent asthma C. Inhaled SABAs with theophylline is a good synergistic combination D. The use of epinephrine causes more significant side effects QMU RESPIRATORY STSTEM 2012 ©

HEMOPHILUS, BORDATELLA, LEGIONELLA 51. The most virulence antigen of all the 6 types of capsule of haemophilus is A. a B. b C. e D. f 52. Below are disease associated with typable haemophilus I acute epiglottis II Pneumonia III acute sinusitis IV otitis media A. I , II, III, IV B. I , II , III C. II, III, IV D. I, II, IV 53. All of the statement below regarding bordatella are false EXCEPT I cause highly infective whooping cough II incubation period is one week only III Catarrhal stage shows mild coughing, sneezing, tears and large no of bacteria expelled IV As haemophilus, it doesn’t produce any toxin A. I , II, III B. II, III, IV C . I, III D. II, IV 54. Erythromycin is use as prophylaxis and treatment for B. pertussis 55. Haemophilus , B. pertussis, and L. pneumophilia are all gram negative bacteria ILA: CHRONIC OBSTRUCTIVE PULMONARY DISEASES PATHOLOGY:

1. 2. 3. 4.

Stimulate proteolytic activity of macrophage & neutrophils Inhibit α1 – antitrypsin activity Direct chemo-attracting effect of nicotine Smoke contains oxygen reactive species

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56. The above is role of smoking in pathogenesis of A. B. C. D. Centriacinar emphysema Chronic bronchitis Distal acinar emphysema Compensatory emphysema

57. All the following are causes or risk factors for COPD except A. B. C. D. E. Cigarette smoking Autoimmune disease Dust and air pollution Chemical fumes None of the above

58. Which of the following is NOT COPD with predominant emphysema? IIIIIIIVA. B. C. D. E. F. Loss of elastic recoil Decrease in airway tethering Narrowing of airway caliber Increase in airway resistance I & II II & III III & IV I & IV I & III II & IV

PHYSIOLOGY: 59. How to differentiate between obstructive lung diseases and restrictive lung diseases by using spirometer? COPD (Obstructive) Increase FVC Decrease FEV1/FVC ratio Increase FEV1 Decrease FRC RLD (Restrictive) Decrease FVC Normal or Increase FEV1/FVC ratio Normal FEV1 Increase FRC

A. B. C. D.

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60. Which of the following shows air trapping in the lung (obstructive lung disease)?

A.

B.

C.

D.

ANSWERS: 1 2 3 4 5 6 7 8 9 10 D 65 D 65 A 64 D 65 D64 C C D B B 11 12 13 14 15 16 17 18 19 20 C D B A D D D C C D 21 22 23 24 25 26 27 28 29 30 C 86 B 86 C 87 B 88 B 89 C C F A D 31 32 33 34 35 36 37 38 39 40 B C A D B A T T F B 41 42 43 44 45 46 47 48 49 50 D 198 C 198 C 200 A 199 B 199 D 231 D 230 A 230 A 231 C 232 51 52 53 54 55 56 57 58 59 60 B D C T T A E C B C (ILA)

Life has no smooth road for any of us and in the bracing atmosphere of a high aim, the very roughness stimulates the climber to steadier steps, till the legend, over steep ways to the stars fulfills itself. W.C. Doane

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