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CVS-Respi > Case 5 > Flashcards

Case 5 Flashcards

1
Q

It causes TB transmitted by unpasteurized milk and is resistant to pyrazinamide.

a. M. tuberculosis
b. M. bovis
c. M. caprae
d. M. pinnipedii

A

B

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2
Q

The lipid in mycobacterial cell wall is linked to this structure which results to low permeability of cell wall, reducing the effectiveness of most antibiotics.

a. arabinogalactan
b. peptidoglycan
c. lipoarabinomannan
d. two of the options
e. none of the options

A

D

lipoarabinomannan - involved in the pathogen-host interaction and facilitates the survival of M. tuberculosis within macrophages

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3
Q

The following are determinants of the likelihood of transmission of TB

a. probability of contact with a person who has TB
b. intimacy and duration of the contact
c. degree of infectiousness
d. shared environment

A

A

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4
Q

Most infectious patients are those who have:

a. cavitary pulmonary disease
b. sputum smear negative but culture positive
c. culture-negative pulmonary TB
d. extrapulmonary TB

A

A + (less commonly) laryngeal TB

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5
Q

It is also referred to as the cough center

a. nucleus tractus solitarius
b. inferior olivary nucleus
c. nucleus ambiguus
d. dorsal vagal nucleus

A

A

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6
Q

Most commonly implicated medications for drug-induced cough

a. Antiretrovirals
b. Beta-blockers
c. ACE inhibitors
d. NSAIDs

A

C

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7
Q

Multiple-drug resistance TB (MDR TB) is caused by bacteria that is resistant to which of the following TB drugs?

a. HR
b. HRZE
c. HZ
d. HRE

A

a. HR
Multidrug-resistant TB (MDR TB) is caused by TB bacteria that is resistant to at least isoniazid (H) and rifampin(R), the two most potent TB drugs. Extensively drug-resistant TB (XDR TB) is a rare type of MDR TB that is resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or
capreomycin).

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8
Q

For extra-pulmonary TB, the patient’s sputum should be examined for AFB if he has a cough for how many weeks?

a. At least 1 week
b. At least 2 weeks
c. At least 3 weeks
d. At least 4 weeks

A

D. At least 3 weeks

If any patient with extra-pulmonary tuberculosis has a cough > 3 weeks, sputum specimens must be collected and examined for AFB.

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9
Q

A 50-year old man presented at the ER with chronic cough with sputum production. He is a known smoker for 30 years with 15 pack years with a history of hospital admission due to a productive cough and chest tightness for the past year. He underwent spirometry which revealed FEV1/FVC = 0.7; FEV1 29%; but 45% predicted. His CAT assessment score was 25 with modified MRC dyspnea scale grade 3. Which of the following is most likely COPD severity classification according to the Global Initiative for lung disease? (GOLD)

a. GOLD group A: Low symptom severity, low exacerbation risk
b. GOLD group B: High symptom severity, low exacerbation risk
c. GOLD group C: Low symptom severity, high exacerbation risk
d. GOLD group D: High symptom severity, high exacerbation risk

A

d. GOLD group D: High symptom severity, high

exacerbation risk

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10
Q

What specimen should be given to diagnose Pulmonary TB?

a. Blood
b. Transbronchial lavage
c. Sputum
d. Transbronchial needle aspiration

A

C. SPUTUM

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11
Q

Retrobulbar neuritis is the most common serious adverse event of which of the following anti mycobacterial drugs

a. Isoniazid
b. Rifampicin
c. Pyrazinamide
d. Ethambutol

A

D. Ethambutol

Ethambutol - retrobulbar neuritis = loss of visual acuity and red-green color blindness

Isoniazid - hepatitis (most common major toxicity); peripheral neuropathy due to pyridoxine deficiency

Rifampin - red-orange secretions and urine

Pyrazinamide - increase uric acid

Streptomycin - ototoxic; may cause deafness in child if taken during pregnancy

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12
Q

Which of the following TB drugs is/are contraindicated during pregnancy?

a. INH
b. PZA
c. Streptomycin
d. Any of the options

A

C. Streptomycin

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13
Q

Which anti-anginal drug partially inhibits the fatty acid oxidation pathway in myocardium by inhibiting the enzyme required for fatty acid oxidation that improves the metabolic status of ischemic tissue?

a. Ivabradine
b. Ranolazine
c. Trimetazidine
d. Nitrates

A

C. Trimetazidine
Certain metabolic modulators (eg, trimetazidine) are known as pFOX inhibitors because they partially inhibit the fatty acid oxidation pathway in myocardium. Because metabolism shifts to oxidation of fatty acids in ischemic myocardium, the oxygen requirement per unit of ATP produced increases. Partial inhibition of the enzyme required for fatty acid oxidation (long-chain 3 ketoacylthiolase, LC-3KAT) appears to improve the metabolic status of ischemic tissue.

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14
Q

Which of the following pathologic features of COPD in small airways is correct?

a. Mucous gland enlargement and goblet cell hyperplasia leading to cough and mucus production.
b. Neutrophil influx has been associated with purulent sputum of upper respiratory tract infections.
c. Reduced surfactant may increase surface tension at the air-tissue interface, predisposing to airway narrowing or collapse.
d. Characterized by destruction of gas-exchanging air spaces, i.e., the respiratory bronchioles, alveolar ducts, and alveoli.

A

C. Reduced surfactant may increase surface tension at the air-tissue interface, predisposing to airway narrowing or collapse.

Surfactant plays a large role in keeping the smaller airways from collapsing. Mucus gland enlargement.. describes large airway changes. Neutrophil influx…upper respiratory tract - small airways are part of the lower respiratory tract so this does not apply Alveolar ducts, alveoli, respiratory bronchioles are parts of the lung parenchyma and not the smaller airways because they are already sites of gas exchange

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15
Q

Which of the following drugs produce modest improvements in expiratory flow rates and vital capacity and a slight improvement in arterial oxygen and carbon dioxide levels in patients with moderate to severe COPD?

a. Albuterol
b. Prednisone
c. Theophylline
d. Ipratropium bromide

A

Theophylline produces modest improvements in expiratory flow rates and vital capacity and a slight improvement in arterial oxygen and carbon dioxide levels in patients with moderate to severe COPD

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16
Q

Which of the following is the hallmark of COPD?

a. Airway hyper-responsiveness
b. Airflow obstruction
c. Airway resistance
d. Airflow restriction

A

B. Airflow obstruction

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17
Q

All of the following are pathologic features of centrilobular emphysema. Which one is the EXCEPTION?

a. It primarily involves the apical segments of the upper lobes.
b. Air trapped behind the collapsed distal terminal bronchioles distends the respiratory bronchioles.
c. Distal terminal and respiratory bronchioles are the sites of elastic tissue destruction.
d. Distal terminal bronchioles and all parts of the respiratory units are the sites of elastic tissue destruction

A

A. It primarily involves the apical segments of the
upper lobes.

Centrilobular (centriacinar) emphysema: Most common form; occurs predominantly in heavy smokers with COPD. The lesions are more common and usually more pronounced in the upper lobes, particularly in the apical segments.

Panacinar emphysema: More common in the lower zones and in the anterior margins of the ling; usually more severe at the bases

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18
Q

What is the most common major toxic effect of isoniazid

a. Hypersensitivity reaction
b. Peripheral neuropathy
c. Hepatitis
d. Vomiting

A

C. Hepatitis

19
Q

Classification as new case-based history refers to which of the following

a. The patient has never been treated for TB
b. The patient has taken anti-TB drugs for less than 2 months.
c. Any of the options.
d. None of the options

A

A. The patient has never been treated for TB.

20
Q

A miliary TB is a form of tuberculosis that spreads through which of the following.

a. Direct contangious
b. Inhalation
c. Lymphohematogenous
d. Any of the options

A

C. Lymphohematogenous

Miliary TB is due to hematogenous spread of tubercle bacilli. Although in children it is often the consequence of primary infection, in adults it may be due to either recent infection or reactivation of old disseminated foci. The lesions are usually yellowish granulomas 1–2mm in diameter that resemble millet seeds (thus the term miliary, coined by nineteenth-century pathologists).

21
Q

Which of the following regarding positive tuberculin test is correct?

a. Strong immunity
b. Exposure to tuberculous infection
c. Disseminated TB
d. Primary complex

A

B. Exposure to tuberculous infection

False positives:
- Prior BCG vaccination
- Exposure to nontuberculous mycobacteria
False negatives:
- Sarcoidosis
- Immunosuppressed state (anergy)
- Young children
- Recent TB infection (within 6–8 weeks)
- Recent live-virus vaccine
- Disseminated TB
22
Q

This nature of respiratory response of hypersensitivity pneumonitis has an occupational exposure in which of the following causative agents

a. Cotton dust
b. Fungal spores
c. Gain dust
d. Second hand tobacco smoking

A

B. Fungal spores

23
Q

A miliary TB is a form of tuberculosis that spreads through which of the following.

a. Direct contagious
b. Inhalation
c. Lymphohematogenous
d. Any of the options

A

C. Lymphohematogenous

Miliary TB is due to hematogenous spread of tubercle bacilli. Although in children it is often the consequence of primary infection, in adults it may be due to either recent infection or reactivation of old disseminated foci. The lesions are usually yellowish granulomas 1–2mm in diameter that resemble millet seeds (thus the term miliary, coined by nineteenth-century pathologists).

24
Q

Which of the following pathogenesis is cardinal to COPD diagnosis & severity grading which depicts intensity of small airway and possibly increased cholinergic airway smooth muscle tone?

a. Elastin proteolysis
b. Fibrotic remodeling of the airways
c. Extensive alveolar and bronchiolar epithelial cells and apoptosis of pulmonary capillary
d. Fixed airway obstruction

A

D. Fixed airway obstruction (?)

Airflow obstruction is the hallmark of COPD.
Fibrotic remodeling of airways - more often associated to asthma

25
Q

Which of the following basic diagnostics need to be requested for a patient with non-obstructive lung disease?

a. Pulmonary function test via spirometry
b. Diffusion capacity of the lung for carbon monoxide (DLCO)
c. Chest radiography
d. Chest computed tomography

A

B. Diffusion capacity of the lung for carbon monoxide (DLCO) or C. Chest radiography

By elimination:
A. PFT via spirometry is more often used to assess obstructive pathophysiology. (Harrisons Ch 278 pg. 1944)
B. DLCO - Diffusion studies the diffusion of gases across the alveolar-capillary membranes. The DLCO is interpreted in conjunction with spirometry and lung volumes. TLC is the gold standard for diagnosis of restrictive lung disease. (TLC is computed using lung volumes. Measurement of lung volumes are not mandatory

26
Q

A suspected case of COVID-19 is a person who meets the clinical and epidemiological criteria. Clinical criteria includes the following except:

a. acute onset of fever and cough
b. acute onset of fever, cough and sore throat
c. acute onset of fever, shortness of breath, headache and chronic cough
d. acute onset of fever, cough, weakness, myalgia, and diarrhea

A

C

27
Q

The following are characteristics of a person with severe acute respiratory illness(SARI), except:

a. acute respiratory infection with history of fever
b. fever >38C
c. cough
d. requires hospitalization
e. two of the options
f. none of the options

A

F

28
Q

A suspected case of COVID-19 is a person who meets the clinical and epidemiological criteria. Clinical criteria includes the following except:

a. acute onset of fever and cough
b. acute onset of fever, cough and sore throat
c. acute onset of fever, shortness of breath, headache and chronic cough
d. acute onset of fever, cough, weakness, myalgia, and diarrhea

A

C

Clinical criteria:

  1. Acute onset of fever AND cough OR
  2. Acute onset of ANY THREE OR MORE of the following signs and symptoms: fever, cough, general weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnea, anorexia/nausea/vomiting, diarrhea, altered mental status
29
Q

A suspected case of COVID-19 is a person who meets the clinical and epidemiological criteria. Epidemiological criteria includes the following except:

a. residing or working in an area with high risk of transmission of the virus
b. residing in or travel to an area with community transmission anytime within the 14 days prior to symptom onset
c. working in health setting, including within health facilities and within households, anytime within the 14 days prior to symptom onset
d. two of the options
e. none of the options

A

E

30
Q

A suspected case of COVID-19 is a person who meets the clinical and epidemiological criteria and a person with severe acute respiratory infection. Clinical criteria includes the following except:

a. acute onset of fever and cough
b. acute onset of fever, cough and sore throat
c. acute onset of fever, shortness of breath, headache and chronic cough
d. acute onset of fever, cough, weakness, myalgia, and diarrhea

A

C

Clinical criteria:

  1. Acute onset of fever AND cough OR
  2. Acute onset of ANY THREE OR MORE of the following signs and symptoms: fever, cough, general weakness/fatigue, headache, myalgia, sore throat, coryza, dyspnea, anorexia/nausea/vomiting, diarrhea, altered mental status
31
Q

A suspected case of COVID-19 is a person who meets the clinical and epidemiological criteria and a person with severe acute respiratory infection. Epidemiological criteria includes the following except:

a. residing or working in an area with high risk of transmission of the virus
b. residing in or travel to an area with community transmission anytime within the 14 days prior to symptom onset
c. working in health setting, including within health facilities and within households, anytime within the 14 days prior to symptom onset
d. two of the options
e. none of the options

A

E

32
Q

It can prevent phagocytosis:

a. surfactant protein A
b. surfactant protein B
c. surfactant protein C
d. surfactant protein D

A

D

33
Q

Gives the virus its well-known appearance and binds to the angiotensin converting enzyme 2

a. Spike
b. Membrane
c. Envelope
d. Nucleocapsid

A

A

34
Q

Gives the virus its well-known appearance and binds to the angiotensin converting enzyme 2

a. Spike
b. Membrane
c. Envelope
d. Nucleocapsid

A

A

Membrane (M): Transmembrane protein important in viral pathogenesis
Envelope (E): Known to play a role in viral replication and infectivity
Nucleocapsid (N): Allows for regulation of viral RNA replication, transcription, and synthesis

35
Q

The following are chest imaging showing findings suggestive of COVID 19 disease, except:

a. chest radiography: hazy opacities, often rounded in morphology, with peripheral and lower lung distribution
b. chest CT: thickened pleural lines, B lines (multifocal, discrete, or confluent), consolidative patterns with or without air bronchograms
c. lung ultrasound: multiple bilateral ground glass opacities, often rounded in morphology, with peripheral and lower lung distribution
d. two of the options
e. none of the options

A

D

baliktad yung C and D

36
Q

The following are the most common hematologic findings in PTB, except:

a. mild anemia
b. leukocytosis
c. thrombocytosis
d. two of the options
e. none of the options

A

E

slightly elevated CRP and ESR

37
Q

It is the most common site of extrapulmonary PTB in both HIV-seronegative individuals and HIV-infected patients.

a. pleura
b. pericardium
c. bones and joints
d. lymph nodes

A

D

38
Q

It is a condition that presents as painless swelling of the lymph nodes, most commonly located at the posterior cervical and supraclavicular sites.

a. Kimura’s disease
b. Kikuchi’s disease
c. scrofula
d. lymphoma

A

C

39
Q

It is more commonly affected by Genital TB.

a. endometrium
b. ovaries
c. epididymis
d. scrotum

A

A

females are more affected by Genital TB
fallopian tube and endometrium are affected

40
Q

Spinal TB is related to the reactivation of hematogenous foci or to spread from adjacent paravertebral lymph nodes and affects mostly which of the following?

a. knees
b. spine
c. hips
d. elbow

A

B

spine - 40%
hip - 13%
knees - 10%

41
Q

It results from the hematogenous spread of primary or postprimary pulmonary TB or from rupture of a subependymal tubercle into the subarachnoid space

a. Tuberculoma
b. Skeletal TB
c. Pleural TB
d. Tuberculous Lymphadenitis

A

A

42
Q

It is the cornerstone diagnosis of Tuberculous Meningitis

a. CXR
b. Urinalysis
c. Synovial biopsy
d. Lumbar puncture

A

D

gold standard - CSF analysis

43
Q

It is an uncommon manifestation of TB of the central nervous system and presents as one or more space-occupying lesions and usually causes seizures and focal signs.

a. Pott’s disease
b. Tuberculous spondylitis
c. Tuberculous otitis
d. Tuberculoma

A

D

CVS-Respi (5 decks)

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