Internal medicine - Pulmonology Flashcards

1
Q

INT - 4.1
The factor that mostly effects the prognosis of a COPD patient is:
A) The continuation of smoking
B) The reversibility of obstruction when using steroids
C) The degree of hypoxia
D) The value of FEV1
E) The presence of hypercapnia

A

ANSWER
D) The value of FEV1

EXPLANATION
Numerous international studies have confirmed that the prognosis of COPD is mainly determined by the FEV1 values. The degrees of the severity (prognosis) were determined by the decline of FEV1.

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2
Q

INT - 4.2
In case of suspected chronic obstructive pulmonary disease, the most important examination that can confirm the diagnosis is:
A) The determination of the daily amount of sputum
B) Physical examination
C) Chest radiograph
D) Pulmonary function testing
E) Blood gas analysis

A

ANSWER
D) Pulmonary function testing

EXPLANATION
The diagnosis of COPD cannot be made without detectable airway obstruction proved by pulmonary function testing, as airway obstruction (O) is the most important criteria.

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3
Q

INT - 4.4
From the following symptoms which one is the most typical for bronchiectasis?
A) Cough
B) Large amount of (>50-100 ml/day), often purulent expectoration
C) Hemoptysis
D) Chest pain
E) Dyspnea

A

ANSWER
B) Large amount of (>50-100 ml/day), often purulent expectoration

EXPLANATION
Although in bronchiectasis both hemoptysis and dyspnea may be present, the most typical symptom that draws the attention to bronchiectasis is the large amount of expectoration, the “full-mouth” spit after targeted cough. In bronchiectasis phlegm stasis serves as an ideal substrate for bacteria, so the sputum is often purulent. It should be noted that bronchiectasis can be permanently asymptomatic as well, especially in the case of even cylindrical dilation.

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4
Q

INT - 4.5
From the following medication groups which one can significantly inhibit the production of mucus?
A) Theophylline
B) β2-adrenergic receptor agonists
C) Non-selective β2-blockers
D) Anticholinergics
E) Furosemide

A

ANSWER
C) Non-selective β2-blockers

EXPLANATION
The non-selective β-adrenergic agonists prevent the movement of the cilia on the columnar cells found on the surface of the bronchial mucous membrane and thus the mucus transport, contrary to theophylline and β2-adrenergic agonists which enhance the functions of the mucociliary clearence. Anticholinergics and furosemide do not inhibit the clearence, in larger doses they even help it.

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5
Q

INT - 4.6
Medications for the rapid treatment of asthma attacks:
A) Sedatives
B) Bronchodilators
C) Antihistamines
D) Corticosteroids
E) Chromoglycate

A

ANSWER
B) Bronchodilators

EXPLANATION
The asthma attack can be eased in a short time by bronchodilators (bronchial smooth muscle relaxants). The bronchodilator effect of antihistamines - that competitively inhibit the bronchoconstrictor effect of histamine released in a significant amount during mast cell degranulation - is irrelevant. In fast evolving asthma attack the spasm of the bronchial smooth muscles is dominant. The bronchial mucous membrane inflammation that later might become dominant can be eased slowly with corticosteroids. The use ofUsing chromoglycate does not end the asthma attack and sedatives are not antiasthmatic drugs.

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6
Q

INT - 4.8
Which of the following answers is not correct?
A) Regular administration of a short-acting β2-receptor agonist bronchodilator is preferred to administration as needed.
B) Inhaled β2-agonists reach their maximal bronchodilator effect within minutes (in 5-15 minutes).
C) The efficiency of inhalation bronchodilator aerosols can be enhanced, if the patient inhales them through an inhalation piece (nebuhaler).
D) The duration of effect of long-acting inhaled β2-receptor agonist products is between 10-12 hours.
E) The most effective medications in case of bronchoconstriction are β-receptor stimulant bronchodilators.

A

ANSWER
A) Regular administration of a short-acting β2-receptor agonist bronchodilator is preferred to administration as needed.

EXPLANATION
Short acting β-adrenergic agonists are used as “risk-drugs” in long-term medical adjustment or without it, reducing airway caliber narrowing (bronchospasm) that evolves acutely. In long-term asthma control treatment, their usage – e.g. application in asymptomatic periods – is unnecessary. So, statement A is not correct.

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7
Q

INT - 4.9
In case of a 56-year-old, alcoholic, heavy smoker male patient with recurrent fever and cough, followed by large amount of purulent expectoration, weight loss, chest pain and poor general condition has occured. His chest x-ray shows a right upper lobe shadow with fissure formation. The most likely pathogen that caused the pneumonia with above-described clinical picture is:

A) Streptococcus pneumoniae
B) Mycoplasma pneumoniae
C) Staphylococcus aureus
D) Klebsiella pneumoniae
E) Mycobacterium tuberculosis

A

ANSWER
D) Klebsiella pneumoniae

EXPLANATION
Pneumonia caused by Mycoplasma pneumoniae and Staphylococcus is not lobar pneumonia. The pneumatic form of Streptococcus pneumonie and M. tuberculosis do not cause putrid sputum, and more than average amount of expectoration occurs rarely. So Klebsiella remains, that can be associated with lobar pneumonia with fissure formation and a large amount of sputum.

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8
Q

INT - 4.10
The size of the hyperergic tuberculin reaction among the vaccinated population is (the largest diameter perpendicular to the longitudinal axis of the induration):
A) > 10 mm
B) > 15 mm
C) > 20 mm
D) > 25 mm
E) > 30 mm

A

ANSWER
B) > 15 mm

EXPLANATION
Regarding international agreement, hyperergic tuberculin reaction means larger than 15mm reaction (induration). A reaction larger than that namely appears only after BCG-vaccination as a rare exception.

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9
Q

INT - 4.11
In case of newly discovered lesion, which is the size of an infant’s palm, inhomogeneous, right apical, clinically considered as TB, but is negative to Mycobacterium with direct sputum test and with PCR, which one is the recommended sufficient drug combination?
A) INH + RAMP + PZA
B) INH + RAMP
C) INH + PZA
D) INH + PZA + RAMP + EMB
E) INH + EMB

A

ANSWER
A) INH + RAMP + PZA

EXPLANATION
Based on international and national recommendation and practical experiences, beside the rare national occurrence of primary multiresistance (1-2%, at most) the triple combination of isoniazid (INH) + rifampicin (RAMP) + pyrazinamide (PZA) is sufficient.

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10
Q

NT - 4.12
Which antibiotic from the followings is most likely to cause hepatitis?
A) INH
B) PZA
C) RAMP
D) PAS
E) EMB

A

ANSWER
B) PZA

EXPLANATION
Although INH and RAMP can lead to liver damage, yet the occurrence of hepatitis is the most common during PZA application.

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11
Q

INT - 4.13
Principles used in the treatment of multidrug-resistant TB patients, except:
A) At least three drugs to which the isolated bacteria are sensitive should be used.
B) First-line antituberculotic treatment should be used primarily.
C) The medication is supplemented with secondary antituberculotics to achieve a combination of four drugs.
D) At least 3-3 microscopic examinations and culture tests should be performed every three months during treatment.
E) A resistance test is need to be performed from the cultures.
F) After bacterial testing came back negative, the treatment must be continued for at least one more year.
G) Surgical solution must be considered.

A

ANSWER
D) At least 3-3 microscopic examinations and culture tests should be performed every three months during treatment.

EXPLANATION
During the treatment until culture results become negative, performing microscopic and culture tests are necessary for three months. After that if the radiological regression is persistent the number of these tests can be decreased.

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12
Q

INT - 4.14
Which treatment is contraindicated in the treatment of pulmonary embolism during pregnancy?
A) O2 addition
B) bedrest
C) early mobilization
D) administration of Syncumar
E) administration of heparin

A

ANSWER
D) administration of Syncumar

EXPLANATION
Syncumar is contraindicated in pregnancy. Given in the 2nd and 3rd trimester it may cause chondrodysplasia puncata, central nervous system abnormalities or abortion. In late pregrancy it may cause fetal bleeding.

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13
Q

INT - 4.15
Characteristics of primer pulmonary hypertension, except:
A) progressive disease of young women
B) exertional, then resting dyspnea
C) high pulmonary wegde pressure
D) Raynaud’s phenomenon
E) effort syncope
F) right ventricular failure
G) chest pain

A

ANSWER
C) high pulmonary wegde pressure

EXPLANATION
High pulmonary wedge pressure is not characteristic of primer pulmonary hypertension, as wedge pressure meter measures the pressure distally from the insertion of the catheter, which becomes pathologically elevated primarily due to the effect of left atrial pressure increase due to left ventricular dysfuction.

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14
Q

INT - 4.16
Characteristics of acute cor pulmonale, except:
A) consequence of pulmonary embolism
B) consequence of severe acute asthma
C) echocardiography shows dilated, thin walled right ventricle
D) echocardiography shows hypertrophic dilated right ventricle
E) the consequence of acute increase of right ventricular pressure

A

ANSWER
D) echocardiography shows hypertrophic dilated right ventricle

EXPLANATION
In acute cor pulmonale there is not enough time to develop rigth ventricular hypertrophy.

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15
Q

INT - 4.17
In which condition could ’Birbeck’s granulomas’ be typically detected from bronchoalveolar lavage by electron microscopy or may be the ratio of CD1-positive cells above 3%?
A) alveolar microlithiasis
B) Goodpasture syndrome
C) Hamman-Rich syndrome
D) histiocytosis X
E) alveolar proteionosis

A

ANSWER
D) histiocytosis X

EXPLANATION
Birbeck’s granulomas also known as x-bodies, or more than 3% of CD1 positive cell ratio in BAL are diagnostic for histiocytosis X.

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16
Q

INT - 4.19
In which condition is pleural exudate most likely expected?
A) heart failure
B) nephrosis
C) cirrhosis hepatis
D) peritoneal dialysis
E) pulmonary embolism

A

ANSWER
E) pulmonary embolism

EXPLANATION
According to literature, the correct answer is pulmonary embolism.

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17
Q

INT - 4.20
All of the following conditions may cause mediastinal lymph node enlargement, except:
A) Hodgkin’s disease
B) Non-Hodgkin’s lymphomas
C) Toxoplasma gondii infection
D) Sarcoidosis
E) Pneumonia

A

ANSWER
E) Pneumonia

EXPLANATION
Pneumonia does not cause mediastinal lymph node enlargement.

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18
Q

INT - 4.21
Symptoms of superior vena cava syndrome, except:
A) swelling of the head
B) cyanosis
C) development of thoracic collateral circulation
D) arrhythmia
E) heavy breathing

A

ANSWER
D) arrhythmia

EXPLANATION
Superior vena cava syndrome results from significant lumen narrowing or total obstruction of this vessel. Its most important features are swelling of the head and neck due to obstruction of venous reflux, cyanosis due to venous congestion and the development of thoracic collaterals. Swelling of the cervical soft tissues causes narrowing of the airways in the case of compression of the trachea (mediastinal tumor), which may lead to heavy breathing even without cerebral hypoxemia. Arrhytmia is not typical in superior vena cava syndrome.

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19
Q

INT - 4.22
Characteristic of respiratory failure based on hypoventilation, except:
A) May be a consequence of neuromuscular disease
B) The degree of hypoxia is not similar to the degree of hypercapnia
C) May be caused by chest deformity
D) Ventilation pulmp failure
E) May be a consequence of obesity

A

ANSWER
B) The degree of hypoxia is not similar to the degree of hypercapnia

EXPLANATION
Not only does arterial O2 tension decrease in hypoventilation, but also the elimination of CO2 is inadequate, thus increases arterial CO2 tension.

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20
Q

INT - 4.23
In the following conditions respiratory failure is predominantly due to diffusion failure, except:

A) fibrotic alveolitis
B) sarcoidosis
C) alveolar cell carcinoma
D) COPD
E) irradiation damage

A

ANSWER
D) COPD

EXPLANATION
In COPD the main cause of respiratory failure is an abnormal change in the ventilation/perfusion rate caused by airway obstruction and ventilation distribution failure caused by the uneven regional lung distensibility. In the case of COPD-related obstructive emphysema it is not the reduction in diffusion that plays a decisive role, but rather the above mentioned factors. In the other diseases listed above, the prolongation of the diffusion pathway and the reduction of the diffusion surface play the major role.

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21
Q

INT - 4.24
Characteristic of trachea dyskinesis:
A) predispose to barking cough
B) common cause of cough
C) usually curable by surgery
D) precancerosis
E) relieved by antihistamines

A

ANSWER
A) predispose to barking cough

EXPLANATION
In tracheadyskinesia during coughing intrathoracic pressure increases, so the abnormally loose parietal membrane of the trachea bulges into the lumen and often slams against the anterior wall of the trachea, which may make the cough barking like. Deep breathing (cold air), inhalation of irritants stimulate the nerve endings of the often inflamed, hyperaemic tracheal mucosa causing cough or coughing attacks. However trachea dyskinesia is by far not the most common cause of cough.

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22
Q

INT - 4.25
Which one of the following clinical signs is not characteristic of sleep apnea?

A) daytime sleepiness
B) intellectual- and personality changes
C) loud snoring at night
D) elevated blood glucose level
E) hypertonia
F) obesity

A

ANSWER
D) elevated blood glucose level

EXPLANATION
Elevated blood glucose level does not play a causal role in sleep apnea and neither is it a sequelae of it.

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23
Q

INT - 4.26
Tuberculosis infections can occur in the following ways, with one exception. Mark the exception.
A) trough airways
B) alimentary infection (by the consumption of contaminated food)
C) percutaneous (contact with the skin)
D) transplacental (through the placenta)
E) genital contact

A

ANSWER
D) transplacental (through the placenta)

EXPLANATION
Tuberculosis bacteria doesn’t cross the placenta.

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24
Q

INT - 4.27
Which one of the following can lead to chronic cor pulmonale?
A) lobar pneumonia
B) pulmonary venous thromboembolism
C) pulmonary edema
D) chronic obstructive pulmonary disease
E) bronchopneumonia

A

ANSWER
D) chronic obstructive pulmonary disease

EXPLANATION
In chronic obstructive pulmonary disease alveolar hypoxia, consequential vasoconstriction, pulmonary vascular resistance, pulmonary hypertension and chronic right heart strain leads to cor pulmonale. In the other listed diseases cor pulmonale either doesn’t develop at all, or there isn’t enough time for it to develop – those being acute diseases.

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25
Q

INT - 4.28
Symptoms of Goodpasture-syndrome, except:
A) focal glomerulonephritis
B) septic spleen
C) pulmonary fibrosis, induration
D) cutaneous purpura
E) Prussian blue staining in lung parenchyma

A

ANSWER
B) septic spleen

EXPLANATION
Goodpasture-syndrome is not an infectious disease, therefore septic spleen is not part of the sypmtoms.

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26
Q

INT - 4.29
All the followings are possible complications of chronic obstructive pulmonary disease (COPD), except:
A) cor pulmonale
B) polycythaemia
C) respiratory failure
D) left ventricular dysfunction
E) bronchogenic carcinoma

A

ANSWER
D) left ventricular dysfunction

EXPLANATION
COPD causes strain on the right side of the heart, not on the left. Altough polycythaemia caused by hypoxaemia increases blood viscosity, thus straining the left side of the heart, but that usually doesn’t lead to left ventricular failure all by itself.

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27
Q

INT - 4.30
Depending on the pathological changes in the lung, chronic obstructive pulmonary disease (COPD) can manifest as emphysema or bronchitis. Although these two COPD-syndromes rarely manifest as independent diseases, by definition they can be separated based on the clinical features. Which one of the following symptomes is common in both COPD’s bronchitic and emphysematous phenotype?

A) polycythaemia
B) airflow improvement with bronchodilators
C) dyspnoea
D) chronic cough
E) hypercapnia

A

ANSWER
C) dyspnoea

EXPLANATION
Dyspnea caused by airway obstruction is typical for both obstructive emphysema and obstructive bronchitis. Polycythaemia, airflow improvement after using bronchodilators and chronic cough are not characteristic for emphysema. In emphysema alone, significant hypoxaemia doesn’t occur, and hypercapnia never happens because of hyperventilation. (Except for in very severe emphysema when exhaustion of the respiratory muscles cause hypoventilation.)

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28
Q

INT - 4.31
Which statement is not true about the autonomic innervation of the respiratory tract?
A) Parasympathetic nerves control the main mechanisms of bronchoconstriction.
B) Sympathetic nerves control the main mechanisms of bronchodilatation.
C) Acetylcholine is the primary mediator of parasympathetic postganglionic neurons.
D) Noradrenaline is the primary mediator of sympathetic postganglionic neurons.
E) Slightly increased cholinergic resting bronchial tone is physiological.

A

ANSWER
B) Sympathetic nerves control the main mechanisms of bronchodilatation.

EXPLANATION
Sympathetic postganglionic neurons innervating the respiratory tract – which are mediated primary by noradrenaline – play a fundamental role only in regulating the bronchial blood flow. Airway smooth muscles don’t have sympathetic innervation, therefore sympathetic nerves don’t mediate bronchodilation. Bronchoconstriction is mainly regulated by respiratory parasympathetic nerves, which are primary mediated by acetlycholine. Acetylcholine activates the M3-receptors of bronchial smooth muscle cells, triggering bronchoconstriction. Tonic acetylcholine release from the parasympathetic nerves is responsible for the slightly increased, physiological resting bronchial tone.

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29
Q

INT - 4.32
Inhalation of non-selective cholinergic antagonists can paradoxically provocate bronchoconstriction. Inhibition of which receptor is responsible for this rare reaction?
A) M1
B) M2
C) M3
D) NA
E) Beta2-adrenergic

A

ANSWER
B) M2

EXPLANATION
Activation of M2-receptors of parasympathetic postganglional nerves inhibits acetylcholine release. Pharmacological inhibition of postganglional nerve’s inhibitory M2-receptors leads to more acetylcholine release during cholinergic stimulation. This decreases the effect of the non-selective cholinergic antagonist or, paradoxically, can trigger bronchoconstriction. Bronchoconstriction caused by cholinergic antagonists is not related to the other listed receptors.

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30
Q

INT - 4.33
How do anticholinergic bronchodilators exert their bronchial smooth muscle relaxing effect?

A) by facilitating sympathetic neuromuscular transmission
B) by inhibiting sympathetic neuromuscular transmission
C) by facilitating parasympathetic neuromuscular transmission
D) by inhibiting parasympathetic neuromuscular transmission
E) by direct effect

A

ANSWER
D) by inhibiting parasympathetic neuromuscular transmission

EXPLANATION
Cholinergic antagonist bronchodilators are competitive antagonists of acetylcholin, which inhibit activation of the muscarinic cholinergic receptors by acetylcholin. This mechanism is responsible for inhibiting the parasympathetic neuromuscular transmission, therefore decreasing the bronchial smooth muscle’s tone, indirectly causing bronchodilation. Sympathetic innervation of the airways doesn’t play a considerable role in regulating bronchial tone.

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31
Q

INT - 4.34
Which one of the following function is not characteristic of pulmonary surfactant?
A) stabilizing alveoli and bronchi during exspiration (anti-atelectasis)
B) maintaining the alveolo-bronchial clearance
C) enhancing alveolar macrophage function
D) enhancing the colonisation of particular viruses and bacteria
E) increasing bronchial clearance by reducing the adhesion between sol and gel phase of the fluid covering the bronchial walls

A

ANSWER
D) enhancing the colonisation of particular viruses and bacteria

EXPLANATION
Surfactant inhibits (and not enchances) bacterial and viral colonisation. The other answers are correct.

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32
Q

INT - 4.35
Which statement is not true?
A) Alveoli can be found on the walls of bronchioles distal to the terminal bronchioles.
B) The terminal bronchiole is divided into two respiratory bronchioles.
C) The third-generation of respiratory bronchioles are divided into alveolar ducts.
D) Alveolar ducts can also originate from first-generation respiratory bronchioles.
E) Airways distal to the terminal bronchioles are called conductive airways.

A

ANSWER
E) Airways distal to the terminal bronchioles are called conductive airways.

EXPLANATION
The respiratory tract up to the respiratory bronchioles leads (“conducts”) the air to the alveolar region where gas exchange occurs. The latter region contains respiratory bronchioles, the distal airways and alveoli. So E statement is not true, but the other statements are true.

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33
Q

INT - 4.36
Which statement is not true?
A) The average diameter of terminal bronchiole is 0,6 mm.
B) The wall of the bronchioles do not contain cartilage.
C) The lung unit provided by terminal bronchioles is called acinus.
D) The basis diameter of acinus is 0,5–1 cm.
E) The unit provided by the third-generation respiratory bronchioles is the terminal respiratory unit.
F) An acinus contains 8-10 lobules.
G) The average airspace of an acinus is 0,2 ml.

A

ANSWER
F) An acinus contains 8-10 lobules.

EXPLANATION
The difference between bronchioles and bronchi is that the bronchioles do not contain cartilage. Their average diameter is 0.6 mm. A lung unit belonging to the terminal bronchioles is the acinus and the diameter of the acinus is 0.5 to 1 cm at its base. The lung unit belonging to the 3rd generation of respiratory bronchioles is now called the “terminal respiratory unit”. Lung acinus consists of 3-5 (and not 8-10) lobules. The airspace of the acinus is 0.2 ml. So all statements are true, except of F.

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34
Q

INT - 4.37
The main features of cells, which cover airways, except for:
A) Clara cells are secretory cells, which do not contain cilium and are predominantly presented in the terminal bronchioles.
B) Kulchitsky cells produce biogenic amines.
C) Type I pneumocytes produce surfactant.
D) The number of goblet cells in the bronchi decreases towards the periphery.
E) In case of chronic irritation goblet cells may also appear in the bronchioles.

A

ANSWER
C) Type I pneumocytes produce surfactant.

EXPLANATION
Surfactant is produced by type II pneumocytes and not type I pneumocytes. The other answers are true. Kulchinsky cells, also known as paracrine or APUD cells, are presented in relatively small numbers in the epithelium and the submucosal glands. They can produce biogenic amines (including 5-hydroxytryptamine, dopamin and noradrenaline) and peptide hormones (for example calcitonin). Endocrin tumours called „apudomas” can be formed from these cells.

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35
Q

INT - 4.38
Which statement is not true?
A) The average ventilation/perfusion ratio is 0,8.
B) Ventilation of basal areas is low compared to the perfusion.
C) Perfusion of apical areas is very low compared to the ventilation.
D) The normal alveolar ventilation is 8 l.
E) Alveolar hypoventilation is characterized by the elevation of CO2 in the arterial blood.

A

ANSWER
D) The normal alveolar ventilation is 8 l.

EXPLANATION
Alveolar ventilation is smaller than minute ventilation, because it is the amount of air that in terms of its gas tension is balanced with the gas tension of arterial blood. Thus, alveolar ventilation is the minute ventilation reduced with anatomical and functional dead space ventilation. It is not characterized by a fixed value. It depends primarily on body size but is also influenced by other factors (for example metabolic rate etc.). If the value of the minute ventilation (at rest) is 6-8 l, then the 8 l alveolar ventilation is unrealistically high. The other statements are true.

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36
Q

INT - 4.39
Which of the following metabolic functions does not occur in the lungs?
A) Production of prostaglandins
B) Production of arylsulphatase-B
C) Production of leukotrienes
D) Hormone production
E) Conversion of angiotensin I to angiotensin II
F) Hypoxaemia-induced erythropoietin production
G) Deamination of serotonine
H) Production of thromboplastin

A

ANSWER
F) Hypoxaemia-induced erythropoietin production

EXPLANATION
Hypoxaemia-induced erythropoietin production is located in the kidney and not in the lungs. The other statements are true.

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37
Q

INT - 4.40
Which of the following cells plays a central role in the pathogenesis of bronchial asthma?
A) neutrophil granulocyte
B) eosinophil granulocyte
C) monocyte
D) histiocyte
E) plasma cell

A

ANSWER
B) eosinophil granulocyte

EXPLANATION
Bronchial asthma is characterized by the chronic eosinophilic cell inflammation in bronchial airways. Almost all other types of inflammatory cells play role in the activation of eosinophilic cells.

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38
Q

INT - 4.42
The most common stimulus which triggers exercise-induced asthma is:
A) running in cold air
B) using stationary bicycle
C) swimming
D) hall football
E) hall aerobic

A

ANSWER
A) running in cold air

EXPLANATION
Practical experiences have shown that running in cold air most commonly provokes asthmatic attack in exercise-induced asthma. Swimming is a well-tolerated sport for asthmatics. Noteworthy, sulfuric or heavily chlorinated water can increase BHR (bronchial hyperresponsiveness) and cause asthma attacks.

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39
Q

INT - 4.43
Which of the following cells is the most important antigen presenting cell in asthma?
A) T-lymphocyte
B) alveolar macrophage
C) dendritic cell
D) epithel cell
E) endothel cell

A

ANSWER
C) dendritic cell

EXPLANATION
Bone marrow dendritic cell is the most important antigen presenting cell in asthma.

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40
Q

INT - 4.45
Which parameter goes first to normal range in case of the adequate treatment of community-acquired pneumonia?
A) fever
B) cough
C) auscultation
D) CRP
E) leukocytosis

A

ANSWER
D) CRP

EXPLANATION
The decrease of CRP, it occurs 1-3 days after. The other parameters will be normalized in 3-4 days.

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41
Q

INT - 4.46
Which virus can be the cause of pneumonia in transplanted patients and which one of the risk factors of rejection?
A) CMV
B) adenovirus
C) flu virus
D) EBV
E) RSV

A

ANSWER
A) CMV

EXPLANATION
Immunsuppressive treatment is predisposed to CMV-infection after the transplantation. The mostly endangered patients are CMV seronegative patients, who gets their organ from a CMV positive donor.

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42
Q

INT - 4.47
The features of aspiration pneumonia are:
A) Community-acquired aspiration pneumonia is most commonly caused by aerob bacterias.
B) The clinical manifestation includes pneumonitis, necrotising bronchopneumonia and pulmonary abscess.
C) Leukocytosis is not a characteristic feature.
D) In diagnostic, the hemoculture has a main role because of its good sensitivity and specificity.
E) The first choice is aminoglycoside antibiotic treatment.

A

ANSWER
B) The clinical manifestation includes pneumonitis, necrotising bronchopneumonia and pulmonary abscess.

EXPLANATION
The aspiration pneumonia is mostly caused by mixed aerob and anaerob bacterias. The clinical manifestation depends on the invasivity and patogenicity of the bacterias.

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43
Q

INT - 4.48
Which bacteria is NOT the cause of pulmonary gangraena?
A) Klebsiella pneumoniae
B) Anaerob bacterias
C) Mycobacterium marinum
D) Hemophilus influenzae
E) Staphylococcus aureus

A

ANSWER
C) Mycobacterium marinum

EXPLANATION
The most common causes of pulmonary gangrene are Klebsiella pneumoniae, then S. aureus, S. pneumoniae, H. influenzae and anaerobic bacteria.

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44
Q

INT - 4.49
Which one of the followings is an exclusion criteria in lung transplantation?
A) idiopathic, non-treated, end-stage pulmonary disease
B) confused psychical status, unsettled severe social status
C) significantly reduced life expectancy without the surgery
D) acceptable nutritional status
E) severe pulmonary arterial hypertension

A

ANSWER
B) confused psychical status, unsettled severe social status

EXPLANATION
The indications of lung transplantation are untreatable end-stage pulmonary diseases of known or unknown etiology including progressive severe pulmonary arterial hypertension. The surgery is indicated if the life expectancy without transplantation is worse. The conditions of the surgery are the acceptable nutritional, emotional and psychical status.

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45
Q

INT - 4.50
Which one of the followings is NOT the indication of lung transplantation?
A) end-stage pulmonary fibrosis
B) pulmonary sepsis
C) severe emphysema due to α-1 antitrypsin deficiency
D) pulmonary arterial hypertension
E) severe COPD with pulmonary hypertension

A

ANSWER
B) pulmonary sepsis

EXPLANATION
(A kérdésben nincs szó egyoldali tüdőtranszplantációról. PAH-ban kétoldali transzplantáció indokolt. Így nem jó) The indications of single lung transplantation are: end-stage pulmonary fibrosis, severe emphysema, severe pulmonary arterial hypertension, various pulmonary diseases, including eosinophil granuloma, sarcoidosis. Pulmonary sepsis is against lung transplantation until the signs of sepsis exist.

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46
Q

INT - 4.51
Which disease is not solved by lung transplantation alone?
A) Eisenmenger-syndrome
B) severe bilateral bronchiectasis with severe symptoms
C) pulmonary arterial hypertension
D) secundery pulmonary hypertension

A

ANSWER
A) Eisenmenger-syndrome

EXPLANATION
The indication of lung transplantation are: severe emphysema (including alfa-1-antitrypsin deficiency), pulmonary arterial hypertension, various diseases including eosinophil granuloma, sarcoidosis. In Eisenmenger-syndrome the initial left-to-right shunt may result in elevated pulmonary vascular resistance and right-to-left/bidirectional shunt causing cyanosis. This is a point at which the pulmonary vascular disease is irreversible with contraindication against closure of the shunt lesion. Transplantation, either combined heart–lung transplantation or lung transplantation with concomitant cardiac repair, remain the only definitive treatment options.

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47
Q

INT - 4.52
What situation can be an indication for combined heart and lung transplantation, if the adequate severity criteria are present?
A) congenital heart defect combined with Eisenmenger-syndrome
B) cystic fibrosis
C) severe emphysema caused by α-1 antitrypsin deficiency
D) end-stage pulmonary fibrosis
E) pulmonary arterial hypertension

A

ANSWER
A) congenital heart defect combined with Eisenmenger-syndrome

EXPLANATION
The indications of heart-lung transplantation are: parenchymal lung disorder with severe independent heart disease, congenital heart disease with Eisenmenger-syndrome, so the answer A is the correct. In case of tuberculosis transplantation is not indicated. In case of end-stage pulmonary fibrosis, single lung transplantation is indicated. In case of emphysema caused by severe α-1 antitrypsin deficiency single or dual lung transplantation is indicated.

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48
Q

INT - 4.53
What is the chance of CMV pneumonia among lung transplanted patients without specific drug therapy?
A) 25%
B) 18%
C) 50%
D) 80%
E) 90%

A

ANSWER
C) 50%

EXPLANATION
CMV infection is the second most common infection in lung-transplanted patients, after bacterial infections. It starts 2-12 weeks after the transplantation. The most severe infection develops in case if a seronegative recipient gets a seropositive graft. The diagnosis is made by BAL, if positive, a transbronchial biopsy is also needed. After heart or heart-lung transplantation the prevalence of CMV infection can reach 50 % without specific drug treatment.

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49
Q

INT - 4.54
When does the bacterial pneumonia occurs the most commonly after lung transplantation?
A) 0–3 months
B) 2–12 weeks
C) 1–3 months
D) 9 days –2 months
E) the first 2 weeks

A

ANSWER
A) 0–3 months

EXPLANATION
The most common disease after lung transplantation is the bacterial pneumonia, which occurs usually in the first 3 months. Among Gram-negative bacteria Enterobacter and Pseudomonas infection, fro other bacteria Haemophilus influenzae and Staphylococcus aureus are the most common causes of the disease.

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50
Q

INT - 4.55
How often do fungal infections occur after a lung transplantation?
A) 30%
B) 10–22%
C) 23–30%
D) less, than 5%
E) 50%

A

ANSWER
B) 10–22%

EXPLANATION
Fungal infections are frequent as a consequence of the immunosupressive therapy. They usually occur in the first two months after the transplantation, with an incidence of approx. 10-22%. They’re caused by Candida and Aspergillus spp. Candida infections usually occur right after the transplantation, because the colonisation takes place from the donor’s airways. Aspergillus spp. can lead to invasive, acute, fulminant infections. Fungal infections have a high mortality, around 40-70%. They’re mostly successfully treatable with amphotericin B, although Aspergillus spp. are hard to eradicate, and often could lead to lethal infections.

51
Q

INT - 4.56
The most common respiratory symptoms of thyreotoxicosis are the following, except:
A) increased consumption of oxygen and increased production of carbon dioxide
B) decreased vital capacity
C) increased lung compliance
D) the enlarged thyroid compresses the trachea
E) dyspnea

A

ANSWER
C) increased lung compliance

EXPLANATION
Most common symptoms of thyreotoxicosis are dyspnea, increased oxygen consumption and carbon-dioxide production - due to increased metabolism -, and increased minute ventilation with tachypnea and tachycardia. The increased circulatory load leads to left ventricular failure and dilation, mitral valve insufficiency and pulmonary hypertension. The enlarged thyroid puts pressure on the trachea. The pulmonary hypertension causes interstitial congestion, extends the diffusion route and reduces (not increases!) the compliance of the lungs and the vital capacity. Either the increased respiratory work - caused by the former mechanism -, the pressure on the trachea or the cardiac abnormalities can cause dyspnea. (Tachypnea, and rarely tachycardia also can be experienced as dyspnea by the patients.)

52
Q

INT - 4.57
How does hypothyreoidism affects the respiration?
A) It dilates the airways.
B) It decreases the central reaction to hypoxaemia and hypercapnia.
C) It increases the vital capacity.
D) It increases the FEV1.
E) It decreases the diffusing capacity.

A

ANSWER
B) It decreases the central reaction to hypoxaemia and hypercapnia.

EXPLANATION
While hyperthyreosis increases, hypothyreosis decreases the reaction to hypoxaemia and hypercapnia. With the possible pressure on the larynx, the trachea and the respiratiory functions (upper airway obstruction, that can cause stridor), obstructive sleep apnea can develop, or less often their effect develops through uni-, or bilateral pleural effusion.

53
Q

INT - 4.58
The general principles of treating pregnant asthmatic pregnant patients are the following, except:
A) avoiding symptom-tirggers (eg. dust mite, animals, infections, pollen etc.)
B) isolation of the patient from the environment
C) follow-up of symptoms
D) adequate drug treatment
E) monitoring the actual status with peak flow meter

A

ANSWER
B) isolation of the patient from the environment

EXPLANATION
In case of extrinsic asthma, avoidance of allergens is the most important aspect, if it is possible (eg. dust mite, fur, infections). With pollen allergy this is a difficult question, because at certain times the pollen is in the air. Adequate medication - bronchodilator and inhaled steroid - is needed, based on the severity of asthma. Home surveillance of patients is possible with a peak flow meter, which gives information about the PEF (peak exspiratory flow) and can be used to control the effectivness of the treatment. The asthmatic patients should be under regular and close pulmonological control. Isolation of the patients is not needed at all. The above findings not only apply to asthmatic pregnancy but to asthma bronchiale in general.

54
Q

INT - 4.59
The following are included in the treatment of status asthmaticus in asthmatic pregnant patients, except:
A) oxygen
B) short acting beta-agonist
C) succinyilcholine
D) methylprednisolone
E) intravenous fluid replacement with magnesium

A

ANSWER
C) succinyilcholine

EXPLANATION
In case of status asthmaticus or acute severe asthma parenteral hydration, treatment of hypoxaemia with oxygen supplementation (usually with a 4-6L/min dosage) and intravenous cannulation are essential. Besides that, intravenous methylprednisolone and inhaled short acting beta-agonist - preferably with nebulizer (it’s more effective than simple inhalation) - should be administered. The muscle relaxing agent, succinylcholine isn’t part of the treatment of status asthmaticus. The former management protocol can be followed in status asthmaticus, irregardless whether the patient is pregnant.

55
Q

INT - 4.60
Doctors notice a 2 cm (diameter) nodule with calcification in the lung of a young woman. What origin could we suspect?
1) tuberculoma
2) metasasis of ovarian cancer
3) hamartoma
4) Echinococcus cyst
5) bronchopneumonia

A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Calcification is typical in tuberculoma, “healed” post-tuberculotic nodules and hamartomas. Metastases of ovarian cancer, bronchopneumonia and cysts (except echinococcus) rarely shows signs of caclification, the latter is eggshell-like.

56
Q

INT - 4.61
Doctors discover a cavern in the top of the lower lobe during a screening x-ray of a 52 years old man. The previous screening was negative. What can we think of?
1) tuberculotic cavern
2) lung cyst
3) disintegrating lung cancer
4) aspergilloma
5) metastasis of colon carcinoma
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Metastatic colorectal cancer mostly appears in the form of multiple nodules in the lungs, without any cavitation. Lung cysts rarely occur in the top of the lower lobe, and while they can look like a cavity with a thin wall, they often consist fliud and rather appear like a nodule or a cavity with an air-fluid level inside. Aspergilloma develops from a preformed cavity with the invasion of fungi, and it is usually in the upper lobe. The top of the lower lobe is the predilection site for tuberculosis, but disintegrating lung cancer can also occur there.

57
Q

INT - 4.62
Unilateral broadening of hilum can be caused by:
1) central lung cancer
2) mediastinal tumor
3) malignant lymphoma
4) lymphangioleiomyomatosis
5) histiocytosis
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Many diseases can cause unilateral hilar widening on the x-ray, such as central lung cancer, mediastinal tumours, malignant lymphoma, tuberculosis, silicosis etc. X-rays in histiocytosis X mostly shows focal lesions in the upper lobes. In LAM (lymphangioleiomyomatosis) fine reticulonodular lesions, pleural effusion and sometimes pneumothorax can be observed.

58
Q

INT - 4.63
Bilateral broadening of hilum can be caused by:
1) idiopathic interstitial pneumonia
2) sarcoidosis
3) Wegener-granulomatosis with polyangiitis
4) bronchial carcinoma
5) alveolar microlithiasis

A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
D) only the 2. and 4. answers are correct

EXPLANATION
Bilateral widening of hilum can have several possible reasons, eg. Boeck-sarcoidosis, bronchial cancer, mediastinal tumours, lymphoma etc. In the early stages of idiopathic pulmonary fibrosis, reticular lesions are present primarily in the lower lobes, and in the later stages “honeycomb lung” is seen. You can see nodular lesions on the X-ray in Wegener-granulomatosis, typically with cavitation. Alveolar microlithiasis causes small intense foci on the X-ray, mainly in the lower lobes.

59
Q

INT - 4.65
Which conditions need to co-exist for long-term steroid therapy to be recommended in COPD?
1) A more than 10% increase of FEV1 after two weeks of 24-32mg oral steroid treatment in a period without exacerbations.
2) No significant reversibility while using beta2-agonist.
3) The patient’s overall condition is not satisfactory without steroid.
4) Persistent airway obstruction is present.
5) The patient has theophyllin intolerance.

A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Long-term steroid therapy is indicated in COPD in cases where either significant increase of FEV1 can be observed after a high dose short-term (two week) steroid therapy, or the patient’s overall state is unsatisfactory without steroids. Nor irreversible airway obstruction despite beta-agonist, nor theophyllin-intolerace are indications for long-term steroid therapy. The persistent airway obstruction in itself is also not an indication for steroid, as airway obstruction is in the definition of COPD and it can be fully irreversible even if the patient takes steroids.

60
Q

INT - 4.66
The FEV1 value of a 50 year old smoker male COPD patient is 30% of the reference value. Immediately after administration of a beta2-agonist it changes to 34%, after 2 weeks of steroid treatment to 39%, while arterial O2 tension is 55 mmHg. What treatment is the most important in increasing the survival?
1) regular administration of a short-acting inhaled beta2-agonist
2) smoking cessation
3) regular administration of an inhaled steroid
4) long-term home O2 therapy
5) long-term oral steroid therapy

A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
D) only the 2. and 4. answers are correct

EXPLANATION
In COPD, the progression of the diasease – and mainly the FEV1 reduction - is highly determined by the smoking. Improvement in prognosis is to await from smoking cessation and from long-term O2 therapy.

61
Q

INT - 4.67
What are common signs in emphysema and in exercise-induced asthma?
1) Reversible respiratory obstruction to beta2-agonist
2) Dyspnoea shortly after stopping exercise
3) Dyspnoea after 6-10 minutes of exercise
4) Exercise-induced dyspnoea
5) Increasing limitation of exhaled flow during exercise
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
E) only the 4. answer is correct

EXPLANATION
The only correct answer is exercise-induced dyspnea, since emphysema is not a reversible airway obstruction. Only exercise-induced asthma is characterized by dyspnea 6 to 10 minutes after cessation of exercise, while exercise-induced asthma does not increase flow restriction during the exercise (provided that the patient had not had previously difficulty of breathing)

62
Q

INT - 4.68
The following statements apply to chronic obstructive pulmonary disease (COPD):
1) airway obstruction caused by chronic bronchitis
2) may be accompanied by respiratory hyperreactivity
3) decreased FEV1
4) decreased FIV1
5) seizure-like dyspnoea
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Statement 1 is the definition of COPD, which implies that the obstruction indicator FEV1 is also reduced. Approximately one third to half of COPD cases are accompanied by bronchial hyperresponsiveness. FIV1 is generally not reduced, especially when emphysema and not bronchitis is dominant. In the rare cases when bronchitis is the leading condition, “fixed” constrictions may occur, which can rarely cause a moderate decrease in FIV1. In COPD, dyspnea does not show rapid alterations and asthma-like attack does not characterize the disease.

63
Q

INT - 4.69
Medications for the continuous maintenance treatment of chronic asthma in moderate stage (Step 3):
1) use of an inhaled short-acting beta2-agonist as needed
2) continuous administration of inhaled corticosteroids
3) use of long-acting β2- agonist
4) regular administration of antihistamines
5) continuous administration of an oral steroid
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Antihistamines should not be given for asthma. This group of drugs has an indication in the potential associated allergic rhinitis. Its effect on asthma is very moderate. Continuous oral steroid administration in moderate asthma (stage 3) is contraindicated. At this stage, administration of an inhaled steroid, a long acting bronchodilator and, if necessary, a short acting β2-agonist will provide adequate control of asthma.

64
Q

INT - 4.70
Which are the right answers?
1) The bronchodilator effect of theophylline application depends on the serum concentration.
2) The duration of the effect of retard theophylline is 10-12 hours.
3) Oral theophylline is used in mild asthma.
4) Therapeutic levels of theophylline in blood are between 5 and 15 µg / ml.
5) The metabolism of the drug shows great individual differences.
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
B) only the 1., 2., 4. and 5. answers are correct

EXPLANATION
Oral theophyllin has not been recommended in mild asthma until the test questions have appeared. So the correct answer is B.

65
Q

Not on website

INT - 4.71
Which pathogens are the most common cause of pneumonia after an influenza epidemic?
1)
Staphylococcus aurus
2)
Streptococcus pyogenes
3)
Streptococcus pneumoniae
4)
Klebsiella pneumoniae
5)
Mycoplasma pneumoniae
A)
only the 1., 2. and 3. answers are correct
B)
only the 1., 2., 4. and 5. answers are correct
C)
only the 1. and 3. answers are correct
D)
only the 2. and 4. answers are correct
E)
only the 4. answer is correct
F)
all of the answers are correct

A

ANSWER
A)
only the 1., 2. and 3. answers are correct
EXPLANATION
Staphylococcus, as well as Streptococcus pyogenes and Str. Pneumoniae have been reported to be the most common pathogens in pneumonia following an influenza epidemic.

66
Q

NT - 4.72
Effective drugs for the treatment of atypical pneumoniae (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila):
1) macrolides
2) fluoroquinolones
3) oxytetracyclin
4) beta-lactam antibiotics
5) aminoglycosides
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Macrolides, fluoroquinolones and oxytetracycline are effective antibiotics in the treatment of atypical pneumonia.

67
Q

INT - 4.73
Which of the following is not a characteristic of pulmonary tuberculosis?
1) cough
2) weight loss
3) higher temperature
4) night sweats
5) bloodstained sputum
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
F) all of the answers are correct

EXPLANATION
In the case of pulmonary tuberculosis, any of these symptoms can occur, but none are specific. However, the coexistence of symptoms greatly raises the possibility of tuberculosis.

68
Q

INT - 4.74
Which tests can prove the tuberculotic origin of pleuritis exsudativa within 3 days?
1) bacterial detection of punctate by PCR
2) thoracoscopy
3) pleurabiopsy
4) liquid cultures (eg BACTEC)
5) Ziehl-Neelsen’s sputum staining (sputum smear for the demonstration of acid-fast bacilli)
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
The TBC bacterium can be detected from the punctate by a PCR technique within 24 hours. Thoracoscopy - ZN staining of the optically representative image and even more of the pleural effusion biopsy and histological image (thoracoscopic or blind pleurabiopsy) - can also give a diagnosis within 3 days. In the case of pleuritis exsudativa, there is often no specific lesion seen in the lungs, so a positive result with ZN staining in the sputum is not expected.

69
Q

INT - 4.76
In addition to the administration of antituberculotics, which corticosteroid treatment is not indicated?
1) primary tuberculosis complex
2) miliary tuberculosis
3) cervical lymph node tuberculosis
4) pleuritis exsudativa tuberculosa
5) toxic pulmonary tuberculosis
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
In addition to toxic pulmonary tuberculosis, corticosteroid treatment is required in all cases where scarring or adhesions causing severe dysfunction is expected. Thus, among those listed, miliary tuberculosis, all tuberculous exudative serous inflammation, including pleuritis exsudativa. Administration of steroid for primary complex and cervical lymph node TB is not indicated.

70
Q

INT - 4.77
Characteristic of tuberculosis associated with HIV infection:
1) faster lymphatic and hematogenous dissemination
2) systemic disease is more common
3) the disease develops predominantly by activation of dormant bacteria and endogenous exacerbation
4) the proportion of extrapulmonary forms increases
5) the rate of false negative tuberculin skin test increases
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
B) only the 1., 2., 4. and 5. answers are correct

EXPLANATION
In TB associated with HIV infection, the proportion of new (exogenous) TB infection dominates (70%) and only 30% is endogenous exacerbation (activation of dormant bacteria). This was determined by genetic engineering methods. The rest of the statements are facts based on observations.

71
Q

INT - 4.78
Pulmonary diseases caused by Aspergillus:
1) allergic bronchopulmonary aspergillosis
2) aspergilloma
3) aspergillus asthma
4) chronic necrotizing pulmonary aspergillosis
5) bronchocentric granuloma
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
F) all of the answers are correct

EXPLANATION
Bronchocentric granuloma is also a fungal disease usually caused by Aspergillus. Tissue and peripheral eosinophilia can be detected in about one third and are therefore classified as eosinophilic diseases of the lungs. In most cases, in sputum or biopsy fungal filaments can be present. The other diseases listed include the name of the fungus, so there is no doubt that it is caused by Aspergillus.

72
Q

INT - 4.79
Treatment of invasive aspergillosis:
1) inhaled Amphotericin B
2) segmental resection
3) hyperbaric oxigen therapy
4) intravenous Amphotericin B
5) cavernostomy
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
E) only the 4. answer is correct

EXPLANATION
Invasive aspergillosis is a multi-segmental lesion that cannot be treated with segmental resection. Caverna is generally not typical for invasive bronchopulmonary aspergillosis. Significant reductions in oxygen tension are rarely accompanied, at most, by healing with extensive scarring (in the absence of steroid therapy). O2 treatment is not a causal therapy and is indicated for respiratory failure. Treatment is carried out with Amphotericin B and given by infusion.

73
Q

INT - 4.80
From the symptoms listed below, which are typical of acute massive pulmonary embolism?
1) severe resting dyspnea
2) syncope
3) cough
4) central chest pain
5) cyanosis
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
B) only the 1., 2., 4. and 5. answers are correct

EXPLANATION
In acute massive pulmonary embolism, severe resting dyspnea-cyanosis-central chest pain syndrome is almost always present and syncope is common. Cough is not a common symptom of the disease.

74
Q

INT - 4.81
Symptoms of pneumothorax (ptx) in general:
1) chest pain on the same side
2) cyanosis
3) dyspnea (maybe only exertional)
4) mediastinum deviating to the side of the ptx
5) wheezing
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Pneumothorax is characterized by chest pain on the same side, which can be pronounced mainly when the PTX occurs and may eventually disappear. The same applies to dyspnea, which occurs only initially in the case of smaller amounts of air in the pleural space. However, as the PTX gradually increases, shortness of breath increases. In a smaller PTX, after initial resting dyspnea exertional dyspnea may persist. Cyanosis occurs mainly in extensive or tension PTX. In a smaller PTX, only if the lung is already severely damaged by other diseases. Wheezing is not typical for PTX. The mediastinum, when pushed, is due to increased intrapleural pressure on the ipsilateral side of the PTX relative to the contralateral side.

75
Q

INT - 4.82
What is conventional therapy for diffuse malignant mesothelioma?
1) pleurodesis
2) chemotherapy
3) symptomatic treatment
4) radiotherapy
5) surgery
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

76
Q

INT - 4.83
Indication of mechanical ventilation:
1) NIF (Negative Inspiratory Force) < 20 H2Ocm
2) respiratory rate > 35–40/min
3) vital capacity < 65–70 ml/kg
4) PaCO2 > 55 Hgmm
5) O2-saturation < 90% by FiO2=0.6
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
B) only the 1., 2., 4. and 5. answers are correct

EXPLANATION
The indication of mechanical ventilation is not primarily influenced by the size of vital capacity. Anyway, the vital capacity of 65-70 ml/kg, or even slightly lower, falls within the normal range. The other 4 statements are correct.

77
Q

INT - 4.84
Acute respiratory failure:
1) is always with CO2 retention
2) it can be the consequence of pneumonia
3) life-threatening acid-base imbalances are rare
4) a common consequence of acute exacerbation of chronic lung disease
5) it can always be well influenced by O2 therapy
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
D) only the 2. and 4. answers are correct

EXPLANATION
There are two forms of respiratory failure, including acute respiratory failure. In the case of Type I, only PaO2 is reduced and does not result in CO2 retention. It can also be a consequence of extensive pneumonia. Regardless of its cause, especially in the case of CO2 retention, acid-base imbalances are common. Acute exacerbation of chronic lung disease is a common cause. O2 therapy does not eliminate the cause and does not always affect hypoxemia (eg ARDS).

78
Q

INT - 4.85
Chronic respiratory failure:
1) develops over months, years
2) characterised by hypoxia and often hypercapnia
3) common consequence of COPD
4) due to compensationmechanisms, buffer bases are reduced
5) rare in fibrosis
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Chronic respiratory failure develops over months to years. A common consequence of COPD. Initially, this disease develops only hypoxaemia, which is accompanied by CO2 retention via further worsening of the ventilation/perfusion rate, and an increase in alveolar hypoventilation. In fibrosis, type I (hypoxaemia only) respiratory failure is typical because diffusion is the main cause but CO2 diffuses well. Compensation mechanisms increase the level of buffer bases.

79
Q

INT - 4.86
Typical for ARDS:
1) PO2/FiO2 < 200
2) always secondary disease
3) elevated pulmonary wedge pressure
4) refractory hypoxemia
5) leading symptom is the dyspnoea
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
B) only the 1., 2., 4. and 5. answers are correct

EXPLANATION
In ARDS, pulmonary artery pressure is high while pulmonary wedge pressure is not, because the disease - and pulmonary edema as a part of it - is not caused by left-sided heart failure.

80
Q

INT - 4.87
Damage caused by smoke inhalation is characterized by:
1) upper airway edema
2) symptoms of CO intoxication
3) respiratory distress may develop after two days
4) immediate respiratory arrest
5) high temperature is the sole cause of symptoms
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Smoke inhalation is characterized by edema of the respiratory tract (including the upper respiratory tract) and symptoms caused by intoxication caused by substances in the smoke. Respiratory dysfunction may develop up to 2 days after the exposure, but this is no longer primarily a causal effect of the main gas exchange inhibiting component (CO) of smoke, since CO cannot be detected in the blood 8 hours after exposure. Immediate respiratory arrest is not a feature; many chemical and physical factors (eg. heat) in smoke are responsible for the symptoms.

81
Q

INT - 4.88
Foreign body aspiration:
1) even the suspicion is a bronchoscopic indication
2) more common in childhood
3) can cause endobronchial granulation
4) requires preventive antibiotic treatment
5) can be excluded by chest CT scan
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Foreign body aspiration, which is more common in children than in adults, is a bronchoscopic indication even when it is just suspected. Failure to diagnose or remove the foreign body in time can result in endobronchial granulation. Detection and removal can be done with a bronchoscope. With chest CT it is not always detectable.

82
Q

INT - 4.89
The partial manifestation of Löfgren’s syndrome may be:
1) bilateral hilar lympadenopathy
2) erythema nodosum
3) polyarthralgia
4) pulmonary infiltrate
5) pleural effusion
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Pulmonary infiltrate and pleural effusion are not part of Löfgren’s syndrome.

83
Q

INT - 4.90
Which of the following can be associated with lung cancer?

1) hypercalcaemia
2) gynaecomastia
3) drumstick fingers
4) Cushing’s syndrome
5) Leukemia-like reaction
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
F) all of the answers are correct

EXPLANATION
In lung cancer, any of these symptoms (including Cushing’s syndrome) can occur.

84
Q

INT - 4.91
Can cause lung fibrosis:
1) amiodarone
2) bleomycin
3) nitrofurantoin
4) atrovent
5) Colchicin
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Atrovent and colchicine do not cause pulmonary fibrosis, unlike amiodorone, bleomycin or nitrofurantoin.

85
Q

INT - 4.92
Which of the following is true about sarcoidosis?
1) histologically epitheloid granuloma
2) hypergammaglobulinaemia is common in the active form
3) hilar lymphadenopathy is not always bilateral
4) shows no spontaneous regression
5) tuberculin test is mostly positive
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
Spontaneous regression in sarcoidosis is common and tuberculin test is mostly negative. Hilar lymphadenopathy can be unilateral in about 5-10% of cases. In its active form, hypergammaglobulinaemia occurs often with elevated β-macroglobulin levels. However, testing for these has not become a part of routine diagnosis of the disease. Pathologically, the disease is characterized by formation of epitheloid cellular granuloma, without caseous necrosis.

86
Q

INT - 4.93
Functionally inoperable lung cancer is indicated by:
1) FEV1 <1 l
2) PaO2 <55 Hgmm
3) severe pulmonary hypertension
4) reduced CO-transfer coefficient
5) Increased TLC (total lung capacity)
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) only the 4. answer is correct
F) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
If FEV1 is below 1 liter, not only pulmonectomy but also segmentectomy is not possible due to the high risk of postoperative mortality. The same applies to respiratory failure and severe pulmonary hypertension. Decreased CO-transfer coefficient and high TLC, which is characteristic of emphysema, are not a contraindication for surgical removal of the tumor. Volume reduction following resection may, in some cases, result in an increase in tension in the remaining lung sections (increase in elastic contractile force), which may reduce airway dynamic compression and thus improve the patient’s physical performance.

87
Q

INT - 4.94
An asthmatic attack is accompanied by a characteristic sound phenomenon, (wheezing). The cessation of the acoustic phenomenon (silent lungs) indicates that the obstruction has ceased.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
C) The first one is correct in itself, but the second one is incorrect

EXPLANATION
The cessation of wheezing during an asthmatic attack (silent lungs) always indicates very severe airway obstruction caused by severe inflammation and edema of the respiratory tract, and extensive obstruction of the small airways by mucus plugs.

88
Q

INT - 4.95
In case of suspected pulmonary embolism, pulmonary scintigraphy is recommended early because of its high information value and low radiation exposure.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
A) Both are correct, and there is a causal relationship between them

EXPLANATION
In case of suspected pulmonary embolism, the sooner the low-radiation lung scintigraphy is performed, the greater its information value.

89
Q

INT - 4.96
Transthoracic fine needle biopsy is more efficient than bronchoscopy when diagnosing a peripheral pulmonary nodule, because the lesion is in the area of the bronchioles which can not be examined with bronchoscopy.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
A) Both are correct, and there is a causal relationship between them

EXPLANATION
When diagnosing a peripheral nodule bronchoscopy and transbronchial biopsy is less efficient than transthoracic fine needle biopsy. The area of the bronchioles can not be examined with bronchoscopy.

90
Q

INT - 4.97
Arterialized capillary blood (from earlobe or fingertip) should be used for blood gas analysis when the patient is in shock, because arterial blood sample would show incorrect results due to the failure of circulation.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
E) Both are incorrect

EXPLANATION
In shock arterialized blood from earlobe or fingertip would significantly undervalue PaO2, thus it is unreliable. Instead of it arterial blood (e.g. drawn from a. radialis) should be used for blood gas analysis.

91
Q

INT - 4.98
Acute severe asthma is an asthmatic state resistant to usual bronchodilator therapies, thus it always needs to be treated with mechanical ventilation.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
C) The first one is correct in itself, but the second one is incorrect

EXPLANATION
The definition is correct, however the patient in severe acute asthma (status asthmaticus) only needs mechanical ventilation when the following criteria are met: - the patient has severe respiratory insufficiency, that does not improve to further therapy than usual bronchodilators - e.g. high dose intravenous corticosteroids, - the patient’s respiratory muscles show signs of fatigue - hypoxaemia is not improving despite oxygen-therapy, hypercapnia is worsening. 90% of the acute severe asthma cases can be managed without ventilation therapy.

92
Q

INT - 4.99
Community-acquired pneumonia is usually caused by atypical pathogens, therefore in most cases community-acquired pneumonia should be treated with amoxicillin.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
D) The first one is incorrect, the second one is correct in itself

EXPLANATION
The explanation itself is true, because amoxicillin is effective against the most common bacteria causing community-acquired pneumonia (CAP). Although pneumonia caused by atypical pathogens is becoming more and more frequent, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the most common bacteria in CAP.

93
Q

INT - 4.100
A hyperergic reaction to the tuberculin test proves active tuberculosis, because there is a strong correlation between the size of the induration and the activity and extension of the disease.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
E) Both are incorrect

EXPLANATION
Hyperergic reaction to tuberculin test can mean previous (already healed) tuberculosis, because the reaction is based on the immunity against mycobacteria. The size of the reaction does not correlate neither with the activity, nor the extension of the disease

94
Q

INT - 4.101
In pulmonary hypertension the pulmonary systolic blood pressure is above 30 mmHg, because the hypoxaemic pulmonary vasoconstriction causes an elevated pulmonary vascular resistance.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
B) Both are correct but there is no causal relationship between them

EXPLANATION
Alveolar hypoxaemia triggers pulmonary vasoconstriction, which elevates the pulmonary vascular resistance. If the pressure in the pulmonary artery exceeds 30 mmHg, there is pulmonary hypertension. There is no causality between the two statements because not only alveolar hypoxaemia can cause pulmonary hypertension (e.g. primary pulmonary hypertension), and hypoxaemia that is present for only a short amount of time does not necessarily cause pulmonary pressure above 30 mmHg.

95
Q

INT - 4.102
In type II respiratory failure there is often an urgent need for endotracheal intubation and mechanical ventilation, because the severe hypoxaemia can cause brain damage.

A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
B) Both are correct but there is no causal relationship between them

EXPLANATION
Both statements are true, but there is no causality because hypoxaemia can be managed with oxygen therapy, although in that case PCO2 level can rise. The indication for mechanical ventilation in type II respiratory insufficiency is primarily the CO2 retention. To reduce the hypercapnia intubation is not always needed.

96
Q

INT - 4.103
Hypercapnia seldom occurs in chronic respiratory failure, because compensatory mechanisms can get on due to slow progression.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
D) The first one is incorrect, the second one is correct in itself

EXPLANATION
Chronic respiratory insufficiency is often type II, especially in COPD. Due to the slow progression of the disease there is time for compensatory mechanisms to evolve, thus pH can be within normal range despite the hypercapnia. First part is incorrect, second part is true.

97
Q

INT - 4.104
Elevated tumor marker readings (higher CEA-, TPA levels) are diagnostic for lung cancer without any radiological findings, because they are very specific parameters.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
E) Both are incorrect

EXPLANATION
Tumor markers can show an elevated level in other diseases as well, they are neither specific, nor diagnostic.

98
Q

INT - 4.105
Heavy smoking causes chronic bronchitis, therefore older patients with chronic bronchitis are expected to have occult lung cancer.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
C) The first one is correct in itself, but the second one is incorrect

EXPLANATION
Smoking does cause chronic bronchitis, but only a subset of smokers will have lung cancer.

99
Q

INT - 4.106
SCLC (small cell lung cancer) is not treated, because there is no treatment option that could improve the overall survival of the patient.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
E) Both are incorrect

EXPLANATION
SCLC (small cell lung cancer) is treated in any case, because the combination therapy can improve quality of life and overall survival.

100
Q

INT - 4.107
If a patient presents with haemoptysis, but the summation chest X ray is negative, lung cancer is excluded, although haemoptysis can be a sign of lung cancer.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
D) The first one is incorrect, the second one is correct in itself

EXPLANATION
Haemoptysis is a common symptom in lung cancer. A negative X-ray does not exclude the presence of lung cancer. In case of haemoptysis, bronchoscopy is mandatory. In case bronchoscopy is negative, a CT scan is needed.

101
Q

INT - 4.108
48-year-old woman had an operation due to breast cancer 3 years ago, followed by radiotherapy. Her novum pleural effusion might be related to the previous breast cancer.
A) Both are correct, and there is a causal relationship between them
B) Both are correct but there is no causal relationship between them
C) The first one is correct in itself, but the second one is incorrect
D) The first one is incorrect, the second one is correct in itself
E) Both are incorrect

A

ANSWER
A) Both are correct, and there is a causal relationship between them

EXPLANATION
Pleuritis carcinomatosa can occur in patients years after operation of breast cancer, even without a visible local recurrance.

102
Q

INT - 4.109
Which of the following examinations are needed for the diagnosis?
A 37-year-old man presents with symptoms that have persisted for 3 weeks: sore throat, muscle pain, headache, photophobia, severe nonproductive cough, fatigue, loss of apetite, fever. He has a history of spontaneous pneumothorax, recent overseas-travel, 20 years of massive smoking. 3 days ago the same signs and sypmtoms have occured in two of his family members.
1) complete blood count and blood chemistry
2) serologic tests for antibodies
3) ECG
4) chest X-ray
5) bronchoscopy
6) ophthalmic examination
7) echocardiography
A) only the 1., 3. and 5. answers are correct
B) only the 2. and 4. answers are correct
C) only the 5. and 6. answers are correct
D) only the 3., 4. and 7. answers are correct
E) all of the answers are correct

A

ANSWER
B) only the 2. and 4. answers are correct

EXPLANATION
Chest X-ray is indicated in case of long-lasting (e.g. 3 weeks) non-productive cough and fever. Family members presenting the same symptoms implies the probability of infection even without a chest X-ray. In case the possibility of tuberculosis emerges, radiomorphology and lesions in the sites of predilection should be considered. However, it is not likely that more family members get infected by Mycobacterium at the same time. The radiological manifestations of invasive aspergillosis may be similar to that seen in atypical pneumonia, however tha fact that this is a relatively rare disease with low infectious rate and most cases occur in people with severely compromised immune systems, it is very unlikely to be present in 3 people at the same time. When the symptoms and radiological findings imply the presence of atypicial pneumonia, serological tests can confirm the diagnosis, and the infection can be treated with antibiotics of proper spectrum.

103
Q

INT - 4.110
What is the probable diagnosis?
A 37-year-old man presents with symptoms that have persisted for 3 weeks: sore throat, muscle pain, headache, photophobia, severe nonproductive cough, fatigue, loss of apetite, fever. He has a history of spontaneous pneumothorax, recent overseas-travel, 20 years of massive smoking. 3 days ago the same signs and sypmtoms have occured in two of his family members.
A) tuberculosis
B) aspergillosis
C) myocarditis
D) atypical pneumonia
E) bronchogenic carcinoma

A

ANSWER
D) atypical pneumonia

EXPLANATION
Chest X-ray is indicated in case of long-lasting (e.g. 3 weeks) non-productive cough and fever. Family members presenting the same symptoms implies the probability of infection even without a chest X-ray. In case the possibility of tuberculosis emerges, radiomorphology and lesions in the sites of predilection should be considered. However, it is not likely that more family members get infected by Mycobacterium at the same time. The radiological manifestations of invasive aspergillosis may be similar to that seen in atypical pneumonia, however tha fact that this is a relatively rare disease with low infectious rate and most cases occur in people with severely compromised immune systems, it is very unlikely to be present in 3 people at the same time. When the symptoms and radiological findings imply the presence of atypicial pneumonia, serological tests can confirm the diagnosis, and the infection can be treated with antibiotics of proper spectrum.

104
Q

INT - 4.111
In case of the right diagnosis which is the recommended therapy?
A 37-year-old man presents with symptoms that have persisted for 3 weeks: sore throat, muscle pain, headache, photophobia, severe nonproductive cough, fatigue, loss of apetite, fever. He has a history of spontaneous pneumothorax, recent overseas-travel, 20 years of massive smoking. 3 days ago the same signs and sypmtoms have occured in two of his family members.
A) chemotherapy
B) antibiotic therapy
C) antifungal therapy
D) immunosuppressive therapy
E) lobectomy

A

ANSWER
B) antibiotic therapy

EXPLANATION
Chest X-ray is indicated in case of long-lasting (e.g. 3 weeks) non-productive cough and fever. Family members presenting the same symptoms implies the probability of infection even without a chest X-ray. In case the possibility of tuberculosis emerges, radiomorphology and lesions in the sites of predilection should be considered. However, it is not likely that more family members get infected by Mycobacterium at the same time. The radiological manifestations of invasive aspergillosis may be similar to that seen in atypical pneumonia, however tha fact that this is a relatively rare disease with low infectious rate and most cases occur in people with severely compromised immune systems, it is very unlikely to be present in 3 people at the same time. When the symptoms and radiological findings imply the presence of atypicial pneumonia, serological tests can confirm the diagnosis, and the infection can be treated with antibiotics of proper spectrum.

105
Q

INT - 4.112
What is the probable diagnosis?
A man with no history of serious illness presents with a trauma-induced pulmonary haematoma that has been unable to resolve for months. Despite taking several cycles of targeted antibiotics, he still has excessive sputum, tomography shows a soft tissue mass located in a surrounding cavity and the sputum test confirmed the presence of Aspergillus fumigatus repeatedly.
A) aspergilloma
B) allergic bronchopulmonalis aspergillosis
C) invasive aspergillosis
D) bronchiectasis due to Aspergillus-bronchitis
E) allergic alveolitis

A

ANSWER
A) aspergilloma

EXPLANATION
Aspergillus fumigatus tends to colonize the surface of preformed lung cavities (e.g. an empty cyst, a ’healed’ tuberculous cavern, cavity of a haematoma) and grows freely within the cavity. It tipically appears as an intracavitary mass outlined by a crescent of air on chest X-ray. This lesion is called an aspergilloma. Diagnosis relies on radiographic findings, the presence of Aspergillus fumigatus in sputum, tomography and positive serum Aspergillus antibody. The gold standard of therapy is surgical removal of the aspergilloma.

106
Q

INT - 4.113
Diagnostic methods:
A man with no history of serious illness presents with a trauma-induced pulmonary haematoma that has been unable to resolve for months. Despite taking several cycles of targeted antibiotics, he still has excessive sputum, tomography shows a soft tissue mass located in a surrounding cavity and the sputum test confirmed the presence of Aspergillus fumigatus repeatedly.
1) tomography
2) lung scintigraphy
3) determine serum Aspergillus-antibody
4) determine DCO
5) repeated sputum cytology
6) blood gas test
7) examine bronchial offspring using Bactec method
A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Aspergillus fumigatus tends to colonize the surface of preformed lung cavities (e.g. an empty cyst, a ’healed’ tuberculous cavern, cavity of a haematoma) and grows freely within the cavity. It tipically appears as an intracavitary mass outlined by a crescent of air on chest X-ray. This lesion is called an aspergilloma. Diagnosis relies on radiographic findings, the presence of Aspergillus fumigatus in sputum, tomography and positive serum Aspergillus antibody. The gold standard of therapy is surgical removal of the aspergilloma

107
Q

INT - 4.114
Which one is the ideal therapy?
A man with no history of serious illness presents with a trauma-induced pulmonary haematoma that has been unable to resolve for months. Despite taking several cycles of targeted antibiotics, he still has excessive sputum, tomography shows a soft tissue mass located in a surrounding cavity and the sputum test confirmed the presence of Aspergillus fumigatus repeatedly.
A) cavernostomy
B) pleurodesis
C) bronchoplasty
D) pulmonary resection
E) permanent chest drain

A

ANSWER
D) pulmonary resection

EXPLANATION
Aspergillus fumigatus tends to colonize the surface of preformed lung cavities (e.g. an empty cyst, a ’healed’ tuberculous cavern, cavity of a haematoma) and grows freely within the cavity. It tipically appears as an intracavitary mass outlined by a crescent of air on chest X-ray. This lesion is called an aspergilloma. Diagnosis relies on radiographic findings, the presence of Aspergillus fumigatus in sputum, tomography and positive serum Aspergillus antibody. The gold standard of therapy is surgical removal of the aspergilloma

108
Q

INT - 4.115
Which examinations are mandatory for the diagnosis?
A 56-year-old man with no previous history of serious illness presents with progressive shortness of breath on exertion, that has persisted for 6 weeks. In addition, he has been experiencing non productive cough, but he has no fever. With physical examination mild cyanosis of the lips and extremities can be spotted and auscultation of the lungs shows late inspiratory crepitation at the bases of both lungs. No other diversion can be observed. Spirometry findings show reduced static lung volumes with normal airway resistance. Diffusion capacity is decreased. Immunological tests are negative.
1) electron microscopic analysis of the bronchoalveolar lavage fluid
2) CD4/CD8 ratio of peripheral blood
3) measuring the level of SACE (serum angiotensin-converting enzyme)
4) chest X-ray
5) ANCA (antineutrophil cytoplasmic-antibody) test
6) histologic examination of bioptatum
7) HRCT (high resolution computed tomography)
A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
B) only the 4., 6. and 7. answers are correct

EXPLANATION
Chest X-ray is indicated since the patient is cyanotic, has a restrictive ventilatory defect, decrease in diffusion capacity (DLCO) and respiratory symptoms. A simple posteroanterior chest X-ray can be informative, even in early stages of diffuse interstial lung disease, which can be confirmed with HRCT imaging. The diagnosis is verified by histology of a bioptatum. Regarding the possible answers of sub-question B, silicosis and asbestosis are incorrect, given that the case report mentions rapid progression. The same stands for Boeck sarcoidosis, since it does not show such rapid progression, even with concomittant bronchopneumonia. Though the chest X-ray can be similar to that seen in interstitial lung disease. Which makes the diagnosis unlikely is that the patient does not have fever in this specific case. In conclusion, the most possible diagnosis, even without histology, is fibrosing alveolitis, which can be treated by corticosteroids and immunosupressive therapy after histological verification.

109
Q

INT - 4.118
The most subservient diagnostics needed in this case:
A 24-year-old doctor developed a febrile condition and a chest fluid accumulation on the right side. No bacteria were grown from the serous chest fluid and the sediment contained mainly lymphocites.
1) Mycobacterial culture from the pleural fluid
2) Pleural needle biopsy
3) Mantoux test
4) Hemoculture
5) SACE
6) ANA
7) Transbronchial biopsy
A) only the 1., 6. and 7. answers are correct
B) only the 4., 5. and 6. answers are correct
C) only the 1., 2. and 3. answers are correct
D) only the 5. and 7. answers are correct
E) only the 2. and 6. answers are correct

A

ANSWER
C) only the 1., 2. and 3. answers are correct

EXPLANATION
In today’s TB epidemiological situation in Hungary tuberculous pleuritis exsudativa is frequent again. Often it appears without any visible pulmonary tuberculous infiltration. To confirm the diagnosis mycobacterial culture from the pleural fluid (lately PCR analysis can give results in 24 hours), pleural needle biopsy can be the primary proof. Mantoux test in such cases is usually highly hiperreactive. Dominance of lymphocytes in the pleural fluid is also an evidence of tuberculotic pleuritis. It can be treated with a combination of antituberculotic drugs, to which adding low dose steroid is recommended to avoid pleural scarring. Administering steroids without antituberculotics leads to rapid progression (“burst”) of the disease, which puts the patient’s life in great danger.

110
Q

INT - 4.119
What is the correct diagnosis?
A 24-year-old doctor developed a febrile condition and a chest fluid accumulation on the right side. No bacteria were grown from the serous chest fluid and the sediment contained mainly lymphocites.
A) Parapneumonic pleuritis
B) Empyema thoracis
C) Hydrothorax
D) Pleuritis exsudativa tuberculosa
E) Pleurodynia

A

ANSWER
D) Pleuritis exsudativa tuberculosa

EXPLANATION
In today’s TB epidemiological situation in Hungary tuberculous pleuritis exsudativa is frequent again. Often it appears without any visible pulmonary tuberculous infiltration. To confirm the diagnosis mycobacterial culture from the pleural fluid (lately PCR analysis can give results in 24 hours), pleural needle biopsy can be the primary proof. Mantoux test in such cases is usually highly hiperreactive. Dominance of lymphocytes in the pleural fluid is also an evidence of tuberculotic pleuritis. It can be treated with a combination of antituberculotic drugs, to which adding low dose steroid is recommended to avoid pleural scarring. Administering steroids without antituberculotics leads to rapid progression (“burst”) of the disease, which puts the patient’s life in great danger.

111
Q

INT - 4.120
Suggested therapy:
A 24-year-old doctor developed a febrile condition and a chest fluid accumulation on the right side. No bacteria were grown from the serous chest fluid and the sediment contained mainly lymphocites.
A) Combination of antituberculotic drugs
B) Antibiotic treatment + steroid
C) Steroid treatment
D) Chest drainage
E) Irrigation and suction (aspiration) of the pleural space

A

ANSWER
A) Combination of antituberculotic drugs

EXPLANATION
In today’s TB epidemiological situation in Hungary tuberculous pleuritis exsudativa is frequent again. Often it appears without any visible pulmonary tuberculous infiltration. To confirm the diagnosis mycobacterial culture from the pleural fluid (lately PCR analysis can give results in 24 hours), pleural needle biopsy can be the primary proof. Mantoux test in such cases is usually highly hiperreactive. Dominance of lymphocytes in the pleural fluid is also an evidence of tuberculotic pleuritis. It can be treated with a combination of antituberculotic drugs, to which adding low dose steroid is recommended to avoid pleural scarring. Administering steroids without antituberculotics leads to rapid progression (“burst”) of the disease, which puts the patient’s life in great danger.

112
Q

INT - 4.121
Which of the following diagnostics are necessary in the case described above?
A 48-year-old female patient has been experiencing fever up to 39 °C in the past two weeks and itching of the skin. Her chest X-ray shows asymmetric tumescence of mediastinal lymph nodes.
1) Gastroscopy
2) Chest CT
3) Spirometry
4) Bronchoscopy
5) ECG
6) Mediastinoscopy
7) Haematological testing
A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
A) only the 2., 4., 6. and 7. answers are correct

EXPLANATION
The patient’s anamnesis and asymmetric tumescence of mediastinal lymph nodes on the chest x-ray indicate chest CT, bronchoscopy, haematological testing and mediastinoscopy. Histology of the lymph node sample acquired with mediastinoscopy leads to diagnosis. Before haematological testing and mediastinoscopy the probable diagnoses surely exclude COPD, asthma and pneumonia. All the other diseases show or can possibly show tumescence of mediastinal lymph nodes. Sarcoidosis can occur in the form of unilateral tumescence of mediastinal lymph nodes.

113
Q

INT - 4.122
Which of the followings are potential diagnoses?
A 48-year-old female patient has been experiencing fever up to 39 °C in the past two weeks and itching of the skin. Her chest X-ray shows asymmetric tumescence of mediastinal lymph nodes.
1) COPD
2) Sarcoidosis
3) Asthma
4) Lymphoma (non-Hodgkin)
5) Pneumonia
6) TB
7) Hodgkin lymphoma
A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
A) only the 2., 4., 6. and 7. answers are correct

EXPLANATION
The patient’s anamnesis and asymmetric tumescence of mediastinal lymph nodes on the chest x-ray indicate chest CT, bronchoscopy, haematological testing and mediastinoscopy. Histology of the lymph node sample acquired with mediastinoscopy leads to diagnosis. Before haematological testing and mediastinoscopy the probable diagnoses surely exclude COPD, asthma and pneumonia. All the other diseases show or can possibly show tumescence of mediastinal lymph nodes. Sarcoidosis can occur in the form of unilateral tumescence of mediastinal lymph nodes.

114
Q

INT - 4.123
Which of the following diagnostics would result in the exact diagnosis?
A 48-year-old female patient has been experiencing fever up to 39 °C in the past two weeks and itching of the skin. Her chest X-ray shows asymmetric tumescence of mediastinal lymph nodes.
A) Histology of the lymph node
B) Chest MRI
C) Sternal puncture
D) Haemogram

A

ANSWER
A) Histology of the lymph node

EXPLANATION
The patient’s anamnesis and asymmetric tumescence of mediastinal lymph nodes on the chest x-ray indicate chest CT, bronchoscopy, haematological testing and mediastinoscopy. Histology of the lymph node sample acquired with mediastinoscopy leads to diagnosis. Before haematological testing and mediastinoscopy the probable diagnoses surely exclude COPD, asthma and pneumonia. All the other diseases show or can possibly show tumescence of mediastinal lymph nodes. Sarcoidosis can occur in the form of unilateral tumescence of mediastinal lymph nodes.

115
Q

INT - 4.124
Which of the following diagnostics can have valuable results in the case described above?
A 35-year-old male patient treated at surgical unit because of acute pancreatitis. He experiences increasing dyspnoea. Physical examination shows severe dyspnoea, tachypnoea, cyanosis, paleness, sweating, tachycardia, hypotonia. ECG shows sinus tachycardia. Decrease in central venous pressure.
1) Serum and urine amylase
2) Chest X-ray
3) Haemogram
4) Perfusion scintigraphy of the lungs
5) Blood gas assessment
6) Echocardiography
7) SGOT, SGPT, LDH, CK
A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
D) only the 2. and 5. answers are correct

EXPLANATION
Progressive dyspnoea and cyanosis together are clear indications for a blood gas assessment and chest x-ray. Typical radiographic appearance and severe hypoxaemia confirm ARDS, which occurs often in patients with pancreatitis. In this case hypoxaemia cannot be managed by simple (nasal) oxygen therapy, only with increased FiO2 administered with mechanical ventilation. To avoid pulmonary oedema continuous positive airway pressure ventilation is needed.

116
Q

INT - 4.125
What is the probable diagnosis?
A 35-year-old male patient treated at surgical unit because of acute pancreatitis. He experiences increasing dyspnoea. Physical examination shows severe dyspnoea, tachypnoea, cyanosis, paleness, sweating, tachycardia, hypotonia. ECG shows sinus tachycardia. Decrease in central venous pressure.
A) Myocardial infarction
B) Pancreatic abscess
C) ARDS
D) Pulmonary embolism
E) Abdominal haemorrhage

A

ANSWER
C) ARDS

EXPLANATION
Progressive dyspnoea and cyanosis together are clear indications for a blood gas assessment and chest x-ray. Typical radiographic appearance and severe hypoxaemia confirm ARDS, which occurs often in patients with pancreatitis. In this case hypoxaemia cannot be managed by simple (nasal) oxygen therapy, only with increased FiO2 administered with mechanical ventilation. To avoid pulmonary oedema continuous positive airway pressure ventilation is needed.

117
Q

INT - 4.126
Which therapy is possibly the most effective in case of a correct diagnosis?
A 35-year-old male patient treated at surgical unit because of acute pancreatitis. He experiences increasing dyspnoea. Physical examination shows severe dyspnoea, tachypnoea, cyanosis, paleness, sweating, tachycardia, hypotonia. ECG shows sinus tachycardia. Decrease in central venous pressure.
A) Thrombolysis
B) Antibiotics
C) Parenteral nutrition
D) Continuous positive airway pressure ventilation
E) Transfusion

A

ANSWER
D) Continuous positive airway pressure ventilation

EXPLANATION
The coexistence of progressive suffocation and cyanosis is clearly an indication of blood gas test and chest x-ray. Typical x-ray result and severe hypoxemia confirms the diagnosis of ARDS, which is not rare together with the diagnosis of pancreatitis. Hypoxemia cannot be corrected by simple (nasal) O2 administration, only correctable with elevated FiO2 delivered by respiratory ventilation. Continuous positive pressure ventilation should be used to reduce the formation of pulmonary edema.

118
Q

INT - 4.127
Informative investigations:
After 2 weeks of respiration and tracheotomy due to a suicide experiment, a 44-year-old woman developed dyspnea and inspirational stridor 2 months later.
1) inspiratory lung function parameters
2) carbon monoxide diffusion capacity
3) bronchoscopy
4) echocardiography
5) compliance-testing
6) blood gas test
7) Pharmacospirometry

A) only the 2., 4., 6. and 7. answers are correct
B) only the 4., 6. and 7. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 5. answers are correct
E) all of the answers are correct

A

ANSWER
C) only the 1. and 3. answers are correct

EXPLANATION
Inspiratoric stridor is characterized by upper respiratory tract constriction - especially extrathoracic - which is well indicated by inspiratory lung function parameters. Clear evidence of stenosis, size and probable cause is provided by bronchoscopy (possibly laryngoscopy). In this case, the probable diagnosis is postintubatic tracheastenosis, with tracheal resection as a therapeutic option.

119
Q

INT - 4.128
Probable diagnosis:
After 2 weeks of respiration and tracheotomy due to a suicide experiment, a 44-year-old woman developed dyspnea and inspirational stridor 2 months later.
A) Trachea cylindrome
B) Postintubatic stenosis
C) Hustenstrang dyskinesis
D) Instability of trachea
E) Asthma bronchiale – intrinsic type

A

ANSWER
B) Postintubatic stenosis

EXPLANATION
Inspiratory stridor is characterized by upper respiratory tract constriction - especially extrathoracic - which is well indicated by inspiratory lung function parameters. Clear evidence of stenosis, size and probable cause is provided by bronchoscopy (possibly laryngoscopy). In this case, the probable diagnosis is stenosis after intubation, with tracheal resection as a therapeutic option.

120
Q

INT - 4.129
Theoretical therapeutic options:
After 2 weeks of respiration and tracheotomy due to a suicide experiment, a 44-year-old woman developed dyspnea and inspirational stridor 2 months later.
A) Afterloading
B) Inhalational steroid
C) Trachea resection
D) Chemotherapy
E) Conicotomy

A

ANSWER
C) Trachea resection

EXPLANATION
Inspiratory stridor is characterized by upper respiratory tract constriction - especially extrathoracic - which is well indicated by inspiratory lung function parameters. Clear evidence of stenosis, size and probable cause is provided by bronchoscopy (possibly laryngoscopy). In this case, the probable diagnosis is stenosis after intubation, with tracheal resection as a therapeutic option.

121
Q

INT - 4.130
Which of the following is the correct acid-base imbalance in this case?
A 58-year-old man with known chronic obstructive pulmonary disease and diabetes mellitus has been urgently hospitalized for high fever, cough with massive purulent sputum, dyspnoea and cyanosis. Arterial blood gas result parameters: pO2: 51 Hgmm pCO2: 54 Hgmm pH: 7,26 St. HCO3: 32 mmol/l
A) metabolic acidosis
B) metabolic alkalosis
C) respiratoric acidosis
D) respiratoric alkalosis
E) respiratoric acidosis with renal compensation

A

ANSWER
C) respiratoric acidosis

EXPLANATION
In COPD, with high pCO2 levels, low pH and elevated st. bicarbonate indicates respiratory acidosis. If the O2 therapy - to achieve sufficient arterial O2 tension - significantly increases pCO2 tension, then mechanical ventilation or respiratory therapy is required.

122
Q

INT - 4.131
Underlying diseases are being treated and the patient is also having oxygen therapy receiving 3 liters of O2 per minute through a nasal tube. The result of the repeated blood gas test after 24 hours:
pCO2: 76 Hgmm
pO2: 65 Hgmm
pH: 7,22
St. HCO3: 35 mmol/l
Which of the following therapies do you choose for treatment?
A 58-year-old man with known chronic obstructive pulmonary disease and diabetes mellitus has been urgently hospitalized for high fever, cough with massive purulent sputum, dyspnoea and cyanosis. Arterial blood gas result parameters: pO2: 51 Hgmm pCO2: 54 Hgmm pH: 7,26 St. HCO3: 32 mmol/l

A) Increases the amount of oxygen delivered through the nasal probe
B) Reduce the amount of oxygen delivered through the nose probe
C) Mechanical ventilation, respirator treatment
D) Provide 100% oxygen inhalation
E) Use bicarbonate infusion

A

ANSWER
C) Mechanical ventilation, respirator treatment

EXPLANATION
In COPD, with high pCO2 levels, low pH and elevated st. bicarbonate indicates respiratory acidosis. If the O2 therapy to achieve sufficient arterial O2 tension significantly increases pCO2 tension, then mechanical ventilation or respiratory therapy is required

123
Q

INT - 4.132
Choose from among the examination procedures below those which may be diagnostic of the suspected diagnosis(es).
A 27-year-old female has persistent colds, mainly from spring to autumn. Occasionally, especially at dawn, she wakes up coughing and feels pressure in her chest. These symptoms disappears when she “coughs up”. Sometimes she hears squeezing in her chest while she is cleaning.
1) Skin test
2) Serum-IgE-testing
3) Bronchoscopy
4) Multi-day PEF monitoring
5) Chest x-ray
6) Sputum bacteriology test
7) KCI inhalation provocation test
8) Specific inhalation provocation test
A) only the 1., 2., 4. and 7. answers are correct
B) only the 2., 3., 5. and 7. answers are correct
C) only the 4., 6., 7. and 8. answers are correct
D) all of the answers are correct
E) none of the answers are correct

A

ANSWER
A) only the 1., 2., 4. and 7. answers are correct

EXPLANATION
The history of the young patient clearly shows possibility of allergic rhinitis and bronchial asthma. To verify or exclude the diagnosis, it is recommended to perform an allergy test using a cutan test, a serum IgE test, PEF monitoring to detect significant fluctuations in airway caliber in asthma bronchiale. If PEF monitoring shows negative result, an inhalation provocation test is recommended with inhalating hypertonic KCl in the asymptomatic state. If the provocation test shows positive result, asthma bronchiale is likely verified. If the provocation test is negative, diagnosis of asthma bronchiale is excluded. For allergic rhinitis, oral antihistamines can be used or local Na-cromoglycate may be given locally (nasally), or inhaled steroid can be used. Depending on the severity of the patient’s asthma bronchiale - in our case a mild intermittent asthma (stage 2) - oral inhaled steroid or Na-chromoglycate are the best choice among the drugs listed. (Other alternatives that are not listed here are also possible.) Cough suppressants are prohibited in asthma bronchiale and digoxin is not a remedy for asthma bronchiale.

124
Q

INT - 4.133
Which of the following would you give to the patient to prevent or control her symptoms?
A 27-year-old female has persistent colds, mainly from spring to autumn. Occasionally, especially at dawn, she wakes up coughing and feels pressure in her chest. These symptoms disappears when she “coughs up”. Sometimes she hears squeezing in her chest while she is cleaning.
1) Inhaled (local) steroid
2) Oral antihistamin
3) Na-cromoglycat
4) Cough suppressant
5) Digoxin
A) only the 1., 2. and 3. answers are correct
B) only the 1., 2., 4. and 5. answers are correct
C) only the 1. and 3. answers are correct
D) only the 2. and 4. answers are correct
E) all of the answers are correct

A

ANSWER
A) only the 1., 2. and 3. answers are correct

EXPLANATION
The history of the young patient clearly shows possibility of allergic rhinitis and bronchial asthma. To verify or exclude this, it is recommended to perform an allergy test using a cutan test, a serum IgE test, PEF monitoring to detect significant fluctuations in airway caliber in asthma. If PEF monitoring shows negative result, an inhalation provocation test is recommended with hypertonic KCl in the asymptomatic state. If the provocation test shows positive result, astha is likely verified. If the provocation test is negative, diagnosis of asthma bronchiale is excluded. For allergic rhinitis, oral antihistamines can be used or local Na-cromoglycate may be given locally (nasally), or inhaled steroid can be used. Depending on the severity of the patient’s asthma - in our case a mild intermittent asthma (stage 2) - oral inhaled steroid or Na-chromoglycate are the best choice among the drugs listed. (Other alternatives that are not listed here are also possible.) Cough suppressants are prohibited in asthma bronchiale and digoxin is not a remedy for asthma bronchiale.