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Flashcards in Samplex 2015 Set A Deck (56)
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A 35/F presented with generalized body weakness. Laboratory tests revealed unremarkable result except for the chest radiograph which revealed widening of the mediastinum. Chest CT scan was done and showed a large anterior mediastinal mass. a CT scan-guided biopsy was done. Give the pathologic diagnosis.

A. Teratoma
B. Lymphoma
C. Thymoma
D. None of the above



The most common source of pulmonary emboli is:
A. Thrombi in the superficial veins of the leg
B. Thrombi in the deep veins of the leg
C. Thrombi in the right atrium
D. Thrombi in the left atrium



Which of the following statements regarding IPF is correct?

A. A restrictive pattern on lung function distinguishes it from other IIPs
B. Bibasilar inspiratory crackles on auscultation are uncommon
C. The insidious onset of symptoms differentiates it from other types of IIPs
D. The 5-year mortality rate is 80%



A typical lung function finding in IPF is:

A. An elevated residual volume
B. A decreased FEV1/FVC
C. A reduced TLC
D. An increased DLco



The parameter(s) that is/are useful in monitoring response to therapy is/are:

A. Chest x-rays
B. Forced vital capacity
C. HRCT scan
D. Oxygen saturation



The histologic manifestation of acute interstitial pneumonia (AIP) is:

A. Mild interstitial chronic inflammation
B. Diffuse alveolar damage
C. Lymphoid hyperplasia
D. Bronchiolocentric alveolar macrophage accumulation



Among the IIPs, the one with the best prognosis is:
A. Idiopathic pulmonary fibrosis
B. Non-specific interstitial pneumonia
C. Respiratory-bronchiolitis ILD
D. Lymphocytic interstitial pneumonia



Which of the following is considered a major criterion to make a diagnosis of IPF in the absence of surgical biopsy?

A. Restrictive pattern on lung function
B. 6th to 7th decade of life
C. Symptom duration > 6 months
D. Bibasilar inspiratory crackles



The typical clinical course of IPF is:

A. Slow and linear decline in lung function
B. Stable with periods of acute worsening
C. Rapidly progressive
D. Gradual spontaneous recovery



The gold standard in the diagnosis of idiopathic pulmonary fibrosis is:

A. Open lung biopsy
B. Chest CT scan
C. Bronchoalveolar lavage
D. Spirometry
E. Pulmonary angiography



Which environmental/occupational lung disease increases the risk for acquiring both Mycobacterium tuberculosis and atypical mycobacterium infections?

A. Asbestosis
B. Coal worker’s pneumonia
C. Silicosis
D. Caplan’s syndrome
E. Berrylliosis



Which of the following occupational lung diseases is associated with lung cancer?

A. Silicosis
B. Asbestosis
C. Berylliosis
D. Coal worker’s pneumoconiosis
E. Byssinosis



This condition results from exposure to moldy hay containing spores of thermophilic actinomycetes that produce a hypersensitivity pneumonitis:

A. Coal worker’s pneumoconiosis
B. Byssinosis
C. Farmer’s lung
D. Berylliosis
E. Caplan’s syndrome



The presence of asbestos bodies in respiratory secretions

A. Indicated previous asbestos exposure
B. Is an early marker for asbestosis
C. Is associated with an increased risk of lung cancer
D. Is associated with the development of mesothelioma, especially in the presence of pleural plaques
E. May only be an incidental finding and is of no clinical relevance



The following inorganic dusts are known to cause occupation exposure related to ILD’s EXCEPT:

A. Coal dust (coal worker’s pneumoconiosis)
B. Beryllium (berylliosis)
C. Thermophilic actinomycetes (farmer’s lung)
D. Iron (arc welder’s lung)
E. None of the above



Which of the following is/are true regarding radiographic lesions of occupational lung diseases?

A. Small rounded opacities are seen in silicosis
B. Linear opacities are seen in coal worker’s pneumoconiosis
C. Small rounded opacities are also seen in coal worker’s pneumoconiosis
D. Only B and C are true



Which of the following is NOT true regarding asbestos-related diseases

A. Asbestos is a generic term for several different mineral silicates, including chrysalite, amosite, anthophyllite, and crocidolite
B. Exposure to asbestos is limited to persons who directly handle the material
C. Asbestosis is a diffuse interstitial fibrosing disease of the lung that is directly related to the intensity and duration of exposure
D. Physiologic studies reveal a restrictive pattern with a decrease in both lung volumes and diffusion capacity; there may also be evidence of mild airflow obstruction (due to peribronchiolar fibrosis)



Which of the following occupational exposures is not correctly matched to the nature of respiratory responses?

A. Asbestos – lung adenocarcinoma
B. Silica – fibrosis
C. Cotton dust – byssinosis
D. Agricultural dust – hypersensititivty pneumonitis



In acute hypercapnic respiratory failure as in narcotic overdose, the alveolar-arterial gradient is:

A. Less than 20
B. Greater than 30
C. The A-a gradient cannot be determined
D. None of the above



Snoring is a most common observed event in:

A. Central sleep apnea
B. Cheyne-Stokes respiration
C. Obesity hypoventilation syndrome
D. Obstructive sleep apnea



In patients with ARDS, the PO2/FiO2 ratio is:

A. Greater than 500
B. Less than 200
C. Greater than 200 but less than 500
D. It cannot be calculated



One can deliver 100% FiO2 to a patient on:

A. Venture mask
B. Partial rebreathing mask
C. Non-rebreathing mask with bag reservoir
D. Mechanical ventilator



The only intervention which has significantly improved outcomes in ARDS (aside from treating the underlying cause) is to:

A. Give IV steroids within the first 48 hours
B. Hydrate with high amounts of fluid to keep the patient on the :wet” side
C. Give anti-tumor necrosis factor to dampen the inflammatory response
D. Ventilate with low tidal volumes to avoid overstretching the lungs



Which of the following is/are indications for mechanical ventilation?

A. Presence of apnea
B. Respiratory failure responsive to oxygen support via re-breather mask
C. PCO2 of 50



Which of the following statements is/are TRUE?

A. During normal breathing, the airway is open and air flows freely to the lungs
B. In obstructive sleep apnea, there is airway collapse during sleep, blocking airflow
C. Clinical manifestations of OSA include snoring and daytime somnolence
D. All of the above



Which of the following is the GOLD STANDARD in the diagnosis of OSA?

A. Pulse oximetry
C. Nocturnal polysomnogram
D. Holter monitoring



Which of the following is TRUE regarding respiratory distress in neonates?

A. A neonate with a respiratory rate of 50-55 breaths/min is considered tachypneic
B. Respiratory distress in a neonate may be present with or without cyanosis
C. Cyanosis is always present with or without respiratory distress in the newborn
D. Cyanosis without tachypnea is still respiratory distress



Chemoreceptors detect metabolic needs and feed it back to the respiratory center. Which of the following is NOT TRUE about chemoreceptors?

A. Medullary chemoreceptors are peripheral chemoreceptors which are indirectly stimulated bu PCO2, pH
B. Aortic and carotid bodies are central chemoreceptors
C. Aortic chemoreceptors mainly detect changes in PaO2, but to a lesser extent, PCO2 and pH
D. J-receptors are chemoreceptors that also act as sensors of thoracic expansion and alveolar respiration



Which of the following non-pulmonary causes of respiratory distress causes increased blood flow to the pulmonary system?

A. VSD with left-to-right shunting
B. Subarachnoid hemorrhage
C. Total anomnalous pulmonary venous drainage
D. AV malformation



Which of the following is NOT TRUE about metabolic acidosis as a cause of respiratory distress in neonates?

A. A compensatory mechanism of the newborn
B. Sequelae of tachypnea
C. Can also be due to mild perinatal hypoxic depression, delayed transition, or other metabolic disorders (i.e. congenital lactic acidosis, organic acidurias)
D. The fastest way to correct acidosis is to induce alkalosis by slow, deep breathing