Respiratory

Year 4
1) All of the followings are useful for the assessment of the
severity of patients with bronchial asthma except :
a- Spirometry .
b- Methacholine tests
c- ABG (arterial blood gases)
d- Peak expiratory flow rate for variability.
e- Physical examination .

2) Which one of the following pulmonary function values

indicates airflow limitation .
a-FEV1 of 60% of predicted .
b-FVC of 60% of predicted .
c-FEV1/FVC of 60% of predicted .
d-DLCO of 60% of predicted .
e- Residual volume of 60% of predicted .

3) All of the followings can be used as a challenge tests for

patients with bronchial asthma except ;
a-Methacholine .
b-Histamine .
c-Normal saline .
d-Excersise .
e-Hypertonic saline .

4) Lung’s failure type respiratory failure is characterized

by which one o the followings :
a-Normal chest X ray .
b-Hypocapnia or normocapnia .
c-Diffusion is the main mechanism of hypoxia .
d- Easy to correct hypoxia .
e- PEEP is contraindicated .
5) All of the following conditions typically can cause pump
failure’s type respiratory failure except :
a-Myasthenia gravis .
b-Multiple rib fractures .
c-Bronchiolitis obliterans .
 d-Severe chest pain .
e-Gullien-Barrie syndrome
6- Wide alveolar-arterial Po2 (PA-a O2) gradient can be
increased in all of the following conditions except :
a-Morphine over dose .
b-Severe pneumonia .
c-Acute Bronchial Asthma .
d-Acute Pulmonary edema .
e-ARDS (acute respiratory distress syndrome) .

7)Atopic bronchial asthma is characterized by all of the

followings except :
a-Positive family history .
b-Positive immediate reaction to skin prik test to
allergiens.
c-Elevated Ig E level .
d-Affects patients after age of 40 y.
e-Elevated serum eosinophills .

8) – All of the followings are true regarding home

monitoring with the PEFR except
a-Usefull in diagnosing asthma
b- Usefull in Identifying environmental triggers of asthma
c- Can detect early signs of deterioration before symptoms change.
d-Long term monitoring is useful for severe brittle asthma .
e- It is less effort dependent than spirometry .

9) The treatment of Bronchial asthma by Anti-inflammatory

agents may cause all of the following except:
a-It reduces symptoms .
b-It improves lung function .
C-It decreases BHR (bronchial hyper reactivity).
d-It improves quality of life
e-It may cure the patient from the disease .
10 )Treatment of bronchial asthma by Leukotriene
pathway modifiers is more effective in which of the
following conditions ?
a- aspirin and exercise induced asthma .
b-Cough variant asthma .
c-Old age asthmatics .
d- Nocturnal asthma
 e-Female asthmatics.

11)The main mechanism of dyspnea is

a) Hypercapnia.
b) alkalosis.
c) Increased work of breathing.
d) Increased deoxygenated Hb .
e) Hypoxia .

12) Noninvasive intermittent positive pressure ventilation

(NIIPPV) in acute exacerbations of COPD patients improves
all of the followings except :

a. Blood gases and pH.

b. Airway secreations .
c. In-hospital mortality.
d. The need for invasive mechanical ventilation .
e.The length of hospital stay.

13) One of the following treatment for patients with

advanced COPD may improve their survival
a. Exercise and rehabilitation.
b. Nocturnal O2 therapy .
c. Long term O2 therapy (more than 15Hrs) .
d. Prophylactic nebulized antibiotics .
e. Nebulized steroids (budesonide).

14) All of the followings are risk factors for pulmonary

tuberculosis except :
a-Close contacts to TB patient
b-Immigration from an endemic area
c-Exposure to under treated cases
-Young adults
-Residence of high incidence location .

15) Regarding pleural effusion caused by TB

a- Fluid analysis Predominated by lymphocytes
b-Fluid positive for AFB stain in less than one third of patients .
c-Negative culture for AFB can’t exclude the disease.
d-Pleural biopsy increases the yield for AFB culture.
 e-Usually it is difficult to treat ,and need treatment for 9-12 months .

16)All of the followings are associated with Worse prognosis

in sarcoidosis except :
a- Incidious onset
b- Multiple extrathoracic lesion.
c- Blacks..
d- Erythema nodosum.
e- Lupus pernio.

17)All of the followings are true combination between a

risk factors and pathgens causing pneumonia except :
a-Alcoholism and klebsella pneumonia
a- old age and mycoplasma pneumonia
b Cigarette smokers and H .infleunza
c-Mechanical ventilation and pseudomonal pneumonia.
d-Abnormal level of consciousness and anaerobic bacteria

18) This is atypical part of 8 hours polysomnography for

a 45 year old male patient .

What is the diagnosis of this patient ?

a-Narcolepsy.
b-Central apnea
c-Obstructive sleep apnea.
d-Mixed apnea .
Hypopnea .

19) ) Next is a typical part of 8 hours polysomnography

for a 45 year old male patient .

What is the diagnosis of this patient ?

a-Narcolepsy.
b-Central apnea
c-Obstructive sleep apnea.
d-Mixed apnea .
e-Hypopnea .

20) 19year old man previously healthy presented to the emergency

room coughing frish red blood , AFB stain is negative and the AFB
culture is pending , he was given three units of blood after which he
remained thermodynamically stable . a spiral CT scan of the chest
using PE protocol showed airspace changes in the Rt lower lobe ,a
bronchoscopy showed large clot in the Rt lower lobe. with no other
abnormalities seen .Which one of the following is the most
appropriate next step in the management of this patient ?
a - Start the patient on anticoagulation as therapeutic dose for PE .
b - Start the patent on anti TB treatment.
c - Ask for conventional CT scan.
d - Ask for conventional pulmonary and bronchial angiogram.
e - Sent the patient for Rt lower lobectomy.

21) This is a typical part of 8 hours polysomnography for

a 45 year old male patient .

What is the diagnosis of this patient ?

a-Narcolepsy.
b-Central apnea
c-Obstructive sleep apnea.
d-Mixed apnea .
e-Hypopnea

22) All of the followings can be caused by sarcoidosis

except :
a- Stridor .
b- Wheezes .
c- Heart block .
d- Facial nerve weakness
e- Hypercalcemia and Hypocalciuria .
23) Which one of the following conditions is an absolute
indication for thrombolytic therapy in patients with PE ?
a- Contraindication for anticoagulation .
b- Large filling defect(s) on spiral CT scan .
c- Hypotention caused by PE .
d- Bilateral PE .
e- presence of ECG changes suggestive of PE .

24) All of the followings are known complications of non

invasive ventilation NIV except.
a- Gastric insufflations .
b- Conjunctival Irritation ..
c- Hypotension.
d- Pulmonary edema .
e- Pneumothorax.

25) A 60 year old man , long standing smoker , has progressive

dyspnea and prductive cough for the last 2 years .1 week ago had flue
like symptoms followed by increase in his symptoms .His best
Spirometry taken 2 months ago showed FEV1 1.1 Liter ,FVC 2.2
without changed after inhaled B2 agonist . The ABG taken 10 minuets
ago while breathing room air was PH 7.29 , Pa Co2 56 HCO3 32 Po2
35 .
One of the followings is true regarding this patient except :

a- O2 therapy by non rebreathing mask should be started

immediately.
b- Hypoventilation is the main mechanism of hypoxia in this patient .
c- CPAP is superior to BiPAP in this patient .
d- After discharge exercise training may improved his
survival.
e- After discharge tiotropium is appropriate therapy .
26) A24 year old female patient has 4 days history of fever .chills and left
sided chest pain which increased by inspiration .Chest x ray showed
consolidation in the left lower zone with signs of pleural effusion on the
same side .All of the followings are indications for insertion of chest
tube and intrapleural thrombolytic therapy except ;

a- multiloculated fluid by CT scan .

b- LDH of 1500 mg/l
c- Gram stain of the pleural fluid is positive for Gram positive cocci .
d- Fever remained >39 in spite of IV antibiotics .
e- Pleural fluid culture +ve for strep.pneumnia .

27) All of the following statements are true regarding avian

influenza except :
a- H5N1 is the killing type.
b- The mortality rate is around 50% .
c- Tamiflu is an effective treatment if given early.
d- Spread from human to human was documented in some cases.
e - R-t PCR is a specific test for the disease .

28) In patients with idiopathic pulmonary fibrosis (usual

interstitial pneumonia) all of the followings are expected
physiological changes except :
a- Low DLCO .
b- Decreased FEV1/FVC .
c- Severe O2 desaturation on exercise.
d- Reduced vital capacity and total lung capacity .
e- Increased pulmonary artery pressure .

29)Broncuiolitis obliterans characterized by all of the following

conditions except
a- Obstructive changes by spirometry .
b Can complicate bone marrow transplant .
c- Good response to systemic corticosteroid .
d- HRCT scan of the chest typically shows mosaic appearance of air
trapping .
e- Transbronchial lung biopsy is in adequate for the diagnosis in most of
cases .
30) All of the followings may improve obstructive sleep apnea
except :
a- Dental extraction .
b- Weight Reduction .
c- Decrease alcohol consumption .
d- Nasal CPAP
e- Tracheostomy .

31) Nasl CPAP/BiPAP can be used to treate all of the following

conditions except :

a- Myasthnia gravis
b- Acute pulmonary edema .
c- Obstructive sleep apnea .
d- Respiratory failure due to severe kyphoscoliosis .
e- Narcolepsy .

32) All of the following statement regarding lung cancer are true
except :
a- Smoking is a known risk factor for all types of bronchogenic
carcinoma .
b- Adenocarcinoma usually is a peripheral lung tumor .
c- Adenocarcinoma in some cases is difficult to be differentiated from
mesothelioma .
d- Thromboembolic disease can be the first manifestation of the
disease.
e- Surgery can be curative for early diagnosed cases .

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