COMMON MCQ & CASES IN

respiratory By Dr.Abdulrauf

1- Regarding pulmonary function test all are true except:

• a. FVC is the volume of air in the lung after maximal inspiration.

• b. Functional residual capacity is the volume of air which remains in the lung
after maximal expiration.

• c. An obstructive pulmonary defect is a feature of sarciodosis.

• d. Residual volume is increased in emphysema.

2- A 50 year old lady with exertional dyspnea. Her pulmonary function test showed:

• - FEV1 1.5L (Her prediction FEV1 is 3.2 Liters)

• - FVC 3L (Her prediction FCV is 4 Liters)

• These results are mostly compatible with one of the following:

• a. Sarciodosis.

• b. Asbestosis

• c. Tuberculosis

• d. Lobar pneumonia.

• e. Chronic bronchitis

3- A 55 years old man who had previously fit, present to hospital complaining from
wheezing and cough, investigation result chest X-ray: NORMAL, PEF:200 l/min
FEV1/FVC ratio 40%, sputum contained normal commensal bacteria and eosinophils.

• The most likely diagnosis is:

 • Acute allergic alveolitis.

• Acute left ventricular failure.

• Late-onset intrinsic asthma.

• Fibrosing alveolitis.

4- Causes of type-I respiratory failure includes one of the following :

• Life treating asthma

• Chronic bronchitis

• Guillian-Barre syndrome

• Myasthenia gravis

• fibrosing alveolitits

5- Type-2 respiratory failure Caused by all except :

• Acute bronchial asthma

• Myasthenia gravis

• Ankylosing spondylitis

• Narcotic overdose

• Chronic bronchitis

6- Recognized causes of hypercapnia include all except

• Myasthenia gravis

• Asthma

• COPD

• Ankylosing spondylitis

• brain stem lesion

7- Clinical manifestations of CO2 reterntion includes all except :

• Flapping termor

• Muscle twitching

• hot extremities

• Weak radial

• Confusion

8- In respiratory Failure all are true except :

• a. Classification into type 1 and type 2 is related to the presence or absence

of hypercapnia.

• b. Lung fibrosis may cause chronic type 1 respiratory failure.

• c. Patients with acute severe asthma and acute type 2 respiratory failure
should be given high concentration oxygen theraphy.

• d. High volume pulse, palmer erythema and flapping tremor do not affect the
prognosis.

• e. If PCO2 continues to rise mechanical ventilation is required.

9- All the following are features of chronic type II respiratory failure except:

• a. PaO2< 60 mmHg.

• b. PaCO2> 50 mmHg.

• c. Low HCO3.

• d. Commenly caused by COPD.

• e. Treated with oxygen 28%.

10- A65 year old man with a history of progressive shortness of breath, his atrial
blood gas analysis showed:
 • PH 7.21

• PaO2 55 mmHg

• PaCO2 65 mmHg

• HCO3 38 mmoI/L

• All of the following can cause these abnormalities except:

• a. Chronic bronchitis.

• b. Sleep apnea.

• c. Marked kyphosis.

• d. Extensive bronchiectasis.

• e. Acute pulmonary oedema.

11- Causes of metabolic acidosis with high anion gap include all except :

• Salicylate poisoning

• Starvation

• Proximal renal tuber acidosis

• Lactic acidosis

• Renal failuer

12- Normal anion gap metabolic acidosis is found in one of the following

• renal tuber acidosis

• carbonic anhydrase inhibitors

• chronic renal failure

• acute renal failure

• Lactic acidosis
13- A 33 year old women recovering from acute gastritis. Her ABG analysis shows:

• pH 7.48

• PaO2 102mmHg

• PaCO2 46 mmHg

• HCO3 32mmHg

• This arterial blood gas abnormality is compatible with:

• a. Mixed metabolic alkalosis.

• b. Compensated metabolic acidosis.

• c. Compensated respiratory alkalosis

• d. Respiratory acidosis.

• e. Compensated metabolic alkalosis.

14- 65 years old man has a H⁄O bone tuberculosis as a young man, resulting in
gibbous deformity of the thoracic spine. He is admitted to the hospital with
increasing breathlessness and confusion.

Admission blood gases were as follows:

PH 7.41, PCO2 8.9pka, PO2 6.1pka, Bicarbonate 42mmol⁄L.

• What is this respiratory problem?

• Type I respiratory failure.

• Type II respiratory failure.

• Sleep apnea syndrome.

• Adult respiratory distress syndrome

15- 45 years old female present to emergency room by acute dyspnoes , tachypnoea
Arterial blood gas analysis shows: PH:7.1 HCO3:10 PCO2:40 PO2:98
Which of the following is most liable diagnosis?

• Acute metabolic alkalosis.

• Acute respiratory acidosis.

• Acute respiratory alkalosis.

• Acute metabolic acidosis.

 16- A 21year old girl is admitted unconscious to ICU. Her ABG shows

• PH- 7.3 (7.4-7.45)

• PCO2- 23 (40-45)

• HCO3- 10 (24-28)

• Blood sugar 105mg, urea 30mg.

Which of the following is most likely explain her abnormal ABG?

• Acute renal failure.

• Diabetic ketoacidosis

• Salicylate poisoning

• Hypoglycemia

17- Complication of chronic bronchitis includes one of the following :

• Respiratory failure type 1

• Left ventricular failure

• Erythrocytopenia

• pulmonary hypertension

• Weight loss
18- Recognized complications of chronic bronchitits are all except :

• Type II respiratory failure

• Polycythmemia

• Right ventricular failure

• Cancer lung

• Pulmonary hypertension

19- In chronic obstructive pulmonary disease all are false except :

• a. Finger clubbing is a characteristic clinical feature.

• b. CXR is the most reliable method to assess the severity of air flow
limitations.

• c. Smoking cessation has been proved to redice the decline in FEV1.

• d. Inhaled corticosteroids do not reduce the frequency and seveity of

exacerbations.

• e. Antibiotic therphy is recommended for all patients with acute

exacerbations.

  20-The following are true regarding Chronic Obstructive Airway disease except:

• a. Little variation of serial PEF and low FEV1 of <15% predicted are strongly
suggestive of the diagcosis.

• b. Continuous supportive antibiotics treatment is indicated and reduce

exacerbation.

• c. Corticosteroids are useful in the management of acute exacerbations.

• d. Acute confusion state is recognized mode of presentation.

• e. Domicillary oxygen therapy is useful is regarding the development of

pulmanory hypertention and cor pulmanory.
21- In COPD which of the following is true:

• a. Long term antibiotic treatment decrease frequency of exacerbation.

• b. Inhaled corticosteroids are of no value.

• c. X-ray of chest shows flat diaphragm.

• d. Auscultation of chest reveals fine crepitations.

• e. Left side heart failure is recognized complication.

22- A60 years old male, smoker for 20 years presented to the OPD complaining of
recurrent attacks of productive cough and dyspnea on moderate exertion for the
last 4 years. On examination, there was mild cyanosis, B.P 120/ 80mmHg pulse
80/min, regular. On chest examination barrel shaped chest, bilateral moderate
rhonchi. The following is true:

• a. Family history of the same symptoms is significant etiologically.

• b. Finger clubbing is an expected finding.

• c. Diurnal variation of peak expiratoy flow rate > 15% is expected.

• d. Controlled oxygen therapy ( 24% - 28%) is expected.

• e. Acute pulmonary edema is a common complication.

  23- A 72 years old man presented with worsening exertional dypnea, associated
with chest tightness, wheezing and cough. He smokes 2 packs of cigarettes daily
since the age of 20 years. On examination, the patient is alert but appears to be in
respiratory distress, with pursed lip breathing, temperature is normal, pulse rate
100/min regular, respiratory rate 22 breath/ min. His skin is cold and dry, with
bilateral ankle edema, no cyanosis or clubbing. Pulse oximerty ( Oxygen saturation)
So2 91% on room air. On chest examination, breath sounds are reduced with
prolonged expiration and rhonchi bilaterally, heart sounds were distant with no
murmur gallop or pericardial rub. ALL the following are true EXCEPT:

• a. History of increasing sputum volume and purulence necessitates

commencing antibiotic treatment.
 • b. Spirometry is not useful in patient assessment.

• c. Controlled oxygen therapy will delay onset of cor pulmonale.

• d. Systemic steroids for 2 weeks help maintain improvement following an

acute attack.

• e. Beta 2 agonists through nebulizer should be administered immediately.

24- Sign of acute sever asthma are all except :

• Increasing symptoms

• Peak flow rate >33% of predicted

• Respairtory rate < 25 breathe/ min

• Heart rate > 100 beats /min

• Inability complete sentences one breath

25- Features of severe acute asthma includes one of the following :

• Pulsus paradoxes

• Peak flow 50-80% of expected

• A Low PH

• Normal heart rate

• Bradycardia

26- Which of the following features suggests acute severe asthma:

• a. Increases chest expansion bilaterally.

• b. PEF of 70% predicted.

• c. Rhonchi all over the chest.

• d. A pulse rate of 84/min.

 • e. SpO2 of 74%.

27- The following are considered poor prognostic features of bronchial asthma
except:

• a. Silent chest.

• b. Ronchi all over the chest.

• c. Confusion

• d. Cyanosis.

• e. Bradycardia

28- A 35 year old man has recurrent attacks of wheezing and breathlessness.
His peak flow meter records show diurnal variation. He was prescribed salbutamol,
but he containues to have frequent wheezy episodes. The next step of
management is :

• a. Oral steroids.

• b. Oral antibiotics.

• c. Inhaled corticosteroids.

• d. Leukotriene antagonists.

• e. Phosphodiesterase inhibitors.

  29- A 30 year old female, known case of bronchial asthma, she failed to respond
adequately to budesonide, 400 µg/day and salbutamol inhaler. The next step in the
management of this patient would be:

• a. Doubling the dosage of inhaled corticosteroids.

• b. Addition of a long acting β-agonist.

• c. Addition of a leukotriene antagonist.

• d. Addition of a theophylline.
 • e. Addition of systemic corticoateriods.

30- Brochial asthma all true except:

• a. Is chronic inflammation that is reversible either spontaneously or with

treatment.

• b. Pulsus paradoxus is a feature of life treating asthma.

• c. Leukotriene antagonists can protect against exercise induced asthma.

• d. High oxygen theraphy concentration should be avoided as it may cause or

aggravate the CO2 retention in acute asthmatic attack.

• e. Inhaled corticosteroids are effective in improving symptoms and reducing

exacerbations.

31- A22 year old non-smoker man because of nocturnal cough and chest
tightness for the last 6 months he gives history of sneezing for last 2 years, he
received different antibiotics without improvement. On examination, pulse
75/min, regular, B.P 120/80 mmHg, chest examination was clear. The following
are true except:

• a. Occupational history is important.

• b. Chest X-ray is expected to be normal.

• c. 20% diurnal variation of peak expiratory flow rate indicates Bronchial

Asthma.

• d. Long acting β agonist is the drug of choice.

• e. High concentration oxygen can be given safely in cute exacerbations.

32- In patients with bronchial Asthma all are true except :

• a. Smoking during pregnancy will increase the risk of atopic disease in the
infant.

• b. Exposure to house dust mite is the commonest cause of extrinsic asthma.

 • c. Finding pulses paradoxcicus is a sign of severe attack.

• d. Mild intermittent asthma patients should be maintained on aminophylline

theraphy to control their symptoms.

• e. Magnesium sulphate I.V is affective in the management of acute severe

asthma.

33- In patients with bronchial asthma all are true except :

• a. Diagnosis depends on compatible clinical history and demonstration of

variable airway obstruction by spirometry.

• b. Pulse rate > 120/min and pulses paradoxus indicated a severe attack.

• c. Continuous suppressive antibiotic theraphy is advisible in patients with

frequent exacerbations.

• d. Inhaled steroid theraphy combined with long acting beta agonists may
control moderate persistent asthma.

• e. Influenza vaccine should be offered to all patients each year

34- The following are causes of bronchiectasis:

• Cystic fibrosis

• Primary hypogammaglobulinaemia

• Mycoplasma pneumonia

• Sarcoidosis

• Bronchial tumor

35- All the following are causes of Bronchiectasis except:

• a. Cystic fibrosis.

• b. Whooping cough.

• c. Pulmonary tuberculosis.
 • d. Hypogammaglobulinaemia.

• e. Pulmonary hypertension

36- Regarding Bronchiectasis all are true except:

• a. Finger clubbing is characteristic.

• b. Pulmonary function test demonstrate typical obstructive pattern.

• c. Childhood pneumonia, whooping cough measles are recognized causes.

• d. Permanent dilatation of small airway with recurrent pulmonary infections

is the hallmark feature.

• e. Postral drainage ( 5-10 min) once or twice per day is effective.

37- 50-year old man came to medical outpatient complaining of malaise and
productive cough. He had this cough for the last 10 months, which is worse in the
morning and elicited by posture change. The most likely diagnosis is

• Emphysema

• Bronchiactasis

• Interstitial lung fibrosis

• Bronchial Asthma

  38- A 25 year old female teacher presented with 2 months history of large
amount of productive cough associated with low grade fever and weight loss. Her
physical examinations showed numerous coarse crepitation’s over the lower base of
the chest. Cardiac and abdominal examinations were normal. All of the following are
true regarding patients case except:

• a. History of recurrent sinusitis would be of clinical significance.

• b. Clubbing of the fingers is a recognized association.

• c. The diagnosis can only be made with certainty by bronchogram.

 • d. Surgical treatment is indicated if the disease is confined to single lobe
or segment.

• e. Right ventricular heart failure is a recognized complication.

38- A 45 years old female presented with chronic productive cough with
large amount of purulent spurtum and a stabbing left sided chest pain. She
reported producing one to two cups of sputum daily. Her daily activity is
limited considerably by shortness of breath. She gives a history of
recurrent respiratory tract infections that had results in three
hospitalizations in the previous year. On chest examination, breath sounds
were audible bilaterally with course crackles and few expiratory rhonchi at
the lung bases. The following are true except:

• a. History of measles during childhood is significant.

• b. Bacteriological and mycological examination of sputum is advisable.

• c. Bronchography is the best diagnostic tool.

• d. Antibiotics are the mainstay of the treatment.

• e. There is risk of developing amyloidosis and metastatic abscesses.

39-  finger clubbing seen in all except :

• Mesothelioma

• Bronchial asthma

• Broncheactesis

• Fibrosing alveolitis

40- causes of sudden onest of breathlessness include all except:

• Inhaled foreign body

• Sever Pneumonia

• Extrinsic allergic alveolitis

 • Pneumothorax

• Pulmonary embolism

41- recognized causes of haemoptysis includes all except :

• Pulmonary oedema

• Bronchial adenoma

• Good-Pasture syndrome

• Extrinsic allergic alveolitis

• Pulmonary infraction

 42- causes of haemoptosis includes:

• Bronchiectasis

• Polyarteritis nodosa

• Pulmonary haemosiderosis

• Lung abcsess

• Bronchial asthma

43- A 20- year-old man, previously healthy, came to hospital complaining of sudden
chest pain, shortness of breath while he was coming out of his car. He was tall thin
young man. The attending physician made the diagnosis by a plain chest X-ray.

The appropriate line of management would be

• Oxygen inhalation

• Chest tube insertion

• Ventolin inhalation

• Observation
44- A 16 year old man patient, previously healthy, came to the emergency
department with complaints of shortness of breath and chest pain which started
one day ago. The shortness of breath was mild in severity, made worse by exertion
and relieved with rest, associated with left sided chest pain, sharp in nature. He
denied any similar symptoms in the past. He denied any similar symptoms in the
past. He did drink alcohol , denied drug abuse and there was no history of truma.
On examination: blood pressure was 112/70 mmHg, pulse rate of 90/min, afebrile
and respiratory rate of 23/min. Chest examination revealed a trachea in midline
with a hyper resonance on precusion of the left side of the chest, auscultation
showed no breath sounds on the left side with no crepitations or wheeze. His
cardiac and abdominal examination were unremarkable. Oxygen saturation was 90%
at room air. All the following are true regarding this case, except:

• a. About 90% of cases are smokers or were smokers.

• b. This condition most commonly affect men between 20-40 years of age.

• c. Some individuals have a genetic predisposition to it.

• d. A CT scan of the chest is the best radiological assessment tool in this

case.

• e. A chest tube has to be placed and connected to underwater seal.

 45- All The following are recognized causes of exudative pleural effusion except:

• e. Tuberculosis.

• b. Pulmonary embolism.

• c. Nephrotic syndrome.

• d. Para pneumonic effusion.

• e. uremia.

46- Pleural aspirate with protein content of =>4gm/it is compatible with all except:

• a. Pneumonia.
 • b. Congestive heart failure.

• c. Tuberculosis.

• d. Pleural metastasis.

• e. Pulmonary infraction

47- exudative pleural effusion seen in all except :

• congestive heart failure

• mesothelima

• chronic renal failure

• pulmonary infraction

• Pneumonia

48- Plural effusion all are false except :

• Empyema suspected if temperature persist in spite of suitable antibiotic

• X-Ray chest can be differentiate between empyema and plural effusion

• The causative organism always isolated from the pus

• Healing is unlikely without surgical intervention

• Plural biopsy has no role

49- Regarding pleural effusion all are true except:

• a. Pleural fluid protein / serum protein ratio >0.5 indicates transudative

pleural effusion.

• b. Could be bilateral in pateints with heart failure, liver failure, and renal
failure.

• c. Is exudative with low suger in patients with rheumatoid arthritis.

 • d. Pleural effusion of tuberculous orgin, adding oral prednisolone will
promote rapid absorption of the fluid.

• e. Pleurodesis is indicated in malignant pleural effusion to prevent rapid

reaccumulation.

50- Which of the following is not a feature of tuberculous pleural effusion:

• a. Serous in appearance.

• b. Exudates.

• c. Predominant lymphocytes in the fluid.

• d. Posative pleural biopsy.

• e. Failure to isolate M.tuberculosis from the fluid excludes the diagnosis.

51- Clinical features of empyema include all except :

• High remittent fever weight loss

• polymorphonuclear leucocytosis

• Pleural pain

• Increased tactile vocal fremitus

52- the following are features of bronchial carcinoma except

• cough

• haemoptysis

• wheeze

• horner's syndrome

• Hypocalcaemaia

53- features of Horner's syndrome includes all except :

• ptosis
 • enophthalmoses

• meiosis

• excessive aweating on ipisilateral half of face

• decresing sweating on ipisilateral half of face

54- non-Metastatic extra pulmonary manifestation of Ca-lung includes all except :

• a) eaton-lambert syndrome

• b) dermatomyositis

• c) hypercalcemia

• d) cough

• e) nephrotic syndrome

55- paraneoplastic syndromeIncludes all except :

• a) peripheral neuropathy

• b) myasthenia – like syndrome

• c) acanthosis nigricans

• d) jaundice

• e) hypetrophic pulmonary osteoarthropathy

56- The following can be non-metastatic manifistations of lung cancer except:

• a. Hypercalcemia.

• b. Polyneuropathy.

• c. Digital clubbing.

• d. Jaundice.

• e. Nephritis syndrome.
 

57- In Bronchial carcinoma all are true EXCEPT:

• a. Lymphatic spread to supraclavicular and mediastinal lymph nodes is

frequently observed.

• b. Hyponatremia due to inappropriate antidiuretic hormone secretion is

typically associated with adenocarcinoma.

• c. Raised hemidiaphragm on chest x-ray in usually caused by phrenic nerve

palsy.

• d. FEVI less than 0.8 liters is a contra-indication for surgical resection.

• e. Palliative radiotherapy is useful in superior vena cava obstruction.

58- The following statements is true about bronchial carcinoma:

• a. Small cell variety accounts for sixty percent of cases.

• b. CT-scan of the chest is indicated for staging.

• c. Hypercalcemia always indicates metaseasis.

• d. Sputum cytology is of no value in the diagnosis.

• e. Bronchoscopy rarly indicated.

59- In patients with bronchial carcinoma all are true except :

• a. Squamous cell variety accounts for 35%of cases.

• b. Hypertrophic Pulmonary Osteoarthropy may be the presenting feature.

• c. Hypercalcemia always indicate metastasis.

• d. Bronchoscopy can be normal.

e. Chemotherapy with radiotherapy can improve survival in pts with small cell
carcinoma.
60- Surgical resection of carcinoma of the bronchus is contraindicated in the
presence of the following:

• a. Maliginant pleural effusion.

• b. Hoarseness with immobile left vocal cord.

• c. FEV of < 0.8 liters.

• d. Recurrent hemoptysis.

• e. Hypertrophic pulmonary osteoarthropathy

61- A 80 years old man who smokes 30 cigarettes daily presents with a 3 day H/O
haemoptysis and mild breathlessness.

O/E BP: 110/70, HR: 80/min, finger clubbing, few rhonchi on examination of the
chest. CXR – Caviating shadow on the left lower lobe. WBC: 7,000, Hb: 10.1, PLT:
210,000, Urea, electrolytes and Blood sugar are normal Serum Ca: 13.9mg/100ml
(N- 9 – 10.4), Phosphate 4mg/100ml (N- 2.2 – 4.3)

Which of the following is the most likely diagnosis?

• Wegener’s granulomatosis.

• Polyarthritis nodosa.

• Pulmonary infarction.

• Bronchial carcinoma.

62- A 70 years old man, ex-smoker presents with left shoulder pain. O/E he is
found to have a barrel chest and diminished air movement. Cardiac examination is
normal, his pupils are asymmetric with noticed meiosis of his left pupil.

CXR shows irregular mass at left apex.

What is the likely diagnosis?

 • Lambert-Eaton syndrome

• Sarcoidosis

• Pan coast tumor

• Pulmonary tuberculosis

63- A 70 years old retired worker presented with a three month history of
productive cough, episodes of haemoptysis, weight loss 10kg on the last two months
and progressive dysponea. He smoked 30 cigarattes per day for more than 40
years. No significant past medical history. On examination he was cyanosed with
finger clubbing and sings of right upper lobe collapse in the chest. Cardiac and
abdominal examination were normal. All of the following are true regarding patients
case except:

• a. History of asbestos exposure is of clinical significance.

• b. The majority of patients with lung cancer have advanced disease at

clinical presentation .

• c. Bronchoscopy is the most useful investigation in this patient.

• d. Systemic chemotherapy is rarely indicated in treatning patient with small

cell lung cancer.

• e. Horners syndrome is a recognized complication.

64- A 57 year old man, constructor worker, presented to the respiratory OPD
complaining of worsening shortness of breath over the last 2 weeks, associated
with minimal productive cough, right sided chest pain and generalized fatigability.
On examination, trachea was shifted to the left side, chest examination showed
reduced chest movment on the right side, with reduced breath sound on the same
side. All of the following are true regarding patients cases except:

• a. History of asbestos exposure is significant.

• b. Tacitile vocal fremitus is expected to be decreased.

 • c. Chest CTscan has an important role in detecting the extent of the
disease.

• d. Patient should be sterted on anti-Tuberculosis therapy immediately.

• e. Pleurodesis is a mode of treatment in recurrent cases.

65- In primary pulomanry tuberculosis all are true except :

• Lungs are mainly involved

• Tonsils or alimentary tract may be involved

• Hematological spread never occur

• Regional lymph nodes are usually involved

• Pleura or pericardium are affected

 66- The following are complications of pulmonary tuberculosis except:

• haemoptysis

• pleural effusion

• Brocs syndrome

• asperiglloma

• Bronchogenic cancer

 67- Which of the following anti tuberculosis drugs commonly causes peripheral
neuropathy:

• a. Isoniazed.

• b. Rifampicin.

• c. Pyrazinamide.

• d. Ethambutol.

• e. Streptomycin.
68- In post primary pulmonary tuberculosis which of the following is true

• a. A purulent sputum that is negative for AFB is a feature

• b. A lower zone infiltration on chest x-ray is common presentation.

• c. A negative tuberculin test indicates that the patient is non infection.

• d. Combination drug therapy is not indicated.

• e. Bronchiectasis is a recognized complication.

  69- In Tuberculosis All true except

• a. Military TB is a complication of post primary TB.

• b. In AIDS patient extra pulmonary TB is more common than pulmonary TB.

• c. Tuberculin Test (Mantoux test) is read after 6 houers of injection of

PPD.

• d. Combination drugs containing Ethambutol and Pyrazinamide should be

given in TB.

• e. Hepatotoxicity is side effect of Rifampicin.

70- The following are true regarding pulmonary tuberculosis except:

• a. The standard treatment duration is twelve months.

• b. Ethambutol produced optic neutits.

• c. Post primary tuberculosis commonly affected the upper lobes of the lung.

• d. Aspergilloma is a recognized complication.

• e. Isoniazid is used as prophylaxis against mycobacterium infection in HIV-

posative patients.

71- Regarding treatment of Tuberculosis which is true :

• a. Mono therapy is indicated in 50% of cases.

 • b. Optic neuritis is a recognized complication of isoniazid.

• c. Ototoxicity is a complication of Rifampicine.

• d. If patient improve treatment should be stopped after 3 months.

• e. Applying DOT ( Directly Observed Therapy) improves outcome of

tuberculosis.

72- A 28 year old African worker presented to the casualty with a 3 weeks history
of fever, night sweating, anorexia, weight loss and dry cough. He never smoked and
has no previous history of any respiratory or cardiac illness. On examination, his
temp. was 38.5ºC. , a pulse of 100/min, a blood temperature of 110/70 mmHg. He
has no jaundice or cyanosis. There is a cervical lymphadenopathy. Chest
examination showed a small right sided pleural effusion. Cardiac, abdominal and
neurogical examination were normal. All the following are true regarding patients
cases except:

• a. History of tender erythematous nodules in the legs will be of clinical

significance in this patient.

• b. Negative tuberculin skin test will exclude the diagnosis of pulmonary

tuberculosis.

• c. Presence of pleural caseating granulomas is virtually diagnostic of

tuberculosis pleural effusion.

• d. Leukamiod reaction &/or pancytopenia are recognized association.

• e. Six months of ant-tuberculous treatment is effective if four drugs

combinations are used in the first 2 months.

73- Regarding mycoplasma pneumonia all true except :

• Caused by haemophilus influenz

• Haemoptysis may occur

• 50% of patient develop cold agglutinin in serum

 • Cold autoimmune haemolytic anaemia is a complication

• Erytromucine is drug of choice

74- Regarding mycoplasma pneumonia the following are true except

• Headache and malaise often precede the chest symptoms

• White blood cell count is high

• Usually causes bronchopneumonia

• Cold agglutinin-hemolytic anemia occur in 90% of cases

• Erythromycin is the drug of choice

75- In a community acquired pneumonia the following indicates a poor prognosis

except:

• a. Respiratory rate of 35/min.

• b. Systolic blood pressure of 80 mmHg.

• c. Age of 70 years.

• d. Temperature of 39.7ºC.

• e. Confusion

76- All the following are true regarding community acquired pneumonia except:

• a. Typically presents with fever rigors and cough.

• b. Majority are due to infection with Streptococcus Pneumponiae.

• c. Bronchail breathing at the right lung base interioly suggests right moddile
lobe consolidation.

• d. Absence of leucocytosis excludes the diagnosis.

• e. The empiric treatment of choice is amoxicillin for 7-10 days.

77- Characteristic finding in patient with pneumonia are all except :

 • a. Reduced chest movement.

• b. Dull percussion note.

• c. Decreased vocal fremitus.

• d. Expiratory Ronchi.

• e. Bronchial breathing

78- In community acquired pneumonia all are true except :

• a. Presence of Herpes labials indicates Pneumococcus pneumonia infection as

the cause of the pneumonia.

• b. Leucopoenia of < 4×10^9/l usually with high mortality.

• c. erytromycin is the drug of choice in patients suspected of having

Mycoplasma pneumonia

• d. Pneumothorax is a recognized complication of Staphylococcus aureus

pneumonia.

• e. The majority are caused by caused by gram negative bacteria.

79- In community acquired pneumonia in adults which of the following is true:

• a. The most common causative organisim is Hemophilus influenza.

• b. Mycoplasma pneumonia accurs in three yearly epidemics.

• c. Serum urea of 60 mg/dl is a bad prognostic feature.

• d. Type II respiratory failure is common.

• e. Third generation cephalosporines should be used if the patient is treated

in the community.

80- 67 years old male presented with fever, shivering, malaise, vomiting, diarrhea,
and cough accompanied by expectoration of mucopurulant sputum on examination
the patient looks conscious, oriented, BP:110/ 70 HR:115 beat/min RR:35
cycle/min, TM:40C, respiratory examination, there is decrease air entry

• X RAY shows homogenous opacity affect right middle and lower lung zone +
Air-bronchogram

• WBC: 16x10/l , Na: 129mmol/ l , urea: 30mg/dl, creatinine: 0.9mg/dl

Albumin: 3g/dl

Which of the following is wrong statement?

• Patient must be admitted to the hospital.

• Erythromycin + rifampicin are the drugs of choice.

• Chlamydia is the most likely bacterial cause in this case.

• Direct fluorescent antibody stain for tracheal aspiration is essential for

diagnosis.

81- A 27 year old engineer presented to the emergency department complaining of

cough fever and a 2 day history of myalgia and headache. He never smoked and has
no previous medical illness. On examination, he is slightly disoriented with a
temperature of 38.9ºC, pulse of 110/min, respiratory rate of 32/min. There was no
jaundice, clubbing lymphadenopathy or neck stiffness. Chest examination showed
coarse crepitations with right lower lobes with pleural rub. Systematic examination
was normal. The following are true about this patient except:

• a. Upper obdominal tenderness may be the only predominant clinical

presentation.

• b. History of travel abroad is significant.

• c. Serum urea of 56 mg/dl indicates high risk and severe disease.

• d. Grouwth of klebesiella pneumonia in sputum culture would be best treated

with erythromycin.

• e. Meningoencephalitis is a recognized complication.

 82- A 57 previously healthy man presents with a 2 week H/O lethargy and cough
productive of yellow sputum. CXR demonstrate patchy consolidation in both lower
zones. Investigations showed:

• Hb 8.7g/dl, WBC 9000,3, Reticulocyte count 4.5%.

• What is the probable diagnosis?

• Mycoplasma pneumonia.

• Pneumocystis carinii pneumonia.

• Acute exacerbation of bronchial asthma.

• Pulmonary tuberculosis

83- A 70 year old man has a 1 day history of increasing cough, dyspnea, fever and
chills. He has no significant past medical history, on examination, he is confused,
temperature is 38.7 ºC, pulse rate is 110/min, and blood pressure is 90/60 mmHg.
Examination of the chest discloses diminished breath sounds, bronchial breathing
and crackles, at the left lung base. The leukocyte count is 31,000/uL (31×10^9/L).
Blood urea is 90 mg/dl< & serum creatinine is 2.4 mg/dl. A chest radiograph shows,
a left lower lobe pulmonary infiltrate. All of the following are true regarding
patients case except:

• a. Gram negative bacteria are the most likely ethiological agent.

• b. Lobar infiltration on chest X-ray is most often caused by streptococcus

pneumonia.

• c. High urea level associated with increased mortality.

• d. Pulse oximetry provides a simple method to monitor respose to oxygen

therapy.

• e. Β-lactam and macrolides are the imperical antibiotics treatment of

choice.

83- A 25 years old lady presented with history of fever and productive cough for
the last 2 days after being discharged from the obstetric department. On
examination, pulse 90/min, B.P120/80mmHg, no cyanosis. Chest examination showed
dullness on percussion note and auscultation revealed decreased breath sounds
over the right lower chest and crepitation. CXR showed a homogeneous shadow in
the right lower zone. The following are true except:

• a. History of general anesthesia and ventilation is etiologically significant.

• b. Underlying causes of immunosuppressant should be excluded.

• c. Pneumococci is the most likely organism.

• d. Cephalosporines are the antibiotic of choice.

• e. Bronchiectasis is a recognized complication

84- A 29 years old man known to have positive HIV on irregular follw up was
admitted because of fever, cough and dyspnea of 12 hrs duration.

• CXR showed fine granular opacities throughout both lung field.

• ABG PO2: 63mmHg, PCO2: 31mmHg, PH: 7.5. a diagnosis of pneumocystis

carinii infection was made.

Which of the following investigation is necessary to prove the diagnosis?

• Serial blood culture.

• CT scan of the chest.

• Bronchoscopy with bronchoalveolar lavage.

• Perfusion lung scan.

85- A 31 year old man, he has a long lasting history of intravenous drug abuse,
presented with a one week history of dry cough and fever. On examination, he was
unwell, temperature 40ºC , pulse 112/min, blood pressure 120/70 mmHg. He has
generalized lymph node enlargement. Chest auscultation reveals bilateral fine basal
crepitations. Cardiac, abdominal and nurological examinations were unremarkable .
CBC: WBC 1.2 × 10^9 /l, Hgb 11g/dl, platelets 261× 10^9/l.Chest X-ray shows
normal diffuse interstitial infiltrate. Urea, creatinine, elecytrolytes, blood suger
and liver function were within normal. All the following are true regarding to this
case except:

• a. A CD4 lymphocyte count is expected to be low.

• b. Bronchoscopy and bronchial lavage are helful.

• c. Pneumocystis jiroveci (Pneumocystis carinii) is the most likely cause of

this chest signs.

• d. Respiratory failure is a recognized complication.

• e. Intravenous ceftriaxone is the treatment of choice.

86- The following regarding deep vein thrombosis are true except:

• a. Recent history of immobilization is of etiological significance.

• b. Family history of thrombosis is important.

• c. CT scan is the initial diagnostic procedure.

• d. Anticoagulants are the treatment of choice.

• e. Pulmonary embolism is a recognized complication.

87- Recurrent DVT are seen in all except :

• Anti phospholipid syndrome

• Protein C and S deficiency

• Anti thrombine III deficiency

• Thalasemia

• ITP ( idiopathic thrombocytopenic purpura )

89- Radiological findings of PE include all except :

• Elevated hemidiaphragm

• Wedge shaped opacity

 • Horizontal linear opacities

• Pleural effusion

• Congested lung fields

90- In pulmonary thromboembolic disease the following are true except:

• a. Diagnosis can be achieved by performing an ECG.

• b. Approximately 70% of patients will have deep venous thrombosis on

venography.

• c. Most patients should receive anticoagulants for at least six months.

• d. In the first trimester of pregnancy heparin is drug of choice.

• e. A normal ventilation/perfusion lung scan exclude pulmonary emboli in most

cases.

91- In pulmonary embolisim the following are true except:

• a. A chest x-ray diagnostic.

• b. Clinical examination of the chest is usually normal.

• c. Deep vein thrombosis is not always detected.

• d. Sudden death is recognized complication.

• e. Anticoagulant treatment is indicated for more than one month

92- A 30 year old female patient with history of caesarean section section 20 day
ago, presented with a sudden onset of right sided chest pain and hemoptysis. She
gives a history for being treated for DVT twice with anticoagulants the last was a
year ago. On examination is unremarkable, she has left lower limb edema. All the
following are true regarding her condition, except:

• a. Chest X-ray is expected to be normal.

• b. D-dimer<500ng/ml excludes pulmonary thromboembolism.

 • c. Doppler U/S to the lower limbs is advisable.

• d. Accentauted pulmonary component of the second sound is expected.

• e. Arterial blood gases usually show type 1 respiratory failure.

93- A 33 year old woman had has H/O deep vein thrombosis presents with sever
chest pain, sharp in nature worse with deep breathing, associated with
breathlessness, she is on oral contraceptive pills. O/E temp 37.5c, HR 135, RR28,
BP100/60, O2 sat 85%, JVP9cm, normal heart sounds, few scattered rhonchi on
lung fields.

• Investigation: WBC 10,Hct 38 ,PLT 210, LFT, UREA, CREAT, are ABG PH 7.4,
PO2 68, Pco2 30. ECG sinus tachycardia, deep S wave in lead 1, Q wave and T
wave inversion in III

• What is the most important specific investigation for the diagnosis?

• CT scan of the chest

• Echocardiogram

• Ventilation-perfusion lung scan

• Bronchoscope

94- A 30 year old male had multiple fractures after a road traffic accident.
Four, days later he had dyspnea and chest pain. He was tachypnic, with a pulse of
120/min, blood pressure of 90/60 mmHg, chest examination showed reduced air
entry in the left hemithorax. Chest X-ray showed small pleural effusion. The
following are true about this patient except :

• a. History of hemoptysis is significant.

• b. Right ventricular gallop and accentuated second heart sound indicates

pulmonary hypertension.

• c. Arterial blood gases will typically show reduced PaO2 and raised PaCO2
values.
 • d. Ventilation-perfusion lung scanning is a standard method to diagnose this
patient.

e. Diffuse alveolar and interstitlial infiltrates on chest X-ray would suggest

the development of adult respiratory distress syndrome.

95- 55 years old female, presented to emergency department by acute right side
chest pain on examination the patient looks dyspnic , tachypnic , central cyanosis
chest X-ray : there is obliteration of cardiopherenic and cardiothoracic angel +
meniscus sign, ABG: PO2=60 Pco2=30 PH=7.47 , diagnostic pleural
aspiration was done and the result is exudates with red blood cell and eosinophilia

• Which of the following is the most liable diagnosis:

• Tuberculosis.

• Pulmonary infarction.

• Rheumatoid arthritis.

• Obstruction of thoracic duct.

96- presentation of sarciodosis includes all except :

• 30% of patient are asymptomatic with abnormal chest x-ray

• Erythema marginatum

• Superficial lymphaadenopathy

• Hypercalcaemia

• Diabetes insipidus

97- in sarcoidosis one is true :

• Parotid gland is not one of the affected organ

• In broncho alveolar lavage there is increase number of eosinophils

• Plasma level of angiotensin enzyme is elevated (ACE)

 • Stage II is an indiction to start the treatmenet

• Fibrosis are develop in the most affected cases

98- Regarding interstitial lung disease, all the following are true except

• a. Pulmonary sarcoidosis is frequently self-limiting.

• b. Is characteristically associated with restrictive lung disease.

• c. High resolution CT-scan is extremely valuable in detecting early disease.

• d. Cryptogenic fibrosing alveiolitis is predominantly a disease of young

people.

• e. Type 1 respiratory failure is recognized complication.

99- A 50 year old male presented with a 3 month of progressive dyspnea and dry
cough, he was non-smoker , on examination he was Afebrile, BP 130/80 mmHg,
apart from bilateral fine end inspiratory crepitations there was no other
abnormality, blood test showed ESR 60 mm per first hour, normal urea and
creatinine, Na+ 137, K+ 4.1, Calcium 12mg/100mI (normal 8.5-10.3mg/100mI) chest
X-ray showed bilateral hilar edenopathy and lung infiltrates. Which of the
following is not correct:

• a. Non caseating granuloma is the characteristic pathological feature.

• b. Angiotensin converting anzyme is elevated in two thirds of patients.

• c. Steroids are the treatment of choice.

• d. Uveitis is a recognized complication

• e. Pulmonary function test will show an obstructive pattern.

100- A 55 year old diabetic housewife, presented with history of dyspnea on

exertion and dry cough for the last 6 months. Clinical examination revealed, central
cyanosis, pulse 90/min regular, respiratory rate 30 breath/min. B.P 130/mmHg.
Chest examination showed bilateral basal fine inspiratory creptions. Chest
examination showed bilateral reticulonodular infiltration in the lower zones. The
following are true except:

• a. History of long standing rheumatoid arthritis is of diagnostic value.

• b. Impaired percussion note is expected.

• c. FEV1/FVC < 55% is expected.

• d. Brounchoalveolar lavage (BAL) is of diagnostic value.

• e. Azathioprine is an effective drug.

101- 40 years black female presented because of exertional dyspnea sience 3

mounts, her face showed violaceous plaqe on the nose and cheeks with telangictesia
over and around the plaques. She got bilateral cervical lymphadenopathy, chest X-
ray showed bilateral hilar lymphadenopathy, both hand X-ray showed phalangeal
cysts.

• Which of the following is the most likely diagnosis:

• Pulmonary tuberculosis.

• Lymphoma.

• HIV infection.

• Sarcoidsis.

102- clinical features of extrinsic allergic alveolitits includes all except :

• Ful-like symptoms

• Myalgia

• Producative cough

• Diffuse rhonchi

• Dyspnea