PULMONOLOGY

Patients with advanced pulmonary fibrosis and emphysema have increased

Vital capacity
Maximal breathing capacity
Residual air
Oxygen tension in the alveoli
All above mentioned
Pulmonary hypertension and cor pulmonale are commonly associated with
Pulmonary tuberculosis
Lung abscess
Bronchogenic carcinoma
Pulmonary emphysema
Acute pneumonia
A 55 year-old man with emphysema will have which kind of respiratory pattern of breathing?
Biot respiration
Apneustic breathing
Cheyne-Stokes respiration
Rapid and shallow breathing
Kussmaul breathing
The greatest danger to patient with bacterial pneumonia during the first night is
involvement of the pericardium
Peripheral vascular collapse
Respiratory insufficiency
Spread of the disease to the opposite lung bacterial pneumonia
Cardiac insufficiency
If several days later a diagnosis of viral pneumonia is convincingly established, the most
likely complication to be especially watched for thereafter is

Aseptic meningitis
Spread of the pneumonia to other lobes
Empyema
Enterocolitis
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Nephritis
If several days later a diagnosis of pneumococcal pneumonia is established, a danger to be
especially watched for thereafter is

Empyema
The emergence of drug-resistant strain of pneumococci
Destruction of a substantial portion f the right lower lobe
Congestive cardiac failure
Pneumothorax
A 55 year-old man who has smoked 30 cigarettes daily since he was 25 is seen because of
hemoptysis. He reports no symptoms except for a cough that produces 5-10 ml of sputum
each morning. Results found on physical examination and x-ray are normal. The most likely
cause of hemoptysis is

Bronchogenic carcinoma
Pulmonary tuberculosis
Bronchiectasis
Chronic bronchitis
Empyema
A 40 year-old woman in good general health has sudden chest pain, fever and shortness of
breath. She is a heavy smoker and takes no medicines. Tachypnea and a temperature of 38C
are found on physical examination. Chest auscultation, percussion and x-ray findings are
normal. The most likely diagnosis is

Tracheobronchitis
Atypical pneumonia
Pulmonary embolus
Bacterial pneumonia
Lung cancer
The most likely microorganism involved in lobar pneumonia is
Streptococcus pneumoniae (Pneumococcus)
Candida albicans
Hemophilus influenza
Staphylococcus aureus
Cytomegalovirus

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The most appropriate antibiotic treatment of lobar pneumonia is:

An aminoglycoside
Penicillin
Bactrim
Cloramphenicol
Vancomycin
A 17 year-old girl is brought to the emergency room for wheezing and severe shortness of
breath. She has been taking several bronchodilator inhalers with no relief of the
symptoms. Physical examination is remarkable for paradoxal pulse, tachypnea,
tachycardia and the accessory respiratory muscles very active with decreased air entry in
both lungs. The most likely underling disease in this patient is

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Asthma
Cystic fibrosis
Pneumonia
Laryngitis
Epiglottitis
The management of patient with asthma includes the following, except:
Admit to the hospital
Breathing treatments with selective beta-2 agonists
Oxygen
Steroids intravenous
Cyclophosphamide
Which f the following is more likely to be a complication in the course of asthma
Pneumothorax
Pneumomediastinum
Hyperglycemia
Restrictive lung disease
Pleuritis
Which of the following treatments would be mostly beneficial in the treatment of a 20 yearold woman with an acute exacerbation of asthma?

Beta adrenergic agents

Corticosteroids
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Magnesium sulfate
Mucolytic agents
Theophylline
What findings on physical examination are suggestive of a pleural effusion?
Dullness to percussion
Diminished breath sounds
Reduced vocal fremitus
None of above
All of above
An exudative pleural effusion meets which one of the following criteria:
Pleural fluid protein/serum protein ratio>0.5
Pleural fluid LDH/serum LDH>0.6
Pleural fluid LDH>two-thirds the upper limit of normal for serum
One or more of above
None of above
When an empyema should be suspected:
The pleural fluid has a high WBC count
The plcural fluid has high protein (>3g/dl)
The pleural fluid has low glucose (<40mg/dl)
The pleural fluid has high LDH (>600 mg/dl), and low PH (<7.2)
All of above
What is the most common cause of community-acquired pneumonia?
S. pneumoniae (Pneumococcus)
Mycoplasma
Legionella
Haemophilus influenza
Viruses
Which community-acquired pneumonias are seen more commonly in the alcoholic patient?
Klebsiella pneumonia
Pneumococcal pneumonia
Mycoplasma pneumoniae
Viral pneumonia
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Legionella pneumonia
What are the common risk factors for the development of anaerobic pneumonia?
Loss of consciousness (seizures or alcohol-related )
Poor oral hygiene
Endobronchial obstruction
Any risk factor for aspiration
All of above
Which one of the risk factors predispose for the development of hospital-acquired
(nosocomial) pneumonia?

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Increased severety of underlying illness

Previous hospitalization
Intubation
Recent thoracic or upper abdominal surgery
All of above
What are the predisposing factors for developing pneumococcal pneumonia?
Cirrhosis and renal failure
Poorly controlled diabetes mellitus
Sickle cell anemia
Post-splenectomy
All of above
Which factors worsenes the prognosis of pneumococcal pneumonia
Underlying illness
Bacteremia
Delay in onset of therapy
Multilobar involvement
All of above
Which organisms most commonly cause nosocomial pneumonia?
Pseudomonas aeruginosa
Klebsiella pneumoniac
Escherichia coli
Staphylococcus aureus
All of above
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What are the predisposing factors for the development of pulmonary emboli?
Surgury of the pelvis and lower extremities
Previous history of deep venous thrombosis
Pregnancy and postpartum period
Immobility
All of above
What is the most common cause of chronic obstructive pulmonary disease?
Cigarette smoking
Air pollution
Allergic factors
Hereditary factors
Occupational factors
Severe emphysema indicated by:
Over distention of lungs in stable state, low diaphragmatic position
Decreased intensity of breath and heart sounds
Pursed-lip breathing
Use of accessory respiratory muscles
All of above
Airflow obstruction evidenced by:
Dyspnea
Wheezing during auscultation on slow or forced breathing
Prolonged forced expiratory phase
All of above
None of above
What complications are associated with COPD?
Chronic cor pulmonale
Spontaneous pneumothorax
Acute and chronic respiratory failure
None of above
All of above
Cor pulmonale can be caused by:
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Pulmonary parenchymal disease (COPD)

Sarcoidosis
Pneumoconiosis
All of above
None of above
Which classes of bronchodilator drugs are available for therapy for the obstructive airway
diseases?

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Anticholinergic agents
Beta-adrenergic agonists
Methylxanthins
All of above
None of above
Which is therapeutic range of theophylline?
10-20 mcg/ml
20-30 mcg/ml
5-15 mcg/ml
30-35 mcg/ml
None of above
What are the toxic effects of theophylline therapy?
Cardiac: various arrhythmias
GI: nausea, vomiting, diarrhea and abdominal pain
Neurologic: headache, nervousness, insomnia, tremor, seizures
None of above
All of above
What are common causes of a restrictive ventilatory defect?
Interstitial lung disease (fibrosis, pneumoconiosis)
Chest wall disease (kyphoscoliosis)
Pleural disease (effusion, pneumothorax)
Extrathoracic conditions (obesity, ascites, pregnancy)
All of above
Which one of these diseases may cause restrictive ventilatory defect?

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Pulmonary fibrosis
Kyphoscoliosis
Obesity
None of above
All of above
Which one of the following may cause an exudative effusion?
Neoplasma
Infection
Collagen vascular diseases
None of above
All of above
Which one of the following may cause transudative effusion?
Congestive heart failure
Nephrotic syndrome
Cirrhosis
All of above
None of above
A pleural effusion represents an increase in fluid in the pleural space, which may be due:
Increased hydrostatic pressure
Decreased oncotic pressure
Obstruction of lymphatic drainage
Increased permeability
All of above
What are common causes of an obstructive respiratory defect?
Emphysema
Bronchitis
Asthma
Bronchiolitis
All of above
What are the pulmonary function tests (PFT) findings suggestive of a restrictive ventilatory
defect?

Decreased vital capacity

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Normal expiratory flow rates

Decreased total lung capacity
All of above
None of above
What are the pulmonary function tests (PFT) findings suggestive of a obstructive ventilatory
defect?

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Decreased forced expiratory flow rates

Decreased forced vital capacity
Increased residual volume
All of above
None of above
Which drugs are commonly used to treat COPD?
Corticosteroids
Diuretics
Antibiotics
Bronchodilators
All of above
Which one of the statements is true regarding the cessation of smoking in a patient with
COPD?

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The morbidity and mortality associated with COPD are reduced

Has no effect on patients with COPD
The benefits are more dramatic in patients with advanced disease
There is no improvement in objective tests of pulmonary function
Subjective symptom severity is not improved
Which one of the predominant symptoms of compensated cor pulmonalc include:
Chronic productive cough
Exertional dyspnea
Wheezing respirations
Easy fatigability
All of above
Which one of the laboratory findings is often present in cor pulmonale:
Anemia
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Polycythemia
Thrombocytosis
Leukocytosis
Leukopenia
What ECG findings are suggestive of cor pulmonale?
Peaked P waves
Right axis deviation
Deep S waves in lead V6
All of above
None of above
Which of the following are characteristic for cor pulmonale:
Cyanosis
Distended neck veins
Enlarged and tender liver
Dependent edema
All of above
What are the signs of cor pulmonale?
Distended neck veins
Clubbing
RV heave or gallop
Epigastric pulsations
All of above
What are echocardiogram signs of cor pulmonale?
RV dilation
RA dilation
Normal LV size
None of above
All of above
Which one of the following statements are true regarding asthma:
Asthma is a chronic inflammatory disorder of the airways
The airway inflammation underlies asthma chronicity and contributes to airway
hyperresponsiveness
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A genetic predisposition to asthma is recognised

All of above
None of above
What are the respiratory symptoms characteristic for asthma?
Recurrent episodes of wheezing
Breathlessness
Chest tightness
Cough
All of above
Pulmonary embolism characterized by sudden onset of
Tachypnea
Tachycardia
Chest pain
None of above
All of above
Which diseases are the indications for the most common use of pulmonary function tests:
Emphysema
Bronchitis
Asthma
Upper airway obstruction (tumors, foreing bodies, stenosis and edema)
All of above
Obstructive airway disease characterized by: except
Decrease in forced expiratory flow rates
Increased residual volume
Increased airway resistance
Normal forced vital capacity
Decreased forced vital capacity
Severe emphysema indicated by:
Use of accessory respiratory muscles
Indrawing of lower interspaces
Decreased intensity of breath and heart sounds
All of above
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None of above
Clinical symptoms of a patient with COPD most often are, except
Cough (chronic, productive)
Wheezing
Dyspnea
Normal vital capacity and expiratory flow rates
Prolonged forced expiratory phase
Which are the complications associated with COPD?
Sleep disturbances due to nocturnal desaturation
Acute and chronic respiratory failure
Chronic cor pulmonale
Spontaneus pneumothorax
All of above
Which of the following statements is true regarding advanced COPD disease type A: Pink
Puffer (Emphysema Predominant)

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Major complaint is dyspnea

Cough is rare
No peripheral edema
Hemoglobin usually normal
All of above
Which of the following statements is true regarding COPD disease type B: Blue bloater
(Bronchitis Predominant)

Chronic productive cough, dyspnea usually mild, chest is noisy with rhonchi
Patients frequently overweight and cyanotic
Peripheral edema is common
Hemoglobin usually elevated
All of above

LITERATURE:
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CURRENT Medical Diagnosis & Treatment. 2008. Edited by Stephen J. McPhee. MD."
University of California, San Francisco.

State Medical University. Department of Internal Medicine

M. Kandelaki M.D.

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