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Lungs 2008 by xiaopangnv


									                                  Lungs 2008
1. What is the most efficient preventive action to prevent spread of pneumonia in
   the hospital?
       a. Giving the patients preventive wide range antibiotics
       b. Hands washing
       c. Giving a constant treatment with H2 blockers
       d. Positioning an artificially ventilated patient in a prone position
       e. Positioning the patient in a supine position

2. All of the following are common causatives of hospital acquired pneumonia
   following more than 5 days of hospitalization, except:
       a. Acinetobacter
       b. ESBL type klebsiella
       c. Hemophilus
       d. MRSA
       e. Pseudomonas

3. One lung atelectasis causes:
      a. Displacement of the mediastinum to the opposite side
      b. Drawing the mediastinum to the pathological side
      c. Does not affect the mediastinum
      d. Pulls the mediastinum upward

4. Which of the following is characteristic of PE (pulmonary embolus)?
     a. The most common symptom is hemoptysis
     b. In most cases signs of DVT can be found upon physical examination
     c. Most patients have arrhythmia with specific ECG changes
     d. Normal blood gases test denies the diagnosis of PE

5. A 52-yo, usually healthy man, a heavy smoker, is admitted to the hospital with
   hemoptysis. CXR (chest X-ray), chest CT and PET/CT show a left upper lobe
   tumor without lymph node enlargement and without metastases. FNA showed
   squamous cells with keratin pearls. The treatment of choice is:
      a. Irradiation followed by chemotherapy
      b. Chemotherapy followed by irradiation
      c. Left lung pneumonectomy
      d. LUL lobectomy

6. Which of the following diseases causes hyperresonance per percussion?
     a. Pneumothorax
     b. Pneumonia
     c. Pleural effusion
     d. Atelectasis
     e. All of the above

7.    In most cases, investigation of hemoptysis includes all of the following,
         a. CXR
         b. Sputum culture and cytology
         c. Bronchoscopy
         d. CT
         e. Pulmonary angiography

8. All of the following are used in staging of lung cancer, except:
       a. CT
       b. PET FDG
       c. Mediastinoscopy or mediastinotomy
       d. Bone scan
       e. US of the pleural space

9. All of the following are common causes of hemoptysis, except:
       a. PE
       b. Chronic bronchitis
       c. TB (tuberculosis)
       d. Lung cancer
       e. Asthma

10. A 38-yo man is admitted with fever of 40o and dyspnea that have begun 3 days
    before his admission. On CXR there is shadowing of the left lung with
    mediastinal displacement to the right. The most probable diagnosis is:
       a. Left lung atelectasis
       b. Left lung pneumonia with pleural effusion at the left
       c. Left lung pneumothorax
       d. Dextrocardia

11. Low diffusion rates (DLCO) are probable in all the following diseases, except:
       a. Restrictive parenchymal diseases
       b. Emphysema
       c. Vascular diseases
       d. Heavy smoking
       e. Asthma

Questions 12-13 are related to the following case:
A usually healthy 33-yo woman was admitted to the ER with acute dyspnea and
left chest pain, aggravated during deep breathing, without cough. The day before
her admission she got back from a prolonged flight of 8 hours. The patient takes
no medications aside birth control pills, and does not smoke. On physical
examination: 22 breaths per minute, pulse 98 regular, BP 120/60, temperature
37.5o, lungs, heart, abdomen examination - without any pathology. Lab:
WBC=12300, ABG (arterial blood gases): pH=7.49, PCO2=28, PO2=70.

12. What is the clinical diagnosis that would explain the complaints?
      a. Pneumonia
      b. Pneumothorax
      c. PE (pulmonary embolism)
      d. Pericarditis
      e. Stress induced hyperventilation

13. What is the best imaging for making the diagnosis?
      a. Cardiac echo
      b. CXR
      c. US legs
      d. CT angio

14. Slide number 3 - there was seen a big bronchus that resembles bronchiectasis,
    but with temporal heterogeneity and UIP characteristics.

15. All is characteristic to the disease above, besides:
        a. Chronic inflammation
        b. Interstitial fibrosis
        c. Multiple smooth muscle fibers in the connective tissue
        d. Bronchial dilatation

16. Slide number 4 - the diagnosis is lobar pneumonia

17. All of the following are characteristic of chronic bronchitis, except:
        a. Multiple goblet cells
        b. Multiple mucus secreting cells in the submucosa
        c. Multiple smooth muscle cells

18. Any of the following can be a cause for bronchiectasis, except:
       a. Cystic fibrosis
       b. 1-antitrypsin deficiency
       c. Primary cilliary dyskinesia
       d. Immunodeficiency

19. Foamy exudate in the alveoli is characteristic of:
       a. CMV
       b. Pneumocystic carinii pneumonia
       c. Aspargillus
       d. Herpes virus

20. What is characteristic of atypical pneumonia?
      a. Acute inflammatory effusion in the alveoli
      b. Respiratory epithelium atypia
      c. Interstitial inflammation
      d. Granulomas

21. What is correct regarding TB?
      a. Hilum lymph nodes involvement is characteristic of secondary TB
      b. Miliary TB is characterized by appearance of spaces in the lungs
      c. Positive Mantoux test indicates an active infection
      d. Secondary TB is usually the result of reactivation of primary TB

22. What is correct regarding bronchioalveolar carcinoma?
      a. Begins at a large bronchus
      b. Does not invade into stroma
      c. Solid structure
      d. Wide necrosis
      e. Common clinical manifestation as atelectasis or emphysema

23. What is correct regarding solitary fibrous tumor of the pleura?
      a. Is related to asbestos
      b. Glandular appearance
      c. Atypical mesothelial cells
      d. In most cases looks like fibrosarcoma
      e. None of the above is correct

24. What is the diagnosis of slide number 2?
      a. Squamous cell carcinoma
      b. Adenocarcinoma
      c. Bronchioalveolar carcinoma
      d. Carcinoid tumor

   In questions 25-28 relate each statement to one of the diagnoses:
          a. Chronic bronchitis
          b. Asthma
          c. Emphysema

   25.   Increase in the incidence of the disease is related to the hygiene hypothesis
   26.   Allergy tests are positive in many of the patients
   27.   The main etiology is not smoking
   28.   Airway obstruction is possible due to loss of elastic recoil

Possible answers:
   1. b
   2. c
   3. b
   4. b
   5. d
   7. e
   8. e
   9. e
   10. b
   11. e
   12. c
   13. d
   14. UIP
   15. d
   16. lobar pneumonia
   18. b
   19. b
   20. c
   21. d
   22. b
   23. d+e
   24. d
   25. b
   26. b
   27. b
   28. c


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