MISC.

Mr. Smith has about 2 asthmatic episodes per month. His PFTs show an FEV1 of 85% of predicted. You prescribe: A. Allergen avoidance alone B. Allergen avoidance and "as needed" use of albuterol inhalers C. Albuterol inhaler daily with an inhaled corticosteroid D. A 10-day course of oral steroids followed by daily albuterol

b

All of the following medication categories are asthma "controller" medications, which affect the underlying causes of the disease, EXCEPT: A. Inhaled corticosteroids B. Inhaled muscarinic receptor antagonists C. Leukotriene receptor antagonists D. Mast cell stabilizers

b

Amount of air in the lungs that remains after deep breathing is called ______.

Residual Volume

What is the pressure of gas within the alveoli at the peak of inspiration, just before expiration, relative to that of atmospheric air?

Same as atmospheric air

In which of the following restrictive lung disease the vital capacity is reduced to below normal levels. pneumonia tuberculosis pulmonary fibrosis all of the above

pulmonary fibrosis

A 26-year-old man was referred to the emergency unit by his general practitioner with a four-hour history of exertional dyspnoea. He experienced undue breathlessness on climbing three flights of stairs associated with mild chest discomfort. The discomfort and breathlessness eased within a few minutes of rest, but recurred when he continued to climb the stairs. On examination, he appeared well. His pulse was 80 beats per minute in sinus rhythm with blood pressure 120/65 mmHg. On auscultation of his chest, there was a loud clicking sound at the lower left sternal border that was synchronised with his heartbeat. What is the most likely diagnosis? Acute non-Q wave myocardial infarction Mitral valve prolapse Pericarditis - Rib fracture Spontaneous pneumothorax

spontaneous pneumothorax

The maximum volume of air contained in the lung by a full forced inhalation is called

total lung capacity

Dissociation curve shifts to the right when a)CO2 concentration decreases b)CO2 concentration increases c)O2 concentration decrease D)CL− concentration increase

b

Emphysema, a chronic disorder is high in cigarette smokers. In such cases the ______ of the person is/are found damaged.

alveolar walls

All of the following statements about the role of inhaled corticosteroids in the management of asthma are correct EXCEPT: A. Due to the frequent side effects of inhaled corticosteroids (thrush, Cushingoid changes, growth retardation in children, acute adrenal insufficiency, etc.) their role is limited to prophylaxis of severe persistent asthma B. Inhaled corticosteroids are not effective in the relief of acute bronchospasm C. Long-term corticosteroid use results in the upregulation of β-receptors enhancing responsiveness to inhaled β-agonists D. Corticosteroids inhibit the release of leukotrienes and decrease IgE synthesis to decrease airway inflammation E. Inhaled corticosteroids can be combined with long acting β-agonists to suppress airway inflammation and hyper-reactivity in moderate to severe persistent asthma

A

An exudative pleural effusion may be characterized by A. Elevated pleural fluid protein levels B. A low fluid pH C. A high RBC count D. A glucose level of less than 70 E. A and B

A

Interstitial lung disease (ILD) refers to a set of conditions which affect the pulmonary interstitium-- the area of tissue and space which lies between the alveoli and alveolar capillaries. What factor in the setting of severe ILD, would NOT decrease the extent to which oxygen passes from the air sacs of the lungs into the blood? A Decreased interstitial thickness (Choice B) B Increased lung elastic recoil (Choice C) C Decreased lung capacity (Choice D) D Increased alveolar surface tension

A

Which of the following statements regarding COPD is/are correct? A. Bilateral basilar panlobular emphysema should prompt you to consider obtaining an alapha-1-antiprotease level B. The compliance curve of the respiratory system is shifted down and to the right in emphysema C. The ciliary defect in chronic bronchitis is characterized by the absence of the outer dynein arm of the 9 + 2 microtubule arrangement seen on electron microscopy of bronchial biopsies D. Smoking cessation leads to a halt in the decline in lung function over the years that follow E. B and D

A

A 68 year old male cigar smoker presents with a cough productive of blood streaked sputum and weakness. His chest X-ray reveals a left sided hilar lung mass. His serum electrolytes demonstrate a low sodium (122), normal renal function, normal liver function tests, and normal serum calcium and phosphate. Which of the following is/are true? A. Paraneoplastic syndromes are most frequently associated with squamous cell carcinoma B. This patient may have SIADH (syndrome of inappropriate anti-diuretic hormone) C. His chest film suggests he may have either adenocarcinoma or small cell carcinoma D. If his pulmonary function studies are good, surgery would be the next step for him E. A, B, and C

B

The predominant histological feature in viral pneumonia is extensive accumulation of lymphocytes in the alveolar spaces. (1 point) A. True B. False

B

Which of the following regarding lung cancer is/are true? A. Surgery is routinely employed in the treatment of all stages of lung cancer B. The majority of patients present with unresectable disease at the time of their lung cancer diagnosis C. Smoking and asbestos exposure are additive in their effect on lung cancer risk D. Proto-oncogenes and tumor suppressor gene mutations are the most important risk factors for the development of lung cancer E. A and C

B

Asthma is due to?

Basic impairment of bronchocontriction and airway inflammation which results in wheezing, coughing, shortness of breath. (*bronchioles) Asthma attacks can be caused by smoke, dust, exercise, cold air, allergens, etc.

A 23 year old female has massive aspiration of gastric contents after being admitted comatose following a drug overdose. She is intubated and an arterial blood gas is obtained with results: FiO2 100%, pH 7.30 PaCO2 30 PaO2 40. Her chest xray is most likely to show the following findings : A. Clear lungs with hyperinflation B. Pleural effusion on the right side C. Bilateral alveolar infiltrates D. Clear lungs without hyperinflation

C

A 60 year old with COPD is admitted with PaO2 of 40 while breathing room air, weight gain, shortness of breath, and 4+ pedal edema. The most likely cause of the edema is: A. Left ventricular failure B. Low albumin due to malnutrition C. Right ventricular failure due to hypoxic pulmonary hypertension D. Increased permeability edema

C

A Swan-Ganz catheter is inserted and pulmonary capillary wedge pressure is found to be 12 cm H2O (normal 8-14 cm H2O). The most likely cause of her hypoxemia is: a. R to L shunting due to acute cardiogenic pulmonary edema b. V/Q mismatch due to bronchospasm c. R to L shunting due to Acute Lung Injury d. Increased dead space due to microvascular occlusion

C

Restrictive Lung Disease is defined as: A. a decrease in FEV1 to less than 80% predicted B. a decrease in vital capacity (VC) to less than 80% predicted C. a decrease in TLC to less than 80% predicted D. an increase in residual volume (RV) to greater than 120% predicted

C

The pulmonary function test that is most characteristic of Obstructive Lung Disease is: A. a decrease in FEV1 B. a decrease in FVC C. a decrease in FEV1 / FVC D. a decrease in diffusion capacity (DLCO) E. a decrease in RV

C

Functional Residual Capacity (FRC) is determined by: A. Expiratory Muscle Strength B. Recoil pressure of the chest wall at FRC C. Recoil pressure of the lung at FRC D. b and c E. a and c

D

The patient's pulmonary function studies follow: Pre-Bronchodilator Percent Predicted FVC 2.53 Liters 72% FEV1 2.07 Liters 85% FEV1/FVC 0.82 114% TLC 3.86 Liters 71% RV 0.98 Liters 67% DLCO 14.53 ml/mm Hg/min 64% These results suggest: A. Restrictive lung disease due to neuromuscular process B. Restrictive lung disease due to a chest wall abnormality C. Obstructive airways disease D. Restrictive disease due to a pulmonary parenchymal process E. Mixed obstructive and restrictive lung disease

D

Total Lung Capacity (TLC) is determined by (choose the best answer) : A. strength of the inspiratory muscles B. recoil pressure of the respiratory system at TLC C. recoil of the chest wall at TLC D. a and b E. a and c

D

A 73 year old man with a prior smoking history complaining of gradually progressive dyspnea on exertion comes to your office. His history is significant for work as an insurance auditor prior to retirement. On your exam, you notice he has clubbing of his fingers and fine crackles over the lower quarter of both posterior lung fields. You 24 order a chest X-ray which shows bibasilar increased lung markings and some honeycomb pattern. Your next steps should include: A. Review the patient's medical history in greater detail with respect to past occupations, hobbies, and exposures B. A CT scan of the chest with high-resolution images C. Starting the patient on albuterol and ipratropium for his pulmonary symptoms D. All of the above E. A and B

E

All of the following statements about the role of theophylline in asthma management are correct EXCEPT: A. Narrow therapeutic window requiring serum drug level monitoring and has multiple drug interactions B. Side effects like insomnia, agitation, nausea, loose stools and tachycardia limit tolerability C. Results in bronchodilation by enhancing the activity of endogenous β adrenergic agonists D. Results in anti-inflammatory activity by antagonizing adenosine mediated proinflammatory activity E. Is used as a rescue medicine for patients taking MAO (monoamine oxidase) inhibitors who can not receive β-adrenergic agonis

E

COPD differs from asthma in the following respects: A. It is characterized by partial reversibility of obstruction at best B. Airway inflammation with many eosinophils renders COPD highly responsive to inhaled steroids C. COPD, unlike asthma, is largely preventable D. All of the above E. A and C

E

A 75-year-old lady is referred to the rapid access chest clinic with a four-month history of progressive breathlessness, lethargy, anorexia and one stone weight loss. She reports a dull right-sided chest pain that has been present for the last one month and is partially relieved with 'low dose' co-codamol prescribed by her GP. She is a housewife and smokes 15 cigarettes a day. Her husband, a retired plumber, recently died from a chest problem. On examination, she is dyspnoeic and cachetic. Examination of her chest demonstrates reduced expansion, vocal fremitus, breath sounds and dull percussion note throughout the right lung. Chest x ray reports a medium sized right-sided pleural effusion. The pleura of the right hemi-thorax are thickened. What is the most likely diagnosis? Asbestosis Adenocarcinoma Mesothelioma Pleural adenocarcinoma sqclc

Mesothelioma

The amount of air a person takes in during normal, restful breathing is called the ______.

Tidal volume

Respiratory Volumes and Capacities

Tidal volume (TV) = volume of air that enters and leaves the lungs in a single breath during regular breathing; Inspiratory reserve volume (IRV) = amount of air that can be forcibly inspired after a tidal inspiration; 1200ml Expiratory reserve volume (ERV) = amount of air that can be forcibly expired after a tidal expiration; Residual volume (RV) is the amount of air that remains in the lungs after a forced expiration; Vital capacity (VC) is the total volume of exchangeable air, which is measured as the volume of air that can be forcibly expelled from the lungs after the deepest inspiration; 3500ml Total lung capacity (TLC) is the maximum volume of air in the lungs after the deepest inspiration.

The maximum volume of air that can be released from the lungs by forceful expiration after deepest inspiration is called the ______.

Vital capacity

A patient in the ICU has a PaO2 of 100 and an FiO2 of 40%. The patient also has a normal PA wedge pressure and bilateral infiltrates on x-ray. Which most accurately describes the most appropriate diagnosis and treatment of this patient? a) Acute lung injury, requires treatment b) ARDS, does not require treatment, send patient home c) ARDS, requires treatment d) Normal lung, send patient home e) Acute lung injury, does not require treatment, send patient home

a

Which of the following is not a mechanism of action of omalizumab? A. Blocks the site on IgE where it binds to the high affinity IgE receptor on 5 mast cells and basophils B. Inhibits the activity of 5-lipoxygenase to prevent the synthesis of leukotrienes from arachidonic acid C. Clears unbound, circulating IgE from the blood D. Inhibits mast cell degranulation and the subsequent release of inflammatory mediators E. Down regulates IgE receptors due to increased turnover of unbound Receptors

b

All of the following statements about β- adrenergic agonists used to treat asthma are correct EXCEPT: A. Inhaled β-agonists used in clinical practice are selective for β receptors at usual doses, but become less selective at escalating doses B. Inhaled β-agonists are functional antagonists of constriction and result in relaxation of the airway smooth muscle regardless of mechanism of constriction C. Repeated exposure to inhaled β-agonists results in up-regulation of the β receptors which allows for decreased doses over time D. Long acting β-agonists are not used for acute symptoms and are not intended as first-line therapy for worsening asthma E. Long acting β-agonists are effective in controlling night-time symptoms and exercise-induced symptom

c

Indicate which of the following asthma medications exerts its activity by inhibiting 5-lipoxygenase to prevent the synthesis of leukotrienes from arachidonic acid. A. Zafirlukast B. Montelukast C. Zileuton D. Cromolyn E. Omalizumab

c

All of the following regarding ventilation-perfusion relationships are true except: 8 A. Regions of the lung with reduced ventilation relative to perfusion will contribute to arterial hypoxia B. In the upright patient, the lung apex may have areas of very high ventilation relative to perfusion C. The lung bases tend to be ventilated to a greater extent than the apices D. Dead space ventilation is a cause of hypoxemia E. In a zero gravity environment, we might expect the Aa gradient to decrease

d

The patient is placed on a mechanical ventilator with Tidal Volume 1500cc and FIO2 50%, PEEP 12. An ABG shows pH 7.45 PaO2 110 PaCO2 25. Your next order is which of the following: a. Increase PEEP to 15 to improve A-a gradient b. Give a blood transfusion to improve oxygen transport c. Increase FIO2 to improve oxygen transport d. Decrease Tidal Volume to reduce volutrauma

d

Bronchiectasis may be the end result of which of the following: A. Defective ciliary function B. IgG deficiency C. Sleep-disordered breathing D. Prior severe infection E. A, B, and D

e

Many respiratory diseases affect pulmonary function by altering the ability of alveoli to participate in gas exchange. What physical change would most greatly reduce the degree to which a particular alveolus is ventilated?

increased alveolar elastic recoil