Chest SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE":

Chest

SECTION A: Read each question carefully and record the answer "TRUE" or "FALSE":

1.   Finger clubbing is a typical finding in:

a)     Chronic bronchitis.

b)     Bronchiectasis.

c)      Primary biliary cirrhosis.

d)     Crypto genie fibrosing alveolitis.

e)     Ventricular septal defect.

2.      Typical chest findings In a large right pleural effusion Include:

a)     Normal chest expansion.

b)     Impaired percussion note.

c)      Absent breath sounds.

d)     Vocal resonance decreased.

e)     Pleural friction rub.

3.      Typical chest findings In right lower lobe consolidation include:

a)     Decreased chest expansion.

b)     Dull percussion note.

c)      Decreased breath sounds.

d)     Increased vocal resonance.

e)     Rhonchi and crepitations,

4.      Typical chest findings In right lower lobe collapse Include:

a)     Decreased chest expansion.

b)     Stony dull percussion note.

c)      Bronchial breath sounds.

d)     Decreased vocal resonance

e)     Crepitations

5.   The suppurative syndrome is characterized by:

a)     Excessive expectoration,

b)     Foetid sputum

c)      Finger clubbing

d)     Multiple peripheral abscesses

e)     Bronchial hyper-reactivity

6.      An increase in ventilatory rate is associated with

a)     lactic acidosis

b)     respiratory alkalosis

c)      exercise

d)     fever

e)      decrease in arterial PaCO₂

7.      The following statements about pulmonary function tests are true

a)            over 80% of vital capacity can normally be expelled in 1 second

b)            the transfer factor is measured using inspired oxygen

c)             residual volume is increased in chronic bronchitis and emphysema

d)     the forced expiratory volume (FEV) forced vital capacity (FVC) ratio is usually normal in ankylosing

e)     peak expiratory flow rates accurately reflect the severity of restrictive lung disorders

8.      In a patient with severe acute breathlessness

a)     a normal arterial PaOg invariably suggests psychogenic hyperventilation

b)     pulsus paradoxus is pathognomic of acute asthma

c)      a normal chest X-ray excludes pulmonary embolism

d)     the extremities are typically cool and sweaty in left ventricular failure

e)     left bundle branch block is strongly suggestive of pulmonary embolism

9.      The following disorders characteristically produce type II respiratory failure

a)     heroin overdose

b)     poliomyelitis

c)      pulmonary embolism

d)     cryptogenic fibrosing alveolitis

e)     bronchial asthma

10. In the treatment of chronic bronchitis associated with type II respiratory failure

a)     oxygen should be given so that the inspired oxygen content should be at least 40%

b)     nebulised doxapram improves small airways obstruction

c)      cough disturbing sleep should be treatedwith pholcodine

d)     corticosteroid therapy is usually contraindicated

e)     respiratory support should be considered if pH falls below 7.26

11. Characteristic features of pneumococcal pneumonia Include

a)     sudden onset of rigors and pleuritic pain

b)     peak frequency in childhood and old age

c)      lobar collapse and diminished breath sounds

d)     bacteraemia and neutrophil leucocytosis

e)     herpes labialis

12. Typical features of staphylococcal pneumonia include

a)     an illness cliriically indistinguishable from pneumococcal pneumonia

b)     multiple lung abscesses appearing as thin-walled cysts

c)      association with influenza A infection

d)     staphylococcal sepsis elsewhere in the body

e)     penicillin resistance

13. A non-pneumococcal pneumonia should be suspected if the clinical features include

a)     respiratory symptoms preceding systemic upset by several days

b)     chest signs less dramatic than the chest X-ray appearances

c)      the development of a pleural effusion

d)     the absence of a neutrophil leucocytosis

e)      palpable splenomegaly and proteinuria

14. Recognised features of military tuberculosis Include

a)     severe systemic upset with fever in childhood

b)     blood dyscrasias and hepatosplenomegaly

c)      negative tuberculin test

d)     inconspicuous physical signs in the chest

e)     characteristic granulomata on liver and bone biopsy

15. Rrecognised complications of post-primary tuberculosis include

a)       Aspergilloma

b)      amyloidosis

c)      miliary tuberculosis

d)     bronchiectasis

e)     paraplegia

16. Prophylactic antitubereulosis drug therapy is indicated in the following subjects

a)     insulin-dependent diabetics

b)     patients receiving long-term immunosuppressant drug

c)      HIV antibody-positive subjects

d)     children aged < 3 years who have not had BCG immunisation

e)     adults who have recently become tuberculin-positive

17. Typical features of late-onset bronchial asthma Include

a)     invariable history of cigarette smoking

b)     multiple allergens are often identifiable

c)      exposure to aspirin and certain chemicals induce attacks

d)     asthma is more often chronic than episodic

e)     serum IgE concentrations are often normal

18. Typical features of asthma Include

a)     eosinophilic bronchial infiltrate

b)     increased airway maorophages

c)      goblet cell hyperpiesia

d)     pithelial shedding

e)     subendotholial fibrosis

19. In the management of chnmic persistent asthma

a)     inhaled R2-agonistuse more than once per day is an indication for inhaled steroid therapy

b)     cromoglycate therapy is often useful as an alternative to inhaled steroids in adults

c)      patients taking high doses of inhaled steroids should use a spacer device

d)     leucotriene antagonists are valuable substitutes for inhaled steroids

e)     anticholinergic agents should be avoided

20. Mediastinal opacification on the chest X=ray is a typical feature of a) thymoma

a)     retrostemal goiter

b)     Pancoast tumour

c)      hiatus hernia

d)      neurofibroma

21. Recognised causes of bronchlectasis Include

a)     primary hypogammaglobulinaemia

b)     an inhaled foreign body

c)      cystic fibrosis

d)     asthmatic pulmonary eosinophilia

e)     sarcoidosis

22. Typical features of bronchial adenoma include'

a)     occurrence in elderly females

b)     carcinoid syndrome if liver metastases are present

c)      recurrent haemoptysis

d)     lobar emphysema

e)     recurrent pneumonia

23. Apleural effusion with a protein content of 50 g/L would be compatible with

a)     congestive cardiac failure (CCF)

b)     pulmonary infarction

c)      subphrenic abscess

d)     pneumonia

e)     nephrotic syndrome

24. The following statements about spontaneous pneumothorax are true

a)     breathlessness and pleuritic chest pain are usually present

b)     bronchial breathing is audible over the affected hemithorax

c)      absent peripheral lung markings on chest X-ray suggests tension

d)     surgical referral is required if there is a bronchopleural fistula.

e)     pleurodesis should be considered for recurrent pneumothoraces

25. Recognised features of pulmonary infarction include

a)     peripheral blood leucocytosis and fever

b)     pleuropericardial friction rub

c)      blood stained pleura! effusion

d)     development of a lung abscess

e)     ipsilateral elevation of the hemidiaphragm

26.     Adult respiratory distress syndrome Is associated with

a)            alveolar oedema with a protein content 20g/L

b)            systemic hypotension

c)      severe dyspnoea with rhonchi rather than crepitations

d)     widespread 'fluffy' or 'soft' opacification on chest X-ray

e)      thrombocytopenia and disseminated Intravascular coagulation

SECTION I3 ': Only one Item appropriately applies to the Statement.

27. Which of the following statement regarding sputum cytology in diagnosis of pneumonia is true:

a)     Sputum cytology is not essential to the accurate diagnosis of pneumonia

b)     A good sputum specimen should contain more than 25 squamous cell/HPF

c)      A good sputum should contain many polymorphnuclear leukocytes

d)     A gram stain of a sputum is a waste of time

e)     Z/N staining needs special laboatories

28. Primary atypical pneumonia Is caused by

a)     M catarrallis

b)     Mycoplasma

c)      Hanta virus

d)     Coxeilla burentti

e)     Pneumocystis carnii

29. Which of the following is false about infection with legionella pneumophilia

a)     Caused by a gram negative bacillus

b)     typically presents with fever, diarrhea, hyponatremia

c)      may be diagnosed by antigen detection in urine

d)     treatment of choice is clindamycin

30.        In primary complications of influenza, the most common bacterial invador is:

a)     Peumococcus

b)     Hemohilus influenza

c)      Streptococcus

d)     Staphylococcus

e)     Neisseria catarrhalis

31. Aspiration pneumonia In the recumbent position Is most likely to be associated with

a)     aerobic and anaerobic organisms

b)     an afebrile course

c)      lower lobe infection

d)     Hemophilus influenza infection

e)     Sterile pneumonia

32. A 32 year-old woman with chronic cough of 6 month-duration may have:

a)     Chronic bronchial disease

b)     Chronic pleural disease

c)      A mediastinal mass

d)     A laryngeal polyp

e)     All of the above

33. Cavernous breathing;

a)   Is a form of bronchial breathing

b)     Is usually associated with Whispering Pectoriloque

c)      Is invariably associated with increased tactile vocal fremitus

d)     Is indicative of underlying pulmonary cavitations

e)      All of the above

34.  Dullness in Traube's area may occur in the following conditions EXCEPT

a)            Basal left pneumonia

b)      Left pleural effusion.

c)             Large pericardia! effusion

d)            Huge splenornegaly

e)            Left lobe hepatorna

35. Asthma may be a manifestation of:

a)            Atopy

b)     Mitral stenosis

c)             Chronic bronchitis

d)     Ischemic heart disease

e)     All of the above .

36.     The following investigations are important in patients with bronchogenic carcinoma;

a)            CT chest.

b)     Bronchoscopy and biopsy.

c)      X-ray chest.

d)     All of the above.

37. Bronchogenic carcinoma may present with:

a)     Hypercalcemia.

b)     Esinophilia,

c)      Hemoptysis.

d)     All of the above.

38. All of the following are true about bronchial adenoma except:

a)     It is more common in males.

b)     It is more common in females.

c)      It can produce recurrent hemoptysis.

d)     It is treated surgically.

39. Characteristic features of acute pneumococcal pneumonia Include

a)     Sudden onset of rigors and pleuritic pain

b)     Peak frequency in children and middle age

c)      Lobar collapse and diminished breath sounds

d)     Bacteraemia and neutrophil leucocytosis

e)     Herpes libialis

40. Typical features of staphylococcal pneumonia include

a)     An illness clinically indistinguishable from pneumococcal pneumonia

b)     Multiple lung abscesses appearing as thin-walled cysts

c)      Association with influenza A infection

d)     Staphylococcal sepsis elsewhere in the body

e)     Penicillin resistance

41. Recognized features of mycoplasma pneumonia include

a)     Institutional outbreaks in young adults

b)     Hemolytic anemia and cold agglutinins in the serum

c)      Fever and malaise preceding respiratory symptoms by several days

d)     Inconspicuous physical signs in the chest

e)     Response to erythromycin, clarithromycin, or tetracyclines

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