EXTRA QUESTIONS MDE RESPIRATORY SYSTEM BATCH KPBI 2007

31. Male, 20 years old, alert. Present at Emergency Room with shortness of breath. Can only speak in short phrases. RR=28, expiratory wheezing, intercostal muscle retraction, chest hyperinflation. O2 saturation=90-95%. Which of the following characterized in this disease?

1. Sodium cromoglycate inhibit phosphodiesterase therefore increase CAMP which lead to brochodilation
2. Silent chest and cyanosis
3. Peak Expiratory Flow Rate during acute attack usually decrease
4. Acute attack characterized by bronchoconstriction which not usually reversible
5. Disease result from lung parenchyme destruction from smoking

32. WOTF characteristic of acute severe in this disease?

1. Urea >7mmol/L
2. PEFR < 33% predicted of the best
3. Pulse > 100 beats/min
4. Mucus secretion decreased
5. Inability to speak in one breath

33. Which of the following exam result will be found in this patient?

1. Ti CO is decreased
2. Residual volume may be increased
3. Bronchial provocation test are essential for diagnosis
4. FEV improves after bronchodilation
5. Cough is typically worse in the morning

34. A 56 years old man come with a complaint of difficult to breath. He is a smoker. His blood gas analysis shows, pO₂ is 6 kpa, pCO₂ is 5 kpa and pH is 7.4.

What is the appropriate condition for this patient?

A.    No significant respiratory problem

B.     Respiratory acidosis

C.     Hypoxia, but unlikely have acidosis

D.    Respiratory alkalosis

E.     Hypoxia, but unlikely have alkalosis

36. Female patient with hyperventilating, frequent, deep, sighing respiration to sustained obvious, rapid, deep breathing fell unconscious on the floor. An attending physician diagnosed her condition as “hyperventilation syndrome” caused by her anxiety and mental stress. He successfully treated her by rebreathing expired CO2 from a paper bag and she completely recovered. According to the clinical scenario above, what do you think the rationale of the treatment?

A.    Rebreathing from the paper bag in which CO2 is accumulated and will normalize the pCO2  and decreases the blood pH to a normal or near normal level

B.     Rebreathing from the paper bag in which O2 is accumulated and will normalize the pO2  and decreases the blood pH to a normal or near normal level

C.     Rebreathing from the paper bag in which HCO3 is accumulated and will normalize the pHCO3  and decreases the blood pH to a normal or near normal level

D.    Rebreathing from the paper bag in which H+ is accumulated and will normalize the pH30  and decreases the blood pH to a normal or near normal level

E.     Rebreathing from the paper bag in which OH- is accumulated and will normalize the pOH-  and decreases the blood pH to a normal or near normal level

37. Which Of the following situation is caused by increased of PO2 in arterial blood that causes the chemoreceptor to stimulate the respiratory center?

1. Increase respiratory rate
2. Decrease respiratory rate
3. Hypocapnia
4. Hypercapnia
5. Hypoxia

39. The pediatric disorder associated with the type 2 epithelial cell. Its lack of maturity and surfactant secretion. Which of the following pediatric disorder is appropriate with the above?

1. Alveolar proteinase
2. HMD
3. Pulmonary embolism
4. Emphysema pulmonum
5. Cystic lung disease

40. The alveoli of human lung are lined by type 2 of epithelial cells,the type 1 epithelial cell and the type 2 epithelial cell. Which are the following is true about type 2 epithelial cell?

1. Extremely broad, thin cell
2. That covers 95%of the alveolar surface
3. It is the source of pulmonary surfactant
4. It is markedly differential cell possessing few organelles
5. Owing to their squamous shape

41. Two elderly person, both diagnosed as having pleurisy were comparing their illness. One had left thoracic pain, whereas the other has left neck and shoulder pain. They were to the point of reviewing the academic qualifications  of their respective physicians. Assuming the diagnosis to be correct, the explanations for these differences in pain distribution is the pleura is innervated by :

1. Cervical splanchic and thoracic splanchnic nerve
2. Intercostal and phrenic nerve
3. Parasymphatetic and symphatetic nerve
4. Phrenic and vagus nerve
5. Vagus and intercostal nerve

42. Lung morphogenesis can be subdivided into distinct periods on the basis of the morphological characteristic of the tissue. This periods is occur from 26-36 weeks of gestation and characterized by increased thinning of the respiratory epithelium and pulmonary mesenchyme, further growth of lung acini, and development of the distal capillary network.

Which of the following period is appropriate to be above?

1. Embryonic period
2. Canalicular period
3. Alveolar period
4. Saccular period
5. Pseudoglobular period

43. A newborn infant was choking and coughing after 1^st feeding. There was excessive mucus secretion and saliva in infant mouth and infant considerably difficult to breath. Pediatricians is unable to pass catheter through the esophagus.

1. Laryngeal atresia
2. Laryngotracheoesophageal atresia
3. Atresia esophagus + trachea esophageal fistula
4. Laryngeal web
5. Tracheal atresia

44. WOTF is the infection caused by this anomaly?

1. Pharyngitis
2. Sinusitis
3. Esophagitis
4. Carditis
5. Gastritis

45. Preterm baby....deep, shallow breathing. Diagnosed as Acute Respiratory Distress. Which statement is true?

1. Surfactant increase alveolar surface tension
2. Surfactant produce in sufficient amount at the end of saccular period
3. Surfactant production at 18-26 weeks
4. Surfactant produce in sufficient amount after birth
5. :(

46. The development of nose started at the 1st trimester. Which of the following is CORRECT?

1. During 5th week, nasal crest invaginate to form nasal sac
2. End of 6th week, oronasal membrane rupture & form permanent conchae
3. After 2nd pate develop, conchae is located at junction of nasal cavity & larynx
4. Medial wall of the nasal cavity develop conchae
5. Olfactory epitelium is derived from ectoderm

47. Human development of ear was started during 1st trimester. Which of the following is correct about the embryological development?

1. Tympanic cavity is derived from 1st pharyngeal arch
2. Auditory tube is derived from 1st pharyngeal arch
3. Stapes is derived from the cartilage of the 2nd pharyngeal arch
4. Malleus is derived from the cartilage of the 2nd pharyngeal arch
5. Stapedius muscle is derived from 1st pharyngeal arch

48. 20 years old man with asthma presents with complains of cough and chest tightness. Which have been requiring him to inhale a β-2 receptor agonist. He notes waking up from sleep approximately 3 times per week with similar symptom. What is the most appropriate diagnosis?

1. Intermittent asthma
2. Mild persistent asthma
3. Moderate persistent asthma
4. Severe persistent asthma
5. Status asthamicus

49. What treatment should be added for this patient?

1. Oral corticosteroid
2. Oral low dose corticosteroid
3. LABA
4. Inhaled cortcosteroid
5. Inhaled anti cholinergenic

50. 62 years old man, increases shortness of breath

Complaint : cough, increased sputum production for last 5 years

History : smoked since 15 years old & stopped smoking 2 years ago

Chest X-ray:

- hyperinflation

- flattened diaphragm

- no infiltrate found

FEV1/FVC 60%, FEV1 45%

PE :

- neck vein distention

- positive hepato-jugular reflux

- peripheral lower extremity edema

- loud pulmonic second sound

ECG : right ventricular hypertrophy

Doctor suspect pulmonary hypertension

The most useful initial treatment:

1. Digitalis
2. Diuretic
3. Oxygen
4. Mucolytic
5. Antibiotic

143. Nowadays Isolation precautions cover all previous precautions ever defined. One of the precaution below included in Isolation precaution:

1. Whole body precaution
2. Contaminant precaution
3. Standard precaution
4. Surface precaution
5. Sputum precaution

144. Airborne precaution should be implemented especially for patients with?

1. Influenza & bacterial meningitis
2. TB & chicken pox
3. Rubella & diarrhea
4. MRSA & skin infection
5. Dengue & typhoid

145. 30 years old man present in ER with complain of high fever, cough and pain on right side of chest.

PE: rales and bronci at right lower lung

Lab: Hb à within normal limit

WBC: 22,400 (N: 4000-10 000)

Diff count 80% of PMN (N : 20-40%)

Sputum microscopy revealed gram +ve cocus in lancet shape

Imaging : chest x-ray revealed right lower lobe infiltrate

What is most likely etiology of the disease?

1. S. Pyogenes
2. S. pneumonia
3. S. Viridans
4. S. Asalactiae
5. S. Equisimitis

146. A patient in Emergency Room with abrupt high fever and cough. He also complains of pain in the chest and breathlessness.

Physical examination : rales and rhonchi at right lower lung

Laboratory examination :

            White blood cell and polymorphonuclear cells increase

            Hemoglobin in normal limit

            Sputum : Garam positive coccus, lancet shape

Radiologic test : right lower lobe infiltrate

What other laboratory test needed?

A.    Blood gas analysis

B.     Blood pH analysis

C.     Blood HCO₃^- analysis

D.    Blood CO₂ analysis

E.     Blood O₂ analysis

148. Patient diagnosed with otitis media suppuration, mastoiditis, rhinosinusitis, tonsil adenoid hypertrophy. What can be found in lab exam for this patient?

1. Hb- 12 g/dl , Lymphocyte- 4500, Platelet- 150k, PBS- granula azurophilic
2. Hb- 12 g/dl , Lymphocyte- 6000, Platelet- 200k, PBS- granula basophilic
3. Hb- 12 g/dl , Lymphocyte- 8000, Platelet- 220k, PBS- granula neutrophilic
4. Hb- 12 g/dl , Lymphocyte- 10500, Platelet- 240k, PBS- granula eosinophilic
5. Hb- 12 g/dl , Lymphocyte- 3000, Platelet- 280k, PBS- granula toxic

149. Mr Cepi, 65 years old man in ER was diagnosed by doctor with Chronic Obstructive Pulmonary Disorder. The doctor needs the test of respiratory status, and the results are :

pH 7.28 (↓), PaCO2 50 (↑), PaO2 60 (↓), O2 saturation 90% (↓)

Which of the following condition would support the diagnosis?

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

151. A 40 years old female admitted to the hospital with dyspnea and bloody cough. Chest X-Ray revealed solitary coin lesion at the right lung. The biopsy was performed and microscopic examination of lesion showed atypical cells arranged in tubular formation. Which of the following is most likely diagnosis?

1. Squamous cell carcinoma
2. Adenocarcinoma
3. Adenoma
4. Carcinoid tumor
5. Malignant mesothelioma

152. A 40 year old man admitted to hospital with dyspnea. He is an active smoker since 25 years ago. The doctor thinks that the patient had COPD and assumed the process still occurred in the centrilobular. WOTF structures involves with this patient?

1. Alveolar sac
2. Terminal Bronchiole
3. Alveolar duct
4. Respiratory Bronchioles
5. Capillary

40 years old man have dyspnea. He is an active smoker since 25 years ago. The doctor thought that he has COPD, problem still around centriacinar.

153. WOTF statement is correct regarding pathogenesis of the disease?

1. Destruction of distal acinus = centrilobular empysema
2. Destruction of distal acinus = paraseptal empysema
3. Destruction of entire acinus = panlobular empysema
4. Destruction of proximal acinus = centrilobular empysema
5. Destruction of proximal acinus = paraseptal emphysema

154. Histological lung tissue revealed massive suppurative, neutrophilic rich exudated which fill the bronchi and bronchioles and it spills into the adjacent alveolar spaces only. Majority of the lung do not involved in the inflammatory process. Hyaline membrane are not found. Which of the following is most likely the diagnosis?

1. Bronchoectasis
2. Bronchopneumonia
3. Lobar pneumonia
4. Interstitial pneumonitis
5. Pulmonary abcess

155. A 45 years old man came with chief complaint of coughing and wheezing preceded by minor cold and worsen during rainy days. His mother has the same symptom. CBC and IgE count is normal. What is the mechanism for the disease above?

1. Mast cell accumulation
2. Eosinophil migration
3. IL4 & IL5 secretion
4. Broncial hyperreactivity
5. Hyperresponsiveness to Aspergillus

156. WOTF morphological changes occur as advance cases of obstructive and restrictive diseases?

1. Marked medial thinning of pulmonary capillaries
2. Fibrosis of the alveolar wall
3. Hemorrhage at the alveolar wall
4. Destruction of elastic tissue
5. Hyaline membrane lining at the ...

161. A 47 years old women suffers from chronic cough, fever and weight loss. Chest X-Rays picture shows picture suggestive of lung tuberculosis. The doctor suspected the patient have TB. The doctor asked for culture. What is the stain used for culture the bacteria?

1. Simple stain
2. Gram stain
3. Ziehl Neelsen stain
4. Capswule stain
5. Spore stain

162. Which of the following statement concerning Mycobacterium tuberculosis is CORRECT?

1. After being stained with carbol fuchsin the bacteria resist decolorization with acid alcohol
2. The cell wall of bacteria has a large amount of lipopolysaccharide
3. The bacteria appears as a red rod in Gram staining specimens
4. The counterstain of acid fast procedure is safranin
5. The color of acid fastness of Mycobacterium tuberculosis caused by color of counterstain