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Home , Acute severe asthma, Bronchodilatation, Wheeze

PULMONARY MEDICINE

1. You see a 68-year-old man in clinic, with a 40 (cigarette) pack 6. A 45-year-old woman with unexpected weight loss, loss of year history, who has been experiencing reathlessness on appetite and presents to you in clinic. exertion and a productive of white over the last On examination, there is reduced air entry and dullness to four months. You assess his results which reveal in the right . A pleural tap is performed and an FEV1/FVC of 51 per cent with minimal reversibility after a the aspirate samples sent for analysis. You are told that the 2-week trial of oral steroids. Cardiological investigations are results reveal a protein content of 30 g/L. From the list below, normal. Which of the following is the most likely diagnosis? select the most likely diagnosis: a. a. Bronchogenic carcinoma b. Chronic obstructive pulmonary disease (COPD) b. Congestive cardiac failure c. Left ventricular failure c. Liver cirrhosis d. Chronic d. Nephrotic syndrome e. Lung fibrosis e. Meig’s syndrome

2. A 67-year-old woman is admitted to accident and emergency 7. You are discussing a patient with your registrar who has with pyrexia (38.1°C) and a cough productive of green become acutely short of breath on the ward. After performing sputum. The observations show a pulse rate of 101, BP 80/60 an arterial blood gas, you have high clinical suspicion that the and of 32. She is alert and orientated in space patient has a . Which of the following is and time. Blood results reveal a WCC of 21, urea of 8.5 and the investigation of choice for detecting pulmonary embolism? chest x-ray shows a patch of consolidation in the lower zone of a. Magnetic resonance imaging (MRI) of the chest the right lung. She is treated for severe community-acquired b. High-resolution CT chest (HRCT) . Which of the following is the correct calculated CURB-65 score? c. Chest x-ray a. 6 d. Ventilation/ scan (V/Q scan) b. 8 e. CT pulmonary angiogram (CT-Pa) c. 4 8. A 28-year-old man has been newly diagnosed with asthma. d. 0 He has never been admitted to hospital with an asthma e. 1 exacerbation and experiences symptoms once or twice a week. You discuss the treatment options with him. His peak 3. Which of the following organisms would typically be found expiratory flow reading is currently 85 per cent of the normal in a patient with atypical community-acquired pneumonia? predicted value expected for his age and height. Which of the a. Staphylococcus aureus following is the most appropriate first step in treatment? b. Pseudomonas spp. a. Short-acting beta-2 agonist inhaler c. Streptococcus pneumonia b. Long-acting beta-2 agonist inhaler d. Legionella pneumophilia c. Low-dose steroid inhaler e. Haemophilus d. receptor antagonists e. High-dose steroid inhaler 4. You are asked to interpret an arterial blood gas of a 76-year- old patient who was admitted to accident and emergency with 9. You see a 46-year-old man who has presented to accident an onset of breathlessness and low oxygen saturations. and emergency with an acute onset of shortness of breath. The test was taken on room air and read as follows: pH 7.37, Your registrar has high clinical suspicion that the patient is PO2 7.8, PCO2 4.1, HCO3 24, SO2 89 per cent. Choose the most suffering from a pulmonary embolism and tells you that likely clinical interpretation from these arterial blood gas the patient’s ECG has changes pointing to the suspected results: diagnosis. From the list below, which of the following ECG a. Compensated respiratory acidosis changes are classically seen? b. Type 1 a. Inverted T-waves in lead I, tall/tented T-waves in lead III and flattened T-waves in lead III c. Compensated respiratory alkalosis b. Deep S-wave in lead I, pathological Q-wave in lead III and d. Type 2 respiratory failure inverted T-waves in lead III e. None of the above c. Flattened T-wave in lead I, inverted T-wave in lead III, and deep S-wave in lead III 5. A 54-year-old woman is seen in clinic with a history of weight loss, loss of appetite and shortnesss of breath. Her respiratory d. No changes in lead I, deep S-wave in lead III rate is 19 and oxygen saturations (on room air) range between e. Deep S-wave in lead I with no changes in lead III 93 and 95 per cent. On examination, there is reduced air entry and dullness to percussion on the lower to midzones of the 10. Which of the following arterial blood gas results, taken on right lung. There is also reduced chest expansion on the right. room air, would you expect to see in a 67-year-old patient who From the list below, select the most likely diagnosis: has been suffering with COPD for two years and is noton a. Right middle lobe pneumonia home oxygen? b. Pulmonary embolism a. pH 7.35, PO2 11, PCO2 5.3, HCO3 24, SO2 98 per cent c. Right-sided b. pH 7.47, PO2 12, PCO2 5.1, HCO3 30, SO2 97 per cent d. Right-sided bronchial carcinoma c. pH 7.44, PO2 8.3, PCO2 6.7, HCO3 28, SO2 93 per cent e. Right lower lobe pneumonia d. pH 7.31, PO2 10.2, PCO2 6.8, HCO3 25, SO2 95 per cent e. pH 7.30, PO2 11.5, PCO2 5.2, HCO3 18, SO2 96 per cent 11. You see a 46-year-old woman on your ward who has been d. Prophylactic dose subcutaneous low molecular weight 1267 diagnosed with following a three-month heparin loading with warfarin and aim for INR between 2 history of a mucopurulent cough. Which of the following and 3 from the list below is not a cause of ronchiectasis? e. Treatment dose subcutaneous low molecular weight a. Kartagener’s syndrome heparin loading with warfarin and aim for INR between 2 b. and 3 c. Pneumonia 17. You see a 67-year-old man who has been referred to the chest d. Left ventricular failure clinic following a three-month history of weight loss and e. Bronchogenic carcinoma signs which may suggest a Pancoast’s tumour. Which of the following symptoms from the list below is not associated with 12. A 30-year-old man presents to your clinic with a cough and a Pancoast’s tumour? finger clubbing. From the list below, which of these answers a. Hoarse voice PULMONARY MEDICINE is not a respiratory cause of finger clubbing? b. Miosis a. Empyema c. Anhydrosis b. Mesothelioma d. Exopthalmos c. Bronchogenic carcinoma e. Ptosis d. Cystic fibrosis e. COPD 18. A 50-year-old Afro-Caribbean man, with no past medical history, presents with a four-month history of dry cough and 13. A 55-year-old woman, who has never smoked, presents to you shortness of breath on exertion. The patient’s GP referred on the ward with a history of weight loss, decreased appetite him to the chest clinic after performing blood tests which and finger clubbing. You are told that her chest x-ray revealed revealed a raised erythrocyte sedimentation rate (ESR) and opacity in the hilar region of the right lung suggesting a serum angiotensin-converting enzyme (ACE) level. You bronchogenic carcinoma. She is currently awaiting a CT-chest review the patient’s chest x-ray which reveals bilateral hilar with bronchoscopy to follow. From the list below, select the lyphadenopathy. From the list below, select the most likely most likely diagnosis: diagnosis: a. Squamous cell carcinoma of the lung a. Rheumatoid arthritis b. Adenocarcinoma of the lung b. Systemic lupus erythematosus (SLE) c. Small cell carcinoma of the lung c. d. Large cell carcinoma of lung d. Idiopathic e. Carcinoid tumour of the lung e. Bronchogenic carcinoma

14. You see a 28-year-old man, with no past medical history, in 19. A 67-year-old man presents with dyspnoea and fatigue with accident and emergency who developed an acute onset of signs of a raised jugular venous pressure (JVP), hepatomegaly pleuritic and shortness of breath while playing and peripheral oedema. The patient has a longstanding history football. On examination, oxygen saturations are 93 per cent of COPD. You suspect cor pulmonale. Which of the following on room air, respiratory rate 20 and temperature is 37.1°C. is not a cause of cor pulmonale? There is decreased expansion of the chest on the left side, a. Pulmonary fibrosis hyper-resonant to percussion and reduced air entry on the left. b. Primary pulmonary The most likely diagnosis is: c. Myasthenia gravis a. Left-sided d. COPD b. Left-sided pneumonia e. Multiple sclerosis c. Left-sided pleural effusion d. Lung fibrosis 20. You are told by your registrar that a 69-year-old man has been e. Traumatic chest injury admitted to the chest ward with dyspnoea, and finger clubbing. His chest x-ray shows bilateral lower zone reticulo- 15. You are asked to request imaging for a patient with a suspected nodular shadowing. From the list below, which is the most pneumothorax who you have just examined in accident likely diagnosis? and emergency. Which of the following would be the most a. Bronchiectasis appropriate first step imaging modality? b. Pulmonary fibrosis a. CT-chest c. Bronchogenic carcinoma b. Ultrasound chest d. Bronchitis c. Chest x-ray e. COPD d. V/Q scan e. CT-PA 21. A 25-year-old woman is admitted to accident and emergency with a severe exacerbation of asthma. On examination, her 16. A 68-year-old woman has presented with acute onset shortness respiratory rate is 30, oxygen saturations are 95 per cent on of breath 24 hours after a long haul flight. Her blood results 15 L O2 and temperature is 37.2°C. As you feel the peripheral show a raised D-dimer level and the arterial blood gas shows pulse, the volume falls as the patient inspires. Which of the a PO2 of 8.3 kPa and PCO2 of 5.4 kPa. Your consultant suspects following explains this clinical sign? a pulmonary embolism and the patient needs to be started a. Increased left atrial filling pressures on inspiration on treatment while a CT-PA is awaited. From the list below, b. Decreased right ventricular filling pressures on inspiration please select the most appropriate treatment regime. c. Peripheral vasodilation a. Commence loading with warfarin and aim for an international normalized ratio (INR) between 2 and 3 d. Decreased right atrial filling pressures on inspiration b. Thromboembolic deterrent stockings e. Decreased left atrial filling pressures on inspiration c. Aspirin 75 mg daily 1268 22. A 55-year-old man, who has never smoked and with no d. it is associated with Kussmaul’s sign past medical history, has been diagnosed with right basal e. the commonest symptom is community-acquired pneumonia. There are minimal changes on his chest x-ray and bloods reveal a count of 8.2 28. You see a 70-year-old man diagnosed with hypersensitivity and a C-reactive protein (CRP) of 15. He has no drug . following a four-month history of shortness of Although he has a productive cough of green sputum, his breath at rest and cyanosis. Which of the following does not respiratory rate is 16, oxygen saturations are 97 per cent on fall under the category of hypersensitivity pneumonitis? room air and his temperature is 37.4°C. You are asked to place a. Coal worker’s lung him on treatment. Which of the following treatment options would be appropriate for this patient? b. Pigeon fancier’s lung a. Oral amoxicillin c. Mushroom picker’s lung b. Oral erythromycin d. Farmer’s lung c. Intravenous ertapenem e. Malt worker’s lung d. Intravenous ertapenem with a macrolide (e.g. 29. A 44-year-old plumber has a 4-day history of fever and clarithromycin) generalized myalgia. Two days ago he developed a dry 's e. Intravenous tazocin cough coupled with mild dyspnoea and has been feeling very lethargic. On examination his temperature is 38.5°C, MCQ 23. A 56-year-old woman who has recently been discharged from respiratory rate 20, oxygen saturations ranging between 93 and your ward, with oral antibiotics for right basal community- 96 per cent on room air and of the chest reveals acquired pneumonia, is re-admitted with transient pyrexia bibasal . Bloods show a raised white cell count of 18.2 and shortness of breath. She is found to have a right-sided and neutrophil count of 11.0, CRP of 90 and a raised ALT of pleural effusion which is drained and some pleural aspirate 261 and ALP 96. Chest x-ray reveals bibasal consolidation. The sent for analysis. The results reveal an empyema. Which of the patient is treated with antibiotics for bibasal pneumonia. From following, from the pleural aspirate analysis, would typically the list below, select the most likely organism responsible for be found in a patient with an empyema? the pneumonia: a. pH 7.2, ↑ LDH, ↑ glucose a. Pseudomonas spp. b. pH 7.2, ↑ LDH, ↑ glucose b. S. pneumoniae c. pH 7.2, ↓ LDH, ↓ glucose c. d. pH 7.2, ↑ LDH, ↓ glucose d. L. pneumophilia e. pH 7.2, ↔ LDH, ↔ glucose e. S. aureus

24. You are told that a patient in clinic has been diagnosed with 30. Which of the drugs below would be the most appropriate to cystic fibrosis using the sodium chloride sweat test. Which treat pulmonary Aspergillus spp. infection? of the following results from the latter test would indicate a a. Amoxicillin positive diagnosis of cystic fibrosis? b. Erythromycin a. Sodium chloride 40 mmol/L c. Amphotericin B b. Sodium chloride 60 mmol/L d. Flucloxacillin c. Sodium chloride 50 mmol/L e. Fluconazole d. Sodium chloride 60 mmol/L e. Sodium chloride 30 mmol/L 31. 68-year-old woman is admitted to accident and emergency with shortness of breath and cough. She has been a smoker 25. Which of the following organisms, responsible for causing for 25 years, on average 20 cigarettes a day, and is chronic pneumonia, is most commonly found in patients with a known COPD patient with home oxygen. The observations longstanding cystic fibrosis? read a pulse rate of 101, blood pressure of 100/60, respiratory a. L. pneumophilia rate of 20, oxygen saturations of 88 per cent on air and b. S. pneumonia temperature of 37.2°C. On auscultation you hear bilateral expiratory . She is prescribed nebulizers ( 5 c. Burkholderia cepacia mg ipratropium 500 g) with oxygen and chest x-ray requested. d. Pseudomonas aeruginosa Intravenous access has been established and bloods sent for e. H. influenza analysis. From the list below, select the most appropriate next step in this patient’s management plan. 26. From, the list below, which of the following carcinomas of the a. Arterial blood gas sampling lung is highly associated with exposure to asbestos? b. Peak flow assessment a. Adenocarcinoma c. Urine dip microscopy and sensitivity b. Small cell carcinoma d. Start non-invasive ventilation (e.g. BIPAP) c. Squamous cell carcinoma e. Obtain sputum for microscopy, culture and sensitivity d. Malignant mesothelioma (MC&S) e. Large cell carcinoma 32. During the consultant ward round, you see a 78-year-old 27. A 45yearold man develops facial swelling and breathlessness. woman who is being investigated for hyponatraemia, weight His chest Xray reveals paratracheal lymphadenopathy. Which loss and haemoptysis. A mass lesion was detected on a CT- of the following statements is most accurate regarding the chest scan which has been biopsied and sent for histological superior vena caval obstruction? analysis. Your consultant has a high suspicion that the patient may have bronchogenic carcinoma. From the list below, select a. the most common cause is squamous cell carcinoma the most likely type of bronchogenic carcinoma that would b. treatment of choice is radiotherapy explain the above patient’s symptoms: c. it may be associated with voice hoarseness a. Large cell carcinoma b. Small cell carcinoma c. Adenocarcinoma below, which of the following answers is the most appropriate 1269 d. Squamous cell carcinoma and recommended treatment regimen for this patient? e. Alveolar cell carcinoma a. Three months of isoniazid, rifampicin, ethambutol and pyrazinamide, followed by three months of isoniazid and 33. The severity of COPD is assessed using post rifamipicin spirometery analysis. From the list below, select the values b. Four months of isoniazid and rifampicin, followed by that you would expect to see in a patient with moderate COPD. two months of isoniazid, rifampicin, ethambutol and a. FEV1/FVC 0.7, FEV1 per cent predicted 30–49 per cent pyrazinamide b. FEV1/FVC 0.7, FEV1 per cent predicted ≥80 per cent c. Six months of isoniazid, rifampicin, ethambutol and pyrazinamide c. FEV1/FVC 0.7, FEV1 per cent predicted 30 per cent d. Six months of isoniazid and rifampicin d. FEV1/FVC 0.7, FEV1 per cent predicted 50–79 per cent e. Two months of isoniazid, rifampicin, ethambutol and PULMONARY MEDICINE e. FEV1/FVC 0.7, FEV1 per cent predicted 60–70 per cent pyrazinamide, followed by four months of isoniazid and 34. A 58-year-old man with known COPD, diagnosed eight rifampicin months ago, attends your clinic with persistent shortness of 38. A 45-year-old man with diabetes, diagnosed with pulmonary breath despite stopping smoking and using his salbutamol TB who started treatment two months ago, presents to you inhaler (given to him at the time of diagnosis), which he with a week’s history of pins and needles in his hands and finds he is using more frequently. You assess the patient’s feet with associated numbness. He tells you that his symptoms lung function tests that have been recorded just before he started since he stopped taking the vitamins given to him at saw you in clinic on this occasion. His FEV1 65 per cent of the the start of his TB treatment. From the list below, which of the predicted value. Oxygen saturations are 95 per cent on room following drugs is responsible for the symptoms described by air, respiratory rate in 18, and his temperature is 37.1°C. From the patient? the list below, select the next most appropriate step in this patient’s management. a. Pyrazinamide a. 40 mg daily oral prednisolone for 5 days b. Rifampicin b. Start long-term oxygen therapy c. Ethambutol c. Start inhaled therapy d. Isoniazid d. Add oral theophylline therapy e. None of the above

e. Add a long-acting 2 agonist inhaler 39. A 37-year-old woman is admitted to accident and emergency with severe facial . Despite prompt management, she 35. A 58-year-old man is admitted with a mild exacerbation of develops acute respiratory distress syndrome (ARDS). Which asthma. He suffers with hypertension which is controlled of the following is not associated with the diagnostic criteria with medication. He was given 5 mg salbutamol and 500 g for ARDS? ipratropium nebulizers, on route to hospital, by paramedics and has received ‘back to back’ salbutamol 5 mg nebulizers a. Bilateral infiltrates on chest x-ray since admission to accident and emergency. The patient b. Acute onset was then sent to the acute medical unit where he was given c. Pulmonary capillary wedge pressure 19 regular nebulizers along with his regular antihypertension medication. Before he was discharged, his serum potassium d. Refractory hypoxaemia (PaO2:FiO2 200) reading was 2.9. Select, from the list below, the drug which is e. Lack of clinical congestive most likely to have caused the hypokalaemia. a. Ipratropium 40. You see a 76-year-old woman in accident and emergency who has been admitted with a 1-day history of shortness b. Ramipril of breath and pyrexia (38.4°C). The patient’s past medical c. Salbutamol history includes hypertension, stroke and insulin-dependent d. Amlodipine diabetes. She has no known drug allergies. The nursing staff report that the patient vomited after her lunchtime meal e. Paracetamol yesterday. On examination the patient’s respiratory rate is 26, oxygen saturations 93 per cent on room air. On auscultation of 36. A 56-year-old man attends your clinic with a three-month the chest, you hear right basal crackles. You suspect that this history of a productive cough with blood-tinged sputum, patient is suffering from . From the list following his return from India. Associated symptoms include below, which is the most appropriate antibiotic regimen for lethargy, night sweats and decreased appetite. He is normally this patient? fit and healthy with no past medical history. On examination, the patient’s chest has good air entry bilaterally with no added a. Intravenous cefuroxime and metronidazole sounds and his temperature is 37.3°C. A sputum sample sent b. Oral amoxillicin and metronidazole from the patient’s GP reveals a growth of acid fast bacilli. c. Intravenous clarithromycin From the list below, which is the most likely diagnosis? d. Intravenous cefuroxime a. Pulmonary embolism e. Oral co-amoxiclav b. c. Bronchitis 41. A 7 month old boy is presented to a doctor by his parents d. Pneumonia with symptoms of reccurent upper infections. No other members of the family suffer from e. Bronchogenic carcinoma any smiliar infections. showed mild facial hypoplasia. Biochemistry investigations revealed 37. Your clinic patient has been diagnosed with pulmonary hypocalcaemia. Microbiological investigations were normal tuberculosis (TB) following a three-month history of and immunoglobulins were within normal limits. The infants haemoptysis and fever. The patient is due to start on treatment immune function would show the following deficiency: and you are asked by your registrar which of the following regimes is the most suitable. The patient has no known drug a. Complement Deficieny allergies and, in addition, liver function tests and urea and b. number and function electrolytes results are all within normal ranges. From the list 1270 c. T cell number and function 50. Unexpectedly increase in is found in d. Plasma Cell a. Cystic fibrosis e. Macrophage number and function a. Pulmonary heamorrage b. Bronchitis 42. Progressive Massive Fibrosis (PMF) is most likely to be found in which of the following? c. Bronchiectasis a. Complicated 51. In a 40 year patient there was pleural fluid .Analysis of this b. Extrinsic allergic alveolitis fluid showed a protein ratio of 0.38 and a LDH level of 125 c. U/L and LDH ratio of pleural fluid to serum of 0.48. The most probable diagnosis is d. Sarcoidosis a. Ureamia e. Simple coal workers b. Congestive cardiac failure 43. A 17yearold girl with known cystic fibrosis presents with a c. Sarcoidosis chest infection. What antibiotic would be most suitable for d. Pulmonary embolism

's her? a. Augmentin 52. Charcterstic pathological feature of pneumococcal pneumonia MCQ b. Cefotaxime a. Consolidation c. Ceftazidime b. interstitiall pneumonitis d. Gentamicin c. increased e. Amoxicillin d. hilar lymphadenopathy

44. A 21yearold gentleman with cystic fibrosis presents with 53. A 28 yr female , has diarrhoea , , high grade fever infertility. What is the most likely cause for this? with b/l pneumonitis. The diagnosis is a. Chronic prostatic insufficiency a. Legionella b. Failure of development of the vas deferens b. Neisseria meningitides c. Increasing alkalinisation of semen c. strep. Pneumoniae d. Primary failure of testosterone production d. H. influenza e. Production of antisperm antibodies 54. DOC for pneumocystic jiroveci is 45. A 16yearold girl presents with shortness of breath and a. Clotrimazole insomnia prior to an examination. Clinical examination is b. cotrimoxazole normal. CXR and PEFR are normal. Which of the following c. penicillin investigations is most suggestive of asthma? d. fluroquinolones a. diurnal variation in PEFR> 20% b. positive skin prick test to common allergens 55. In “pneumonia severity scale” most important factor is c. past medical history of hayfever and eczema a. Age d. increased total IgE b. CHF e. resolution of symptoms the day after the exam c. hypothermia d. hyponatremia 46. All of following produce exudative “pleural effusion” except a. Rheumatoid Disease 56. Dose og MgSO4 in asthma is- b. Pulmonary infarction a. 8 gm iv over 20 min c. Acute Pancreatitis b. 2 gm iv over 40 min d. Cardiac Failure c. 2 gm iv over 20 min d. 6 gm iv over 20 min 47. All of the following can precipitate Asthma except : a. LRTI 57. Granulomatous condition showing hypercalcemia are all b. Aspirin except c. GERD a. TB d. None b. sarcoidosis c. 48. Which is not a feature of kartagener syndrome: d. SLE a. Dextrocardia b. Situs Inversus 58. Which of the following is characteristically not associated c. Cystic Fibrosis with development of interstitial lung disease a. Organic dust d. Absence of cilia b. inorganic dust 49. What does the abbreviation BIPEP stand for? c. toxic gases eg chlorine , sulphur dioxide a. Bivalvular positive airway pressure d. tobacco smoke b. Bilateral preventive aerodynamic pressure

c. Bidirectional positive airway pressure 59. Which of the following collagen disorder is not associated with pulmonary fibrosis d. Bilevel positive airway pressure a. SLE b. progressive systemic sclerosis c. dermatomyositis d. Require 34 months to reach completion 1271 d. RA e. Be irreversible

60. A truck driver has chronic cough with fever since one month. 69. The Symptoms of allergenmediated asthma result from which Chest x ray showing reticonodular infiltrate in mid and lower of the following? zone. Diagnosis is a. Increased release of mediators from mast cells a. TB b. Increased adrenergic responsiveness of the airways b. ILD c. Increased vascular permeability of bronchial tissue c. pneumococcal pneumonia d. Decreased calcium influx into the mast cells d. pneumocystis carini pneumonia. e. Decreased prostaglandin production

61. “creola bodies “ in sputum pathognomic of 70. Which of the following will result from blockade of H2 PULMONARY MEDICINE a. bronchial asthma receptors? b. chronic bronchitis a. Decreased camp in cardiac muscle c. bronchogenic carcinoma b. Increased camp in cardiac muscle d. pulmonary TB c. Decreased IP3 in gastric mucosa d. Increased IP3 in gastric mucosa 62. Charcot leyden crystals are derived from e. Increased IP3 in a. b. basophil 71. Toxicities of H2 antihistamines include which one of the c. following? d. bronchial goblet cells a. Blurred vision b. Diarrhea 63. To prevent exercise induced asthma drug used is c. Orthostatic a. ipratropium bromide d. P450 inhibition b. terbutalin e. Sleepiness c. epinephrine d. sodium chromoglycate 72. A patient undergoing cancer chemotherapy is vomiting frequently. A drug that might help in this situation is 64. Monday chest tightness is characterstic of a. Bromocriptine a. b. Cimetidine b. coal worker pneumoconiosis c. Ketanserin c. d. Loratadine d. silicosis e. Ondansetron

65. Farmers lung is caused by 73. Which of the following is most useful in the treatment of a. cryptostroma corticale hyperprolactinemia ? b. asperigullus a. Bromocriptine c. thermophilic actinomycetes b. Cimetidine d. grain dust c. Ergotamine d. Ketanserin 66. Most likely precursor to bronchiectesis is e. LSD a. TB b. carcinoma 74. Drugs that can dilate bronchi during an acute asthmatic attack include all of the following except c. bronchial adenoma a. Epinephrine d. b. Terbutaline 67. Which of the following terms best describes the antagonism c. Nedocromil of leukotriene’s ronchoconstrictor effect (mediated at d. Theophyline leukotriene receptors) by terbutaline (acting a adrenoceptors) in a patient with asthma? e. Ipratropium

a. Pharmacologic antagonist 75. Which of the following is a nonselective but very potent and b. Partial agonist efficacious bonchodilator that is not active by the oral route? c. Physiologic antagonist a. Aminophyline d. Chemical antagonist b. Cromolyn e. Noncompetitive antagonist c. Epinephrine d. Ipratropium 68. If therapy with multiple drugs causes induction of drug metabolism in your asthma patient, it will e. Metaproterenol

a. Result in increased smooth endoplasmic reticulum 76. Which of the following is a prophylactic agent that appears to b. Result in increased rough endoplasmic reticulum stabilize mast cells? c. Result in decreased enzymes in the soluble cytoplasmic a. Aminophyline fraction b. Cromolyn c. Epinephrine 1272 d. Ipratropium c. Microacerophiles e. Metaproterenol d. Facultative organisms

77. Which of the following is a direct bronchodilator that is most 85. The symptoms of allergenmediated asthma result from which often used in asthma by the oral route? of the following? a. Aminophyline a. Increased release of mediators from mast cells b. Cromolyn b. Increased adrenergic responsiveness of the airways c. Epinephrine c. Inceased vascular permeability of bronchial tissue d. Ipratropium d. Decreased calcium influx into the mast cell e. Metaproterenol e. Decreased prostaglandin production

78. Acute exacerbations of asthma can be triggered by all of the following except 86. Acute exacerbations of asthma can be triggered by all of the a. Bacterial of following except

's b. Hypertsensitivity reaction to penicillin a. Bacterial or viral pneumonia c. Discontinuation of asthma medication b. Hypersensitivity reaction to penicillin MCQ d. Hot, dry weather c. Discontinuation of asthma medication e. Stressful emotional events d. Hot, dry weather e. Stressful emotional events 79. Which of the following has overdose toxicity that includes insomnia, arrhythmias, and convulsions? 87. In the emergency department, the preferred firstline therapy a. Aminophyline for asthma exacerbation is b. Cromolyn a. Theophyline c. Epinephrine b. A ßagonist d. Ipratropium c. A corticosteroid e. Metaproterenol d. Cromolyn sodium e. An antihistamine 80. Which of the following is a very longacting ß2 – selective agonist that is used for asthma prophylaxis? 88. Which of the following tests is used at home to assess therapy a. Aminophyline and determine if a patient with asthma should seek emergency b. Cromolyn care? c. Epinephrine a. Forced expiratory volume in one second (FEV1) d. Ipratropium b. Forced (FVC) e. Salmeterol c. Total lung capacity (TLC) d. rate (PEFR) 81. Which one of the following drugs is most suitable for e. Residual volume (RV) management of essential tremor in a patient who has pulmonary disease? 89. Which of the following agents and dosage regimens is the best a. Diazepam choice of treatment for an asthma patient with rheumatoid b. Levodopa arthritis who is considered sensitive to aspirin (experiences with use)? c. Metoprolol a. Lbuprofen, 800 mg three times daily d. Propranolol b. Acetaminophen, 650 mg every 4 hours e. Terbutaline c. Gold injections, 25 mg intramuscularly once a week 82. A drug useful in the treatment of asthma but lacking d. Azathioprine, 75 mg daily bronchodilator action, is e. Cyclophosphamide, 100 mg daily a. Cromolyn b. Ephedrine 90. A drug administered by of powder as a prophylactic for asthma is c. Isoproterenol a. Ephedrine d. Metaproterenol b. Disodium cromolyn e. Metoprolol c. Isoproterenol 83. Relative to fexofenadine, diphenhydramine is more likely to d. Ocytriphylline a. Be used for treatment of asthma e. Epinephrine b. Be used for treatment of gastroesophageal reflux disease 91. Which of the following may precipitate an asthma attack? c. Cause cardiac arrhythmias in overdose a. Respiratory acidosis d. Have efficacy in the prevention of motion sickness b. Viran and bacterial infections e. Increase the serum concentration of warfarin c. Respiratory alkalosis 84. that make either a fementative or respiratory set of d. Cranberry jiuce enzymes are known as e. Chocolate or Coca Cola a. Obligate anacerobes b. Obligate aerobes 92. Terbutaline has a preference for stimulation of which of the c. Individual susceptibility 1273 following receptors? d. Ratio of H1 : H2 blockade produced by the drug a. Alpha

b. Gamma 101. While prescribing the conventional H1 antihistaminics the patient should be advised to avoid c. Beta 1 a. Driving motor vehicles d. Beta 2 b. Consuming processed cheese e. Dopaminergic c. Strenuous physical exertion 93. The National Institutes of Health (NIH) guidelines for the d. All of the above treatment of asthma recommended institution of routine inhaled when patients are classified as having 102. The antihistaminc which has calcium channel blocking and greater than or equal to which type of asthma? labyrinthine suppressant property is PULMONARY MEDICINE a. Mild intermittent a. Cyproheptadine b. Mild persistent b. Cinnarizine c. Moderate persistent c. Clemastine d. Severe persistent d. Cetirizine

94. Isoxuprine is used to treat 103. Erythromycin should not be given to patient being treated a. Asthma with terfenadine because a. Erythromycin induces the metabolism of terfenadine b. Severe hypotension b. Dangerous ventricular arrhythmias can occur c. c. Terfenadine inhibits metabolism of erythromycin d. Premature labor d. Terfenadine antagonizes the antimicrobal action of e. Hypertension erythromycin 95. The most likely complication of prolonged use of nasal 104. Select the H1 antihistaminic which is used topically in the decongestant drops is nose for allergic a. Atrophic rhinitis a. Deep intraabdominal operation b. Hypertrophy of nasal mucosa b. Trachial intubation c. Nasopharyngeal moniliasis c. Tetanus d. Blockage of Eustachian tubes d. Diagonosis of myasthenia gravis 96. Which of the following is a selective H1 receptor agoinist ? 105. H1 antihistaminics are beneficial in a. 4methyl a. All types of allergic disorders b. Impromidine b. Certain type I allergic reactions only c. 2Thiazolyl ethylamine c. Anaphylactic shock d. Mepyramine d. Bronchial asthma 97. Fall in blood pressure caused by larger doses of histamine is 106. The action of 5Hydroxy tryptamine mediated by the 5HT3 blocked by receptor is a. H1 antihistaminics alone a. Vasoconstriction b. H2 ANTAgonists alone b. Bradycardia c. Combination of H1 and H2 antagonists c. EDRF release d. None of the above d. Platelet aggregation 98. Histamine is involved as a mediator in the following 107. Tachyphylaxis to many actions on repeated injection is a pathological conditon feature of the following autocoid a. Cocaine a. Histamine b. Dibucaine b. 5Hydroxytryptamine c. Lidocaine c. Bradykinin d. Procaine d. Angiotensin 99. In the emergency department, the preferred firstline therapy 108. The smooth muscle stimulating action of 5HT is most marked for asthma exacerbation is in the a. Theophylline a. Bronchi b. A ßagonist b. Intestines c. A corticosteroid c. Ureter d. Cromolyn sodium d. Billary tract e. An antihistamine 109. The 5HT antagonist that has antihypertensive property is 100. The capacity of an antihistaminic to produce sedation depends a. Methysergide on the following except b. Cyproheptadine a. Relative affinity for central versus peripheral H1 receptors c. Ketanserin b. Ability to penetrate bloodbrain barrier d. Ondansetron 1274 110. The most important receptor involved in cytotoxic drug 119. In a patient of bronchial asthma, inhaled salbutamol produces induced vomiting is the following effect(s). a. Histamine H1 receptor a. Inhibits antigenantibody reaction in the b. Serotonin 5HT3 receptor b. Causes bronchodilatation c. Dopamine D2 receptor c. Reduces bronchial hyperreactivity d. Opioid μ receptor d. Both (b) and (c)

111. Which of the following expectorants acts both directly on the 120. Select the correct statement about salmeterol. airway mucosa as well as reflexly ? a. It is a long acting selective ß2 agonist bronchodilator a. Potassium iodide b. It is a bronchodilator with anti-inflammatory property b. Guaiphenesin c. It is a ß blocker that can be safely given to asthmatics c. Terpin hydrate d. It is an antihistaminic with mast cells stabilizing property d. Bromhexine 121. Caffeine is more powerful than theophylline in exerting the

's 112. Bromhexine acts by following action a. Inhibiting cough center a. Bronchodilatation MCQ b. Irritating gastric mucosa and reflexly increasing bronchial b. Cardiac stimulation secretion c. Diuresis c. Depolymerizing mucopolysaccharides present d. Augmentation of skeletal muscle contractility d. Desensitizing stretch receptors in the lungs 122. Methylxanthines exert the following action (s) at cellular/ 113. The primary goals of asthma therapy include all of the molecular level following except a. Intracellular release of Ca2+ a. maintain normal activity levels b. Antagonism of adenosine b. maintain control of symptoms c. Inhibition of phosphodiesterase c. avoid adverse effects of asthma medications d. All of the above d. prevent acute exacerbations and chronic symptoms

e. prevent destruction of lung tissue 123. Relatively higher dose of theophylline is required to attain therapeutics plasma concentration in 114. Antitussives act by a. Smokers a. Liquifying bronchial secretions b. Congestive heart failure patients b. Raising the threshold of cough centre c. Those receiving erythromycin c. Reducing cough inducing impulses from the lungs d. Those receiving cimetidine d. Both (b) and (c) 124. The antiasthma drug which cannot be administered by 115. Which of the following antitussive is present in opium but has inhalation is no analgesic or addicting properties ? a. Theophylline a. Noscapine b. Ipratropium bromide b. Codeine c. c. Pholcodeine d. Terbutaline d. Ethylmorphine 125. A 10 year old child suffers from exercise induced asthma: 116. are useful in cough Which is the most suitable first line drug for regular prophylactic therapy ? a. Only when cough is nonproductive a. Oral salbutamol b. Only when cough is associated with thick sticky secretions b. Oral theophylline c. Only when reflex is associated c. Inhaled sodium cromoglycate d. Irrespective of nature of cough or associated features d. Inhaled beclomethasone dipropionate 117. The common and dose related side effect of salbutamol is 126. Which of the following drugs is neither bronchodilator a. Rise in blood pressure nor antiinflammatory, but has antihistaminic and mast cell b. Muscle tremor stabilizing activity ? c. Hyperglycaemia a. Sodium cromoglycate d. Central nervous system stimulation b. Ketotifen c. Beclomethasone dipropionate 118. Which of the following tests is used at home to assess therapy and determine if a patient with asthma should seek emergency d. Mepyramine maleate care? 127. The most consistent, pronounced and sustained relief of a. Forced expiratory volume in one second (FEV1) symptoms in chronic bronchial asthma is afforded by b. Forced vital capacity (FVC) a. ß2 sympathomimetics c. Total lung capacity (TLC) b. Anticholinergics d. Peak expiratory flow rate (PEFR) c. Sodium cromoglycate e. Residual volume (RV) d. Corticosteroids 128. Intransasal spray of budesonide is indicated in c. Dexamethasone 1275 a. d. Triamcinolone b. Acute vasomotor rhinitis 137. Which derivative has no function in asthma ? c. Perennial vasomotor rhinitis a. Theophylline d. Epistaxis b. Pentoxyphyllin 129. In patients of bronchial asthma inhaled corticosteroids c. Enprofylin achieve the following except d. None of the above a. Reduce the need for bronchodilator medication

b. Control an attack of refractory asthma 138. What is symport ? a. Counter transport

c. Reduce bronchial hyperreactivity PULMONARY MEDICINE b. Contransport d. Reverse diminished responsiveness to sympathomimetic bronchodilators c. Carrier mediated diffusion d. Solvent drug 130. Budesonide is a a. Nonsteroidal anti-inflammatory drug 139. Pyridostigmine differs from neostigmine in that b. High ceiling diuretic a. More potent orally c. Inhaled corticosteroid for asthma b. Longer acting d. Contraceptive c. Less muscarinic side effects d. All of the above 131. In an asthma patient treated with systemic corticosteroids, bronchodilator drugs 140. The following are recognized features of Pancoast’s tumour a. Are not needed except: b. Are contraindicated a. ipsilateral Horner’s syndrome c. May be used on ‘as and when required’ basis b. wasting of the dorsal interossei d. Are ineffective c. pain in the arm radiating to the fourth and fifth fingers d. erosion of the first rib 132. To be a useful inhaled glucocorticoid the drug should have e. weakness of abduction at the shoulder a. High oral bioavailability b. Low oral bioavailability 141. Which of the following is true concerning Whooping cough c. Additional bronchodilator activity (pertussis)? a. is a greater threat to children during the second 6 months of d. Prodrug character life, after maternal antibody has declined, than during the 133. Histamine first 6 months a. May be released from mast cells by a number of therapeutic b. may lead to hemiplegia agents c. is characteristically associated with a polymorph b. Causes sedation leucocytosis c. Decreases the force of contraction of ventricular muscle d. is associated with convulsions less frequently than is the case with other febrile conditions d. Can cause strong contractions of the gravid human uterus e. rapidly resolves with antibiotic treatment 134. Chronic Bronchitis is characterized by 142. A 19yearold female developed pleural effusions, ascites I. the distruction of central and peripheral portions of the and ankle swelling. Her blood pressure was 112/76 mmHg. acinus Investigations revealed: serum alanine transferase 17 U/L (5 15), serum total bilirubin 17 umol/L (1 22), serum albumin 21 II. an increased number of mucous glands and goblet cells g/L (34 94), serum total cholesterol 9.8 mmol/L (<5.2), What is the next most appropriate investigation? III. edema and inflammation of the a. Antinuclear antibody a. only I is correct b. Pregnancy test b. only III is correct c. Prothrombin time c. I and II are correct d. Serum protein electrophoresis d. II and III are correct e. Urinary protein estimation e. I, II and III are correct 143. A 51 year old businessman complains of dyspnoea on 135. Smooth muscle relaxation is due to stimulation of which type exertion. He recently returned from a business trip to the USA. of histamine receptors He has distant heart sounds on auscultation of the chest. A a. H1 chest radiograph reveals that there is a thin rim of calcification surrounding the cardiac outline. Which of the following b. H2 conditions is most likely responsible for these findings? c. H3 a. Uraemia d. All of the above b. Tuberculosis 136. All the following are employed in inhalation therapy of c. Group B coxsackie virus asthma except d. Sarcoidosis a. Beclomethasone e. Metastatic carcinoma b. Budesonide 1276 144. A 48yearold woman presented with shortness of breath, cough b. High resolution CT scan of chest with heavy sputum production, and a low grade fever. She has c. Measurement of diffusion capacity smoked 20 cigarettes per day for 30 years. Her arterial blood d. Serum angiotensinconverting enzyme (ACE) level gases revealed pH of 7.4, PaCO2 of 45 and a PaO2 of 78. What is the most likely diagnosis? e. Transbronchial lung biopsy a. Bronchial asthma 150. A 20yearold male student is assessed for shortness of breath b. Chronic bronchitis that occurs whilst running. He has no other symptoms and c. Cryptogenic fibrosing alveolitis does not smoke. Examination, full blood count, and chest Xray d. Paraneoplastic syndrome are normal. Which of the following is most likely to be helpful in confirming the suspected diagnosis? e. Pulmonary embolism a. Arterial blood gas studies before and after exercise 145. A 49yearold man with a long history of alcoholism presents b. Determination of and diffusing capacity with cough, haemoptysis and pleuritic chest pain. He has had c. Measurement of venous blood lactate before and after night sweats and 10 kg weight loss in the last three months. exercise On chest Xray tgere is a subtle nodular pattern throughout the

's d. Spirometry before and after administration of lung. He underwent a transbronchial biopsy which showed bronchodilators multinucleated giant cells, epithelioid cells and necrotic MCQ debris. Which of the following is the most likely diagnosis? e. Spirometry before and after exercise a. Aspergillosis 151. A 40yearold worker presents with wheezing and breathlessness b. Pneumocystis carinii pneumonia which seem to improve over weekends and holiday periods c. Small cell carcinoma when he is not working. What is he most likely to be exposed d. Squamous cell carcinoma to at work? e. Tuberculosis a. Platinum salts b. Avian bloom 146. A55 year old man who has a 25 year pack history of smoking c. Aspergillus clavatus presents with productive cough with mucoid sputum of 2 d. Work in the Silver industry year duration. On examination he has scattered ronchi and wheezing. The likeliest diagnosis is : e. Exposure to spores of Actinomyces a. Bronchial Asthma 152. The pulmonary vascular system is different from the systemic b. Bronchiectasis circulation in that the pulmonary system demonstrates which c. Chronic Bronchitis of the following? d. Pneumonitis a. High pressures, high flow rates, highly compliant vessels e. Fibrosing Alveolitis b. High pressures, high flow rates, low compliance vessels c. Low pressures, high flow rates, high compliance vessels 147. A 67 year old who is known to suffer from severe chronic d. Low pressures, low flow rates, high compliance vessels bronchitis is admitted from home with an acute exacerbation. Which of the following is true? e. Low pressures, low flow rates, low compliance vessels a. An Acidosis with a low bicarbonate would be expected 153. A 60 year old man with ankylosing spondylitis presents with b. Extensor plantar responses feature cough, weight loss and tiredness. His CXR shows longstanding c. Gentamicin would be a reasonable initial treatment until upper lobe fibrosis. Three sputum tests stain positive for Acid cultures are available fast bacilli but are consistently negative for Mycobacterium d. Oxygen therapy should aim to increase the pO2 to above tuberculosis on culture. Which of the following is the most 8kPa (60mmHg) likely cause? e. Peripheral oedema indicates coexisting heart failure a. Mycobacterium avium intracellulare complex b. Micropolyspora faeni 148. A 65yearold woman, has smoked 50 cigarettes a day for 40 c. Allergic Bronchopulmonary Aspergillosis years. She has had increasing dyspnoea for the several years, d. Sarcoidosis but no cough. A Chest Xray shows increased lung size along with flattening of the diaphragms, consistent with emphysema. e. Tuberculosis Over the next several years she develops worsening peripheral oedema. Her vital signs show T° 36.7 C, P 80, RR 15, and BP 154. Which of the following is a recognised cause of a phrenic 120/80 mm Hg. Which of the following cardiac findings is nerve palsy? most likely to be present? a. Aortic aneurysm a. Mitral valve stenosis b. Dermoid b. Constrictive pericarditis c. Ganglioneuroma c. Right ventricular hypertrophy d. Pericardial cyst d. Left ventricular aneurysmm e. Sarcoidosis e. Nonbacterial thrombotic endocarditis 155. Which of the following statements is true of the pulmonary 149. A 55yearold plumber presented with a dry nocturnal cough function test’s vital capacity (VC)? and increasing exertional breathlessness. On examination a. Vital capacity cannot be measured from spirometry alone he had early finger clubbing, cyanosis and bilateral basal b. Vital capacity is increased in emphysema and reduced in crackles. A chest Xray showed bilateral lower zone shadowing. interstitial fibrosis Investigations revealed: PaO2 ( air) 8.2 kPa (11.312.6), FEV1/FVC ratio 85%, Which of the following investigations is c. Vital capacity is the maximal amount of air which can be most likely to establish the diagnosis? exhaled after maximal inspiration a. Echocardiography. d. Vital capacity is the sum of (VT) and inspiratory capacity (IC) e. Vital capacity, when reduced, is a specific indication of 162. A 26yearold man with a history of alcohol and drug abuse was 1277 admitted with a 14 day history of fever, cough and fatigue. He was emaciated. His temperature was 39.4°C. Cervical and 156. A 24 year old asthmatic female is admitted with acute severe axillary lymphadenopathy were present. Chest Xray revealed asthma. Which of the following statements regarding the bilateral areas of pulmonary shadowing. Which of the diagnosis is correct? following is the most likely diagnosis? a. Agitation should be managed with a benzodiazepine a. alcoholic cardiomyopathy b. A high inspired Oxygen concentration should be used b. pneumococcal pneumonia routinely c. c. Inhaled salmeterol is indicated as first line therapy d. pulmonary tuberculosis d. Normal arterial pCO2 is reassuring e. tricuspid endocarditis e. Pulsus paradoxus is a reliable sign of severity PULMONARY MEDICINE 163. A 75yearold man with squamous cell carcinoma is thought to 157. Recognised associations. Which of the following is correct? have resectable disease. Which of the following would be a a. pneumoconiosis and clubbing contraindication to surgery? b. lung carcinoids and pleural effusion a. clubbing c. pulmonary embolus and left bundle branch block b. FEV1 of 0.75 L d. pulmonary fibrosis and c. his age of 75 years e. bronchopulmonary aspergillosis and wheezing d. pleural effusion e. Syndrome of Inappropriate ADH 158. Randomised controlled trials have shown that longterm oxygen therapy (LTOT) reduces mortality in: 164. A 65yearold female presents with a 3 week history of malaise a. cryptogenic fibrosing alveolitis and blood in her sputum. Bronchoscopy reveals a mass in the right main , and histology demonstrates it to be a b. cor pulmonale due to chronic airflow obstruction small cell carcinoma. Further investigation fails to show any c. asthma metastases. What is the most appropriate step in management? d. cystic fibrosis a. Chemotherapy e. pulmonary sarcoidosis b. Endobronchial laser therapy

159. A 65yearold woman, a heavy smoker for many years, has had c. Radiotherapy worsening dyspnoea for the past 5 years, without a significant d. Surgery cough. A chest Xray shows increased lung size along with e. Palliative therapy flattening of the diaphragms, consistent with emphysema. Over the next several years she develops worsening peripheral oedema. BP 115/70 mmHg. Which of the following cardiac 165. A 41 year old man with a history of nasal congestion, findings is most likely to be present? breathlessness, cough and wheeze presents with a left foot a. Constrictive pericarditis drop. Which of the following is the most likely diagnosis? b. Left ventricular aneurysm a. Diabetes mellitus c. Mitral valve stenosis b. Wegeners Granulomatosis d. Nonbacterial thrombotic endocarditis c. Churg Staus Syndrome e. Right ventricular hypertrophy d. Pulmonary eosinophilia e. Polyarteritsis Nodosa 160. A 45yearold solicitor had an onset of severe, crushing, substernal chest pain while attending a football match. He 166. In asbestos related disorders which of the following collapsed on his way to the car. Bystander Cardiorespiratory statements is correct? Resuscitation was begun immediately and continued until arrival in Casualty where an endotracheal tube was a. basal fibrotic shadowing on CXR suggests coincidental inserted and ventilation was maintained on 100% oxygen. idiopathic fibrosing alveolitis Investigations revealed: pH 7.13, PaO2 560 mmHg, PaCO2 18 b. increased incidence of primary mmHg, Bicarbonate 5.8, SaO2 98%, Based on these laboratory c. pleural effusion develops more than 20 years after causative values, which of the following statements best describes his asbestos exposure current pathophysiology? d. pleural plaques are recognized precursors of mesothelioma a. He is demonstrating a primary respiratory alkalosis e. the risk of malignant mesothelioma is greatly increased in b. He probably developed a large right to left intracardiac smokers compared with nonsmokers shunt c. His anion gap is probably normal 167. A 60 year old man was admitted with communityacquired d. His oxyhemoglobin curve is shifted to the left pneumonia and deteriorated over the next few hours. Which one of the following indicates a poor prognosis? e. His pressure is probably elevated a. A total white cell count of 17 x 109/L (411) 161. Obstructive sleep apnoea characteristically associated with: b. Blood pressure of 110/70 mm Hg a. hypersomnolence c. Respiratory rate of 35 breaths/min b. impotence d. Rigors c. macrognathia e. Temperature of 39oC d. insomnia 168. Which of the following statements concerning industrial lung e. polydipsia disorders is correct? a. pneumoconiosis can be diagnosed in the absence of chest Xray abnormalities 1278 b. occurs more frequently in atopic 175. A 24 year old male presents after developing a bluish persons discolouration of the body, lips and nails. He denies any c. silo fillers disease is caused by to grain relevant past medical history. Examination reveals a central cyanosis and a grey complexion. Investigation revealed: d. widespread crepitations are typically heard in extrinsic Haemoglobin 17.0 g/dL (13.018.0), PaO2 13.0 kPa (11.312.6)m allergic alveolitis SaO2 (using an oximeter) 85% (>95), What is the most likely e. symptoms occur within minutes if exposure to mouldy hay diagnosis? in Farmer’s lung a. Argyria 169. A young child presents with respiratory distress, worsening b. Cyanotic congenital heart disease over 2 days. Blood gases show a pH of 7.25, a PCO2 of 7.5kPa, c. Haemochromatosis a PO2 of 8.5kPa, and a base excess of 4. Which of the following d. Methaemoglobinaemia interpretations is correct? e. Methylene blue poisoning a. Results are consistent with bronchopulmonary dysplasia. b. Blood gases suggest type 1 respiratory failure. 176. Which of the following is true of BCG vaccination? c. Immediate intubation is required. a. is contraindicated in neonates 's d. Results are consistent with late severe asthma. b. is a killed polysaccharide antigen vaccine MCQ e. Bicarbonate may be necessary to correct the acidosis. c. should be given to all children who have a strongly positive tuberculin test 170. A 19 year old female presents with acute breathlessness. d. is presently routinely offered in the UK at age 16 years She has had asthma for approximately 3 years and recently commenced new therapy. Which agent may be responsible for e. Provides protection against leprosy this exacerbation? 177. Carcinoid tumors of the lung (bronchial adenomas) originate a. Salmeterol from which of the following cell types? b. Theophylline a. Ciliated cell c. Beclomethasone b. Clara cell d. Ipratropium bromide c. Kulchitsky (K) cell e. Monteleukast d. (goblet) cell 171. A 22 year old lady recently returned from a holiday in Malta e. Type 2 Alveolar cell was admitted with a 3 day history of fever, generalised 178. A 55 year old woman on treatment for longstanding lymphadenopathy and a macular rash over the trunk and legs. rheumatoid arthritis has recently become dyspnoeic on mild Which of the following is the most likely diagnosis? exertion and developed a dry cough. The a. Sarcoidosis was found to be 87% on air. The chest xray showed a diffuse b. Tuberulosis bilateral interstitial infiltrate. An extensive infection screen c. Familial Mediterranean Fever was negative and her symptoms were felt to be druginduced. Which drug is most likely to have caused this adverse effect? d. Infectious Mononucleosis a. azathioprine e. Actinomycosis b. cyclosporin 172. Which of the following is a recognised treatment for c. hydroxychloroquine complications of cystic fibrosis? d. methotrexate a. DNAase to assist in reinflating collapsed lung segments. e. sulphasalazine b. Rectal pullthrough and anastamosis for rectal prolapse. c. Pancreatic transplant for diabetes mellitus. 179. The following is true about Cystic Fibrosis: d. Nebulised tobramycin for pseudomonas colonisation of the a. Is an autosomal dominant condition. lower respiratory tract. b. Is due to mutation of CFTR gene on chromosome 17 e. Hypotonic saline drinks for hypernatraemic dehydration. c. Skin test may be positive for aspergillus d. Median survival rate is 10 to 15 years. 173. Which of the following is a typical feature of Farmer’s lung? e. Is a cause of mental retardation. a. basal crackles b. Eosinophilia 180. A 67yearold man presents with a long history of c. Haemoptysis cough,breathlessness on minimal exertion and ankle swelling. He smokes 3040 cigarettes per day. Investigations d. Increased pCO2 are as follows: Haemoglobin 19g/dl, white blood count 7.3, e. Positive serum paraproteins PaO2 (air) 6.2kPa, PaCO2 (air) 8.9kPa, serum [H+] 44 nmol/l, serum [HCO3] 36 mmol/l, What is the most likely explanation 174. A 28 year old man who had had tuberculosis of the mediastinal of these results? lymph nodes diagnosed two weeks previously and who had a. acute respiratory acidosis been started on chemotherapy with rifampicin, isoniazid and pyrazinamide was admitted because of the increasing b. chronic respiratory acidosis dyspnoea and stridor. Chest Xray showed compression of c. chronic respiratory alkalosis both main bronchi by carinal lymph node enlargement. What d. metabolic acidosis is the next step in management? e. metabolic alkalosis a. Start prednisolone b. Mediastinoscopy and biopsy 181. Which of the following statement is true of infections with c. Refer for stent insertion/tracheostomy Mycobacterium tuberculosis: d. Refer for urgent CT scan of the a. nonsputum producing patients are noninfectious e. The addition of ethambutol b. a positive tuberculin test indicates active disease c. lymph node positive disease requires longer treatment than a. aspirin therapy 1279 pulmonary disease b. antibiotics d. in pregnant women treatment should not be given until c. inferior vena cava filter after delivery d. low molecular weight heparin treatment e. pyrazinamide has high activity against active extracellular e. warfarin treatment organisms 188. Which of the following is a recognised feature of massive 182. In restrictive lung disease due to respiratory muscle weakness, pulmonary embolism? which of the following statements is true? a. reduced plasma lactate levels a. Low FEV1/FVC, high RV/TLC b. an increase in serum troponin levels b. Low FEV1/FVC, normal TLC

c. an arterial pH less than 7.2 PULMONARY MEDICINE c. Low VC, low FEV1, normal TLC, low RV/TLC d. blood gases show increased pCO2 on air d. Low VC, low RV, low TLC e. normal Ddimer levels e. Low VC, low TLC, high RV/TLC 189. Which of the following statements is true of the diffusion 183. Which of the following would be the least likely finding in a capacity of carbon monoxide? patient with sarcoidosis? a. Is a specific measure of lung perfusion. a. Hepatic granulomas b. Depends on the thickness of the alveolar wall. b. Restrictive pulmonary function tests c. Depends on the surface area available for . c. Skin lesions d. Is increased in cigarette smokers. d. Uveitis e. Is increased in emphysema. e. X bodies on bronchoalveolar lavage (BAL) fluid 190. A 19 year old woman became breathless while travelling on an 184. A 72yearold lifelong smoker presents with progressive aeroplane. Which one of the following features most strongly dyspnoea on exertion. He has a chronic, nonproductive supports a diagnosis of acute related to a cough. On examination he is thin, breathing with pursed panic disorder? lips, respiratory rate 25/min, with mild wheezing on chest auscultation. Investigations show FEV1 0.8 L, FVC 1.6 L, a. Carpal spasm. pH 7.35, paCO2 45 mmHg, paO2 55 mmHg. What is the b. Finger paraesthesiae. predominant mechanism of the airflow limitation in this c. Hypotension. gentleman? d. Lightheadedness. a. Bronchospasm e. Loss of conciousness b. Foreign body obstruction c. Increased airways resistance 191. A 64 year old man is found to have squamous cell bronchogenic d. Loss of carcinoma. Which of the following statements is true regarding surgical resection? e. Mucus plugging in the small airways a. An FEV1 of 2 L is a major contraindication to surgical 185. Which of the following statements regarding cryptogenic resection. fibrosing alveolitis is correct? b. Hypercalcaemia makes further assessment for surgery a. Active inflammation may be suggested by a CT scan unnecessary. b. peak flow rate is a good guide to severity c. Is precluded if a CT scan of the shows enlarged mediastinal lymph nodes. c. 80 per cent of patients iniiration d. Positive sputum cytology excludes the need for d. Reduced cardiac output bronchoscopic examination of the airways. e. Reduced e. The presence of finger clubbing indicates that liver 186. A 54year old woman was admitted with acute breathlessness. metastases are already present. On examination she had a temperature of 37.9oC, a respiratory 192. A 60yearold man with breathlessness, fever and headache rate of 32 breaths per minute, a pulse of 120 beats per minute, is suspected of having Farmers Lung. A CXR shows diffuse a blood pressure of 100/60 mmHg, and a peak expiratory flow nodular shadowing predominantly in the mid and lower rate of 250 litres per minute. Auscultation of the heart and chest zones. What would be the most useful diagnostic test? was normal. The Chest Xray was normal and blood gases on air showed: pH 7.35 (7.36 7.44), Pa02 6.0, kPa (11.3 12.6), PaC02 a. Blood Culture 3.9, kPa (4.7 6.0), Serum bicarbonate 20 mmol/l (20 28). She was b. Sputum Culture started on high flow oxygen. What is the most important next c. Serum precipitating antibodies to Micropolyspora faeni treatment? d. Serum Precipitating antibodies to Aspergillus clavatus a. amoxycillin intravenously e. Serum Precipitating antibodies to Cryptostroma corticale b. intravenously c. intravenous fluids 193. A 43 year old asthmatic develops worsening breathlessness d. low molecular weight heparin and his full blood count has revealed an eosinophilia. Which of the following statements is true with allergic e. nebulised salbutamol bronchopulmonary aspergillosis that the patient is likely to suffer from? 187. A 76yearold with a recent history of cerebral haemorrhage is admitted with a cough, worsening breathlessness and a. The immediate skin test to an extract of aspergillus right pleuritic chest pain. He is also mildly pyrexial. His fumigatus is negative ventilationperfusion scan reveals several areas of ventilation/ b. Circulating IgG precipitins to aspergillus fumigatus are perfusion mismatches. What is the most appropriate line of positive management? c. The CO transfer factor is unaffected 1280 d. Recurrent haemoptysis is a characteristic feature b. A haemorrhagic and necrotizing pneumonia e. Pleural effusion is a complication c. An acute respiratory distress syndrome (ARDS) with widespread hyaline membrane formation 194. A 35yearold man presents after 3 months of chronic cough d. An interstitial pneumonitis with foamy intraalveolar with purulent sputum and shortness of breath on exertion. exudate He gives a history of at least two sinus or bronchial infections per year requiring treatment with antibiotics. He also says e. An organizing bronchopneumonia he and his wife have been unable to have children. He 200. Which of the following statements is NOT true of primary smokes 15 cigarettes per day. Examination is normal except pulmonary tuberculosis: for some wheezing and an area of focal crackles at the left lung base. Chest Xray shows patchy infiltrates at both bases. a. It is characteristically asymptomatic Investigations revealed FEV1 2.0 L, FVC 2.7 L, pH 7.38, PaCO2 b. Miliary spread is commoner in a younger age group 40 mmHg, PaO2 82 mmHg, What is the most likely diagnosis? c. The initial immunological response causes hilar a. alpha1Antitrypsin (Antiprotease) deficiency lympadenopathy b. Asthma d. pleural effusion occurs before tuberculin skin testing is

's c. Cystic fibrosis positive d. Hypogammaglobulinemia e. A positive tuberculin skin test develops within two weeks of MCQ infection e. Immotile cilia syndrome 201. In which of the following have randomised controlled 195. An 18 year old attending the A+E department is noted to have trials shown that longterm oxygen therapy (LTOT) reduces central cyanosis. She is perfectly well but was told to go to mortality? A+E by her friends who said she looked blue. What is the most likely cause? a. Asthma a. Carbon Monoxide Poisoning b. Cor pulmonale due to chronic airflow obstruction b. Lead Poisoning c. Cryptogenic fibrosing alveolitis c. Drinking water contaminated with nitrates d. Cystic fibrosis d. Anorexia Nervosa e. Pulmonary sarcoidosis e. Severe Anaemia 202. Which ONE of the following is true regarding acute pulmonary embolism? 196. A 59 year old female smoker is diagnosed with oat cell carcinoma of the bronchus. Which of the following relating to a. a normal ECG excludes the diagnosis this diagnosis is true? b. embolectomy is more effective than thrombolysis in a. The tumour is likely to be radiosensitive improving survival b. occurs with equal frequency in smokers and nonsmokers c. Heparin is as effective as thrombolytic therapy c. has a 5 year survival greater than 20% d. the presence of hypoxaemia is an indication for thrombolysis d. Is associated with the elaboration of ectopic ADH secretion e. thrombolysis administered through a peripheral vein is as effective as through a pulmonary artery catheter e. Is typically associated with ectopic parathormone secretion. 203. A 36 year old man complains of a persistent cough. A CXR 197. Which of the following conditions may give a false/positive shows fibrosis of both upper lobes. What is the most likely sweat test? diagnosis? a. Congenital adrenal hyperplasia a. Systemic Sclerosis b. Hyperthyroidism b. Primary c. Hyperparathyroidism c. Cystic Fibrosis d. Obesity d. Ankylosing Spondylitis e. Glucose6phosphatase deficiency e. Allergic bronchopulmonary aspergillosis 198. A 60yearold man was diagnosed last year with adenocarcinoma 204. Which one of the following statements is true of chronic of the lung, and a 4 cm mass lesion was treated with a obstructive pulmonary disease? right lower lobectomy. He now has an abdominal CT scan that reveals scattered hepatic mass lesions and hilar a. patients show at least a 15 per cent improvement in the lymphadenopathy. For several weeks, he has had increasing FEV1 after nebulised bronchodilator malaise. A urinalysis reveals marked proteinuria, and a 24 b. inhaled corticosteroid usage does not improve longterm hour urine protein collection is 2.7 g/24hr. His serum urea is 30 prognosis mmol/L (2.5 7.5) with creatinine of 450 μmol/L (60 110). A renal c. breathlessness is uncommon until the FEV1 falls to biopsy is performed, and there is focal deposition of IgG and approximately 50 per cent of predicted C3 with a granular pattern. He is most likely to have which of the following conditions? d. emphysema is associated with increased transfer factor a. Goodpasture’s syndrome e. in advanced cases there is reduced pulmonary vascular resistance b. Membranous glomerulonephritis c. Minimal change glomerulonephritis 205. A 16 year old boy with cystic fibrosis presents with abdominal d. Nodular glomerulosclerosis pain. Which of the following is most likely to be the cause? e. Rapidly progressive glomerulonephritis a. Ulcerative colitis b. Irritable Bowel Syndrome 199. The morphological appearance of Pneumocystis carinii c. Pyelonephritis infection in the lung is best characterised as which one of the following? d. Meconium Ileus Equivalent Syndrome a. A bronchopneumonia with abscess formation e. Renal Calculi 206. A patients’ arterial blood gases give the following results; pO2 d. Morbid obesity 1281 10 kPa (75mmHg), pCO2 7 kPa (52 mmHg), pH 7.47, [HCO3] e. kyphoscoliosis 37. Which of the following is the most likely cause? a. Chronic Hyperventilation Syndrome 213. A lifelong nonsmoker is diagnosed with emphysema. Which b. Acute exacerbation of COPD of the following would be the most likely aetiological agent ? a. Isocyanates c. Several days of Pyloric obstruction b. Cadmium Exposure d. Pulmonary Embolism c. Steel e. Diabetic Coma d. Zinc 207. A patient with Rheumatoid arthritis complains of progressive e. Asbestos breathlessness. Which of the following is the most likely cause? 214. Which cell type is responsible for the early asthmatic PULMONARY MEDICINE a. Pulmonary Eosinophilia response? b. Asthma [0] a. Basophil c. Pulmonary nodules b. Eosinophil d. Fibrosing Alveolitis c. Mast cell e. Pulmonary Embolus d. Neutrophil e. TH1lymphocyte 208. In the normal adolescent lung which of the following is correct? 215. A 43yearold Caribbean female Comprehensive school a. There is an of 30 cmH2O (3kPa) at the teacher complains of slowly increasing breathlessness. end of normal expiration. She has no smoking history. Investigations reveal she has b. There is a resting pulmonary blood flow of 10L/min. bilateral enlarged hilar lymph nodes, elevated serum calcium, interstitial lung disease, and enlarged liver and spleen. What c. The V:Q ratio is greater in apical than basal segments of the is the most likely diagnosis? lung when upright and at rest. a. Coccidioidomycosis [0] d. The majority of airway resistance is from large airways. b. Hyperparathyroidism [0] e. Cartilage is present in all respiratory bronchioles. c. Hypervitaminosis D [0] 209. Sleep Apnoea syndrome is best diagnosed by the following: d. Sarcoidosis [100] a. Polygraphic Sleep Studies e. Tuberculosis [0] b. therapeutic trial of amphetamines 216. A 58yearold man presents with weight loss and haemoptysis. c. EEG He has smoked most of his life. On examination he is clubbed d. Blood gases during apneic episodes and has clinical evidence of right pleural effusion. His serum e. Presence of HLADR2 and DQw1 calcium is 3.2mM. Which of the following histological type of lung cancer is he most likely to suffer from? 210. A 70yearold man presented with weight loss and haemoptysis. a. mesothelioma He was a heavy smoker. A chest radiograph showed a mass b. small cell carcinoma lesion in the left lung bronchoscopic biopsies confirmed a squamous carcinoma. c. large cell carcinoma a. Chest wall invasion by primary tumour d. squamous cell carcinoma b. An enlarged mediastinal lymph node on CT scanning e. adenocarcinoma c. Forced expiratory volume (FEV1) of 1.2 litres 217. A 68yearold man presents with a onemonth history of d. Hypercalcaemia dyspnoea and a 3kg weight loss. On examination there were e. Malignant pleural effusion signs of a large left pleural effusion, confirmed on Chest Xray. Investigations revealed: Pleural fluid analysis: Protein 38 g/L, 211. Which of the following statements regarding prognosis in Cytology a few and red blood cells. Which one of lung cancer is true? the following investigations should be considered next? a. Combined modality therapy (chemotherapy, radiation a. Bronchoscopy. therapy and surgery) has improved overall lung cancer b. CT scan of thorax. survival to 40% at 5 years. c. Repeat pleural aspiration with biopsy. b. Overall lung cancer survival is < 15% at 5 years. d. Thoracoscopic pleural biopsy. c. Patients undergoing radiation therapy have a 5 year survival e. Tuberculin test. of 40%. d. Patients who qualify for surgery have a 50% 5 year survival. 218. A 63yearold woman presents a 5 day history of progressive e. With chemotherapy, overall survival in small cell (oat cell) shortness of breath. Her family brought her in because she carcinomas has risen to 60% at 5 years. was increasingly sleepy during the last 24 hours. She was diagnosed with Chronic Obstructive Pulmonary Disease 212. A breathless patient undergoes pulmonary Function testing. 3 years ago and has a FEV1 less than 50% of predicted. She The following results are obtained; FEV1 = 74% predicted, FVC has an oxygen concentrator at home. Examination revealed = 68% predicted, TLC = 77% predicted, Tlco = 46% predicted, depressed consciousness and a respiratory rate of 24 with Kco = 53% predicted. Which of the following is the most likely shallow breaths. There were decreased breath sounds with cause ? minimal air movement. If an arterial blood gas on room air were to be performed, which of the following results would a. COPD you expect? b. Asthma a. pH 7.16 paCO2 70 paO2 50 HCO3 24 c. Cryptogenic Fibrosing Alveolitis b. pH 7.24 paCO2 80 paO2 55 HCO3 30 1282 c. pH 7.32 paCO2 60 paO2 70 HCO3 30 d. More than 60mmol/L of chloride in sweat is diagnostic of d. pH 7.41 paCO2 40 paO2 50 HCO3 24 cystic fibrosis. e. pH 7.48 paCO2 30 paO2 85 HCO3 24 e. False/positive results may be encountered in children with nephrotic syndrome. 219. A 47 year old woman presenting with breathlessness has arterial blood gases taken which give the following results: 226. A 42 year old woman presents with an acute attack of asthma. pO2 8.7 kPa (65mmHg), pCO2 4.4 kPa (33mmHg), pH 7.46, She is able to speak in short sentences. Her respiratory rate {HCO3]24. Which of the following is the most likely diagnosis. is 28 breaths per minute and the peak expiratory flow rate 120L/min (predicted 480 L/min. What is the most appropriate a. Hyperventilation syndrome treatment for this patient? b. a. Intravenous aminophylline. c. Emphysema b. Intravenous salbutamol d. Kyphoscoliosis c. Nebulized salbutamol e. Opiate overdose d. Oral salbutamol e. Oral theophylline

's 220. Which of the following forms of pulmonary embolism is the commonest cause of secondary pulmonary hypertension? 227. A 15 year old boy presented with wheezing when playing MCQ a. Air embolism (Caisson’s disease) football and nocturnal cough. b. Fat embolism Which is the best test to confirm the underlying condition? c. Massive pulmonary embolism (e.g., saddle embolism) a. A trial of oral corticosteroids d. Multiple small recurrent pulmonary embolism b. A trial of inhaled corticosteroids e. Paradoxical embolism c. A trial of inhaled salbutamol 221. Primary Pulmonary tuberculosis: d. Serial peak expiratory flow rate measurements a. Leads to pleural effusion e. Spirometry alone

b. Is highly infective 228. Which of the following is NOT true with regard to the c. Commonly leads to military TB radiological appearance of a chest Xray? d. May be totally asymptomatic a. Consolidation of the right middle lobe will obliterate the e. Usually produces cavitation right atrial shadow in the PA view b. Consolidation of the right apical lobe will extend to the 222. An elderly man with a history of asthma, congestive heart horizontal fissure in the PA view failure, and peptic ulcer disease is admitted with bronchospasm c. Consolidation of the right anterior segment of the right and rapid atrial fibrillation. He recieves frequent nebulised middle lobe will extend to the right transverse fissure and salbutamol and IV digoxin loading, his regular medications the right hilum in PA view are continued. 24 hours after admission his serum potassium is noted to be 2.8 mmol/l. Which of his medications is most d. A consolidation of the lingular lobe will obliterate the aortic likely to have caused this abnormality. knuckle and pulmonary trunk in the PA view a. Digoxin e. A consolidation of the left lower lobe will elevate the left hemidiaphragm b. ACE inhibitor c. Salbutamol 229. Which of the following statements is true of psittacosis d. Ranitidine (ornithosis): e. Spironolactone a. It is only a risk from contact with psittacines (parrots), not other birds 223. The parents of a child with cystic fibrosis consult you wishing b. It usually causes many polymorphs to be present in the to know what is the risk of their next child being a carrier of sputem the condition. Which ONE of the following percentages is the c. It is more of a risk to children than to adults who are exposed correct risk? to birds a. 0% d. It does spread from person to person b. 25% e. Infection responds rapidly to penicillin therapy c. 50% d. 75% 230. Which of the following statements is true regarding smoking in pregnancy? e. 100% a. Smoking assists in maturation of the fetal lung. 224. Most of the cells that fill the alveoli in desquamative interstitial b. The reduction in birth weight is related to the number of pneumonitis (DIP) are which of the following? cigarettes smoked per day. a. Eosinophils c. Maternal smoking may adversely affect testicular function b. Lymphocytes in male children. c. Macrophages d. Dysmorphic facies is a recognised complication. d. e. The newborn baby may require adjustments in drug e. Plasma cells dosages because of it.

225. Which of the following statemtns regarding the sweat test is true? a. Sweating is enhanced by application of atropine. b. The filter paper is left on for a total of about 4 hours. c. At least 25mg of sweat is necessary for a reliable result. 231. A 55 year old man presents with ataxia and bilateral 233. Which one of the following is correct regarding longacting 1283 gynaecomastia. Which of the following is the most likely beta2 agonists? diagnosis? a. Can be used to prevent activityinduced symptoms without a. Kleinfelters Syndrome anti-inflammatory therapy. b. Long term treatment with cyclophosphamide for Wegener’s b. Become less effective over time (tolerance). Granulomatosis c. Are beneficial in acute viral . c. Long term treatment with oral steroids for chronic asthma d. Protect against allergen challenge for up to 48 hours. d. Bronchial Carcinoma e. Should not be used in association with erythromycin. e. Hypereosinophilic Syndrome

232. A 45 year old female presents with a 6 month history of exertional dyspnoea and is diagnosed with pulmonary PULMONARY MEDICINE fibrosis. Over the last one year she has received a variety of medications. Which of the following drugs could be responsible? a. Dexamethasone b. Ibuprofen c. nalidixic acid d. penicillamine e. sulphasalazine 1284 Pulmonary Medicine - Answers

1. b 38. d 75. c 112. c 149. b

2. c 39. c 76. b 113. e 150. e

3. d 40. a 77. a 114. d 151. a

4. b 41. c 78. d 115. a 152. d

5. c 42. a 79. a 116. c 153. a

6. a 43. c 80. e 117. b 154. a

7. e 44. b 81. c 118. d 155. c 's

MCQ 8. a 45. a 82. a 119. b 156. b

9. b 46. d 83. d 120. a 157. e

10. c 47. b 84. d 121. d 158. b

11. d 48. d 85. a 122. d 159. e

12. e 49. b 86. d 123. a 160. e

13. b 50. b 87. b 124. a 161. a

14. a 51. d 88. d 125. c 162. c

15. c 52. a 89. c 126. b 163. b

16. e 53. a 90. b 127. d 164. a

17. d 54. b 91. b 128. c 165. c

18. c 55. a 92. d 129. b 166. c

19. e 56. c 93. b 130. c 167. c

20. b 57. d 94. d 131. c 168. b

21. e 58. d 95. a 132. b 169. d

22. a 59. c 96. c 133. d 170. a

23. d 60. d 97. c 134. c 171. d

24. b 61. a 98. b 135. b 172. d

25. d 62. a 99. b 136. c 173. a

26. d 63. d 100. d 137. b 174. a

27. c 64. c 101. a 138. b 175. d

28. a 65. c 102. b 139. b 176. e

29. d 66. a 103. b 140. e 177. c

30. c 67. c 104. d 141. b 178. d

31. a 68. a 105. b 142. e 179. c

32. b 69. a 106. b 143. b 180. b

33. d 70. a 107. b 144. b 181. a

34. e 71. d 108. b 145. e 182. e

35. c 72. e 109. c 146. c 183. e

36. b 73. a 110. b 147. b 184. d

37. e 74. c 111. a 148. c 185. a 186. e 196. d 206. c 216. d 226. c 1285

187. c 197. e 207. d 217. d 227. d

188. b 198. b 208. c 218. b 228. e

189. b 199. d 209. a 219. b 229. d

190. a 200. e 210. e 220. d 230. b

191. c 201. b 211. b 221. d 231. d

192. c 202. e 212. c 222. c 232. e PULMONARY MEDICINE 193. b 203. e 213. b 223. c 233. a

194. e 204. b 214. c 224. c

195. c 205. d 215. d 225. d