I n t e r n a L medicine questions Bank

Answer: B (Lung’s type respiratory failure = type 1 respiratory failure).

Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. In practice, it may be classified as either hypoxemic or hypercapnic.

^{Hypoxemic respiratory failure (type I) is characterized by an arterial oxygen tension (P}a ^O2^{) lower than 60 mm Hg with a normal or low arterial carbon dioxide tension (P}a ^CO2^{). This is the most common form of respiratory} failure, and it can be associated with virtually all acute diseases of the lung, which generally involve fluid filling or collapse of alveolar units. Some examples of type I respiratory failure are cardiogenic or noncardiogenic pulmonary edema, pneumonia, and pulmonary hemorrhage.


^{Hypercapnic respiratory failure (type II) is characterized by a PaCO}2 ^{higher than 50 mm Hg. Hypoxemia is} common in patients with hypercapnic respiratory failure who are breathing room air. The pH depends on the level of bicarbonate, which, in turn, is dependent on the duration of hypercapnia. Common etiologies include drug overdose, neuromuscular disease, chest wall abnormalities, and severe airway disorders (eg, asthma and chronic obstructive pulmonary disease [COPD]).

Source: Medscape, http://emedicine.medscape.com/article/167981-overview

3. 
   All of the followings can be caused by sarcoidosis EXCEPT :
   
   1. 
      Stridor .
      
   2. 
      Wheezes .
      
   3. 
      Heart block .
      
   4. 
      Facial nerve weakness
      
   5. 
      Hypercalcemia and Hypocalciuria .
      

4. 
   In patients with idiopathic pulmonary fibrosis (usual interstitial pneumonia) all of the followings are expected patho physiological changes EXCEPT :
   

1. 
   Low DLCO .
   
2. 
   Decreased FEV1/FVC .
   
3. 
   Severe O2 desaturation on exercise.
   
4. 
   Reduced vital capacity and total lung capacity .
   
5. 
   Increased pulmonary artery pressure
   

Answer: B (increased FEV1/FVC ratio).

5. 
   All of the followings may improve obstructive sleep apnea EXCEPT:
   
   1. 
      Dental extraction .
      
   2. 
      Weight Reduction .
      
   3. 
      Decrease alcohol consumption .
      
   4. 
      Nasal CPAP
      
   5. 
      Tracheostomy
      

6. 
   All of the following statement regarding lung cancer are true EXCEPT :
   
   1. 
      Small cell lung carcinoma metastasis late in the course of the disease
      
   2. 
      Adenocarcinoma usually is a peripheral lung tumor .
      
   3. 
      Adenocarcinoma in some cases is difficult to be differentiated from mesothelioma .
      
   4. 
      Thromboembolic disease can be the first manifestation of the disease.
      
   5. 
      Surgery can be curative for early diagnosed cases .
      

Answer: “A. Compared to non-small cell lung cancer, small cell lung cancer is just bad disease. The tumor grows fast and metastasizes early. Small cell is more often associated with paraneoplastic syndromes (e.g., Eaton- Lambert) and ectopic hormonal syndromes (e.g., SIADH).

7. 
   All of the followings are useful for the assessment of the severity of an attack of bronchial asthma, EXCEPT :
   

1. 
   Spirometry .
   
2. 
   Methacholine test
   
3. 
   ABG (arterial blood gases)
   
4. 
   Peak expiratory flow rate
   
5. 
   Physical examination.
   

Answer: B. Methacholine tes: methacholine challenge test: a test that involves the inhalation of increasing concentrations of methacholine, a potent bronchoconstrictor, in patients with possible bronchial hyperreactivity; usually performed when a diagnosis of asthma or bronchospastic lung disease is not clinically obvious. Source: Stedman’s.

8. 
   Which one of the following pulmonary function values indicates airflow limitation
   
   1. 
      FEV1 of 60% of predicted .
      
   2. 
      FVC of 60% of predicted .
      
   3. 
      FEV1/FVC of 60% of predicted .
      
   4. 
      DLCO of 60% of predicted.
      
   5. 
      Residual volume of 60% of predicted.
      

Answer: C. FEV1/FVC of 60%. Total lung capacity (TLC) is used to assess interstitial lung disease. Expiratory flow rate (FEV1/FVC is used to assess obstructinve lung disease. Airway obstruction is diagnosed when the FEV1/FVC is <0.7 (70%0). (Source: MedStudy Pulmonology 2013, p. 6)

9. 
   Wide alveolar-arterial Po2 (PA-a O2) gradient can be increased in all of the following conditions EXCEPT:
   

1. 
   Morphine overdose .
   
2. 
   Severe pneumonia .
   
3. 
   Acute Bronchial Asthma .
   
4. 
   Acute Pulmonary edema .
   
5. 
   ARDS (acute respiratory distress syndrome)
   

Answer: In morphine overdose  Hypoventilation  No washout of alveolar CO2 and replacement with new O2
 Both arterial and alveolar O2 are decreased. Therefore, the PAa O2 gradient is decreased.

10. 
    Atopic bronchial asthma is characterized by all of the followings EXCEPT:
    
    1. 
       Positive family history .
       
    2. 
       Positive immediate reaction to skin prik test to allergens.
       
    3. 
       Elevated IgE level .
       
    4. 
       Affects patients after age of 40.
       
    5. 
       Elevated serum eosinophils count.
       

Answer: D. Onset of asthma early in life.

11. 
    The main mechanism of dyspnea is
    
    1. 
       Hypercapnia.
       
    2. 
       Alkalosis.
       
    3. 
       Increased work of breathing.
       
    4. 
       Increased deoxygenated hemoglobin.
       
    5. 
       Hypoxia .
       

Answer: A? Hypercapnia  metabolic acidosis?. For hypoxia and deoxygenated hemoglobin, it is true that they
cause dyspnea. But in metabolic acidosis, for example, there is no hypoxia. Nonetheless, there is “dyspnea”.

12. 
    All of the followings are true combination between a risk factor and pathogens causing pneumonia EXCEPT :
    

1. 
   Alcoholism and klebsella pneumonia
   
2. 
   Old age and mycoplasma pneumonia
   
3. 
   Cigarette smoking and H .infleunza
   
4. 
   Mechanical ventilation and pseudomonal pneumonia.
   
5. 
   Abnormal level of consciousness and anaerobic bacteria
   

Answer: B (Mycoplasma  Young, otherwise healthy patients).

13. 
    This is atypical part of 8 hours polysomnography for a 45 year old male patient
    

What is the diagnosis of this patient?

1. 
   Narcolepsy.
   
2. 
   Central apnea
   
3. 
   Obstructive sleep apnea.
   
4. 
   Mixed apnea .
   
5. 
   Hypopnea
   

Answer: I don’t know and I don’t want to know! Most probably, this is not required from us! Medscape article
about polysmnography: http://emedicine.medscape.com/article/1188764-overview#showall

Part 6

1.