Respiratory System Practice Quiz For Um/Fau

True or false:  A negative PPD test rules out TB in a patient with AIDS.

• True

• False

Which statement is true regarding TB treatment regimens?

• There is no resistance to the rifampin or isoniazid

• After the initial phase of two months, if symptoms are gone, treatment is ended

• Cavitation on CXR indicates a good prognosis

• One touch of Tim Tebow's garment instantly cures TB

• Rifampin, which inhibits RNA synthesis, and Isoniazid, which inhibits cell wall synthesis, are the 'anchors' of TB treatment

A 70 year old man with a 50 pack year history of smoking presents to the ED with a COPD exacerbation.  ABGs are:pH: 7.24PO2: 30PCO2: 60HCO3: 34What is the acid base disturbance?

• Respiratory alkalosis

• Metabolic alkalosis

• Respiratory acidosis

• Metabolic acidosis

• Normal

Which of the following are physical defense systems of the lung?

• Phagocytic, Immunologic, Cough reflex

• Cough reflex, Sneeze reflex, Upper airway filtering, Immunologic

• Immunologic, Phagocytic

• Upper airway filtering, Cough and Sneeze reflexes, mucociliary escalator

• Chuck Norris

Which of the following is seen in Chronic Lung Disease (aka Bronchopulmonary dysplasia)?

• Mechanical injury

• Oxygen toxicity

• Infection and sepsis

• Inflammation

• All of the above

What is the most common type of cancer in the head and neck?

Why is it more difficult for the lungs to compensate for a metabolic alkalosis than a metabolic acidosis?

• The response to alkalosis is hypoventilation, which results in hypoxemia.

• The lungs can't do anything to raise blood pH.

• The statement is incorrect, it is actually the same.

• The statement is incorrect, it is easier to compensate for a metabolic alkalosis then acidosis.

A 20-year-old man presents to the emergency department with complaints of left-sided chest pain and shortness of breath. He states that these symptoms began suddenly 4 days ago while he was working at his computer. He initially thought that he may have strained a chest wall muscle but, since the pain and dyspnea had not resolved, he decided to seek medical attention. He has no significant past medical history but has smoked cigarettes since the age of 16 years. His older brother suffered a pneumothorax at the age of 23 years. The patient's vital signs are normal. He appears in mild discomfort. X-ray is shown below:What physical exam findings would you expect to see in this patient?

• Dullness to percussion

• Egophany

• Whispered pectoriloquoy

• Hyperresonance to percussion

• Increased tactile fremitus

What grade of pulmonary hypertension is this image? 

• I-II

• III

• IV+

A 64 year old former politician is seen by his primary care physician for pain on urination, wheezing, dyspnea, and cough productive of brown sputum.  He admits to trying marijuana, but "didn't inhale." He is diagnosed with aspergilloma and chlamydia.  Given that aspergillus particles are about 3.5 microns in diameter, in which part of the airway is the aspergillus likely to be lodged?

• Alveolus

• Capillary

• Bronchiole

• Trachea

Which of these is not a phase of coughing?

• Expiratory

• Expressive

• Compressive

• Inspiratory

Which of the following is characteristic of an exudate?

• Pleural fluid LDH < 2/3 of the upper limits of normal serum LDH

• Pleural fluid protein/serum protein > 0.5

• Pleural fluid LDH/serum LDH < 0.6

• Pleural fluid protein > 1.0 g/dL

• Pleural fluid cholesterol < 45 mg/dL

What is the most common cause of bronchiolitis in children?

• Parainfluenza

• Rhinovirus

• Adenovirus

• Respiratory syncytial virus

• Coronavirus

Which of the following is/are true about Haemophilus influenza?

• Gram-negative bacillus, lacks polysaccharide capsule

• Colonizes upper respiratory tract, sputum sample is a highly specific test for H. flu

• Clinically similar to other Community Acquired Pneumonias, nearly eliminated in young children due to vaccination

• Rarely associated with COPD, requires blood containing medium for growth

Which of these is a disadvantage of pressure controlled ventilation?

• Can control inspiratory pressure level and I:E ratio

• Optimal patient synchronization

• Reduced airway pressures

• Unable to control minute ventilation

• Less likely to induce pneumothorax

Which of these patients would be indicated to receive mechanical ventilation?

• 80 kg male with a tidal volume of 320 mL

• 80 kg male with a tidal volume of 500mL

• 80 kg male with a vital capacity of 1550 mL

• 80 kg male with a PCO2 of 48

• 80 kg male with a a minute ventilation of 11 L/min

A 34-year-old man with a history of sex with men presents with 3 weeks of worsening dyspnea associated with fevers and a non-productive cough. He is tachycardic, tachypneic and has a temperature of 100.5°F (38.1°C). His pulse oximetry is 86% on room air. He appears thin and in moderate respiratory distress. His lung examination is unremarkable.  Patient lives in Arkansas, and denies recent travel.  Chest x-ray shows bilateral symmetrical interstitial infiltrates.  LDH is measured at 250 IU/L.  A-a O2 gradient is elevated.  What is the diagnosis?

• Sarcoidosis

• Coccidiomycosis

• MAC

• Streptococcus pneumoniae

• Pneumocystis jiroveci

A:    B:     Which of these are suspicious for cancer?

• A only

• B only

• A and B

• Neither A nor B

• What's cancer?

Which group of pulmonary hypertension is correctly matched with its definition?

• Group 1 PAH: Pulmonary hypertension with left heart disease

• Group 2 PH: Pulmonary Arterial Hypertension

• Group 3 PH: Pulmonary hypertension associated with lung diseases and/or hypoxemia

• Group 4 PH: Miscellaneous or caused by inflammation, obstruction, or extrinsic compression

• Group 5 PH: Pulmonary hypertension due to chronic thrombotic and/or embolic disease

A patient in the ICU has a PaO2 of 100 and an FiO2 of 40%.  The patient also has a normal PA wedge pressure and bilateral infiltrates on x-ray.  Which most accurately describes the most appropriate diagnosis and treatment of this patient?

• Acute lung injury, requires treatment

• ARDS, does not require treatment, send patient home

• ARDS, requires treatment

• Normal lung, send patient home

• Acute lung injury, does not require treatment, send patient home

Which of the following is not one of the common constitutional symptoms of reactivation TB?

• Anorexia

• Fever

• Unintentional weight loss

• Headache

• Night sweats

Which statement is true regarding patients with latent TB infections?

• Will not test positive on a PPD test

• Not at increased risk for developing active TB later in life

• They are currently contagious

• Show normal symptoms of active TB

• Should be treated with Isoniazid for 9 months

Which of the following pulmonary diseases is properly matched up with the CD4 count (cells/mm3) it is associated with in HIV patients?

• Sinusitis: only at

• PCP:

• CMV:

• Bacterial pneumonia: relationship with CD4 count not well established

• TB: only at

The patient with the above angiogram has a BP of 80/60, and is determined to be hemodynamically unstable.  What treatment is indicated?

• Aspirin

• Thrombolytics

• Supportive treatment only

• Heparin

• Medical marijuana

A 50 year old male presents with productive cough, fever, and chills.  His respiratory rate is 32.  The medical student on duty orders a CBC and the results show a WBC count of 20,000.  CXR shows a lobar consolidation.  Blood cultures return positive for Streptococcus pneumoniae.  Which of the following is/are true about S. pneumoniae?

• Abcesses and cavitations are common

• A blood culture is a highly sensitive test for S. pneumo

• Produces a protease that can cleave IgG

• The pneumovax vaccine can prevent all 84 serotypes

• S. pneumo is alpha hemolytic and does not grow well in the presence of optochin

A 36-year-old woman presents with a 6-month history of gradually progressive dyspnea on exertion and fatigue. On physical exam, her vital signs are normal and she appears not to be in any distress. Her lungs are clear to auscultation. Her cardiac exam shows a prominent jugular V wave, an accentuated pulmonic component to the second heart sound (P2) and a high-pitched holosystolic murmur best heard at the left sternal border.  Which of the following statements is most likely to be true about the pathogenesis of her condition?

• She has elevated NO levels

• She has elevated prostacyclin levels

• She has elevated endothelin levels

• There is no genetic factor in her disease

• Her disease is the result of an occupational exposure

A 3-month-old boy is referred by his pediatrician with intermittent inspiratory stridor and progressive feeding difficulties resulting in failure to thrive. The stridor has been present since he was 1 week old. His parents report that his noisy breathing is present more frequently and is particularly prominent when he is lying down, feeding, or crying. He has difficulty feeding and chokes frequently but has a normal cry. His mother reports that he feeds slowly and often has to stop several times during the feed to "gasp for breath." He has recently been diagnosed with GERD.  Flexible laryngoscopy reveals the following image:What is the diagnosis?

• Bronchiolitis

• Asthma

• Laryngomalacia

• Tracheoesophageal fistula

• Eisenmenger's syndrome

This sample was isolated from a 75 year old woman in the ICU who has been on mechanical ventilation for 1 month following a viral infection.  Which of the following would you, as an astute medical student, expect to see in this patient?

• Positive sputum culture, negative blood culture

• CXR with multiple nodular infiltrates, skin lesions

• Catalase negative, coagulase positive

• Diarrhea, dry cough, rigors

• Myalgia, arthralgia, rash

What are the predominant features of this EKG, taken from a patient with pulmonary hypertension?

• Left Axis deviation

• P pulmonale in lead II

• R/S ratio in V1 is

• Digitalis effect

• Atrial fibrillation

Which of the following would increase the likelihood of the condition depicted above the most?

• Smoking

• Asbestos exposure

• Sandblasting

• Smoking plus asbestos exposure

• Smoking plus sandblasting

For a patient with a pulmonary embolism, which is the most likely acid-base disturbance?

• Respiratory acidosis

• Respiratory alkalosis

• Metabolic acidosis

• Metabolic alkalosis

• Compensated respiratory acidosis

Which of the following statements about antibiotic treatment of pneumonia is/are true?

• Beta-lactams are only effective against organisms with a peptidoglycan cell wall, and are rarely subject to bacterial resistance

• Carbapenems are effective against gram-negatives, anaerobes, and gram-positives and are generally resistant to beta-lactamase cleavage.

• Monobactams are generally effective against gram-positives, but not gram negatives

• Azithromycin binds irreversibly to the 30 S subunit of bacterial ribosomes, and is active against atypical pathogens such as M. pneumoniae and C. pneumoniae

• Doxycycline binds irreversibly to the 50 S subunit of bacterial ribosomes and is effective against M. pneumoniae, S. pneumo, and Anthrax

Patients A, C, D, and E would be expected to have which of the following presentations?

• Polyhydramnios

• Inability to pass NG tube

• Gets better with feeding

• A and B

• All of the above

A patient has the following ABGs:pH: 7.40PO2: 75PCO2: 23HCO3: 15 (increased anion gap)What is/are the primary disturbance?

• Compensated respiratory alkalosis

• Compensated metabolic alkalosis

• Respiratory acidosis and metabolic alkalosis

• Respiratory alkalosis and metabolic acidosis

• Respiratory alkalosis and metabolic alkalosis

A 71-year-old male resident of Minnesota regularly spends several winter months in Arizona to play golf in the sun. Last March he experienced a gradual onset of fever and a headache, followed by a nonproductive cough, myalgia, and profound fatigue. His local physician diagnosed bronchopneumonia on chest x-ray and prescribed azithromycin. The antibiotic provided no benefit, and ultimately the patient received two more courses of different empiric antibiotics. He returned to Minnesota with continued cough and fatigue, even though the fever had abated somewhat. Two months following the initial onset of symptoms, a bronchoscopy was performed.  What would you expect to see growing in culture?

• Blastomycosis

• Coccidiomycosis

• Aspergillus

• Cryptococcus

• Staphylococcus aureus

Justin Bieber walks into your office and describes symptoms of hoarseness and lack of vocal control.  Flexible laryngoscopy is performed yielding the above image.  Which of the following treatments would you advise at this time?

• Voice rest

• Antacids

• Speech therapy

• A and C

• All of the above

A 70 year old woman presents to an inexperienced second year medical student with mild but persistent sinusitis, pharyngitis, and cough for the last few months.  The symptoms began in the summer.  CXR shows a streaky infiltrate.  The patient denies diarrhea, myalgias, arthralgias or rash.  Gram stain is unable to be attained but the wise old attending who already knows the diagnosis tells you that it would have been gram-negative.  What is the most likely diagnosis?

• Streptococcus pneumoniae

• Klebsiella pneumonia

• Mycoplasma pneumonia

• Legionella pneumonia

• Chlamydophila pneumonia

A 65-year-old man presents to the ER with acute onset of SOB of 30 minutes' duration. Initially, he felt faint but did not lose consciousness. He is complaining of left-sided chest pain that worsens on deep inspiration. He has no history of cardiopulmonary disease. A week ago he underwent a total left hip replacement and, following discharge, was on bed rest for 3 days due to poorly controlled pain. He subsequently noticed swelling in his left calf, which is tender on examination. His current vital signs reveal a fever of 100.4°F (38.0°C), heart rate 112 bpm, BP 95/65, and an O2 saturation on room air of 91%.  A second year medical student from the University of Miami (main campus) orders a D-dimer test.  The results are negative.  What is the significance of the D-dimer test result?

• Rules out PE

• Confirms the diagnosis of PE

• No significance, cannot rule out PE

• The student clearly went to the inferior campus at UM

• C and D

Select each answer choice that would be part of the differential diagnosis for this patient.

• Thyroid enlargement

• Terrible lymphoma

• Aneurysm

• Neurogenic tumor

• Thymoma

A 1-year-old child presents with failure to thrive. By history, the child was born at the 50th percentile for weight, but has crossed multiple percentile lines despite having a ravenous appetite. The child has more bowel movements per day than other children of the same age, and the stools often look shiny and have an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent, wet cough. On measurement, the child is small for age, with weight and length below the third percentile.  His mother states that his skin tastes 'salty' when she kisses him.  Which of the following would you also expect to see in this patient?

• Obstructive pattern on flow-volume loop

• Restrictive pattern on flow-volume loop

• Bronchiectasis

• Bacterial colonization

• History of meconium ileus

Which of these is/are causes of hypoxemic-hypercapnic respiratory failure?

• Asthma

• ALS

• Idiopathic pulmonary fibrosis

• Obesity

• Pneumonia