The lungs …..All are true except

1.   ?    the right lung has 10 segments
2.   ?    the left lung had 9 segments
3.   ?    the visceral pleura is exteremly sensitive to pain
4.   ?    the parietal pleura is extremely sensitive to pain
5.   ?    the left upper lobe has 4 segments

Causes of hypercapnia include all of the followings except:

1.   ?    myasthenia gravis
2.   ?    central sleep apnea
3.   ?    ankylosing spondylitis
4.   ?    motor neuron disease
5.   ?    acute pneumonia

Hypoxemia that is corrected with O2 therapy includes all of the followings except:

1.   ?    Large pulmonary arterio-venous malformation
2.   ?    acute pneumonia
3.   ?    pulmonary hemorrhage
4.   ?    acute pneumonia
5.   ?    pulmonary hemorrhage
6.   ?    pulmonary thromboembolism
7.   ?    acute asthma

Regarding lung imaging …which is the true statement?

1.   ?    MRI is usually used for parenchymal lesions
2.   ?    high resolution CT scan is less helpful in interstitial diseases
3.   ?    V/Q scan is contraindicated in ASD
4.   ?    bronchoscopy is useful in peripheral lung tumors
5.   ?    ultrasound examination of the chest is insensitive for the small detection pleural effusions

Causes of low TLCO with normal or increased KCO includes all of the followings except :

1.   ?    right sided pneumonectomy
2.   ?    Severe ankylosing spondylitis
3.   ?    myasthenia gravis
4.   ?    poliomyelitis
5.   ?    fibrosing alveolitis

Common causes of solitary lung nodule include all of the followings except:

1.   ?    single metastasis
2.   ?    bronchial carcinoma
3.   ?    Wegner's Granuloma
4.   ?    tuberculoma
5.   ?    lung abscess

Long term domiciliary oxygen therapy in COPD …all are true except:

1.   ?    has been shown to decrease the mortality by 50%
2.   ?    used for at least 15 hours / day
3.   ?    the objective is to produce PaO2 of more than 8 kPa without unacceptable rise in PaCO2
4.   ?    the patient should stop smoking before hand
5.   ?    indicated when the PaO2 is below 8 kPa with any level of PaCO2

The Acute exacerbation of COPD may be presented as all of the followings except

1.   ?    inbcrease in the amount sputum production
2.   ?    increase in the purulence of the sputum
3.   ?    fluid retention
4.   ?    increase in the chest tightness and wheeze
5.   ?    fever

Indications for corticosteroids in COPD...all are true except:

1.   ?    previuos response to steroids
2.   ?    during acute exacerbation
3.   ?    early in the course to lessen progression
4.   ?    concomitent asthma
5.   ?    if the patients was already on steroids

regarding the prognosis of COPD…all are true except

1.   ?    the best guide to progression of COPD is the decline in FEV1 over time
2.   ?    the prognosis is inversely related to age
3.   ?    the prognosis is directly related to post-bronchodilator FEV1
4.   ?    atopy patients have bad prognosis
5.   ?    pulmonary hypertension in COPD implies a poor prognosis

Treatment of acute exacerbation of COPD:

1.   ?    prophylactive subcutaneous heparin should be considered
2.   ?    the PH is less than 7.26 and the PaCO2 is rising consider ventilatory support
3.   ?    if ventilatory support is needed but not indicated because of poor quality of life or significant co-morbidity, then doxapram should be considered
4.   ?    Duiretics should be avoided
5.   ?    when giving O2, it is better to be given at a rate of 2 liters / minutes by nasal prongs

Air traveling for a patient with COPD … which one is the wrong statement :

1.   ?    there is a risk of expansion of non-functional pulmonary bullae
2.   ?    there is a risk of producing excessive abdominal gases
3.   ?    high risk of dryness of the bronchial secretions
4.   ?    all patients with a resting PaO2 less than 9 kPa on air require supplementary O2
5.   ?    hypercapnia is an absolute contraindication to air travel

In COPD…which one is the wrong statement?

1.   ?    central cyanosis may bee seen
2.   ?    peripheral edema may indicate cor pulmonale
3.   ?    wiegh loss is uncommon
4.   ?    only 15 % of smokers are likely to develop clinically significant COPD
5.   ?    Smoker emphysema is usually seen in the upper zones of the lung

Bronchial asthma...During histopathological examination all are true except

1.   ?    there is smooth muscles hypertrophy and hyperplasia
2.   ?    desequamation of the epithelium and edema of the sub mucosa thichening of the basement membrane is rarely seen
3.   ?    thichening of the basement membrane is rarely seen
4.   ?    mucus plugs are common especially in severe episodes
5.   ?    the changes are initially reversible

Prophylaxis of exercise induced asthma...All of the followings may be used... except:

1.   ?    adequate warm up exercises
2.   ?    pretretment with Beta 2 agonists
3.   ?    intravenous steroids
4.   ?    nedochromil sodium
5.   ?    moteleukast

Chest x ray findings in asthma …all are true… except:

1.   ?    may be totally normal
2.   ?    prximal bronchiectasis may indicate allergic bronchopulmonary aspergillosis
3.   ?    fluffy transient and patchy changes may indicate Church Strauss vasculitis
4.   ?    during an acute attack of asthma hyperlucency is rare
5.   ?    peumothorax should always be looked for in severe cases unresponding to standard treatment

In preventive measures against asthma episodes...the followings are considered to be with a HIGH efficiency when used to prevent asthma provocation...except

1.   ?    avoid contact with dogs, cats and horses (for animal dander)
2.   ?    avoid all possible drugs that may induce asthma attack (for drug-induced asthma)
3.   ?    avoid exposure to chemicals or change occupation if necessary (industrial chemicals)
4.   ?    for feathers in pillows, substitute latex foam pillows (feathers in pillows)
5.   ?    for food, try to identify and eliminate it from diet (for food)

Treatment of acute asthmatic attack...All are true… except:

1.   ?    the objective is to maintain PaO2 above 8.5 to 8 kPa with O2 therapy
2.   ?    High flow high concentration should be given even in the presence of hypercapnia
3.   ?    Systemic steroids should be given in all acute severe asthmatic attacks
4.   ?    peak expiratory flow rate has no role in the initial management
5.   ?    nebulized Beta 2 agonsits are preferred over the IV rout

In the treatment of acute severe asthma ……still signs of severity are present...What to do ….all are true except:

1.   ?    ipratropium bromide 0.5 mg should be added to the nebulized Beta 2 agonists
2.   ?    magnesium infusion may be considered
3.   ?    loading dose aminophyllin may be used even in those who are already on oral theophyllin
4.   ?    iv Beta 2 agonists may be used
5.   ?    there is a place for mechanical ventilation

Indications for mechanical ventilation in acute severe asthma...All are true...except

1.   ?    exhausion, confusion and drowsiness
2.   ?    coma
3.   ?    sudden respiratory arrest
4.   ?    PH less 7 and rising
5.   ?    PaCO2 more than 6 kPa and rising

In bronchiectasis …all are true...Except:

1.   ?    may be caused by pulmonary sequestration
2.   ?    may be caused by bronchomalacia
3.   ?    hemoptysis is common and may be life threatening
4.   ?    clubbing is uncommon
5.   ?    dry bronchiectasis indicates upper lobe bronchiectasis and may be caused by TB.

Cystic fibrosis …all are true except:

1.   ?    The commonest mutation is the delta 508 in CFTR gene on chromosome 7
2.   ?    staph infections tends to occur early in the course while pseudomonas and tends to be later
3.   ?    spontaneous pneumothorax should be suspected in any sudden deterioration
4.   ?    nasal polypi are common
5.   ?    amyloidosis may be seen

In cystic fibrosis which one is the wrong statement?

1.   ?    treatment with recombinant human DNAase has been shown to decrease the infective exacerbation in a sub group of patients
2.   ?    Treatment with recombinant human DNAase has been shown to improve the pulmonary function and the sense of wellbeing in a subgroup of patients
3.   ?    Recombinant human DNAase is delivered to the bronchial tree by a nebulizer
4.   ?    Treatment with recombinant human DNAase has been shown to be effective in cystic fibrosis as well as other causes of bronchiectasis
5.   ?    Treatment with recombinant human DNAase has been shown to be expensive

Community acquired pneumonias …..All are true… except:

1.   ?    the commonest causes is streptococcus pneumoniae
2.   ?    staph aureus is a rare cause
3.   ?    Many have overlapping picture
4.   ?    it is easily to differentiate between typical and atypical pneumonias
5.   ?    in any severe community acquired pneumonia; legionella infection has to be excluded

Objectives in the management of pneumonias in general …all are true ...except

1.   ?    obtain radiological confirmation of the diagnosis
2.   ?    exclude other conditions which may mimic pneumonias
3.   ?    Obtain microbiological diagnosis
4.   ?    asses the severity of pneumonia
5.   ?    looking for the development of complications is usually a minor thing

The following microbiological investigations should be done in all cases of community acquired pneumonias …except one investigation:

1.   ?    sputum for gram stain and culture
2.   ?    sputum for acid fast bacilli and culture
3.   ?    pleural fluid aspirate
4.   ?    blood cultures
5.   ?    seorology with acute and convalescent titers to diagnose mycoplasma, Chlamydia, legionella and viral pneumonias

Feature suggestive of high mortality in pneumonias …all are true except:

1.   ?    respiratory rate more than 30/minute
2.   ?    systolic blood pressure below 90mmHg and or Diastolic blood pressure below 60 mmHg
3.   ?    blood urea more than 17 mmol/L
4.   ?    hypoalbuminaemia
5.   ?    positive blood culture

Differential diagnosis of acute pneumonias...all are true except

1.   ?    pulmonar infarction
2.   ?    pleural / pulmonary TB
3.   ?    certain types of pulmonary edema. Usually atypical types
4.   ?    subphrenic abscess
5.   ?    paracolic abscess

Hospital acquired pneumonia ….all are wrong except:

1.   ?    does not include post operative pneumonia
2.   ?    does not include new pneumonia while the patient is on a ventilator
3.   ?    include certain types of aspiration pneumonias
4.   ?    occures in up to 10% of hospital admissions
5.   ?    Usually gram positive organisms predominate

Cryptic military TB …all are true except

1.   ?    usually occurs in old females
2.   ?    chest signs are rare
3.   ?    leukemoid reaction may be seen
4.   ?    pancytopenia may be seen
5.   ?    chest x ray usually abnormal

False negative tuberculin test may be seen in all of the followings ….except

1.   ?    miliary TB
2.   ?    immune suppressive therapy
3.   ?    early in the course of TB meningitis
4.   ?    eldery patients
5.   ?    AIDS patients

In the treatment of pulmonary TB ….which one is true

1.   ?    Thiacetazone is contraindicated in AIDS
2.   ?    optic neuritis is usually caused by pyrazinamide
3.   ?    hemolytic anemia with rifampicin is common
4.   ?    streptomycin mainly affects hearing rather than vestibular function
5.   ?    pyridoxin should be given to all patients receiving isoniazide

Allergic broncho-pulmonary aspergillosis all are true except

1.   ?    serum IgG precipitins is usually strongly positive
2.   ?    an immune complex disease, not invasive
3.   ?    esosinphilia is very common
4.   ?    is not caused by aspirgillus clavatus and the total IgE is raised
5.   ?    usually there is a preexistent lung disease

Lung cancer….all are true except

1.   ?    passive smoking is responsible for 5% of all lung cancers
2.   ?    exposure to naturally occurring RADON is responsible for 5 % of all lung cancers
3.   ?    may be caused by chromium and cadmium exposure
4.   ?    the incidence is slightly higher in rural than urban dwellers
5.   ?    the incidence of adenocarcinoma is rising

In lung Cancer...all are true except:

1.   ?    resposible for 25% of all cancer deaths
2.   ?    8% of cancer deaths in women and 4% cancer deaths in men
3.   ?    the commonest cause of cancer death in men
4.   ?    the most rapidly increasing cause of cancer death in women
5.   ?    more than 3 folds increase in cancer deaths since 1950

Chest X ray findings in lung cancer …..All are true except

1.   ?    totally normal films virtually exclude lung cancer
2.   ?    pleural effusion
3.   ?    lung, lobe or segmental collapse
4.   ?    broadening of the mediastinum
5.   ?    rib destruction

Contraindications to surgery in non-small cell lung cancer …….all are true except

1.   ?    Esophageal invasion
2.   ?    FEV1 less than 1.8 L
3.   ?    malignant pleural effusion
4.   ?    severe ischemic heart disease
5.   ?    contralateral mediastinal lymph node involvement

Posterior mediastinal mass on chest x ray includes al of the followings except:

1.   ?    paravertebral abscess
2.   ?    neurogenic tumors
3.   ?    foregut duplication
4.   ?    Diaphragmatic hernia through foramen of Morgagni
5.   ?    Diaphragmatic hernia through foramen of Bockdaleck

Presentation of sarcoidosis …all are true except

1.   ?    may be asymptomatic and discovered incidentally by x ray in up to 30 % of cases
2.   ?    occular symptoms in 5-10 % of patients
3.   ?    skin sarcoids in 5 % of cases
4.   ?    symtoms of hypercalcemia in 20% of cases
5.   ?    superficial lymph node enlargement in 5 % of cases

Indications of treatment of sarcoidosis with steroids

1.   ?    hypercalcemia per se
2.   ?    occular sarcoidosis
3.   ?    CNS involvement
4.   ?    stage I or II disease
5.   ?    cardiac sarcoidosis

Cryptgenic fibrosing alveolitis ……all are true except

1.   ?    twice as common among cigarette smokers than in nonsmokers
2.   ?    bronchoalveolar lavage shows predominance of neutrophils
3.   ?    clubbing is seen in 60% of cases
4.   ?    Query association with Epstien Barr virus
5.   ?    LDH is elevated in a minority of patients

In extrinsic allergic alveolitis and other lung diseases due to exposure to organic dusts …which one of the following associations is true

1.   ?    Byssinosis-penicillium cassie
2.   ?    Malt worker's lung –aspirgillus fumigatus
3.   ?    maple bark stripper's lung-cryptostroma corticale
4.   ?    cheese worker's lung –thromophilic actinomycetes
5.   ?    bird fancier's lung –aspirgillus clavatus

In asbestosis...all are true except

1.   ?    the commonest type of asbestos fibers produced world-wide is the white one (chrysotile)
2.   ?    exposure mainly occurs through mining and milling of the mineral
3.   ?    greatly increases the risk of lung adenocarcinomas especially in smokers
4.   ?    greatly increases the risk of pleural mesotheliomas especially in smokers
5.   ?    the overall risk of malignancy is higher in smokers than non-smokers

Pulmonary eosinophilia may be seen in all of the followings except

1.   ?    nitufurantoin
2.   ?    mansonella steptocerca
3.   ?    Wuchereria Bancrofti
4.   ?    phenylbutazon
5.   ?    Wegner's granulomatosis

In alveolar proteinosis …all are true except:

1.   ?    sponateous remission occurs up to 30 %
2.   ?    fever and hemoptysis are common
3.   ?    5 % remission rate after whole lung lavage
4.   ?    air bronchogram on chest x ray is common
5.   ?    diffuse bilateral shadowing mainly around the hili is the usual cheat x ray finding

Lymphangioleiomyomatosis…..all are true except

1.   ?    usualy seen in females during their child bearing age
2.   ?    chylous pleural effusions are common
3.   ?    recurrent pneumothorces are seen
4.   ?    hormonal ablation and progestins are highly effective in the treatment
5.   ?    hemoptysis is seen

Uncommon cases of pleural effusions …..All are true except

1.   ?    yellow nail syndrome
2.   ?    Meig's syndrome
3.   ?    acute rheumatic fever
4.   ?    subphrenic abscess
5.   ?    myxedema

Indication for tube drainage in Pneumothorax …….all are true except

1.   ?    Tension type per se
2.   ?    More than 2-5 liters of air aspirated
3.   ?    if you faced resistant during aspiration
4.   ?    pneumothorx with underlying COPD
5.   ?    any degree of dyspnea

Causes of elevation of the hemidiaphragm ……all are true except

1.   ?    severe pleuritic pain
2.   ?    subphrenic abscess
3.   ?    pulmonary infarction
4.   ?    eventration of the diaphragm
5.   ?    intercostal nerve palsy