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Lung?1. The type of emphysema associated with smoking isa. Panacinarb. Centriacinarc. Distal acinard. Irregulare. None of the above2. squamous cell lung carcinomaa. has a 5 year survival rate of 60%b. is most commonly associated with smokersc. is commonest peripherallyd. is commonest in femalese. ?3. Intrinsic asthma:a. Decreases vagal afferent responsivenessb. Is associated with atopyc. is commonly triggered by viral infectionsd. IgE levels are often elevatede. The airway is not hyperreactive4. Lobar pneumoniaa. Is more common in the young and the elderlyb. Involves morphological changes of red to grey hepatisationc. Not usually associated with a productive coughd. Is associated with immunosuppressione. Rarely caused by streptococcus5. Chronic bronchitis is characterized bya. Smooth muscle hypertrophyb. Leukocyte infiltrationc. Mucous gland hypertrophyd. Increased size of goblet cellse. ?6. All of the following cause compressive atelectasis EXCEPT:a. Pneumothoraxb. Asthmac. CCFd. Peritonitise. Pleural effusion7. Which is not true of bronchogenic cystsa. They may become dysplasticb. They occasionally cause pneumothoraxc. They have an epithelial layerd. They may contain mucouse. They are often associated with bronchioles8. Chronic bronchitis major morphological change involvesa. Leukocyte infiltrationb. Decreased goblet cell numberc. Smooth muscle hypertrophyd. Increased mucosal gland depth (REID index)e. Monocyte infiltration9. Regarding bronchogenic carcinomaa. It most often arises around the hilum of the lungb. Distant spread occurs solely by lymphatic spreadc. Metastasis are most common to the liverd. Small cell carcinoma is the most common typee. Surgical resection is often effective for small cell carcinoma10. In emphysemaa. A deficiency of alpha 1 antitryptin is protectiveb. Centriacinar destruction leads to obstructive overinflationc. The protease-antiprotease mechanism is the most plausible explanation of the diseased. Smokers have an increased number of macrophages in the bronchie. Elastase activity is unaffected by oxygen free radicals11. In chronic bronchitisa. The hallmark is hypersecretion of mucous in the large airwaysb. There is a marked increase in goblet cells in the main bronchic. Infection is a primary caused. Cigarette smoke stimulates alveolar leukocytese. Dysplasia of the epithelium leads to emphysema12. In bronchial asthmaa. Extrinsic asthma is initiated by diverse non-immune mechanismsb. Sub-epithelial vagal receptors in respiratory mucosa are insensitive to irritantsc. IgG plays a roled. Bronchial wall smooth muscle is atrophice. Primary mediators include eosinophilic and neutrophilic chemotactic factors13. In bacterial pneumoniaa. Patchy consolidation of the lung is the dominant feature of bronchopneumoniab. A lobar distribution is a function of anatomical variationsc. Klebsiella pneumonia is a common virulent agentd. Alveolar clearance of bacteria is achieved by lymphocytese. The nasopharynx is inconsequential in defending the lung against infection14. Regarding anatomical types of emphysema:a. Panacinar is more common than centriacinarb. Centriacinar is not common in smokersc. Paraseptal emphysema is associated with alpha-1 antitrypsin deficiencyd. Spontaneous penumothorax is common in panacinar typee. Distal portion of acinus is predominantly involved in paraseptal emphysema15. Comparing the pulmonary oedema of CCF with ARDS, a defining characteristic of ARDS is:a. Spontaneous resolution within 48 hoursb. Formation of hyaline membranesc. A deficiency of surfactantd. A distinct lobar pattern of consolidatione. High pulmonary wedge pressures16. Bacterial pneumonia:a. May be predisposed to by immotile cilia syndromes (eg. Kartageners)b. Is characterized by an acute (neutrophilic) suppurative exudates within alveolar spaces and airwaysc. Is a frequent cause of death in hospitalized patientsd. May be complicated by organisatione. All of the above17. Atypical pneumoniaa. Is characterized by exudates within the alveolar air spacesb. Has a predominantly neutrophilic cell infiltratec. Has a mortality rate of 20% in non-epidemic casesd. Is most often caused by cytomegaloviruse. Is associated with the formation of hyaline membranes within the alveolar air spaces18. Regarding pulmonary infections:a. Respiratory tract infections are more frequent than infection of any other organb. Patchy consolidation is uncommon with bronchopneumoniac. Lobar pneumonia is more frequent than bronchopneumoniad. Haematogenous secondary seeding of lungs does not occure. Commonest infectious agents are H. influenzae and K. pneumoniae19. The following is not an obstructive airways diseasea. Emphysemab. Pneumoniac. Asthmad. Bronchitise. Bronchiectasis20. With respect to atelectasisa. The mediastinum may shift away from the affected lungb. Obstructive atelectasis is commonest after traumac. Compressive atelectasis is commonly encountered in patients with chronic obstructive airways diseased. It is an irreversible disordere. It can develop when there is loss of pulmonary surfactant21. Regarding lung abscesses:a. Aspiration most commonly results in abscesses in the left lungb. Anaerobic organisms are the exclusive isolates in 60% of casesc. A central area of liquefactive necrosis developsd. Infected emboli from bacterial endocarditis typically affect the right lunge. Secondary empyema occurs in 50% of cases22. Regarding emphysemaa. The usual age of onset is 40-50 yearsb. Copious sputum production is commonc. Cor pulmonale is a common featured. Airways resistance may be normale. CXR usually shows a large heart23. Regarding bronchogenic carcinomaa. It most often arises around the hilum of the lungb. Distant spread occurs solely by lymphatic spreadc. Metastasis is most common to the liverd. Small cell carcinoma is the most common typee. Surgical resection is often effective for small cell carcinoma24. All of the following are neoplastic syndromes associated with lung cancer EXCEPT:a. Cushings syndromeb. Syndrome of inappropriate ADH secretionc. Hypocalcaemiad. Carcinoid syndromee. Hypertrophic osteoarthropathy25. Which of the following is not a paraneoplastic syndrome associated with lung carcinoma?a. Ectopic ADH secretionb. Dermatomyositisc. Migratory thrombophlebitisd. Eaton-Lambert (myasthenic) syndromee. Thrombocytosis26. The features of bronchogenic carcinoma includea. The classification of “oat cell” tumour withing the large cell typeb. High initial response to chemotherapy for small cell typec. The strongest correlation with cigarette smoking in the adenocarcinoma typed. That 50% of small cell type occur in non-smokerse. Histological deatures identical in small cell carcinomas and squamous cell types27. In lobar pneumonia:a. It is more common in the young and elderlyb. Get a change from red to grey hepatisationc. Not usually associated with a productive coughd. Rarely caused by streptococcuse. Associated with immunosuppression28. obstructive atelectasisa. the mediastinum moves away from lesionb. involves the reabsorption of airc. is caused by pleural fluidd. ?e. ?29. Asthma shows all EXCEPTa. Thinning of basement membraneb. Submucosal gland hypertrophyc. Hypertrophy of smooth muscled. Charcot Leyden crystalse. Cushmann’s spirals30. Regarding the use of steroids in Asthmaa. They inhibit cytokinesb. Cause bronchodilationc. Given nocte because of diurnal variationd. ?e. ?31. The most common type of emphysema associated with cigarette smoking isa. Centrilobularb. Panacinarc. Paraseptald. Irregulare. Compensatory32. In regards to bacterial pneumoniaa. A predominantly interstitial pattern of inflammation is seen in some paediatric patientsb. Most lobar pneumonias are caused by pneumococci which enter the lung haematogenouslyc. Congestion predominates in the first 72 houesd. Complications are more common with bronchopneumoniase. Organisation of exudates into a fibrotic scar tissue is not a complication33. Chronic bronchitisa. Is twenty times more common in heavy smokersb. Is present in any patient with persistent cough with sputum production for at least two months in three consecutive yearsc. Is characterized by early functional respiratory impairmentd. Can progress to cor pulmonale and cardiac failuree. Is a disease of the large airways34. Regarding emphysemaa. The commonest type is panacinar formb. In centrilobular form, the distal alveoli are sparedc. In panacinar form, the upper lobes of the lungs are mainly affectedd. In centrilobular form, the lower lobes of the lungs are mainly affectede. There is no association between cigarette smoking and emphysema35. Features of atopic asthma include all of the following EXCEPT:a. IgE production by beta-cellsb. Induction of TH1 cellsc. Release of IL-4 and IL-5d. Growth of mast cellse. Activation of eosinophils36. Restrictive lung disease is characterized bya. Acute inflammation of alveolar interstitiumb. Increased compliancec. Ground glass appearance on chest X-ray filmd. Long term complication of mesotheliomae. Increased lung volume37. ARDS is associated with all of the following EXCEPT:a. Interstitial fibrosisb. Pulmonary vein obstructionc. Hypoxaemia responsive to oxygen therapyd. Radiation injurye. DKA38. In the lungsa. Bacterial invasion evokes exudative liquificationb. Bronchopneumonia is commonly caused by Chlamydia organismsc. 90-95% of lobar pneumonias are caused by Streptococcus pneumoniaed. grey hepatisation is the first stage of the inflammatory responsee. bronchopneumonia shows characteristic radiological appearance of radio-opaque well circumscribed lobe39. Pulmonary oedemaa. Contains a protein rich fluid in the alveolar spacesb. Fluid accumulates especially in the dependent apical regions of the lower lobec. In a chronic state, can result in interstitial fibrosisd. Is not associated with ARDSe. Can result from increased hydrostatic pressure such as in the nephritic syndrome40. Characteristic histologic findings of asthma include:a. Thinning of the basement membrane of the bronchial epitheliumb. Oedema and an inflammatory infiltrate in the bronchial walls with a prominence of plasma cellsc. An increase in size of the submucosal glandsd. Atrophy of the bronchial wall musclee. Undistended lungs because of occlusion of bronchioles41. Regarding the pathogenesis of COPD:a. Macrophage elastase function is inhibited by alpha1-antitrypsinb. Cigarette smoking activates the classic complement pathwayc. Microbiologic infections initiate the changesd. Cmokers have decreased numbers of neutrophils in their alveolie. Chronic bronchitis is up to 10 times more common in heavy smokers42. Regarding bacterial pneumoniaa. Lobar pneumonia is most often caused by staphylococcib. Coliform bacteria are unlikely to cause bronchopneumoniac. Particles larger than 10mm are deposited in terminal airways of alveolid. Lobar distribution is an indication of the virulence of the organisme. During resolution, the transudate is digested by enzymes43. emphysemaa. is defined clinically as persistent cough with sputum production for at least three months in at least two consecutive yearsb. is defined morphologically as the abnormal enlargement of air spaces proximal to the terminal bronchiolesc. is a restrictive lung diseased. has airway dilation and scarring as its major pathological changee. develops earlier in smokers with an alpha 1 antitrypsin deficiency44. Regarding asthmaa. The inflammatory infiltrate of bronchial walls is predominantly neutrophilsb. Hypertrophy of bronchial wall muscle reflects prolonged bronchoconstrictionc. It is triggered by IgG responsed. Sympathetic stimulation provokes bronchoconstrictione. Bacteria are the most common provokers of an acute attack45. Regarding malignant mesotheliomaa. It is asbestos related in more than 90% of casesb. It has been found to contain adenovirus DNA sequencec. Smoking increases the risk of developing mesotheliomad. 50% of patients die within 6 months of diagnosise. can contain epithelioid and sarcomatoid cells ................
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