Respiratory Physio 1. Increases in heart rate and cardiac out are observed in a 32 yr old woman.

Simultaneous arterial blood gas studies show a normal PaO2 and PaCO2. These changes are most likely part of an integrated response to which of the following? a. High altitude decrease Patm decrease PAO2 decrease PaO2 stimulated peripheral chemoreceptors Hyperventilation decrease PaCO2 b. Exercise c. Pulmonary Embolism perfusion defect d. Carotid Sinus Massage e. Panic Attack

2. Patient suffering from sleep apnea is most likely to develop Stop breathing increase CO2 pulmonary vasoconstriction Long term Pulmonary HTN 3. Why PO2 of left atrium is lower than pulmonary capillaries? ID 1542 venous mixture 4. 1981: 44 yr old truck driver with SOB and mild calf swelling a week ago. What will be his pH, PaO2, PaCO2 and HCO35.

Respiratory Behavior 1. 76 year old patient with COPD, Athersclerosis, diabetes presents with COPD exacerbation. Patient is being treated with bronchodilators, antibiotics, systemic corticosteroids. What is the most essential topic to discuss a. Education about the need to increase exercise and improve glycemic control and heart health b. Ensure presence of a will so that personal matters are organized should be he pass away during his hospitalization c. Document financial status as patient has a potential need for home ventilator if lung disease continues to worsen d. Educationa bout quitting smoking to lessen chances of dying from heart and lung disease e. Inquire about presence of an advance directive and the patients wishes for end life care Part of the admission, no matter what the health condition, patient and health care provider should always discuss advance planning, advance directive and their wishes

Pulmonary Pharm 1. Isolates of M. tuberculosis obtained from 23 yr old HIV positive male significantly decreases activity of intracellular catalase-peroxidase. The isolates would most likely grown in the presence of: a. Isoniazid b. Rifampin resistance via DNA-Dependent RNA polymerase mutation c. Ethambutol resistance via increasing arbainosyl transferse Ethambutol inhibits arbaninosyl transferase d. Streptomycin resistance occurs via 30S ribosomal protein modification streptomycin cant bind e. Pyrazinamide pyrazinamidase in bacterial activates pyrazinamide resistance via pyrazinamidase modification 2. Target of fungal drugs diagram ID 271 3. New medication inhibits fungal colongy growth by altering the fungal cell membrane composition. In humans volunteers, the drug inhibits the liver cytochrome P450-dependent metabolism of several drugs. This drugs is most similar to? a. Amphotericin B b. Itraconazole azole decreases ergosterol synthesis also inhibits P-450 c. Terbinafine d. Griseofulvin e. Caspofungin f. Flyctosine Respiratory Microbiology 1. 45 yr old male presents to your office because of occasional hemoptysis. PMH is significant for tuberculosis, which was treated. Apical region of lung is resected. Gross oexamination reveals a fibrous cavity partially filled with a round mass of hyphae. This patient condition is best described as: a. Contagious aspergillus not contagious b. Necrotizing can invade blood vessels and cause tissue necrosis c. Allergic occurs in patients with asthma, presentation with wheezing increased IgE d. Colonizing occurs in old cavity pt with TB e. Invasive occurs in immunosuppressed with neutropenia f. Disseminated Aspergillus fumigates grows old cavities (doesnt invade) fungus ball 2. 63 yr old man brought to emergency department after recent onset of high fever, confusion, headache watery diarrhea and mild productive cough. He has been smoking 2 packs of

cigarettes daily for more than 30 years and has been diagnosed with chronic bronchitis. Sputum gram stain shows numerous neutrohils but no bacteria. Which bacteria is most likely the cause a. Mycoplasma pneumonia b. Klebsiella pneumonia c. Streptococcus pyogenes d. Legionella pneumophila Legionnaires Disease Smoker with High Fever and diarrhea e. Myobacterium kansasii f. Coccidiodes immitis 3. ID 553 4. 34 yr old suffering from pneumonia with productive cough green sputum. What is causing the green sputum a. Myeloperoxidase is Blue-green heme base pigment blue-green sputum 5. 48 yr old has fibrosis of lower lobe of right lung and calcified lymph node in the right lung hilus. This is most consistent with? a. Primary exposure of TB Fibrosis of lower lobe + hilar calcification Ghon focus primary TB b. Secondary exposure of TB Apical cavitary lesions 6. 35 yr old male with recurrent hemoptysis is found to have apical infiltrative cavitary lung lesions. Culture grows acid fast bacilli. What is the mechanism of tissue damage a. Exudation and alveolar hepatization pneumonia caused by strep pneumo b. Delayed type hypersensitivity TB TH1 CD8 Delayed Hypersensitivity

Respiratory Path ID 2116 1. 56 yr old Caucasian male presents to the mergency department with a six

Pulmonary Biochem 1. 6 yr old pt with cystic fibrosis. Nasal transepithelial potential difference is negative proving that it is CF. What process occur as a result of CF. Increased Cl- secretion CF causes a decrease in Cl- secretion not increase b/c of Cl- channel mutation a. Increase Na Absorption CF decrease Cl- excretion increases Na Absorption to balance charge water follows thickens mucous 2. 14 yr old Pt suffers from asthma. What test can you perform to exclude asthma?

a. Absence of eosinophilia asthma increases eosinophils but not sensitive for asthma b. Normal IgE IgE elevated in atopic asthma but normal in intrinsic causes of asthma c. Negative methacholine challenge sensitive but not specific for asthma negative methacholine challenge tests rules out asthma 3. Pt exposed to UV radiation. What will happen now as a result of the sun exposure Double Stranded DNA breaks undergoes end-joining repair: occurs in ionizing radiation (Xray and Gamma Rays) Adjacent purine bases forms covalent bonds: Thymine-Thymine is a pyrimidine bond nor purine bond Specific glycosylase removes deaminated bases: occurs due to exposure of certain chemicals Specific endonuclease nicks the damaged DNA strand: pyrimidine repair due to UV light exposure

4. Students went cave exploring and few days later developed cough, fever, maaise. CXR shows hilar adenopathy. Lung biopsy will likely show: a. Multinucleated spherules south western U.S spherules b. Ovoid cells within macrophages histoplasmosis c. Budding yeast w a thick capsule bird and pigeon dropping meningitis Cryptococcus neoformans d. Pseudohyphae and blastoconidia Candida forms pseudohyphae e. Septate hyphae with dichotomous branching aspergillus fumigates 5. 24 yr old male complaining of paroxysmal episodes of breathlessness and wheezing. Sputum shows granule-containing cells and crystalloid mass. The sputum findings suggests the role of which of the following substances in the patients condition. a. IL-5 IgE, IgG, Th2 and Eosinophils 6. Pt has fish bone stuck in the piriform recess. Upon removing the food a nerve is damaged. What is now impaired in the patient. a. Gag reflex glossopharyngeal nerve induces cough b. Cough reflex superior laryngeal nerve 7. Aminocentesis performed on 35 yr old pregnant woman. Phospholipid content determines? a. Neural tube defect AFP b. Erythroblastosis fetalis bilirubin c. Fetal adrenal dysfunction check 17 hydroxyprogesterone levels d. Fetal lung maturity phospholipids dipalmitoyl phosphatidylcholine

8. Brochoalveolar lavage fluids of 34 yr old pt contains elastase enzyme. Which cell produces elastase? a. Clara cells secretes Clara cell secretory protein inhibits neutrophil recruitment and activation b. Alveolar macrophages secretes elastase

9. Small DNA virus is described that has affinity for stratified squamous epithelium. The virus is most likely to affect which of the following respiratory structures? a. Paranasal sinusciliated pseudostratifed columnar mucus secreting epithelium b. Laryngeal vestibule upper airway ciliated pseudostratified columnar mucus secreting epithelium c. False vocal cords same as above d. True vocal cords stratified squamous epithelium e. Trachael bifurcation ciliated pseudostratified columnar mucus secreting epithelium

10. 56 yr old smoker presents with puffy face for 2wks. Physical examination shows facial swelling and conjuctival edema. Pupils are equal, round and reactive to light. Dilated vessels are seen over his neck and upper trunk a. Mediastinal mass pancoast tumor apex of lung brachial plexus compression shoulder pain Horner syndrome (ptosis, miosis and anhydrosis) b. Superior Vena Cava Syndrome Superior vena cava drains head and upper trunk compression face swelling, neck and upper extremities & dilated collateral veins on chest

11. 23 yr old suffers from occasional nighttime dyspnea and wheezing. Brother suffers from atopic dermatitis. Which drug can be used as a provocation test in this patient? a. Allergic rhinitis or atopic dermatitis family Hx asthma methacholine

12. 54 yr old found to have hemorrhagic pleural effusion. He has worked in a shipyard for past 25 years and has smoked for past 30 years. CT scan shows diffuse nodular thickening of the pleura. Pleural biopsy shows columnar cells joined by desmosomes, with abundant tonofilament and studded with very long microvilli. This patients suffers from a. Mesothelioma nodular or smooth pleural thickening 13. ID 806

14. 62 yr old presents to office w/copious amounts of plan tan colored fluid. CXR shows pulmonary infiltrate that is subsequently histology shows columnar mucin-secreting cells that fills the alveolar spaces without invading the stroma or vessels. a. Bronchiolo-alveolar CA tall, columnar cells w/o invading stroma or vessels malignant neoplasm

15. 35 yr old African American with arthralgias and tender deep nodules on her leg. Hepatomegaly, enlarged lymph nodes and elevated ACE levels. PPD is negative. Liver biopsy will show? a. Sarcoidosis increase Ca increase ACE granulomas on liver

16. 42 yr old female with primary pulmonary HTN gets transplant. Some time later she complains of fatigue and exertional dyspnea. Biopsy shows fibrotic obstruction of the terminal bronchioles b. Acute rejection perivascular infiltrates dry cough, dyspnea and fever c. Chronic rejection small bronchioles obstruction lymphocytic inflammation and necrosis of bronchiolar walls 17. 52 yr old females with left leg cellulitis gets cefazolin. Then complains of SOB, diffuse itching and dizziness. BP 62/30 and HR 130/min. What is elevated in patients serum a. Tryptase anaphylaxis mast cell degranulation Tryptase is Mast cell enzyme

18. How does IgE mediation causes Mast cell degranulation? a. Anti-body receptor dissociation releases IgE Cant degranulate b. Antibody receptor covalent binding covalent = strong bond it is high affinity c. Receptor internalization occurs in nerve desenitization d. Receptor aggregation antigen in the middle with Antibodies on side aggregation degranulation e. Receptor detachment from cell surface

19. Which of the following parameters would increase most as a direct result of vagal stimulation Vagal parasym broncho-constriciton M3 increase mucous obstructive decrease expiratory increase work of breathing 20. Patient with COPD suffers MI. You administer B-blocker. Which beta blocker would you administer? a. Propanolol non-selective broncho-constriction

Nadolol non-selective broncho-constriction Metoprolol B-1 selective Timolol non-selective broncho-constriction Isoproterenol alpha-adrenergic bronchodilation, decrease HR, CO and Peripheral arterial resistance bronchodilation CI in MI 21. 44 yr old truck driver came to ER with SOB. Smokes 2 pk a day. Mild calf swelling in the past week. What will be his arterial blood gases ID 1981 b. c. d. e.