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NAME:

MODULE: RESPIRATORY SYSTEM (MODULE 13)

DURATION:

ANATOMY OF THE LUNG 2

1. The following are true about the following statements EXCEPTA. Aspiration of fluid from pericardium is done at the medial ends of 4 th and 5th intercostals spacesB. Lungs are supplied by bronchial arteries and bronchial veinsC. In erect position, a foreign body entering the trachea will go to the posterior basal segment of

the left lung

D. Bronchodilatation occurs in muscular exerciseE. Pleural injury causes pneumothorax

2. The following are true about the surface anatomy of lung or pleura EXCEPTA. The apex of the lung lies above the medial end of the clavicleB. Two points close to the middle line behind the sternum, at the level of 2nd and 4th costal

cartilage respectively (anterior border)

C. The visceral pleura has the same surface anatomy as the lungD. For the anterior border, there is a point behind 6th costal cartilage, 2 cm from sternum for the

right lung

3. The following are true EXCEPTA. The superior lobe of right lung s divided into anterior, posterior and apical segmentsB. A segment from a lobe of a lung can be removed without affecting the functions of other

segments as each segment has their own supply of bronchus and artery

C. The medial segment of the middle lobe can be seen from the surface of the lungD. Only the left lung contain fused segments

4. The following are false EXCEPTA. The left lung is smaller and shorter than the right lungB. The oblique fissure of the right lung begins at the posterior border of lung opposite to 4 th

thoracic spine and end at the inferior border opposite the 5 th costochondral junction

C. Cardiac notch is found only in the left lung but lingual can be present in both lungsD. The left lung is supplied by only one main bronchus entering the hilum

5. The hilum of lung gives passage to the following structures EXCEPTA. Pulmonary ligamentB. Pulmonary plexusC. Hilar lymph nodesD. Pericardiaco-phrenic artery

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ANATOMY OF THORACIC CAGE

6. Which of the following is not part of thoracic cage ?A. SternumB. ribsC. VertebraeD. Trachea

7. Choose the false statement regarding boundaries of thoracic outletA. anterior ; xyphoid processB. Posterior ; last thoracic vertebraeC. Both side ; lower six costal cartilageD. Superior ; larynx

8. All of the following are typical ribs and vertebrae exceptRibs Vertebrae

A. 1st 12th

B. 3rd 3rdC. 5th 6th

D. 7th 8th

-Single articular facet

-no tubercle & no neck

-no costal groove

9. Which rib has the above characteristicA. 10thB. 12thC . 1st

D. 9th

10. Below are characteristic of typical vertebrae exceptA. Spine is horizontal

B. Have large upper demifacet that articulate with head of corresponding rib

C. Body small in size

D. Body is in heart shape

MECHANICS OF RESPIRATION

11. Choose the correct answer about the respiration process:I- Main goal of respiration is for pH regulation and water balance

II- It involve 2 process which are concerning the gaseous exchange and utilization of O2 with

production of CO2

III- Perfusion: Distribution of air in the lung

IV- Diffusion: Exchange of gases (O2 and CO2)

A. I & II

B. I, II & III

C. II & IV

D. ALL of the above

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12. All of the following are correct regarding the function of the conducting zone EXCEPT:A. Through air conditioning, inspired air reaches respiratory zone at 37

0C

B. The inspired air is saturated 100% by the water vapour by the time it reaches larynx as to

protect the delicate lung tissue

C. The foreign and irritant substance are removed from the respiratory passages through sneezing

or coughing reflex

D. Very small particles are trapped by hairs at the nose

13.Choose the correct matching between the muscle and its action:A. Diaphragm : during contraction, it increase the vertical dimension and transverse diameter of

the thorax

B. Scalene muscles: Raise the sternum

C. Stenomastoid muscles : Elevate the first two ribs during forced inspiration

D. External intercostals muscles : Increase the antero-posterior diameter of the thorax and vertical

dimension

14.All of the following are true regarding the mechanics of inspiration, EXCEPT:A. Both normal quiet breathing and forced inspiration is an active processB. The main muscles of inspiration are diaphragm and external intercostals muscle

C. During inspiration the ribs are pulled upward and downward

D. By contraction of the main muscles, the chest cavity are expanded in all dimensions

15.Choose the correct answer regarding the forced expiration :A. It is an active process occur at rest

B. Extra force is achieved by the contraction of rectus and transverse abdominus, internal and

external oblique and internal intercostals muscle

C. The inspiratory muscles recoil and the the thoracic cage drop by its weight

D. Elastic force is sufficient to expel air from the lung during the active process of expiration

RESPIRATORY PORTION(HISTOLOGY)

16. Respiratory portion is composed of the following except:A. Alveolar duct

B. Bronchi

C. Alveoli

D. Respiratory bronchioles

17. All of the following are true about the respiratory bronchioles except:A. Arise from the bifurcations of the terminal bronchioles

B. They have definite walls are lined by columnar ciliated epithelium

C. Cilia will gradually disappear

D. From their walls very thin saccular outpocketing called alveoli arise

18. Choose the correct statement regarding the alveolar duct:A. They are long branching passages arising from respiratory bronchioles

B. Have walls of their own, the ducts are created by neighboring alveoli

C. End into a small space called ventricle into which the alveoli open

D. The functional and structural units in which gaseous exchange takes place

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19. The following statements are true regarding the cells of alveolar epithelium except:A. Type I pneumocytes line most of alveolar surface (90%)

B. Type II pneumocytes are large rounded secretory cells

C. Type II alveolar cells are progenitor cells for type I alveolar cells

D. Type II cells have dense ovoid membrane-bound lamellated granules called lamelated bodies

20. Alveolar capillary barrier is composed of the following except:A. A layer of surfactant

B. Fused basal laminae of type I pneumocytes and endothelial cells of the capillary

C. Cytoplasm of type II pneumocytes

D. Cytoplasm of endothelial cells of the continuous capillary

PHARMACOLOGY OF ALLERGY AND RESPIRATORY SYSTEM

21. Allergy isA. Reaction involving degranulation of mast cell particularly

B. The only hypersensitivity reaction

C. Antigenantibody reaction involving several inflammatory cells in an atopic individualD. Reaction can be happened in anyone

22. Regarding to the variables included in allergy, all of the following are true EXCEPTA. Products of mast cells degranulation are histamine, leukotriene, prostaglandin and

thromboxane A2

B. Interleukin produced by white blood cells can either stop or worsen the allergy reaction

C. The most common antigens are pollens, dust mite, animal dander and mould spores

D. Atopic individual produces high level of IgE reacting to common inhalant allergens genetically or

acquired

23.

A patient with allergic symptoms is sent to the hospital, which of following allergy diagnosis can bedone?

I. Clinical diagnosis by ask patient history

II. Skin testing (patch testing)

III. Cellular blood investigation (CBS of eosinophils : 9-10%)

IV. Conjuctival allergen provocation

A. I and III

B. II and IV

C. I, II and III

D. All of the above

24. Choose INCORRECT statement regarding pharmacotherapy of allergyA. Sodium cromoglycate, nedocromil sodium and ketotifen can be used in prophylaxis

B. Use of corticosteroid is commonly neglected

C. Prostaglandin antagonist competing for the tissue receptor upons which the mediators act

D. Antihistamine and leukotriene receptor antagonist antagonize mediator effects at target organs

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25. Which of the following statements are CORRECT about immunetherapy?I. It is exposure of an atopic subject to gradually increasing doses of antigenic substances at

varying intervals for 3-5 years

II. Mechanism : increases IgG blocking antibodies and secretary IgA mucosal level

III. Local erythema and induration at the site of injection may precede systemic reactions

IV. Treatment of systemic side effect is by local cold compresses and antihistamine

V. It indicates in allergic rhinitis and allergic asthma and hymenoptera sensitivity

A. I, II, and III

B. I, III and IV

C. I, II and III and V

D. All of the above

COMPLIANCE

26. Measure for distensability (stretchability) of the lungs ?A. Transpulmonary pressure

B. Intra-pleura pressure

C. ComplianceD. Alveolar pressure

27. What is normal value for pulmonary system compliance?A. 150ml/cm H20

B. 190ml/cm H20

C. 200ml/cm H20

D. 130ml/cm H20

28. Which of the following is false about compliance?A. At higher lung volume, compliance decrease because lung cannot expand more

B. Compliance slightly decrease when measured during lung deflation than inflationC. Individual with one lung has approximately half the V for a given P.

D. Surface tension is important factor affecting the compliance of the lung.

29. All the following are the diseases that decrease lung compliance except?A. Poliomyelitis of respiratory muscle

B. Arthritis of the joints at leg

C. Pulmonary congestion

D. Scoliosis

30. All the following the causes increased compliance except?A. Young age

B. Emphysema

C. Heavy cigarette smoking

D. Chronic bronchitis

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ANATOMY OF DIAPHRAGM

31. The following are structures that pass through the major opening in the diaphragm, EXCEPTA. Inferior vena cava

B. Vagus nerve

C. Left phrenic nerve

D. Azygos vein

32. Which of the following are true regarding diaphragmI. Right crus only has 3 opening for splanchnic nerve

II. Thoracic duct passing in between the aorta and azygos vein

III. Left phrenic nerve is present in the IVC opening

IV. Left crus is larger than right crus

A. I and II

B. I and III

C. II and III

D. III and IV

33. Which of the following ligament is NOT present in relation to diaphragmA. Medial arcuate ligament

B. Sternomediastinal ligament

C. Median arcuate ligament

D. Lateral arcuate ligament

34. The true statements regarding the major openings in the diaphragm areI. Aortic opening is present at level of T12

II. Lymphatics can be found in the oesophageal opening

III. Oesopageal plexus of vessels can be found in the right crus

IV. Inferior hemiazygos is one of the structures passing through the major openings.A. I and II

B. I and III

C. II and III

D. III and IV

35. The following are structures that pass through the diaphragmI. Lesser splanchnic nerve

II. Quadratus lumborum

III. Subcostal vessels

IV. Psoas major muscle

A. I, II and III

B. I, III and IV

C. II, III and IV

D. I, II, III and IV

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HISTOLOGY (CONDUCTING PORTION)

36. The following are true statements EXCEPTA. Terminal bronchioles are the sites of gas exchange

B. Inspired air is filtered, moistened and warmed by the conducting portion of respiratory tract

C. Respiratory portion includes alveolar ducts and alveolar sacs

D. Cartilage and bones antagonize the effect of strong inspiratory movements

37. The following are true EXCEPTA. Respiratory epithelium lines the larynx except at the superior surfaces of the epiglottis and vocal

folds

B. Elastic cartilages of larynx: cuneiform, corniculate, inferior aspect of arytenoids

C. The mucosal layer of trachea is lined by respiratory epithelium

D. Over distension of tracheal rings is prevented by fibro-elastic connective tissue

38. The following are true EXCEPTA. Brush cells of the submucosal layer of trachea act as sensory receptors

B. Seromucous glands are present in larynx, trachea and bronchiC. Lamina propria of trachea is separated from submucosal layer by condensed elastic fibers

D. Adventitia of trachea anchors trachea to adjacent structures

39. The following are true EXCEPTA. Extra pulmonary bronchi is similar in structure to trachea except in diameter and wall thickness

B. Mucosal layer of bronchi lack elastic membrane

C. Smooth muscle are transversely arranged around the lumen of bronchi causing formation of

longitudinal folds in the mucosa

D. Dense connective tissue constitutes the adventitia of bronchi

40.

The following are true about bronchioles EXCEPTA. Epithelial lining: ciliated columnar epithelium

B. Muscle: circumferentially arranged

C. Lamina propria: elastic fibers + circumferential smooth muscle

D. Walls: containing cartilaginous plates with lymphatic nodules

TRACHEA, BRONCHIAL TREE AND DEVELOPMENT OF FETAL LUNG

A [TRUE] B [FALSE]

41. Fetal lung is very well in function .42. Tracheoesophageal fistula is caused by failure of separation between trachea and esophagus.43. Right lung has 3 lobes only, thus it is smaller in size compared to left lung.44. Lung is made up by endoderm of foregut only.

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45. The termination of trachea is at the level of ______ which continue then as bronchusA T6

B T2

C C4

D T4

46. Choose the correct statements regarding right main bronchusI Shorter

II Narrower

III More in line with trachea

IV Divides before entering the lung

A I , II, III

B I , IV

C II, III, IV

D I, III, IV

TBL- FUNGI CAUSING RESPIRATORY TRACT INFECTION

47. Which of the following diseases will show positive precipitin test?I- Allergic bronchopulmonary aspergillosis

II- Bronchial asthma

III- Extrinsic alveolitis

IV- Invasive pulmonary aspergillosis

A. I and III

B. II and IV

C. I and II

D. III and IV

48.

Which of the following is TRUE regarding the major criteria of Allergic bronchopulmonaryaspergillosis?

I- Positive skin test type III (Arthus type).

II- Positive skin test with Aspergillus antigen.

III- Proximal bronchiecatasis on X-ray.

IV- High systemic eosinophilia

A. I and IV

B. I and III

C. II and III

D. II, III and IV

49. The diagnosis is only confirmed by bronchial wash or brushing or by biopsy after thoracotomy This disease is

A. Pleural aspergillosis

B. Invasive pulmonary aspergillosis

C. Extrinsic alveolitis

D. Interstitial plasma cell pneumonitis

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50. Which of the following statement is TRUE regarding Pneumocystis Jiroveci?I- Can exist in the form of cysts which are thin walled

II- Growth in lungs is limited to the surfactant layer above the alveolar epithelium.

III- causes pneumonia in immunocompromised patients

IV- Plasma cells are present in AIDS related P.jiroveci pneumonia.

A. I and II

B. II and III

C. II, III and IV

D. I, III and IV

51. Which of the following can be used for the treatment of disease caused by candidosis?I- Ketoconazole

II- Fluconazole

III- Itraconazole

IV- Voriconazole

A. I and II

B. III and IV

C. I, II and IIID. II, III and IV

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ANSWER:

1.C 17.B (pg.60) 33.B 49.B (pg.177)

2.D 18.A (pg.60) 34.B 50.B (pg.178)

3.C 19.A (pg 61) 35.D 51.C (pg.179)

4. D 20.C (pg.63) 36.A5.D 21.C (pg.227) 37.B

6.D 22.D (pg.227) 38.A

7.D 23.D (pg.228) 39.C

8.A 24.B (pg.228) 40.D

9.B 25.C (pg.229) 41.B

10.A 26.C 42.A

11.C (pg.66,67) 27.D 43.B

12.D (pg.67,68) 28.B 44.B

13.A (pg.69,70) 29.B 45.D

14.C (pg.69,70) 30.A 46.B

15.B (pg.70) 31.C 47.A (pg.177)16.B (pg.60) 32.A 48.C (pg.177)