E.

inferior wall of Highmore’s sinus

1. All of
the following statements about
spontaneous pneumothorax are true EXCEPT 5. Nasolacrimal canal opens in
A. breathlessness and pleuritic chest pain are A. middle meatus
usually present B. nasopharynx
B. diminished or absent breath sounds over the C. inferior meatus
affected hemithorax D. superior meatus
C. surgical referral is required if there is a E. semilunar hiatus
bronchopleural fistula
D. absent peripheral lung markings on chest X- 6. Acute medial otitis is characterized by
ray suggests tension
E. pleurodesis should be considered for recurrent A. hyperemic and bulging membrane
pneumothoraces

2. Defective sodium and chloride secretion account

for all of the following findings in cystic fibrosis
B. depressed and petrified membrane
EXCEPT
C. hemorrhages of the membrane and external
auditory meatus
A. decreased sweat production
D. necrotizing lesions of tympanic membrane,
B. bile duct proliferation.
middle, and, rarely, inner ear
C. autodigestion of the pancreas
E. multiple perforations of the membrane
D. chronic cholecystitis
E. intestinal obstruction
7. A 21-year-old male is brought to the hospital for
increasing shortness of breath, fever with chills
3. Mycoplasma pneumoniae accounts for up to 20
during the past week. He is a non-smoker. Past
% of all pneumonias in children and young adults.
medical history revealed several episodes of
All of the following are true regarding
pneumonia with chronic productive cough and
mycoplasmas EXCEPT
pancreatitis. Physical examination shows body
weight deficit, bilateral decreased alveolar sounds,
A. because they lack a cell wall, they do not
wheezings and rales. Chest X-ray shows bronchial
respond to antibiotics such as beta-lactams or
dilatation. Sputum culture grew Pseudomonas
vancomycin
aeruginosa. The most likely diagnosis is
B. positive antinuclear antibodies, false-positive
VDRLs, and positive rheumatoid factor seen in
A. bronchiectasis
this disease probably occur as a consequence of
B. bacterial pneumonia
the wide range of mycoplasma's
C. cystic fibrosis
immunomodulatory effects
D. metabsorption syndrome
C. Mycoplasma pneumoniae is transmitted
primarily by asymptomatic carriers
8. Whichof the following is the most accurate
D. Mycoplasma pneumoniae infection is spread
statement regarding interstitial lung disease?
via large droplets of respiratory secretions,
particularly in closed environments
E. infection spreads slowly through a population
A. The variety known as cryptogenic fibrosing
because the incubation is long
alveolitis is more common in men than in women
B. The majority of patients with cryptogenic
4. Maxillary artery abuts
fibrosing alveolitis respond to corticosteroid
therapy with an increase in total lung capacity
A. medial wall of Highmore’s sinus
C. Sarcoidosis is twice as common in blacks as in
B. posterior wall of Highmore’s sinus
whites
C. anterior wall of Highmore’s sinus
D. Pneumothorax is a common complication of most
D. superior wall of Highmore’s sinus
types
 E. Spirometry is the most sensitive measurement and an arterial PO2 of 8.1 kPa (61 mm Hg) while
to detect early disease breathing 40% inspired O2. The arterial PCO2 is
normal. Which of the following conditions would
9. A patient presents
in acute pulmonary edema. most likely account for these findings?
The respiratory rate is 45/min and arterial blood
gas reveals an O2 saturation of 69 %. A. Idiopathic pulmonary fibrosis
Electrocardiogram is normal. The most B. Chronic obstructive pulmonary disease
appropriate management at this time is CAntitrypsin deficiency
D. Severe asthma exacerbation
A. place the patient in a sitting position and start E. Osler-Rendu-Weber syndrome
the patient on 100 % O2. No drug therapy is
usually needed 13. A 40-year-old patient with multiple traumas is
B. emergent dialysis transferred to the ER nine hours after a motor
C. start 100 % O2 and bolus patient with 2 L of accident. He has sustained head injuries and
lactated ringers Glasgow coma scale of 3. Chest X-ray shows
D. start 100 % O2 and administer 10-20 mg bilateral infiltrates. He is intubated and ventilator
furosemide and 2 mg morphine IV settings are as follows: Mode intermittent mandatory
E. start 100 % O2 and load the patient with ventilation (IMV)
digitalis FiO2 100 %
Rate 15
10. A 50-year-old chronic smoker presents with Tidal Volume 800
increasing exertional breathlessness. The patient ABG reveals pH of 7.3, PaO2 45 mm Hg, PaCO2
has a productive cough. The patient is diagnosed 45mm Hg
with panacinar emphysema. He is also found to What should be done to the ventilator settings?
have cirrhosis of the liver. Which of the following
is an underlying disease that cough relate A. Tidal volume should be increased to 1000 cm3
panacinar pulmonary emphysema to cirrhosis of B. Add positive end expiratory pressure (PEEP) in
the liver? small increments
C. Change ventilation mode to assist control
A. Wilson's disease D. Increase the ventilator rate to 100
B. Cystic fibrosis E. Decrease the ventilator rate
C. IV drug use
D. Alpha-1 anti-trypsin deficiency 14. A 40-year-old alcoholic has а sudden onset of fever
E. Alcoholism with a single shaking chill. He is complaining of
11. An18-year-old female presents to her shortness of breath and producing purulent blood-
pediatrician with complaints of intermittent itchy tinged sputum. He has а temperature of 1030 F,
eyes, itchy nose, bilateral rhinorrhea, and respiratory rate of 40, and pulse 140. Chest X-ray
sneezing with certain exposures. By taking a good film shows lobar consolidation of the right lower
history, the pediatrician is able to conclude that lobe with an air bronchogram. WBC count is 19,000,
the likely diagnosis is vasomotor rhinitis. Which and gram-positive lancet shaped diplococci are
of the following might be one of her triggering identified. He is allergic to penicillin.
factors? The most effective treatment for this patient would
be
A. Peanuts
B. Cold weather A. erythromycin
C. Ragweed B. cefoxitin
D. Poison ivy C. ampicillin CC
E. Foreign body D. chloramphenicol
E. tetracycline
12. A patient who is being evaluated for shortness of
breath is found to have an arterial PO2 of 7.9 kPa 15. A 39-year-oldmale runner undergoes spirometry
(59 mm Hg) while breathing room air at sea level testing. Gas analysis finds the concentration of
 carbon dioxide is 0 % in room air, 4 % in expired examination and chest X-ray are unchanged. Which
air and 6 % in mixed venous blood. Vital capacity of the following test results should be used to guide
equals 5000 mL. Tidal volume is 600 mL. Which this patient’s antimicrobial therapy?
of the following best describes the dead space
volume? A. Chest radiograph
B. Sputum Gram stain
A. Increased due to bronchospasm C. Blood culture
B. Decreased due to bronchospasm D. Sputum culture
C. Normal, approximately 200 mL
D. Normal, approximately 50 mL
E. Equal to residual volume

16. The most likely disease process to produce

transudative pleural effusion is which one of the
following?

A. Congestive heart failure

B. Cirrhosis 19. Compared to Mycobacterium tuberculosis, all of the
C. Malignancy following are true concerning transmission of
D. Nephrotic syndrome Mycobacterium avium EXCEPT
E. Pneumonia
A. it is less virulent
17. Typical features of an empyema thoracic include B. it frequently colonizes, rather than produces
all of the following EXCEPT disease
C. person-to-person spread occurs rarely
A. unilateral effusion on chest X-ray D. it has an animal as well as a human reservoir
B. a fluid level on chest X-ray suggests a E. infections rarely result from inhalation or direct
bronchopleural fistula inoculation from environmental sources
C. recent abdominal surgery
D. persistent pyrexia despite antibiotic therapy 20. Highmore’s sinus opens into
E. bacteriological culture of the organism despite
antibiotic therapy A. inferior meatus
B. superior meatus
18. A 49-year-old man is evaluated because of C. sphenoethmoidal recess
shaking chills, cough, and dyspnea. The patient is D. middle meatus
a smoker with a history of chronic obstructive E. nasopharynx
pulmonary disease. On physical examination, his
temperature is 39 ºC (102.2 ºF), pulse is 90/min, 21. Which of the following pathologies is a
respiration rate is 36/min, and blood pressure is precancerous condition?
120/70 mm Hg. Examination of the chest reveals
diminished breath sounds throughout both lung A. Laryngeal tumor
fields and faint crackles in both bases. Chest B. Pachydermia
radiograph reveals bibasilar patchy areas of C. Infraglottic hyperplastic laryngitis
consolidation. A sputum Gram stain is positive D. Singer’s nodules in vocal cords
for many gram-positive cocci in chains, many E. Laryngeal papillomatosis of childhood
large gram-negative rods, a few slender
pleomorphic gram-negative rods, a moderate
Questions 22 - 23 :
number of polymorphonuclear leukocytes, and a
moderate number of epithelial cells. He is begun
on antibiotics. Two days later his sputum culture
A 28-year-old man is brought to the emergency
grows Candida species, and blood culture grows
department after a motor vehicle accident in which he
Streptococcus pneumoniae. His physical
sustained serious trauma, including a massive
hemithorax. It is obvious to you that he has blood 25. Ofthe following anatomical areas, branchial cleft
within the thoracic cavity, and maybe it’s helping to cysts are most usually found
tamponade the source of bleeding. You draw blood
for an urgent type and cross-match and contact the A. in the midline of the neck
laboratory, informing them that you must have the B. medial to the sternocleidomastoid muscle
blood available immediately. To your dismay the C. in the posterior cervical triangle
laboratory technician informs you that no blood is D. lateral to the sternocleidomastoid muscle
available at all. Despite your pleas, the laboratory is
unable to comply and has suggested that you call 26. Non-pneumococcal pneumonia should be suspected
back in an hour’s time when they would have the if the clinical features include all of the following
requisite blood. They apologize for the error that EXCEPT
occurred because of a corruption of the database in
their computer, and, as a result, inadvertently A. systemic upset preceding respiratory symptoms by
showed adequate stocks. In fact, they inform you several days
that they are frantically trying to locate donors. You B. chest signs less dramatic than the chest X-ray
are infuriated about this and concerned about its appearances
implications. C. the absence of a neutrophil leukocytosis
D. the development of a pleural effusion
22. The appropriatestep has been taken. The most E. palpable splenomegaly and proteinuria
appropriate next step in management is to
27. Clinical features
characteristic of massive
A. give blood pulmonary embolism include all of the following
B. go with the attorney to the laboratory and EXCEPT
confront the technician
C. speed up the fluids you are giving to the A. central and peripheral cyanosis
maximum rate possible B. pleuritic chest pain and haemoptysis
D. go with your partner to the laboratory and C. tachycardia and elevated jugular venous pressure
confront the technician D. breathlessness and syncope
E. spruce yourself up to face the television E. ECG pattern is S1, Q3, T3
cameras
28. A 48-year-old patient comes in with the history of
shortness of breath. He is being evaluated for his
23. The most appropriate next step is to symptoms. His arterial PaO2 is found to be 58 mm
A. continue resuscitation with the fluids you are Hg, while breathing room air and arterial PaO2 was
presently giving until blood is available 60 mm Hg while breathing 50 % oxygen. Which of
B. drain the hemithorax the following would least account for this finding?
C. notify the local TV station about this lapse
D. inform the hospital attorney in case of a lawsuit A. Atelectasis
E. notify your partner B. Klebsiella pneumonia
C. Osler-Rendu-Weber syndrome
24. A 37-year-old airline steward presents with a 1- D. Cardiogenic pulmonary edema
week history of fever, dry cough, and shortness of E. Idiopathic pulmonary fibrosis
breath. On examination, he is tachypneic. His
lungs are clear to auscultation. Choose the most
likely diagnosis.

A. Anemia
B. Valvular disease
C. Atelectasis 29. Defective
articulation secondary to motor deficits of
D. Bronchial asthma the muscles used for speech describes which of the
E. Atypical pneumonia following etiologies?
 33. All
of the following mediastinal lesions are
A. Dyslalia characteristically found in the anterior mediastinum
B. Dysphonia EXCEPT
C. Dysarthria
D. Dysphasia A. teratomas
E. Cerebellar dysarthria B. thymic tumors
C. bronchogenic cysts
30. Ininfantile lobar emphysema, all of the D. intrathoracic parathyroid adenomas
following are found on the chest film EXCEPT E. B and D

A. wedge-shaped densities adjacent to the affected 34. Composition of nasal septum is

lobe
B. elevation of the ipsilateral diaphragm A. osseous
C. retrosternal radiolucency B. cartilaginous
D. mediastinal shift to the opposite side C. osseous and cartilaginous
D. membranous
31. A 43-year-old woman with allergic rhinitis and E. muscular
recurrent sinusitis comes to the clinic for follow-
up. Approximately 1 month ago she underwent 35. A 69 year-old patient with known severe mixed
bilateral endoscopic sinus surgery for chronic obstructive pulmonary disease and decompensated
sinusitis refractory to prior medical treatment with cor pulmonale comes to the ED with increasing
oral corticosteroids and multiple courses of shortness of breath and а productive cough. He is
antibiotics. She reports that her symptoms of alert and can speak in short sentences but has а
headache and facial pain and pressure are much respiratory rate of 40. The best initial treatment
improved since the surgery. She is currently on no would be
medications other than a daily topical nasal
steroid spray prescribed by her otolaryngologist. A. 40 % mist mask
Her only complaint is intermittent clear “runny B. terbutaline subcutaneously
nose” on the left side, which she notices almost C. immediate intubation
every day. In addition, she has noticed the D. 24 % Venturi mask
rhinorrhea to be exacerbated by straining or E. IV aminophylline
bending forward. Her symptoms are most
consistent with 36. A 60-year-oldman with a history of chronic
productive cough now presents to Accident and
A. a common side effect of topical steroid sprays Emergency with shortness of breath and drowsiness.
B. a leakage of cerebrospinal fluid Most likely diagnosis is
C. a recurrent episode of acute sinusitis
D. a recurrence of her allergic rhinitis symptoms A. bronchial carcinoma
E. a viral upper respiratory illness B. acute pulmonary edema
C. exacerbation of chronic bronchitis
32. A 26-year-old male presents with history of two D. pulmonary embolus
week dry cough, shortness of breath. If you feel E. metastatic carcinoma
the diagnosis is Mycoplasma pneumonia. What
would you least expect in the history if this 37. A 42-year-oldfarmer has acute onset of severe,
patient? progressive dyspnea associated with cough and
weakness. These symptoms occurred 1 hour he had
A. Sore throat worked in a silo that had been filled with fresh corn
B. Fever silage the previous day. Which of the following is
C. Headache most likely to have caused his acute pulmonary
D. Malaise decompensation?
E. Joint symptom
A. Viral pneumonia
 B. Pneumothorax signs of hypoxemia. His chest X-ray shows
C. Allergic bronchopulmonary aspergillosis pulmonary edema. The diagnosis is pneumonitis.
D. Nitrogen dioxide pneumonitis What is the most likely etiology?
E. Hypersensitivity pneumonitis
A. Chlorine
B. Sulfur dioxide
38. A 71-year-old woman with chronic obstructive
C. Nitrogen dioxide
pulmonary disease and repeated episodes of
D. Phosgene
bronchitis seeks advice about precautions to be
E. Toluene diisocyanate
taken during a trip from New York City to Hong
Kong in January. She asks specifically about
43. A 12-year-old boy presents with wheezing attacks
antibiotics during the airplane ride to prevent
and episodic shortness of breath. His peak expiratory
acquisition of bronchitis or pneumonia. Which of
flow rate is 400 L/min. Select the most appropriate
the following agents is most likely to provide
treatment.
prophylactic benefit to this patient?
A. Beta-2-adrenoreceptor agonist
A. Antibiotics B. Intravenous aminophylline
B. Antiviral agents C. Tobramycin and carbenicillin
C. Zinc lozenges D. Erythromycin
D. Immunizations E. Ciprofloxacin

39. Optical nerve borders 44. A 51-year-old male presents with complaints of
high-grade fever for about a week, along with cough
A. Highmore’s sinus wall productive of yellow sputum. Sputum examination
B. frontal sinus wall reveals numerous neutrophils. The chest X-ray
C. posterior ethmoid and sphenoid sinus shows patchy infiltrates in all the lung fields with an
D. anterior ethmoid area of consolidation in the right upper lobe with an
E. superior wall of nasal cavity air-fluid level. Which of the following organisms
would be the cause of the infection in the above
patient?
40. Factors determining the extent of pulmonary
injury in gastric acid aspiration include all of the A. Staphylococcus aureus
following EXCEPT B. Aspergillus niger
C. Mycobacterium tuberculosis
A. pH of the aspirate D. Mycoplasma pneumoniae
B. presence of food particles E. Adenovirus
C. distribution of the aspirate
D. volume of the aspirate Questions 45 - 46 :
E. overgrowth of normal oropharyngeal flora
A 57-year-old asbestos worker has hemoptysis and
41. Sphenoid sinus drains into cough. His chest film shows an enlarged mediastinal
shadow with opacification of the left upper lobe. He has
A. inferior meatus ap alpable mass in the left supraclavicular
B. middle meatus region.
C. sphenoethmoid recess
D. superior meatus 45. The most likely diagnosis is
E. lateral wall of the nasopharynx A. pulmonary hamartoma
B. tuberculosis
42. A 48-year-old
farmer presents with symptoms of C. histoplasmosis
cough, shortness of breath, fever, and myalgias. D. silicosis
On examination, he has bilateral rales, ocular and E. carcinoma of the lung
oropharyngeal mucous membrane erythema, and
46. The cytologicexamination of the sputum for D. bronchoscopic aspiration of pus
malignant cells is negative, and the bronchoscopic
examination is indeterminant. The next step 51. Number of paranasal sinuses is
toward establishing the diagnosis would be
A. 4
A. right scalene node biopsy B. 6
B. left scalene node biopsy C. 8
C. thoracotomy D. 7
D. repeat bronchoscopy E. 2
E. tomography 52. A patientcoughs up large amounts of purulent, foul-
smelling sputum. A lung abscess is considered to be
47. A 20-year-old male presents with a 2 day history a possible cause of this problem. All of the following
of sore throat. He has no drug allergies. On statements about lung abscess are true EXCEPT
physical exam, he has a fever of 102 F. Bilateral
tonsillitis is noted. His rapid strep test is positive. A. the most common cause of lung abscess is
He should be started on which medication? aspiration, with subsequent pneumonia
B. when the patient is supine, there is a tendency for
A. Trimethoprim/sulfamethoxazole (bactrim) aspirated material to enter either the posterior
B. Doxycycline segment of the right upper lobe or the superior
C. Amoxicillin/clavulanic acid (Augmentin) segment of the right lower lobe
D. Ciprofloxacin (Cipro) C. initial treatment consists of culture of the sputum,
E. Penicillin the appropriate antibiotics, and regular, repeated
bronchoscopy to maintain drainage
48. A 53-year-old, asymptomatic man from Ohio has D. alcoholism, dental caries, and diabetes predispose
a concentrically calcified solitary coin lesion in to the development of a lung abscess
the right upper lung lobe. This lesion most likely E. external surgical drainage or lobectomy is
represents required in most patients

A. a primary lung cancer 53. Allof the following statements about patients with
B. a bronchial hamartoma chronic obstructive pulmonary disease are true
C. a granuloma EXCEPT
D. metastatic cancer
A. they usually require use of accessory muscles of
49. A 52-year-old male presents with history of breathing
breathlessness. The chest X-ray shows B. loud breath sounds are usually found on physical
diaphragmatic fibrous pleural plaques and examination
interstitial fibrosis. What is the most probable C. the extra work of breathing increases caloric
histopathological finding possible in this case? expenditure and contributes to weight loss
D. they tend to have a mixed respiratory and
A. Noncaseating granulomas with asteroid bodies metabolic acidosis because of CO2 retention and
B. Ferruginous bodies in the lung metabolic acidosis from anoxia
C. Dystrophic calcification
D. Neutrophilic infiltrate 54. Meanpulmonary arterial wedge pressure of > 12
E. Necrotizing granulomas in bronchovascular mm Hg is compatible with all of the following
distribution EXCEPT

50. The primary treatment of pyogenic lung abscess A. left ventricular failure
consists all of the following EXCEPT B. mitral stenosis
C. constrictive pericarditis
A. postural drainage D. mitral regurgitation
B. surgical excision E. volume depletion
C. prolonged appropriate antibiotic therapy
55. When positive end-expiratory pressure (PEEP) A. Dyslalia
ventilation is working to the benefit of the patient, B. Dysphonia
it C. Dysarthria
D. Dysphasia
A. decreases the functional residual capacity E. Cerebellar dysarthria
(FRC)
B. increases the compliance 60. A 54-year-oldpoorly controlled diabetic woman
C. decreases venous return presents with periorbital and perinasal discharge. On
D. increases arterial oxygen tension examination, the nasal mucosa is black and necrotic.
E. decreases atelectasis Choose the most likely cause?
F. All of the above are correct
G. A, B and C are correct A. Nasal polyposis
H. B, D and E are correct B. Rhinosinusitis
C. Quinsy
56. In study of the nature of pleural effusions D. Rhinocerebral mucormycosis
E. None of the above
A. a high eosinophil count suggests an allergic
origin 61. Ligation of the thoracic duct in the neck usually
B. a low glucose level compared with serum results in
glucose in a patient with rheumatoid arthritis
suggests superimposed infection A. serious metabolic alterations
C. transudates show a pleural fluid to plasma ratio B. no detectable metabolic abnormalities
of total protein  0.5 C. peripheral lymphedema
D. the presence of blood in the absence of trauma D. development of marked ascites
suggests malignancy
62. A 28-year-old person has rapidly developing cough,
57. Alteredpitch, quality, or volume of speech dyspnea and expectoration with blood-tinged
describes which of the following etiologies? sputum. On examination patient is toxic, febrile and
rhonchi are present. Patient has hyponatremia and
A. Dyslalia proteinuria. X-ray shows consolidation in the right
B. Dysphonia hemithorax. The most likely diagnosis is
C. Dysarthria
D. Dysphasia A. pulmonary tuberculosis
E. Cerebellar dysarthria B. pleural effusion
C. asbestosis
58. Pulmonary aspiration of the gastric contents is D. Legionella pneumonia
correctly described by which of the following E. septicemic plague
statements?
63. A 35-year-old female comes to your office with a 1-
A. The incidence of aspiration is 25 percent week history of bilateral red eyes associated with
during emergency anesthesia tearing, and crusting, a sore throat with difficulty
B. Tracheostomy predisposes to aspiration swallowing, and a cough that was initially
C. Reported mortality of massive aspirate is 50 to nonproductive but has become productive over the
90 percent last few days. The patient displays significant fatigue
D. Chemical damage is minimal when pH is > 2.5 and lethargy and is having great difficulty
E. All of the above performing any of her routine daily chores.
F. A, B and D On physical examination, there is bilateral
G. B and C conjunctival infection. There is significant
pharyngeal erythema but no exudate of membrane.
59. Poorly
coordinated, irregular speech describes Cervical lymphadenopathy is not present.
which of the following etiologies? Examination of the chest reveals a few expiratory
crackles bilaterally.
 Concerning this patients' sore throat and in D. bronchography
relation to the case scenario described and the E. tomogram
physical findings provided, what would you do?
67. A 49-year-oldmale, chronic smoker, is labeled to
A. Perform a throat culture and order antibiotics have chronic bronchitis. Which of the following has
B. Perform a throat culture and a rapid enzyme- the minimum chance to be one of the findings in this
linked immunosorbent assay (ELISA) patient?
Streptococcus test and treat with an antibiotic if
the ELISA test is positive A. Bronchial mucous gland hypertrophy
C. Perform a throat culture and await the results B. Productive cough for months
D. Order a complete blood count and total C. Increased airway resistance
eosinophil count D. Severe dyspnea
E. None of the above E. Frequent infection

64. A 39-year-old female received an orthotopic 68. A 50-year-old man underwent an emergency
cardiac transplant three months ago. She has had operation to repair a left lung laceration from a knife
acute mild rejection treated with increasing wound to the chest received during a brawl in a bar.
immunosuppressive therapy. She has developed a A few days later, he develops anxiety, tremor,
cough with fever and headache. A chest X-ray hallucinations, overactivity, and seizure activity. The
revealed consolidation involving the right mid- most likely diagnosis is
lung. A bronchoalveolar lavage reveals long
filamentous Gram-positive organisms. What A. a reaction to anesthetic drugs
would be the most likely cause of the B. delirium tremens (DTs)
consolidation? C. intensive care unit syndrome
D. postoperative psychosis
A. Lobar pneumonia
B. Intestitial pneumonitis 69. Theanterior mediastinum is bounded by all of the
C. Acute abscessing bronchopneumopnia following structures EXCEPT
D. Chronic abscessing pneumonia
E. Military granulomata A. ventral pericardial surface
B. costal cartilages of the left fifth, sixth and seventh
65. A patient is
thought to have sustained a massive ribs
air embolus due to defective infusion equipment. C. pleural reflection of both left and right lungs
Of the following, the first thing to do in this case D. costal cartilages of the left seventh, eight and
is to ninth ribs

A. give 1 cm3 of 1:1000 adrenalin 70. A 37-year-oldmale presents with rhinorrhea, cough,
B. turn the patient onto his left side B haemoptysis, and pleuritic pain. Chest X-ray shows
C. perform a thoracotomy and massage the heart multiple nodules. Select the most appropriate
D. perform a thoracotomy and aspirate the right treatment.
atrium
A. Co-trimoxazole
66. A 38-year-old woman has a 3-year history of B. Rifampicin and isoniazid
intermittent hemoptysis and intermittent yellow C. Cyclophosphamide
sputum. X-ray shows a 2-cm density in the region D. Prednisolone
of the hilum of the lower lobe of the right E. Tetracycline
lung.The most helpful diagnostic procedure
would be 71. Select adiagnosis based on the following clinical
description. A febrile children younger than 7-year-
A. sputum cytology A old with rhinitis develop worsening of the general
B. sputum culture condition. Hoarseness absent. During the night
C. bronchoscopy asphyxia attacks develop (stridor, barking cough,
 irritability, cyanosis, profuse sweating). Upon E. CD4 lymphocyte count of 28
remission children calm down and fall asleep.
Similar events often accompany pediatric 75. A 47-year-old female comes in with complains of
infections (rubella, pertussis, etc.). slight cough for about a week. She is a non-smoker
Laryngoscopically mucous edema of the cords is and does not remember having a fever or feeling
seen. sick. Auscultation of the chest reveals clear lung
fields. A chest X-ray shows a subpleural "coin
A. Acute stenosing laryngotracheitis lesion" in the right upper lobe. The most probable
B. Diphteritic (membranous) croup diagnosis in this case would be
C. Laryngeal perichondritis
D. Catarrhal (false) croup D A. small cell anaplastic carcinoma
E. Laryngeal tonsillitis B. bronchiectasis
C. granuloma
72. Vocal cords are opposed by contraction of D. silicosis
E. exogenous lipid pneumonia
A. posterior cricoarytenoid muscle
B. mylohyoid muscle 76. A child inhales a bean, and it produces complete
C. stylohyoid muscle obstruction of the right mainstem bronchus. Which
D. digastric muscle of the following will be the primary pathologic
E. None of the above change produced?

A. Emphysema of the right lung

B. Emphysema of the left lung
73. A 38-year-old male patient working in a nursery C. Atelectasis of the left lung
comes in for a certification of disability. He gives D. Atelectasis of the right lung
history of occasional breathlessness for which no E. Pneumonia of the right lung EE
medical record is present. Examination shows
tachypnea and scattered rhonchi are heard all over 77. Theinitial treatment of a lung abscess includes
the chest. Spirometry in such an individual will be systemic antibiotics and
helpful if
A. lobectomy
A. done alone B. tube drainage of the abscess
B. done once and repeated again with C. bronchoscopy
bronchodilator therapy D. pneumonectomy
C. spirometry is not important E. segmental resection
D. done only with bronchodilator therapy
E. spirometry conducted alone or with 78. A 35-year-old man with HIV presents with a
bronchodilator therapy, does not matter productive cough and hemoptysis. The X-ray shows
a round ball in the right upper lobe surmounted by a
74. A 41-year-old female presents with non- dome of air.
productive cough and dyspnea since several days. Choose the most likely causative organism for this
The chest radiograph shows extensive bilateral condition.
infiltrates. A bronchoalveolar lavage demonstrates
the presence of numerous cysts of Pneumocystis A. Coxiella burnetii
carinii. Among the following, which of the B. Aspergillosis
following laboratory findings are most likely to C. Streptococcus pneumoniae
appear? D. Actinomycosis
E. Staphylococcus aureus
A. Raised absolute neutrophil count up to 10,000
B. Positive pregnancy test 79. In a patient with a symptomatic pleural effusion
C. Positive mono-spot test
D. Hemoglobin SS on hemoglobin electrophoresis A. physical signs in the chest are invariably present
 B. pleural biopsy should be avoided given a
protein content of 50 g/L
C. lymphocytosis in the pleural fluid is
pathognomonic of pleural tuberculosis
D. tuberculosis can be excluded if the chest X-ray
is otherwise normal

80. Vocal cords separate by contraction of

A. oblique arytenoid muscle

B. transverse arytenoid muscle
C. aryepiglottic muscle
D. thyroarytenoid muscle
E. posterior cricoepiglottic muscle