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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 EXCEPT A. Aspiration of fluid from pericardium is done at the medial ends of 4th and 5th intercostals spaces B. Lungs are supplied by bronchial arteries and bronchial veins C. 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 exercise E. Pleural injury causes pneumothorax 2. The following are true about the surface anatomy of lung or pleura EXCEPT A. The apex of the lung lies above the medial end of the clavicle B. 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 lung D. 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 EXCEPT A. The superior lobe of right lung s divided into anterior, posterior and apical segments B. 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 lung D. Only the left lung contain fused segments 4. The following are false EXCEPT A. The left lung is smaller and shorter than the right lung B. The oblique fissure of the right lung begins at the posterior border of lung opposite to 4th thoracic spine and end at the inferior border opposite the 5th costochondral junction C. Cardiac notch is found only in the left lung but lingual can be present in both lungs D. The left lung is supplied by only one main bronchus entering the hilum 5. The hilum of lung gives passage to the following structures EXCEPT A. Pulmonary ligament B. Pulmonary plexus C. Hilar lymph nodes D. Pericardiaco-phrenic artery

ANATOMY OF THORACIC CAGE 6. Which of the following is not part of thoracic cage ? A. Sternum B. ribs C. Vertebrae D. Trachea 7. Choose the false statement regarding boundaries of thoracic outlet A. anterior ; xyphoid process B. Posterior ; last thoracic vertebrae C. Both side ; lower six costal cartilage D. Superior ; larynx All of the following are typical ribs and vertebrae except Ribs Vertebrae A. 1st 12th B. 3rd 3rd C. 5th 6th D. 7th 8th -Single articular facet -no tubercle & no neck -no costal groove Which rib has the above characteristic A. 10th B. 12th C . 1st D. 9th

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10. Below are characteristic of typical vertebrae except A. 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

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 370C 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 process B. 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

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 is A. Reaction involving degranulation of mast cell particularly B. The only hypersensitivity reaction C. Antigen antibody reaction involving several inflammatory cells in an atopic individual D. Reaction can be happened in anyone 22. Regarding to the variables included in allergy, all of the following are true EXCEPT A. 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 be done? 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 allergy A. 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

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. Compliance D. 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 inflation C. 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

ANATOMY OF DIAPHRAGM 31. The following are structures that pass through the major opening in the diaphragm, EXCEPT A. Inferior vena cava B. Vagus nerve C. Left phrenic nerve D. Azygos vein 32. Which of the following are true regarding diaphragm I. 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 diaphragm A. 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 are I. 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 diaphragm I. 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

HISTOLOGY (CONDUCTING PORTION) 36. The following are true statements EXCEPT A. 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 EXCEPT A. 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 EXCEPT A. Brush cells of the submucosal layer of trachea act as sensory receptors B. Seromucous glands are present in larynx, trachea and bronchi C. 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 EXCEPT A. 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 EXCEPT A. 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.

45. The termination of trachea is at the level of ______ which continue then as bronchus A T6 B T2 C C4 D T4 46. Choose the correct statements regarding right main bronchus I 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 bronchopulmonary aspergillosis? 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

50. Which of the following statement is TRUE regarding Pneumocystis Jiroveci? ICan exist in the form of cysts which are thin walled IIGrowth in lungs is limited to the surfactant layer above the alveolar epithelium. IIIcauses pneumonia in immunocompromised patients IVPlasma 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? IKetoconazole IIFluconazole IIIItraconazole IVVoriconazole A. I and II B. III and IV C. I, II and III D. II, III and IV

ANSWER:
1.C 2.D 3.C 4. D 5.D 6.D 7.D 8.A 9.B 10.A 11.C (pg.66,67) 12.D (pg.67,68) 13.A (pg.69,70) 14.C (pg.69,70) 15.B (pg.70) 16.B (pg.60) 17.B (pg.60) 18.A (pg.60) 19.A (pg 61) 20.C (pg.63) 21.C (pg.227) 22.D (pg.227) 23.D (pg.228) 24.B (pg.228) 25.C (pg.229) 26.C 27.D 28.B 29.B 30.A 31.C 32.A 33.B 34.B 35.D 36.A 37.B 38.A 39.C 40.D 41.B 42.A 43.B 44.B 45.D 46.B 47.A (pg.177) 48.C (pg.177) 49.B (pg.177) 50.B (pg.178) 51.C (pg.179)

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