SELECTION EXAMINATION FOR​ DTCD 2018

1. Regarding COPD

a. X Ray is essential for diagnosis

b. Inhaled corticosteroids reduce exacerbations.
c. LTOT is indicated when PaO2 < 60 mmHg with PaCO2 > 50 mmHg.
d. Infiltration with neutrophils is characteristic.
e. FEV1 is a prognostic factor.

2. ​Regarding lung CA,

a. Small cell CA prevalence is 20-25 %.

b. impotence is a recognized feature of Para neoplastic feature of lung CA.
c. chemotherapy with cisplatin improves 1 year survival even with conservative
management in incurable CA.
d. solitary nodule popcorn like calcifications in CXR suggest CA.
screening with frequent CXR reduce mortality of lung CA.

3. ARDS,

a.PaO2 / FiO2 < 300 mmHg is diagnostic.

b.acute interstitial pneumonia mimics ARDS.

c.Treatment with methylprednisolone reduce survival.

d.prone ventilation reduce mortality.

e.survivers can get fibrosis.

4.T/F

a.IPF can cause B/L lower zone fibrosis.

b.asbestosis cause mainly apical pleural thickening.

c.Streptokinase reduce morbidity in advanced pleural disease.

d.Anti Hu antibodies detect cerebral lesions.

5​. Acute severe attack of ASTHMA in 16 years old boy,

a.inhaled beta agonist mainly act on Beta 1 receptors.

B.MgSO4 is not recommended in RX.

 c.SpO 2 100% reduces the hypoxic drive of this patient.

d.increased PaCO2 means muscle fatigue.

e.Respiratory acidosis indicates type I respiratory failure.

6. ​Composition of Lowenstein-jenson medium.

a.Agaros jel

b.Asparageine.

c.Sodium citrate.

d.Magnesium salt.

e.Egg.

7. ​Respiratory centre.

a.regulated by autonomic central from medulla.

b.central chemoreceptors induce respiratory center.

c.opioids directly inhibit respiratory center.

d.H+ concentration not affected for stimulation

e.Hypoxia is more sensitive than hypercapnoea.

8.T/F,

a.FEVI 25-75 indicates small vessel disease.

b.plethesmogarphy cannot use to measure TLC when there is a large bullae.

c.FEV 1 needs more effort than does for PEFR.

9. T/F,

a.in a healthy lung in a erect position apex is more ventilated than base.

b.perfusion is more in bases.

c.half of the Cardiac output flow through the pulmonary circulation.

10.​Mycobacterum tb,

a.is an obligate aerobic.

b.Can grow in cell free medium.

c.grow well when CO2 pressure is high.

d.doubling time is 18 H.

11.Antimicrobials

a.Co-amoxiclave can be used alone in lung abscess.

b.i cefuroxime is effective in pseudomonas.

e.Anti Tb drugs are never used as monotherapy.

f.fluoroquinolones is used in drug resistant or intolerant patients.

12. ​Pleural effusion

a.cholesterol can be used as a marker to differentiate exudate from transudate.

b.very low glucose is diagnostic of RA.

c.PH < 7.2 in Para pneumonic effusion is an indication for drainage.

d.lateral decubitus xray can identify pleural effusion only when volume > 100 ml.

13. Pneumothorax

a.Of all pneumothorax 50 % will recur.

b.B/L pneumothorax is an indication for surgery.

c.ILD is a common cause for B/L pneumothorax.

d.lateral decubitus xray is the best to identify small pnomothorax.

e.clamping of IC tube is advisable when transporting a patient with pneumothorax.

14.T/F

a.Quite expiration is an active process and quite inspiration is passive.

b.during expiration trans pulmonary pressure is more than atmosphere.

c.in healthy individual alveoli capillary thickness is < 1 micromelimiter.

d.external intercostal muscle is the main muscle involved in inspiration.

e.during inspiration intraalveolar pressure is more negative.

15.T/F

a.MDR TB is resistance to Isonaizid and rifampicin.

b.XDR TB is resistance to atleast INH & Rifampicin and to a quinolone and one of the
second line anti TB injectable drug.

c.panresistance TB is resistant to INH ,ethambutol,fluoroquinolone and one injectable

second line anti TB drug.

d.Xpeert MTB is the WHO preferred method to identify rifampicin resistance.

e.pyrazinamide sensitivity assessment is routinely done to asses drug sensitivity in sri

lanka.

16.T/F,

a.patients who exposes to TB may or may not get the infection.

b.an infected individual can get disease mainly in first 2 years.

c.In HIV patient have a 10% risk of getting infection.

d.IFN gamma assay used to detect latent TB in immunocompromised patients.

e.risk of getting Tb in patinetns who are going to start infliximab is 20 %.

17.T/F,

a.isolated hyperbilirubeaneamia is an indication to stop all anti TB drugs.

b.with elevated levels of AST/ALT . 5 times upper limit,can continue antiTB treatment.

c.drug desensitization is a method used for drug induced hepatitis.

d.in 2016 MDR cases in sri lanka is 20%.

e.clarythromycin an be usedt o traet for non tb mycaobacteria.

18​.What is T/F regarding first branching that involves gas exchange in bronchial
tree,

a.terminal bronchiole.

b.respiratory bronchilole.

c.alveoli.

d.alveoli duct.

e.Segmental bronchi.

19.​T/F regarding CO2 trasnport from tissues to alveoli,

a.O2 binds with H2O – mkes HCO3 which conerts to CO2 at lung + deoxy Hb binds with
H+ and some co2 racts with globin ahin of Hb and makes carbamino compound.

b.O2 binds with CO2 ……………

c.O2 binds aith amino group ……

d.makes HCO3 + Hb complex and………

e.CO2 disoles 20 times that of O2

20​. 70 years old COPD patients comes with SOB breathlessness, he was given
60% O2 and sent to ward after improvement. Later at ward found to be confused
with GCS 14/15.ABG is as follow,

pH- 7.25 PaO2-90 PCo2-60 HCO3- -35

What is next step of management.

a.stop O2.

b.24% o2

c.give 60% O2.

d.NIIV

e.mechanical ventilation

Best wishes
Teaching hospital /kurunegala