Respiratory: Mocks

Sr. No	Question	A	B	C	D	E	Correct Answer	Explanation
1	%age of arterial oxygenation at high altitude like k2	40	35	10	50	25	The correct answer is: 40	the arterial oxygenPo2 in the natives at high altitude is only 40 mm Hg,but because of the greater quantity of hemoglobin,the quantity of oxygen in their arterial blood is greaterthan that in the blood of the natives at the lower altitude
2	mesothelioma is associated with exposure to	beryllium	Carbon dust	asbestos	Mg exposure	silicon	The correct answer is: asbestos	Malignant mesiothelioma is associated with the long term exposure to the asbestos
3	Diagnostic test for dry mouth dry eyes is	Anti Igs	Anti SMA	Anti dsDNA	Anti SSA	Anti TNF	The correct answer is: Anti SSA	Features are suggestive of the Sjogren syndrome and investigation of choice is Anti SSA
4	How much amount of air needed for air embolism	2cc	50cc	100cc	150cc	10 cc	The correct answer is: 100cc	A larger volume of air, generally more than 100 cc, is necessary to produce a clinical effect in the pulmonary circulation; unless care is taken, this volume of air can be inadvertently introduced during obstetric or laparoscopic procedures, or as a consequence of chest wall injury.
5	Ghon complexes are characteristic of	primary TB	secondary focus of TB	Chronic bronchitis	Pneumonia	Sarcoidosis	The correct answer is: secondary focus of TB	Ghon focus is due to primary lesion of the TB while Ghon complexes with advanced lymphadenopathy are characteristics of the secondary TB
6	Leg vein thrombus will lodge in	brain vessels	posterior vessels	pulmonary veins	left atrium	right ventricle	The correct answer is: pulmonary veins	This venous thrombus goes to the heart and this to the pulmonary veins by pulmonary circulation
7	investigation of choice for cystic fibrosis is	genotyping	LFTs	sweat Cl test	CBC	bronchoscopy	The correct answer is: sweat Cl test	Investigation of choice for cystic fibrosis is the sweat chloride test
8	A patient has H/O recurrent respiratory infections,eczema and his platelet count is 10,000/cmm.This is due to	Pneumonia	DIC	Sepsis	Wiskott-Aldrich syndrome	Hematogenous infection	The correct answer is: Wiskott-Aldrich syndrome	Wiskott–Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count), immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia).
9	All of these are true about bronchial asthma except	Allergens play significant role in pathogenesis	Leukotriene antagonists are not helpful in the treatment	Regular inhaled steroids casuse growth retardation in children	Symptoms are worse at night	Cromolyns are very effective for exercise induced asthma	The correct answer is: Leukotriene antagonists are not helpful in the treatment	Leukotrienes are the inflammatory mediators. Their antagonist reduce the inflamation and can be used in asthma.
10	In chronic smoker, SOB after hyperbaric O2 for longer time, Dx..?	spontaneous pneumothorax	pneumothorax	dysplasia	fibrolental hyperplasia	hemothorax	The correct answer is: spontaneous pneumothorax	A chronic smoker (COPD), when in O2 therapy for prolonged time is at risk of spontaneous pneumothorax leading to dyspnea
11	emphysematous changes are due to deficiency of	fibronectin	fibrin	α1 anti trypsin	ALP	Elastin	The correct answer is: α1 anti trypsin	Two types of Emphysema are:Centriacinar—associated with smoking.Panacinar—associated with α1-antitrypsin deficiency.
12	ectopic parathyroid is produced by which tumor	BCC	melanoma	CML	lymphoma	SCC	The correct answer is: SCC	Squamous cell carcinoma: Hilar mass arising from bronchus; Cavitation; Associated with Cigarettes; hyperCalcemia (produces PTHrP)
13	In an acute state of status asthmaticus, The most important PFTs which will be abnormal	tidal volume	inspiratory reserve volume	FEV1	expiratory resrve volume	residual volume	The correct answer is: FEV1	Bronchial asthma is a obstructive lung disease. The most important pulmonary function test for the diagnoses is FEV1 to FVC ratio. That is always less then 70%. Whereas in restrictive lung diseases this ratio is always greater than 80%
14	non casseating granuloma is associated with	Sarcoidosis	syphilis	asthma	lung cancer	TB	The correct answer is: Sarcoidosis	Among the features of the Sarcoidosis, non casseating granuloma with asteroid bodies are the characteristic
15	A male working in plastic factory is at risk of tumor of	CA tongue	scabies	CA lung	skin lesions	CA bladder	The correct answer is: CA bladder	Plastic factory contains the hydrocarbons that are causitive agents of the CA bladder
16	A parasite comes from nose of a child, it is	E. histolytica	W. Bancrofti	A Dudenale	Ascaris	trypanasoma	The correct answer is: Ascaris	A worm affecting both the GIT and respiratory tract is the Ascaris lumbricoids
17	In 15 years old boy, the most important sign of ARDS is hypoxia it is	corrected by CO2	affect red membrane	epithelial damage	always infective	corrected by O2	The correct answer is: corrected by O2	ACUTE RESPIRATORY DISTRESS SYNDROME:A. Diffuse damage to the alveolar-capillary interface (diffuse alveolar damage) Plexiform lesion, primary pulmonary hypertension. B. Leakage of protein-rich fluid leads to edema and formation of hyaline membranes in alveoli. Treatment 1. Address underlying cause 2. Ventilation with positive end-expiratory pressure (PEEP)
18	A smoker has interstitial lung disease and pleural plaque, most common cause is ?	asbestosis	byssinosis	silicosis	pneumoconiosis	anthracosis	The correct answer is: asbestosis	Asbestosis:Associated with shipbuilding, roofing, and plumbing. “Ivory white,” calcified pleural plaques are pathognomonic of asbestos exposure, but are not precancerous. Associated with an increased incidence of bronchogenic carcinoma and mesothelioma
19	A 58 year old male with Patient of COPD present with breathlessness. pH shows acidosis. His electrolytes test will show	hyperkalemia	hypernatremia	hypoglycemia	hypokalemia	hypocalcemia	The correct answer is: hyperkalemia	In any case of acidosis, if there is derranged K level than it will be hyperkalemia resulted from outward shift of K.
20	65 years old male develops respiratory distress after abdominal surgery, A diagnosis of pulmonary infarction was made on the basis of subsequent investigation. This is likely to result from	pulmonary embolism involving large sized artery	due to paradoxical embolism	pulmonary artery thrombosis	pulmonary embolism involving medium sized artery	PE in small sized artery	The correct answer is: PE in small sized artery	after surgery, immobilization of patient causes an increased risk for thrombosis. Thrombi can be dislodged and can block pulmonary vasculature most commonly small sized pulmonary artery causing dyspnea.
21	In a 23 year old male patient, parasite related to lung infection	Chlonorchis	T. solium	S. hematobium	ascaris	S. mansoni	The correct answer is: ascaris	Ascaris lumbricoides :(giant roundworm)Transmitted by Fecal-oral; eggs visible in feces under microscopeIntestinal and lung infection
22	An 8 year old boy with Cystic fibrosis typical signs and symptoms and having recurrent pseudomonas infections, these infections can cause:	atypical Pneumoniae	Lobar Pneumoniae	Bronchectasis	Chronic bronchitis	Acute bronchitis	The correct answer is: Bronchectasis	Complications of Bronchetasis: Recurrent pulmonary infections (e.g., Pseudomonas), chronic bronchitis and bronchiectasis increased reticulonodular pattern on CXR, pancreatic insufficiency, malabsorption and steatorrhea, nasal polyps, and meconium ileus in newborns. Infertility in males (absence of vas deferens, absent sperm). Fat-soluble vitamin deficiencies (A, D, E, K).
23	A patient has pyogenic lung abscess.The responsible organism is	Proteus	staph aureus	H influenza	strep Pneumoniae	bacteriods	The correct answer is: staph aureus	The most common cause of the pyogenic lung abscess is the staph aureus.
24	A 43 year old male with history of coal worker presents with cough, weight loss and montoux positive, Cause..?	Silicosis	berrylium	hydrocarbons	organic dust	asbestosis	The correct answer is: Silicosis	Silicosis: Associated with foundries, sandblasting, and mines. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB.
25	Regarding hemodynamics, most common cause of increased pulmonary artery pressure	hypoxia	intake of nitroglycerine	exercise	essential hypertension	sympathetic stimulation	The correct answer is: hypoxia	hypoxia results in constriction of pulmonary vusculature resulting in increased pressure. Chronic hypoxia may leads to pulmonary hypertension.
26	Primary TB is characterized by the	ghon focus	cough	skin lesions	ghon complex	lymphadenopathy	The correct answer is: ghon complex	Ghon complexes are seen in primary TB while Ghon focus in secondary one
27	A 47 year old female on vent. has greenish sputum, organism	klebsella	staph aureus	Pseudomonas	spirochete	Actinomycetes	The correct answer is: Pseudomonas	Pseudomonas aeruginosa:Aerobic gram-negative rod. Non-lactose fermenting, oxidase positive. Produces pyocyanin (blue-green pigment); has a grape-like odor. Water source. Produces endotoxin (fever, shock) and exotoxin (inactivates EF-2).
28	Caplan"s syndrome usually occurs among	radar assembly worker	textile worker	coal worker	arc welder	hay farmer	The correct answer is: coal worker	lung fibrosis along with rheumatoid arthritis is known as caplan syndrome. It is most common among coal workers.
29	What type of CA lung that causes clubbing, in non smokers	oat cell CA	Adeno CA	large cell CA	small cell CA	SCC	The correct answer is: Adeno CA	Most common lung cancer in nonsmokers and overall (except for metastases). Activating mutations include k-ras, EGFR, and ALK. Associated with hypertrophic osteoarthropathy (clubbing).
30	A male gardener develops cough and his chest X-ray reveals a rounded opacity in right lobe of lung. Diagnosis is	tuberculosis	Sarcoidosis	blastomycosis	Actinomycosis	aspergillosis	The correct answer is: aspergillosis	findings are characteristics of the aspergillosis and formers are most affected by it
31	58 year old man presented with cushing syndrome. CT chest shows a lesion in lung.. Most likely diagnosis is	metastatic carcinoma of lung	squamous cell carcinoma	adenocarcinoma of lung	mesothelioma	small cell carcinoma	The correct answer is: small cell carcinoma	small cell carcinoma is a neuroendocrine tumor produces ACTH causing uncontrolled release of cortisol resulting in cushing syndrome. It also causes SIADH
32	While regarding respiratory physiology, deficiency of surfactant causes	asthma	inc. alveolar resistance	dec. airway calber	pneumonia	dec. alveolar resistance	The correct answer is: inc. alveolar resistance	pulmonary surfactant decreases the alveolar surface tension and prevention of alveolar collapse (atelectasis).
33	In a atopic asthamatic patient, the allergen inhaled rapidly interacts in the bronchi with?	mucosal mast cell	smooth muscle	T-lymphocytes	alveolar epithelial cells	eosinophills	The correct answer is: mucosal mast cell	in asthamatic patients, there are presensitized mast cells. When there is exposure to allergens or cold these mast cells start releasing chemical mediators that cause bronchoconstrictors.
34	Histopathology LNs of a young female revealed granuloma. A definite diagnosis of TB in this case requires	presence of caseation necrosis	evidence of lung involvement by Xray	presence of langherhan giant cells.	demonstration of AFB	mantoux test	The correct answer is: demonstration of AFB	gold standard test for the diagnosis of TB is the presence of acid fast bacillus
35	Investiagtion of choice for severity of asthma?	FEV	CO2 clearance	RV	FVC	O2 saturation	The correct answer is: FVC	Obstruction of air flow resulting in air trapping in the lungs. Airways close prematurely .Patient have highlung volumes, increased RV and decreased FVC.
36	A mine worker is suffering from mesiothelioma due to	carbon	Mg	silicon	asbestos	hydrogen	The correct answer is: asbestos	Asbestosis is the leading cause of the Mesothelioma in mine workers.
37	A patient with skin lesion and SOB, his chest X-ray shows diffuse interstitial diease with hilar masses. Biopsy of a skin lesion and a lymph node show granulomas with no necrosis. The most likely diagnosis is	Sarcoidosis	Tuberculosis	Alveolar proteinosis	Silicos	Carcinomatosis	The correct answer is: Sarcoidosis	Sarcoidosis is the Granulomatous disorder characterized by Non-Caseating granuloma and hilar lymphadenopathy.
38	In an old 57 year male, Oat cell CA causes what	cushing syndrome	Down syndrome	asthma	Carcinoid	Sarcoidosis	The correct answer is: cushing syndrome	Small cell (oat cell) carcinoma:Central location, Undifferentiated and very aggressive.May produce ACTH (Cushing syndromeg) , ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome).
39	A 55 year old smoker developed cough and SOB. Slightly drowsy his labs showed PCO2 9.5 KPA (4.4-6.1) PO2 6.2 KPA, HCO3 27 MMOL/L, Na 134 MMOL/L, K 3.8 MMOL/L. the mose likely diagnosis is	Acute Respiratory acidosis	compensated respiratry acidosis	Respiratory alkalosis and metabolic acidosis	mixed respiratory acidosis & metabolic acidosis	metabolic acidosis	The correct answer is: Acute Respiratory acidosis	labs shows increased pCO2, and the patients is having acute shortness of breath likely suffering from obstructive disease with long history of smoking. Acute shortness of breath causes retention of CO2 causing respiratory acidosis.
40	A patient with lung infiltrates and non casseating granuloma	churg Strauss	TB	pneumonia	Sarcoidosis	syphilis	The correct answer is: Sarcoidosis	pulmonary infiltrates with dry cough and hilar lymphadenopathy and non casseating granuloma are the features of the Sarcoidosis
41	Patient has no cough, but diffuse fibrosis on chest X-ray, cause	inorganic dust	asbestos	hydrocarbon	berrylium	silicon	The correct answer is: inorganic dust	Pneumoconioses. These environmental diseases are caused by inhalation of inorganic dust particles. Chronic exposure causes diffused bilalteral lung fibrosis.
42	A 32 old female with low grade fever, hypercalcemia stones with B/L lymphadenopathy\ histopathological findings will be?	Granuloma	Cassius	Fibrinoid	Granuloma with asteroid bodies	abscess	The correct answer is: Granuloma with asteroid bodies	Sarcoidosis is Associated with restrictive lung disease (interstitial fibrosis), erythema nodosum, lupus pernio, Bell palsy, epithelioid granulomas containing microscopic Schaumann and asteroid bodies, uveitis, and hypercalcemia (due to increased 1α hydroxylase–mediated vitamin D activation in macrophages). Treatment: steroids.
43	True about the pulmonary embolism is	long bone fracture	pregnancy	inc. V/Q	hypoxia	dec. V/Q	The correct answer is: inc. V/Q	In pulmonary embolism, the V/Q is increased due to decreased perfusion and normal ventilation
44	Eosinophilia on sputum is due to	worm infestation	viral infection	asthma	Sarcoidosis	fungal infection	The correct answer is: asthma	In sputum of the asthmatics, the eosinophilic count is increased.
45	Dead space is increased in	emphysema	pulmonary infarct	pulmonary embolism	both asthma and emphysema	asthma	The correct answer is: both asthma and emphysema	dead space is the volume of air which is inhaled that does not take part in the gas exchange, either because it (1) remains in the conducting airways, or (2) reaches alveoli that are not perfused or poorly perfused. The alveolar deadspace is caused by ventilation/perfusion inequalities at the alveolar level. The commonestcauses of increased alveolardeadspace are airways disease--smoking, bronchitis, emphysema, and asthma. Other causes includepulmonary embolism, pulmonaryhypotension, and ARDS.
46	A pt with pain radiating to backand rustling sound on auscultation has	myocarditis	pleural fluid	pleural effusion	pneumonia	pericarditis	The correct answer is: pericarditis	Pericardial rub or the russling sounds over auscultation are due to the pericarditis
47	6 year old boy presented to E/R with recurrent respiratory tract infections and failure to thrive. He also gives history of chronic diarrhea. Family history is positive for such complaints. The most relevant examination in this case to confirm the diagnosis would be	citamin B12 assay	jejunal biopsy	chloride sweat test	fat absoption test	serum immunoglobulin level	The correct answer is: chloride sweat test	patient is most likely suffering from cystic fibrosis. Autosomal recessive defect in CFTR gene on chromosome 7. CFTR encodes an ATP-gated Cl− channel that secretes Cl− in lungs and GI tract, and reabsorbs Cl− in sweat glands. increase  Cl− concentration (> 60 mEq/L) in sweat is diagnostic. Recurrent pulmonary infections (eg, S aureus [early infancy], P aeruginosa [adolescence]), chronic bronchitis and bronchiectasis, pancreatic insufficiency.
48	which of the following is the effect of asthma	alveolar sacs	trachea	alveolar ducts	alveoli	broncheoles	The correct answer is: broncheoles	Reversible airway bronchoconstriction, most often due to allergic stimuli (type I hypersensitivity) B. Presents in childhood; often associated with allergic rhinitis, eczema, and a family history of atopy
49	A 35 years old woman is unconcious, BP unrecordable, thready pulse. Aortic and carotid feedback is increased, Dx..?	dec. pO2	dec. CO2	inc. O2	inc. Na	dec. H	The correct answer is: dec. pO2	Chemoreceptors in the carotid and aortic bodies■ are located near the bifurcation of the common carotid arteries and along the aortic arch.■ have very high rates of O2 consumption and are very sensitive to decreases in the partial pressure of oxygen (Po2).
50	Familial emphysema is associated most closely with	Paraneoplastic syndrome	Chronic bronchitis	Silicosis	Smoking	Alpha- anti-trypsin deficiency	The correct answer is: Alpha- anti-trypsin deficiency	Familial Emphysema is associated with α-1 anti-trypsin deficiency. This enzyme limits the breakdown of Elastin & its deficiency causes excessive breakdown of Elastin leading to damaged airways, collapse and thus emphysema.
51	A 21 years old died after 5 days of femor fracture, cause	sepsis	hypovolumic shock	fat embolism	spinal shock	abscess	The correct answer is: fat embolism	Fat embolism: These emboli are particles of bone marrow and other fatty intra osseous tissue that enter the circulation as a result of severe (often multiple) fractures. b. They lodge in the lungs, brain, kidneys, and other organs
52	Among the following, which is true about pulmonary Thromboembolism	sec. resistance	collapse	V/Q mismatch	inc. resistance	dec. surfactant	The correct answer is: V/Q mismatch	Pulmonary emboli:V/Q mismatch causes hypoxemia and leading to respiratory alkalosis. Sudden-onset dyspnea, chest pain, tachypnea. May present as sudden death
53	In 5 yr old child with cystic fibrosis, is diagnosed to have chest infedtionis suspected clinically, sputum gulture shows large, opaque, Circularcolonies on blood agar which are coagulase positive. which bacteriumis most likely causeing this patient"s illness	Pycoplasma pneumoniae	Staphylococcus aureus	Haemophilus influenae	Klebsiella pneumoniae	streptococcus pneumoniae	The correct answer is: Staphylococcus aureus	Cystic Fibrosis is a genetic disorder in which body secretions become thick. It especially affects the respiratory tree and causes thick mucous and obstruction. 3 microorganisms cause infection S. Aureus, H. influenza & Pseudomonas. Here coagulative necrosis supports the infection by S.Aureus.
54	An old patient has COPD from 6 months. ABGs show pH 7.37(normal) PCO2 48( normal below 47) HCO3 30( normal below 29). Diagnosis is	alkalosis	compensated respiratory acidosis	compensated metabolic acidosis	acidosis	diabetic acidosis	The correct answer is: compensated respiratory acidosis	The acid base disturbance is toward the acidosis, but mild derranged CO2 and HCO are characteristics of the compensated disturbance.
55	A 54 year old male Patient with cough and bronchial spasm, cause	IgG	IgE	IgM	IgA	IgD	The correct answer is: IgE	IgE: Binds mast cells and basophils; cross-links when exposed to allergen, mediating immediate (type I) hypersensitivity through release of inflammatory mediators such as histamine. Mediates immunity to worms by activating eosinophils. Lowest concentration in serum
56	Which organ is least likely to be affected by infarction	intestine	liver	pancreas	spleen	kidneys	The correct answer is: liver	liver is supplied by dual blood supply. Thrombosis in one artery is least likely to cause infarction in liver. Lungs also doesnot infarct with thrombosis
57	Among the following, most imp. factor in maintaining pressure in pleural cavity is	osmotic pressure	CO2 concentration	hydrostatic pressure	venous drainage	lymphatic drainage	The correct answer is: lymphatic drainage	lymphatic drainage is the most important factor for maintaining pressure in pleural cavity.
58	A smoker is diagnosed case of lung carcinoma.Now he presented with frank hemoptysis. The likely cause of hemoptysis is	erosion of bronchial vessels	invasion of pulmonary vein	consolidation of lungs	erosion of bronchi	tumor necrosis	The correct answer is: erosion of bronchial vessels	tumors invading the bronchial vessels results in massive hemoptysis.
59	V/Q is increased in	asbestosis	COPD	asthma	TB	pulmonary embolism	The correct answer is: pulmonary embolism	In pulmonary embolism, the perfusion is decreased without affecting the ventilation
60	In an RTA patient with chest trauma, chest tube is inserted in which space	7th	4th	5th	3rd	6th	The correct answer is: 5th	A chest drain is inserted into the pleural cavity via an intercostal space, the fi fth space being preferred. After cutting through the overlying skin in the midaxillary line, the remaining insertion is done by blunt dissection into the pleural cavity, at which point the drain is inserted and connected to an underwater seal
61	A patient has emphysema. What would be the acid-base imbalance present in him?	alkalosis	retained HCO3	anemia	hypoxia	acidosis	The correct answer is: acidosis	emphysema causes CO2 retention and hence causes acidosis
62	Rock crusher can be affected by which disease?	Asbestosis	Sarcoidosis	mesiothelioma	pneumoconiosis	Silicosis	The correct answer is: Silicosis	Rock contains silicon and chronic exposure can cause Silicosis
63	A 57 year old male Factory worker presented in opd with progressive peripheral motor disfunction and anemia. Cause can be	Lead poisoning	B1 deficiency	Vitamin C deficiency	Folate deficiency	B3 deficiency	The correct answer is: Lead poisoning	Lead poisoning:Lead inhibits ferrochelatase and ALA dehydratase dec. heme synthesis and inc. RBC protoporphyrin and dec. B6 leading to neurological problems.Also inhibits rRNA degradation, causing RBCs to retain aggregates of rRNA (basophilic stippling).High risk in old houses with chipped paint and lead factory worker.
64	dull percusion over the chest is characteristic of	emphysema	pleural effusion	temponade	pericarditis	pneumonia	The correct answer is: pleural effusion	Regarding the physical examination of the respiratory system, dull percusion note is associated with the pleural effusion
65	Granuloma with asteroid bodies is in	churg Strauss	dystrophic calcification	TB	aspergillosis	Sarcoidosis	The correct answer is: Sarcoidosis	Non cassious granuloma with asteroid bodies is the characteristic of the Sarcoidosis
66	A man with sudden onset of respiratory distress but ECG and CXR normal, he died of..?	emphysema	asthma	chronic bronchitis	MI	pulmonary embolism	The correct answer is: pulmonary embolism	Sudden onset of respiratory distress and no findings on ECG and chest X-ray is consistent with the pulmonary embolism
67	paraneoplastic syndrome is associated with	overian CA	small cell CA lung	gastric CA	pancreatic CA	large cell CA lung	The correct answer is: small cell CA lung	Paraneoplastic syndrome is associated with the small cell CA of the lungs
68	Patient has dyspnoea on lying supine but normal CVS examination.It is due to	CKD	CCF	MI	retrosternal goitre	asthma	The correct answer is: retrosternal goitre	Patient has SOB on lying down but has normal CVS is due to the retrosternal goiter.
69	11 days menstruation after every 15 days is	Bicornuate Utrus	poly myalgia	menorrhogia	polymenorrhea	PID	The correct answer is: polymenorrhea	Both the increased frequency the duration of the menstruation is called the polymennorrhea and increased amount is called the menorrhogia
70	New born with recurrent URTI for the last 3 months and diarrhea, family Hx positive, how to confirm diagnosis?	sweat Cl test	plasma protein	jejunal biopsy	genetic analysis	marrow biopsy	The correct answer is: sweat Cl test	DIAGNOSIS: Sweat Cl- concentration (>60 mEq/L) in sweat is diagnostic. Can present with contraction alkalosis and hypokalemia (ECF effects analogous to a patient taking a loop diuretic) because of ECF H2O/Na+ losses and concomitant renal K+/H+ wasting.
71	Joint pain associated with metabolism of	lipids	pyrimidine	carbohydrates	purine	proteins	The correct answer is: purine	end product of purine metabolism is the uric acid and increased uric acid causes the gout
72	A 6 year old boy came to ER lowgrade fever and productive cough for the last 5 days. On physical examination his temperature is 102 F. He is a diagnosed case of cystic fibrosis.A clinical diagnosis of pneumonia is suspected. Sputum culture yielded non-lactose fermenting gram- negative rods with green pigmentation. which bacterium is mostprobably causing his iiiness	Hemphilus influenzae	Klebsiella pneumoniae	Streptococcus pneumorniae	Pseudomonas aeruginosa	Mycoplasma pneumoniae	The correct answer is: Pseudomonas aeruginosa	Pseudomonas is one of the most common bacteria to cause infection in CF. It is gram negative fructose non-fermenting that forms green colonies.
73	Most common cause of fat embolism is frature of	sternum	humerus	fibula	tibia	femor	The correct answer is: femor	Fat emboli:a. These emboli are particles of bone marrow and other fatty intra osseous tissue that enter the circulation as a result of severe (often multiple) fractures of long bones. Femor is the most common bone involved, others are the tibia and humerus.
74	A 43 year old male with Diabetes and smoker came with papillary construction and ptosis, Diagnosis?	cervical spinel lesion	ptosis	horner syndrome	WPS syndrome	misosis	The correct answer is: horner syndrome	Horner syndrome: Sympathectomy of face:Ptosis (slight drooping of eyelid: superior tarsal muscle)Anhidrosis (absence of sweating) and flushing (rubor) of affected side of faceMiosis (pupil constriction)Associated with lesion of spinal cord above T1 (e.g., Pancoast tumor, Brown-Séquard syndrome [cord hemisection], late-stage syringomyelia).
75	Hilar lymph node is most commonly associated with asteriod bodies in histology	emphysema	Sarcoidosis	asthma	RSV	TB	The correct answer is: Sarcoidosis	Sarcoidosis is characterized by chronic cough with lymphadenopathy and asteriod bodies on Histopathology
76	What is the drug of choice for acute severe asthma?	N/S nebulization	Salbutamol nebulization	Oral steroids	Antihistamine	Inhalational steroids	The correct answer is: Salbutamol nebulization	The first line treatment of acute severe asthma is bronchodilators either inhalational or I/V.
77	An old man developed respiratory distress after abdominal surgery. A diagnosis of pulmonary infarction is made on the basis of subsequent investigations. The infarction is most likely the result of	paradoxical embolism	pulmonary embolism involving large sized artery	PE in small sized artery	pulmonary artery thrombosis	PE in medium sized artery	The correct answer is: PE in small sized artery	after surgery, immobilization of patient causes an increased risk for thrombosis. Thrombi can be dislodged and can block pulmonary vasculature most commonly small sized pulmonary artery causing dyspnea.
78	A rock crusher developed lymphadenopathy and bireferengence on biopsy, Dx..?	byssinosis	anthracosis	asbestosis	silicosis	pneumoconiosis	The correct answer is: silicosis	Rock crush is associated with silicosis exposure.
79	A 28 year old female with previous TB now presented with fever, pericardial effusion and thick sputum, Dx..?	Chronic bronchitis	asthma	atelectasis	Bronchiectasis	acute bronchitis	The correct answer is: Bronchiectasis	Bronchiectasis is Associated with bronchial obstruction, chronic infection like TB, poor ciliary motility (smoking), Kartagener syndrome, cystic fibrosis, allergic bronchopulmonary aspergillosis.
80	V/Q inc in	asthma	pulmonary infarct	Pulmonary embolism	emphysema	COPD	The correct answer is: Pulmonary embolism	Increasing the V/Q ratio to infinity: Mathematically, dividing by zero produces the answer of infinity - so an increase in V/Q to infinity is produced when perfusion goes to zero. In a patient, regions of zero blood flow will result from a pulmonary embolism that blocks the blood flow.
81	On examination of 22 yr male with low grade fever, his nasal bridge was distorted and and cervical lymphnodes were plapable. Histology of these lymph nodes is the most probable diagnosis?	Cat scratch disese	Sacoidosis	leprosy	Tyberculosis	Syphilis	The correct answer is: leprosy	Mycobacterium Laprae is an AFB that causes Leprosy in which there are lion facies, glove and stocking loss of sensation & non-Caseating Granuloma.
82	In a patient with chronic cough and pleural plaques on CXR, diagnosis is	aspergilloma	asbestosis	mesothioma	Silicosis	mycetoma	The correct answer is: asbestosis	pleural plaques with dry cough are the features of the asbestosis
83	Which cells are increased in bronchial asthma?	monocytes	Eisinophils	Basophils	lymphocytes	leukocytes	The correct answer is: Eisinophils	Asthma is a chronic lung disease in which diseased airways are infiltrated by inflammatory cells (and thus thickened) and obstructed by fluid and mucous. .In eosinophilic asthma, the numbers of eosinophils are increased in blood, lung tissue, and mucus is coughed up from the respiratory tract.
84	Dry cough and hilar lymphadenopathy are seen in	Silicosis	CA lung	Sarcoidosis	asbestosis	TB	The correct answer is: Sarcoidosis	Both the dry cough and hilar lymphadenopathy are suggestive of the Sarcoidosis
85	most common cause of pulmonary embolism	ATT	immobilization	COPD	injury	astma	The correct answer is: immobilization	Risk factors for the Thromboembolic phenomenon are given by Virchow"s triad: Immobilization, Hypercoagulable state and endothelial injury.
86	A patient has SOB on lying down but normal CVS and otherwise normal respiratory examination. Diagnosis will be	CLD	CKD	retrosternal goiter	respiratory distress	heart failure	The correct answer is: retrosternal goiter	As the CVS and respiratory system of the patient is normal so the SOB is due to the retrosternal goiter.
87	A young lady with hemoptysis one week after delivery. There is no fever. ECG shows S1 Q3 T3 pattern. The most appropriate investigation would be	CPK	Gallium Scan	LDH	X-Ray Chest	SGOT	The correct answer is: Gallium Scan	patient is likely suffering from pulmonary infarction due to thromboembolic process. Best diagnostic test is CT angiography or gallium Scan.
88	Medullary CA is associated with the	CA 13	myosin	keratin	calcitonin	actin	The correct answer is: calcitonin	Calcitonin is the tumor marker of the Medullary carcinoma of thyroid
89	A pteint has generalized anasarca and his renal biopsy shows Amylodosis. What is the reason of edema?	Increased hydrostatic pressure	Increased salt retention	Increased water retention	Hypoproteinemia	Increase Amyloid	The correct answer is: Hypoproteinemia	Patient has renal amyloidosis, it is secondary due to pulmonary tuberculosis i.e. chronic inflammatory disorder. Renal amyloidosis results in proteinuria and Nephrotic syndrome.
90	In hypothyroidism what will increase?	cholesterol	carbohydrates	proteins	LDL	chylomicrons	The correct answer is: cholesterol	In hypothyroidism, cholesterol level is increased due to increased lipoprotein receptors
91	A boy with reccurent chest infections and salty sweat, test..?	sweat Cl test	marrow examination	RFTs	ESR	serum electrolytes	The correct answer is: sweat Cl test	All the features given in scenario are characteristics of the cystic fibrosis, and test to perform is the sweat chloride test
92	lung cancer spread through	direct invasion	nerve plexus	lymphatics	chemokines	Hematogenous	The correct answer is: lymphatics	In the lung, metastases (usually multiple lesions) are more common than 1° neoplasms. Most often from breast, colon, prostate, and bladder cancer. Lung cancer metastases through lymphatics to—adrenals, brain, bone (pathologic fracture), liver (jaundice, hepatomegaly).
93	A 45 years old African-American female presented to medical OPD with shortness of breath.You are suspecting sarcoidosis.Cause of hypercalcemia in sarcoidosis is	primary HPTH	malignancy	vitanim D excess	renal failure	vit A excess	The correct answer is: vitanim D excess	in sardoidosis there is excess of vitamin D, due to increase activity of 25- dehydrogenase enzyme inside the macrophages.
94	A Young female with respiratory distress has no CVS or respiratory issue but has proptosis	retrosternal goiter	asthma	lymphoma	CCF	COPD	The correct answer is: retrosternal goiter	Proptosis is pointing to thyroid disease and respiratory distress is due to retrosternal goiter compresses over the trachea
95	Chest pain not related to respiration is due to	pleura	pericardium	epicardium	mesocardium	myocardium	The correct answer is: myocardium	Chest pain not related to respiration is due to disease of the myocardium.
96	In a 48 year old man with Small cell lung cancer is related to	Thyroiditis	glacttorhia	hyperthyroidism	hyperparathyroidism	Cushing syndrome	The correct answer is: Cushing syndrome	Small cell (oat cell) carcinoma is Central, Undifferentiated very aggressive.May produce ACTH (Cushing syndrome) , ADH, or Antibodies against presynaptic Ca2+ channels (Lambert-Eaton myasthenic syndrome). Amplification of myc oncogenes common. Inoperable; treat with chemotherapy.
97	best investigation for pneumonia is	bronchoscopy	ESR	CT	CXR	suputum culture	The correct answer is: suputum culture	For the diagnosis of the Pneumonia, best investigation is the suputum culture to see the causitive organism
98	In a 36 year old female, common site of DVT in vein at	abdominal	thigh	pulmonary	below knee	neck	The correct answer is: below knee	Pathologic formation of an intravascular blood clot (thrombus) 1. Can occur in an artery or vein 2. Most common location is the deep veins (DVT) of the leg below the knee.
99	An old smoker with H/O fever, weight loss and worker in hydrocarbons factory presents to you.What is the diagnosis?	asthma	hemangioma	tuberculosis	pneumonia	bronchogenic CA	The correct answer is: bronchogenic CA	All the features given in the scenario are characteristics of the lung cancer.
100	A 24 year old male for suspicion of pneumonia Dx, sample taken	sputum culture	Blood	urine sample	nose swab	serum culture	The correct answer is: sputum culture	Consolidation (lobar pneumonia)Bronchial breath sounds; late inspiratory crackles. Confirmed by suputum culture.
101	R/R control is a function of	None of these	PO2	HCO3	PH	PCO2	The correct answer is: PCO2	Increase PCO2 stimulates central chemoreceptors in medulla which in result increases respiratory rate to get rid of CO2 from body.
102	Surfactant production starts during intrauterine life at	32weeks	36 weeks	28 weeks	Both A and B	34 weeks	The correct answer is: 28 weeks	Surfactants production start at 28 weeks but maturation is achieved uptill 35 weeks.
103	atmospheric pressure is 700mmhg, what will be gases content	PaO² 47, CO² 53	PaO² 153, paCO² 147	PaO2 will be 147 and Nitrogen will be 553 mmHg	PaO² 147, Pa N 253	PaO² 147, pa N 153	The correct answer is: PaO2 will be 147 and Nitrogen will be 553 mmHg	O2 percentage in air is 21, so 700 x 21/100=147Nitrogen percentage is 79, so 700 x 79/100=553
104	What is the effect of low Hb on aleolar ventillation in an old aged male person?	Remains the same	Decreases	Increases	Increases than decreases	Decreases than increases	The correct answer is: Increases	Decrease oxygen content will increase R.R for comensation so incresase in R.R will increase alveolar ventilation.
105	in fetus pulmonary resistance is increased because of	sickle cell anemia	vasoconstriction	methylated Hb	anemia	Hemolytic anemia	The correct answer is: vasoconstriction	Fetal pulmonary vascular resistance is very high because of generalized hypoxic vasoconstriction; as a result, blood flow through the fetal lungs is low. With the first breath, the alveoli of the neonate are oxygenated, pulmonary vascular resistance decreases, and pulmonary blood flow increases and becomes equal to cardiac output (as occurs in the adult
106	Diffusion of CO2 from blood into ?	liver	venules	lungs	capillaries	blood	The correct answer is: lungs	Lungs are the organs that have large surface area and are main place for the gaseous exchange (O2 & CO2).
107	What is ture of hypoxia in lung vessels?	dec. CO2	dec. CO2	sec. CO	Inc. O2	dec. pO2	The correct answer is: dec. pO2	Whenever there is decrease level of O2 content (dec. PO2) in pulmonary vessels, it leads to pulmonary Hypoxia
108	Surfactant has following features EXCEPT:	Increase surface tension in alveolar lumen	Is important at the time of birth	Is decreased in the lungs of cigarette smokers	Is produced by type 2 alveolar epithelial cells	Deficiency is also associated with patchy atelactesis	The correct answer is: Increase surface tension in alveolar lumen	Surfactants reduce surface tension inhibiting collapse of alveoli (i.e. atelactasis) and are important at time of birth to open the alveoli to make lungs functioning.
109	Ventilation is more than perfusion in	Anatomic dead space	None of these	Normal response	Dead space	Shunt	The correct answer is: Dead space	Ventilation > perfusion i.e. air is present but not equal amount of blood is present to get oxygenatied which forms dead space.
110	Focal length is 0.25m. Power will be	plus 4 dioptor	minus 4 dioptor	minus 1 dioptor	plus 1 dioptor	plus 2 diopter	The correct answer is: plus 4 dioptor	Power is defined as the reciprocal of the of focal length taken in meterhence Power = 1/ (0.25m)= 4 Dioptor
111	what is dec. in emphysema?	alveoli	volume	space	surface area	plaques	The correct answer is: surface area	in emphysema, the surface area decreases but the lung volume increases
112	If Phrenic nerve damages, it will result into	tilting head	respiratory distress	torticulus	tachycardia	respiratory loss	The correct answer is: respiratory distress	Phrenic nerve supplies the diaphragm and its lesion causes respiratory depression.
113	A young smoker was playing soccer when he suddenly became breathless with deep pain in chest.Reason for SOB	Alveolar capillary block	Depression of respiratory centre	Ventilation perfusion mismatch	Low blood count	Low o2 tension/pressure	The correct answer is: Ventilation perfusion mismatch	Smoking causes permanent destruction of alveoli in the lung and irreversible decrease in airflow leading to ventilation perfusion mismatch. This may also be scnerio of dissecting aneurysm causing ventilation perfusion mismatch.
114	Why pO2 in arteries is less than in pulmonary blood?	surface area	diffusion	pressure gradient	membrane thickness	active transport	The correct answer is: pressure gradient	Presence of an gas in body is dependent on the pressure gradient in that area and membrane thickness. Pressure gradient of O2 is more in pulmonary blood than in arteries.
115	On reaching mount everest a man developed severe dyspnea, reason.?	toxemia	anemia	polycythemia	pulmonary edema	hypoxia	The correct answer is: pulmonary edema	Acute pulmonary edema. The cause of this is stillunknown, but a suggested answer is the following:The severe hypoxia causes the pulmonary arteriolesto constrict potently, but the constriction is muchgreater in some parts of the lungs than in otherparts, so that more and more of the pulmonaryblood flow is forced through fewer and fewer stillunconstricted pulmonary vessels
116	In med E/R a man is given oxygen for 22hrs. he is likely to develop?	tension Pneumothorax	blindness	open pneumothorax	spontaneous pneumothorax	fibrolental hyperplasia	The correct answer is: spontaneous pneumothorax	A traumatic pneumothorax requires insertion of a chest drain, in contrast to a spontaneous pneumothorax, which may resolve without intervention that usually follows the high flow O2 therapy.
117	Respiratory centre is activated during hypoxia via	Directly acting on medulla	Acting on central chemoreceptor	None of these	Stimulating peripheral chemoreceptor	Both B and C	The correct answer is: Stimulating peripheral chemoreceptor	Central chemoreceptors are sensitive to increase PCO2 and increase H+ while peripheral chemoreceptors are also sensitive to decrease PO2 along with increase PCO2 and increase H+.
118	hyperventilation is accompanied by tetanic spasm. why?	dec. O2	fatigue	lactic acidosis	dec. pH	Ca squestration	The correct answer is: Ca squestration	In hyperventilation, CO2 is washed out leading to respiratory alkalosis. Conc. of H ions decreases and then plasma proteins use Ca for binding in place of H laeding hypocalcemia (and tetanic spasms)
119	Hypoxemia is improved by O2 supplementation in all EXCEPT	Impairement of diffusion	Right to left shunts	Alveolar hypoventilation	None of these	Poorly ventilated lung	The correct answer is: Right to left shunts	In right to left shunt, there is continuous mixing of blood between right and left side so increased O2 administration does not improve hypoxemia.
120	Result of sympathetic activation is	Bronchosonstricion	None of these	Increase GIT motility	Bronchodilation	Vasodilation in skin	The correct answer is: Bronchodilation	Sympathetic stimulation causes bronchodilation via B2 receptors, vasoconstriction in skin and decreases GIT motility.
121	Labor breathing flared nostrils is associated with	acessary muscles	TB	asthma	emphysema	type 2 respiratory failure	The correct answer is: acessary muscles	Difficult breathing is associated with the use of the acessary muscles of respiration
122	Respiratory centre feature is	None of these	Basic rhythm lies in dorsal medulla	Apneumotaxic centre changes inspiration	Medullary chemoreceptors directly respond to hypoxia	Pneumotaxic centre lengmens inspiration	The correct answer is: Basic rhythm lies in dorsal medulla	Dorsal respiratory group is primarily responsible for inspiration and generates basic rhythm for breathing. Ventral respiratory group is primarily responsible for expiration ony when its active.
123	Surfactant deacreases alveolar tension. It is secreted from	Terminal bronchioles	Type I pneumocytes	Both B and C	Lung endothelium	Type II pneumocytes	The correct answer is: Type II pneumocytes	Lumellar bodies are found in type II pneumocytes and secrete surfactant.
124	Peanut inhaled will get lodged in	right upper bronchus	right lower bronchus	left lower bronchus	right middle segment	left upper bronchus	The correct answer is: right lower bronchus	while standing, the penut will go to the right lower bronchus and while supine, it will go to the right middle bronchus
125	pCO2=25, O2=50, Ph=7, HCO3=1.1 are findings on an ABGs report.Diagnosis will be	None of these	Aspirin toxicity	COPD	Haemothorax	Morphine overdose	The correct answer is: Aspirin toxicity	Aspirin/ salicyclate toxicity leasds to respiratory alkalosis due to direct stimulation of respiratory center causing hyperventilation. This is an example of partially compensated respiratory alkalosis.
126	upon bedside examination a female has left shifted trachea and resonant note on right side.Diagnosis?	Right pneumothorax	None of these	Pleural effusion	Left pneumothorax	Consolidation	The correct answer is: Right pneumothorax	Only pneumothorax gives resonant note, while effusion and consolidation give dull note and pneumothorax shift trachea to opposite side that’s why right sided.
127	Regarding surfactant, what statement is true in your opinion?	Decrease lung compliance	Slow turnover	Secreted by type 1 pnuemocytes	Production decreases as the size of alveoli decrease	Forms macromolecular layer on fluid	The correct answer is: Forms macromolecular layer on fluid	Surfactants are macromolecutes consisting 70-80% of phospholipids aminly (DPPL), 10% surface profeins and 10% neutral lipids (cholestrol mainly).
128	Quite inspiration is the function of	Scalenius posterior	Diaphragm	Intercostal muacle	None of these	Sternocladomastoid	The correct answer is: Diaphragm	Main muscle responsible for quite inspiration is diaphragm, other are accessory.
129	Function of Pneumotaxic center	control expiration	control respiration	cause apnea	limit inspiration	control apnea	The correct answer is: limit inspiration	A Pneumotaxic Center Limits theDuration of Inspiration and Increasesthe Respiratory Rate: A pneumotaxic center, located dorsally in the nucleusparabrachialis of the upper pons, transmits signals tothe inspiratory area.
130	what change will be seen in lung compliance if surface tension is decreased?	shift to left	increase	decrease	shift to right	become zero	The correct answer is: increase	Compliance—change in lung volume for a given change in pressure; maintained by surfactant decreased in pulmonary fibrosis, pneumonia, and pulmonary edema and deccreased surfactant; increased in emphysema, increased surfactantand normal aging
131	Physological shunt is associated with	Ventilation is zero	Both A and C	Perfusion is zero	Ventilation is infinity	None of these	The correct answer is: Ventilation is zero	When V is zero e.g. in tracheal obstruction. V/Q = zero i.e. on gas exchange in a lung that is perfused but not ventilated, it is called shunt.
132	Prolonged O2 therapy for 24 hours can cause	fibroplasia	retrosternal fibrosis	spontaneous pneumothorax	angiomatosis	angiogenesis	The correct answer is: spontaneous pneumothorax	High flow O2 therapy for prolonged time is the leading cause of spontaneous pneumothorax.
133	Pulmonary artery embolism lead to	None of these	Alveolar pO2 increased	Alveolar pCO2 increased	Pumonary artery pCO2 decreased	Pulmonary artery pCO2 increased	The correct answer is: Pumonary artery pCO2 decreased	Patient of pulmonary embolism becomes tachypncic, exholes CO2, decreased pulmonary artery pCO2.
134	Reason for pulmonary O2 toxicity	Prolong O2 therapy	In under water	At high altitude	Increase PCO2	None of these	The correct answer is: Prolong O2 therapy	Prolonged exposure to increased O2 levels at normal pressure can cause oxidative damage to cell membranes, collapse of alveoli in the lungs causing O2 tonicily.
135	If oxygen dissociation curve is dissociated towards right, T50 would be:	None of these	26	18	35	20	The correct answer is: 26	T50 is the oxygen tension at which Hb is 50% saturated. The normal P50/T50 is 26.7. A rightward shift increases P50 and lowers Hb affinity for O2thus releasing O2 in tissues.
136	Before waking cortisol levels are at its peak in body. Cause?	circannual	deep sleep	circadian rhythm	morning stress	stress	The correct answer is: circadian rhythm	Glucocorticoid secretion ■ oscillates with a 24-hour periodicity or circadian rhythm.■ For those who sleep at night, cortisol levels are highest just before waking (ª8 am) and lowest in the evening (≈12 midnight).
137	Lung has metabolic actions in addition to breathing. One of these is	Inactivation of bradykinin	Inactivation of serotonin	Metabolism of basic drugs by cytochrome P450 system	Conversion of angiotensin I to angiotensin II	None of these	The correct answer is: Conversion of angiotensin I to angiotensin II	In renin-angiotensin system, renin converts orgiotensinogent to angiotensin I and then angiotensin I is converted to antgiotensin II in lungs. Renin angiotensin pathway is very important in maintaining BP and plasma volume.
138	surfactant is secreted by	alveoli	alveolar sacs	alveolar ducts	type 2 pneumocytes	type 1 pneumocytes	The correct answer is: type 2 pneumocytes	Surfactant is secreted by the type 2 pneumocytes of the respiratory tract
139	Which of the following has maxmimum value upon standing at the apex of lung?	dec. V/Q value	increased Ventilation	increased profusion	inc. V/Q value	decreased perfusion	The correct answer is: inc. V/Q value	Ideally, ventilation is matched to perfusion (i.e., V/Q = 1) in order for adequate gas exchange.Lung zones:1. Apex of the lung—V/Q = 3 (wasted ventilation)2. Base of the lung—V/Q = 0.6 (wasted perfusion)Both ventilation and perfusion are greater at the base of the lung than at the apex of the lung
140	When a person becomes apneic for a minute only, the value of rise in pCO2 is	6 mmHg/min	10 mmHg/min	8 mmHg/min	4 mmHg/min	2 mmHg/min	The correct answer is: 10 mmHg/min	PaCO2 increases during first minute to apnea by 10 mmHg and 3 mmHg for each minue afterwards.
141	by which week surfactant begins to appear?	12	16	18	14	26	The correct answer is: 26	Surfactant synthesis begins around week 26 of gestation, but mature levels are not achieved until around week 35
142	Pleural rupture results in	Inward collapse and inward chest wall spring	Inward collapse and outward chest wall spring	Outward collapse and outward chest wall spring	None of these	Outward collapse and inward chest wall spring	The correct answer is: Inward collapse and outward chest wall spring	If pleura is ruptured, negative intrathoracic pressure is lost and chest wall recoils outwards and lungs collapse which are their normal tendencies inhibited by negative pressure.
143	The central chemoreceptors in the medulla are sensitive to	None of these	H+	All of these	CO2	O2	The correct answer is: CO2	Central chemoreceptors respond to increase CO2 and increase H+ both but more sensitive to CO2.
144	left shift in Hb-O2 curve is result of?	dec. Na	dec. K	increased pH	dec. O2	dec. pH	The correct answer is: dec. pH	An increased in all factors (including H+) causes a shift of the curve to the right.A decreased in all factors (including H+) causes a shift of the curve to the left.
145	Bluish discoloration of skin or cyanosis results from	Both A and B	Increased myoglobin in blood	Increased CO2 in blood	Increased deoxy hemoglobin in blood	Decreased PO2 in blood	The correct answer is: Increased deoxy hemoglobin in blood	Deoxy Hb absorbs most of the red light and reflects blue light so > 5 g/dl deoxy Hb cause peripheral cyanosis.
146	Drop in arterial o2 saturation is seen without drop in arterial O2 tension in	Carbon monoxide poisoning	Low v/q	Anemia	Both A and B	None of these	The correct answer is: Carbon monoxide poisoning	In CO poisoning arterial O2 content/ tension remains same but Hb has much more affinity for CO so CO birds Hb more than O2 and O2 saturation decreases.
147	In pulmonary fibrosis spirometry shows low values of all BUT:	Vital capacity	Total lung capacity	Residual volume	FEV1 to FVC	None of these	The correct answer is: FEV1 to FVC	In pulmonary fibrosis FEV1 and FVC both decrease but FVC decrease more than FEV1 that’s why FEV1/FVC ration is > 0.8.
148	Pulmonary edema without any cardiac cause is due to?	emphysema	pulmonary embolism	asthma	ARDS	pulmonary edema	The correct answer is: ARDS	Acute respiratory distress syndrome:May be caused by trauma, sepsis, shock, gastric aspiration, uremia, acute pancreatitis, or amniotic fluid embolism. Diffuse alveolar damage and increased alveolar capillary permeability leading to protein-rich leakage into alveoli and noncardiogenic pulmonary edema (normal PCWP)
149	Surfactant is released by pneumocytes and	Has a low tumover rate	None of these	Decrease compliance	Decreases whtn alveolar size decreased	Decreases compliance work	The correct answer is: Decreases compliance work	Surfactants greatly reduce surface tension, increasing compliance allowing lungs to inflate much more easily, thereby reducing the work of breathing.
150	what phenomenon is carried out at dead space?	ventilation	convection	radiation	perfusion	conduction	The correct answer is: ventilation	physiologic dead space = anatomic dead space of conducting airways plus functional dead space in alveoli; apex of healthy lung is largest contributor of functional dead space. Volume of inspired air that does not take part in gas exchange.
151	In hypermetropia, image is formed	at lens	in front of retina	at retina	lateral to retina	behind the retina	The correct answer is: behind the retina	Hypermetropia or the farsightedness is defined as focusing defect when image is formed behind the retina.
152	dead space remains unchanged in	ventilator	mask	shallow breathing	oropharangeal airway	tracheostomy	The correct answer is: shallow breathing	Among the given list of features, the least likely change in dead space is by the shallow breathing.
153	Exchange of gas from alveoli to blood is by	active transport	carrier mediated	simple diffusion	osmosis	facilitated diffusion	The correct answer is: simple diffusion	In lungs, the gases are exchanged by the simple diffusion
154	Pulmonary vsoconstriction during low oxygen levels in blood is accompanied by	Decreas PCO2	Decrease PO2	Increase PCO2	None of these	Increase PO2	The correct answer is: Increase PCO2	Hypoxia (decrease pO2) causes pulmonary vasoconstriction which is accentuated by increased PCO2 (hypercarbia).
155	Dependant on diffusion	O2	O2 during exercise	All fo these	N2O	Co2	The correct answer is: O2 during exercise	Guses which have diffusion limited exchange are CO and O2 (in emphysema, fibrosis, exerose, more affinity for CO so CO birds Hb more than O2 and O2 saturation decreases.
156	Aqueous humor is produced by	cilliary process	Arachnoid villi	Bruch"s membrane	cilliary body	Arachnoid granulation	The correct answer is: cilliary process	aqueous humor is produced by the ciliary process and it is collectes to medial canthus through blinking and drains to NL duct.
157	Role of pneumotaxic center	control hypoxia	limits inspiration	expiration center	inc. respiration	limits expiration	The correct answer is: limits inspiration	A pneumotaxic center, located dorsally in the nucleusparabrachialis of the upper pons, transmits signals tothe inspiratory area. The primary effect of this centeris to control the “switch-off” point of the inspiratoryramp, thus controlling the duration of the filling phaseof the lung cycle
158	O2 tension normal but O2 saturation is declined because of	sec. alveoli	dec. surfactant	dec. plasma	dec. RBC	inc. plasma	The correct answer is: inc. plasma	In case of increased plasma volume but no increase in hemoglobin (relative anemia) leads to decreased O2 saturation.
159	A patient has been on supplemental O2 therapy for more than 24 hours and later develops difficulty in breathing.Diagnosis is	hypoxemia	O2 toxicity	spontaneous pneumothorax	optic atrophy	fibrolental hyperplasia	The correct answer is: spontaneous pneumothorax	Prolong O2 therapy is associated with the development of the spontaneous pneumothorax
160	O2 is transmitted through alveoli by	osmosis	pinocytosis	active transport	active diffusion	passive diffusion	The correct answer is: passive diffusion	Passive diffusion is the most common and effective method of O2 transport in the lungs.
161	Considering chronic respiratory acidosis, for every 10mmHg increase in pCO2, there is rise in HCO3 of	15 mEq	7 mEq	3 mEq	1 mEq	10 mEq	The correct answer is: 3 mEq	1 mm rise in CO2 = 0.35 mEq HCO3, 10 jmm rise in CO2 = 3.5 mEq, 20 mm rise in CO2 = 7 mEq HCO3.
162	Transport of CO2 from alveoli to blood in lungs is via	Active transport	Osmosis	Faciliated diffusion	Diffusion	Secondary active transport	The correct answer is: Diffusion	Exchange of CO2 and O2 both occurs through diffusion which depends on partial pressure difference, permeability of alveolar-pulmonary-capillary barrier, diffusion co-efficient of gas and surface area. Inversely related to thickness of membrane.
163	Physiologically highest partial pressure of oxygen is seen in	Pulmonary capillaries	None of these	Pulmonary arteries	Aorta	Pulmonary veins	The correct answer is: Pulmonary veins	As pulmonary capillaries are continuous exchanging CO2 with O2 and pulmonary veins receive only oxygenated blood so pO2 in pulmonary veins is highest.
164	How R/R is affected by rising blood CO2?	Increases	Decreases	No change	Stops	First increases then decreases	The correct answer is: Increases	Increased CO2 diffuses from arterial blood to CSF, here it combines with water to release H+, which affects central chemoreceptors resulting in hyerventilation then releases arterial pCO2 towards normal.
165	In last trimester what changes are mostly found regarding respiration.	dec. CO2	dec. O2	dec. HCO3	dec. CO	dec. K	The correct answer is: dec. O2	In 3rd trimester of pregnancy, gravid utrus pushes causes upward push of the diaphragm and decreases tidal volume and hence increases respiratory rate and dec. O2 saturation.
166	cut off for the metabolic alkalosis is	HCO3 less than 32	CO2 more than 32	HCO3 more than 24	HCO3 less than 20	more CO2	The correct answer is: HCO3 more than 24	among the given list, the level of HCO3 more than 24 is associated with the metabolic alkalosis
167	measure of the physiological dead space is	air conduction	alveoli	emphysema	bronchus	trachea	The correct answer is: air conduction	Dead space is the part of air way that participates only in air conduction but not in gases exchange
168	surfactant is produced by	Mast cells	pleura	pneumocytes II	pneumocytes I	alveoli	The correct answer is: pneumocytes II	Surfactant is secreted by the type II pneumocytes
169	Max. inspiration + normal expiration is equivalent to	expiratory capacity	expiratory volume	residual volume	inspiratory capacity	total capacity	The correct answer is: inspiratory capacity	Maximum inspiration with normal expiration is used to measure the inspiratory capacity.
170	The Normal quiet expiration results from action of:	None of these	Elastic tissue in thoracic and lung wall	Abdominal muscles	Sternocleidomastoid	Diaphragm	The correct answer is: Elastic tissue in thoracic and lung wall	Normal expiration is brought about by recoil of elastic tissue and in thoracic and lung wall, when expiration is a passive process.
171	Which of the following vein has arterialization of blood?	Intenal juglar vein	Veins on dorsum of a warm hand	Anticubetal vein	Femoral vein	Subclavian vein	The correct answer is: Veins on dorsum of a warm hand	This is due to the fact that in warm hand more blood is supplied than need for heat exchange. This causes arterilization of venous blood.
172	Active thyroid released in blood is	TRH	T2	T3	T1	TSH	The correct answer is: T3	Active form of the thyroid hormone is the T3 while abundant is the T4
173	O2 dissociation curve shifts to the left due to rising	None of these	Temperature	Partial pressure of CO2	2-3 DPG concentration	Oxygen affinity of haemoglobin	The correct answer is: Oxygen affinity of haemoglobin	Increase in oxygen affinity of Hb (as in fetal Hb) causes the curve shift towards left i.e. decrease O2 release in tissue.
174	Which test is most relevant for pulmonar function to check obstructve vs restrictive diseases	ventilation	RC	FEV1/ FVC	RV	FVC	The correct answer is: FEV1/ FVC	Obstructive lung diseases:Obstruction of air flow resulting in air trapping in the lungs. Airways close prematurely at high lung volumes inc. RV and dec. FVC. PFTs: decreased FEV1/FVC ratio (hallmark),
175	Gaseous exchange through lungs is dependant on	Surface area available for gas exchange	All fo these	Solubility and molecular weight fo the gases	Diffusion distance	Partial pressure difference of the gases	The correct answer is: All fo these	All these given factors are responsible for determining exchange through lungs wall, enlargement of air space and increase in compliance.
176	Stem related to normal Hb and there is decrease oxygen saturation:	acidosis	CO2 excess	Suffocation	NO2 excess	CO poisoning	The correct answer is: CO poisoning	The problem with carbon monoxide (CO) is that it inhibits your ability to distribute O2 (oxygen). Hemoglobin, a protein in your red blood cells, binds oxygen in your lungs, and distributes oxygen throughout your body. Hemoglobin has a very high affinity for oxygen. However, it has a HIGHER affinity for CO.
177	Condition causing respiratory acidosis is	Emphysema	Ingestion of excess amount of sodium bicarbonate	Vomiting	Hyperventilation	Starvation	The correct answer is: Emphysema	In emphysema inspiration is normal but expiration is impaired due to loss of elastic recoil, lungs cant expire properly which leads to CO2 retention and decrease pH.
178	Low arterial O2 tension results from	Hypoventilation	None of these	CO poisoning	Anemia	Moderate exercise	The correct answer is: Hypoventilation	In hypoventilation, there is CO2 retention and decreased O2 tension while in all other scnerios O2 tension is unchanged and saturation is decreased.
179	Maximal vasodilatory effect of CO2 is seen in	Heart	Kidney	Both A and B	Liver	Brain	The correct answer is: Brain	Of all ranges, brain is the most sensitive to increase pCO2.
180	The Lowest PO2 is observed in	Maternal uterine vein	Umbilical artery	Maternal femoral vein	Maternal artery	Umbilical vein	The correct answer is: Umbilical artery	Umblical artery carries all the deoxygenated blood from fetus to mother that’s why has fewest PO2.
181	respiration is directly proportional to	surfactant	alveoli surface area	alveoli	alveolar ducts	alveoli sac	The correct answer is: alveoli surface area	Diffusion: Vgas = A/T × Dk(P1 – P2) where A = area, T = thickness, and Dk(P1 – P2) ≈difference in partial pressures: A dec. in emphysema. T inc. in pulmonary fibrosis.
182	Blood supply to lungs in L/min during rest	5	3	2	2.5	6	The correct answer is: 5	Lungs receive blood both from right and eft heart so if CO is 5 l/min, lungs also receive 5 l/min of blood at rest.
183	V/Q ratio is maximum at upper part of lung because	Blood flow is decreased considerably more than ventilation	Direct connection with trachea	None of these	Blood flow is increased considerably more than ventilation	Base of lund has high ventilation in relation to blood flow	The correct answer is: Blood flow is decreased considerably more than ventilation	Ventilation is lower at apex, higher at base while perfusion is lower at apex and highest at base, so V/Q at apex is higher than V/Q at base. This is due to more gravity effect on perfusion.
184	Respiration will be stopped centrally if following structure is damaged	Midbrain	Pons	Medulla	None of these	Cerebellum	The correct answer is: Medulla	Respiratory centre is present in medulla which has basic rhythm of respiration, its damage will lead to central cessation of breathing
185	inc. in thoracic vol during quiet inspiration is due to	external intercostal	internal intercostal	external oblique	quadratus Lumborum	diaphragm	The correct answer is: diaphragm	Intra thoracic volume is increased by the movements of the diaphragm
186	decrease in surfactant in lungs will result in?	dec. complience	inc. complience	cause Hypoxia	inc. O2 affinity	dec. CO affinity	The correct answer is: dec. complience	Surfactant deficiency inc. surface tension decreases lung compliance and increased chances of alveolar collapse. A lecithin:sphingomyelin ratio < 1.5 in amniotic fluid is predictive of neonatal respiratory distress syndrome.
187	Mark the true narrative regarding peripheral chemoreceptors:	Respond to PO2 less than 40 mmhg	None of these	Detect increased CO2/PH	Have increased O2 consumption	Respond on PO2 less than 60 mmhg	The correct answer is: Respond on PO2 less than 60 mmhg	PO2 must decrease to < 60 mmgh before breathing is stimulated.
188	Diffusion rate of CO2 is raised through alveolar membrane because of	None of these	Both A and B	Increased solubility	Increase density of CO2	Increased diffusion co-efficient	The correct answer is: Increased diffusion co-efficient	CO2 is the gas with maximum diffusion co-efficient in body.
189	A patient’s blood shows PO2 70 mmHg. What kind of hypoxia is he suffering from?	hypoxic hypoxia	dilutional hypoxia	anemic Hypoxia	anoxic hypoxia	toxic Hypoxia	The correct answer is: hypoxic hypoxia	In all the cases of the hypoxia, the saturation is normal except for the hypoxic hypoxia
190	dead space minus from tidal volume times breathing rate, is	alveolar ventilation	ventilation	breathing	gaseous exchange	ventilation rate	The correct answer is: alveolar ventilation	Alveolar ventilation is defined as dead space minus from tidal volume times breathing rate.
191	mechanism of CO2 transport from tissues to lungs	uptake of HCO3	uptake of HCO3 in exchange of Cl	uptake of HCO3 in exchange of K	uptake of K in exchange forCl	exchange of K	The correct answer is: uptake of HCO3 in exchange of Cl	HCO3- leaves the RBCs in exchange for Cl- (chloride shift) and i is transported to the lungs in the plasma. HCO3- is the major form in which CO2 is transported to the lungs.
192	Keeping in mind physiology of vital capacity, true is	None of these	Both A and C	Measured directly by spirometry	Is the sum of Tidal Volume+ERV+IRV	Is decreased in some lung diseases	The correct answer is: Is the sum of Tidal Volume+ERV+IRV	Vital capacity is maximum volume of air that can be expelled from the lungs after taking the deepest possible breath, VC = TV + IRV + ERV.
193	stony dull percusion is character of	air in plueral cavity	fluid in pleural cavity	fibrosis	Pneumoniae	COPD	The correct answer is: fluid in pleural cavity	Whenever there is a fluid in the the pleural cavity, the percussion note will be dull,normal note is tympanic in presence of normal pleural cavity.
194	After forced expiration amount of RV in ml is	None of these	1200 ml	1000 ml	2400 ml	500 ml	The correct answer is: 1200 ml	RV = 1200 ml , TV = 500 ml , dead space =150 ml.
195	V/Q scan is important for diagnosis of	Pneumonia	Emphysema	Pulmonary embolism	Interstitial lung disease	None of these	The correct answer is: Pulmonary embolism	In pulmonary embolism, Q = O, V/Q = infinity
196	what changes hb dissociation curve to extreme left	NO3	CO2	SO2	N2O	CO	The correct answer is: CO	In addition, binding of CO to hemoglobin increases the affinity of remaining sites for O2, causing a shift of the curve to the left
197	At rest, transverse diameter of chest is increased by	diaphragm	external intercostal	internal oblique	internal intercostal	quadratus Lumborum	The correct answer is: external intercostal	transverse diameter of the chest is increased by the external intercostal muscles
198	Which volume is inhaled maximum than exhaled?	residual capacity	inspiratory capacity	TLC	vital capacity	residual volume	The correct answer is: vital capacity	Vital capacity is defined as the volume of air that is maximally exhaled after deep inspiration