Layan Nidal

Leen Hajeer

Ameen Alsaras

Samia Simrin

RS-Final

Pharmacology

1) Rifabutin is used instead of Rifampin because:

a. It is not affected by CYP P450

b. It causes more side effects of protease inhibitors

c. Rifampin decreases antiviral activity

2) Antitussive drugs are used for:

a. Bronchial asthma

b. Cystic fibrosis

c. Nonproductive dry cough

d. Pneumonia

3) Choose the mismatch:

a. Lemon oil – Increased lysosomal activity

b. Hydration – Decreased viscosity

c. Carbocisteine – reduction of disulfide bonds

4) A drug that is an expectorant nor enhances mucocilliary action:

a. Dextromethorphan

b. Bromhexine

c. Carbocisteine

5) Most active drug in Tb treatment is:

a. Rifampin

b. Isoniazid

c. Streptomycin

6) The agent that is metabolized by mycobacterial catalase–peroxidase (KatG) is:

a. Isoniazid

b. Rifampin

c. Streptomycin

7) A less potent Anti-TB inducer of CYP450 and is used with HIV patients using protease

inhibitor therapy:

a. Rifabutin

b. Rifampin

c. Capreomycin

8) Ethionamide is related in its mechanism to:

a. PAS

b. Rifampin

c. Isoniazid

9) A drug that affects mucociliary function and is used in asthma:

a. Ammonium chloride

b. Bromhexine

c. Beta 2 agonist

10) Which of the following drugs is narcotic?

a. Glaucine

b. Diamorphine

c. Pholcodine

11) Isoniazid is used in combination to:

a. reduce resistance

b. have bactericidal effects

c. have higher efficacy

Answers

A 7 C 1

C 8 C 2

C 9 A 3

B 10 A 4

A 11 B 5

- - A 6

bAnatomy + histology la

1) Name the green pointed bone.

a. Lacrimal bone

b. perpendicular plate of palatine bone

c. ethmoidal bone

d. lateral pterygoid plate of sphenoid

2) Which of the following passes through the opening

a. Inferior laryngeal artery

b. External laryngeal nerve

c. Internal laryngeal nerve

d. Superior thyroid artery

3) A stupid dentist drops something into your mouth

while you are sitting, where will it go?

a. A

b. B

c. C

d. D

4) The pointed structure is:

a. Pulmonary vein

b. Pulmonary artery

c. Ep arterial bronchus

d. Hyp arterial bronchus

5) The green surface is supplied by which nerve?

a. Intercostal nerves

b. Phrenic nerve

c. pulmonary plexus

6) Which of the following isn’t found in this fossa?

a. Maxillary nerve

b. Pterygopalatine ganglia

c. Sphenopalatine nerve

d. First part of the maxillary artery

7) The pointed opening is:

a. Sphenoid Air sinus

b. Bulla ethmoidalis

c. Eustachian tube

d. Middle meatus

8) Which of the following is wrong about the

pointed structure?

a. It has a smooth muscle

b. no blood vessels

c. no lymph drainage

d. it is lined by oral epithelium

9) Which bone is not found in this figure

a. ethmoid

b. lateral plate of pterygoid

c. perpendicular plate of palatine

d. lacrimal bone

10) What nerve supplies the pointed structure?

a. internal laryngeal nerve

b. external laryngeal nerve

c. recurrent laryngeal nerve

11) What is the pointed structure?

a. vagus nerve

b. sympathetic chain

c. phrenic nerve

12) Which sinus drains in this opening?

a. maxillary

b. posterior ethmoidal

c. anterior ethmoidal

13) Pointed impression is of:

a. trachea

b. inferior vena cava

c. esophagus

14) What structure leaves the pointed fossa to the

infratemporal fossa?

a. Maxillary artery

b. maxillary nerve

c. sphenopalatine nerve

15) All of the following are attached to the pointed

structure except:

a. thyroepiglottic ligament

b. quadrangular membrane

c. conus elasticus

16) Which of the following is associated with the

pointed structure?

a. Superior thyroid artery

b. Inferior thyroid artery

17) This section was taken from:

a. Trachea

b. Primary bronchus

c. Secondary bronchus

d. Tertiary bronchus

18) The green arrowed cell represents:

a. Type I pneumocyte

b. Type II pneumocyte

c. Endothelial cell

d. none of the above

19) The orange arrow represents:

a. Mesothelium

b. Hyaline cartilage

c. Elastic fibers

d. Endothelium

20) Which of the following doesn’t exist in this

picture?

a. Loose connective tissue

b. pseudostratified ciliated columnar

c. Goblet cells

d. hyaline cartilage

21) the pointed structures are:

• inferior lingual + lateral basal segments

22)Tracheal section showing mucosa and submucosa only – Structure not seen in

this section

• hyaline cartilage

23) Section of intrapulmonary airway, with circular lumen, two cartilages, folded

epithelium and abundant smooth muscle

• tertiary bronchus

24) Section of alveolar duct – pointed structure is

• smooth muscle (knob of alveolar opening)

25) which of the following is not present (true vocal cord)

• respiratory epithelium

26) All of the following structures are present except (posterior section in the trachea)

• seromucous glands

Answers

C 15 A 8 A 1

B 16 B 9 B 2

C 17 B 10 C 3

A 18 A 11 B 4

C 19 C 12 B 5

D 20 C 13 D 6

- 21 B 14 C 7

Physiology lab

1)You did a spirometry test to a patient. The test was reproducible and acceptable and it

is done 3 times. A table of results show that FEV1/FVC=90%, FVC of predicted= 72%. What

to do next?

a. Repeat the test again

b. It is normal

c. give bronchodilator and repeat

d. Do methacholine challenge test

e. Complete pulmonary function test is needed

3)A normal person with VC = 3.5L IC = 2L Vt = 0.5L FRC = 2.5L, find his ERV

a. 1.5 L

b. 1 L

c. 2.5 L

4)The volume in the lung after normal inspiration:

a. tidal volume

b. vital capacity

c. inspiratory reserve volume

d. total lung capacity

e. none of the above

2)This flow volume loop represent:

a. COPD

b. restrictive lung disease

c. asthma

6)RR=10 breaths/minute , tidal volume=600mL, Vd=150mL, then RMV and AV

respectively=

• 6L/minute, 4.5L/minute.

Answers

1 E

2 B

3 A

4 E

5 D

5)Which of the following phases in the figure

represent air expired from apical alveoli alone :

a. 1

b. 2

c. 3

d. 4

Microbiology

1) Which of the following is an appropriate media for all fungi?

a. SDA

b. Chrome Agar

2) Which of the following is sensitive for bacitracin?

a. Enterococcus

b. Strep agalactiae

c. Strep pneumonia

d. strep pyogenes

3) The following media is:

a. chrome agar

b. Lowenstein-Jensen

c. Sabouraud dextrose agar

4) The test shows:

a. Strep. Pneumonia

b. Strep. Viridans

c. Strep. Pyogenes

d. Strep. Agalactiae

5) The most common cause of Rhinosinusitis is

a. Enveloped single stranded RNA

b. Naked Double stranded RNA

c. Enveloped double stranded DNA

d. Naked single stranded RNA

6) What is the best management for rhinovirus infections?

a. Antiviral therapy with ribavirin

b. Antiviral therapy with tenofovir

c. Systemic corticosteroids

d. Supportive therapy

e. Salbutamol

7) Which of the following coronaviruses causes severe respiratory infection?

a. SARS

b. OC43

c. 229E

8) The most common cause of bronchiolitis is

a. Adenovirus

b. parainfluenza

c. Coxsackie A

d. RSV

9) Croup and steeple sign are caused by:

a. Acute rhinosinusitis

b. Bronchiolitis

c. Laryngotracheobronchitis

d. Bacterial tracheitis

10) A 3-year-old child develops Haemophilus influenzae meningitis. Therapy is begun with

cefotaxime. Why is this third-generation cephalosporin used rather than ampicillin?

a. About 20% of Haemophilus influenzae organisms have a plasmid that encodes for β-

lactamase

b. A lot of cases are penicillin allergic

c. It is easier to administer intravenous cefotaxime than intravenous ampicillin.

d. About 80% of Haemophilus influenzae organisms have modified penicillin binding

proteins that confer resistance to ampicillin.

e. The drug of choice, trimethoprim–sulfamethoxazole, cannot be used because the

child is allergic to sulfonamides.

11) A 13-valent capsular polysaccharide protein conjugate vaccine for pneumococcal

infections is recommended

a. For children up to age 18 years and for selected adults

b. Only on exposure to a patient with disease caused by the organism

c. For all children ages 2–60 months plus selected older children and adults with

immunocompromising conditions

d. For children ages 24–72 months

e. For all age groups older than age 2 months

12) A patient is present with oral membrane that bleeds profusely when touching it, what

is the most likely causative agent?

a. Gram negative non encapsulated bacteria

b. Gram positive anaerobic bacteria

c. Gram negative encapsulated bacteria

d. Gram positive aerobic bacteria

13) Which of the following statements regarding interferon- release assays (IGRAs) is

correct?

a. They are useful for evaluating immunocompromised patients for active tuberculosis

b. They detect antigens present in all Mycobacterium species

c. They are not available yet for testing in the hospitals

d. They are performed using molecular probes that detect organism DNA

e. They are used as alternatives to the tuberculin skin test to evaluate for latent

tuberculosis

14( Mycoplasma pneumoniae is considered. All of the following are methods to confirm

the clinical suspicion except

a. PCR amplification of Mycoplasma pneumoniae DNA in sputum

b. Culture of sputum for Mycoplasma pneumoniae

c. Gram stain of sputum smear

d. Culture of a lung aspirate for Mycoplasma pneumoniae

e. Enzyme immunoassay test of acute and convalescent sera

15) Humans become infected with Legionella pneumophila by

a. Kissing a person who is a legionella carrier

b. Breathing aerosols from environmental water sources

c. Receiving a mosquito bite

d. Consuming undercooked pork

e. All of the above

16) One of the most serious upper respiratory tract infections is:

a. Tracheitis

b. Epiglottitis

c. Acute rhinosinusitis

17) Both H. influenza and S. pneumonia are involved in:

a. Sinusitis and otitis media

b. Epiglottitis

c. Conjunctivitis

d. Atypical pneumonia

18) The most common cause of community acquired pneumonia is:

a. N. meningitidis

b. H. influenza

c. S. pneumonia

19) Which of the following is wrong regarding TB?

a. It triggers humoral immunity

b. The causative agent is said to be acid-fast bacillus

c. It is strongly associated with immunodeficiency caused by HIV

20) A patient is present with barky cough along many other symptoms and was diagnosed

as having croup. The isolated causative agent would be from which family?

a. Orthomyxoviridae

b. Paramyxoviridae

c. Coronaviridae

21) One of these organisms causes common cold but has too many serotypes to develop a

beneficial vaccine:

a. Rhinovirus

b. Parainfluenza virus

c. RSV

d. Human coronavirus

22) Generally, antibiotics are not commonly used in upper respiratory tract infections

because:

a. They are mostly caused by resistant strains

b. Most of them are viral infections

c. They are mild infections with minimal symptoms

23) Which of the following is false regarding B. pertussis?

a. It causes whooping cough

b. It’s still endemic in Jordan

c. It’s an encapsulated gram-negative rod

24) Which of the following does not have a vaccine?

a. S. pneumonia

b. B. Pertussis

c. C. diphtheriae

d. Mycoplasma pneumonia

25) In which stage of pertussis is the characteristic whooping sound made?

a. Convalescence

b. Catarrhal

c. Paroxysmal

d. Prodromal

e. None of the above

Answers

A 17 C 9 A 1

C 18 A 10 D 2

A 19 C 11 A 3

B 20 D 12 B 4

A 21 E 13 D 5

B 22 C 14 D 6

B 23 B 15 A 7

D C

24 25

B 16 D 8

PBL

1) Typical description for Infantile RDS. What is the main cause?

• lack of surfactant

2) How to treat ARDS?

• Steroids

3) Wheezing and Family history of the same disease with other allergies?

• Asthma

4) Barking cough with steeple sign?

• Croup

Pathology

1) Which of the following is correct about TB

a. primary TB is infective

b. regional lymph nodes are less involved in secondary TB

c. 80 % of primary TB become secondary

2) Which of the following is correct about TB

a. Secondary TB is localized in the lower lobe

b. Mycobacterium bovis causes oropharyngeal TB

c. Mycobacterium avium complex causes disease in 3% of AIDS patients

3) Which of the following is true about pulmonary embolism

a. The more peripheral the embolic occlusion the lower the risk for infarction

b. 40 % of them are silent

c. Consequences are only determined by the size of embolus

d. Small emboli cause alveolar hemorrhage

4) Which of the following is true about Goodpasture syndrome

a. Autoimmune disease affect the lungs only

b. IgG granular deposition in the lung are diagnostic

c. Results in necrotizing hemorrhage interstitial pneumonitis

d. Predominance in females

5) Choose the true sentence

a. hyalinized collagen fibers are found in silicosis

b. asbestos bodies are golden brown rounded structures

c. pleural plaques contain Ca++ and iron

6) Mass that contains large cells, with large nuclei and prominent nucleoli, and show no

glandular or squamous differentiation, what is the diagnosis ?

a. Squamous cell carcinoma

b. Large cell carcinoma

c. Carcinoid

d. Small cell carcinoma

7) True about sarcoidosis

a. Higher prevalence in smokers

b. Mainly occupational disease

c. In liver it manifests as granulomas surrounding central veins

d. In more than 50%, it causes granuloma in spleen

8) True about adenocarcinoma

a. Form large masses

b. Centrally located

c. It has a wide range of metastasis in a short time

9) True about lung tumors

a. They have good prognoses

b. Adenocarcinoma is the most common in smokers

c. women are more susceptible to carcinogens in tobacco than men

10) Long case that begins centrally in a localized area and spread widely to the pleura

(pleural cell proliferation), this case is associated with ?

a. distant metastasis

b. Adenocarcinoma

c. Extensive pleural fibrosis

11) Intraalveolar fibrosis with patchy air space consolidation

a. Cryptogenic Organizing pneumonia

b. Carcinoid syndrome

c. Nonspecific interstitial pneumonia

12) 51 year old patient presented with right chest pain that increases with inspiration

which one is the less likely diagnosis:

a. pneumonia

b. Pulmonary embolism

c. MI

d. Pneumothorax

13) What’s specific for sarcoidosis ?

a. Non-caseating necrosis

b. Schaumann bodies

c. Asteroid bodies

d. none of the above

14) Which is wrong about chronic bronchitis :

a. caused by air pollutants

b. may be manifested by wheezing

c. obstructive bronchitis manifest as blue bloaters

d. significant airway obstruction is almost always complicated by chronic bronchiolitis

Answers

15) True sentence that

• coal worker's pneumoconiosis is found in the upper lobes of the lung, so are silicosis

nodules

16) True sentence that

• Adenocarcinoma is the most common lung tumor

17) Wrong about emphysema

• usually in the lower lobes

D 13 C 9 A 5 B 1

D 14 C 10 B 6 B 2

- A 11 D 7 D 3

- C 12 C 8 C 4

18) Wrong about ARDS

• in most patients after acute phase, pulmonary function is restored in a year or two

19) Wrong about lung

• obstructive overinflation is due to complete obstruction of affected area

20) Wrong about bronchiectasis

• diagnosis is only through biopsy

21) Wrong about sarcoidosis

• subcutaneous nodules indicate acute sarcoidosis

22) Wrong about Pigeon Breeder’s lung disease

• predominant cell in bronchioalveolar lavage is neutrophil

23) Wrong restrictive lung disease

• hypersensitivity pneumonitis is caused by type I hypersensitivity

24) Temporal heterogeneity is found in

• idiopathic pulmonary fibrosis

25) Wrong about fibrosing lung diseases

• PMF is specific to coal-worker pneumoconiosis

26) Wrong about silicosis

• a definitive correlation with lung cancers is proven

27) Not a lung lesion caused by asbestosis

• visceral pleural plaques

28) Wrong about goodpasture disease

• only treatment is renal transplant (or lung can’t remember but both are wrong)

29) Wrong about pathogenesis of TB infection to a previously unexposed person

• first 3 weeks most patients are symptomatic

30) Wrong about secondary TB

• in an HIV patient with CD4 Cells count above 300/microL, they patient develops

primary progressive TB

31) An old, male, patient with suspicion of lung cancer. Biopsy showed cells with high

nuclear/cytoplasmic ratio, scanty cytoplasm and apoptotic bodies. Wrong about him

• he probably will develop hypercalcemia

32) Wrong about lung carcinoma

• adenocarcinoma usually begins centrally

33) True about bronchioalveolar carcinoma

• preservation of normal alveolar architecture

34) Incorrect about IPF:

• productive cough

35) Incorrect about chronic bronchitis:

• decreased number of goblet cells

36) Paraneoplastic syndrome:

• clubbing of the finger with 5cm adenocarcinoma

37) 60 years old smoker, central tumor:

• squamous cell carcinoma

38) PPD:

• tuberculin skin test

39) Small cell carcinoma :

• no keratin

40) wrong about Hypersensitivity pneumonitis:

• obstructive disease

41) Inhalation of coal without fibrosis:

• anthracosis

42) Which one is mismatched:

• coal worker pneumoconiosis and increased risk of lung cancer

43) ARDS which is wrong:

• major cause is surfactant deficiency

44) wrong about cryptogenic organizing pneumonia:

• only treatment is lung transplant

45) Which atelectasis is irreversible:

• irregular

46) Cystic fibrosis causes:

• bronchiectasis

47) Chronic bronchitis:

• airway obstruction early in the disease

48) Emphysema related to:

• smoking

49) Choose the wrong statement about pneumothorax:

• increase compliance

50) Not a cause of bronchiectasis :

• acute pneumonia

Explanation 50: Bronchiectasis is

secondary to persisting infection and

obstruction, the keyword here is acute,

the pneumonia has to be necrotizing or

suppurative in order to cause

bronchiectasis.

51) True about chronic bronchitis:

• IL13 & histamine .

52) Mismatch about asthma:

• drug (aspirin) induced asthma is caused by inhibition of lipoxygenase

53) Wrong about atelectasis:

• can be caused by obstructive emphysema

54) Wrong about NRDS & ARDS :

• numerous neutrophils

55) Most probably to have ARDS:

• the 16 boy with car accident etc .

Explanation 52: it is presumed that

aspirin inhibits the cyclooxygenase

pathway of arachidonic acid

metabolism without affecting the

lipoxygenase route

Explanation 53: atelectasis has many

causes including bronchial asthma,

chronic bronchitis, bronchiectasis, and

postoperative states. BUT obstructive

emphysema doesn’t cause atelectasis.

Explanation: in order to solve this question, you must

be familiar with definition of ARDS which states that,

“ARDS is respiratory failure occurring within 1 week

of a known clinical insult with bilateral opacities on

chest imaging not fully explained by effusion,

atelectasis, cardiac failure or fluid overload. It is graded

based on the severity of the changes in arterial blood

oxygen level”.

Explanation 51: IL13 and histamine

play an important role in the

pathogenesis of chronic bronchitis,

as they lead to mucus hyper

secretion.

Explanation: it’s false because in

NRDS there is a remarkable paucity

of neutrophilic inflammatory

reaction.

56) Wrong about emphysema -two choices are correct-:

• decrease in tidal volume, not quite sure but I believe because it is an obstructive

disease, and total lung capacity is normal in those diseases results in scarring,

because there is no fibrosis in emphysema.

57) ARDS, which is wrong

• result in hypoxemia that is susceptible to oxygen therapy with good prognosis .

58) Which is wrong:

• irregular emphysema result in severe complications

59) Which is wrong:

• protease anti-protease imbalance explains only panacinar emphysema

61) Which is wrong about bronchiectasis :

• result in reversible dilation .

62) Which is wrong:

• idiopathic pulmonary fibrosis appears under the microscope as desquamated

63) Which is wrong:

• resorption atelectasis is caused by partial obstruction of airway .

64) Which is wrong about pneumoconiosis

• particles less than 0.5 micrometer are the most dangerous ones

65) Which is wrong about silicosis :

• amorphous form is more toxic than crystalline form .

66) Which is wrong:

• hypersensitivity pneumonitis is marked by type I hypersensitivity reaction .

67) Which is wrong:

• 30% of the cases of pulmonary embolism end in pulmonary infarction

68) Which is wrong:

• primary pulmonary hypertension is more common than secondary one

69) which is wrong :

• idiopathic pulmonary hemosiderosis is associated with circulating antibodies against

basement membrane collagen

70) Which is wrong about community acquired acute pneumonia :

• alveolar spaces are reserved from inflammation

71) Which is wrong:

• peripheral involvement of the lung in small cell carcinoma

72) Which of the following is a wrong combination in paraneoplastic syndrome:

• cushing syndrome - squamous cell neoplasm .

73) Which is wrong ?

• Atypical pneumonia is associated with consolidation

74) Which is true about pulmonary HTN ?

• severe long standing disease leads to "plexogenic pulmonary fibrosis "

73) Female, plexiform, mother dies:

• mutation BMPR2

74) Non smoker, thromosis, peripheral primary cancer:

• adenocarcinoma

75) Paraneoplastic hypercalcemia:

• squamous cell carcinoma

76) Isn’t a cause of secondary pulmonary hypertension:

• compression atelectasis

77) Choose the wrong statement:

• asbestos and smoking more chance of mesothelioma

78) Choose the wrong statement:

• No need for subdivision of NSCC into adenocarcinoma and squamous cell carcinoma

79) Good pasture syndrome wrong:

• Immunoglobulins "granular "

80) All are diseases of lower lobes except:

• silicosis

81) Wrong about male with CD4

89) Both pleural and peritoneal mesothelioma are caused by asbestosis.

90) No asbestos bodies in pleural plaque.

Pathology Lab

1) These clear structures represent:

• ARDS

2) True about this pathological section :

a. Diagnosed by exclusion

b. Macroscopic shows cobblestones appearance

c. Caused mainly by occupational hazard

d. You can’t know the origin of the disease

Answer: d

3) This section shows:

a. severe restrictive abnormality

b. moderate restrictive abnormality

c. mild restrictive abnormality

d. mild eosinophilia

Answer: c

4) Smoker for 15 years, choose the right answer about this

case

• Something about squamous cell carcinoma

نّ اللهّم بلوغ الهناايت. ،عوذ بك من فتور الهِمة و ضياع املقاصدن اللهّم ا

Good Luck!!