Question 1

What could be the diagnosis if the electrocardiogram shows no sinus origin rhythm associated with 'P' waves presenting as F waves with a characteristic saw-tooth pattern, and a T wave dominated by an atrial wave?
A)Atrial fibrillation
B)Atrial flutter
C)Sinu atrial exit block
D)Sinus arrest

Accepted Answer

In Atrial flutter, the electrocardiogram shows no sinus origin rhythm, P' waves are present as 'F' waves with a characteristic saw-tooth pattern, and the T wave is dominated by an atrial wave.
In sinus arrest, the ECG shows the sinus rhythm, long pauses, 3 or more beats missing, P waves followed by a QRS complex.
In Sinu atrial exit block, the ECG shows sinus rhythm, occasional pause, one whole complex missing, P waves usually followed by QRS complex.
In atrial fibrillation, the ECG shows no sinus rhythm, P waves absent, F waves absent or replaced by wavy /flat baseline. There will be an irregular rhythm present.

Question 2

Based on the blood gas analysis, which group of values in the choices below may indicate that the patient has a chronic carbon dioxide retention?
A)Pco2 55 mmHg , pH 7.25
B)Pco2 55 mmHg , pH 7.32, Base excess +3
C)Pco2 55 mmHg , pH 7.35
D)None of the above

Accepted Answer

Blood gas values Pco2 55 mmHg, pH 7.35 may indicate that the patient has chronic carbon dioxide retention.
The pH level is key in determining the stage as acute or chronic. If the pH is not in the normal range of 7.35 - 7.45, then the patient is in an acute stage. Option A is an acute stage.
As the pH progresses back to normal with the base excess, then the patient is partially compensating as given in option B.
If the pH falls within the normal level as in option C, i.e., Pco2 55 mmHg, pH 7.35, which indicates that the patient is in the chronic stage.

Question 3

Which is the most definitive test used to detect pulmonary embolism?
A)Ultrasound
B)Pulmonary angiogram
C)Ventilation perfusion scan
D)Positive emission tomography

Accepted Answer

Pulmonary angiogram is the most definitive test used to detect pulmonary embolism.
Pulmonary angiogram is an invasive test that involves injection of dye into the arterial vasculature. It must be carried out in the catheterization laboratory under a sterile environment.
Ultrasound is commonly used to find the pockets of fluid during thoracocentesis. The ultrasound waves are bounced off by the bones of the thoracic cavity so it is not very useful in the thoracic region.
Ventilation perfusion scan is the primary test used to detect pulmonary embolism. However, research has found that this scan can give indeterminate results.
Positron emission tomography also shows the function of the organs rather than just their structure. It is commonly used to detect the viable cardiac muscle.

Question 4

Which cardiac injury enzyme is a more sensitive indicator of myocardial infarction?
A)Creatine kinase
B)Aspertate aminotransferase
C)LDH1
D)Total LDH

Accepted Answer

LDH1 is the more sensitive indicator of myocardial infarction.
LDH1 is an isoenzyme of LDH which is the more sensitive indicator than the total LDH.
Creatine kinase starts rising at 4 - 6 hours and peaks at 12 hours and then falls back normal within 48 to 72 hours.
Aspertateaminotransferate rises at 12 hours and peaks at the first and the second day.
Total LDH rises after 12 hours and peaks after 2 -3 days, and remains elevated for a week.

Question 5

In an acute asthmatic attack, which one of the following results is NOT expected in the lung function test?
A)Increased total lung capacity
B)Increased peak expiratory flow rate
C)Reduced vital capacity
D)Reduced FEV1/VC

Accepted Answer

Increased peak expiratory flow rate cannot be expected in lung function test of an acute asthma attack.
In acute asthma there is narrowing of airways with bronchospasm, mucosal edema, inflammation and mucous plugging of small airways. These changes results in reduced peak expiratory flow-rate, reduced FEV1 / VC and MEFV. Airway resistance increases. The tendency of the narrowed airways to close even during tidal expiration results in increase in FRC and RV. Total lung capacity is increased due to air being trapped behind closed airways.

Question 6

Of the following, what is the common cause of primary lymphedema?
A)Infection
B)Inflammation
C)Trauma
D)None of the above

Accepted Answer

None of the above. The common cause of primary lymphedema is none of the above.
Primary lymphedema is not associated with any underlying disease process or intrinsic abnormalities.
Secondary lymphedema is associated with infection, inflammation, trauma, malignancy, and underlying venous disease.

Question 7

In aortic regurgitation, what does the Hill's sign refer to?
A)Prominent carotid pulsation in neck
B)Popliteal cuff systolic pressure exceeding the brachial cuff systolic pressure
C)To and from movement of head synchronized with cardiac cycle
D)Booming systolic and diastolic sounds heard over the femoral artery

Accepted Answer

In aortic regurgitation the Hill's sign refers to popliteal cuff systolic pressure exceeding the brachial cuff systolic pressure.
Hill's sign is a peripheral sign of aortic regurgitation. The other options are also peripheral signs of aortic regurgitation.
Prominent carotid pulsations are known as Corrigan's neck sign.
To and fro movement of head synchronized with cardiac cycle is referred as De - Musset's sign.
Booming systolic and diastolic sounds heard over the femoral artery is Traube's sign.

Question 8

A 35-year-old male presents with fever, and cough which is chronic and worse in the mornings. He expectorates copious, purulent, foul- smelling sputum which is three layered. The chest X-ray shows a honey-comb appearance. What can be the diagnosis?
A)Asthma
B)Chronic bronchitis
C)Tuberculosis
D)Bronchiectasis

Accepted Answer

Bronchiectasis can be the diagnosis for the 35-year-old male having fever, cough which is chronic and worse in mornings, and expectorating copious , purulent, foul-smelling sputum which is three layered along with an X-ray showing honey-comb appearance.
Bronchiectasis is defined as a permanent abnormal dilatation of one or more bronchi, due to elastic and muscular components of bronchial wall. The hall mark of brochiectasis is chronic cough with sputum production. Cough is worse in the mornings and brought on by postural changes. Sputum is characteristically copious, purulent, and foul-smelling. Honey comb appearance in the chest x ray occurs in saccular bronchiectasis.
The other options of bronchitis and tuberculosis are also characterized by cough but the expectoration is not usually purulent and foul-smelling. Asthma is characterized by the presence of a wheeze. In addition, the chest X ray findings do not show honey-comb appearance in other conditions.
Chronic bronchitis (blue bloaters) is the inflammation of the bronchial tree secreting excessive mucous.
Asthma is the chronic inflammatory respiratory disease in which there is constriction of the airways and production of extra mucus.
Tuberculosis is bacterial infection of the lungs caused by bacteria known as mycobacterium tuberculosis. The bacteria spread through airborne particles, which are inhaled deep into the lungs.

Question 9

Which is a differentiating feature between pleural effusion and hydropneumothorax?
A)Pain
B)Dyspnea
C)Percussion note
D)Chest expansion reduction

Accepted Answer

Percussion note is a differentiating feature between pleural effusion and hydropneumothorax.
In the case of pleural effusion, there will be a stony, dull percussion note. Whereas in hydropneumothorax, the upper will be hyperresonant and lower part of lung will show a stony, dull note.
Pain, dyspnea, and reduced chest expansion are common for both conditions.

Question 10

A 30-year-old female has a history of repeated attacks of spontaneous pneumothorax on the right side. It occurs 48-hours after the onset of menstruation. What can be the diagnosis?
A)Recurrent spontaneous pneumothorax
B)Catamenial pneumothorax
C)Valvular pneumothorax
D)Clicking pneumothorax

Accepted Answer

Catamenial pneumothorax
Catamenial pneumothorax is a rare condition occurring in women over 25 - 30 years old. Usually spontaneous pneumothorax occurs repeatedly on the right side. Attacks usually occur within 48-hours of the onset of menstruation. It may be due to endometrial cysts attached to thoracic region which releases blood and collapses the lung.
Recurrent spontaneous pneumothorax occurs commonly in patients with emphysematous bullae.
Valvular pneumothorax occurs due to persistence of communication between pleura and lung. It acts as a valve and allows air to enter only in pleura but does not allow it to escape.
Clicking pneumothorax occurs on the left side and may be localized in front of the pericardium. This may make the heart sound louder.

Question 11

Which of the following is NOT the usual side effect of salbutamol?
A)Anxiety
B)Nervousness
C)Insomnia
D)Dysrhythmias

Accepted Answer

Dysrhythmias are not the usual side effects of salbutamol.
Salbutamol is a beta-2 selective drug. The medication that has an affinity for binding to beta-1 receptors will affect cardiac function. Beta-2 adrenergic stimulation causes bronchodilation and will have primary effect on the lungs.

Question 12

Which is the drug of choice for acute asthma?
A)Fluticasone
B)Salmeterol
C)Albuterol
D)Omeprazole

Accepted Answer

Albuterolis the drug of choice for acute asthma.
Albuterol (Ventolin, Proventil) is a bronchodilator, and a short-acting beta agonist. It is the drug of choice for acute asthma.
Asthma is a chronic inflammatory respiratory disease in which there is constriction of the airways and production of extra mucus. Anti-asthmatic drugs will decrease swelling, mucous production in the lungs, and relax muscles.
Salmeterol (Serevent) is a long-acting bronchodilator which relieves asthma symptoms for a long period of time.
Fluticasone (Flovent) is a corticosteroid. It is used for long-term asthma attacks.
Omeprazole (Prilosec) is used to treat gastro esophageal reflux disease (GERD) and other conditions caused by the increase in stomach acids. It acts by suppressing the proton pump action in the stomach. (Proton pumps are hydrogen potassium ATPase or H+ /K+ ATPase which are found at the gastric parietal cells. This enzyme system is regarded as the acid pump within the gastric mucosa).

Question 13

Which one of the following oxygen delivery systems is a high-flow system?
A)Nasal prongs
B)Transtracheal oxygen catheter
C)Venturi mask
D)Partial rebreathing mask

Accepted Answer

Venturi mask is the high-flow oxygen delivery system.
If a patient requires the oxygen to be delivered at FiO2 of 50 % to keep the safe oxygen saturation level, then the high-flow system is used. Venturi mask is the commonly used high-flow system. It provides 24% - 50% oxygen concentration.
Other options are low-flow oxygen delivery systems.
Nasal prongs are commonly used in low-flow oxygen delivery systems. Oxygen flow rate is from 1 liter to 6 liter/ min.

Question 14

Which muscle is affected in the vertical approach of median sternotomy?
A)External intercostals
B)Internal intercostals
C)Pectoralis major
D)Trapezius

Accepted Answer

Pectoralis major muscle is affected in the vertical approach of median sternotomy.
The pectoralis major muscle is affected because of the incision through the pre-sternal aponeurosis.
The external and internal intercostals are affected in a transverse approach.
The lower fibers of trapezius are affected in a posterolateral incision.

Question 15

In which congenital condition does the scapula fail to descend from its embryological position in the neck?
A)Sprengel's shoulder
B)Madelung's deformity
C)Syndactilism
D)Polydactylism

Accepted Answer

Sprengel's shoulder is a congenital condition in which the scapula fails to descend from its embryological position in the neck.
In Sprengel's shoulder the patient will have an elevated shoulder on the affected side. The superior angle of the scapula can be felt in the neck.
Madelung's deformity is the congenital dorsal and lateral bowing of distal radius and subluxation of inferior radioulnar joint.
Syndactilism is the congenital fusion of fingers.
Polydactylism is the congenital presence of extra fingers.

Question 16

What is the infection at the hip joint that is spread by a septic umbilicus called?
A)Tom Smith's arthritis
B)Osteomyelitis
C)Small pox arthritis
D)Cultton's joint

Accepted Answer

Septic infection at the hip joint spread by septic umbilicus is known as Tom Smith's arthritis.
Septic arthritis in infancy is called Tom Smith's arthritis. The condition presents with high fever and swelling in the hip region. An X-ray and ultrasound are helpful in diagnosis. In the acute stage, it is treated by aspiration and antibiotic instillation.
Osteomyelitis is the inflammation of bone and bone marrow.
Small pox arthritis occurs after an episode of small pox infection.
Due to congenital syphilis in children, sometimes bilateral serous synovitis of knee joints occurs. This condition is usually painless with marked knee effusion. It is known as Cultton's joints.

Question 17

What is the cause of primary osteoporosis?
A)Prolonged use of corticosteroids
B)Hypercorticism
C)Aging
D)Malignancy

Accepted Answer

Aging is the cause of primary osteoporosis.
Primary osteoporosis is also called senile osteoporosis. It is related to aging and decreased gonodal hormones. Due to the sedentary life style in old age, there is diminished muscle stress and diet fat that leads to demineralization of bone.
Prolonged use of corticosteroids, hypercorticism, and malignancy causes secondary osteoporosis (indirect causes that affect bone).

Question 18

What is rickety rosary?
A)Persistent fontenellae, even after 2 years of age
B)Beading at the costochondral junction
C)Groove-like deformity in the lower chest
D)Protuberant abdomen

Accepted Answer

Beading at the costochondral junction is called rickety rosary.
Rickets is commonly caused by vitamin D deficiency in children below 4 years of age. Multiple musculoskeletal changes occur in this condition including pigeon chest deformity, and presence of beading at the costochondral junction called rickety rosary.
Failure of the closure of frontenellae, even after 2 years of age, gives the "hot cross bun appearance" (craniotabes) along with the parietal and frontal bossing.
Groove-like deformity in the lower chest is called Harrison's sulcus.

Question 19

According to the American Rheumatism Association, which of the following is NOT the essential criteria in the diagnosis of rheumatoid arthritis>
A)Morning stiffness
B)Pain in one joint
C)Swelling in one joint for 6 weeks
D)Asymmetrical joint involvement

Accepted Answer

Asymmetrical joint involvement is not an essential criteria for the diagnosis of rheumatoid arthritis.
There should be symmetrical joint involvement in rheumatoid arthritis.
The other features include swelling in other joints within 3 months, a positive agglutination test, subcutaneous nodules, and typical X-ray changes.

Question 20

Which factor is responsible for ankylosing spondylitis?
A)IgM
B)HLA- B27
C)Both A. and B.

Accepted Answer

HLA - B27 factor is responsible for ankylosing spondylitis.
Ankylosing spondylitis is a chronic, progressive, crippling disease affecting the spine. There should be a strong genetic association for this condition. Commonly HLA - B27 factors are more prone for contracting the disease. In lab testing, this factor will be positive.
IgM is a rheumatic factor which is positive in rheumatoid arthritis.

Quiz 2: Diseases and Conditions

What could be the diagnosis if the electrocardiogram shows no sinus origin rhythm associated with 'P' waves presenting as F waves with a characteristic saw-tooth pattern, and a T wave dominated by an atrial wave?

Based on the blood gas analysis, which group of values in the choices below may indicate that the patient has a chronic carbon dioxide retention?

Which is the most definitive test used to detect pulmonary embolism?

Which cardiac injury enzyme is a more sensitive indicator of myocardial infarction?

In an acute asthmatic attack, which one of the following results is NOT expected in the lung function test?

Of the following, what is the common cause of primary lymphedema?

In aortic regurgitation, what does the Hill's sign refer to?

A 35-year-old male presents with fever, and cough which is chronic and worse in the mornings. He expectorates copious, purulent, foul- smelling sputum which is three layered. The chest X-ray shows a honey-comb appearance. What can be the diagnosis?

Which is a differentiating feature between pleural effusion and hydropneumothorax?

A 30-year-old female has a history of repeated attacks of spontaneous pneumothorax on the right side. It occurs 48-hours after the onset of menstruation. What can be the diagnosis?

Which of the following is NOT the usual side effect of salbutamol?

Which is the drug of choice for acute asthma?

Which one of the following oxygen delivery systems is a high-flow system?

Which muscle is affected in the vertical approach of median sternotomy?

In which congenital condition does the scapula fail to descend from its embryological position in the neck?

What is the infection at the hip joint that is spread by a septic umbilicus called?

What is the cause of primary osteoporosis?

What is rickety rosary?

According to the American Rheumatism Association, which of the following is NOT the essential criteria in the diagnosis of rheumatoid arthritis>

Which factor is responsible for ankylosing spondylitis?