Medicine

1. GP & Respiratory solve
class
Dr. Farzana Yasmin

2. 1. Following substances can cause
inhibition of Na-k ATPase pump
a. Insulin
b. Thyroxin
c. Hypoxia
d. Ouabin
e. Aldosterone

4. 1. Following substances can cause
inhibition of Na-k ATPase pump
a. Insulin
b. Thyroxin
c. Hypoxia
d. Ouabin
e. Aldosterone
FFTTF

5. 2. Positive stimulus for homeostasis are
a) Blood clothing
b) Regulation of CO2 in ECF
c) Child birth
d) Generation of nerve signals
e) Regulation of BP

7. 2. Positive stimulus for homeostasis are
(positive feedback for homeostasis)
a) Blood clothing
b) Regulation of CO2 in ECF
c) Child birth
d) Generation of nerve signals
e) Regulation of BP
TFTTF

8. 3. The example of Primary active transport are
a) Na+ -K+ pump in cell membrane
b) Na+ -H+ exchange in DCT cells
c) CI –HCO3 exchange in RBC membrane
d) Na+ linked glucose uptake by enterocycle
e) Na+ -K+ leaking in cell membrane

11. 3. The example of Primary active transport are
a) Na+ -K+ pump in cell membrane
b) Na+ -H+ exchange in DCT cells
c) CI –HCO3 exchange in RBC membrane
d) Na+ linked glucose uptake by enterocycle
e) Na+ -K+ leaking in cell membrane
TFFFF

12. 4. The organelles which incorporate
a unite membrane
a) Actin
b) Golgi apparatus
c) Lysosome
d) Nuclear envelop
e) Ribosome

14. 4. The organelles which in corporal as a unite membrane
a) Actin
b) Golgi apparatus
c) Lysosome
d) Nuclear envelop
e) Ribosome
FTTFF

15. 5. Na-K pump is significantly present
in
a) Brain
b) Kidney
c) Liver
d) Muscle
e) Neuron

16. 5. Na-K pump is significantly present in
a) Brain
b) Kidney
c) Liver
d) Muscle
e) Neuron
TFFTT

17. 6. In Which disease broncho-pulmonary segment rules are
not applicable
a. Pneumonia
b. TB
c. Malignancy
d. Lung abcess
e. Bronchiectasis

18. 6. In Which disease broncho-pulmonary segment rules are
not applicable
a. Pneumonia
b. TB
c. Malignancy
d. Lung abcess
e. Bronchiectasis
FTTFF

19. 7. Following statements are true for the blood supply of the
lung
a. Rt lung is supplied by 2 bronchial artery
b. Left lung is supplied by 1 bronchial artery
c. Rt bronchial artery is the branch of the decending
thoracic aorta
d. Rt bronchial vein drain into azygos vein
e. Lt bronchial vein drains into hemiazygos vein

22. 7. Following statements are true for the blood supply of the
lung
a. Rt lung is supplied by 2 bronchial artery
b. Left lung is supplied by 1 bronchial artery
c. Rt bronchial artery is the branch of the descending
thoracic aorta
d. Rt bronchial vein drain into azygos vein
e. Lt bronchial vein drains into hemiazygos vein
FFFTT

23. 8. Among all the pneumocytes which one is most abundant
in the lung alveoli
a) Type I cells
b) Type II cells
c) Alveolar macrophage
d) Goblet cell
e) Brush cell

24. Q. Which is the most abundant cell in the surface epithelium?
Ans: Type-I pneumocyte 40%
Q. which is the most abundant cell in the alveoli?
Ans: Type-II Pneumocyte (60% of the total cell)

25. 8. Among all the pneumocytes which one is most abundant
in the lung alveoli
a) Type I cells
b) Type II cells
c) Alveolar macrophage
d) Goblet cell
e) Brush cell
FTFFF

26. 9. Muscles helps in both inspiration & expiration
a) Scaleni
b) Sternocleidomastoid
c) Intercostal
d) Latissimus darsi
e) Serratus posterior

27. A. Inspiration
In quite inspiration
 The diaphragm (75%)
 External intercostal muscle
In forceful inspiration:
The above muscles+ additional muscles:
 Sternocleidomastoid muscles
 Scaleni
 Anterior serrati
 Scalenus posterior
 Latissimus dorsi muscle
B. Expiration:
1. In quite expiration: Does not involve any muscle
2. In forceful expiration: (Additional muscles)
 Rectus abdominis
 Internal intercostal
 Serratus posterior inferior muscle
Muscles common in both inspiration and expiration:
1. Intercostal
2. Serratus posterior

28. 9. Muscles helps in both inspiration & expiration
a) Scaleni
b) Sternocleidomastoid
c) Intercostal
d) Latissimus darsi
e) Serratus posterior
FFTFT

29. 10. Biologically active substance synthesized & used in lungs
a) Serotonin
b) Acetylcholine
c) VIP
d) Surfactant
e) Bradykinin

30. Biologically Active substances Metabolized by the lungs.
Synthesized and used in the lung
Surfactant
Synthesized or stored and released into the blood
Prostaglandins
Histamine
Kallikrein
Partially removed from the blood
Prostaglandins
Bradykinin
Adenine nucleotides
Serotonin
Norepinephrine
Acetylcholine
Activated in the lungs
Angiotensin I
Angiotensin II

31. 10. Biologically active substance synthesized & used in lungs
a) Serotonin
b) Acetylcholine
c) VIP
d) Surfactant
e) Bradykinin
FFFTF

32. 11. Hemodynamic effects of respiration
a) Increase JVP during expiration
b) Increase BP during inspiration
c) Increase HR during inspiration
d) Increase Venous return during inspiration
e) Increase Ejection fraction during expiration

33. Inspiration Expiration
JVP Falls Rises
BP Falls Rises
HR Accelerates Slows
Second Heart sound Splits fuses

34. 11. Hemodynamic effects of respiration
a) Increase JVP during expiration
b) Increase BP during inspiration
c) Increase HR during inspiration
d) Increase Venous return during inspiration
e) Increase Ejection fraction during expiration
TFTTT

35. 12. During normal quiet breathing
a) Intraplural pressure lowest at the end of inspiration
b) Intra esophageal pressure lowest at the end of inspiration
c) Intra pulmonary pressure lowest at mid inspiration
d) Rate of air flow greatest in the end of inspiration
e) At mid expiration intra alveolar pressure Lowest

37. During Inspiration:
1. There is a fall of intra thoracic pressure
2. Promotion of venous flow into the chest
3 There is an increase in the flow of blood through the Rt
heart
4. There is sequestration of a substantial volume of blood
in the chest as the lungs expand
5. There is an increase in the capcitance of the pulm
vascular bed
6. There is reduction in the flow of blood into the left heart
During Expiration:
1) there is a fall in venous return to the Rt heart
2) There is reduction in output from Rt heart
3) Blood is squeezed out of the lungs
4) There is a rise in the venous return to the left heart
5) There is a rise in the output of left heart.

38. 12. During normal quite breathing
a) Intrapleural pressure lowest at the end of inspiration
b) Intra esophageal pressure lowest at the end of inspiration
c) Intra pulmonary pressure lowest at mid inspiration
d) Rate of air flow greatest in the end of inspiration
e) At mid expiration intra alveolar pressure Lowest
TTTFF

39. 13. Spirometer can not be used to measure
a) FRC
b) RV
c) VC
d) IRV
e) Closing volumes

40. Types Definition Normal value
tidal volume (TV) It is volume of air inspired or expired with
each normal breath
500ml
Inspiratory reserve volume
(IRV)
It is the maximum extra volume of air that
can be inspired forcefully after completing
a normal tidal inspiration
3000ml
Expiratory reserve volume
(ERV)
It is the maximum extra volume of air that
can be expired by forceful expiration after
the end of a normal tidal expiration
1100ml
Residual volume (RV) It is volume of air remaining in the lungs
after the most forceful expiration
1200ml

41. Lung capacities
1. Inspiratory capacity (IC= TV + IRV)-3500 ml
2. Functional residual capacity (FRC=ERV+RV)-2300 ml
3. Vital capacity (VC=IRV+TV+ERV)-4600 ml
4. Total lung capacity (TLC=VC+RV)-5800 ml

42. Spirometer Can’t measure:
 Residual volume
 So, TLC= VC+RV, can’t measure TLC
 So, FRC=ERV + RV, can’t measure FRC
 Closed Volume

43. 13. Spirometer can not be used to measure
a) FRC
b) RV
c) VC
d) IRV
e) Closing volumes
TTFFT

44. 14. Following are true for the function of surfactant
a. Decreases 90% of the surface tension
b. Helps to maintain the lung patency
c. Its deficiency causes Hyaline membrane disease
d. Maintain the size of the alveoli
e. Increases net filtration pressure

45. 1. Dipalmitoyl lecithin of surfactant decreases the surface
tension of the fluid lining the alveoli, thus prevents the
collapsing of the lungs during expiration.
2. It helps in the expansion of lungs of new born babies.
3. It increases compliance & stability of the lung.
4. It stabilizes the size of alveoli.
5. It prevents the pulmonary edema by reducing pulmonary
capillary filtration.
6. It has some bactericidal effects.

46. 14. Following are true for the function of surfactant
a. Decreases 90% of the surface tension
b. Helps to maintain the lung patency
c. Its deficiency causes Hyaline membrane disease
d. Maintain the size of the alveoli
e. Increases net filtration pressure
FTTTF
respiratory distress syndrome (RDS

47. 15. In older people there is a decreased in
a) Lung elasticity
b) RV
c) VC
d) Closing volumes
e) FEV1

48. Lung compliance:
 Old> Adult>Infant
 Greater In standing than recombinant subject
 Greater than compliance of lung thorax
 Max at tidal volume
In obstructive lung disease >Restrictive Lung di

49. 15. In older people there is a decrease in
a) Lung elasticity
b) RV
c) VC
d) Closing volumes
e) FEV1
TFTFT

50. 16. The compliance of the lungs is greater
a) In obstructive lungs D. than restrictive lung D.
b) In restrictive lung D. than normal person
c) In a part of the lungs than base
d) Then the compliance of the lungs & thorax together
e) In old age than adult

51. Lung compliance:
 Old> Adult>Infant
 Greater In standing than recombinant subject
 Greater than compliance of lung thorax
 Max at tidal volume
In obstructive lung disease >Restrictive Lung disease

52. 16. The compliance of the lungs is greater
a) In obstructive lungs D. than restrictive lung D.
b) In restrictive lung D. than normal person
c) In a part of the lungs than base
d) Then the compliance of the lungs & thorax together
e) In old age than adult
TFFTT

53. 17. Following are true for pulmonary circulation
a. High pressure circulation
b. High flow circulation
c. High compliance
d. Low pressure circulation
e. Low flow circulation

54. Peculiarities of pulmonary circulation:
 Pulmonary arteries carry CO2 containing blood, whereas, whereas, pulmonary veins carry O2 containing blood.
 The pulmonary vascular bed resembles the systemic except that the walls of the pulmonary artery and its large
branches are about 30% thick as the wall of the aorta. and the small arterial vessels, unlike systemic arterioles,
are endothelial tubes with relatively little muscle in their walls.
 The blood put out by the left ventricle returns to the right atrium and is ejected by the right ventricle, making the
pulmonary vasculature unique in that it accommodates a blood flow that is almost equal to that of all the other
organs in the body.
 The entire pulmonary vasculature system is a distensible low-pressure system. The pulmonary arterial pressure is
about 24/9 mm Hg. and the mean pressure is about 15 mm Hg.
 The volume of blood in the pulmonary vessels at any one time is about 1 L of which less than 100 ml is in the
capillaries.
 The mean velocity of the blood in the root of the pulmonary artery is the same as that in the aorta (about 40 cm/s)
 Pulmonary capillary pressure is about 10 mm Hg. whereas the oncotic pressure is 25 mm Hg, so that there is an
inward directed pressure gradient of about 15 mm Hg which keeps the alveoli free of fluid.
 The ratio of pulmonary ventilation to pulmonary blood flow for the whole lung at rest is about 0.8 (4.2 L/ min
ventilation divided by 5.5 L/min blood flow)

55. Peculiarities of RBF with their importance:
1. It is a portal system containing-
 Glomerular capillary- It designed for filtration of plasma. It is a high pressure capillary be. Hydrostatic pressure in glomerular
capillary is very high: 60mm of Hg.
Importance: Hydrostatic pressure facilitates the filtration of blood.
 Peritubular capillary- It is designed for the reabsorption of desirable substances from the filtrate.
2. Kidney has a high pressure capillary bed:
3. Rate of blood flow is very high (3.5-4ml/gm/min).
Importance: The helps to clear the waste products very rapidly.
4. Blood flow is selective, not uniform: It is 90%-95% in cortex and 5-10% in medulla. Maximum, about
100% glomerular capillary lies in cortex. So blood flow in cortex is very high.
Importance:
 High blood flow in cortex ensures the filtration.
 Less blood flow in medulla ensures the concentrated urine formation.
5. Auto regulation of RBF by kidney itself
6. Renal blood flow is not altered in denervated or innervated kidney.
7. Presence of vasa recta: In the vasa recta velocity of blood flow is very slow & direction
of blood flow is antiparallel.

56. T F F T T
33. Renal artery
a) Direct branch of abdominal aorta
b) Blood flow is very selective and uniform
c) Dennervated and innervated kidney has same
blood supply
d) Velocity of blood flow is very slow in vasarecta
e) Has portal system

57. 17. Following are true for pulmonary circulation
a. High pressure circulation
b. High flow circulation
c. High compliance
d. Low pressure circulation
e. Low flow circulation
FFTTT

58. 18. Compare with the base the apex of the upright human
lungs has
a) Larger alveoli
b) More compliance
c) More ventilation
d) More negative intra pleural pressure
e) More PO2

60. Apex Base
Blood flow Lowest Highest
Ventilation (V) Lower Higher
Perfusion Lower Higher
V, Q V> Q V<Q
V/Q Highest lowest
PO2 Highest (↑) Lower (↓)
PCO2 Lower (↓↓) Higher (↑)
Gas exchange More Less
Alveolar size Larger Smaller

61. 18. Compare with the base the apex of the upright human
lungs has
a) Larger alveoli
b) More compliance
c) More ventilation
d) More negative intra pleural pressure
e) More PO2
TFFTT

62. 19. Compared to obstructive lung disease a case of
restrictive lung disease has lower
a) RV
b) FEV1
c) FEV1/FVC ratio
d) FRC
e) Compliance of the lungs

63. Patterns of respiratory function abnormalities in diseases
Obstructive lung disease Restrictive lung
disease
Asthma Chronic bronchitis Emphysema Pulmonary fibrosis
FEVI ↓↓ ↓↓ ↓↓ ↓
Vital capacity (VC) ↓ ↓ ↓ ↓↓
FEVI/VC ↓ ↓ ↓ →/↑
TLco → → ↓↓ ↓↓
Kco →/↓ → ↓ →/↑
Total lung capacity (TLC) →/↑ ↑ ↑↑ ↓
Residual volume (RV) →/↑ ↑ ↑↑ ↓

64. 19. Compared to obstructive lung disease a case of
restrictive lung disease has lower
a) RV
b) FEV1
c) FEV1/FVC ratio
d) FRC
e) Compliance of the lungs
TTFTT

65. 20. During exercise following event occurs
a) ↑Rate & depth of respiration
b) ↑Pulmonary blood flow
c) ↓O2 consumption
d) ↓Arterial PO2
e) ↓Arterial PH

66. 66
HR,FOC ,CO: Increased Increased
Stroke volume : Little change Marked increased
Systolic pressure : Increased sharply Increased moderately
DP: Increased sharply Unchanged or fall
MAP: Increased sharply Does not usually change
PP: Normal PP: Increased
Anaerobic metabolism Aerobic metabolism
BF to contracted muscle: Reduce Does Not reduced

67. Explanation:
Just Remember:
 During Exercise all things increases except
 PO2
 PCO2
 Arterial pH

68. 20. During exercise following event occurs
a) ↑Rate & depth of respiration
b) ↑Pulmonary blood flow
c) ↓O2 consumption
d) ↓Arterial PO2
e) ↓Arterial PH
TTTFF

69. 21. Diffusion of the gases through respiratory membrane is
directly proportional to
a. Molecular weight
b. Thickness of the membrane
c. Diffusion co-efficiant
d. Solubility of the gas
e. Surface area

70. Factors affecting diffusion of gas through res. membrane:
Directly Proportional
 Surface Area
 Diffusion Co efficient
 Solubility of the gas
Inversely Proportional
 Thickness of the membrane
 Molecular Wt

71. 21. Diffusion of the gases through repiratory membrane is
directly proportional to
a. Molecular weight
b. Thickness of the membrane
c. Diffusion co-efficiant
d. Solubility of the gas
e. Surface area
FFTTT

72. 22. Factors affecting vital capacity.
a. Its more in older age
b. More in female than male
c. Directly proportional with the surface area
d. More In case of kyphosis
e. It is increased during pregnancy

73. 1. Age: It is more in young due to increased muscular strength.
2. Sex: It is 10 % less in case of female due to
• Short thoracic cage
• Less surface area
• Less muscular activity.
Posture: It is more in erect posture than in lying posture due to
• Intra-abdominal pressure
• Pulmonary vascular blood volume.
4. Surface area: Vital capacity is proportional to surface area. It is usually 2.6L /m' surface area in male and | 2.1 L/m' in female.
5. Anatomical built of chest: Vital capacity decreases in some thoracic cage deformities such as
• Pigeon chest.
• Kyphosis: forward bending of vertebral column.
6. Disease of lungs & pleura: Diseased condition of lungs & pleura decreases the vital capacity
(i.e. Emphysema, Poliomyelitis, Respiratory obstruction, oedema)
7. Paralysis of respiratory muscles: Vital capacity is decreased as low as 500-1000 ml in such condition.
8. Congestive left heart failure: It causes pulmonary vascular congestion & oedema which then decreases lung compliance and
subsequently vital capacity.
9. It is reduced in pregnancy & ascites
10. It is increased in swimmers & divers.

74. 22. Factors affecting vital capacity.
a. Its more in older age
b. More in female than male
c. Directly proportional with the surface area
d. More In case of kyphosis
e. It is increased during pregnancy
FFTFF

75. 23. Following are lung function test
a. Spirometry
b. Arterial blood gas analysis
c. Exercise test
d. PEFR
e. Shuttle walk test

76. Lung function tests:
Spirometry
 forced expiratory volume during the first second (PEV)
 forced vital capacity (FVC)
 FEV1/FVC
Lung volume
 Body plethysmography
 Diffusing capacity of the lungs for carbon
 Arterial capacity of the lungs for carbon carbon
 Exercise blood gas analysis (ABG) & Oximetry
Exercise test:
 6-minute walk test
 shuttle walk test
 cardio pulmonary exercise test
 Peak expiratory flow rate (PEFR)
 Maximum inspiratory pressure and maximum expiratory
pressure.

77. 23. Following are lung function test
a. Spirometry
b. Arterial blood gas analysis
c. Exercise test
d. PEFR
e. Shuttle walk test
TTTTT

78. 24. O2-Hb dissociation curve is shifted to the right
a. Fall of P50
b. Exercise
c. Increase Temp
d. Higher Ph
e. Systemic circulation

79. Shifts to Right = Raised oxygen
delivery
Shifts to Left = Lower oxygen
delivery
 Raised [H+] (acidity)
 Raised PCO2
 Raised 2,3-DPG
 Raised temperature
 Low [H+] (alkali)
 Low PCO2
 Low 2,3-DPG
 Low temperature
 HbF, methemoglobin,
carboxyhaemoglobin

80. O2- Hb dissociation curve
Factors shifting the curve to right Factors shifting the curve to left
 ↑H+ or ↓pH  ↓H+ or ↑ pH
 ↑PCO2  ↓ PCO2
 ↑Temperature  ↓ Temperature
 ↑2,3 DPG  ↓2,3 DPG
 HbS  HbF (fetal Hb)
 ↑PO2  Fall of P50
 Hypoxia  ↓PO2
 Exercise  CO poisoning
 Thyrotoxicosis  HbF
 Polycythemia
 High altitude

81. Tips to Remember:
 Just remember 1 line
“the curve will shift to right if the factors increase including
all anemia except Thalassemia “
 As example
 Increase temp; the curve shifts to Right
 But there is an exception that is pH.
 Increase pH shifts the curve to Left.

82. 24. O2-Hb dissociation curve is shifted to the right
a. Fall of P50
b. Exercise
c. Increase Temp
d. Higher Ph
e. Systemic circulation
FTTFT

83. 25. O2-Hb dissociation curve is shifted to the left
a. Systemic circulation
b. Thallasemia
c. Stored blood
d. Pulmonary circulation
e. Decrease 2,3 BPG

84. 25. O2-Hb dissociation curve is shifted to the left
a. Systemic circulation
b. Thallasemia
c. Stored blood
d. Pulmonary circulation
e. Decrease 2,3 BPG
FTTTF

85. 26. Following factors increases P50
a. Increase Temparature
b. Inc. Ph
c. High altitude
d. Fetal hemoglobin
e. Exercise

86. 26. Following factors increases P50
a. Increase Temparature
b. Inc. Ph
c. High altitude
d. Fetal hemoglobin
e. Exercise
TFTFT

87. 27. When blood passes in the systemic circulation
a. Efflux of Cl
b. Efflux of HCO3
c. Influx of Cl-
d. Increase Ph
e. Dec PCV

89. 27. When blood passes in the systemic circulation
a. Efflux of Cl
b. Efflux of HCO3
c. Influx of Cl-
d. Increase Ph
e. Dec PCV
FTTFF

90. 28. When blood goes into pulmonary circulation
a. Influx of Cl-
b. Influx of HCO3
c. Efflux of HCO3
d. Ins. Ph
e. Dec Ph

92. 28. When blood goes into pulmonary circulation
a. Influx of Cl-
b. Influx of HCO3
c. Efflux of HCO3
d. Ins. Ph
e. Dec Ph
FTFTF

93. 29. Duration of inspiration is decreased and rate of
ventilation is increased due to stimulation of which centre
a. Apneustic centre
b. Vagus nerve
c. Nucleous tractus soliterous
d. Pneumotaxic centre
e. Ventral Res group

94. Groups Location Name of nucleus Function
1. Inspiratory center (Dorsal
respiratory group
Dorsal portion of medulla
oblongata
Nucleus of Tactus
solitarius
It causes inspiration while stimulated
2. Expiratory centre (ventral
respiratory group)
Antero lateral part of
medulla oblongata.
Nucleus ambiguous and
nucleus retro ambiguous
1. It causes either expiration or inspiration
depending upon which neurons in the
group are stimulated. But generally causes
expiration.
2. It sends inhibitory impulse to the
apneustic center.
3. Pneumotaxic center Upper part of pons Nucleus parabrachialis 1. It controls both rate & pattern of
breathing.
2. It sends impulse to limit inspiration.
There may be 4th center
4. Apneustic Lower part of pons 1. It sends stimulatory impulse to the
inspiratory centre causing inspiration.
2.It receives inhibitory impulse from
pneumotaxic centre and from stretch
receptor of lung.
3. It sends inhibitory impulse to expiratory
centre.

97. 29. Duration of inspiration is dec and rate of ventilation is
increased due to stimulation of which centre
a. Apneustic centre
b. Vagus nerve
c. Nucleous tractus soliterous
d. Pneumotaxic centre
e. Ventral Res group
FFFTF

98. 30. Chemical control of respiratory centre is done by
a. Low CO2
b. High O2
c. Low Ph
d. High CO2
e. Low O2

99. 30. Chemical control of respiratory centre is done by
a. Low CO2
b. High O2
c. Low Ph
d. High CO2
e. Low O2
FFTTT

100. 31. Function of apneustic centre are
a. It controls rate and pattern of breathing
b. Sends stimulatory imulse to inspiratory centre
c. It sends inhibitory response to expiratory centre
d. It sends impulse to limit respiration
e. Necleous: Parabrachialis

101. 31. Function of apnestic centre are
a. It controls rate and pattern of breathing
b. Sends stimulatory imulse to inspiratory centre
c. It sends inhibitory response to expiratory centre
d. It sends impulse to limit respiration
e. Necleous: Parabrachialis
FTTFF

102. 32. Following are features of CO2 retention
a. Bounding pulse
b. Flapping tremor
c. Cold periphery
d. Vesoconstriction
e. Dec cerebral blood flow

103. 32. Following are features of CO2 retention
a. Bounding pulse
b. Flapping tremor
c. Cold periphery
d. Vesoconstriction
e. Dec cerebral blood flow
TTFFF

104. 33. Following are important sign of tetany
a. Trismus
b. Risus sardonicus
c. Opisthotonos
d. Carpopedal Spasm
e. Chvostok sign positive

107. 33. Following are important sign of tetany
a. Trismus
b. Risus sardonicus
c. Opisthotonos
d. Carpopedal Spasm
e. Chvostok sign positive
FFFTT

108. 34. Following are true for acclimatization
a. Dec PO2
b. Ins erythropoietin secration
c. Inc. 2,3 DPG
d. Pulmonary veso-constriction
e. Respiratory alkalosis

109. Acclimatization refer to changes in the body tissues in response
to long term exposure to hypoxia at a high altitude.
 ↓PO2
 Hyperventilation (up to 65%)
 Respiratory alkalosis
 ↑Erythropoietin secretion
 ↓PCO2, ↑pH
 ↑ 2,3 DPG
 ↑Number of mitochondria, cytochrome oxidase
 O2 Hb dissociation curve to left.
 ↑Hb, myoglobin
 ↑diffusion capacity if lung, ↑ vascularity of tissues, ↑ability
to use O2 deposit.
  Circulatory blood volume
  Pulmonary vascular pressure
 Right ventricular hypertrophy

110. 34. Following are true for acclimatization
a. Dec PO2
b. Ins erythropoietin secration
c. Inc. 2,3 DPG
d. Pulmonary veso-constriction
e. Respiratory alkalosis
TTTTT

111. 35. Following are true for O2-CO2 transport
a. Most of the oxygen are transported by Hb
b. About 3% is transported in dissolve state
c. A small amount of CO2 is transported with HCO3
d. Most of the CO2 is transported with Hb
e. CO2 can be transported in dissolved state

112. 35. Following are true for O2-CO2 transport
a. Most of the oxygen are transported by Hb
b. About 3% is transported in dissolve state
c. A small amount of CO2 is transported with HCO3
d. Most of the CO2 is transported with Hb
e. CO2 can be transported in dissolved state
TTFFT

113. 36. Following are true considering the volumes and
capacities of the Lung
a. Tidal volume-500ml
b. Inspiratory reserve volume-1100ml
c. Residual volume-3000ml
d. Vital capacity-4600ml
e. Total lung capacity-5800ml

114. 36. Following are true considering the volumes and
capacities of the Lung
a. Tidal volume-500ml
b. Inspiratory reserve volume-1100ml
c. Residual volume-3000ml
d. Vital capacity-4600ml
e. Total lung capacity-5800ml
TFFTT

115. 37. Following are cause of Hypoxic hypoxia
a. Lung failure
b. Pulmonanry Fibrosis
c. Shunt
d. Lack of Hb
e. CO poisoning

116. Types Definition Causes
A. Hypoxic hypoxia Where occurs; It occurs
mainly in High altitude Mine
When hypoxia occurs due to decreased O2
availability in the atmosphere or in the
source, this is called hypoxic hypoxia
1. Lung failure (gas exchane failure)
2. Pulmonary fibrosis
3. ventilation perfusion imbalance
4. Shunt
5. pump failure (ventilatory failure)
6. Fatigue
7. Mechanical defects
8. Depression of respiratory controller in the
brain.
B. Anaemic hypoxia When O2 tension in air is normal but
hypoxia develops due to less O2 carriage is
celled anaemic hypoxia.
1. Lack of Hb
2. CO poisoning
3. Altered Hb
C. Stagnant hypoxia When O2 tension is normal but the amount
of O2 reaching the tissue is inadequate, this
hypoxia is called stagnant hypoxia.
1. ↓Cardiac output
2. Impaired venous return
3. ↓Blood flow to the orgen
4. Hemorrhage, shock ctc.
D. Histotoxic hypoxia when hypoxia occurs due to failure of cell to
utilize O2 is called histotoxic hypoxia
1. Poisoning with KCN
2. Narcotics

117. 37. Following are cause of Hypoxic hypoxia
a. Lung failure
b. Pulmonanry Fibrosis
c. Shunt
d. Lack of Hb
e. CO poisoning
TTTFF

118. 38. Following are cause of Histotoxic Hypoxia
a. CO poisoning
b. Altered Hb
c. KCN poisoning
d. Narcotics
e. Dec. Cardiac Output

119. 38. Following are cause of Histotoxic Hypoxia
a. CO poisoning
b. Altered Hb
c. KCN poisoning
d. Narcotics
e. Dec. Cardiac Output
FFTTF

120. 39. O2 therapy is 100% effective in case of
a. Hypoxic hypoxia
b. Anemic hypoxia
c. Stagnant hypoxia
d. Histotoxic hypoxia
e. None of the above

121. Types Role of O2 therapy
A. Hypoxic hypoxia O2 therapy is 100% effective
B. Anemic hypoxia O2 therapy is less effective because O2
carriage by Hb can’t be altered but in O2
therapy O2 is dissolved state is increased
between 7 & 30%. This small amount of
extra O2 may be the difference between life
& death.
C. Stagnant hypoxia It is less value due to decreased O2 carriage
by blood.
D. Histotoxic hypoxia It is of no value because cell cannot utilize
O2

122. 39. O2 therapy is 100% effective in case of
a. Hypoxic hypoxia
b. Anemic hypoxia
c. Stagnant hypoxia
d. Histotoxic hypoxia
e. None of the above
TFFFF

123. 40. Cause of Type 1 acute respiratory failure
a. Acute asthma
b. Pneumonia
c. ARDS
d. COPD
e. Sleep apnoea

124. How to interpret blood gas abnormalities in respiratory failure
Type
Hypoxia (PaO2< 8.0 kpa (60mmhg)
Normal or low PaCO2 (≤6 kPa (45 mmHg)
Type II
Hypoxia (PaO2 <8.0 kPa (60 mmhg)
Raised PaCO2(>6kPa (45 mmhg)
Acute chronic Acute chronic
H+ → → ↑ →or↑
Bicarbonate → → → ↑
Causes  Acute asthma
 Pulmonary
 Pneumonia
 Lobar collapse
 pneumothorax
 pulmonary
embolus
 ARDS
 COPD
 Lung fibrosis
 Lymphangitis
 Carcinomatosis
 Right to left shunts
 Brain stem lesion
 Acute severe asthma
 Acute exacerbation of
COPD
 Upper airway
obstruction
 Acute neuropathies/
paralysis
 Narcotic drugs
 primary alveolar
hypoventilation
 Flail chest injury
 COPD
 Sleep apnoea
 Kyphoscoliosis
 myopathies/
muscular dystrophy
 Ankylosing
spondylitis

125. 40. Cause of Type 1 acute respiratory failure
a. Acute asthma
b. Pneumonia
c. ARDS
d. COPD
e. Sleep apnoea
TTTFF

126. 41. Cause of Type-2 Acute repiratory failure
a. COPD
b. Acute asthma
c. Strangulation
d. Myopayhies
e. Ankylosing spondylitis

127. 41. Cause of Type-2 Acute repiratory failure
a. COPD
b. Acute asthma
c. Strangulation
d. Myopayhies
e. Ankylosing spondylitis
FFTFF

128. 42. In case of type 2 repiratory failure
a. PaO2 >8kpa
b. PaCO2>6kpa
c. PaO2<8kpa
d. HCO3 normal or decreased
e. H+ increased

129. 42. In case of type 2 repiratory failure
a. PaO2 >8kpa
b. PaCO2>6kpa
c. PaO2<8kpa
d. HCO3 normal or decreased
e. H+ increased
FTTFT

130. 43. Following are causes of Respiratory acidosis
a. COPD
b. Life threatening Asthma
c. Opiate overdose
d. High altitude
e. Pregnancy

131. Respiratory acidosis may be caused by a number of conditions:
 COPD
 decompensation in other respiratory conditions e.g. life-
threatening asthma /pulmonary oedema
 sedative drugs: benzodiazepines, opiate overdose

132. 43. Following are causes of Respiratory acidosis
a. COPD
b. Life threatening Asthma
c. Opiate overdose
d. High altitude
e. Pregnancy
TTTFF

133. 44. Following are causes of recurrent hemoptysis
a. PTB
b. Chronic bronchitis
c. Bronchiectasis
d. Bronchial Ca
e. Acute bronchitis

134. Causes of haemoptysis
Carcinoma Bronchial adenoma
Bronchiectasis Foreign body
Acute bronchitis
Parenchymal disease
Tuberculosis Trauma
Suppurative Actinomycosis
Lung abscess Mycetoma
Parasites (e.g hydatid disease. flukes)
Cardiovascular disease
Acute left ventricular failure aortic aneurysm
Mitral stenosis
Blood disorders
Leukaemia Anticoagulants
Haemophilia

135. 44. Following are causes of recurrent hemoptysis
a. PTB
b. Chronic bronchitis
c. Bronchiectasis
d. Bronchial Ca
e. Acute bronchitis
TTTTF
Recurrent Hemoptysis:
 Pulmonary tuberculosis
 Chronic bronchitis
 Bronchiectasis
 Bronchial carcinoma

136. 45. How to asses acute severe asthma
a. PEF 33-50%
b. Heart < 110b/min
c. Respiratory rate <25b/min
d. Inability to complete a sentence in 1 breath
e. FEV1> 15%

137. Immediate Assessment of Acute Severe Asthma
Acute Severe Asthma
 PEF 33-50% predicted (<200l/ min)
 Heart ≤110 beats/ min
 Respiratory rate ≥ 25 breaths/ min
 Inability to complete sentences in 1 breath
Life –threatening features
 PEF < 33% predicted (100L/min)
 ApO2<92% or PaO2 <8 kPa (60 mmHg) (especially if being treated with oxygen)
 Normal or raised PaCO2
 Silent chest
 Cyanosis
 Feeble respiratory effort
 Bradycardia or arrhythmias
 Hypotension
 Exhaustion
 Confusion
 Coma
Near-fatal asthma
 Raised PaCO2 and/ or requiring mechanical ventilation with raised inflation pressures

138. 45. How to asses acute severe asthma
a. PEF 33-50%
b. Heart < 110b/min
c. Respiratory rate <25b/min
d. Inability to complete a sentence in 1 breath
e. FEV1> 15%
TTFTF

139. 46. Indication of assisted ventilation in severe acute asthma
a. Coma
b. Respiratory Arrest
c. PaO2 <8kpa
d. PCO2>6kpa
e. Confusion,drowsiness

140. Indication of assisted ventilation in severe acute asthma:
1. Coma
2. Respiratory arrest.
3. Deterioration of arterial blood gas tensions despite optimal
therapy
 PaO2 <8 kPa (60mm Hg) and falling
 Pa CO2 > 6 kPa (45 mmHg) and rising
 PH low and falling (H+ high and rising)
4. Exhaustion, confusion, drowsiness.

141. 46. Indication of assisted ventilation in severe acute asthma
a. Coma
b. Respiratory Arrest
c. PaO2 <8kpa
d. PCO2>6kpa
e. Confusion,drowsiness
TTTTT

142. 47. CURB-65 stands for
a. Coma
b. Confusion
c. Urea>7mmol/L
d. Respiratory rate <30/min
e. Age>65yrs

143. Any of:
 Confusion
 Urea>7 mmol/L
 Respiratory rate>30/min
 Blood pressure (sustolic< 90 mmHg or Diastolic<60 mmHg)
 Age> 65 years

144. 47. CURB-65 stands for
a. Coma
b. Confusion
c. Urea>7mmol/L
d. Respiratory rate <30/min
e. Age>65yrs
FTTFT

145. 48. Following are causes of Central cyanosis
a. Arterial obstruction
b. Cold exposure
c. Raynaud’s phenomenon
d. Venous obstruction
e. Massive Pulmonary embolism

146. Causes of central cvanosis:
A. Lung disease:
1. Massive pulmonary embolism
2. Acute exacerbation of COPD
3. Acute severe asthma
4. Severe pneumonia
5. Interstitial pneumonia
6. infection –Acute laryngealtracheal bronchitis.
B. Heart diseases:
1. Congenital cyanotic heart disease: Tetralogy of fallot,
transposition of great vessels, tricuspid atresia.
2. LVE
3. Eisenmenger’s syndrome (Rt--+>Lt shunt) in VSD, PDA.
C. Inadequate O2 uptake: eg. in
1. Methaemaoglobinaemia
2. Sulphaemoglobinaemia

147. 48. Following are causes of Central cyanosis
a. Arterial obstruction
b. Cold exposure
c. Raynaud’s phenomenon
d. Venous obstruction
e. Massive Pulmonary embolism
TTTTT

148. 49. Following are lung causes of Clubbing
a. Bronchiectasis
b. Lung abcess
c. Pneumonia
d. Congenital heart disease
e. Thyrotoxicosis

149. Bilateral clubbing
A. Respiratory 1. Bronchogenic carcinoma (common adult)
2. Suppurative lung disease
 Bronchiectasis
 Lung abscess
 Empyema thoracis
 Cystic fibrosis
3. Pulmonary TB
4. Fibrosing alvelitis
5. Pleural mesothelioma
B. Cardiac 1. Congenital cyanotic heart disease – Fallot’s
tetralogy
2. Sub-acute bacterial endocarditis.
C. Alimentary 1. CLD –cirrhosis of liver.
2. Inflammatory bowel diseases: (Crohn’s disease,
Ulcerative colitis)
3. Coeliac disease
D. Others 1. thyrotoxicosis
2. Familial (rare)
3. Idiopathic

150. 49. Following are lung causes of Clubbing
a. Bronchiectasis
b. Lung abcess
c. Pneumonia
d. Congenital heart disease
e. Thyrotoxicosis
TTFFF

151. 50. Following are non-metastatic extra-pulmonary features
of bronchial Ca
a. SIADH
b. Ectopic ACTH
c. Polyneuropathy
d. Mysthenia
e. Digital clubbing

152. Endocrine
 Inappropriate ADH secretion, causing hyponatremia
 Ectopic ACTH
 Hyercalcaemia due to secretion of PTH related peptides
 Carcinoid syndrome
 Gynaecomastia
Neurological
 Polyneuropathy
 Myelopathy
 Cerebeller degeneation
 Myasthenia (Lambert-Eaton syndome)
Others
 Digital clubbing
 Hypertrophic pulmonary osteoarthropathy
 Nephritic syndrome
 Polymyositis & dermatomysitis
 Eosinophilia

153. 50. Following are non-metastatic extra-pulmonary features
of bronchial Ca
a. SIADH
b. Ectopic ACTH
c. Polyneuropathy
d. Mysthenia
e. Digital clubbing
TTTTT

154. Thank You