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 RESPIRATORY MODULE
RES 216
Anatomy

BY

PROF. DR. HODA ELAASAR

PROFESSOR & HEAD OF ANATOMY DEPARTMENT

FACULTY OF MEDICINE - MTI

PROFESSOR OF ANATOMY
FACULTY OF MEDICINE - CAIRO UNIVERSITY

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 Self-assessment Questions
A. The Trachea and Bronchi:
a. Examine the level of the beginning and end of the trachea.
b. Measure its length.
c. Examine the cartilaginous ring of the trachea.
d. Inspect the relations of the trachea to the surrounding
structures.
e. Notice the level of bifurcation of the trachea.
f. Notice the length and diameter of the two principal bronchi
g. Notice the angle between the trachea and each of the two
main bronchi.
h. Write on the dotted lines the marked features:

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B. The Lung:
a. Examine the surfaces and borders of right and left lung
b. Inspect the fissures and lobes of both lungs.
c. Inspect the surrounding structures forming the grooves
and impression on the mediastinal surface of each lung.
d. Examine the structures forming the hilum of each lung.
e. Differentiate between right and left lung.
f. Write on the dotted lines the marked features:

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C. The Mediastinum:

a. Examine the structures of the right side of the

mediastinum after removal of the right lung.
b. Examine the structures of the left side of the mediastinum
after removal of the right lung.
c. Inspect the structures in the middle and posterior
mediastinum.
d. Write on the dotted lines the marked features:

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 Self-Assessment Questions

A.Short Assay Questions:

1. Give the surface anatomy of the trachea.

2. What are the sites of constriction of the trachea.

3. Give the blood supply and lymphatic drainage of the

trachea.

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4. What is the difference between the right and left main
bronchus.

5. Describe the pleural recesses.

6. Give the innervation of the parietal pleura.

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 7. Give the sites of referred pain in cases of irritation of
different parts of the pleura.

8. Describe the surface anatomy of the pleura and lung

9. Enumerate the structures forming the hilum of right and left

lung.

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10. Give the distribution of the bronchopulmonary segments
of both right and left lung and their clinical significance.

11. Mention the difference between right and left lung.

12. Give the boundaries of the posterior mediastinum and its

contents.

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13. Give the course of the phrenic nerve in the thorax and its
distribution.

14. Describe the course and branches of the vagus nerve in

the superior mediastinum and the related clinical problems.

15. Give the components of the pulmonary plexus.

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16. Enumerate the Lymph nodes draining the lungs, bronchi
and trachea.

17. Give the beginning, end and the course of the thoracic
duct.

18. Enumerate the field of drainage of the thoracic duct.

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B. MCQS:

1. One of the following branches not arising from descending

thoracic aorta:
a. Posterior intercostal artery.
b. Subcostal artery.
c. Left subclavian artery.
d. Left bronchial artery.

2. The lesser splanchnic nerve is formed by which of the following

sympathetic nerves?

a. T5-T7
b. T8-T9
c. T9-T10
d. T12

3. One of the following structures is not related to thorax contents:

a. The lungs
b. The cisterna chyli
c. The heart
d. The azygos vein

4. Which of the following structures lies in the anterior mediastinum?

a. Sternopericardial ligaments.
b. Pericardial sac.
c. Trachea.
d. Heart.

5. One of the following structures is Not a content of the posterior

mediastinum:

a. Esophagus.
b. Thoracic duct.
c. Azygos vein.
d. Internal thoracic artery.

6. Regarding the lymphatic drainage of the lung, choose the correct

answer:

a. The walls of the alveoli contain lymph vessels

b. Interstitial lymphatics drain from center to periphery
c. The tracheobronchial lymph nodes lie at the bifurcation of the trachea
d. Mediastinal lymph trunks on both sides drain into the thoracic duct

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7. Regarding the bronchial vessels, choose the correct answer:
a. The bronchial arteries run along the anterior aspect of the bronchial
tree
b. Each lung is supplied by two bronchial arteries
c. The left bronchial arteries arise from the descending thoracic aorta
d. The left bronchial vein end into the inferior hemiazygos

8. Regarding the tracheo-bronchial tree, a foreign body enter more

commonly into:
a. The left primary bronchus
b. The right primary bronchus
c. The carina of the trachea
d. The beginning of the trachea
9. One of the following structure is a content of the middle mediastinum:
a. Descending aorta
b. Ascending aorta
c. Thoracic duct
d. Esophagus
10. Regarding the mediastinal syndrome, choose the correct answer:
a. Compression of arteries lead to ischemia
b. Compression of trachea leads to dysphagia
c. Compression of esophagus leads to dyspnea
d. Compression of left recurrent laryngeal nerve leads to aphasia
11. Regarding the trachea, choose the correct answer:
a. It begins at the level of the lower border of C6
b. It is formed of 5-10 C-shaped cartilages
c. It measures 4.5 cm in length
d. It divides at the level of the 6th thoracic vertebra into 2 main bronchi
12. Regarding the bronchi, choose the correct answer:
a. The right bronchus is shorter and narrower than the left
b. The left bronchus is more in line with the trachea
c. The left bronchus divides into 2 lobar bronchi
d. The left bronchus receives one bronchial artery
13. Regarding the phrenic nerves, choose the correct answer:
a. They contain only somatic motor nerve fibers
b. They pass posterior to the roots of the lung
c. The right phrenic is more vertical than the left one
d. The left phrenic is related to the venous side of the heart

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14. Regarding the vagus nerve, choose the correct answer:
a. Each vagus nerve ends by breaking up to form the anterior pulmonary
plexus
b. The right vagus shares in the formation of the anterior esophageal
plexus
c. The left vagus shares in the formation of the posterior esophageal
plexus
d. The left vagus is related laterally to the left pleura and lung along its
whole course in the superior mediastinum
15. Regarding the thoracic part of the sympathetic chain, choose the
correct answer:
a. It leaves the thorax by passing behind the lateral arcuate ligament of
diaphragmatic
b. All its branches are postganglionic fibers
c. The oesophageal plexus receives sympathetic fibers from the upper 5
ganglia
d. The pulmonary plexus receives sympathetic fibers from the 3 rd, 4th and
5th ganglia.
16. Regarding the thoracic duct, one of the following statements is
Regarding the thoracic duct, choose the correct answer:
a. It enters the thorax through the esophageal opening of the diaphragm
b. It measures about 55 cm in length
c. It ends in the cisterna chyli
d. It contains many valves

17. Regarding phrenic nerve, which of the following statements is true?

a. It passes posterior to root of lung.
b. It forms the esophageal plexus of nerves.
c. It contains only somatic motor nerve fibers.
d. It supplies pericardium and diaphragm.

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 18. After a 2-day-old newborn male swallowed milk he became cyanotic.
After 3 days he developed pneumonia. A tracheoesophageal fistula was
suspected. Failure of development has occurred most specifically in
which of the following structures?
a. Esophagus
b. Trachea
c. Tongue
d. Tracheoesophageal septum

19. A 45-year-old female is admitted to the hospital with difficulty of

breathing. Radiographic examination reveals a tumor invading the
lung surface anterior to the hilum. Which nerve is most likely
compressed by the tumor to result in dyspnea?
a. Phrenic
b. Vagus
c. Intercostal
d. Recurrent laryngeal

C. Fill in the blank:

1- The superior mediastinum bounded below by an imaginary plane from
…………………… anteriorly to ……………………… posteriorly.

2- The retromanubrial structures are ……… ,…………………,…………………

and ………………………………

3- The inferior mediastinum is bounded anteriorly by …………………………

and posteriorly by …………………………… vertebrae.

4- The right lung is differed from that of the left in being it has ……………
and ………………

5- The right principal bronchus is differed from the left one in having
…………… and ………………………

6- The pleura is formed of two layers ……………………… and

………………………

7- The recesses of the pleura are ……………………… and ………………………

8- The anterior border of left lung presents two characteristic features

……………… and ………………………

9- The visceral pleura is innervated by …………………… nerve fibers from

the ………………… plexus.

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10- The parietal pleura is innervated by ……………… nerve fibers from
……………………… and …………………… nerves.
11- The costal pleura is supplied by …………………… nerve while the
diaphragmatic and mediastinal pleura are supplied by
……………………… nerve.
12- The cardiac notch of the left lung extends from ……… to ………………
costal cartilages
13- The cardia notch lies on the ……………………… lung only and deviates
laterally ………………… inches from the midline.
14- The right lung consists of ………………………… segments while the left
lung consists of ………………………… segments.
15- The right main bronchus divides ………………… entering the hilum of
the right lung by giving the …………………………
16- The left main bronchus divides ………………… entering the hilum of the
left lung by giving ……………………………
17- The right bronchial artery arises from ……………………………… while
the left bronchial arteries arise from ……………………………
18- The right bronchial veins drain into …………………… vein while the left
bronchial veins drain into either ……………………… or
……………………… vein.
19- The hilum of the right lung, above it passes …………………… and behind
it passes ……………………………
20- The hilum of the left lung , above it passes …………………… and behind
it passes ………………………………
21- The trachea begins at the level of ………… and ends at the level of
…………
22- The phrenic nerve arises from …………………… rami of cervical
…………, …………… and ………………
23- The phrenic nerve gives motor supply to …………… and sensory supply
to …………………… and ………………………… in the thorax.
24- The right phrenic nerve is related to ………………………
and………………… veins.
25- The right phrenic nerve passes through the ………………… opening of
the diaphragm opposite ……………………… vertebra.

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26- The left phrenic nerve descends between the ………………… and
………………… arteries.
27- The left phrenic nerve descends on the left side of ………………………
and …………………
28- The thoracic duct begins at …………………… and ends in
………………………
29- The thoracic duct enters the thorax by passing through the ………………
opening of the diaphragm opposite …………………… vertebra.
30- The thoracic duct passes behind the ………………………… in the
posterior mediastinum then it crosses to the left side opposite
…………………… vertebra.
31- The thoracic duct drain the lymph from the left upper limb through
…………………… and the left side of head and neck thorough
………………………… and the left side of the thorax through
……………………
32- The thoracic duct is ………… cm in length while the right lymphatic duct
is ……… cm in length.
33- The autonomic plexuses in the thoracic are ………………………,
…………………… and …………………

D. Cross Matching Questions

Match the following nerves with their branches:

(A) (B)

1. Vagus nerve a. Cardiac branches to the heart

2. Phernic nerve b. Lateral cutaneous branch
3. Sympathetic chain c. Greater splanchnic nerve
4. Intercostal nerve d. Sensory branches to pleura
5. Deep cardiac plexus e. Recurrent laryngeal nerve

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 RESPIRATORY MODULE
RES 216

Histology

BY

PROF. DR. GHADA FAROUK MOHAMED

PROFESSOR & HEAD OF HISTOLOGY AND CELL BIOLOGY DEPARTMENT
FACULTY OF MEDICINE - MTI

PROFESSOR OF HISTOLOGY AND CELL BIOLOGY

FACULTY OF MEDICINE - ASU

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 MCQ RESPIRATORY
1. Which of the following cellular activities describes the function of
Clara cells in terminal and respiratory bronchioles?
a) Degradation of mucin
b) Fluid uptake via pinocytosis
c) Antigen presentation
d) Secretion of surfactant
2. Which of the following terms best describes goblet cells?
a) Unicellular endocrine glands
b) Unicellular exocrine glands
c) Multicellular endocrine glands
d) Multicellular exocrine glands
3. In an electron micrograph of the alveolus, the barrier that
separates atmospheric air from blood shows:
a) Fusion of epithelial and endothelial basal laminae
b) Cartilaginous plates between epithelial and endothelial cells
c) Cilia on the epithelial and endothelial cells
d) Lymph nodules between epithelial and endothelial cells
4. There is continuous removal of dust and mucous from the
respiratory tract. This is done by its lining epithelium which is
a) Pseudo-stratified columnar ciliated with goblet cells.
b) Simple columnar with goblet cells.
c) Stratified squamous epithelium.
d) Simple columnar with brush border.
5. In an electron micrograph of the alveolus, the surfactant-secreting
cell is characterized by having:
a) Lamellar granules
b) Keratohyaline granules
c) Melanin granules
d) No granules
6. Which of the following cellular activities describes the function of
goblet cells in the conducting passages of the respiratory system?
a) Exchange of gases
b) Secretion of mucin
c) Antigen presentation
d) Production of surfactant
7. In the alveoli, the barrier that separates atmospheric air from
blood shows:
a) Mucous
b) Surfactant
c) Clara cells
d) Pneumocyte type II

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8. Monocyte is the cell of origin of:
a) Adipocyte
b) Osteoclast
c) Dust cell
d) Thrombocyte
9. Clara cell:
a) Is a ciliated cell.
b) Secretes mucous like material.
c) Lines the respiratory portion of the lung.
d) Is columnar cell with dome shaped apex.
10.The wall of the bronchioles has:
a) Well developed smooth muscles.
b) Lymphatic follicles.
c) Seromucous glands.
d) Cartilaginous plates.
11.One of the following is a character of type I pneumocyte:
a) Simple squamous cell
b) Tall columnar cell
c) Secrete surfactant
d) Contains lamellar bodies
12.The type of epithelium covering the vocal cord is:
a) Simple squamous
b) Stratified squamous non keratinized
c) Pseudostratified columnar ciliated with goblet cells
d) Stratified columnar

ANSWERS OF RESPIRATORY MCQ

1 D
2 B
3 A
4 A
5 A
6 B
7 B
8 C
9 D
10 A
11 A
12 B

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 CARDIOVASCULAR MCQ

1. Aorta is:
a) An elastic artery
b) A muscular artery
c) A medium sized artery
d) An arteriole

2. In medium sized artery, adventitia contains the following EXCEPT:

a) Smooth muscles
b) Collagen fibers
c) Elastic fibers
d) Vasa vasora

3. Longitudinal muscle fibers are found in:

a) Femoral artery
b) Femoral vein
c) Common carotid artery
d) Inferior vena cava

4. Fenestrated elastic lamina is found in:

a) Blood capillaries
b) Femoral vein
c) Common carotid artery
d) Inferior vena cava

5. Prominent internal elastic lamina is found in:

a) Aorta
b) Femoral vein
c) Basilar artery
d) Superior vena cava

6. Tunica media matrix is synthesized by:

a) Fibroblasts
b) Smooth muscle cells
c) Endothelial cells
d) Pericytes

7. Tunica intima in a blood vessel is:

a) The thickest layer
b) Lined by simple cuboidal cells
c) Rich smooth muscle
d) Having elastic fibers occasionally

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8. A medium sized artery:
a) Has thick tunica media
b) Is rich in elastic fiber content
c) Contains longitudinal smooth muscle
d) Lacks vasa vasora

9. The intima of the medium sized vein:

a) Has internal elastic lamina
b) Contains elastic fibers
c) Is the thickest layer
d) Shows intimal folds

10. In inferior vena cava, tunica adventitia contains:

a) Circular smooth muscles
b) Elastic fibers
c) Longitudinal muscle fibers
d) All of the above

11. Continuous capillaries have:

a) Thin tunica media
b) Interrupted basement membrane
c) Fenestrated endothelial cells
d) Associated pericytes

12. Endothelial cells of continuous capillaries contain:

a) Pinocytotic vesicles
b) Prominent Golgi complex
c) Small pores
d) All of the above

13. Thickest layer in medium sized vein is the:

a) Tunica intima
b) Tunica media
c) Tunica adventitia
d) None of the above

14. In blood brain barrier, capillaries are:

a) Fenestrated with diaghragm
b) Fenestrated without diaghragm
c) Continuous with zonula occludens
d) Continuous with fascia occludens

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15. Medium sized artery is characterized by
a) Collapsed lumen
b) External elastic lamina
c) Thick tunica adventitia
d) All of the above

16. Medium sized vein is characterized by:

a) Thick tunica media
b) Longitudinal muscle fibers
c) Elastic fibers
d) Collapsed lume

17. In Marfan syndrome which is characterized by improper deposition

of elastic fibers, which part of the cardiovascular system would be
mostly affected?
a) Middle cerebral artery
b) Basilar artery
c) Aorta
d) Superior vena cava
18. In H&E-stained section of the inferior vena cava, the characteristic
feature is the:
a) Well-developed internal elastic lamina
b) Fenestrated elastic membranes in the tunica media
c) Longitudinal smooth muscles in the tunica adventitia
d) Vasa vasora in the tunica intima
19. One of the following is a characteristic feature of blood sinusoid:
a) Discontinuous basal lamina
b) Non fenestrated endothelial cells
c) Narrow regular lumen
d) Well-developed internal elastic lamina
20. Endothelial cells of the blood capillaries of the brain:
a) Rest on a discontinuous basal lamina.
b) Have wide gaps between them.
c) Are fenestrated.
d) Contain pinocytotic vesicles.
21. The endothelium of the continuous capillaries is characterized by:
a) Being fenestrated
b) Contains numerous pinocytotic vesicles
c) Has discontinuous basement membrane
d) Cells are joined by gap junctions

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22. The media of the femoral vein is characterized by having:
a) Internal elastic lamina
b) External elastic lamina
c) Smooth muscle fibers
d) Vasa vasorum

ANSWERS OF CVS MCQ

1 A
2 A
3 D
4 C
5 C
6 B
7 D
8 A
9 D
10 C
11 D
12 A
13 C
14 C
15 B
16 D
17 B
18 C
19 A
20 D
21 B
22 C

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 RESPIRATORY SYSTEM
Describe the microscopic structure of the olfactory epithelium
Formed of 3 types of cells
• Supporting cells • Sensory cells
• Basal cells
1) Supporting "sustentacular" cells:
U

- High columnar
- Oval apical nuclei
- Apical striated border "microvilli"
- Apical pigment granules "hence yellow color of olfactory epithelium"
- Junctional complexes with nearby cells
2) Sensory "olfactory" cells
U

- Bipolar nerve cells.

- lie between supporting cells and basal cells.
- Apical dendrite form bulb like expansion→ olfactory vesicle with cilia:
• Long
• Non motile
• Lie flat parallel to the surface
- axon of these bipolar neurons → olfactory nerve → C.N.S.
3) Basal cells:
U

• Short
• Spherical
• Rest on basement membrane
• Responsible for regeneration of olfactory epithelium.
Lamina propria:
• Dense c.t.
• Contain axons of bipolar
• Contains many veins, and Bowman's gland that secrete watery to:
1. Refresh olfactory epithelium
2. solvent for gases
Function of olfactory epithelium: perception of odor

Describe the microscopic structure of the ciliated cells of the respiratory epithelium

Ciliated columnar cell (30%)

 It is tall columnar cell with oval basal nuclei.
 Its apical surface is provided with 200-300 cilia.
 Apical cytoplasm contains many mitochondria (for ATP production) required for ciliary
beating.
 Cilia beat towards the pharynx.

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Describe the microscopic structure of the Goblet cells of the respiratory epithelium
Goblet cells (30%):
 It is goblet in shape with:
o Expanded apical part.
o Narrow constricted basal part.
 With LM: it has:
o Apical vacuolated part.
o Basal basophilic part containing the nucleus.
 With EM: it shows:
o The apical part is filled with mucinogen granules.
o The basal part has rER, Golgi complex, ribosomes & mitochondria.

Compare the microscopic structure of the trachea and intrapulmonary bronchi

Trachea Intrapulmonary bronchus

Lumen Wide Narrower

Mucosal fold Absent “only present posteriorly” Numerous

Goblet cells Numerous Decrease as we go downwards

Cartilage C-shaped rings Irregular plates

Wall Flattened posteriorly “oesophagus” Not flattened

Elastic lamina Present Absent “ distributed in the adventitia”

Submucosa Present Absent

Muscle layer Absent Present

Lymphatic nodules absent Present in adventitia

Describe the microscopic structure of the Clara cells

Clara cells:
 It is present among bronchiolar lining epithelium.
 With LM:
o It is non ciliated columnar cell.
o It has central nucleus.
o It has dome shaped apex project above other cells.
 With EM:
o Its surface is covered by microvilli.
o It has supranuclear Golgi apparatus, rER & mitochondria.
o Its apical cytoplasm contains secretory granules.
Function:
 Secretion of surfactant like material to decrease surface tension.
 Detoxification air born toxins.
 It may be chemoreceptor for concentration of gases in inspired air.
 It may regenerate bronchiolar epithelium.

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Compare the microscopic structure of the bronchus and bronchiole

Bronchus Bronchiole

Lumen wide Narrow

Epithelium Respiratory epithelium Low columnar with no goblet cells

Clara cells Absent Present

Muscle coat Present Well developed

Cartilage plates Present Absent

Lymphoid follicles Present Absent

Glands Present Absent

Describe the microscopic structure of the interalveolar septum

Inter alveolar septum:
U

 It is the partition between the lumena of adjacent alveoli.

 It is lined on both sides by the alveolar epithelium.
 It is penetrated by the alveolar pores.
 It contains:
o Many elastic fibers.
o Continuous non fenestrated capillaries.
o Basement membrane of endothelial cells that fuses with basement membrane of alveolar
epithelium.
o C.T. cells.
 It separates alveolar space from the capillary "blood gas barrier or interface".
Blood gas Barrier "blood air interface":
U

 It is the area of the inter-alveolar septum in which gas exchange occurs.

 It is formed of :
1. Pulmonary surfactant.
2. Type I pneumocytes.
3. Fused basal lamina of type I pneumocytes & capillary endothelium.
4. Endothelium of continuous capillaries.
 Function: it allows diffusion of gases between air & blood.
Describe the microscopic structure of the pneumocyte type I

 It covers about 95% of the alveolar surface.

 With LM:
- It is squamous cell resting on basement membrane.
- The nucleus is central flattened.
 With EM:
- The perinuclear cytoplasm contains few organelles.
- Few pinocytotic vesicles.
- They are attached to each other & type II cells by occluding junctions.
 It is not able to divide

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 Function: Gas exchange.
Describe the microscopic structure of the pneumocyte type II

 It covers about 2-3% of the alveolar surface.

 With LM:
- They are cuboidal cells.
- They are found in groups of 2-3 cells.
- The cytoplasm is basophilic and foamy.
- The nucleus is rounded, vesicular and central.
 With EM: they have:
- Microvilli on the surface.
- Well developed Golgi complex.
- rER & mitochondria.
- Lamellar bodies (secretory granules that contain surfactant)
 Function:
o They synthesis & secrete pulmonary surfactant.
o They can divide & regenerate to both types of pneumocytes.
Compare the microscopic structure of the pneumocyte type I and pneumocyte type II

Pneumocyte I Pneumocyte II

 It covers about 95% of the alveolar  It covers about 2-3% of the alveolar
surface. surface.
 It is squamous cell resting on basement  They are cuboidal cells.
membrane.
 The perinuclear cytoplasm contains few  Microvilli on the surface.
organelles.  Well developed Golgi complex.
 rER & mitochondria.
 Lamellar bodies (secretory granules that
contain surfactant)
 It is not able to divide  They can divide & regenerate to both
types of pneumocytes.
 Function: Gas exchange.  Function:
o They synthesis & secrete pulmonary
surfactant.

Describe the microscopic structure of the alveolar macrophage

Alveolar macrophage:
U

It is free migrating cell inside the lumen of alveoli

Origin: monocytes that travels the interstitium of the lung to become macrophage
Large cell with eccentric kidney shaped nucleus and many cytoplasmic vacuoles
It contains many lysosomes, phagosomes and residual bodies
It can be supravitally stained by trypan blue
It can be histochemically stained for lysosomal enzymes
Function:-
1. Phagocytose dust & bacteria "Dust cell"

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 2. In congestive heart failure, they phagocytose extravasated blood "Heart failure cell"
Give reasons for:

• Presence of hair in the anterior part of the nasal cavity

To trap dust and foreign particle in inhaled air

• Tracheal cartilage is C-shaped not complete ring

To allow passage of food in the oesophagus

• Presence of elastic fibers in the lung interstitium

To pull on the wall of the bronchioles and aveoli to maintain their lumens always open

• Bronchioles lack cartilaginous support yet they are maintained open

This is due the presence of elastic fibers in the interstitium of the lung which pull on their walls

• Type II pneumocyte doesn't function in gas exchange but it is an important cell lining the
alveoli
As they are involved in:
o Synthesis & secretion pulmonary surfactant.
o Division & regeneration to both types of pneumocytes "I&II".

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 RESPIRATORY MODULE
RES 216

Physiology

BY

PROF. DR. MAGED HAROUN

PROFESSOR & HEAD OF PHYSIOLOGY DEPARTMENT
FACULTY OF MEDICINE - MTI

PROFESSOR OF PHYSIOLOGY
FACULTY OF MEDICINE - CAIRO UNIVERSITY

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 Respiration

1) Which of the following is not part of the respiratory zone?

a- alveolar sacs
b- Alveolar ducts
c- Terminal bronchioles
d- Respiratory bronchiole

2) Inspiration occurs when the:

a. Diaphragm contracts
b. The alveolar pressure equals the atmospheric pressure
c. The alveolar pressure increases
d. The intra-pleural pressure becomes less negative

3) The muscles of inspiration include all of following, EXCEPT:

a) diaphragm.
b) external intercostals.
c) sterno-cleidomastoil.
d) internal intercostal.

4) The recoil tendency of the lungs:

a) results from tendency of the lung to expand.
b) is due to surface tension of the fluid lining the alveoli.
c) increases during emphysema.
d) decreases in lung fibrosis.

5) During inspiration there is decrease in the following except:

a) Intra-alveolar pressure
b) Intra-thoracic pressure
c) Intra-atrial pressure
d) Intra-abdominal pressure

6) Which of the following represents the pressure difference that acts

to distend the lungs?

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a- Alveolar pressure
b- Airway opening pressure
c- Transthoracic pressure
d- Transpulmonary pressure

7) Intra-alveolar pressure:
a- Is negative throughout normal quiet breathing
b- Is zero during pause between inspiration and expiration
c- Is greater than 5-6 mmHg during quiet expiration
d- Is more negative than 5-6 mmHg during quiet inspiration

8) The intrapleural pressure at the end of inspiration is:

a- - 4 mmHg
b- + 4 mmHg
c- - 6 mmHg
d- + 6 mmHg

9) The intra-pleural pressure, all are correct except:

a) Is always subatmospheric
b) Helps in lung expansibility
c) Is done by elastic recoil of lung against expansion of thoracic cage
d) Is 40 cmH2O during inspiration and 30 cmH2O during expiration

10) Which of the following cells produce surfactant in lung alveoli?

a- Endothelial cells
b- Goblet cells
c- Type I alveolar cells
d- Type II alveolar cells e- Dust cells

11) Surfactant:
a- Is the only cause of lung expansion
b- Is produced by type-1 alveolar cells
c- Is commonly deficient in full term neonates
d- Acts as surface tension lowering agent

42
12) Surfactant:
a- Is a glycoprotein
b- Is secreted by type I pneumocytes
c- Increases the surface tension of the alveolar fluid
d- May be deficient in respiratory distress syndrome premature babies

13) The action of the ribs during breathing:

a- Carries the larynx downward
b- Results in the contraction of the diaphragm, during expiration
c- Increase antero-posterior and transverse diameters of thoracic cavity.
d- Is that they are lowered during inhalation.

14) In quiet breathing, expiration is:

a- Passive due to elastic tissue alone
b- Passive due to surface tension in the alveoli and elastic tissue recoil
c- Active due to contraction of internal intercostal muscles
d- Active due to contraction of diaphragm

15) Which of the following occurs during inspiration?

a- Diaphragm contracts and flattens
b- Intrathoracic pressure does not change
c- External intercostals relax
d- Thoracic volume decreases

16) Forced expiration

a- Is called hyperpnoea.
b- Involves contraction of internal intercostal and abdominal muscles
c- Is caused by contraction of external intercostal muscles
d- Is that in which the intrathoracic pressure markedly decreased

17) Bronchoconstriction is produced by:

a- Histamine
b- Noradrenalin
c- Vasopressin

43
d- Adrenaline

18) The volume of air inspired above the tidal volume is called:
a) Inspiratory reserve volume
b) Residual volume
c) Vital capacity
d) Inspiratory capacity

19) The tidal volume in a normal man at rest is about:

a. 0.5 L
b. 1.2 L
c. 2.5 L
d. 4.9 L

20) Which one of the following would increase in obstructive, but

not in restrictive, lung disease?
a. Vital capacity
b. Maximum breathing capacity
c. FEV1
d. Functional residual capacity

21) Tidal volume is air:

a- Remaining in the lungs after forced expiration
b- Exchanged during normal breathing
c- Inhaled after quiet inspiration
d- Forcibly expelled after normal expiration

22) Total lung capacity is equal to:

a- Vital capacity x Tidal volume
b- Functional residual capacity + Expiratory reserve volume
c- Anatomical dead space + Alveolar dead space
d- Residual volume + Vital capacity

23) Inspiratory capacity is:

44
a- The total amount of air that can be inspired after a tidal expiration
b- The total amount of exchangeable air
c- Another name for functional residual capacity
d- The amount of air inspired after a tidal inspiration

24) Vital capacity:

a- Is increased in pregnancy
b- Is dependent on the strength of the respiratory muscle
c- Is higher in females than males
d- All of the above are correct

25) The residual volume is:

a) The air remaining in the lung after maximal inspiration
b) A dynamic lung volume
c) Measured directly using spirometer
d) Measured by dilution method

26) If tidal volume is 0.5 L, respiratory rate is 12/min and dead space
volume is 0.15 L, the pulmonary ventilation is:
a) 4.2 L/min
b) 4.2 ml/min
c) 6 L/min
d) 6 ml/min

27) Functional residual capacity equals:

a) Residual volume + tidal volume.
b) Residual volume + expiratory reserve volume.
c) total lung capacity - tidal volume.
d) tidal volume + inspiratory reserve volume.

28) The vital capacity is reduced by all, EXCEPT:

a) lung fibrosis
b) kyphosis
c) athletes.

45
d) decreased secretion of surfactant

29) One of the following is NOT a function of dead space?

a- Warms expired air to body temperature,
b- Saturates inspired air with water vapor,
c- Removes bacteria and other particulate matter,
d- Conducts the warmed air to the respiratory membranes

30) Concerning dead space:

a) It is about 150 L in normal persons
b) It is not present in normal persons
c) Anatomical dead space can not be measured directly
d) Physiological dead space equals anatomical dead space in healthy

31) Concerning alveolar ventilation, all is true, except:

a- May be reduced while the pulmonary ventilation is normal.
b- Is decreased by shallow rapid respiration.
c- Equals 350 ml x 16 at rest.
d- Equals tidal volume x respiratory rate.

32) Which of following is a component of respiratory membrane?

a- Plasma membrane of the alveolar cell
b- Plasma membrane of the capillary endothelial cell
c- Fused basal laminae of the alveolar and the capillary endothelial cell
d- All of the above

33) The following factors affect the rate of gas diffusion through the
respiratory membrane:
a- Thickness of the respiratory membrane
b- Surface area of the membrane
c- Partial pressure difference between the two sides of the membrane .
d- All of the above

34) With respect to gas exchange across the alveolar membrane:

46
a- The oxygen saturation in venous blood is 40%
b- On average, the hemoglobin in 100ml of blood can combine with 20 ml
of Oxygen
c- Acidosis causes the oxygen - Hb dissociation curve to shift to the left
d- Decreased CO2 concentration causes the oxygen - Hb dissociation
curve to shift to the right

35) Gas diffusion across the pulmonary membrane occurs through:

a) simple diffusion.
b) active transport.
c) facilitated diffusion
d) several layers of alveoli epithelium.

36) Most CO2 is transported in the blood in the form of:

a- Dissolved gas
b- Carbaminohemoglobin
c- Bicarbonate ion
d- Carboxyhemoglobin

37) About 70% of the carbon dioxide is transported to the lungs:

a- In the form of bicarbonate ions
b- In the form of carbonic acid
c- In the form of Carbaminohemoglobin
d- In chemical combination with albumin

38) With respect to gas exchange across the alveolar membrane:

a- Oxygen diffusion across the alveolar membrane is more rapid than
carbon dioxide diffusion
b- The intracellular partial pressure of CO2 is l00 mmHg
c- The partial pressure of CO2 in tissue fluid is 45 mmHg
d- The partial pressure of CO2 in venous blood leaving tissues is 40
mmHg

39) Carbonic anhydrase:

47
a- Is present in plasma
b- Is present in erythrocytes
c- Catalyzes the reaction between carbon dioxide and hemoglobin
d- Catalyzes decomposition of citric acid into bicarbonate & hydrogen ions

40) Oxygen is mainly transported as:

a) Carboxyhemoglobin
b) Carbaminohemoglobin
c) Oxyhemoglobin
d) Dissolved gas in the blood

41) The oxygen content of arterial blood is about:

a) 19 mg%
b) 19 ml%
c) 19 ml/mg
d) 19 mg/min

42) Factors that cause shift of oxygen dissociation curve to right are:
a- Increased 2, 3 DPG
b- Acidosis.
c- Increased temperature.
d- All of the above.

43) During chloride shift:

a- HCO3 enters the RBC in exchange for Cl-
b- Red cell in arterial blood shrinks in size.
c- Blood becomes more acidic.
d- RBCs size in arterial blood is increased

44) Factors that shift oxygen dissociation curve to the left include:
a- Acidosis
b- Increased temperature.
c- Carbon monoxide poisoning.
d- Increased 2, 3 DPG

48
45) How much oxygen is normally carried in the blood?
a- 2 ml oxygen/100 ml blood
b- 5 ml oxygen/100ml blood
c- 10 ml oxygen/100ml blood
d- 20 mi oxygen/100ml blood

46) The oxygen-hemoglobin dissociation curve will shift to the right with:
a- Acute alkalosis
b- Decrease in PCO2
c- Decrease in temperature
d- Exercise

47) CO2 is transported mainly as:

a) Carbonic acid
b) HCO'3
c) Carboxy hemoglobin
d) Carbonate

48) In the arterial blood: all are correct, except:

a) The PCO2 is 46 mmHg
b) The carbamino-cornpounds are less than in the venous blood
c) CO2 present as bicarbonate is 42 ml/100 mi blood
d) CO2 in physical solution is 3 ml/100 blood

49) Tidal CO2 means:

a) Volume of CO2 produced in the body/min
b) Volume of CO2 given to each 100 ml blood at the tissues
c) Carried mainly as bicarbonate
d) Decreased during exercise

50) During the chloride shift phenomena:

a) Bicarbonate ion enter the red cell in exchange for chloride
b) Red cell size in venous blood is increased

49
c) Blood pH rises
d) Potassium ion concentration inside RBC decreases

51) When compared with alveolar air, the expired air has:
a) Less oxygen
b) Less water vapour
c) Less CO2
d) More O2 and CO2

52) The respiratory center receives inhibitory impulses from:

a) Hypothalamus
b) Cerebral cortex
c) Aortic bodies
d) Pneumotaxic center

53) Respiratory chemoreceptors:

a- In the carotid and aortic-bodies are most important in the ventilator
response to an elevated PCO2
b- In the carotid and aortic bodies are strongly stimulated by the high
arterial O2 content
c- In the medulla are responsive to changes in arterial PCO2
d- All of the above are correct
54) Which of the following discharge spontaneously during quiet
breathing?
a- Stretch receptors in lung
b- Motor neurons of respiratory muscles
c- Dorsal respiratory group of neurons
d- Ventral respiratory group of neurons

55) Pneumotaxic center functions primarily to:

a- Limit inspiration
b- Prolong expiration
c- Decrease rate
d- Discharge inspiratory action potentials

50
56) The respiratory center is located in the:
a) Hypothalamus
b) Pons and medulla
c) Cerebral cortex
d) Cerebellum

57) An immediate stoppage of respiration occurs in the following:

a) Transection of the spinal cord below the 7lh cervical vertebra
b) Transection of spinal cord at the level of the second cervical vertebra
c) Transection between the pons and medulla
d) Section of both vagi

58) The apneustic center:

a) Is present in the lower pons
b) Can initiate rhythmic inspirations
c) Sends excitatory impulses to the Inspiratory center
d) All of the above

59) Peripheral chemoreceptors are stimulated by:

a- Hypoxia
b- Anemia
c- Hypocapnia
d- Alkalosis

60) The activity of the central chemoreceptors is stimulated by:

a. An increase in the PCO2 of blood flowing through the brain
b. A decrease in the PO2 of blood flowing through the brain
c. A decrease in the oxygen content of blood flowing through the brain
d. A decrease in the metabolic rate of the surrounding brain tissue

61) Non-chemical regulation of respiration include all of the following,

EXCEPT:
a) pain sensation through hypothalamus.

51
b) swallowing.
c) coughing,
d) hypoxia.

62) If the vagus nerves are cut, the respiratory rate:

a) increases
b) decreases.
c) remains constant.
d) stops.

63) Hypoxic hypoxia:

a- Is characterized by normal oxygen tension in arterial blood and
normal saturation of hemoglobin with oxygen.
b- Is accompanied with cyanosis,
c- Is produced by carbon monoxide poisoning,
d- Is accompanied with low hemoglobin content.

64) Hypoxic hypoxia is caused by:

a) Hyperventilation
b) Anemia
c) Ascending to high altitude
d) Severe cold

65) Pulmonary fibrosis would be expected to produce:

a) Histotoxic hypoxia
b) Stagnant hypoxia
c) Decreased vital capacity
d) Cyanosis

66) Concerning CO-poisoning:

a) Hemoglobin content is normal
b) Oxygen tension is below normal
c) Oxygen content is normal
d) The oxyhemoglobin dissociation curve is shifted to the right

52
67) Anemic hypoxia is caused by all of the following, except:
a) CO-poisoning
b) Blood loss
c) Anemia
d) Polycythemia

68) Stagnant hypoxia is caused by:

a) A large increase in RBC count (polycythemia)
b) A decrease in Hb content (anemia)
c) Ascending to high altitude
d) None of the above

69) Anemic hypoxia is caused by:

a) Lung fibrosis
b) Congestive heart failure
c) Cyanide poisoning
d) CO-poisoning

70) Cyanosis is caused by which of the following:

a) An increase in the affinity of hemoglobin for oxygen
b) A decrease in the percent of red blood cells
c) An increase amount of carbon monoxide
d) An increase in the concentration of deoxygenated hemoglobin

71) Cyanosis:
a- Can be seen in a person if his capillary blood contains 5 mg
reduced hemoglobin per 100 ml blood.
b- Is observed in histotoxic hypoxia.
c- Is seen in carbon monoxide poisoning
d- Is present in severe lung disease
72) Coughing:
a) is initiated by irritation of the alveoli.
b) is associated with relaxation of airways smooth muscle.
c) depends on contraction of the diaphragm

53
d) differs from sneezing in that the glottis is initially closed.

73) Cyanosis:
a) may be caused by high levels of Carboxyhemoglobin in the blood.
b) occurs more easily in anemic than in polycythemic patients.
c) is severe in cyanide poisoning.
d) Observed in stagnant and hypoxic hypoxia.

74) Expiration during rest occurs when:

a- The diaphragm contracts
b- The respiratory center gets active
c- The pressure inside the alveoli becomes less than atmospheric pressure
d- The diaphragm relaxes

75) The recoil tendency of the lungs:

a) results from tendency of the lung to expand.
b) is due to surface tension of the fluid lining the alveoli.
c) increases during emphysema.
d) decreases in lung fibrosis.

76) During inspiration there is decrease in the following except:

a- Intra-alveolar pressure
b- Intra-thoracic pressure
c- Intra-atrial pressure
d- Intra-abdominal pressure

77) During normal inspiration, the intra-alveolar pressure:

a- Does not change
b- Becomes about 1 mmHg negative to the atmospheric pressure
c- Decreases to 6 mmHg
d- Becomes positive at the end of inspiration

78) The most likely response in a patient with pneumothorax upon

entry of air into the chest would be:

54
a- The lungs collapse inward, and the chest wall collapses inward
b- The lungs collapse inward, and the chest wall springs outward
c- The lungs expand outward, and the chest wall springs inward
d- The lungs expand outward, and the chest wall springs outward

79) Concerning the alveolar pressure:

a- It is negative only during inspiration
b- It is always negative
c- It is negative between breaths
d- It is higher during inspiration than during expiration

80) The intra-pleural pressure, all are correct except:

a- Is always sub atmospheric
b- Helps in lung expansibility
c- Is done by elastic recoil of lung against expansion of thoracic cage
d- Is 50 cmH2O during inspiration and 3 cmH2O during expiration
81) A major function of surfactant is to increase:
a- Alveolar surface tension
b- Pulmonary compliance
c- Release of 62 from hemoglobin in alveolar capillaries
d- The work of breathing

82) The action of the ribs during breathing:

a- Carries the larynx downward
b- Results in the contraction of the diaphragm, during expiration
c- Increase antero-posterior and transverse diameters of thoracic cavity.
d- Is that they are lowered during inhalation.

83) Inspiration:
a- is accomplished by increasing the volume of the lungs.
b- Takes place when the air pressure in the lungs equals atmospheric
pressure
c- Is accompanied by an increase in intrapleural pressure
d- Occurs when the lung volume is decreased

55
84) Which of the following occurs during inspiration?
a- Diaphragm contracts and flattens
b- Intrathoracic pressure does not change
c- External intercostals relax
d- Thoracic volume decreases

85) Which of the following are muscles of inspiration?

a- Abdominal muscles and external intercostals
b- Diaphragm and abdominal muscles
c- Diaphragm and external intercostals
d- Diaphragm and internal intercostals

86) Forced expiration

a- Is called hyperpnea.
b- Involves contraction of internal intercostal and abdominal muscles
c- Is caused by contraction of both internal and external intercostals
d- Is that in which the intrathoracic pressure markedly decreased

87) Bronchoconstriction is produced by:

a- Histamine
b- Noradrenaline
c- Vasopressin
d- Adrenaline

88) When the respiratory muscles are relaxed, the lungs are at:
a- Residual volume (RV)
b- Expiratory reserve volume (ERV)
c- Functional residual capacity (FRC)
d- Inspiratory reserve volume (IRV)

89) The residual volume:

a- Cannot be measured directly with a spirometer
b- Is part of vital capacity

56
c- Is part of the expiratory reserve volume
d- Is the volume at which the lungs tend to recoil outwards

90) Surfactant:
a- Is completely formed at 6 months of intrauterine life
b- Is secreted by type II alveolar cells
c- Is responsible for static hysteresis
d- Increased with cigarette smoking

91) Deficient surfactant secretion may lead to all, except:

a- Respiratory distress syndrome
b- Pulmonary edema
c- Decreased wok of breathing
d- Normal respiratory rate

92) Which of the following lung volumes and capacities can not be
measured directly by an ordinary spirometer?
a) VC
b) FRC
c) TV
d) IRV

93) After forced expiration, the lung contains:

a) Functional residual capacity
b) Residual volume
c) Minimal air
d) Total lung capacity

94) Vital capacity is:

a) The sum of the Inspiratory and expiratory reserve volumes
b) Increased in old age
c) The volume of air expired from full inspiration to full expiration
d) Greater in women than in men

57
95) FEV1:
a) is normally 55% of vital capacity in health.
b) reduced in obstructive lung disease.
c) is greater than FVC in healthy subject.
d) increases in bronchial asthma.

96) Functional residual capacity (FRC):

a) Volume of air remaining in the lung after end of forced expiration
b) Volume of air remaining in the lung after quite inspiration
c) Volume of air remaining in the lung by the end of quite expiration
d) When the lung contains FRC, the intra-pleural pressure is 6 mmHg

97) All the following volumes can be measured by spirometry, except:

a) The tidal volume
b) The expiratory reserve volume
c) The vital capacity
d) The functional residual capacity

98) Maximal breathing capacity:

a) increases in pregnancy.
b) is measured by dilution method.
c) is measured by spirometer.
d) equals 3500 ml/minute.

99) Gas diffusion across the pulmonary membrane occurs through:

a) simple diffusion.
b) active transport.
c) facilitated diffusion
d) several layers of alveoli epithelium.

100) By spirometry alone it is impossible to find out values for:

a) functional residual capacity.
b) total lung capacity,
c) residual volume,

58
d) all of the above.

101) The residual volume:

a) Is measured by nitrogen meter method
b) Increases with emphysema
c) Normally equal to 35% of total lung capacity
d) Decreases in old age

102) The functional residual capacity includes:

a) The residual volume + the tidal volume
b) The ideal volume + the expiratory reserve volume
c) The tidal volume + the inspiratory reserve volume
d) The residual volume + the expiratory reserve volume

103) The volume of air inspired above tidal volume is called:

a) The expiratory reserve volume
b) The vital capacity
c) The inspiratory reserve volume
d) The functional residual capacity

104) Concerning the pulmonary volumes, all the following are

correct, except:
a) The tidal volume in a normal adult is 500 ml air
b) The residual volume cannot be measured by spirometry
c) The vital capacity increases in restrictive lung disease
d) The total lung capacity = The vital capacity + the residual volume

105) The residual volume is:

a) The air remaining in the lung after maximal inspiration
b) A dynamic lung volume
c) Measured directly using spirometer
d) Measured by dilution method

106) The breathing reserve is the:

59
a) Maximum breathing capacity minus respiratory minute volume
b) Maximum breathing capacity minus tidal volume
c) Maximum breathing capacity divided by minute volume
d) Maximum breathing capacity divided by tidal volume

107) Concerning dead space:

a) It is about 150 L in normal persons
b) It is not present in normal persons
c) Anatomical dead space can not be measured directly
d) Physiological dead space equals anatomical dead space in healthy

108) Concerning dead space:

a) Dead space volume equals the alveolar ventilation
b) Anatomical dead space measures the volume of air in the
conducting airways only
c) Physiological dead space measures the volume of air in the alveoli and
conducting airways
d) Anatomical dead space volume is usually greater than the
physiological dead space

109) Dead space:

a) Volume of air that undergoes gas exchange
b) Explain the difference between alveolar and pulmonary ventilation
c) Normally, physiological dead space is more than anatomical dead space
d) Can be measured by respirometer

110) In a normal adult, the dead space contributes to:

a) 10% of the tidal volume
b) 20% of the tidal volume
c) 30% of the tidal volume
d) 40% of the tidal volume

111) Compliance of the lung:

a) Measures the recoil tendency of the lung

60
b) Is expressed as change in volume per unit change in pressure
c) Is expressed as change in pressure per unit change in volume
d) Is less than the total thoracic compliance (combined compliance of the
lung and chest wall)

112) The lung compliance:

a) Measures the recoil tendency of lung
b) Is a measure of the expansibility of the lung
c) Is increased in fibrosis
d) Does not change in emphysema
113) Which of the following is correct concerning lung compliance?
a) If can be obtained from the pressure-volume curve
b) Lung compliance is highest at TLC
c) Lung compliance is highest at residual volume
d) Total thoracic compliance = lung compliance + chest wall compliance

114) Work of breathing increases in all, except:

a) Increased lung compliance
b) Narrowing of respiratory passages
c) Hyaline membrane diseases
d) Restrictive lung diseases

115) Lung compliance:

a) Is a measure of recoil tendency of the lungs
b) Decreases in emphysema
c) Increases during lung fibrosis
d) Is ratio of changes of lung volume to changes in transmural pressure

116) Concerning the ventilation/perfusion ratio all the following are

correct, except:
a) Is normally 0.8
b) Is uniform throughout the lung
c) It increases in the apex
d) Decreases in the base

61
117) Increased airway resistance occurs in all, except:
a) Sympathetic stimulation
b) Bronchial asthma
c) Parasympathetic stimulation
d) Old age

118) Concerning ventilation perfusion ratio:

a) There is more ventilation than perfusion at the base of the lung
b) The ratio is constant throughout the lung
c) The ratio is 8.0 for the whole lung
d) The ratio is less at the base than at the apex of the lung

119) Which of the following is higher at the apex of the lung that
standing?
a) Blood flow
b) V/Q ratio
c) Ventilation
d) Lung compliance

120) Alveolar ventilation. All are true, except:

a) May be reduced while the pulmonary ventilation is normal
b) Is decreased by shallow rapid respiration
c) Equals 350 ml x 16 at rest
d) Equals tidal volume x respiratory rate

121) Which of the following is a component of the respiratory

membrane?
a- Plasma membrane of the alveolar cell
b- Plasma membrane of the capillary endothelial cell
c- Fused basal laminae of the alveolar and the capillary endothelial cell
d- All of the above

62
122) The following factors affect the rate of gas diffusion through the
respiratory, membrane:
a- Thickness of the respiratory membrane
b- Surface area of the membrane
c- Partial pressure difference between the two sides of the membrane .
d- All of the above

123) Concerning distribution of ventilation and perfusion:

a- Gradient of change in ventilation is greater than that for perfusion
b- Ventilation increases as we go up the lung
c- Perfusion increases as we go up the lung
d- VA/Q ratio at apex is greater than at base

124) Which one of the following is higher at the apex of the lung than
at the base when a person is standing?
a. VA/Q ratio
b. Blood flow
c. Ventilation
d. PaCO2

125) Ventilation/perfusion (VA/Q) ratio:

a- Is lower at the apices of the lungs than at bases in the upright position
b- Is expected to increase in obstructive lung disease
c- May be determined from the respiratory minute volume and the
pulmonary blood flow
d- Is expected to increase following blockage of a major pulmonary artery

126) Most CO2 is transported in the blood in the form of:

a- Dissolved gas
b- Carbaminohemoglobin
c- Bicarbonate ion
d- Carboxyhemoglobin

127) About 70% of the carbon dioxide is transported to the lungs:

63
a- In the form of bicarbonate ions
b- In the form of carbonic acid
c- In the form of Carbaminohemoglobin
d- In chemical combination with albumin

128) With respect to the binding of carbon monoxide to haemoglobin:

a- The binding site of carbon monoxide to Hb is different from that of
oxygen
b- Hemoglobin has a higher affinity for carbon monoxide than for oxygen
c- 97% of carbon monoxide transported by blood is in solution in the
water of plasma
d- The carbon monoxide-Hb dissociation curve lies to the right of the
oxygen-Hb dissociation curve

129) Carbon dioxide is transported in blood in the following forms,

except:
a- In solution in the water of plasma
b- As bicarbonate ion
c- Combined to hemoglobin to form Carboxyhemoglobin
d- Bound to plasma proteins

130) With respect to gas exchange across the alveolar membrane:

a- Oxygen diffusion across the alveolar membrane is more rapid CO2
b- The intracellular partial pressure of CO2 is l00 mmHg
c- The partial pressure of CO2 in tissue fluid is 45 mmHg
d- The partial pressure of CO2 in venous blood leaving tissues is 40 mmHg

131) Adult hemoglobin:

a) has more affinity for O2 than myoglobin.
b) has less affinity for O2 than fetal Hb.
c) has 2 alpha and 2 gamma polypeptide chain.
d) has iron in the ferric state.

132) Oxygen-Hb dissociation curve shift to the left by:

64
a) acidosis.
b) adult Hb.
c) fetal Hb.
d) hyperthermia.
133) Tidal CO2:
a) the amount of CO2 in the tidal air.
b) carried mainly in the form of carbamino compound.
c) is about 20 ml.
d) is the amount of CO2 added to each 100 ml arterial blood.

134) During the chloride shift phenomena:

a) bicarbonate ion enters the red cell in exchange for chloride.
b) red cell size in venous blood is increased.
c) blood pH rises.
d) potassium ion concentration inside RBC decreases.

135) Most of venous CO2 is in the form of:

a) bicarbonate.
b) carbonic acid.
c) dissolved CO2.
d) carbamino haemoglobin.

136) During the chloride shift phenomena:

a) Bicarbonate ion enter the red cell in exchange for chloride
b) Red cell size in venous blood is increased
c) Blood pH rises
d) Potassium ion concentration inside RBC decreases

137) In chloride shift phenomena at the tissues:

a) Chloride ions increases in plasma
b) Bicarbonate ions increase in plasma
c) Na+ ions diffuses out of RBCs
d) K+ ions diffuses in the RBCs

65
138) Carbonic anhydrase:
a- Is present in plasma
b- Is present in erythrocytes
c- Catalyzes the reaction between carbon dioxide and hemoglobin
d- Catalyzes decomposition of carbonic acid into bicarbonate & hydrogen

139) How much oxygen is normally carried in the blood?

a- 2 ml oxygen/100 ml blood
b- 5 ml oxygen/100ml blood
c- 10 ml oxygen/100ml blood
d- 20 ml oxygen/100ml blood

140) The oxygen-hemoglobin dissociation curve will shift to the right with:
a- Acute alkalosis
b- Decrease in PCO2
c- Decrease in temperature
d- Exercise

141) Which of the following variables must be known to calculate

Inspiratory reserve volume?
a- Tidal volume and expiratory reserve volume
b- Tidal volume and residual volume
c- Tidal volume, vital capacity and expiratory reserve volume
d- Tidal volume, vital capacity and residual volume

142) All about diffusion of 02 across a membrane is correct, except:

a- Increasing the thickness of the membrane would decrease flow of O2
b- Increasing the area of the membrane would increase the flow of O2.
c- If you increased the alveolar concentration of C2, you would increase
the total flow of O2 across the alveolar membrane
d- The lower the diffusion coefficient, the higher the flow.

143) Oxygen unloading:

a- Increases with increased Paco2

66
b- Decreases with increase in temperature
c- Decreases with increase in 2, 3 DPG
d- Increases with exposure to carbon monoxide poisoning

144) Concerning the interaction of respiratory centers in the

brainstem and their effect on respiration:
a- Sectioning the brainstem above the pons, near the inferior colliculus of
the midbrain results in immediate respiratory arrest
b- The medullary center is a discrete group of neurons whose rhythmicity
is abolished when the brain is transected above and below this area
c- Transection above the apneustic center results in prolonged expiration
and very short inspiration
d- Transection of the afferent fibers of the vagus and glossopharyngeal
nerves results in prolonged inspiration and shortened expiration

145) The most potent stimulator of the respiratory center is:

a- Decrease in the blood oxygen tension
b- Decrease in the blood hydrogen ion concentration
c- Decrease in the carbon dioxide tension in the cerebrospinal fluid
d- Increase in the blood carbon dioxide tension

146) The largest amount of CO2 is transported by the blood as:

a) CO2 in plasma.
b) H2CO3 in plasma.
c) HbCO2.
d) HCO3- ion in plasma.

147) Medullary Inspiratory neurons are stimulated by:

a) afferent impulses from proprioceptors.
b) Vagal afferent from lung stretch receptors.
c) increased hydrogen ion concentration in arterial blood.
d) afferent impulses from arterial baroreceptors.
148) Regarding the nervous control of respiration:
a) the apneustic centre sends inhibitory impulses to inspiratory centre,

67
b) the Inspiratory centre is present in the medulla.
c) the cerebral cortex has no effect on respiration.
d) Pneumotaxic centre stimulates inspiration.

149) Non-chemical influence on respiration include all of the

following, EXCEPT:
a) pain sensation through hypothalamus.
b) swallowing.
c) coughing,
d) hypoxia.

150) Destruction of the pneumotaxic centre and cutting of the vagus

nerves lead to:
a) apnea.
b) hyperventilation.
c) periodic breathing
d) apneusis.

151) If the vagus nerves are cut, the respiratory rate:

a) increases
b) decreases.
c) remains constant.
d) disappears.

152) Respiratory chemoreceptors:

a- In the carotid and aortic bodies are most important in the ventilator
response to an elevated PCO2
b- In the carotid and aortic bodies are strongly stimulated by the low
arterial O2 content in anemic patients
c- In the medulla are responsive to changes in arterial PCO2
d- All of the above are correct

153) Which of the following discharge spontaneously during quiet

breathing?

68
a- Stretch receptors in lung
b- Motor neurons of respiratory muscles
c- Dorsal respiratory group of neurons
d- Ventral respiratory group of neurons

154) Pneumotaxic center functions primarily to:

a- Limit inspiration
b- Prolong expiration
c- Decrease rate
d- Discharge inspiratory action potentials

155) Peripheral chemoreceptors are stimulated by:

a- Hypoxia
b- Anemia
c- Hypocapnia
d- Alkalosis

156) All about peripheral chemoreceptors is true, except:

a- Are located in the carotid sinus
b- Are located in the aortic body
c- Are more sensitive to changes in PC2 than the central chemoreceptors
d- Have a rich blood supply

157) The carotid and aortic bodies increase their rate of discharge in
response to:
a- Blood H+ concentration
b- Blood O2 content,
c- The partial pressure of CO.
d- Dissolved oxygen in CSF

158) Concerning alveolar ventilation, all is true, except:

a- May be reduced while the pulmonary ventilation is normal.
b- Is decreased by shallow rapid respiration.
c- Equals 350 ml x 16 at rest.

69
d- Equals tidal volume x respiratory rate.

159) The respiratory center receives inhibitory impulses from:

a) Hypothalamus
b) Cerebral cortex
c) Aortic bodies
d) Pneumotaxic center

160) The main function of the Pneumotaxic center is:

a) To limit the duration of inspiration
b) To activate the apneustic center
c) To mediate the Herring Breuer reflexes
d) Inhibited by Vagal afferents

161) Concerning the respiratory centers:

a) Apneustic center is a medullary center
b) Ramp signal increase 3 second and stop 2 second
c) Bilateral vagotomy is associated with increase the tidal volume
d) Damage of the apneustic centers causes apneustic respiration

162) An increase in the activity of the afferent nerves associated with

Hering-Breuer reflex indicates that:
a) inspiration is occurring.
b) expiration is occurring .
c) pulmonary congestion.
d) PO2 in arterial blood is less than 60 mmHg.

163) The basic respiratory rhythm is generated in the :

a) Pneumotaxic centre.
b) nucleus parabrachial is.
c) dorsal medulla.
d) apneustic centre.

164) The apneustic center:

70
a) Is present in the lower pons
b) Can initiate rhythmic inspirations
c) Sends excitatory impulses to the Inspiratory center
d) All of the above

165) Concerning the chemoreceptors:

a) The aortic bodies are the main central chemoreceptors
b) Central chemoreceptors are not normally responding to hypercapnia
c) Peripheral chemoreceptors are stimulated mainly by alkalosis
d) Impulses from the carotid bodies to the RC are carried through the
glossopharyngeal nerve

166) Peripheral and central chemoreceptors are stimulated

simultaneously as a result of:
a) A decrease in arterial oxygen content
b) A decrease in arterial oxygen tension
c) An increase in arterial carbon dioxide tension
d) An increase in arterial pH

167) Peripheral chemoreceptors respond mainly to:

a) Alkalosis
b) Hypoxia
c) Hypothermia
d) Hyperventilation

168) Hypoxic hypoxia is caused by:

a) Hyperventilation
b) Anemia
c) Ascending to high altitude
d) Severe cold

169) Concerning CO-poisoning:

a) Hemoglobin content is normal
b) Oxygen tension is below normal

71
c) Oxygen content is normal
d) The oxyhemoglobin dissociation curve is shifted to the right

170) Anemic hypoxia is caused by all of the following, except:

a) CO-poisoning
b) Blood loss
c) Anemia
d) Polycythemia

171) Stagnant hypoxia is caused by:

a) A large increase in RBC count (polycythemia)
b) A decrease in Hb content (anemia)
c) Ascending to high altitude
d) None of the above

172) Anemic hypoxia is caused by:

a) Lung fibrosis
b) Congestive heart failure
c) Cyanide poisoning
d) CO-poisoning

173) Cyanosis is caused by which of the following:

a) An increase in the affinity of hemoglobin for oxygen
b) A decrease in the percent of red blood cells
c) An increase amount of carbon monoxide
d) An increase in the concentration of deoxygenated hemoglobin

174) Cyanosis:
a) is due to pressure of 5 mg reduced hemoglobin per 100 ml blood
b) is observed in anemia,
c) is observed in hypoxic hypoxia
d) is observed in cyanide poisoning.

72
175) Anemic hypoxia include all of the following, EXCEPT:
a) lower Hb content.
b) low number of RBCs.
c) low PO2 in physical solution in arterial blood.
d) increased 2,3 DPG.

176) Regarding cyanosis, all are true, EXCEPT:

a) is more likely with a person with a high than with a low Hb level.
b) is produced when there is at least 5 gms of reduced Hb/100 ml blood.
c) is seen in histotoxic type of hypoxia.
d) when it is central in origin the tongue is also affected.

177) Cyanosis:
a) is due to the presence of reduced Hb more than 5 gm% in blood.
b) is seen in histotoxic hypoxia.
c) is commonly seen in anemic person.
d) is due to increased % of oxygenated Hb.

178) Hypoxic hypoxia is caused by:

a) more oxygen in air.
b) poisoning of oxidative enzyme.
c) high altitude
d) too little Hb in blood.

179) Cyanosis is caused by:

a) presence of 5 mg of reduced hemoglobin per 100 ml blood.
b) carbon monoxide poisoning.
c) low Hb percentage.
d) slow blood flow.

180) Hypoxic hypoxia is caused by:

a) more oxygen in air.
b) poisoning of oxidative enzyme.
c) high altitude.

73
d) too little Hb in blood.

181) Cyanosis:
a) can be seen in a person if his capillary blood contains 5 mg reduced
hemoglobin per 100 ml blood.
b) is observed in histotoxic hypoxia.
c) is seen in carbon monoxide poisoning.
d) is present in severe ventilation perfusion imbalance.

182) Hypoxic hypoxia:

a) is characterized by normal oxygen tension in arterial blood and normal
saturation of hemoglobin with oxygen,
b) is accompanied with cyanosis.
c) is produced by carbon monoxide poisoning.
d) is accompanied with low hemoglobin content.

74
 Respiration
Key Answers of MCQ
No. Answer No. Answer No. Answer No. Answer No. Answer
1 C 37 A 77 B 117 A 157 A
2 A 38 C 78 B 118 D 158 D
3 D 39 B 79 A 119 B 159 D
4 B 40 C 80 D 120 D 160 A
5 D 41 B 81 B 121 D 161 C
6 D 42 D 82 C 122 D 162 A
7 B 43 C 83 A 123 D 163 C
8 C 44 C 84 A 124 A 164 D
9 D 45 D 85 C 125 D 165 D
10 D 46 D 86 B 126 C 166 C
11 D 47 B 87 A 127 A 167 B
12 D 48 A 88 C 128 B 168 C
13 C 49 B 89 A 129 C 169 A
14 B 50 B 90 B 130 C 170 D
15 A 51 C 91 C 131 B 171 D
16 B 52 D 92 B 132 C 172 D
17 A 53 C 93 B 133 D 173 D
18 A 54 C 94 C 134 B 174 C
15 A 55 A 95 B 135 A 175 C
16 B 56 B 96 C 136 B 176 C
17 A 57 B 97 D 137 B 177 A
18 A 58 D 98 C 138 B 178 C
19 A 59 A 99 A 139 D 179 D

75
20 D 60 A 100 D 140 D 180 C
21 B 61 D 101 B 141 C 181 D
22 D 62 B 102 D 142 D 182 B
23 A 63 B 103 C 143 A
24 B 64 C 104 C 144 D
25 D 65 C 105 D 145 d
26 C 66 A 106 A 146 D
27 B 67 D 107 D 147 A
28 C 68 D 108 B 148 B
29 A 69 D 109 B 149 D
30 D 70 D 110 C 150 D
31 D 71 D 111 B 151 B
32 D 72 D 112 D 152 C
33 D 73 D 113 A 153 C
34 B 74 D 114 A 154 A
35 A 75 B 115 D 155 A
36 C 76 D 116 D 156 A

76
 RESPIRATORY MODULE
RES 216

Medical Biochemistry

BY

PROF. DR. MARWA MATBOLI SAYED

PROFESSOR & HEAD OF BIOCHEMISTRY DEPARTMENT

FACULTY OF MEDICINE - MTI

PROFESSOR OF BIOCHEMISTRY
FACULTY OF MEDICINE - ASU

77
78
Respiratory Module MCQ

 QUIZ On Electron Transport Chain

1. All of the following statements about the complex that carries out the synthesis of ATP
during oxidative phosphorylation are correct except:

(A) It is located on the inner mitochondrial (C) It contains Fo and F1 subunits

membrane.
(D) It can bind molecular O2
(B) It is inhibited by Oligomycin
(E) It is called complex V
2. Which of the Following is oxidized by the respiratory chain?

a. NADPH d. NAD+.

b. Acetyl CoA. e. NADH

c. Oxygen.
3. Cyanide toxicity results from inhibition of:

a. Succinic dehydrogenase d. PDH

b. Cytochrome C oxidase e. Malate dehydrogenase
c. Cytochrome C reductase
1. Given a healthy individual with a normal metabolic rate, which of the following compounds
is the most energy rich?

a. ATP c. NADH
b. GTP d. FADH2
2. What phase of cellular respiration has the highest ATP yield

a. Glycolysis d. Oxidative phosphorylation

b. Fermentation e. Krebs cycle
c. Gluconeogenesis
3. Why is oxygen necessary in aerobic cellular respiration?

a. It is the final electron acceptor in the electron transport chain.

b. It provides the hydrogen nuclei needed to create a proton gradient in the intermemberane space.
c. It is needed for glycolysis, which begins the process of respiration in cells.
d. It is important in creating oxaloacetic acid in the Kreb's cycle.

79
 Quiz on Role of respiration in glycolysis, CO2 and H2O production

I. What is the term for metabolic pathways that release stored energy by breaking down complex
molecules?

A) anabolic pathways C) fermentation pathways

B) catabolic pathways D) thermodynamic pathways

II. Which of the following statements describes NAD+?

A) NAD+ is reduced to NADH during both D) NAD+ can donate electrons for use in
glycolysis and the citric acid cycle. oxidative phosphorylation.

B) NAD+ has more chemical energy than E) In the absence of NAD+, glycolysis can still
NADH. function

C) NAD+ is reduced by the action of

hydrogenases.

III. Where does glycolysis takes place?

A) mitochondrial matrix D) mitochondrial intermembrane space
B) mitochondrial outer membrane E) cytosol
C) mitochondrial inner membrane
IV. The oxygen consumed during cellular respiration is involved directly in which process or
event?
A) glycolysis C) the citric acid cycle
B) accepting electrons at the end of the electron D) the oxidation of pyruvate to acetyl CoA
transport chain E) the phosphorylation of ADP to form ATP

80
 Quiz on Biochemistry of the lung and pulmonary system

 1) Mention the name of the major constituent of lung surfactant.

 2) What is the disease which results from deficiency of this constituent.
 3) premature baby, shortly after birth, presents with rapid breathing, and intercostal
retractions. A blood gas analysis reveals low oxygen and acidosis. A diagnosis of
Respiratory Distress Syndrome is quickly made. This syndrome is seen in newborns with
immature lungs whose pneumocytes do not synthesize enough:
a) phosphatidyl choline c) sphingosin
b) phosphatidyl inositol d) sphingomyelin

1. Which ECM molecule provides structure while allowing certain tissues to expand and contract
(e.g., lungs during breathing, intestine during digestion)?
A. collagen D. laminin
B. elastin E. glycosaminoglycans
C. fibronectin

2. As regard Elastin; all of the following are true except

a. is synthesized by the liver d. is digested by a1-antitrypsin
b. contains cross-linking polypeptides involving e. can be stretched to several times its length
lysine and can still return to its original shape.
c. is the most common connective tissue in
lungs

3. People with cystic fibrosis may experience:

A. Infertility C. Respiratory infections
B. Exocrine pancreatic insufficiency D. All of the answers are correct
4. A 10-month-old girl is brought to the physician by her father because she does not seem to be
gaining weight despite an increased appetite. He says that she passes 8 to 10 stools daily. She has
no history of major medical illness, but during the past winter she had several infections of the ear

81
and respiratory tract that were treated with antibiotics. She appears malnourished but is in no
apparent distress. She is at the 5th percentile for length and weight. Diffuse crackles are heard
over the lower lung fields on auscultation. Her sweat chloride concentration is 69 mmol/L. Which
of the following is the most likely underlying cause of these findings?
(A) Abnormal cystic fibrosis transmembrane (D) α-l-Fucosidase deficiency
conductance regulator gene function (E) Impaired production of phosphatidylcholine
(B) Acid phosphatase deficiency (lecithins)
(C) Atypical conjugation of arylsulfatase

Quiz on general protein metabolism

1. Most of the ammonia released from L-amino acids reflects the coupled action of
transaminase and
(A) L-glutamate dehydrogenase (D) Asparaginase
(B) L-amino acid oxidase (E) D-amino acid oxidase
(C) Glutaminase
2. A glucogenic amino acid is one which is degraded to
A.keto-sugars C.pyruvate or citric acid cycle
B.either acetyl CoA or acetoacetyl CoA intermediates
D.none of the above
3. Oxidative deamination is the conversion of an amino
A. group from an amino acid to a keto acid D. group from an amino acid to a carboxylic
B. acid to a carboxylic acid plus ammonia acid
C. acid to a keto acid plus ammonia
4. An example of a transamination process is
A.glutamate = hexanoic acid + NH3 C.aspartate + α ketoglutarate = glutamate +
B.aspartate + hexanoic acid = glutamate + oxaloacetate
oxaloacetate D.glutamate = α-ketoglutarate + NH3
5. Which of the following enzymes is responsible for the transfer of amino groups from an amino
acid to an alpha keto acid?

82
A. Transaminase C. Deaminase
B. Transketolase D. Lyase
6. An amino group shifts from a donor amino acid to an acceptor acid and the acceptor becomes a
new amino acid in a process called ____________.
A) deamination
B) glucose-alanine cycle
C) transamination
D) crossamination

83
84
 RESPIRATORY MODULE
RES 216
Medical Microbiology and Immunology

BY

ASSIST. PROF. DR. NAGWA MAHMOUD

ASSIST. PROFESSOR & HEAD OF MEDICAL MEICROBIOLOGY & IMMUNOLOGY

DEPARTMENT
FACULTY OF MEDICINE - MTI

ASSIST. PROFESSOR OF MEDICAL MICROBIOLOGY & IMMUNOLOGY

FACULTY OF MEDICINE - ASU

85
86
 Theoretical revision on Respiratory system
Upper Respiratory Tract Infections

1.Diseases caused by which of the following bacteria can be prevented by a

toxoid vaccine?
a) Bacillus anthracis.
b) Corynebacterium diphtheriae.
c) Clostridium perfringens.
d) Bacillus cereus.

2. Which of the following BEST describes the laboratory diagnosis of

rhinoviruses?
a) Demonstration of virus particles by electron microscopy.
b) Serological tests for detection of IgM.
c) Isolation in cell culture.
d) Detection of viral RNA using PCR-based assay.

3. A 15-year-old man presented with fever 38.5OC and sore throat. On examination,
his throat is inflamed, enlarge cervical lymph nodes are palpable and an enlarged
spleen. A throat culture reveals no β-hemolytic colonies. A heterophil antibody test
was positive. Which of the following viruses is the MOST likely cause of this
condition?
a) Adenovirus.
b) Epstein–Barr virus.
c) Cytomegalovirus.
d) Influenza virus.

4. A 7-year-old girl with unknown vaccination history presented to her pediatrician

with fever of 38 0C, sore throat, malaise, and difficulty breathing. Physical
examination revealed cervical lymphadenopathy and a gray membrane covering
the oropharynx. Which of the following BEST describes the etiologic agent of this
infection?
a) Gram positive cocci in chains, bacitracin sensitive.
b) Gram-positive budding yeasts; form germ tubes in serum at 370C.
c) Gram-negative anaerobic bacilli; normal flora of the mouth.
d) Gram-positive bacilli, produce toxin that inhibits protein synthesis.

87
5. A 10-year-old boy presented with fever of 39°C, sore throat and malaise.
Physical examination revealed inflamed tonsils with yellowish exudate and
cervical lymphadenopathy. A throat culture revealed β-hemolytic, Gram-positive
cocci in chains. Which of the following is the MOST likely causative agent of this
condition?
a) Corynebacterium diphtheriae.
b) Streptococcus agalactiae.
c) Streptococcus pyogenes.
d) Staphylococcus aureus.

6- A 9-year-old boy attending summer camp developed fever of 39.5°C, sore

throat, headache, fatigue and conjunctivitis. Within the next 2 days, several of the
other campers developed similar symptoms, which last for 5 days.
Which of the following activities is the MOST likely source of the campers’
infection?
a) Hiking in wooded areas with tall grass.
b) Swimming in the camp pool.
c) Walking barefoot in the bath house.
d) Sleeping outdoors without protective netting.

7.A 1-year-old girl presented with fever and pain in her right ear. On examination,
the drum is found to be perforated and a bloody exudate is seen. A Gram stain of
the exudate reveals Gram-positive diplococci. Which one of the following
organisms is the most likely cause of this infection?
a) Streptococcus pneumoniae.
b) Streptococcus pyogenes.
c) Staphylococcus aureus.
d) Corynebacterium diphtheriae.

Upper and Lower Respiratory Tract Infections

1.Which of the following is the MOST accurate regarding antigenic shift of
influenza virus?
a) Antigenic shift variants appear frequently every year.
b) Occurs in both influenza A and B viruses.
c) Due to mutations in the RNA genome.
d) Due to reassortment of segments of the RNA genome.

2. Which of the following viruses is the MOST likely cause of croup?

a) Parainfluenza viruses.
b) Mumps virus.
c) Measles.
d) Parvovirus B19.

88
3.Which of the following is CORRECT regarding the prevention of influenza?
a) The killed vaccine gives lifelong immunity.
b) The live attenuated vaccine is given by nasal spray.
c) Oseltamivir is effective against influenza A virus only.
d) The main antigen in the recombinant vaccine is viral neuraminidase.

4.Which one of the following is most accurate regarding the structure of influenza
virus?
a) The viral genome is segmented single-stranded positive sense RNA.
b) The internal ribonucleoprotein is the type-specific antigens.
c) The hemagglutinin and neuraminidase are the group-specific antigens.
d) The virus has helical nucleocapsid and outer lipoprotein envelope.

5.A 5-year-old boy with incomplete vaccination history presented to the emergency
department with vomiting and severe cough in which he can’t catch his breath.
Physical examination revealed fever and conjunctival injection. A nasopharyngeal
swab grew Gram-negative coccobacilli on Bordet Gengou media. Which of the
following is the mechanism of action of the toxin involved in this disease?
a) Inhibits protein synthesis.
b) Blocks release of acetylcholine.
c) Blocks release of inhibitory transmitters GABA and glycine.
d) Stimulates adenylate cyclase with a consequent rise in cAMP.

6. A 10-month-old infant has a runny nose, mild cough and low-grade fever for
several days. The cough got worse and sounded like ‘’ parking’’. A lateral x-ray
examination of the neck showed a subglottic tracheal narrowing. Which of the
following viruses is the MOST likely etiologic agent of this condition?
a) Rhinovirus.
b) Adenovirus.
c) Parainfluenza virus.
d) Coronavirus.

7. Which of the following BEST describes the genome of parainfluenza virus?

a) Segmented single stranded, positive sense RNA.
b) Segmented single stranded, negative sense RNA.
c) Non-segmented, single-stranded, positive-sense RNA.
d) Nonsegmented single stranded, negative sense RNA.

89
Lower Respiratory Tract Infections
1.Which one of the following regimens is optimal treatment for patient with latent
tuberculosis?
a) Isoniazid and gentamicin for 2 weeks.
b) Isoniazid and rifampin for 4 months.
c) Isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months.
d) Isoniazid for 9 months.

2.A 55-year-old man developed pneumonia. The organism isolated from the
sputum is alpha hemolytic, optochin sensitive, Gram-positive cocci. Which of the
following structures provides protection against phagocytosis for the MOST
likely etiologic agent of this infection?
a) M protein.
b) Teichoic acid.
c) Capsule.
d) Flagellar protein.

3.A 25-year-old bird collector presented with flu-like symptoms. He has low grade
fever, headache, and a dry hacking cough. There are no crackles heard on
auscultation, and a radiograph shows small streaks of infiltrate. It is determined
that he has pneumonia. Which of the following is the MOST likely organism causing
his disease?
a) Streptococcus pneumoniae.
b) Haemophilus influenzae.
c) Chlamydia pneumoniae.
d) Chlamydia psittaci.

4. Which of the following is the drug of choice for treatment of Chlamydia psittaci
infection?
a) Azithromycin.
b) Ciprofloxacin.
c) Doxycycline.
d) Ampicillin.

5. A 50-year-old male presented with cough, fever, sharp chest pain that is worse
when coughing or taking a deep breath, headache, achy joints, and sweatiness at
night. His only recent travel was a weeklong vacation to San Joaquin Valley 3
weeks ago. Microscopic examination of a fresh sputum specimen revealed
numerous spherules. Which of the following fungi is the most likely cause of this
patient’s condition?
a) Histoplasma capsulatum.
b) Aspergillus fumigatus.
c) Candida albicans.
d) Coccidioides immitis.

90
6.A 12-year-old boy with acute leukemia had a bone marrow transplant and is on
immunosuppressive drugs. he is markedly granulocytopenic. Seven days after the
transplant, he developed fever and productive cough of bloody, purulent sputum.
Chest X-ray revealed patchy consolidation. A wet mount of the sputum revealed
septate hyphae with Y-shape branching. Which of the following fungi is the most
likely etiologic agent of this patient’s condition?
a) Histoplasma capsulatum.
b) Coccidioides immitis.
c) Candida albicans.
d) Aspergillus fumigatus.

7.Which of the following BEST describes the morphology of Aspergillus

fumigatus?
a) Yeast cells.
b) Metachromatic granules.
c) Septate hyphae.
d) Pseudohyphae.

8.A 45-year-old man with COPD was admitted to the ICU with fever and poor
oxygenation. On the fifth day of mechanical ventilation, the nurse reported
increased respiratory secretions on endotracheal tube suctioning. Culture of
endotracheal aspirate revealed oxidase positive Gram-negative bacilli. Which of
the following bacteria is the most likely causative agent of this condition?
a) Escherichia coli.
b) Klebsiella pneumoniae.
c) Haemophilus influenzae.
d) Pseudomonas aeruginosa.

9.A 6-month-old infant is brought to the pediatric emergency room with cough and
fever of 38°C. symptoms started with a mild cough and runny nose 2 days ago, but
has progressively worsened. On examination, the infant has prominent nasal
flaring, subcostal retractions on inspiration and loud expiratory wheezes in all lung
fields. Which of the following viruses is the MOST likely cause of this respiratory
illness?
a) Adenovirus.
b) Influenza virus.
c) Parainfluenza virus.
d) Respiratory syncytial virus.

91
10. A 40-year-old presented with fever, night sweats, weight loss and cough
productive of blood streaked sputum for the past 4 weeks. An acid-fast stain of the
sputum revealed acid-fast bacilli. Culture of the sputum revealed no growth at 7
days. Which of the following is the MOST likely causative organism of this
infection?
a) Haemophilus influenzae.
b) Klebsiella pneumoniae.
c) Mycobacterium tuberculosis.
d) Mycoplasma pneumoniae.
11. A 30-year-old man presented with nonproductive cough, chest pain, and fever.
Gram stain and culture of sputum on routine Culture on a special medium
containing several lipids produced colonies with fried-egg appearance after 1 week.
Serology 2 weeks later revealed high titer of cold agglutinins. Which of the
following fungi is the most likely etiologic agent of this patient’s condition?
a) Mycoplasma pneumoniae.
b) Coxiella burnetii.
c) Chlamydia pneumoniae.
d) Legionella pneumophila.
12- A 50-year-old man presented with a fever of 39°C and a cough productive of
yellowish sputum. Gram stain of the sputum shows small Gram-negative bacilli. colonies
grow on chocolate agar supplemented with hemin and NAD. Which one of the following
bacteria is the most likely cause of this infection?
a) Bordetella pertussis.
b) Klebsiella pneumoniae.
c) Legionella pneumophila.
d) Haemophilus influenzae.

13.A 30-year-old woman working with wool presented to the physician with
symptoms of dyspnea, cyanosis, hemoptysis, and chest pain. Chest x-ray reveals
mediastinal widening. Sputum cultures are negative for all routine respiratory
pathogens. Diagnosis was made by serology. Which of the following organisms is
the most likely causative agent of this infection?
a) Legionella pneumophila.
b) Bacillus anthracis.
c) Chlamydia pneumoniae.
d) Mycoplasma pneumoniae.

14-A 60-year-old alcoholic and smoker patient developed signs and symptoms of
pneumonia. Gram stain of the sputum reveals neutrophils but no bacteria.
Colonies appear on buffered charcoal yeast (BYCE) agar. Which of the following
bacteria is the MOST likely causative agent of his pneumonia?
a) Bordetella pertussis.
b) Haemophilus influenzae.
c) Legionella pneumophila.
d) Klebsiella pneumoniae.

92
15.A known HIV positive patient with CD4 count of 75 cells/mm3 developed fever
38.5°C, nonproductive cough, dyspnea. Chest X-ray revealed diffuse interstitial
infiltration with ground glass appearance. Microscopic examination of bone
marrow aspirate revealed oval yeast cells within macrophages Which of the
following is the MOST likely etiologic agent of this patient’s condition?
a) Aspergillus fumigatus.
b) Histoplasma capsulatum.
c) Coccidioides immitis.
d) Cryptococcus neoformans.

Emerging viral diseases

1.Shortly after returning from a hiking trip, a 30-year old male experienced
influenza like symptoms but 4 days later he suddenly developed acute respiratory
failure and required mechanical ventilation. Which of the following viruses is the
MOST likely cause of his condition?
a) Influenza virus.
b) Hantavirus.
c) Parainfluenza virus.
d) Adenovirus.

2.Regarding the previous case, which of the following best describes the mode of
transmission of MOST likely etiologic agent?
a) Tick bite.
b) Ingestion of contaminated meat.
c) Inhalation of aerosols of rodent’s feces.
d) Mosquito bite.

3. Which of the following is the target receptor of MERS-CoV in the respiratory

tract?
a) Angiotensin-converting enzyme-2.
b) Neuraminic acid.
c) Sialic acid.
d) CD-26.

93
 Model answer of Theoretical revision on Respiratory system

Upper Respiratory Tract Infections Emerging viral diseases

Question Answer
1 B Question Answer
2 D 1 B
3 B 2 C
4 D 3 D
5 C
6 B
7 A

Upper and Lower Respiratory Tract Infections

Question Answer
1 D
2 A
3 B
4 D
5 D
6 C
7 D

Lower Respiratory Tract Infections

Question Answer
1 D
2 C
3 D
4 C
5 D
6 D
7 C
8 D
9 D
10 C
11 A
12 D
13 B
14 C
15 B

94
 CASE Study Activity
I. An 8-year-old girl presented with sore throat and fever of 39.50C of 4 days
duration. Physical examination revealed enlarged tonsils and her tongue appears
bright red, also an erythematous rash is observed on her chest and both arms.
1.What is your provisional diagnosis of this child’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this child’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3. What exotoxin produced by the most likely causative organism is responsible
for the erythematous rash in this child?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4.Mention the diagnostic methods for this child’s condition.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
II. A 5-year-old girl, with no history of vaccination presented with sore throat, fever,
malaise, and difficulty in breathing. On examination, a gray membrane is noted
covering the pharynx. Growth of the etiologic agent on tellurite blood agar
produced black colonies.
1.What is your provisional diagnosis of this child’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this child’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3. Mention the exotoxin produced by most likely causative organism and explain
its mode of action.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4.Mention the preventive vaccine of this child’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………

95
III- A 4-year-old boy is presented to the pediatric emergency department with
severe series of hacking coughs that end with inspiratory whoop. Physical
examination revealed fever and erythematous conjunctiva. CBC revealed
lymphocytosis. A nasopharyngeal swab grew Gram-negative coccobacilli on
Bordet Gengou media.
1.What is your provisional diagnosis of this child’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this child’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3.What is the mode of transmission of the etiologic agent of this child’s
condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4. Mention the exotoxin responsible for the lymphocytosis present in this child.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
IV. A 60-year-old smoker presented with a fever of 390 C, dry cough, chest pain and
mental confusion. Laboratory analysis revealed hyponatremia. Gram stain of the
sputum reveals neutrophils but no bacteria but culture of the sputum specimen
grew the causative organism on buffered charcoal yeast extract agar.
1.What is your provisional diagnosis of this patient’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3.What is the mode of transmission of the etiologic agent of this patient’s
condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
4. Mention the preventive strategies for infections caused by the etiologic agent
of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………

96
V. A known AIDS patient with CD4 count of 150 cells/mm3 presented with
nonproductive cough, low-grade fever and shortness of breath. Chest X-ray
revealed diffuse interstitial infiltration with ground glass appearance. Microscopic
examination of Giemsa stained lung biopsy revealed cysts.
1.What is your provisional diagnosis of this patient’s presentation?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
2.What is the most likely causative organism of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………
3.Mention the best drug to be used for prophylaxis against other attacks by the
etiologic agent of this patient’s condition?
………………………………………………………………………………………………………
………………………………………………………………………………………………………

97
 Practical Work Sheets
CASE 1
A 10-year old girl presented with fever (390C), sore throat and dysphagia. Physical
examination revealed enlarged tonsils with whitish pus-filled spots and enlarged
cervical lymph nodes.

1.What is your clinical diagnosis of this patient’s condition? Mention the MOST
likely etiologic agent.

……………………………………………………………………………………………….
……………………………………………………………………………………………….
2.What is the appropriate specimen to be collected from this patient?

……………………………………………………………………………………………….
……………………………………………………………………………………………….
3. What is the preferred medium for isolation of the causative organism of this
patient’s condition? Mention the expected effect of the grown colonies of the
organism on the medium.

……………………………………………………………………………………………….
……………………………………………………………………………………………….
4.Mention the expected result and the importance of performing catalase test for
the causative organism.

……………………………………………………………………………………………….
……………………………………………………………………………………………….

98
 CASE 2
A 50-year-old man presented with abrupt onset of fever (390C), chills, chest pain
and cough productive of rust colored sputum. A chest x-ray revealed a dense
consolidation of the right lower lobe.
1.What is your clinical diagnosis of this patient’s condition? Mention the MOST
likely etiologic agent.

……………………………………………………………………………………………….
……………………………………………………………………………………………….
2.What is the appropriate specimen to be collected from this patient?

……………………………………………………………………………………………….
……………………………………………………………………………………………….
3. What is the effect of the grown colonies of the causative organism on
MacConkey agar medium? Mention the type of this medium.

……………………………………………………………………………………………….
……………………………………………………………………………………………….
4.Mention the effect of the causative organism on triple sugar iron medium.

……………………………………………………………………………………………….
……………………………………………………………………………………………….

99
 References
-Review of Medical Microbiology and Immunology (2022) Warren L, 17 th edition by
McGraw- Hill Education.

-Microbiology: an introduction (2013) Gerard J. Tortora, Berdell R. Funke, Christine

L. Case, 11th Edition, Pearson Education

-Jawetz, Melnick, & Adelberg’s Medical Microbiology (2019) Riedel S, Morse SA,
Mietzner TA, Miller S, 28th edition by McGraw-Hill Education.

-Case files Microbiology (2015) Toy EC, Debord CR, Wagner A, Mackenzie C, Pillai
AS, Kettering JD, 3rd edition by McGraw-Hill Education.

- Lippincott’s illustrated Q&A review of microbiology and immunology (2010)

Buxton B A, Lauritz A. Jensen and Randal K. Gregg. 1st edition by Lippincott Williams &
Wilkins. Microbiology.

-Sherris Medical microbiology (2014) Kenneth J. Ryan, C. George Ray, Nafees

Ahmad, W. Lawrence Drew, Michael Lagunoff, Paul Pottinger, L. Barth Reller, Charles
R. Sterling. 6th edition, McGraw-Hill Education.

-Mims’ medical microbiology (2013) Goering RV, Dockrell MH, Zuckerman M,

Chiodini PL, Roitt MI, 5th edition, Elsevier.
-https://www.cdc.gov/coronavirus/2019-ncov/

-Guidelines for the Management of Adults with Hospital-acquired, Ventilator-

associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med
Vol 171. pp 388–416, 2005. DOI: 10.1164/rccm.200405-644ST.

- APIC (2005): APIC text of infection control and epidemiology, 2nd edition, Association
for professionals in infection control and epidemiology, INC.

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 RESPIRATORY MODULE
RES 216

Medical Parasitology

BY

ASSIST. PROF. DR. FATIMA ZAHARAN

HEAD OF MEDICAL PARASITOLOGY DEPARTMENT

FACULTY OF MEDICINE - MTI
ASSIST. PROFESSOR OF MEDICAL PARASITOLOGY FACULTY OF MEDICINE - ASU

AND
ASSIST. PROF. DR. SALWA MORSI
ASSIST. PROFESSOR OF PARASITOLOY- FACULTY OF MEDICINE - MTI
ASSIST. PROFESSOR OF MEDICAL PARASITOLOGY FACULTY OF MEDICINE
CAIRO UNIVERSITY

101
102
 PARASITOLOGY QUESTIONS
I. MULTIPLE CHOICE QUESTIONS

1. Which of the following is the mode of infection of Paragonimus westermani

parasite?
a) Drinking contaminated water
b) Eating infected crustacea
c) Eating infected fish
d) Eating infected water chestnuts

2. Which of the following is the specimen of choice for diagnosis of paragonimiasis?

a) Bile drainage
b) Duodenal aspirate
c) Rectal biopsy
d) Sputum

3. Which of the following parasitic larvae can cause Visceral larval migrans in human?
a) Ascaris lumbricoides
b) Ancylostoma duodenale
c) Toxocara canis
d) Strongyloides stercoralis

4. A 9-year-old boy who plays with dogs developed skin rash, and an enlarged liver and
spleen for 1 year. Laboratory investigations showed eosinophilia and
hypergammaglobulinemia. Which of the following parasites is the most likely cause of
this infection?
a) Ancyclostoma duodenale
b) Strongyloides stercolaris
c) Ascaris lumbricoides
d) Toxocara canis

5. Which of the following parasites can be transmitted to human by consumption of

crustacean?
a) Strongyloides stercolaris
b) Ancylostoma duodenale
c) Toxocara canis
d) Paragonimus westermani

6. Which of the following is a Lung flukes, endemic in parts of Asia, Africa, and
America, parasitize in pulmonary cysts and cause a tuberculosis-like clinical picture?
a) Paragonimus westermani
b) Ancyclostoma duodenale
c) Strongyloides stercolaris
d) Ascaris lumbricoides

103
 7. A family of four goes on a vacation for 3 weeks to Central and South America.
They consume the usual diets in all the areas they visit, including raw and pickled
crustacean. Weeks later, two members produce brown sputum when coughing,
hemoptysis, and eosinophilia, while the others are asymptomatic. The diagnostic
stage of this disease may be found in feces and which of the following specimens?
a) Biopsied muscle
b) Blood
c) Duodenal contents
d) Sputum

II. CASE STUDY ACTIVITY

I. A 17-year-old exchange student returned home after finishing his school year in
Japan. He complained of fever, cough, and reddish sputum. The patient gave a
history of eating unusual Japanese foods “crayfish”. The physician ordered cultures
for routine bacteriology and tuberculosis, but no acid-fast bacteria were noted. The
physician then ordered sputum examination for parasitic diseases and the laboratory
found an operculated egg.
a) What parasite do you suspect?
b) Why did the physician order a parasitic examination of the patient’s sputum?
c) Mention the intermediate hosts included in this parasite’s life cycle?
d) Mention other specimen that can be used to diagnose this disease?

II. A two and half year-old male child from a rural background presented with fever,
anorexia, hepatosplenomegaly and marked eosinophilia. Further investigations
revealed hypergammaglobulinemia. CT scan of Abdomen showed low density
lesions in liver and liver biopsy showed granulomas and infiltrates of lymphocytes
and eosinophils. There were no pets at home but plenty of stray dogs in
neighborhood. We decided to get a confirmatory serological diagnostic test and the
result was positive. The child was treated for it with oral Albendazole and responded
dramatically.

a) What parasite do you suspect? What is the name of the disease?

b) What is the mode of infection of this disease?

104
 KEY ANSWER
I- MULTIPLE CHOICE QUESTIONS
1. B
2. D
3. C
4. D
5. D
6. A
7. D
II- CASE STUDY ACTIVITY
1. a) Paragonimus westermani
b) In endemic areas, patients with manifestations as tuberculosis but
was found negative for it, paragonomiasis should be suspected and its
diagnosis is done by detecting egg in sputum.
c) 1st Freshwater snail
2nd Freshwater crabs or crayfish (crustacea)
d) Stool
2. a) Toxocara canis & Toxocara cati
Visceral larva migrans
b) Ingestion of embryonated eggs in contaminated soil

105
106
 RESPIRATORY MODULE
RES 216

Pathology

BY

PROF. DR. HALA KHEIDR

PROFESSOR & HEAD OF PATHOLOGY DEPARTMENT

FACULTY OF MEDICINE - MTI

PROFESSOR OF PATHOLOGY
FACULTY OF MEDICINE - CAIRO UNIVERSITY

107
108
1- As regard pneumonia, all of the following is true EXCEPT:
a) It is patchy or diffuse inflammation of lungs with consolidation.
b) May be bacterial or non-bacterial.
c) Lobar pneumonia is caused by viral infection.
d) Interstitial pneumonia may end in honeycomb lung.

2- Regarding lung abscess due to aspiration of septic material:

a) It is usually related to peripheral bronchus.
b) It is rarely caused by inhalation of foreign body.
c) It is usually multiple.
d) The pleura and hilar LNs are usually not affected.

3- Regarding Tuberculosis:
a) It is chronic disease characterized by formation of non- infective granuloma.
b) There are two methods of infection.
c) Has three types of tissue reactions.
d) In 1ry tuberculosis tissue destruction is less marked than 2ry type.

4- Regarding pneumoconiosis, all of the following is true EXCEPT:

a) Bagassosis is caused by inhalation of cane sugar fibers.
b) It is a group of acute lung diseases caused by inhalation of dust particles.
c) Microscopic picture of silicosis shows multiple foreign body granulomas.
d) Pleural mesothelioma is a common complication of asbestosis.

5- Which of the followings is true regarding pulmonary edema:

a) It can be complicated by asphyxia.
b) It can be caused by gradual withdrawal of pleural effusion.
c) The lungs appear grossly small in size and weight with dry surface.
d) Chronic pulmonary edema is caused by increased intracranial tension.

6- Pneumothorax:
a) It is an accumulation of serous fluid in pleural cavity.
b) It can be caused by rupture of tuberculous cavity.
c) It is caused by Meig’s syndrome.
d) It can be a complication of ruptured aneurysm.

7- Concerning malignant mesothelioma which of the followings is true:

a-It is a low grade tumor with good prognosis arising from mesothelial cells.

b- Silicosis is the most common predisposing factor.

109
 c- It can not spread

d-It may show monophasic epithelial, or biphasic microscopic patterns.

8-Adenocarcinoma of the lung

a- is more common in males

b- occurs at lung periphery

c- is related to smokers

d- is the commonest type of bronchogenic carcinoma

9-One of the followings can be a predisposing factor of mesothelioma

a- silicosis

b- bronchiectasis

c- anthracosis

d- asbestosis

10- A male patient 65 years old presented by loss of weight, haematuria, chest pain and haemoptysis.
Radiology revealed multiple very large cannon ball like nodules. Biopsy was done. What is the most
probable microscopic finding of this lesion?

a- metastatic renal carcinoma

b- tuberculous granuloma

c- mesothelioma

d- bronchogenic carcinoma

11-One of the followings is not a criteria of bronchial asthma

a- excess mucin secretion

b- mainly expiratory dyspnea

110
 c- squamous metaplasia

d- curshmanns spirals

12-Regarding centriacinar emphysema

a- it affects the alveoli and spares the bronchioles

b- it is the main type occurring in smokers

c- it is a reversible condition

d- it is the main type occurring with Alpha 1- AT deficiency

13-Which of the followings is not a suppurative disease

a-Byssinosis

b- Empyema

c- Bronchiectasis

d- Postpneumonic lung abscess

14-One of the followings is not a site of primary TB

a- liver

b- lung

c- tonsil

d- intestine

15-Barrel shaped chest is the term given due to

a- Congenital bronchiectasis

b- Emphysema

c- Extrinsic bronchial asthma

111
 d- Lung in Adult Respiratory Distress Syndrome

16-Regarding chronic fibrocaseous pulmonary tuberculosis one of the followings is not true

a- it is a type of 2ry pulmonary TB

b- lymph nodes are enlarged

c- characterized by apical and acinar lesions

d- can be complicated by lung fibrosis

17-Septic bronchopneumonia can be complicated by

a- mesothelioma

b- toxic myocarditis

c- bronchial asthma

d- bronchial carcinoid

18-One of the followings is not a chronic obstructive pulmonary disease

a- Kartegner syndrome

b- emphysema

c- simple chronic bronchitis

d- bronchial asthma

112
 RESPIRATORY MODULE
RES 216
Pharmacology

BY

PROF. DR. HISHAM ALSHEKHEPY

PROFESSOR & HEAD OF PHARMACOLOGY DEPARTMENT

FACULTY OF MEDICINE - MTI

PROFESSOR OF PHARMACOLOGY
FACULTY OF MEDICINE - CAIRO UNIVERSITY

113
 MCQ
Respiration
1- Which of these groups of drugs is used for asthma treatment?
a. Methylxanthines
b. Muscarinic blocking agents
c. Beta2 - stimulants
d. All above

2-One of the following drugs belongs to non-selective beta agonist:

a. Salbutamol
b. Isoprenaline
c. Salmeterol
d. Terbutaline

3- Select the side-effect characteristic for selective beta2- agonist:

a. Depression of the breathing center
b. Tachycardia
c. Peripheral vasoconstriction
d. Dry mouth

4- Select the bronchodilator drug related to xanthine:

a. Atropine
b. Orciprenaline
c. Adrenaline
d. Theophylline

5- Select the bronchodilator drug belonging to sympathomimetics:

a. Isoprenaline
b. Ephedrine
c. Atropine
d. Salbutamol

6- The benefit of sustained release theophylline use is the prevention of night

asthmatic attacks. It’s:
a. True
b. False

7- The mechanism of methylxanthines action is:

a. Inhibition of the enzyme phosphodiesterase
b. Beta2 -adrenoreceptor stimulation
c. Inhibition of the production of inflammatory cytokines
d. Inhibition of M-Cholinoceptors

8- Which one of the following muscarinic blocking agents is used especially as an

anti-asthmatic?
a. Atropine
b. Ipratropium
c. Hyoscine
d. Emepronium

114
9- Indicate the side effect of Theophylline:
a. Bradycardia
b. Increased myocardial demands for oxygen
c. Depression of respiratory center
d. Elevation of the arterial blood pressure

10- All of the following drugs are inhaled glucocorticoids except:

a. Triamcinolone
b. Beclomethasone
c. Sodium cromoglycate
d. Budesonide

11- Choose the drug belonging to membrane stabilizing agents:

a. Zileuton
b. Sodium cromoglycate
c. Zafirlukast
d. Montelukast

12- Select the drug, which is a 5-lipoxygenase inhibitor:

a. Budesonide
b. Sodium cromoglycate
c. Zileuton
d. Beclomethasone

13-Indicate the drug that is a leukotriene receptor antagonist:

a. Sodium cromoglycate
b. Zafirlukast
c. Zileuton
d. Triamcinolone

14- The following drugs may induce bronchospasm except:

a- Pilocarpine
b- Acetylcholine.
c- Aspirin
d- Ephedrine

15- Which of the following is most useful in treatment of acute attack of bronchial
asthma:
a- Aspirin
b- Methacholine
c- Salbutamol inhalation
d- Disodium cromoglycate

16-- One of the following drugs is a useful bronchodilator but not acting via
stimulation of Beta adrenoceptors in respiratory smooth muscles:
a- Adrenaline
b- Isoprenaline
c- Salbutamol
d- Theophylline

115
17- In asthmatics, mast cell degranulation could be inhibited by the following
except:
a- Disodium cromoglycate
b- Cromolyin
c- Aminophylline
d- Pindolol

18- The following drug is contraindicated in bronchial asthma:

a- Nedocromil
b- Zafirlukast
c- Morphine
d- Salbutamol

19- Moniliasis of mouth is a complication of inhalation of:

a- Beclomethasone
b- Formoterol
c- Ipratropium
d- Nedocromil

20- all of the following drugs can dilate the bronchi, except:
a- Salbutamol
b- Theophylline
c- Ipratropium
d- Sodium cromoglycate

21- treatment of status asthmaticus include all the following, except:

a- Adequate hydration
b- Salbutamol by nebulizer
c- Aminophylline orally
d- Antibiotics

22- First line in treatment of acute bronchial asthma as quick relief medication:
a- Inhaled B2 - agonist
b- Muscarinic agonist inhalation
c- Oral theophylline
d- Adenosine intravenously

23- Concerning salbutamol, which of the following is incorrect:

a- It stimulates beta-2 adrenoceptors
b- It may produce bradycardia
c- It relaxes bronchial smooth muscle
d- It may cause skeletal muscle tremors

24- Terbutaline specifically stimulates:

a- Alpha 1 receptors
b- Beta 1 receptors
c- Beta 2 receptors
d- Muscarinic receptors

116
25- The following drugs are useful in management of asthma except:
a- Montelukast
b- Leukotreine
c- Prednisolone
d- Terbutaline

26- all of the following statements about anti-cough remedies are true, except:
a. Cough suppressants are called antiemetics.
b. Dry irritative cough can be suppressed.
c. Guaiacol is a stimulant expectorant.
d. Codeine can be complicated by constipation.

27-Indicate the drug belonging to antitussives of narcotic type of action:

a. Sodium benzoate
b. dihydrocodeinone
c. benzonatate
d. Libexin

28- Select the drug belonging to non-narcotic antitussives:

a. dihydromorphinone
b. Dextromethorphan
c. Codeine
d. Methadone

29- Indicate the expectorant with the reflex mechanism:

a. Sodium benzoate
b. Sodium citrate
c. Ambroxol
d. Derivatives of Ipecacuanha

30-. Select the antitussive agent with a peripheral effect:

a. Codeine
b. Narcotine
c. benzonatate
d. Morphine

31- Long-term control medications of chronic bronchial asthma include the

following drugs except
a- Selective long-acting β2-agonists (LABA) as salmeterol
b- Slow release theophylline
c- Inhaled corticosteroids as budesonide
d- β-adrenergic antagonists as pindolol

32- Which one of the following adrenergic agonists drugs is classified as an

adrenergic agonist, but has not physiologically relevant or clinically useful effects
on airway smooth muscle tone?
a- Albuterol
b- Norepinephrine
c- Salmeterol
d- Terbutaline

117
33- An elderly man with COPD is being managed with several drugs, one of which
is inhaled ipratropium. Which of the following is the main mechanism that accounts
for the beneficial effects of this drug?
a- Blocks muscarinic receptors that cause bronchospasm
b- Inhibits cAMP breakdown via phosphodiesterase inhibition
c- Prevents antigen-antibody reactions that lead to mast cell mediator release
d- Stimulates ventilatory rates (CNS effect in brain's medulla)

34- A 16-year-old girl treated for asthma develops skeletal muscle tremors that are
drug-induced. Which of the following was the most likely cause?
a- Salbutamol
b- Beclomethasone
c- Cromolyn
d- Ipratropium

35- A 26-year-old patient with asthma is being treated with montelukast. Which of
the following is the main mechanism by which this drug works?
a- Inhibits cAMP breakdown via phosphodiesterase inhibition
b- Enhances release of epinephrine from the adrenal (suprarenal) medulla
c- Increases airway β-adrenergic receptor responsiveness to endogenous
norepinephrine
d- Blocks the proinflammatory effects of certain arachidonic acid metabolites

Respiration Key Answers

1 d 21 c
2 b 22 a
3 b 23 b
4 d 24 c
5 b 25 b
6 a 26 a
7 a 27 b
8 b 28 b
9 b 29 d
10 c 30 c
11 b 31 d
12 c 32 b
13 b 33 a
14 d 34 a
15 c 35 d
16 d
17 d
18 c
19 a
20 d

118