Pulmonology: Tuberculosis and DOTS

1. Cerebral tuberculosis focus is called
a) Simmond’s
b) Simmons
c) Richs
d) Wigard’s

2. Which of the following are seriously ill TB patients except:
a) Pericardial
b) Bilateral pleural
c) Peritoneal
d) GIT
e) Pott’s disease
f) TB osteomyelitis of long bones
g) Genitourinary

3. All the following second line TB drugs are bacteriocidal except:
a) Capreomycin
b) Cycloserine
c) Kanamycin
d) Thiacetazone

4. Time interval for occurance of genitourinary TB after primary infection is:
a) 1-2 yrs
b) 5-15 yrs
c) 20-30 yrs
d) >50 yrs

5. Live TB bacteria is identified by:
a) Sputum smear
b) BACTEC
c) PCR
d) ELISA

6. Wigard’s focus is infection of TB of:
a) Brain
b) Hilar LNE
c) Eye
d) Endothelium

7. Treatment default is for:
a) >1 month
b) >2 months
c) >3months
d) >4 months

8. Class IV DOTS regimen is for:
a) Relapse
b) MDR
c) Chronic cases
d) HIV patients

9. A chronic case of TB is diagnosed when:
a) Sputum positive after 5 months of ATT
b) Sputum positive after retreatment for treatment failure
c) Patient who has sequelae and TB focus sfter ATT
d) Immunosuppressed patient with positive sputum

10. A Class I DOTS patient after 3 months of ATT was subjected to sputum examination was found to be positive then you will:
a) Diagnose chronic TB
b) Diagnose MDR TB
c) Continue ATT for 1 more month and repeat sputum examinatio
d) Diagnose treatment failure

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Pulmonology: Lung collapse

1. In collapse the changes are:
a) Reduction in lung volume but normal air volume
b) Reduction in both air and lung volume
c) Increase in air but decrease in lung volume
d) Increased lung and air volume.

2. Decrease in air volume but normal lung volume occurs in:
a) Fibrosis
b) Collapse
c) Consolidation
d) Emphysema

3. The direct sign of collapse in X ray is:
a) Mediastinal shift
b) Crowding of ribs,blood vessels and bronchi
c) Hyperdensity with loss of aeration
d) Shifting of interlobar fissures

4. In active collapse all are true except:
a) Intrapleural pressure in negative
b) Trachea is pushed to opposite side
c) Oppsite lung is emphysematous
d) No chest bulging on same side

5. Which lobe is collapsed in the x ray enclosed:
a) Rt Middle lobe
b) Rt Lower lobe
c) Rt upper lobe
d) Posterior segment of Rt upper lobe

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Pulmonology: Lung cavity

1. Thick walled cavity is seen in all except:
a) Wegeners granulomatosis
b) Adeno- carcinomas
c) Tuberculosis
d) Fungal infection

2. Bleb is defined as:
a) Diameter>1cm and wall <1mm
b) Diameter <1cm>1 mm
c) Diameter >1cm and wall>1mm
d) Diameter <1cm and wall<1mm

3. Shaggy border is seen in:
a) Wegeners granulomatosis
b) Lung abscess
c) Hydatid cyst
d) Bronchogenic carcinoma

4. Cavity is:
a) Lined by epithelium
b) Has no epithelial lining
c) Wall thickness <1mm
d) Tuberculosis causes thin walled cavities

5. Signs of a superficial collapsible and communicating cavity are all except:
a) Cavernous breathing
b) Amphoric breathing
c) Crackpot sign
d) Post tussive suction

6. The sign of an empty cavity is:
a) Post tussive suction
b) Crackpot sign
c) Cavernous breathing
d) Drop sound

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Pulmonology: Chest wall deformities

1.Normal AP:TD ratio is:
a) 5:7
b) 3:4
c) 5:9
d) 1:2

2. Pthnoid chest has a APD:TD ratio of atleast:
a) 1:2
b) 3:4
c) 2:1
d) 7:5

3. Pomphret’s heart is seen in:
a) Pectus carinatum
b) Pectus excavatum
c) Pthnoid chest
d) Alar chest
e) Flail chest

4. Painful chest deformity is:
a) Rickety rosary
b) Scorbutic rosary
c) Alar chest
d) Pthnoid chest

5. Normal subcostal angle is _____________ O:
a) 90-110
b) 120-140
c) 140-160
d) 160 onwards

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Pulmonology: Auscultation

1. Normal vesicular breath sound has a frequency of :
a) 15-200 Hz
b) 200-600Hz
c) 20-2000Hz
d) Variable

2. In vesicular breath sound the I:E ratio is:
a) 1:3
b) 3:1
c) 4:1
d) 3:2

3. All the following are predominantly low pitched except:
a) Vesicular BS
b) Cavernous BS
c) Tubular BS
d) Amphoric BS

4. Amphoric BS is heard in all except:
a) Bronchopleural fistula
b) Tension pneumothorax
c) Large superficial communicating cavity
d) Collapse with patent bronchus

5. Clinical description of Breath Sounds was given by:
a) Laenac
b) Sapira
c) Goll
d) Edmondo

6.All are true regarding crepitations according to ATS definitions except:
a) Non continous
b) Non musical
c) Explosive
d) Duration >250ms
e) Duration <250 ms

7. Al the following are late inspiratory crepitations except:
a) Idipopathic pulmonary fibrosis
b) Bronchiectasis
c) Lupus lung
d) Asbestosis

8. ILD shows which added sounds:
a) Squawks
b) Expiratory wheeze
c) Fixed monophonic wheeze
d) Coarse crepitations
e) Death rattle

9. All the following differentiate rub from crackles except:
a) Discontinous
b) Superficial
c) Cough variation
d) Tenderness
e) Non segmental

10. De espine sign is positive in all except:
a) Central pneumonia
b) Mediastinal lymphoma
c) Thymoma
d) Mediastinal neuroblastoma

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Pulmonology: Percussion

1. Normal percussion has a frequency of :
a) 140Hz
b) 240Hz
c) 640Hz
d) 1400Hz

2. A treatise on the clinical interpretation of percussion was given by:
a) Sapira
b) Auenbrugger
c) Christopher
d) Koch

3. Auenbrugger’s father was a:
a) Percussionist
b) Brewer
c) Sewer
d) Tailor

4. Stony dullness is heart in all except:
a) Pleural effusion
b) Empyema
c) Pleural thickening
d) Parenchymal disease with pleursal thickening

5. The following are cardinal rules of percussion except:
a) Movements should arise from wrist
b) Move from abnormal to normal areas of percussion note
c) Direct percussion should not be done outside medial 1/3 of clavicle
d) Lesions more than 5cm below cannot be detected

6. Percussion myokymia is seen in:
a) Myotonia
b) Paraneoplastic manifestations
c) Wasting PTB
d) All of the above.

7. Tidal percussion is positive in all except:
a) Liver mass
b) Subdiaphramatic absecess
c) Normal
d) Diaphramatic paralysis

8. Barkun’s method is the percussion for:
a) Kornigs isthmus
b) Traubes space
c) Splenic percussion
d) Direct percussion of clavicle

9.Traube’s area is dull in all conditions except:
a) Splenomegaly
b) Left pleural effusion
c) Lung mass on Left side
d) Full stomach
e) Achalasia cardia
f) Situs inversus

10. During crack pot elicition :
a) Keep the mouth of pt. Open
b) Keep your mouth open
c) Percuss with a knee hammer
d) Use direct percussionKeep both your mouths open

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Pulmonology: Clubbing

1.Lovibond’s sign is:
a) Cyanosis
b) Clubbing
c) Edema
d) Crepitations

2. Angle beyond which you will say there is definite clubbing:
a) 160
b) 180
c) 200
d) 210

3. Pachydermatoperiosteitis (Congenital/Touraine solente gole syndrome) is known to spare:
a) Index finger
b) Thumb
c) Little finger
d) Big toe

4. Pseudoclubbing is seen in all except:
a) Hansens disease
b) Vinyl chloride workers
c) Hyperparathyroidism
d) Leukaemia
e) Mesothelioma

5. Which of the following is not a suspected cause for clubbing:
a) Neurogenic
b) PTH
c) PG
d) PDGEF
e) GH
f) Insulin
g) Hypoxia
h) Ferrirtin

6. Unilateral clubbing is seen n all except:
a) Hemiplegia
b) Pancoast syndrome
c) Brachial AV fistulas
d) PDA
e) Anuerysms of subclavian artery

7. In which finger does clubbing occurs first:
a) Index finger
b) Thumb
c) Bigtoe
d) Little finger

8.Unidigital clubbing is seen in:
a) Trauma
b) Gout
c) Sarcoidosis
d) All of the above

9. Acute clubbing is clubbing occurring in:
a) 1-7 days
b) 7-10 days
c) 10-14 days
d) 21-30 days

10. In Parrot beaking or Gr III clubbing there is :
a) Increase in both AP and Transverse diameter
b) Increase in AP diamter alone
c) Increase in transverse diameter alone
d) Whole distal phalanx is enlarged

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Pulmonology: Bronchopulmonary segments

1. Which BP segment is absent in left lung and what percentage:
a) Lateral basal segment (90%)
b) Lateral basal segment (80%)
c) Medial basal segment (90%)
d) Medial basal segment (8%)

2. Which of the following is not exclusive of BP segments:
a) Pulmonary arterial branches
b) Bronchial arterial branches
c) Pulmonary veins
d) Bronchial veins
e) Tertiary bronchus

3. Kornigs isthmus overlies:
a) Apical BP segment
b) Medial basal apical seg ment
c) Lateral beasl medial segment
d) Posterior segment

4. Secondary pulmonary TB commonly affects which BP segment
a) Apical
b) Posterior
c) Anterior
d) Anterior basal

5. Which BP segment is contigous with arch of aorta:
a) Medial BP segment of middle lobe Rt
b) Superior segment of Lingula
c) Anterior segment Lt lung
d) Posterior segment in Lt. Lung

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Cardiology: Myocardial infarction

1.Mortality in killips class III :
a) 10-20%
b) 30-40%
c) 80-90%
d) 100%

2. Accelerated idioventricular rhythm in MI is a :
a) Ventricular ectopic
b) Atrial ectopic
c) Heart block
d) None of these

3. Heart rate in Accelerated idioventricular rhythm is__________(beats/min),if his SA node is beating at 60-100/min:
a) 60-100
b) 100-120
c) >140
d) >160

4. The following are studies on MI treatment except:
a) TIMI
b) GUSTO
c) AIRE
d) ALLHAT
e) PROGRESS

5. All indications of Permanaent pacemeaker in MI except:
a) Wenckebach
b) Mobitz type II
c) Third degree heart blocks in AWMI
d) Sick sinus syndrome

6. Post MI myocardial ruprure is common in all except:
a) Males
b) Hypertensives
c) Female
d) First week
e) Fourth week
f) Both a,e
g) Both c,e

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Cardiology: Echo for Physicians

1.Pioneering works in ECHO was done by:
a) Angle
b) Edler
c) Frossmann
d) Christopher

2. Typical frequency produced by an ECHO is:
a) 1 MHz
b) 2.5 MHz
c) 5 MHz
d) 20MHz

3. Which of the following structures are poorly visualized by TEE:
a) Mitral valve
b) Aortic valve
c) Left atrium
d) Left ventricle

4. What is the defect in the ECHO attached:
a) Aortic aneurysm
b) Ventricular aneurysm
c) Aortic dissection
d) RWMA

5. Indication/s of TEE in IE is/are except:
a) One major dukes criteria but normal TTE
b) Two minor dukes criteria but normal TTE
c) Vegetation in TTE itself
d) Suspected aortic valve abscess
e) Prosthetic valves
f) All patients suspected of IE

6. The best semi quantitative assessment of RV function is:
a) Pulmonary valve movements
b) Tricuspid annulus movements
c) Pulmonary Doppler flow assessment
d) Right atrial dilatation

7. Mc Connels sign in ECHO is seen in:
a) PAH
b) Tricuspid regurgitation
c) Pulmonary embolismIE

Cardiology: Sgarbossa's criteria

1. Cabrera’s sign refers to :
a) Slurring of ascending limb of S wave >0.05s in V3,V4.
b) Slurring of the ascendind limb of R wave >0.05s in I,aVl,V5-6
c) Extreme left axis deviation
d) ST elevation >1mm in two contigous leads.

2.Which is most diagnostic of all of MI in LBBB:
a) Slurring of ascending limb of S wave >0.05s in V3,V4.
b) Slurring of the ascendind limb of R wave >0.05s in I,aVl,V5-6
c) Extreme left axis deviation
d) ST elevation >1mm in two contigous leads.

3. Patients studied for sgarbossa’s criteria was from the following study:
a) TIMI
b) GCCT
c) GUSTO
d) UKPDS
e) LIVE

4. Is chapman’s sign present in the ecg enclosed:
a) NO
b) YES
c) Cannot determineOnly cabrera’s sign is present

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Cardiology: Pulmonary hypertension

1.First sign of pulmonary venous hypertension in CXR is:
a) Cephalisation of pulmonary veins
b) Kerly B lines
c) Kerly A lines
d) Batwing appearance

2.Pulmonary hypertension is present if pulmonary MAP is at least:
a) 10
b) 15
c) 20
d) 30

3. In CXR hilar to thoracic ratio of at least ____________ is suggestive of PAH:
a) 0.34
b) 0.44
c) 0.54
d) 0.64

4. In CXR the diameter of first descending pulmonary artery should be atleast_______for diagnosis of PAH:
a) 12
b) 13
c) 14
d) 15
e) 16

5. In which condition is pulmonary hemosiderinosis seen:
a) Primary PAH
b) Secondary PAH
c) Pulmonary venoocclussive disease
d) Haemochromatosis

6.What type of cyanosis is common in PAH:
a) Central
b) Peripheral
c) Pigmentary
d) None of these

7.In a patient with PAH, with regular pulse shows absent “a” wave in JVP it indicates:
a) RAF
b) LAF
c) LVF
d) RVF
e) Pulmonary embolism

8. Which produces maximum rise in PAP:
a) Acute pulmonary embolism
b) Chronic pulmonary embolism
c) Maladie de roger
d) Tricuspid stenosis

9. Pulmonary edema occurs when PVP is atleast:
a) 10
b) 15
c) 25
d) 30

10. Mean survival of patients with Primary PAH is :
a) 1.8 yrs
b) 2.8 yrs
c) 3.8 yrs
d) 4.8 yrs

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Cardiology: Infective endocarditis

1.The composition of vegetation includes:
a) Fibrin
b) Platelet
c) Microorganism
d) Inflammatory cells
e) All of the above

2.Dukes criteria for diagnosis of IE was published in:
a) 1900
b) 1985
c) 1994
d) 2000

3.Fever of IE is typically absent in patients with:
a) CCF
b) Diabetes
c) CRF
d) Liver failure
e) Previous Rx with antibiotics
f) Less virulent organisms
g) All of the above

4. The best predictive sign of myocardial abscess in IE of aortic valve is:
a) Tachycardia
b) Ejection systolic murmur
c) S3 of LV
d) ECG showing new onset AV block

5. Duke criteria is based on a/an:
a) Physician
b) Patient
c) Hospital
d) University

6.Emboli of IE commonly affect in the following order:
a) Kidney>spleen>liver>mesenteric arteries
b) Mesenteric arteries>liver>spleen>kidney
c) Spleen>kidney>liver>mesenteric arteries
d) Liver>spleen>kidney>mesenteric arteries

7. Drug of choice for HACEK organisms in IE:
a) Vancomycin
b) Ceftriaxone
c) Ampicillin
d) Metronidazole

8.The strongest indication for surgery in IE is:
a) Persistence of fever
b) Septic embolism
c) Congestive cardiac failure
d) Perivalvular invasive disease

9. All are true regarding Libman sach’s endocarditis except:
a) Seen in ventricular surface of valves
b) Multiple
c) Commonly affects aortic valve than mitral valve
d) Recur after valve replacement

10.Roth spots are seen in :
a) IE
b) Leukaemias
c) Scurvy
d) Aplastic anaemia
e) All of the above

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Cardiology: Heart diseases in Pregnancy

1.Cardiac output and blood volume is maximum during ___________ weeks of pregnancy:
a) 12-14 weeks
b) 20-24 weeks
c) 30-32 weeks
d) At delivery

2.Haemodynamic changes regress to normal after __________ weeks of delivery:
a) 1-2
b) 2-4
c) 4-6
d) 6-8

3. Echocardiogram is indicated when the following are detected in pregnancy except:
a) Diastolic murmur
b) Continous murmur
c) Gr 2 systolic murmur
d) ECG abnormalities

4. A healthy female with RHD MS/MR at the time of hospital vaginal delivery should:
a) Receive Infective endocarditis prophylaxis.
b) Shall decide after a predelivery ECHO for IE prophylaxis
c) No need for IE prophylaxis if there are no features of infection
d) Shall do a cardiology consultation

5. If a patitent needs BMV during pregnancy , ideal timing is:
a) First trimester
b) Second trimester
c) Third trimester
d) Before delivery

6. A female in first trimester with congenital AS with transvalvular gradient >50mm of and LVF symptoms came to you for advice , the ideal course is:
a) Terminate pregnancy
b) Immediate valve replacement
c) Manage medically with nifedipine
d) Ask her to continue normally till delivery.

7.Urogenital abnormalities in fetus is seen when treated with:
a) Hydralazine
b) Digoxin
c) Enalapril
d) B-blockers

8.AHA/ACC guideline for absolute indication for termination of pregnancy is in:
a) Eissenmenger syndrome
b) PrimaryPulmonary hypertension
c) Cyanotic congenital heart disease
d) Pulmonary veno occlusive disease
e) All of the above

9.When an anti coagulant is indicated in a pregnant female, the drug distribution during 1-12weeks,12-36weeks,36-delivery -- is respectively:
a) Heparin,Heparin,Heparin
b) Heparin,Warfarin,Heparin
c) Heparin,Warfarin,Warfarin
d) Warfarin,Heparin,Heparin

10.Caeserian section is indicated in:
a) RHD-MS/MR
b) RHD -AS/AR
c) VSD
d) Coarctation of aorta

11. Peripartun cardiomyopathy can occur upto________months of delivery.
a) 3
b) 4
c) 5
d) 6

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Cardiology: Medical Rx of Valvular heart disease

1. All the following group of drugs may be used for symptom control in AS except:
a) B- Blockers
b) Digoxin
c) Nitrates
d) Frusemide
e) HMG co-A inhibitors

2.All the following drugs are contraindicated in AS except:
a) Nifedipine
b) Hydralazine
c) Prazosin
d) B-Blockers
e) ACE inhibitors
f) Frusemide

3.Which of the following drugs are contraindicated in AR:
a) Diuretics
b) Calcium channel blockers
c) B-blockers
d) Frusemide
e) Nitroprusside

4.Which is the drug of choice in acute AR:
a) Digoxin
b) B- blockers
c) Nitroprusside
d) Morphine
e) Phenylephrine

5.Treatment of choice for acute AR is:
a) Nitroprusside
b) Surgery
c) Digoxin
d) B-Blockers

6. Rule of ‘55’ deals with the treatment of which valvular heart disease:
a) AR
b) AS
c) MR
d) MS
e) PS

7. Name of balloon commonly used for BMV in MS is :
a) Inoue
b) TUBBS
c) St.Jude
d) Lindsay

8. Digoxin produces all except:
a) First degree heart block
b) Mobitz type I
c) Mobitz type II
d) Complete heart block

9.Digoxin produces all except:
a) LAHB
b) PSVT
c) VT
d) CHB

10. Treatment of Digoxin toxicity include all except:
a) Phenytoin
b) Quinidine
c) Digoxin antibodiesKCl

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Cardiology: Valvular heart diseases

1.Mitral valve prolapse (MVP) commonly affects:
a) Anterior mitral leaflet.
b) Posterior mitral leaflet
c) Both equally.
d) None of the above.

2. In MVP the duration of murmur decreases with:
a) Digoxin
b) Amyl nitrate
c) Squatting.
d) Standing.
e) Valsalva maneuver

3. Click in MVP narrows with:
a) Digoxin
b) Valsalva
c) Amylnitrate
d) Standing
e) All of the above

4. All are features of severe MR except:
a) Cardiomegaly
b) S3
c) Loud S1
d) Diastolic rumble
e) Systolic thrill over apex

5.Which of the following is a true statement:
a) Systolic murmur at apex is seen in AS and MS.
b) In a patient with AF intensity of murmur varies from beat to beat in AS.
c) In a patient with AF intensity of murmur varies from beat to beat in MR
d) AF is poorly tolerated in MR than MS.
e) Aneurysmal dilatation of LA is seen in MS than in MR of equal severity

6. Which of the following is correctly matched in case of AS:
a) Syncope= 2years survival.
b) LVF = 4 years survival.
c) Angina = 2 years survival.
d) Syncope= 3 year survival.

7. LBBB in a patient with AS is commonly due to involvement of :
a) Left posterior fascicle
b) Left anterior fascicle
c) RBB
d) SA node
e) AV node

8. “Mayne’s sign” is seen in:
a) Aortic stenosis
b) Aortic regurgitation
c) Mitral stenosis
d) Mitral regurgitation
e) All of the above

9. Causes of low pulse pressure in severe AR are the following except:
a) Acute AR
b) AR with AS or MS
c) AR with CCF
d) AR with systemic hypertension
e) AR with MR

10. All are features of acute AR except:
a) Pulse pressure normal
b) Austin flint (presystolic) murmur present
c) S3 common
d) ECG and CXRs normal.
e) None of above.

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