Sample practice multiple choice questions

Block B 2016

Please note: These randomly designed questions sample a small proportion of Block B content; they do
not comprehensively cover all of the important concepts that have been presented. The main purpose of
these questions is to primarily to demonstrate the style that will appear on the final Block B exam and
secondarily to assist with selective review of lecture content.

An answer key is found at the end of each set of 10 questions.

1. Which of the following is incorrect:

a. Each hemoglobin molecule can carry up to 4 molecules of oxygen

b. The hematocrit quantifies the proportion of red blood cells in a known volume of blood
c. Bleeding and hemolysis are associated with an increased reticulocyte count
d. Anemia of chronic disease is typically associated with a normal mean cell volume (MCV)
e. Reticulocytes can be distinguished from mature circulating red blood cells by the presence of a
nucleus

2. Implantation occurs at which of the following stages:

a. zygote
b. morula
c. blastocyst
d. bilaminar embryo
e. trilaminar embryo

3. Which of the following is true:

a. Lung buds arise from the laryngotracheal groove

b. The respiratory tract arises from the primitive midgut
c. Apoptosis is not required for normal gut formation
d. Lung development is complete at birth
e. The embryonic pleural cavities are lined with a mesothelium

4. Which of the following is correct:

a. True ribs do not have a direct insertion on the sternum

b. Ribs XI and XII are false ribs
c. Ribs VIII-X are false ribs
d. False ribs have a direct insertion on the sternum
e. Floating ribs have an indirect insertion on the sternum
5. The posterior costodiaphragmatic recess extends to:

a. T8
b. T9
c. T10
d. T11
e. T12

6. How many bronchopulmonary segments form the upper lobe of the right lung?

a. 1
b. 2
c. 3
d. 4
e. 5

7. Which of the following measurements is not included in the vital capacity?

a. The residual volume (RV)

b. The tidal volume
c. The expiratory reserve volume (IRV)
d. The inspiratory reserve volume (ERV)
e. The inspiratory capacity (IC)

8. Which of the following are correct at total lung capacity (TLC)?

a. The chest wall recoil is outwards; the lung recoil is inwards

b. The chest wall recoil is inwards; the lung recoil is inwards
c. The chest wall recoil is outwards; the lung recoil is outwards
d. The chest wall recoil is inwards; the lung recoil is outwards
e. The chest wall recoil is outwards and equal to the lung recoil that is inwards

9. Which of the following is an example of a benign neoplasm that acts in a malignant fashion?

a. lymphoma
b. seminoma
c. melanoma
d. insulinoma
e. dysgerminoma

10. Which of the following statements is incorrect?

a. Carcinomas are more common than sarcomas

b. The incidence of carcinoma increases with age
c. Carcinomas do not have metastatic potential
d. Sarcomas tend to spread by a hematogenous route
e. Both carcinomas and sarcomas may have a viral etiology
Answers:

1. e
2. c
3. e
4. c
5. e
6. c
7. a
8. b
9. d
10. c
1. Which of the following statements regarding laminar flow in the respiratory system is least
correct:

a. The driving pressure is inversely proportional to the fourth power of the tube radius
b. The driving pressure varies directly with tube length
c. Laminar flow is energetically more efficient compared to turbulent flow
d. Driving pressure is proportional to flow rate
e. Driving pressure is proportional to the square of the flow rate

2. Which of the following structures are not considered part of the respiratory zone?

a. pulmonary acinus
b. respiratory bronchioles
c. alveolar ducts
d. terminal bronchioles
e. alveolar sacs

3. Decreased respiratory system compliance is caused by disease involving all of the following
structures except:

a. ribs
b. chest wall muscles
c. large conducting airways
d. diaphragm
e. visceral pleura

4. Which of the following statements best characterize the control of breathing?

a. Low oxygen levels are sensed by the retrotrapezoid nucleus (RTN)

b. There is a linear relationship between alveolar ventilation and decreasing PAO2
c. There is a non-linear relationship between alveolar ventilation and increasing PCO2
d. The pre-Botzinger complex near the rostral medulla is the inspiratory pacemaker
e. Glomus cells in the carotid body mainly sense the partial pressure of carbon dioxide

5. Cholinergic synapses are found at each of the following except:

a. sinoatrial node of the heart

b. pre-ganglionic synapses
c. neuromuscular junction
d. sweat glands
e. renal vascular smooth muscle
6. Which of the following signs is most characteristic of muscarinic agonist overdose?

a. fast heart rate

b. bronchoconstriction
c. constipation
d. dry mouth
e. dry skin

7. Which of the following statements about pulmonary vascular system is most correct?

a. The right ventricular pressure is the downstream pressure for the pulmonary circulation
b. At TLC the main increase in pulmonary vascular resistance is associated with extra-alveolar
vessels
c. Pulmonary resistance decreases with exercise
d. The pulmonary vascular system provides blood flow to the conducting airways
e. Zone I, II, and III are anatomical divisions of the lung that explain regional blood flow

8. Which of the following structures confers ciliary motility?

a. protofilaments
b. dynein arms
c. Outer doublet microtubules
d. inner sheath
e. nexin

9. Which of the following statements is most accurate:

a. Ultrasound waves travel best through low-density objects

b. CT images are based on reconstruction of multiple planes of imaging
c. The frequency of medical ultrasound is up to 20000Hz
d. MRI scans use gamma irradiation
e. Both CT and MRI expose the patient to ionizing radiation

10. Which of the following are not typical of respiratory function during sleep?

a. Reduced muscle activity

b. Decreased upper airway resistance
c. Reduced output from the central respiratory controller
d. Reduced responses to chemical stimuli (oxygen and carbon dioxide)
e. Reduced end expiratory lung volume
Answer Key:

1. e
2. d
3. c
4. d
5. e
6. b
7. c
8. b
9. b
10. b
1. Which of the following statements regarding the hypothalamic pituitary (HPA) axis is least
correct?

a. Corticotropin releasing hormone (CRH) is a neuropeptide produced by the paraventricular

nucleus (PVN) of the hypothalamus
b. ACTH is produced by the pituitary gland and acts on the adrenal cortex
c. Cortisol functions as a negative feedback signal to the pituitary and hypothalamus
d. A normal physiological effect of cortisol is immunosuppression
e. Glucocorticoid receptors are part of the nuclear receptor superfamily of ligand-activated
transcription factors

2. Which of the following statements about indoor air quality is incorrect?

a. Dampness or excess humidity is the most important factor for indoor mold growth
b. Drying will immediately remove the hazardous properties associated with molds
c. Variation in wall temperature can be assessed with an infrared camera
d. Lack of maintenance is the main factor leading to water damage and excess humidity
e. Under appropriate environmental conditions molds can produce aerosols that contain
enzymes, mycotoxins, irritants, and allergens

3. Which of the following statements regarding the diagnosis of pneumoconiosis is incorrect?

a. It requires a history of exposure to inorganic dust

b. The exposure history must include a suitable latency period
c. There is a lack of alternative explanation
d. A definitive diagnosis can be made without abnormal radiologic tests
e. Certain pneumoconiosis increase the risk of lung cancer

4. Cavitary disease is most commonly seen in the following type of lung cancer?

a. Carcinoid
b. Squamous cell
c. Large cell
d. Small cell
e. Adenocarcinoma

5. Which of the following does not contribute to expiratory airflow limitation in COPD?

a. decreased airway tethering

b. increased airways resistance
c. diaphragm muscle weakness
d. decreased lung elastic recoil
e. dynamic airways compression
6. Which of the following statements is least accurate?

a. Beta-2 adrenergic receptors are G-protein coupled receptors (GPCR) that signal via
heterotrimeric G-proteins to activate adenyl cyclase
b. Theophylline is a phosphodiesterase inhibitor that decreases cyclic AMP (cAMP) degradation
c. Inhaled corticosteroids are the most effective disease-modifying therapy for asthma
d. Leukotriene receptor antagonists may be used in place of short acting beta2-agonists (SABA)
for rescue treatment of asthma
e. Dry powder inhalers are not a preferred mode of drug administration for patients with
extremely severe COPD

7. Which of the following statements is least correct?

a. Adenocarcinoma is the least common form of lung cancer in non-smokers

b. The relative risk of lung cancer with asbestos exposure and cigarette smoking is >20X that of a
non-exposed non smoker
c. Low dose CT scanning may be an effective screening tool for high-risk patients
d. PET scanning detects the rate of radiolabeled glucose metabolism
e. Small cell carcinoma is highly responsive to chemotherapy

8. Which of the following about lung cancer is most accurate?

a. Surgery is usually indicated for limited stage small cell lung cancer
b. Most patients with non-small cell lung cancer present with early stage disease
c. A Pancoast tumor develops at the apex of the lung and can cause Horner’s syndrome
d. Hypercalcemia is the most common paraneoplastic syndrome associated with small cell lung
cancer
e. Bronchioloalveolar carcinoma can mimic pneumonia on Chest X-ray

9. Bronchiectasis may be characterized by all of the following except?

a. Loss of the ciliated epithelial cells and impaired drainage of mucus from the airways
b. Inflammatory destruction that results in dilation and scarring of the airway walls
c. Chronic colonization with bacteria, fungi, or non-tuberculous mycobacteria (NTM)
d. Chronic cough without sputum production
e. Digital clubbing

10. Dynamic hyperinflation is best described as:

a. A progressive increase in tidal volume during exercise

b. An increase in residual volume at rest
c. An increase in inspiratory capacity during exercise
d. A progressive increase in end expiratory lung volume with increased ventilation
e. A progressive increase in minute ventilation during exercise
Answer Key:

1. d
2. b
3. d
4. b
5. c
6. d
7. a
8. c
9. d
10. d
1. Which of the following congenital abnormalities is most common?

a. Esophageal atresia without tracheo-esophageal fistula

b. Esophageal atresia with tracheo-esophageal fistula from the upper esophageal segment
c. Esophageal atresia with tracheo-esophageal fistula from the lower esophageal segment
d. Esophageal atresia with tracheo-esophageal fistula from the upper and lower esophageal
segments
e. Isolated tracho-esophageal fistula without esophageal atresia

2. Which of the following is most characteristic of UIP?

a. It is highly responsive to current treatments

b. It presents with a sudden, rapid onset of breathlessness
c. Disease typically develops at a very young age
d. It is characterized by cough with purulent sputum
e. It has a poor prognosis with a mean survival from time of diagnosis of 5 years

3. Which of the following statements about sarcoidosis is least accurate?

a. It is a multisystem disease with no known cause

b. The lungs are the most common affected organ
c. The diagnosis is usually confirmed with transbronchial biopsy or lymph node biopsy
d. Corticosteroid therapy results in an improvement in 75% of patients
e. It affects males more than females

4. All of the following are true about Mycobacterium tuberculosis except:

a. It can survive for long periods in a dormant state

b. The likelihood of household transmission can be decreased by improved ventilation
c. It affects both humans and animals
d. It is an aerobic curved non-motile rod with a thick waxy cell wall
e. Transmission is exclusively by the airborne route

5. Risk factors for the development of disease caused by Mycobacterium tuberculosis include all of
the above except:

a. Very young or advanced age

b. Kidney failure
c. Diabetes
d. Cystic fibrosis
e. Immune compromised state
6. Asthma is characterized by all of the following except:

a. Decreasing prevalence in Canadian adults

b. Chronic airway inflammation
c. Bronchial hyperresponsiveness
d. Airway smooth muscle hypertrophy and hyperplasia
e. Variable airflow obstruction

7. The most common trigger for an asthma exacerbation is:

a. Medications
b. Allergens
c. Rhinovirus
d. Physical factors including exercise or cold air
e. Physiological factors including obesity or gastroesophageal reflux

8. Which of the following is an unbalanced chromosomal rearrangement?

a. Reciprocal translocation
b. Paracentric inversion
c. Pericentric inversion
d. Ring deletion
e. Robertsonian translocation

9. Which of the following statements is least correct?

a. A type I error is detection of a difference between study groups that is due to chance
b. Selection bias only occurs in case control studies
c. Confounding may occur in observational studies
d. Systematic error can be minimized by careful measurement practices
e. A confounding factor cannot be in the causal pathway for disease

10. Which of the following statements is least accurate?

a. A major limitation of cohort studies is loss to follow-up

b. An inception cohort study enrolls patients at the time of diagnosis
c. A hazard ratio is defined as time to event in exposed/time to event in non-exposed
d. Attributable risk can be calculated in case-control studies
e. Attributable Risk is a better measure of public health impact than Relative Risk
Answer key:

1. c
2. e
3. e
4. c
5. d
6. a
7. c
8. d
9. b
10. d
1. The most common cause of acute bronchopneumonia is:

a. Measles virus
b. Staphylococcus aureus
c. Pseudomonas aeruginosa
d. Influenza virus
e. Streptococcus pneumoniae

2. The threshold for toxicity is defined as:

a. The presence of a dose-response curve for toxicity

b. The dose below which there is no detectable response
c. The dose at which a statistically significant adverse effect is observed
d. The dose at which no statistically significant response is observed
e. The presence or absence of toxicity

3. Empyema is best defined as

a. Normal pH of pleural fluid

b. Absence of inflammatory cells in the pleural fluid
c. Pus in the pleural space
d. Red blood cells in the pleural fluid
e. Air in the pleural space

4. Primary hemostasis includes all of the following except:

a. Endothelial damage with exposure of the subendothelial extracellular matrix

b. Platelet adhesion to Von Willebrand Factor mediated by glycoprotein Ib
c. Platelet shape change with granule release
d. Platelet aggregation through binding of platelet GpIIb-IIIa receptors to fibrinogen
e. Activation of thrombin and formation of fibrin polymerization

5. Which of the following clinical signs is not directly due to deep venous thrombosis?

a. An abnormally swollen leg

b. Elevated jugular venous pressure
c. A painful leg
d. An erythematous (red) leg
e. Tenderness to palpation of the calf

6. The highest incidence of tuberculosis is in:

a. Metis
b. Inuit
c. All aboriginal populations
d. Foreign-born individuals
e. Canadian born individuals
7. The main cause of sudden death due to pulmonary embolism is:

a. Obstruction of venous return from the legs

b. Uncontrolled hemoptysis due to pulmonary infarction
c. Severe hypoxemia
d. Acute right heart failure
e. Severe increase in physiological dead space

8. Which of the following is the strongest risk factor for pulmonary embolism in the Well’s score?

a. Cancer
b. Previous DVT and/or pulmonary embolism
c. Immobilization
d. Hemoptysis
e. Clinical signs and symptoms of DVT

9. Which of the following has pro-thrombotic properties?

a. Tissue-type plasminogen activator

b. Prostacyclin (PGI2)
c. Plasminogen activator inhibitor (PAI)
d. Adenosine diphosphatase
e. Thrombomodulin

10. Aspiration pneumonia is characterized with each of the following except:

a. It is a common complication of influenza

b. It usually involves gravity-dependent regions of the right lung
c. The sputum culture may have polymicrobial growth
d. The sputum is typically foul smelling
e. It is associated with neurological disorders
Answer Key:

1. b
2. b
3. c
4. e
5. b
6. b
7. d
8. e
9. c
10. a