A Medical quiz -the questions mostly from two Pulmonary medicine quiz competitions hosted by two Medical Colleges in Kerala.

1. PULMONARY
MEDICINE QUIZ

3. ACKNOWLEDGEMENTS
• To the Pulmonary Medicine Department ,
Kottayam Medical college
• To My Quiz partner Sachin James

4. QUIZ MASTER’S ADVICE

5. 6 ROUNDS …
• Anatomy & Physiology ( 7 Qns )
• Trivia ( 12 Qns )
• Clinical Medicine & Investigations
( 15 Qns )
• Respiratory Infections & Neoplasms
( 18 Qns )
• Respiratory Pharmacology ( 8 Qns )
• Rapid Fire ( 30 Qns )

6. ARE U READY ?

7. ANATOMY &
PHYSIOLOGY

8. Q1.
• The human respiratory tree may consist on an
average of 23 generations (Weibel’s Lung
Model)
• 1- 16 generations constitute the conducting
zone ,while 17-23 constitute the transitional &
respiratory zones.
• What is the 17th generation in the respiratory
tree ?

9. ANSWER
• Respiratory Bronchiole

10. Q2.In the cross section of a bronchus,
what is X ?• X =
Thickness of the mucous gland layer / Thickness of
the wall between epithelium & perichondrium

11. ANSWER
• X = Reid Index
• Normal Reid Index – 0.4

12. Q3.Name these “named” connections .
• Pores of ‘X’ – Inter alveolar connections
• Canals of ‘Y’ – connections between alveoli &
bronchioles
• Channels of ‘Z’ – Interbronchiolar connections

13. ANSWER
• X – Kohn
• Y – Lambert
• Z – Martin

14. Q4.
• Surfactants are the molecules secreted mainly by
Type 2 alveolar epithelial cells in the lungs .
• The surfactants lower surface tension – this in
turn increase pulmonary compliance & prevent
atelectasis at the end of expiration.
• The pulmonary surfactant mixture contains both
Phospholipids & Proteins.
• Name the strongest & the chief phospholipid in
the surfactant mixture.

15. ANSWER
• Dipalmitoyl phosphatidylcholine (DPPC)

16. Q5.
• Name the Neuroendocrine cells in the Lungs
from which the Carcinoid tumour is thought to
arise ?

17. ANSWER
• Kulchitsky cells

18. Q6.
• The Club cells or Bronchiolar exocrine cells were known as
X cells till Dec 31st,2012.
• They were named as X cells after an Austrian anatomist Y –
Y was an active member of Nazi Party & used to take
tissues from executed victims for research.
• In May 2012,the editorial boards of most of the respiratory
journals concluded that continued use of Y’s name would
be equivalent to honouring him – so they brought about
this name changing policy.
• The X cells (now Club cells) are found in the small airways ,
protect the bronchiolar epithelium & detoxifies the
harmful substances inhaled into the lungs.
• Name X & Y.

19. ANSWER
• X - Clara cells
• Y - Max Clara

20. Q7.
• What is the functional unit of lung as per High
Resolution CT ( HRCT) Terminology ??

21. ANSWER
• Secondary Pulmonary Lobule
• Each secondary pulmonary lobule is supplied
by a terminal bronchiole and a pulmonary
artery branch. They are drained by pulmonary
veins which form in at the periphery of the
lobule and pass though the interlobular
septa.

22. TRIVIA !!!!!

23. Q1.
• X is a method of tapping on a surface to determine the
underlying structure & is used in clinical examination to
assess the condition of the thorax or abdomen.
• X was first used to distinguish between empty & filled
barrels of liquor & Y, an Austrian physician is said to be the
first person who introduced this technique in modern
medicine.
• But X was used by Z, a Persian polymath,as early as in 10th
century CE.
• Z is widely known for his work, ”The Canon of Medicine ”,
which was a standard medical textbook in many medival
universities.
• Identify X,Y & Z

24. ANSWER
• X – Percussion
• Y- Dr.Leopold Auenbrugger
• Z - Avicenna

25. Q2.
Identify this famous French Physician
credited with the invention of Stethoscope

26. ANSWER
Rene
Laennac

27. Q3.
 Identify this German
physician who was a
pioneer in
microbiology.
 He is known for his role
in identifying the
specific causative
agents
of tuberculosis, cholera,
and anthrax and for
giving experimental
support for the concept
of infectious disease .
 He was awarded Nobel
Prize for Medicine in
1905.

28. ANSWER
• Robert Koch

29. Q4.
• In the late 1940s & 1950s, one common technique used by
the ……… industry to reassure a worried public was to
incorporate images of physicians in their ads.
• The none-too-subtle message was that if the doctor, with all
of his expertise, chose to use a particular brand, then it must
be safe.
• RJ Reynold Company promoted the ads and their brand Camel
was advertised as the most commonly used brand by doctors.
• The response of the organized medical community was to do
nothing, because the ads showed doctors looking wise.
• RJ Reynolds Company is at present the second largest ……….
company in the US.
• About which Industry am I talking about ?

30. ANSWER
• Tobacco
Industry
TOBACCO
INDUSTRY

31. Q5.
 Identify this
German
laryngologist
who is
regarded as
the Founder of
Bronchoscopy.
 A part of the
pharyngeal
wall is named
after him.

32. ANSWER
• Gustav Killian
• Killian dehiscence
• Killian forceps
• Killian nasal speculum

33. Q6.
• X is Charles Dickens’ first novel.
• There is a character by the name of Joe (The
Fat Boy Joe) who consumes large quantities of
food & constantly falls asleep in any situation
at any time of day.
• His sleep problem is the origin of the medical
term Y which ultimately led to the description
of Obesity Hypoventilation syndrome.
• Identify X & Y

35. ANSWER
• X – Pickwick Papers
• Y – Pickwickian syndrome

36. Q7.
• This word means ,”out of place, unusual or
extraordinary”.
• It was coined by Arthur F Coca & Robert A
Cooke (both are American immunologists &
allergy specialists) who in 1923 attempted to
develop a classification for hypersensitiveness
,an abnormal level of sensitiveness for which
the mechanism was not known.
• What is the word ?

37. ANSWER
• Atopy

38. Q8.
• What is the active principle in the “Asthma cigarettes”
,which were popular in Germany by this name in the
mid 20th century ?
• These cigarettes consisted of powdered stramonium
leaves & their inhalation brought about some relief
from asthma.
• It caused dryness of mouth & mucous membranes and
it was regarded as one of its major side effects.
• A later study proved that the active principle in this
cigarette has got some beneficial effect on bronchial
obstruction.
• ( Image follows )

40. ANSWER
• Atropine

41. Q9.
• The image (next slide) is that of ……. , a British
Respiratory scientist, currently Professor of Thoracic
Medicine at the National Heart & Lung Institute, Head
of Respiratory Medicine at Imperial College and
Honorary Consultant Physician at the Royal Brompton
Hospital ,London.
• He is known for his groundbreaking research in the
molecular mechanisms responsible for Asthma & COPD
, which have helped formulate several novel treatment
strategies (under clinical trial).
• Name him.

43. ANSWER
• Peter John Barnes

44. Q10.
• Who completed the first successful lung
transplant and also the first successful double
lung transplant in the world ?

45. ANSWER
• Joel D. Cooper

46. Q11.
• The Mutter Museum is a medical museum located in
Philadelphia – it is a part of “The College of Physicians of
Philadelphia” .
• This museum is currently the only place where members of
the public can view slides of Einstein’s brain.
• A notable attraction of this museum is “The Foreign Body
Collection of X”.
• X is an American Laryngologist ,known as the “Father of
Endoscopy”.
• His obituary referred to him as “one of the greatest ,if not
the greatest laryngologist of all time”.
• Identify X.

48. ANSWER
• Chevaliar Jackson

49. Q12.Fill in the Blank.
• John Hutchinson ,an English surgeon designed a device (which
was as tall as an adult patient) was essentially a calibrated
bucket that was placed upside down in water.
• The volume of exhaled air from fully inflated lungs could
accurately be measured by exhaling into a tube leading into the
bucket.
• Dr. Hutchinson coined the term …………………….. when he realized
that compromise of this crucial measurement was predictive for
premature mortality.
• Because of the strong correlation between this measurement
and mortality, Hutchinson argued that it should be utilized in
actuarial predictions for life insurance policies.
• Neither the device nor its measurements were accepted by the
insurance industry and the device was used primarily in a limited
function to measure usable lung volumes in patients at
tuberculosis sanitariums.

50. The device designed by John
Hutchinson

51. ANSWER
• Vital Capacity
• The device is Spirometer

52. CLINICAL MEDICINE &
INVESTIGATIONS

53. Q1.What is the name of the the angle
shown ?

54. ANSWER
• Lovibond Angle
• Named after Dr.JL Lovibond ,a 20th century
English dermatologist

55. Q2.
• This is a posture is adopted by
patients experiencing
respiratory distress .
• It is thought that this position
optimizes the mechanics of
respiration by taking advantage
of the accessory muscles of the
neck and upper chest to get
more air into the lungs.
• ( But a 2007 Indian study of
COPD patients found no
significant helpful effects for
this posture )
• What is this posture known as
?

56. ANSWER
• Tripod Posture

57. Q3.
• Which is the abnormal pattern
of breathing characterized by progressively
deeper and sometimes faster breathing,
followed by a gradual decrease that results in
a temporary stop in breathing ?
• The pattern repeats, with each cycle usually
taking 30 seconds to 2 minutes.

58. ANSWER

59. Q4.FITB
• The inward movement of the lower rib
cage during inspiration (instead of outward as is
normal) implying a flat, but functioning,
diaphragm, often associated with COPD is known
as ………….
• COPD (more specifically emphysema) often lead
to hyperinflation of the lungs due to air trapping.
The resulting flattened diaphragm contracts
inwards instead of downwards, thereby
paradoxically pulling the inferior ribs inwards with
its movement.

60. ANSWER
• Hoover’s sign
• Named after Charles Franklin Hoover ,an
American Physician

61. Q5.
• The crackles heard in the Interstitial Fibrosis
are referred to as

62. ANSWER
• Velcro like crackles
( they sound like a Velcro being ripped apart )

63. Q6.
• ………….. a crunching, rasping sound, synchronous
with the heartbeat, heard over the precordium in
spontaneous mediastinal emphysema produced
by the heart beating against air-filled tissues.
• This sound is heard best over the left lateral
position.
• It has been described as a series of precordial
crackles that correlate with the heart beat and
not the respirations.

64. ANSWER
• Hamman’s mediastinal crunch
• Named after Dr.Louis Hamman

65. Q7.
• The auscultation of the sound “AH” instead of
“EEE” when a patient phonates “EEE” is
known as ?

66. ANSWER
• Aegophony
• It is heard in Pneumonia

67. Q8.Name this criteria used to classify
Pleural effusion as Exudative or
Transudative

68. ANSWER
 Light’s Criteria
 Named after
Richard W
Light
 (He developed
this while
working as an
intern at John
Hopkins
Hospital)

69. Q9.
• The cytologic examination of Pleural Fluid
revealed malignant cells.
• What is the principle behind this ?

70. ANSWER
• Exfoliative cytology

71. Q10.Identify this needle used for blind
biopsy of the Pleura
Outer cannula(A) of the
Needle with trocar point and
cutting window, which can be
closed with a turning action of
the inner tube (B) inner stylet.
Complete Needle assembly
with stylet needle. The needle
is in the closed position

72. ANSWER
• Abram’s Pleural Biopsy Needle
• Indications for pleural biopsy include the
following:
Recurrent pleural effusion of unknown
etiology
Pleural mass or thickening

73. Q12.
• The investigation of choice for the diagnosis of
Pulmonary thromboembolism ?

74. ANSWER
• CT Pulmonary angiography
• It may either confirm the suspected embolism
or highlight an alternative diagnosis.

75. Q13.
• Which is the molecular test that can detect TB
bacilli from the Sputum sample by isolating
genomic material from the sample by
sonication,then amplifies it by PCR ,also
identify all the clinically relevant rifampicin
inducing mutations in the RNA polymerase
beta(rpoB) gene in the bacilli ??
• The result is obtained within 2 hours !!!!

76. ANSWER
• Gene Xpert Study

77. Q14.
 The image shows the
histological finding
in interstitial lung
disease that is
suggestive of
significant
occupational
Asbestos exposure.
 They are usually
identified following a
parenchymal lung
biopsy.
 What are they known
as ?

78. ANSWER
• Asbestos Body

79. Q15.Identify the cells
(seen in chronic alveolar congestion)

80. ANSWER
• Heart Failure cells

81. RESPIRATORY INFECTIONS &
NEOPLASMS

82. Q1.
• Name the long chain fatty acids found in the cell
walls of the tuberculosis causing bacteria.
• These fatty acids
 lend the organism increased resistance to
chemical damage and dehydration, and prevent
the effective activity of hydrophobic antibiotics.
 allow the bacterium to grow readily
inside macrophages, effectively hiding it from the
host's immune system.

83. ANSWER
• Mycolic acids

84. Q2.
• Which organism is responsible for “Walking
Pneumonia” ?
• It is so called because clinically patients do not
feel very sick.

85. ANSWER
• Mycoplasma pneumoniae

86. Q3.
• Which is the most common lung malignancy in
women & non smokers ?

87. ANSWER
• Adenocarcinomas

88. Q4.
• The most common causative agent
responsible for Viral bronchiolitis in infants ?

89. ANSWER
• Respiratory Syncitial Virus (RSV)

90. Q5.
• Which organism is responsible for
“Pseudohemoptysis” ?

91. ANSWER
• Serratia marcescens

92. Q6.
• Uveoparotid Fever (Heerdfordt’s syndrome) is
a manifestation of ?

93. ANSWER
• Sarcoidosis

94. Q7.What is this known as ?

95. ANSWER
• Wallgren’s time table of tuberculosis
• Named after Arvid wallgren

96. Q8.
• Which is the most commonly involved organ
in metastasis from a pulmonary malignancy?

97. ANSWER
• Adrenal Glands

98. Q9.
• Name the pathogen
well known to cause
pneumonia in
immunocompromised
individuals .
• The risk of infection
with this pathogen
increases when CD4+ T
cell levels are less than
200 cells/μL.

99. ANSWER
• Pneumocystis jiroveci

100. Q10.
• Which is the parasitic infestation that is
associated with raised Pulmonary arterial
pressure ?

101. ANSWER
• Schistosomiasis

102. Q11.
• What is the reactive arthritis occurring in
patients with active tuberculosis known as ??

103. ANSWER
• Poncet’s arthritis
• The occurrence of polyarthritis in patients with
active tuberculosis was first reported by Antonin
Poncet in 1897 .
• In contrast to the usual tuberculous arthritis
which is monoarticular, infectious and
destructive, tuberculous rheumatism (Poncet’s
disease) is a non-destructive parainfective
polyarthritis occurring in patients with active
tuberculosis, which resolves completely on anti-
tuberculosis therapy

104. Q12.
• What is the new name of “Bronchioloalveolar
carcinoma” ?

105. ANSWER
• Adenocarcinoma in situ (AIS)

106. Q13.
• What is the paraneoplastic syndrome caused
by Parathyroid hormone like peptide,a peptide
secreted by tumour cells ?

107. ANSWER
• Hypercalcemia

108. Q14.
• “Swimming Pool granuloma” is caused by

109. ANSWER
• Mycobacterium marinum

110. Q15.
• A patient with small cell lung cancer
developed muscle weakness .
• The patient was investigated & antibodies
against presynaptic voltage-gated calcium
channels in the neuromuscular junction was
detected.
• What is the condition known as ?

111. ANSWER
• Lambert Eaton Syndrome

112. Q16.
• Endemic hemoptysis is seen in ?

113. ANSWER
• Paragonimas westermani infestation

114. Q17.
• The image is the X Ray
of Wrist & Forearm of a
patient with
Bronchogenic
Carcinoma.
• The patient had
Clubbing of fingers &
pain in the forearm.
• The X Ray Finding is ?

115. ANSWER
• Hypertrophic Pulmonary Osteoarthropathy

116. Q18.
• This is a characteristic
histological finding in a
patient with squamous
cell carcinoma of lungs.
• What is this known as ?

117. ANSWER
• Keratin Pearls

118. RESPIRATORY
PHARMACOLOGY

119. Q1.
• Which is the monoclonal antibody targeted
against IgE used for treating moderate to
severe allergic asthma & chronic spontaneous
urticaria ?

120. ANSWER
• Omalizumab

121. Q2.
• Which is the ultra long acting beta agonist
approved for use in COPD patients ?
• It is delivered as an aerosol formulation
through a dry powder inhaler .

122. ANSWER
• Indacaterol

123. Q3.
• Name the antitubercular drug approved by
Food & Drug Administration in 2012 –
specifically approved to treat MDR TB ?
• It is in fact the first drug to be approved for
Anti tubercular therapy in 40 years !!!

124. ANSWER
• Bedaquiline

125. Q4.
• Name the Phospho diesterase 4 (PDE 4)
inhibitor that is used as an orally
administered drug for the treatment of
inflammatory conditions of the lungs such
as chronic obstructive pulmonary disease
(COPD) ?

126. ANSWER
• Roflumilast

127. Q5.
• Which is the first line antitubercular drug that
is active in the acidic environment also ??

128. ANSWER
• Pyrazinamide (Z)
• Pyrazinamide diffuses into M. tuberculosis, where
the enzyme pyrazinamidase converts
pyrazinamide to the active form pyrazinoic acid.
Under acidic conditions, the pyrazinoic acid that
slowly leaks out converts to the protonated
conjugate acid, which is thought to diffuse easily
back into the bacilli and accumulate. The net
effect is that more pyrazinoic acid accumulates
inside the bacillus at acid pH than at neutral pH.

129. Q6.
• This drug is used as a mucolytic agent - it
reduces mucus viscosity by splitting disulfide
bonds linking proteins present in the mucus
(mucoproteins).
• It is also used for the treatment of Paracetamol
overdose,as a nephroprotective agent,in
hemorrhagic cystitis ,to prevent the progression
of Interstitial lung disease and in some psychiatric
disorders.
• Which drug ?

130. ANSWER
• Acetyl Cysteine

131. Q7.
• This drug is a leukotriene receptor antagonist
(LTRA) used for the maintenance treatment
of asthma and to relieve symptoms of
seasonal allergies .
• The drug was developed by MERCK,an American
pharmaceutical company & the first part of the
name of the drug is named after a Canadian city
(the second largest Canadian city) where the drug
was developed.
• The drug is ?

132. ANSWER
• Monteleukast
• ‘Mont’ from Montreal

133. Q8.
• Name the Epidermal Growth Factor Receptor
inhibitor (EGFR) inhibitor approved by FDA on
July 2015 as a first line treatment for Non
small cell carcinomas.

134. ANSWER
• Geftinib

135. RAPID FIRE

136. • Q1.Which is the hereditary condition
predisposing to emphysema ?
• Alpha 1 Antitrypsin deficiency
• Q2.What are the components of Samter’s triad ?
• Asthma,Aspirin Intolerance & Nasal Polyposis
• Q3.What is the immediate management in
Tension Pneumothorax ?
• Needle Thoracostomy

137. • Q4.The gene responsible for Cystic Fibrosis is
located on ?
• Chromosome 7
• Q5.Bronchial Thermoplasty is a treatment
modality (approved by FDA in 2010) for ?
• Bronchial asthma
• Q6.The drug of choice for Pneumocystis jiroveci
pneumonia is ?
• Cotrimoxazole

138. • Q7.What is the investigation of choice for
diagnosing Obstructive Sleep Apnoea ?
• Polysomnography
• Q8.Prone Position Ventilation is
recommended for ?
• Acute Respiratory Distress Syndrome (ARDS)
• Q9.CURB -65 is a scoring system for ?
• Community acquired Pneumonia (CAP)

139. • Q10.What is the most common cause for SVC
obstruction in young adults ?
• Lymphoma
• Q12.Which is the occupational lung disease that
mimics sarcoidosis clinically,radiologically &
histopathologically ?
• Beryllosis
• Q13.Where is the National Institute for Research
for tuberculosis located ?
• Chennai

140. • Q14.What is the pattern of inheritance of Cystic
Fibrosis ?
• Autosomal Recessive
• Q15.Bronchiectasis , Sinusitis & Situs Inversus –
this triadis found in?
• Kartagener’s Syndrome
• Q16.Which is the first anti tubercular drug to be
discovered ?
• Streptomycin

141. • Q17.Expand GOLD.
• Global Initative for Obstructive Lung Disease
• Q18.Expand LVRS
• Lung Voulme Reduction Surgery
• Q19.Expand VATS
• Video assisted Thoracoscopy

142. • Q19.The only pharmacologic therapy that
have demonstrated uniequivocally to decrease
mortality rates in patients with COPD.
• Supplemental Oxygen therapy /Long Term
Oxygen Therapy (LTOT)
• Q21.The most common cause of Chylothorax
• Trauma (Surgical)

143. • Q22.The triad of Ovarian fibroma,Pleural effusion
& ascites is called
• Meig’s Syndrome
• Q23.Name the biochemical agent used in
Positron emission tomography (PET) .
• 18 - Fluoro deoxy Glucose
• Q24.Which obstructive lung disease is considered
as a systemic disease ?
• Chronic Obstructive Pulmonary Disease (COPD)

144. • Q23.List the 4 common indications for Lung
transplantation.
• COPD, Idiopathic Pulmonary Fibrosis, Cystic fibrosis,
Alpha 1 antitrypsin deficiency emphysema & Idiopathic
Pulmonary Arterial Hypertension
• Q24.List any 3 therapeutic indications for bronchoscopy.
• Foreign Body removal, Control of Hemoptysis, Dilatation
of airways partailly or completely occluded by tumours
(LASER Therapy, Cryotherapy,
Argon plasma coagulation, Electrocautery,
Balloon Bronchoplasty & Dilation ,Stent placement)

145. • Q25.List any 2 conditions where epitheloid
granulomas are seen.
• Tuberculosis,Sarcoidosis
• Q26. List any 3 drugs that can be given for
cessation of smoking.
• Bupropion,Cytisine,Varnecillin
• Q27.List 3 Non Small cell carcinomas
• Large cell carcinoma, Squamous cell carcinoma
& Adenocarcinoma

146. • Q28.Which respiratory disease was previously
called as “Consumption” because of the severe
wasting that occurred in patients ?
• Tuberculosis
• Q29.Which group of Antihypertensives worsen
Asthma ?
• Nonselective Beta Blockers
• Q30.Which group of antihypertensives is known
to produce Dry Cough ?
• ACE -inhibitors

147. HOPE YOU ALL ENJOYED
IT !!