At which of the following times in the respiratory cycle is the intrapleural pressure most negative?
A. Just after the beginning of inhalation (inspiration)
B. Just before the end of inhalation
C. Just after the beginning of exhalation (expiration)
D. Just before the end of exhalation
E. The intrapleural pressure is constant during the normal respiratory cycle

Which of the following does not cause airway narrowing in an asthma attack?
A. Mucous hypersecretion
B. Airway oedema
C. Bronchospasm
D. Destruction of airways

Following the COPD-X plan, exacerbations can be managed with the following EXCEPT for:
A. Mucolytics
B. Eplerone
C. Prednisolone
D. Salbutamol
E. Antibiotics

Prolonged hyperventilation will result in:
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. No pH change

Burkitt’s lymphoma is an example of what type of mutation?
A. Translocation
B. Amplification
C. Substitution
D. Insertion
E. Deletion

Aspirin can precipitate an asthma attack in sensitive individuals because it:
A. Lowers body temperature
B. Inhibits blood clotting
C. Causes accumulation of arachidonic acid
D. Blocks leukotriene receptors
E. Inhibits mast cell degranulation

In a person standing upright, which region of the lungs has the highest ventilation rate and which region has the highest circulatory perfusion rate?
A. Highest ventilation: Apex; highest perfusion: Apex
B. Highest ventilation: Apex; highest perfusion: Base
C. Highest ventilation: Base; highest perfusion: Apex
D. Highest ventilation: Base; highest perfusion: Base
E. There is no "highest" region as the apex and base have equal ventilation and perfusion rates

Which of the following is a feature of asbestosis?
A. Interstitial fibrosis confined to the upper lobes
B. Stellate interstitial nodules throughout both lungs
C. Hyaline nodules in lung and mediastinal nodes
D. Bilateral pleural effusions
E. Pleural fibrosis and plaques

In the management of COPD, current pharmacological treatments can assist with all of the following EXCEPT:
A. Prevent and control symptoms
B. Reduce frequency of exacerbations
C. Reduce severity of exacerbations
D. Improve exercise tolerance
E. Prevent decline in lung function

In response to metabolic acidosis, central chemoreceptors:
A. Promote an increase in ventilation
B. Promote a decrease in ventilation
C. Detect no change in pH
D. Detect a high pH
E. Transmit signals to the respiratory control centres in the midbrain

Which of the following is NOT consistent with a type B pattern of COPD?
A. PaO2 < 60
B. V/Q mismatch
C. Hypercapnia
D. Low diffusing capacity of the lung for CO
E. Right heart failure

Which of the following drugs has the least direct bronchodilating effect?
A. Theophylline
B. Ipratropium
C. Beclomethasone
D. Montelukast
E. Formoterol

Which phenomenon best describes the impairment of H+ binding to haemoglobin in oxygenated blood of the lungs?
A. Bohr effect
B. Homeostasis
C. Law of LaPlace
D. V/Q mismatch
E. Haldane effect

A 12-year-old girl is brought to the physician because of a history of coughing and wheezing and repeated attacks of difficulty breathing. The attacks are particularly common in the spring. During an episode of acute respiratory difficulty, a physical examination shows that she is afebrile. Her lungs are hyper resonant, and a chest radiograph shows increased lucency of all lung fields. Laboratory tests show an elevated serum IgE level and peripheral blood eosinophilia. A sputum sample examined microscopically also has increased numbers of eosinophils. Which of the following histologic features is most likely to characterize the lung in this patient's acute condition?
A. Dilation of respiratory bronchiole and distention of alveoli
B. Dilation of bronchi with inflammatory destruction of walls
C. Interstitial and alveolar edema with presence of hyaline membranes that line alveoli
D. Thickening of bronchial epithelial basement membrane and hypertrophy of bronchial smooth muscle
E. Patchy areas of consolidation surrounding bronchioles and neutrophilic exudate in affected alveoli

A 40 year old man presents to the physician with a 1 year history of chronic coughing with regular sputum production. He experiences shortness of breath from minimal exertion, severely impacting on his daily activities. As of a few months ago, the patient has been having severe exacerbations with increasing frequency. His FEV1 was discovered to be 30% of the predicted value. Which intervention would the physician prioritise?
A. Encourage the patient to exercise and return if symptoms worsen
B. Prescribe inhaled corticosteroids and educate the patient on the correct use of a puffer
C. Give them a flu shot and tell the patient to return in a few weeks
D. Commence the patient on oxygen therapy and consider surgery
E. The patient is having a midlife crisis and should be sent to a therapist for rehabilitation