Physiology Question Set 1

A 60-year-old man, a known case of severe persistent asthma since age of 14 years, presented with acute exacerbation of asthma. His asthmatic symptoms were usually well controlled with regular high-dose inhaled corticosteroids till age of 59 years. However, he mentioned that over last 12 months, control of his asthma was not good and he often used to have nocturnal cough and limitation in daily activities, despite good compliance with controller medications. He was advised spirometry, which was suggestive of bronchial asthma with partial irreversibility of airway obstruction. Which of the following is most likely to be associated with recent loss of asthma control in the patient?

A 23-year-old man presented with history of gradual onset of progressive dyspnea for last 2 weeks. He reported that dyspnea was more significant when he adopted supine position. He did not have cough and other upper respiratory symptoms, but he complained of morning headache and excessive daytime somnolence over last a few weeks. He did not have past medical history of cardiac or respiratory disease. On physical examination, respiratory rate was 40/min, respiratory movements were shallow and labored with paradoxical inward movement of abdomen during inspiration. Auscultation of lungs and heart revealed no abnormality except for absent breath sounds over lower chest bilaterally. At present, which of the following muscles are most important for inspiration in the patient?

A 64-year-old man, a known case of ischemic heart disease, presented with complaints of increasing exercise intolerance, easy fatigability, excessive daytime somnolence, and breathlessness on exertion. Further inquiry revealed that he often experienced breathlessness in recumbent position, and after approximately 2 hours of sleep, he used to suddenly awake with breathlessness and suffocation, which was relieved after assuming upright position for more than 30 minutes. Physical examination identified presence of tachycardia, S3 gallop, positive hepatojugular reflux, and distended neck veins. Which of the following is not an explanation for Cheyne-Stokes respiration in the patient?

A 7-year-old, previously healthy boy presented with abrupt onset of periorbital oedema, followed by progressive development of ascites and anasarca over four days. There was no history of hematuria or decreased urine output. Renal etiology for his symptoms was suspected and his laboratory evaluation revealed following findings: 4+ proteinuria using dipstick, urine protein 4 g/L, urine protein: creatinine ratio 2.6 g/g, no hematuria, serum creatinine 0.4 mg/dL, serum albumin 1.9 g/dL, and serum cholesterol 350 mg/dL. Ultrasonogram of abdomen revealed kidneys with normal morphology and gross ascites. Which of the following statements is correct regarding complications that this boy may develop?

A 22-year-old man presented with history of light-headedness, weakness, and palpitation, when he would assume upright position from supine position. He was otherwise a healthy man without history of alcoholism or other substance abuse. His supine and standing blood pressures (measured at interval of 3 minutes) were 124/82 mm Hg and 102/72 mm Hg respectively. He was advised to perform Valsalva maneuver while monitoring blood pressure and heart rate to assess integrity of baroreflex control. Which of the following statements is incorrect?

A 48-year-old man comes to his pulmonologist for a regular check-up. He has been diagnosed with pulmonary fibrosis several years ago. He says that he is slightly dyspnoic during physical activity, but other than that feels good. His family history is unremarkable. Which of the following is expected to be seen in the spirometry?

A 45-years-old coal mine worker is brought to the emergency room after being in a closed confined space for too long. He is presented with nausea, vomiting, dizziness and headache. He says that this is the first time something like this happened to him. Reports from the coal mine show high levels of carbon dioxide in the air. Arterial gas analysis of the patient show, he is suffering from hypercapnia. How is CO2 transported across cell membranes?

A 68-year-old man comes to the emergency room with difficulty in breathing. He was diagnosed with severe obstructive lung disease a few years back. He uses his medication but often has to come to the emergency room for intravenous therapy to help him breathe. He was a smoker for 40 years and smoking two packs of cigarettes every day. Which of the following best represent his expected ventilation, perfusion and V/Q ratio?

A 1-year-old boy is brought to the pediatric clinic with a “sick look”. On examination, he has a poor hair texture, diarrhea, edema and distended abdomen. No abnormalities are found on examination of other systems. The kid is categorized as a case of failure to thrive and further evaluation is started. As part of the evaluation, duodenal aspirate is sent for biochemical analysis and “enterokinase” deficiency is found. Which of the following enzymes is affected in the present case?

A 41-year-old female is brought to the Emergency department with pain in her abdomen in right hypochondriac region associated with nausea. On further inquiry, she says the pain is colicky in nature and aggravating after meals especially fat rich meals. Postprandial aggravation of symptoms is caused by which of the following enzymes?