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Dr. Keshv PART I Exam 2 RESPIR

Total questions: 63

Worksheet time: 5hrs 35mins

Name
Class
Date
1.

A genetic tendency to develop Type I HS toward antigens (food & environment)

a)

Atopy

b)

PAH

2.

Which of the following are considered signs of Atopy? Select all that apply

a)

atopic dermatitis

b)

eczema

c)

asthma

d)

ENT & eyes allergic manifestations

3.

Which of the following is TRUE about Atopy? Select all that apply

a)

Mucus membranes are overly responsive

b)

Atopic patients show an overproduction of IgE & abnormal response

c)

Mast cells are easily activated

d)

High levels of IgE and abnormal response

e)

signs: atopic dermatitis, eczema, asthma, ENT and eyes allergic manifestations.

4.

Which of the following is TRUE about Atopic individuals?

a)

They have a B lymphocyte cells imbalance with low inflammation (Th2) and low pathogen killing (Th1)

b)

They have a T cells imbalance with high inflammation (Th2) and low pathogen killing (Th1)

c)

They have a T cells imbalance with high inflammation (Th2) and high pathogen killing (Th1)

d)

They have a T cells imbalance with very low inflammation (Th2) and high pathogen killing (Th1)

5.

Which of the following T cells are involved in intracellular pathogen killing?

a)

Th1

b)

Th2

c)

IL-4

d)

IL-5

e)

IL-9

6.

Which of the following T cells are involved in extracellular pathogen killing? Select all that apply

a)

Th1

b)

Th2

c)

IL-4, IL-5

d)

IL-9, IL-13

e)

IFN-Y

7.

Which of the following plays a role in B cells class switching (IgG to IgE)?

a)

IL-9

b)

IL-4

c)

IL-5

d)

IL-13

8.

Which of the following plays a critical role in Eosinophil recruitment & activation?

a)

IL-4

b)

IL-5

c)

IL-9

d)

IL-13

9.

Which of the following plays a critical role stimulating mast cell proliferation?

a)

IL-4

b)

IL-5

c)

IL-9

d)

IL-13

10.

Which of the following plays a multiple roles by activating mast cells, eosinophils epithelial cells and does many other things?

a)

IL-4

b)

IL-5

c)

IL-9

d)

IL-13

11.

Which of the following are the results of T cell imbalance in Atopy? Select all that apply

a)

Hyperresponsive airways

b)

Higher IgE level

c)

Eosinophilia

d)

Underlying inflammation

e)

Basophilia

12.

Which of the following factors can be influencing the imbalance recently? Select all that apply

a)

too much time indoor so vitamin D deficiency

b)

diet and gut flora

c)

antibiotics

d)

preservatives

e)

use of medications

13.

Which of the following reduces the risk of allergies growing up in a farm? Select all that apply

a)

genetic, epigenetic, environment

b)

gut bacterial composition

c)

vitamin D

d)

antibiotics

14.

Which of the following cells its function is to clear/remove the mucus in the airways?

a)

goblet cells

b)

Ciliated epithelial cells

c)

bronchial smooth cells

15.

Which of the following cells are specialized in mucus production?

a)

Bronchial smooth muscles

b)

Ciliated epithelial cells

c)

Goblet cells (mucus glands)

16.

Which of the following is hyperresponsive in many asthma patients causing bronchoconstriction?

a)

Goblet cells

b)

Ciliated epithelial cells

c)

Bronchial smooth muscles

17.

Eosinophils, mast cells, and other cells can accumulate in airways.

a)

True

b)

False

18.

Which of the following biologic/antibodies are against IL-5?

a)

Reslizumab

b)

Mepolizumab

c)

Benralizumab

d)

Dupilumab

e)

Omalizumab

19.

Which of the following inhibits IL-4 receptor and IL-13?

a)

Omalizumab

b)

Dupilumab

20.

Which of the following drugs directly bind to IgE which prevents the activation of mast cell?

a)

Dupilumab

b)

Omalizumab

c)

Benralizumab

d)

Mepolizumab

e)

Reslizumab

21.

Which of the following are more potent bronchoconstrictors?

a)

Histamine

b)

Leukotrienes

22.

Which of the following inhibits all aspects of inflammation?

a)

Corticosteroids

b)

Leukotrienes

c)

Histamines

23.

Why do we need to control inflammation by avoiding persistent inflammation due to unmanaged asthma? Select all that apply

a)

avoid epithelial damage and cilia cells loss

b)

avoid airway remodeling

c)

avoid subepithelial fibrosis

d)

avoid myocyte hypertrophy

e)

avoid thickening of airways which decreases elasticity

24.

Which of the following are characteristics of COPD? Select all that apply

a)

Inflammation predominantly in small airways

b)

Inflammation is chronic & minimally responsive to corticosteroids

c)

Small airway narrowing & fibrosis (obstructive bronchiolitis)

d)

Destruction of alveolar walls & lung parenchyma (emphysema)

e)

Excessive mucus production (obstructive)

25.

Which of the following manifestations are seen only in COPD and not Asthma? Select all that apply

a)

Skeletal muscle wasting

b)

Weight loss

c)

Depression

d)

Osteoporosis

e)

Ischemic Heart Disease

26.

Which of the following are cellular components presented in COPD? Select all that apply

a)

IL-5

b)

Cytotoxic T lymphocytes (Tc1)

c)

Neutrophils

d)

Macrophages

e)

IL-13

27.

In which of the following there are proteases damaging the alveolar wall and mucus hypersecretion as non-cellular components ?

a)

Asthma

b)

COPD

28.

Which of the following are TRUE regarding the role of sympathetic fibers? Select all that apply

a)

constrict the airways by constricting smooth muscle

b)

dilates the airways by relaxing smooth muscle

c)

activation of B2 receptors

d)

activation of M3 receptors

29.

Which of the following are TRUE regarding the role of parasympathetic fibers? Select all that apply

a)

causes bronchodilation and dilation of smooth muscle

b)

causes bronchoconstriction and mucus production

c)

activation of B2 receptors

d)

activation of M3 receptors

30.

Which of the following are produced during inflammation process and trigger bronchoconstriction? Select all that apply

a)

Acetylcholine

b)

Histamine

c)

Leukotrienes

d)

Prostaglandin (PGD2)

e)

M3

31.

In the Beta-2-Aderenergic Receptor Signaling Pathway which of the following inhibits MLCK causing bronchodilation/relaxation?

a)

cAMP

b)

AMP

c)

PKA

d)

AC

e)

ATP

32.

Which of the following are TRUE about how can we get bronchodilation in Beta-2-Aderenergic Receptor Signaling Pathway?

a)

We can inhibit AMP

b)

We can inhibit phosphodiesterase to get bronchodilation

c)

We can inhibit AC (adenylate cyclase)

d)

We can inhibit MLCK causing relaxation/bronchodilation

33.

Which of the following are Beta-2-Aderenergic Receptor Signaling Pathway benefits ? Select all that apply

a)

Increase ciliary activity (mucus clearance)

b)

Mast cell stabilization (during acute inflammation)

c)

Increase the intracellular effects of corticosteroids

d)

Decrease ciliary activity (mucus clearance)

34.

Understand that not only M3 receptors cause bronchoconstriction, but also others like Histamine, Leukotrienes and PGD2.

** ANTICHOLINERGICS do not prevent bronchospasm.

a)

Yes

b)

No

35.

Memorize this table, draw it!!

a)

Yes

b)

No

36.

Which of the following drugs are Beta-2 Agonist Inhalers of short acting (SABA)?

a)

Albuterol (salbutamol)

b)

Levalbuterol (Xopenex)

c)

Terbutaline

d)

Salmeterol

e)

Formoterol

37.

Which of the following drugs are Beta-2 Agonist Inhalers of long acting (LABA)?

a)

Salmeterol

b)

Formoterol

c)

Arformoterol

d)

Olodaterol

e)

Indacaterol, Vilanterol

38.

Which of the following statements is TRUE?

a)

norepinephrine has slightly greater affinity for b2 receptors because of the methyl group.

b)

epinephrine has slightly greater affinity for b2 receptors because of the methyl group.

39.

Which of the following are TRUE about this structure? Select all that apply

a)

Isoproterenol has a short life

b)

catechol is inactivated by COMT

c)

has a long life

d)

selectively bind to B1 and B2

e)

increase HR

40.

Which of the following is TRUE about this structure? Select all that apply

a)

Selective B2

b)

N-t-butylnorephinephrine

c)

has less adverse effects than Isoproterenol

d)

has a short half life and catechol ring inactivated by COMT

e)

Selective towards b1 and b2 (not a)

41.

Which of the following B2 agonists are not inactivated by COMT having longer half lives? Select all that apply

a)

Terbutaline

b)

Albuterol (Salbutamol)

c)

Levalbuterol (Xopenex)

d)

Isoproterenol

e)

N-t-butylnorepinephrine (Colterol)

42.

Which of the following B2 Agonists has an R enantiomer 68 times more active than the S enantiomer and it is more effective ?

a)

Terbutaline

b)

Albuterol (Salbutamol)

c)

Levalbuterol (Xopenex)

d)

Isoproterenol

e)

N-t-butylnorepinephrine (Colterol)

43.

Know these!

a)

Yes

b)

No

44.

Which of the following are considered TWICE DAILY LABA? Select all that apply

a)

Salmeterol (Serevent®)

b)

Formoterol (Foradil®)

c)

Arformoterol (Brovana®)*

d)

Olodaterol (Striverdi Respimat)

e)

Indacaterol (Arcapta Neohaler)

45.

Which of the following are considered ONCE DAILY LABA? Select all that apply

a)

Indacaterol (Arcapta Neohaler)

b)

Olodaterol (Striverdi Respimat)

c)

Vilanterol (with fluticasone furoate in Elipta Brio)

d)

Salmeterol (Serevent®)

e)

Formoterol (Foradil®)

46.

Which of the following is the alpha R,R enantiomer of Formoterol (Foradil)?

a)

Salmeterol (Serevent)

b)

Arformoterol (Brovana®)

c)

Salmeterol (Serevent®)

d)

Indacaterol (Arcapta Neohaler)

e)

Vilanterol (with fluticasone furoate in Elipta Brio)

47.

Which of the following is TRUE about the highlighted yellow area in this image?

a)

it causes long acting effect (bid)

b)

tend to be more lipophilic

c)

used for COPD

d)

used for asthma as a monotherapy

e)

it causes short acting effect

48.

Which of the following is true about this image?

a)

tend to be more lipophilic

b)

the highlighted area means long acting effect

c)

longer half live (bid)

d)

used for COPD

e)

used for asthma as a monotherapy

49.

Which of the following drugs are ultra long acting which means the longer long acting? Select all that apply

a)

Olodaterol

b)

Indacterol

c)

Salmeterol

d)

Formeterol

e)

Arformoterol

50.

Which of the following drugs is ONCE DAILY INHALATION SPRAY ultra long acting used for COPD?

a)

Indacterol

b)

Olodaterol

c)

Salmeterol

d)

Formoterol

e)

Arformoterol

51.

Which of the following drugs is ONCE DAILY DRY POWDER ultra long acting used for COPD?

a)

Formoterol

b)

Salmeterol

c)

Indacterol

d)

Olodaterol

e)

Arformoterol

52.

Which of the following LABA + CORTICOSTEROIDS combinations is used ONCE DAILY and its ultra long acting?

a)

Advair

b)

Breo Ellipta

c)

Symbicort

d)

Dulera

53.

Which of the following LABA + CORTICOSTEROIDS combinations is used TWICE DAILY? Select all that apply

a)

Breo Ellipta

b)

Advair

c)

Symbicort

d)

Dulera

54.

Which of the following LABA + CORTICOSTEROIDS combinations is used ONCE DAILY and its ultra long acting?

a)

fluticasone propionate + salmeterol

b)

fluticasone furoate + vilanterol

c)

budesonide+formoterol

d)

mometasone+formoterol

55.

Which of the following LABA + CORTICOSTEROIDS combinations is used TWICE DAILY? Select all that apply

a)

Fluticasone propionate +  Salmeterol

b)

Budesonide + Formoterol

c)

Mometasone + Formoterol

d)

Fluticasone furoate + Vilanterol

56.

Which of the following are general adverse effects of SABA Beta 2 Agonists? Select all that apply

a)

Tachycardia/palpitations: reflux tachycardia due to vasodilation (skeletal muscles)

b)

Muscle tremor: stimulation of skeletal beta-2 receptors

c)

CNS (headache, restlessness, nervousness)

d)

Angioedema

57.

Which of the following is TRUE about Albuterol Pharmacokinetic? Select all that apply

a)

Because of the first pass effect we get minimal adverse effects

b)

80% is deposited in the oral cavity and goes down to the GI tract

c)

a lot of the drug is inactivated before it reaches the systemic circulation (first pass effect)

d)

the 20% deposited in the lungs eventually get into the systemic circulation

58.

Know this! It is very helpful to support Dr. Kearns content regarding pathways.

a)

Yes

b)

No

59.

Which of the following is TRUE regarding Atropine VS. Ipratropium?

a)

Because of the methyl group (makes it more lipophilic) in Ipratropium that results in quaternary amine which has better lung penetration and less adverse effects

b)

Because of the isopropyl group (makes it more lipophilic) in Ipratropium that results in quaternary amine which has better lung penetration and less adverse effects

c)

Because of the tertiary amine in Atropine will lead to CNS (brain blood barrier) effects

d)

Because of the quaternary amine in Atropine will lead to CNS (brain blood barrier) effects

60.

Which of the following Anticholinergics stays in the receptor for a longer period of time and it has a longer duration of action?

a)

Ipratropium

b)

Tiotropium

c)

Acetylcholine

d)

Aclidinium

e)

Glycopyrrolate

61.

Which of the following drugs that decreases mucus secretion in airway epithelium and prevents muscle contraction has the SHORTEST DURATION OF ACTION?

a)

Aclidinium

b)

Ipratropium

c)

Glycopyrrolate

d)

Tiotropium

e)

Umeclidinium

62.

Which of the following are the adverse effects for anticholinergics? Select all that apply

a)

Dry mouth

b)

GI disturbance (constipation)

c)

Blurred vision

d)

May worsen glaucoma (mydriasis)

e)

No CNS penetration

63.

Which of the following are considered PDE (Phosphodiesterase) Inhibitors? Select all that apply

a)

Roflumilast

b)

Theophylline

c)

Revefenacin

d)

Umeclidinium

e)

Glycopyrrolate

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