Internal Medicine 2015

CARDIOLOGY PART
SCQ
1. According to NYHA classification of heart function, slight limitation of physical activity belong to (B)
a. Heart failure NYHA I
b. Heart failure NYHA II
c. Heart failure NYHA III
d. Heart failure NYHA IV
e. Normal heart function

2. Blood pressure is 150/90mmHg belong to (A)

a. Grade 1 Hypertension
b. Grade 2 Hypertension
c. Grade 3 Hypertension
d. Grade 4 Hypertension
e. Normal blood pressure

3. Blood pressure is 195/86mmHg belong to (C)

a. Grade 1 Hypertension
b. Grade 2 Hypertension
c. Grade 3 Hypertension
d. Grade 4 Hypertension
e. Normal blood pressure

4. The most sensitive and safe way for diagnosis of pericardial effusion is (C)
a. Cardiac X-ray
b. ECG
c. Echocardiography
d. Apex beat map
e. Right heart catheterization and angiography

5. The key differences of cardiac asthma and bronchial asthma is (C)

a. Whole lung full of wet rale and wheezing rale
b. Age of onset
c. Large pink foamy sputum and apical diastolic gallop
d. Long history of repeated attacks
e. None of the above

6. Typical X-ray change of acute pulmonary edema is (C)

a. Signs of hilar change
b. Thickening of lung markings
c. Butterfly shadow of halar
d. Increased transparency of the lung
e. None of the above

7. Which of the following is NOT a complication of myocardial infarction? (d)

a. Cardiac rupture
b. Myocardial infarction syndrome
c. Ventricular aneuryism
d. Aortic valve perforation
e. Embolism

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8. Choose from the right interpret of the ECG (C)

a. PJC (Premature junctional complex)

b. Atrial flutter
c. Atrial fibrillation
d. AV nodal reentrant tachycardia
e. Accelerated junctional rhythm

9. Which drug belong to dihydropyridines calcium antagonists (C)

a. Captopril
b. Diltiazem
c. Amiodipine
d. Losartan
e. Hydrochlorothiazide

10. What is this arrhythmia? (B)

a. 1st degree AV Block Type 2

b. 2nd degree AV Block Type 1
c. 2nd degree AV Block Type 2
d. 3rd degree AV Block
e. AV nodal reentrant tachycardia

11. Which is not the typical Symptom of left heart failure (d)
a. Dyspnea
b. Cough, sputum
c. Hemoptysis
d. Gastrointestinal symptoms
e. Fatigue, weakness, abnormal mind

12. What is this arrhythmia? (C)

a. 1st degree AV Block Type 2

b. 2nd degree AV Block Type 1
c. 2nd degree AV Block Type 2
d. 3rd degree AV Block
e. AV nodal reentrant tachycardia

13. For old hypertension people, the target should be (D)

a. < 140 / 90 mmHg
b. < 160 / 90 mmHg
c. < 135 / 85 mmHg
d. < 150 / 90 mmHg
e. < 130 / 80 mmHg

14. What is this arrhythmia? (B)

a. LBBB
b. RBBB
c. Atrial fibrillation
d. AV nodal reentrant tachycardia

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 e. Accelerated junctional rhythm

15. When the mitral stenosis patients have orthopnea, cyanosis, cough, pink foamy sputum, lungs full of blisters, the
disease has been in which stage (c)
a. Compensation stage
b. Pulmonary hypertension
c. Failure of the left heart
d. Right heart failure
e. End stage disease

16. Assessment indicator of heart failure processes and prognostic is (c)

a. E/A
b. CHMB
c. BNP
d. Tid
e. AST

17. Which drug belong to dihydropyridines calcium antagonists (c)

a. Captopril
b. Diltiazem
c. Amiodipine
d. Losartan
e. Hydrochlorothiazide

18. Which is not the typical Symptom of left heart failure (d)
a. Dyspnea
b. Cough, sputum
c. Hemoptysis
d. Gastrointestinal symptoms
e. Fatigue, weakness, abnormal mind

19. Patient have valvular heart disease, what kind of examination would you give him? Echocardiography
20. Heart failure shouldn't use digitalis If have hypertrophic obstructive myocardiopathy shouldn’t give
treatment of digitalis. Why? ….???? C-Systolic ejection murmur of left sterna edge???….
21. The main symptom of Left Ventricular Dysfunction – E-Dyspnea
22. Hypertension people with diabetes or chronic kidney BP, target BP– E < 130/80
23. Which of the following antiplatelet drug can be used in MI? Aspirin & Clopidogrel
24. According to patient risk factors or clinical condition…judge….belong to low risk or medium or high risk?

Fill In Blanks
1. For young hypertension people the target BP should be less than ______ 140/90.
2. The normal area of the mitral valve orifice is about____ cm2. 4-6
3. The most common cause of mitral stenosis in China is ____________ Rheumatic Fever.
4. ________was in the past a common cause of valvular heart disease. Rheumatic Fever
5. ____Valve is the most commonly involved, followed by the _____ valve. Mitral valve & aortic valve
6. The symptom of left ventricular dysfunction?infarction? is _ner?_
7. According to their Pathogenesis, arrhythmias are divided into two major categories: ____ and _____
abnormal impulse formation and abnormal Impulse conduction.
8. According to the major categories of for arrthyhmia is it true?
9. The most common cause of heart failure was _____ Rheumatic Fever
10. A patient with conduction abnormality….
11. Organ damage of hypertension including: ____,___,____,____ heart, brain, kidney and eye.
12. What was the common cause of valvular heart disease in the past? ____ and _____ valve was involved?
Rheumatic Fever & Mitral valve

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13. Main clinical manifestations of Heart Failure are ____,____,____
respiratory difficulties, limitation of activity and edema.
14. What ________ murmur can often be heard in mitral stenosis and which region ______?
Mid-diastolic rumbling & Apical
15. Idiopathic myocardiopathy include: ____,____,____,_____
_Dilated cardiomyopathy_, _Hypertrophic cardiomyopathy_, _Restrictive cardiomyopathy_,
_Arrhythmogenic right ventricular cardiomyopathy_
16. Drug belongs to Dihydropyridine include: ____ and ____ Nifedipine and Amlodipine
17. Drugs belongs to Nondihydropyridines include: ____ and ____ Diltiazem and Verapamil.
18. Specific Cardiomyopathy includes ___ and ___
alcoholic cardiomyopathy and peripartum cardiomyopathy

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True/False

1. Rational use of diuretics is the basic treatment for heart failure - True
2. Which 155/111 BP belongs to grade 2 hypertension - False
3. The mechanism of Beta Blocker is an inhibitor of Sympathetic hyperactivity ---- true
4. The stricture of heart disease, without signs or symptoms of heart failure belong to clinical Stage B - True
5. ACEI and beta blockers are the basic treatment of heart failure. True.
6. Hydrochlorothiazide, belong to potassium-sparing diuretics – False.
7. NSTEMI belong to Thrombolytic treatment indications – False
8. Arrhythmias are the inducement of heart failure - True

Short Answer

1. The classification of heart failure (NYHA)

I. No limitation of physical activity.

II. Slight limitation of physical activity.
III. Marked limitation of physical activity.
IV. Unable to carry out any limitation of physical activity and symptoms occur at rest.

2. Clinical staging of Chronic Heart Failure （ACC/AHA）

A. At high risk for HF but without functional or structural heart disease or symptoms of HF.
B. Structural heart disease but without signs or symptoms of HF.
C. Structural heart disease with prior or current symptoms of HF.
D. Refractory HF requiring special interventions.

3. The classification of anti-arrhythmic drugs – and an example of each.

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Case

1. Case: male 70y

Diagnosis:

Acute Inferior MI? / NSTEMI? - Myocardial infarction?

Dx Basis:
*** NEED TO FIT TO THE CASE!!!!! ***
(i) Symptoms
Chest pain, typically radiating to your left arms, neck, shoulder.
A tight band around the chest
Bad indigestion
Squeezing or heavy pressure
The pain usually lasts longer than 20 minutes.
Rest and nitroglycerin do not completely relieve.
(ii) Other symptoms
Anxiety, Cough, Fainting, Light-headedness, dizziness
Nausea or vomiting, Palpitations .
Shortness of breath, Sweating, which may be extreme.
(iii) Signs:
(a) Cardiac signs
Mild to moderate enlargement, increased or decreased heart rate,decreased loudness of
first sound, third / fourth heart sound gallop, pericardial friction, systolic murmur, and
clicks.
(b) Blood pressure: low BP, and may not recovery
(c) Others: related signs of arrhythmias, shock or HF.
Laboratory:
ECG, myocardial enzymes

NSTEMI
Depressed ST segment, T wave inversion deepened symmetry, T wave changes.

Differential diagnosis: (of myocardial infarction)

• Angina • Acute pericarditis
• Acute aortic dissection • Pericardial effusion
• Acute pulmonary embolism • Tension pneumothorax
• Acute abdomen • Esophageal rupture

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Tests:

1. ECG:
Q wave myocardial infarction
1. Pathologic Q Wave (necrosis)
2. ST-segment elevation (injury)
3. T wave inversion (ischemia)
No Q wave myocardial infarction
• No pathological Q, ST depression ≥ 0.1 mV
• T wave inversion only
2. General laboratory tests (leukocyte, ESR, CRP)
3. Elevated Serum enzyme level
• CK / CK-MB creatine kinase / isoenzyme
• AST / GOT aspartate aminotransferase
• LDH lactate dehydrogenase
4. Serum troponin I / T (Tnl / TnT) increased
CK-MB, Tnl / TnT-serum markers of myocardial necrosis
5. Echocardiography
6. Chest X-ray
7. Radionucleotide

Principles of treatment:

– To restore myocardial blood perfusion ( thrombolysis 30 mins, PCI 90 mins), to save the dying
myocardium, to prevent infarction expansion and reduce the scope of myocardial ischemia.
– Protection and maintenance of cardiac function.
– To deal with serious arrhythmias, pump failure and complications in time, to prevent sudden death.
– To maintain more functional myocardium.

Treatment:

• Monitor and general treatment : Rest, monitor, oxygen, nursing, establish

• Intravenous access, aspirin, clopidogrel, avoid dry stool.
• Relief of pain: meperidine, morphine, papaverine, nitrate preparations :
• Reperfusion therapy active treatment
• Elimination of arrhythmia
• Treatment of low blood pressure and shock
• Treatment of Heart Failure
• Other treatment

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2. Case: HTN

Diagnosis:

Hypertension, and classification and risk stratification

Dx Basis:
*** NEED TO FIT TO THE CASE!!!!! ***
Persistently high blood pressure.
Three separate measurements at least one week apart.
Identification of primary or secondary
Blood pressure classification
Hypertension risk stratification

Differential diagnosis:
Secondary hypertension
by definition results from an identifiable cause.
Major cause
Renal Hypertension
Renovascular hypertension
Primary aldosteronism
Pheochromocytoma
Cushing's syndrome
Coarctation of the aorta

Tests:

1. Routine Exams
Blood sugar, Total cholesterol, HDL-C, LDL-C, Fasting serum TG, Serum uric acid, Serum creatinine,
Serum potassium, Hemoglobin and hematocrit, Urinalysis, ECG)

2. Further Exams
Echocardiography, Carotid (and femoral) ultrasound, C-reactive protein, Microalbuminuria
(diabetic patients), Urinary protein. Ophthalmoscopy (severe hypertension), Sternite

Treatment:

1. Improve Living Behaviour

• Weight loss BMI
• Reduce daily sodium intake < 6g
• Added calcium and potassium
• Reduce fat intake
• Limit alcohol <50g ethanol daily
• Increased physical activity
2. Antihypertensive Medications
1. Diuretics:
① potassium-excrete diuretics: Hydrochlorothiazide
② loop diuretics: Furosemide
③ potassium-sparing diuretics: Spironolactone
2. β blockers: Metoprolol
3. Calcium channel blocker (CCB):
Dihydropyridines: Nifedipine, Amlodipine
Non-dihydropyridine: Diltiazem, Verapamil
4. Angiotensin-converting enzyme inhibitor (ACEI): Captopril, Enalapril
5. Angiotensin II receptor blocker (ARB): Losartan

Page 8 of 24
Helpful to know
Blood pressure classification and definitions （Chinese Hypertension League Hypertension Guideline ）.

Classification （
Systolic pressure mmHg ） （
Diastolic pressure mmHg）
Normal <120 and <80
High normal 120-139 or 80-89
Hypertension
stage 1 140-159 or 90-99
stage 2 160-179 or 100-109
stage 3 ≥180 or ≥110
Isolated systolic hypertension ≥140 and <90

Cardiovascular risk stratification of hypertensive patients.

risk factors and blood pressure (mmHg)

medical history grade 1 grade 2 grade 3

No risk factors Low medium High

1～2 risk factors medium medium The highest level

≥3 risk factors, or
High High The highest level
TOD

Complications or
The highest level The highest level The highest level
diabetes

Complications of Myocardial infarction?

Second infarction, Congestive heart failure, Myocardial rupture, Arrhythmia, Pericarditis,
Cardiogenic shock.

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Arrhythmias

Sinus Arrhythmia

Sinus Tachycardia

Sinus Bradycardia

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Sick Sinus Syndrome (SSS)

Atrial Tachycardia (AT)

Atrial Flutter

Junction premature Beats

Paroxysmal SVT

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Atrial Fibrillation

Ventricular Tachycardia

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Ⅰ°AV Block

Ⅱ°Ⅰtype AV Block
(Wenckebach)

Ⅱ°Ⅱ type AVB

Ⅲ°AVB

Page 13 of 24
 RESPIRATORY PART
SCQ
1. Which one is correct in the following descriptions of bronchiectasis ( _C_ )
A. Bronchiectasis is a disorder of bronchi less than 2mm.
B. The patient may have the past history of measles or pneumonia
C. the most typical signs of bronchiectasis is clubbing.
D. The diagnosis of bronchiectasis depends on chest X-ray.

2. What is not the clinical cause of pleural effusion? ( _A_ )

A. Bronchiectasis
B Congestive heart failure
C Tuberculous pleurisy
D Lung cancer

3. The most typical symptom in patients with hypoxia is ( _C_ )

A. heart rate B. cyanotic C. breathing difficulty D. excited

4. Which one is the performance of peripheral lung cancer in all of the following X-Ray findings? ( _B_ )
A. segment or lobe of the limitations of emphysema
B. round or oval mass, often has lobulated, with umbilical-like notch or burr-like change.
C. obstructive pneumonia
D. inverted "S"-shaped atelectasis and high density patchy shadows

5. Which one is not the performance of central lung cancer in all of the following X-ray findings,? ( B )
A. segment or lobe of the limitations of emphysema
B. round or oval mass, often has lobulated, with umbilical-like notch or burr-like change.
C. obstructive pneumonia
D. inverted "S"-shaped atelectasis and high density patchy shadows

6. A patient with a long history of cough and sputum, which exacerbated in autumn and winter, the most likely
diagnosis is ( _A_ )
A. Chronic bronchitis B. Acute bronchitis C. Bronchiectasis D. Pneumonia

7. The typical symptoms of pneumococcal pneumonia is ( _C_ )

A. chills and high fever
B. mucoid purulent sputum
C. rust colored sputum cough
D. shortness of breath and cyanosis

8. Which of the following types of lung cancer is significantly sensitive to chemotherapy ( _C_ )
A. squamous cell carcinoma
B. Adenocarcinoma
C. Small cell carcinoma
D. Iarge cell carcinoma

9. What is the most reliable means in diagnosis of lung cancer ? (A )

A. Cytology, histology, pathology B. History, signs
C. Chest X-ray examination D. Chest tomography radiography

10. What is the most common pathogen of nosocomial pneumonia ? (C)

A. Viruses B. anaerobic C. Gram-negative bacteria D. fungi

12. What is the clinical typical symptoms of bronchial asthma ? (C )

A chest congestion B. chest pain C Recurrent expiratory dyspnea D hemoptysis
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15. What is not the clinical cause of pleural effusion ? ( A )
A Bronchiectasis B Congestive heart failure
C Tuberculous pleurisy D Lung cancer

16. The most common cause of death of chronic obstructive pulmonary disease and chronic pulmonary heart
disease is (D)
A. arrhythmias
B. Shock
C. electrolyte disturbance
D. respiratory failure

17. What is the most common cause of hemoptysis (C)

A. lung cancer
B. Pneumonia
C. Bronchitis
D. Bronchiectasis

18. What is the most common sign of pulmonary embolism (A)

A. Tachypnea and tachcadia
B. P2>A2
C. breathing difficulty
D. excited

19. What is the most common symptom appearing in pulmonary embolism patients ? (C)
A. chest pain
B. breathing difficulties
C. tachypnea
D. cyanotic

20. What is the most common pathogen in the community acquired pneumonia? (A)
A. Streptococcus pneumoniae
B. Staphylococcus aureus
C. Haemophilus influenzae
D. Mycoplasma pneumonia

21. What is the most common pathogen of community acquired pneumonia? (A)
a. Streptococcus Pneumoniae
b. Haemophilus influenza
c. Gram-negative bacteria
d. Staphylococcus aureus

22. What is the most reliable means in diagnosis of COPD (D)

A. visual examination shows that barrel chest
B. palpation language chatter less
C. percussion were voiced, heart cloud
D. FEV1/FVC<70% after inhalation of salbutrol

23. What is the most common cause of Pulmonary Embolism (PE)? _Deep Venous Thrombosis (DVT)_

24. What is the most reliable mean of diagnosis of lung cancer? _Biopsy_

25. What is the most reliable mean of diagnosis of COPD? _Lung Function Test (LFT)_

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26. What is the gold standard test for pulmonary embolism diagnosis? D
a. V/Q lungscan
b. CT scan
c. D-dimer
d. Angiography

27. Which of the following types of lung cancer might not be related to cigarette smoking? C
a. Squamous cell carcinoma
b. Adenocarcinoma
c. Small cell carcinoma
d. Large cell carcinoma

28. Which one is the most common risk factor for COPD? A
a. Cigarette smoking
b. Environmental dust,fumes,gases
c. a1 antitrypsin deficiency
d. Bronchial infection

29. Which one is the most effective measure for COPD prevention? C
a. Inhaled bronchodilators
b. Vaccinations
c. Smoking cessation
d. pulmonary rehabilitation

30. The typical symptoms of pulmonary embolism is D

a. Chills and high fever
b. Pleuritic chest pain, dyspnea and hemoptysis
c. Rust colored sputum cough
d. Shortness of breath and cyanosis

31. Which of the following types of lung cancer is not sensitive to chemotherapy A
a. Squamous cell carcinoma
b. Adenocarcinoma
c. Large cell carcinoma
d. Small cell carcinoma

32. Which of the following types of lung cancer is significantly sensitive to chemotherapy C
A. squamous cell carcinoma B. adenocarcinoma
C. Small cell carcinoma D. large cell carcinoma

33. What is the most common pathogen of nosocomial pneumonia ? C

A. Viruses B. anaerobic C. Gram-negative bacteria D. fungi

34. The typical symptoms of asthma is C

A. Chest pain
B. Hemoptysis
C. Recurrent Respiratory Dyspnia
D. ?

Page 16 of 24
Fill In Blanks

1. Please list the mechanism of hypoxemia___,___,___ and ___.

_decreased diffusion_, _Hypoventilation_, _shunting_, and _V/Q mismatch_.
2. Please list the Virchow's triad ___,___ and ___.
_hypercoagulability_, _venous stasis_ and _venous injury_.
3. Please list 4 types of bronchogenic carcinoma ___,___,___ and ___.
_squamous cell carcinoma_, _adenocarcinoma_, _Iarge cell carcinoma_, _small cell carcinoma_.
4. The characteristics of respiratory failure (type 1) is _________ _hypoxia_
5. The most common cardiac arrhythmia in Chronic pulmonary heart disease is___ _ventricular arrhythmia_
6. The most common cause of death of chronic obstructive pulmonary disease and chronic pulmonary heart
disease is _____ _pulmonary hypertension & RVF_
7. __is significantly sensitive to chemotherapy in lung cancer. Small Cell Carcinoma
8. __ is the common clinical cause of pleural effusion in China. TB pleurisy
9. __ is the first choice for the treatment of community acquired pneumonia.
Azithromycin
10. The key treatment of acute exacerbation of COPD is ____
Control of infection
Ⅱ ，
11. The characteristics of respiratory failure(type ) is PO2< mmHg PC02> mmHg ， 60 & 50
12. The principles of tuberculosis chemotherapy are ___,___,___,___,___
_early_,_regular_,_consistent_,_adequate_,_combined_.
13. The typical symptoms of pneumococcal pneumonia is: ___,___,___,___,___
_Chills_, _fever_, _cough_, _rust colored sputum_, _chest pain_

True and False

1. Pulmonary tuberculosis is characterized by formation of granuloma in infected tissue. _True_

2. In pneumonia patient, antibiotic therapy is initiated only after the doctor gets the results of bacterial culture.
_False_
3. COPD is a disease state characterized by the presence of not fully reversible airflow obstruction. _True_
4. The diagnosis of COPD depends on the result of Lungs Functions Test. _True_
5. The clinical picture of PE must have chest pain, dyspnea and hemoptysis. _False_
6. The key treatment of acute exacerbation of COPD is mechanical ventilation. _False_
7. Pulmonary tuberculosis often have an insidious onset and general toxic symptoms. _False_
8. The characteristics of respiratory failure (type ll) is Pa02 < 60mmHg with reduced or normal PaC02. _False_
9. Bronchiectasis is classified as an obstructive lung disease. _True_
10. Bronchiectasis is a classified as an obstructive lung disease. (T)
11. In a pneumonia patient ,antibiotic therapy is initiated only after the docter gets the results of bacterial
culture. (F)
12. The most meaningful check for diagnosis of pulmonary embolism is CTPA (T)
13. Asthma is a disease state characterized by the presence of unreversible airflow obstruction. (F)
14. In a pneumonia patient ,antibiotic therapy is initiated only after the docter gets the results of bacterial
culture. (F)
15. The characteristics of respiratory failure (type II )is PaO2 < 60mmHg with reduced or normal PaCO2. (F)
16. Asthma is a disease state characterized by the presence of unreversible airflow obstruction. (F)
17. The diagonosis of COPD relys on the result of CT . (F )
18. The key treatment of acute exacerbation of COPD is control infection. _True
19. The characteristics of hypoxemic respiratory failure is PaO2 < 60mmHg with reduced or normal PaCO2. True

Page 17 of 24
Short Questions

1. Please list the major type of Pneumonia according to their causes?

1. Bacterial Pneumonia (S. pneumonia, S. aureus, H. Influenza, Anaerobic)

2. Viral Pneumonia (adenovirus, influenza, RSV)
3. Mycoplasma Pneumonia
4. Fungal Pneumonia (Candida, Aspergillus)
5. other pathogens : Rickettsia, ch lamydia, toxoplasmosis, protozoa and parasites
According to the environment :
1. Community Acquired Pneumonia (CAP)
2. Hospital Acquired Pneumonia (HAP)

2. What are the major causes of Chronic Respiratory Failure?

(A) obstructive airway diseases

(B) lung tissue lesions

(C) pulmonary vascular disease

(D) internal thoracic diseases

(E) central nervous system and respiratory muscles and their conduction disorders

3. What are the common found pathogens of Community Acquired Pneumonia?

S. pneumoniae, H. influenzae, S. aureus,

M. pneumoniae, C. pneumoniae,
aerobic gram-negative bacteria,
influenza viruses, adenoviruses, and respiratory syncytial virus.

4. What are the common found pathogens of Hospital Acquired Pneumonia?

S. pneumoniae, H. influenzae, S. aureus,

and enteric gram-negative bacilli

Page 18 of 24
Case Analysis

1. Case
A 68-year-old salesman complained of a productive cough of 20 years duration and increasingly
severe dyspnea over a two-month period.The amount of sputum averaged about 20 ml per day and
was muciod .He admitted a daily consumption of 40 cigarettes for 20 years. Physical examination:
℃
T38.0 , P110 / min, R26 /min,Bp120/80mmHg. Conscious, lips cyanosis, barrel chest, there was a
generalized decrease in bresth –sound intensity. Rhonchi ,with prolonged expiration could be heared
over both lungs.the heart was not enlarged, heart rate is 110 times / min and regular, the abdomen
was soft,no tenderness. No edema in both lower extremities.

1. What is the diagnosis?

_COPD_

2. Give your evidences for the diagnosis?

Symptoms: (>2yrs)
1, cough: chronic, long-term, repeated.
2, sputum: mainly white, may have sputum.
3, wheezing.
Signs:
barrel chest
weakened breathing movement
decreased breath sounds
Diagnostic criteria:
smoking and other risk factors
chronic bronchitis + gradually increased difficulty breathing

3. What further test you will do?

• X-ray or CT
• Lung Function Test
• ECG
• Blood Gas Analysis
• Blood and Sputum Analysis

4. Please list the treatment options, and explain the reasons.

（
1. Antibiotics 2weeks the most common cause for a AECOPD patient is infection ）
2. Ambroxol (to help the patient expectoration)
3. Bronchodilator (Rhonchi, with prolonged expiration could be heared over both lungs.)
4. if the patient has respiratory failure ,the patient may also need Mechanical ventilation
support.

Page 19 of 24
2. Case

1. What is the diagnosis?

_Asthma_

2. Give your evidences for the diagnosis?

3. What further test you will do?

o Pulmonary Function Tests

o Blood Routine Test for Eosinophils
o Sputum Smears
o Positive wheat-and-flare reactions to skin tests
o Chest X-ray
o Metacholine Challenge Test

4. What is treatment?

1) Theophylline
2) Anti-inflammatory (Mast Cell Stabilizers, Anti Leukotrines)
3) Adrenergic drugs:
4) Calcium antagonists
5) Disodium cromoglycate
6) Glucocorticoids
7) Anticholinergic
8) Ketotifen

Page 20 of 24
3. Case
A 28-year-old married female was admitted to the hospital on May 3, 2011, because of a 6-day fever
and cough. Six days ago, she began running a fever and having a bad cough productive of mucous
sputum, for which she has not taken any medical treatment up to now. In the past three days, she
has been having a persistent high fever, an exacerbated cough productive of rusty sputum and a
thoracalgia intensified with respiration. During her illness, she has been weak and has had a poor
appetite without specific urine or stools. PE T:39C ; P 107/min. R:25/min ; BP:110/70mmHg. No
cyanosis. No eruption or purpura on skin. Chest symmetrical. Tactile fremitus exaggerate slightly
over the right upper chest and a lot small and moderate moist rales heard here. Heart beat regular
with no murmur. Abdomen flat, soft and free from tenderness. Routine blood test: WBC 21,
000/mm3, N 80%, L 19%, E 1%. Chest fluoroscopy: A big patchy density in the right upper Lung.

1. Please give the most likely diagnosis of the patient.

_Pneumonia (Right Upper)_

2. Give your evidences for the diagnosis (How do you make the diagnosis?)

Symptoms and signs :

fever, cough, and rusty sptum
Tactile fremitus over the right upper chest
moist rales could be heard;

Laboratory study showed: WBC21*109 / L, N 80%

3. What further tests are needed?

X-ray or CT; sputum analysis

4. Please give the patient's treatment plan.

• Antibacterial treatment: Preferred: penicillin – 2 weeks

• Those who are allergic to penicillin: erythromycin. Iincomycin
• Severe patients: the first, second and third generation of cephalosporins
• Supportive therapy
• Take a rest
• Added energy, liquids, protein and vitamins, etc.
• Ambroxol (to help the patient expectoration)

Page 21 of 24
 ENDOCRINOLOGY PART
（D）
SCQ
1. The drug withdrawal indication of ATD is
〈 〈 〈
A.WBC 6.0×10*9/L or NEU 1.0×10*9/L B. WBC 4.0×10*9/L or NEU 1.0×10*9/L 〈
〈 〈 〈
C. WBC 3.5×10*9/L or NEU 2.5×10*9/L D. WBC 3.0×10*9/L or NEU 1.5×10*9/L 〈
〈
E. WBC 5.0×10*9/L or NEU 0.5×10*9/L〈
2. Female, 45 years old, slightly obesity, without any thirsty , polydipsia and polyuria symptoms,her fasting
．
glucose is 6 8mmol/L. To diagnosing whether she suffers diabetes ,we should test （ ）
A
A HBA1C B urine glucose of 24 hours C OGTT D recheck fasting blood glucose
E 2-h post glucose

3. The diagnostic criteria of diabetes is symptom plus fasting glucose （A ）

A ．≥ ．
7 0 mmol L B ／ ．≥ ． ／ ．≥ ．
9 1 mmol L C l0 1 mmoL L ／
D ．≥ ．
11 1 mmoL L E ／ ．≥ ． ／ 12 0 mmoL L

4. The basic treatment for diabetes patient is （A）

A Diet Therapy + physical exercise B Pancreas transplantation C Biguanides
D Sulfonylureas E insulin

5. The chief therapeutic measurement of DKA is ( E )

A Transfusion B Anti-infection C Transfusion+Insulin
D Alkali supplementary E Correct electrolyte disturbance

1. The cause of diabetic blindness is C

A. Cerebrovascular accident
B. Catarac
C. Retinopathy
D. Glaucoma
E. Iridociliary disorder

2. Insulin resistance is D?
A. The body of the supernormal reaction of insulin
B. The body’s extraordinary sensitivity to insulin
C. Increased the body physiological effects of insulin
D. The body down the physiological effects of insulin
E. The body of the reduced requirement of insulin

3. The main cause of diabetic metabolic disorders is E?

A. Increased hormone insulin antagonism
B. Absolute or relative lack of insulin
C. Affinity to reduce insulin
D. Hyperproinsuloinemia
E. Insulin resistance

4. The main side effects of antithyroid drugs is B?

A. Gastrointestinal reaction
B. Drug eruption
C. Liver damage
D. Granulopenia
E. Acute renal damage

5. Which is not the side-effect of glucocorticoid E

A. Infection
B. Peptic ulcer
C. Diabetes mellitus
D. Cushing’s syndrome
E. Arrest of bone marrow
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Fill In Blanks
6. There are 5 kinds of oral blood glucose lowering drugs, please write down Sulfonylureas , Biguanides ,
α-glucosidase inhibitors , Thiazolidinediones , Meglitinides .

True/False
9.There are 3 kinds of treatment for Graves , antithyroid drug,surgery,radioiodine. （ T）
10.Biguanides can not be use for type 1 diabetes ( F )
9.Insulin can not be use for type 2 diabetes ( F )
10.The side effects of antithyroid drug is tachycardia ( F )

四、Briefly answer the following questions.

5. Please write down the indication of insulin treatment
Type 1 DM
Type 2 DM
• Acute complications
• Severe chronic complications of diabetes
• Emergency
• Severe dysfunction of liver or kidney
• Gestation and bleeding women
， ，
• Without tolerance OHA curative effect of OHA SU invalidation
• Distinct lean
• With diseases treated by glucocorticoid
： 、 、
Some specific types of DM secondary pancreas disease endocrinopathies genetic diabetes

6. There are 5 kinds of oral blood glucose lowering drugs, please write down
• Sulfonylureas
• Biguanides
• α-glucosidase inhibitors
• Thiazolidinediones
• Meglitinides

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五、Case
五、 analysis questions
3. Male, 20 years old , cloudiness of consciousness for 2 hours , he was type 1 diabetes for 5 years, and used
insulin for long time. But he have stopped insulin for 3 days because of diarrhea when he come to hospital.
／ ，
Physical examination: BP 70 50 mmHg, skin dehydration, deep and fast respiration heart rate 130counts
per minute.
Questions:
① Which disorder does the patient have?
Diabetic Ketoacidosis
② Please write down all the Inducement of this disorder you known.
• Interrupted drug therapy
• Improper diet
• Fatigue
• infection
• Trauma
• operation
、
• pregnancy delivery
• drinking
• myocardial infarction

③ Which test need to do at once in order to diagnosing this disorder?

Urine tests
• glucosuria
• ketourine
Blood tests
• Blood sugar
• Blood ketone
• CO2CP
• Electrolyte

④ Write down therapeutic Principle of this illness.

1) Correcting acute metabolic turbulence
2) Preventing and curing complications
3) Reducing the case fatality rate

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