Medicine 5th LE Feedback (Respi & Hema)

1. what is a sign of advanced tissue iron deficiency?
a. pallor
b. cheilosis
c. reduced exercise capacity
d. chest pain
2. What is true regarding myelodysplastic
syndrome(MDS)?
a. Fever and weight loss point to a myelodysplastic
syndrome
b. The total WBC count is high except in chronic
myelodysplastic leukemia
c. MDS is caused by environmental exposures such as
radiation and benzene
d. The therapy of MDS is generally unsatisfactory
3. What feature distinguishes AML from ALL?
a. Absence of clefting characteristic of monocytoid
cells
b. Uniformly fine or lacelike nuclear chromatin
c. Positive myeloperoxidase stain
d. Cytogenetic and molecular mechanisms
10. Which are true of hemoglobins during embryonic,
fetal and adult life?
a. The major adult haemoglobin is Hba which is a
structure of 2 alpha and 2 gamma
b. According to the Bohr effect, haemoglobin has a
higher oxygen affinity at low pH facilitating delivery to
tissues
c. Fetuses and newborns require alpha globin but not
beta globin for normal gestation
d. All of the above
11. Which is true of CML?
a. There is clonal expansion of stem cells that contain a
reciprocal translocation between chromosomes 8 and
14 leading to the formation of the BCR/ABL fusion gene
b. Disease acceleration is defined as blood or bone
marrow blasts >20%
c. Laboratory evaluation reveals elevated WBC
associated with high leukocyte alkaline phosphatase
d. Early satiety with left upper quadrant pain are
almost always appreciated in patients with
splenomegaly

4. What is the common manifestation of paroxysmal 12. regarding the clinical course of patients with AML
nocturnal hemoglobinuria? a. patients most often present with nonspecific
a. Venous thrombosis symptoms that begin gradually or abruptly
b. Extravascular hemolysis b. significant intracranial, gastrointestinal and
c. Thrombocytosis pulmonary hemorrhage occur most often in
d. Thrombocytopenia myelomonocytic leukemia
c. usually, patients may present with a mass lesion, a
5. What is the most feared complication of tumor of leukemic cells called a granulocytic sarcoma or
haemophilia? chloroma
a. Hematuria d. functional abnormalities in the WBC maybe
b. Oropharyngeal bleeding manifested as abnormal lobulation and deficient
c. Hemarthrosis granulation.
d. GI bleeding
13. multiple myeloma represents a malignant
6. What is the most convenient laboratory test to proliferation of plasma cells derived from a single clone.
estimate iron stores? Which of the following is true?
a. Serum iron a. bone pain is usually often worse at night and usually
b. Serum ferritin involves the back and the ribs
c. Total iron binding capacity b. pallor is the most common symptom of patients,
d. Marrow iron stores affecting nearly 70%
c. bony lesions are osteoblastic in nature; therefore,
7. What is the usual pattern of anemia of chronic radioisotope bone scanning is less useful than plain
disease? radiography in diagnosis.
a. Hypochromic, microcytic d. renal involvement is usually secondary to
b. Normochromic, hypochromic hypercalcemia.
c. Normochromic, normochromic
d. Microcytic, normochromic 14. true regarding adverse reactions to blood
transfusion:
8. What is the cytogenetic hallmark of CML? a. allergic reactions occur when the recipient has
a. P53 mutation preformed antibodies that lyse donor erythrocytes
b. Monosomy 7 b. a delayed hemolytic transfusion reaction occurs 12-
c. Trisomy 8 24 hours post transfusion
d. t(9,22) c. febrile nonhemolytic transfusion reactions are the
most common frequent reactions with blood
9. What is the most common preceding infection transfusion
associated with aplastic anemia? d. platelet concentrates are acellular preparations and
a. Ebstein Barr virus do not transmit intracellular infections
b. Hepatitis infection
c. Parvovirus B infection 15. hemophilia maybe a deficiency in Factor VIII or IX.
d. CMV virus Which of the following is true?
a. factor IX is synthesized in the liver while Factor VII is a. ARDS
not. b. LV failure
b. hemarthosis is extremely painful but is not associated c. pneumonia
with joint destruction once bleeding stops d. toxic gas inhalation
c. patients may receive aspirin to relieve pain.
d. inhibitors of factor VIII maybe formed with repeated 24. a post-bronchodilator improvement of this
transfusions spirometric parameter indicates a reversible obstructive
airways defect:
16. the most common structural hemoglobinopathy a. FVC
a. hemoglobin SC b. FEV1/FVC
b. sickle cell disease c. FEV1
c. beta thalassemia D. FEF 25-75%
d. alpha thalassemia
25. the reduction of this parameter indicated the
17. smudge cells are commonly seen in presence of restrictive lung defect:
a. ALL a. FVC
b. CLL b. FEV1
c. AML c. FEV1/FVC ratio
d. CML d. FEF 25-75%

18. what is true regarding disseminated intravascular
coagulation?
a. DIC is most frequently associated with obstetric
catastrophes and bacterial sepsis
b. the most sensitive test is the determination of
platelet count
c. heparin therapy should be started once DIC is
recognized
d. blood transfusions should be avoided
19. true of immune thrombocytic purpura:
a. acute ITP is common in adults while chronic type is
more commonly seen in children
b. patients with chronic ITP who fail to maintain a
normal platelet count after a course of prednisone are
eligible for elective splenectomy
c. patients who present with acute ITP should be started
immediately with corticosteroids
d. patients with ITP usually show a good incremental
response with platelet concentrate transfusion
20. the most commonly encountered anemia in the
congenital nonspherocytic hemolytic anemias is caused
by a deficiency of:
a. pyruvate kinase
b. metheglobin reductase
c. G6PD
d. glucose phosphate isomerase
21. in moderate exercise, the O2-dissociation curve is
shifted to the:
a. right
b. left
c. mid-position
d. variable, dependent on exercise level
22. response to oxygen is poor if hypoxemia is due to:
a. hypoventilation
b. V/Q mismatch
c. shunt
d. diffusion defect
23. the low-permeability pulmonary edema
exemplified by:
26. on chest xray, an obscured costophrenic sulcus with
a meniscus sign is suggestive of:
a. consolidation
b. pleural fluid
c. atelectasis
d. pneumothorax
27. on chest xray, a homogenous opacification on the
right apical area with displacement of the minor fissure
upwards is indicative of:
a. pleural fluid
b. consolidation
c. pneumothorax
d. atelectasis
28. to reduce V/Q mismatch and lessen hypoxemia, a
patient with consolidated left lung from pneumonia is
best lying in which position?
a. supine
b. right lat decubitus
c. prone
d. left lat decubitus
29. a 65 year old male, 20pack years current smoker
complains of progressive difficulty of breathing with
occasional dry cough. On PE, breath sounds were
distant and there were persistent bilateral expiratory
wheeze. The chest xray showed hyperaerated lung
fields. The PFT show FEV1/FVC post-BD = 60%; FEV1
baseline 1.2L, post-BD 1.5L. the most likely diagnosis is:
a. asthma
b. simple bronchitis
c. emphysema
d. chronic bronchitis
for questions 30-32, refer to the following case: a 60
year old ex-heavy smoker is seen at the ER because of
progressive worsening over 3 weeks of chronic cough
associated with cough and thick muco-purulent
secretions. He was drowsy with RR=26 BP=150/90 and
widespread coarse and fine crackles with persistent
expiratory wheezing. The ABGs at room air showed
is pH=7.32, pO2=40, pCO2=65, HCO3=30
30. the ABGs is best described as hypoxemia with:
a. acute respiratory acidosis
b. acute metabolic acidosis
c. chronic respiratory acidosis
d. chronic metabolic acidosis
31. he was given O2 at 1L/min and the ABGs showed
pH=7.12, pO2=75, pCO2=75, HCO3=30. The mechanism
responsible for the hypoxemia is:
a. hypoventilation plus V/Q mismatch
b. hypoventilation plus diffusion defect
c. hypoventilation plus shunt
d. hypoventilation alone
32. the worsening hypoxemia is due to depression of
the:
a. central respiratory drive
b. peripheral hypoxic drive
c. apneustic center
d. lateral dorsal center
33. a 28 year old female with a 10pack year smoking
history complained of sudden onset of difficulty of
breathing after coming in from a flight from the USA.
She was tachypneic at 26bpm but the rest of
examination is unremarkable. The chest xray is normal.
The best test to establish the diagnosis is:
a. cardiac enzymes
b. ECG
c. CT angiography
d. spirometry
34. a 70 year old male, heavy smoker consulted because
of progressive difficulty of breathing. He has had
productive cough for the most days of the past 3 years
and recently had increase volume of mucopurulent
sputum associated with moderate grade fever. He has
widespread wheezing and coarse crackles. The chest
xray showed prominent basal bronchovascular markings
and a homogenous density with air bronchogram
obscuring the left hemi-diaphragm. He most likely
developed:
a. pneumonia
b. lung cancer
c. pulmonary hemorrhage
d. pulmonary edema
35. a 60 year old female 15 pack years smoker, with
uncontrolled hypertension is seen at the ER because of
severe difficulty of breathing that woke her up from
sleep, associated with coughing of pinking frothy
sputum. BP is 180/110, neck veins distended,
widespread fine crackles from mid to base of thorax and
occasional wheezing. Chest xray showed caardiomegaly
and redistribution of blood flow to the upper lung
zones. She most likely is suffering from:
a. chronic bronchitis
b. idiopathic pulmonary fibrosis
c. congestive failure
d. bronchiectasis
36. a 50 year old male farmer 20 pack year smoker,
complains of progressive difficulty of breathing of 2
months duration, later associated with occasional dry
cough. He had no fever, RR=28bpm, there is a lag of the
left hemithorax, absent breath sounds, dullness on the
same side. The PMI is displaced to the right. The chest
xray showed almost complete opacification of the left
hemithorax and the mediastinum is displaced into the
right side. He most likely has a left-sided massive:
a. consolidation
b. atelectasis
c. effusion
d. tumor
37. a 60 year old male laborer, 30 pack year smoker,
complains of progressive difficulty of breathing of 4
months duration, later associated with occasional
blood-streaked sputum and 10 lbs weight loss. He has
no fever. RR is 26 bpm, there is a lag of the left
hemithorax, no breath sounds and dullness on the same
side. PMI is normally located. Chest xray showed almost
complete opacification of the left hemi-thorax but the
mediastinum is midline. He most likely has a left-sided:
a. effusion
b. atelectasis
d. tumor
d. AOTA
38. a 60 year old male 30 pack year smoker complains
of progressive difficulty of breathing over the past 2
years, lately associated with occasional dry cough. His
chest is hyperresonant with distant breath sounds.
Chest xray showed bilateral hyperlucent lung fields,
flattened diaphragm and a narrowed vertical heart
shadow. He most likely has:
a. emphysema
b. chronic bronchitis
c. asthma
d. pneumothorax
39. a 68 year old COPD male complains of progressive
increase in cough and phlegm production without fever
for the past 3 months. There are occasional bilateral
wheezing and decreased breath sounds and dullness
over the right lower lung. Chest xray showed a
homogenous density with no air-bronchogram on the
right lower lung field not seen in a film 2 years earlier.
He most likely has developed:
a. pneumonia
b. PTB
c. lung cancer
d. pleural effusion
40. a 50 year old smoker, jeepney driver consulted at
the OPD complaining of one month history of cough
with scanty to moderate phlegm associated with poor
appetite and 2 lbs weight loss. His temperature was
37.8C, RR=20. There were fine crackles over both
apices. The best test to establish diagnosis is:
a. chest xray
b. sputum examination
c. spirometry
d. chest CT scan.
41. a 56 year old previously healthy surrent smoker
developed community-acquired pneumonia. She was
assessed to have a low risk for complicated course.
Antibiotic therapy should include coverage for:
a. H. influenza 49. a 56 year old female was admitted at the general
b. S. aureus ward (non-ICU) because of CAP. She has no risk factors
c. L. pneumophilia for anaerobic infection. Which of the following
d. drug-resistant S. pneumonia combination therapy is appropriate?
a. coamoxiclav and cefuroxime
42. which of the following is a risk factor for pneumonia b. clindamycin and levofloxacin
due to Enterobacteriaceae? c. ceftriaxine and azithromycin
a. IV drug use d. moxifloxacin and clarithromycin
b. preceding viral infection
c. recent luxury ship cruise 50. which of the following is a risk factor for multidrug
d. presence of co-morbidities resistant pathogens in hospital acquired pneumonia
(HAP)?
43. physical findings of decreased breath sounds with a. comatose state
dullness on percussion in a patient suspected of having b. immunosuppressive therapy
pneumonia suggests the presence of c. preceding viral upper respiratory infection
a. bronchospasm d. previous history of pneumonia 6 months ago
b. pleural effusion
c. pneumatocoeles 51. cancer chemotherapy increases the risk of
d. consolidation with open airway developing pulmonary tuberculosis by interfering with
a. innate immunity
44. a 70 year old male consults because of fever. He is b. humoral immunity
oriented and alert with temperature of 39C, HR=93, c. cell mediated immunity
RR=20, BP=104/70. Chest xray shows hazy density on d. delayed tissue hypersensitivity
the right lower lung. Serum creatinine is normal. The
CURB65 score is 52. in patients with adequate nonimmunologic
a. 1 defenses, exposure to suspended particles containing
b. 2 TB bacilli would most likely result in
c. 3 a. no infection
d. 4 b. infection with late progression
c. infection with early progression
45. a 40 year old current smoker consulted because of 4 d. infection with continued containment throughout the
days of cough with yellow phlegm, dyspnea and low persons lifetime
grade fever. PE revealed bibasal crackles. CBC showed
mild leukocytosis and chest xray showed clear lung 53. engulfment of the TB bacilli by a nonactivated
fields. The diagnosis is: macrophage results in
a. pneumonia a. killing the bacilli
b. lung abscess b. containment of the bacilli
c. bronchial infection c. activation of that macrophage
d. pulmonary tuberculosis d. multiplication of the bacilli inside the macrophage

46. in the treatment of CAP, which of the following is 54. the initial specimen of choice for the bacteriologic
the strongest indication for ICU admission? evaluation of PTB is
a. confusion a. sputum
b. age 70 years or over b. gastric aspiration
c. need for mechanical ventilation c. fiberoptic bronchoscopy
d. systolic BP <100mmHg at time of admission d. needle aspiration lung biopsy

47. which of the following parameters is used in the 55. which of the following situations represent latent TB
calculation of the clinical pulmonary infection score infection
(CPIS)? a. asymptomatic patient with positive PPD and normal
a. respiratory rate chest xray
b. sputum purulence b. asymptomatic patient with negative PPD and
c. lung radiodensities abnormal chest xray
d. blood culture results c. patient with cough of 3 weeks, negative PDD, and
normal chest xray
48. a 42 year old chronic alcoholic and with COPD, was d. patient with cough of 3 weeks, positive PPD and
diagnosed with CAP. His pneumonia risk classification abnormal chest xray
allows for outpatient treatment. Which single antibiotic
therapy is recommended? 56. a 50 year old male diabetic consulted for chronic
a. macrolide cough. History revealed that he was diagnosed with PTB
b. clindamycin 8 months ago, for which he took anti-Kochs treatment
c. co-amoxiclav for only 2 weeks. At present, sputum smears are
d. ciprofloxacin positive for AFB. He is presently classified as
a. relapse
b. new case patients history for evidences that asthma is caused by
c. treatment failure it.
d. return after default a. cough variant asthma
b. sensitizer-induced asthma
57. a patient who has completed his anti-TB treatment c. aggravation of pre-existing asthma
is classified as having healed PTB if there is d. reactive airway dysfunction syndrome (RADS)
a. resolution of cough
b. resolution of radiographic lesions 65. major site of increased airway resistance in COPD
c. negative AFB smear at end of treatment individuals is found in
d. no evident relapse during the next 2 years a. terminal bronchioles
b. airways <2mm diameter
58. The treatment for a new case of sputum smear- c. medium and small airways
negative PTB is d. AOTA
a. 6HR
b. 2HRZ, 4HR 66. extracellular matrix destruction from chronic
c. 2HRZE, 4HR inflammation in this location may cause airway
d. INH for 6-9 months distortion and narrowing in COPD.
a. alveoli
59. a 22 year old male with fever and cough for 2 weeks b. alveolar sacs
was found to have positive sputum AFB. History c. terminal bronchioles
revealed treatment with quadruple anti-TB drugs for 2 d. respiratory bronchioles and alveolar ducts
months 2 years ago. He stopped treatment because he
already felt well. Pending results of sputum drug 67. improvements of FEV1 after inhaled bronchodilator
sensitivity tests, you will start the patient on in patients with COPD are common up to how many
a. HRZE percent?
b. HRZES a. 15%
c. HRZE plus 2 new drugs b. 20%
d. no empiric regimen. Await drug susceptibility results. c. 25%
d. 30%
60. a 45 year old diabetic has been taking INH and
ethambutol for the last 6 months for PTB. There was no 68. severe pulmonary hypertension enough to cause cor
intake of other anti-TB drugs. He noticed that his cough pulmonale and RV failure due to COPD occurs only in
has returned during the last month. Sputum AFB smear individuals with FEV1
at this time was positive. The patient has a. <25% of predicted
a. TB relapse b. <30% of predicted
b. treatment failure c. <35% of predicted
c. multidrug resistant TB d. <40% of predicted
d. extensive drug resistant TB
69. this mechanism accounts for all of the reduction in
61. this deposition in the lung causes tissue reaction PaO2 in COPD
leading to pneumoconiosis a. shunting
a. paint b. V/Q mismatching
b. mineral dust c. alveolar hypoventilation
c. welding fumes (oxides of nitrogen) d. diffusion abnormality
d. low molecular weight minerals (silicates)
70. the most effective initial controller medication for
62. what is the usual type of lung cancer in patient with patient with asthma for all ages
asbestosis? a. theophylline
a. adenocarcinoma b. inhaled corticosteroids
b. small cell carcinoma c. leukotriene modifiers
c. large cell carcinoma d. cromones
d. squamous cell carcinoma
71. these are given on an as-basis or a regular basis to
63. the restrictive ventilator defect (as % predicted) in prevent or reduce symptoms and exacerbations of
patients with asbestosis who deteriorate over 10 years COPD
prior to death will show this in spirometry a. mucolytics
a. low FVC b. theophyllines
b. low FEV1 c. inhaled corticosteroids
c. low FEV1/FVC d. bronchodilator medications
d. low FEF 25-75
72. the single most effective intervention to reduce risk
64. this type of occupational asthma requires and stop progression of COPD disease is
assessment of material safety data sheets (MSDS) and a. smoking cessation
b. chronic oxygen therapy
c. pulmonary rehabilitation
d. combination bronchodilator regimen
73. this examination is a prerequisite for assessing PAP
increase before the diagnosis of pulmonary arterial
hypertension can be made
a. CT scan
b. chest xray
c. ECG
d. Doppler echocardiography
74. this phenomenon explains the decrease end
diastolic volume and cardiac output of the left ventricle
in patients with significant pulmonary arterial
hypertension.
a. leftward septal shift
b. right ventricular ischemia
c. right ventricular hypertrophy
d. decrease right ventricular end diastolic volume
75. the following mediator cause vasoconstriction in
primary pulmonary arterial hypertension
a. increased NO
b. decreased TxA2
c. increased PGI2
D. increased ET-1
76. patient presenting with systolic heart failure may
show which of the following during the clinical
assessment?
a. third heart sound
b. left ventricular hypertrophy
c. congestion w/o cardiomegaly
d. left ventricular ejection fraction of 40% or higher
77. patient presenting with diastolic heart failure may
show which of the following during the clinical
assessment?
a. third heart sound
b. left ventricular hypertrophy
c. congestion w/o cardiomegaly
d. left ventricular ejection fraction of 40% or higher
78. first hint and the most common complaint/s of
pulmonary arterial hypertension is/are
a. chest pain with syncope
b. bipedal edema and ascites
c. fatigue, dizziness, palpitations
d. progressive dyspnea on exertion
79. hepatomegaly, ascites or spider angiomata may
suggest group 1 PAH due to
a. hepatopulmonary syndrome
b. drugs and toxins associated PAH
c. associated collagen vascular disease
d. congenital systemic to pulmonary shunts
80. this is the gold standard for the diagnosis of PAH in
all suspected patients with significant PAH
a. CT angiography
b. MR angiography
c. right heart catheterization
d. transesophageal echocardiography
81. a patient diagnosed with bronchogenic ca was found
to have multiple nodular metastatic lesions adherent to
the pleura in the right hemithorax. 1 month after
diagnosis, the patient develops an ipsilateral pleural
effusion that is moderate in amount. The most likely
route of fluid entry in this situation is via:
a. pores in the diaphragm
b. interstitial spaces of the lung
c. pores in the mediastinum
d. capillaries in the parietal pleura
82. a thoracentesis was done on the above patient.
Which of the following pleural fluid characteristics
would confirm your suspicion that it is an exudate?
a. pleural fluid LDH less than 2/3 normal upper limit for
serum
b. pleural fluid LDH/serum protein >0.6
c. pleural fulid protein/serum protein >0.4
d. pleural fluid LDH/serum LDH >0.6
83. a 45 year old male with ascites develops an effusion
that is found to be a transudate by criteria. Which of the
following clinical entities will typically yield this
effusion?
a. bronchogenic carcinoma
b. cirrhosis
c. pneumonia
d. postcoronary artery bypass
84. a 25 year old male Filipino with chronic cough,
fever, and weight loss develops an effusion on the left
hemithorax. Which of the following clinical diseases will
likely explain this effusion?
a. connective tissue disease
b. malignancy
c. pulmonary embolism
d. tuberculosis
85. a victim of a motorcycle accident sustained
significant chest trauma. A chest tube is immediately
inserted. Hemorrhage in the pleural space warrants
immediate exploration through thoracoscopy or
thoracotomy if bleeding is at least:
a. 20ml/hr
b. 20ml/min
c. 200ml/hr
d. 200 ml/min
86. a patient presents with a chest radiograph showing
a widened mediastinum. A mass was found upon doing
a lateral view chest radiograph that is believed to be in
the anterior compartment of the mediastinum. It is
likely a/an:
a. thymoma
b. pleuropericardial cyst
c. meningocoele
d. enlarged mediastinal lymph node
87. in a patient suspected of having acute respiratory
distress syndrome, a diagnostic criteria that should be
found through chest xray is:
a. bilateral massive pleural effusion
b. diffuse bilateral infiltrates
c. multiple nodules of various sites
d. tension pneumothorax
88. the natural history of ARDS occurs in the following
sequence of phases:
a. proliferative exudative fibrotic
b. fibrotic proliferative exudative
c. exudative proliferative fibrotic
d. exudative proliferative death
89. decreased venous return to the heart is one of the
typical dangers of:
a. primary spontaneous pneumothorax
b. secondary spontaneous pneumothorax
c. tertiary spontaneous pneumothorax
d. tension pneumothorax
90. which of the following disease states will you
suspect first when evaluating bilateral and symmetric
pleural effusions?
a. congestive heart failure
b. chronic renal failure
c. hepatic hydrothorax
d. uremia
96. the underlying mechanism of type 3 respiratory
failure is:
a. shock
b. alveolar flooding
c. atelectasis
d. depression in sensorium
97. once the patients clinical status has started to
improve, possible weaning from respiratory support is
considered. An effective and preferred method is:
a. synchronized intermittent mandatory ventilation
b. pressure support ventilation
c. pressure control ventilation
d. assist control mode ventilation
98. a stroke patient in coma with minimal respiratory
drive needs a ventilator mode that provides full
assistance for every breath with added timer backup.
This is best provided by:
a. synchronized intermittent mandatory ventilation
b. pressure support ventilation
c. assist control mode ventilation
d. continuous positive airway pressure

91. which statement/s describe/s the field of critical 99. a patient is recovering from respiratory failure. You
care medicine? intend to initiate respiratory muscle conditioning by
a. goals can range from resuscitation to providing shifting to a ventilator mode that allows spontaneous
comfort breaths in between fixed ventilator breaths. This is
b. involves resuscitation at extremes of physiologic achieved by:
deterioration a. synchronized intermittent mandatory ventilation
c. requires a thorough understanding of b. pressure support ventilation
pathophysiology c. non-invasive ventilation
d. AOTA d. continuous positive airway pressure

92. in a patient with shock, which of the following is a 100. a reliable and validated indicator of a patients
sign of end-organ hypoperfusion? weanability is the weaning index. It is given by the
a. tachypnea formula:
b. nocturia a. RR x TV
c. loose stools b. RR / TV
d. paranoid behavior c. TV / RR
d. TV x RR
93. preventable complications of critical illness include:
a. stroke
b. morbid obesity
c. profuse sweating
d. increased salivation

94. a patient with community acquired pneumonia is

admitted due to severe hypoxemia. The underlying
mechanism here is:
a. hypotension
b. alveolar flooding
c. atelectasis
d. hypoventilation

95. a severely dyspneic patient presents with absent

breath sounds on the left hemithorax. Chest xray
reveals massive pleural effusion on the left. The
underlying mechanism of respiratory failure here is:
a. ARDS
b. alveolar hemorrhage
c. atelectasis
d. hypoventilation