review questions boards.ppt

1. Multiple discrete nodules scattered throughout all lobes of the lungs is a pattern associated most frequently with which of the following?

a) metastatic carcinoma in the lung b) bronchogenic carcinoma of the lung c) bronchial carcinoid d) hamartomas of the lunge) large cell carcinoma

A 55-year-old man with a 55 pack year history of smoking cigarettes has recently experienced an episode of hemoptysis along with his usual cough. He has a sputum cytology examination performed that demonstrates the presence of atypical cells with hyperchromatic nuclei and oval to rounded cells. Labortory studies show a serum calcium of 11.3 mg/dL, with phosphorus 2.1 mg/dL. Which of the following chest radiographic findings is this man most likely to have? a) Large hilar massb) Adenocarcinoma c) bronchioalveolar carcinoma d) Mesothelioma e) Pancoast tumor

Bronchial carcinoid tumors are a) benign b) hamartomas c) highly aggressive carcinomas d) low-grade malignanciese) are not amenable to surgical treatment

A 44-year-old woman, a non-smoker, has had a fever and cough for the past 4 days. She does not have hemoptysis. She has not experienced weight loss, malaise, nausea, or vomiting. There are decreased breath sounds over the right upper lung. A chest radiograph reveals a 6 cm area of infiltrates in the right upper lobe. She is given a course of antibiotic therapy, but her cough persists. A month later her chest x-ray now reveals a 3 cm peripheral mass in the right upper lobe. Which of the following neoplasms is most likely to be present in this woman? a) Squamous cell carcinoma b) Small cell carcinoma c) Adenocarcinomad) Mesothelioma e) Carcinoid tumor

Of the following, which lung carcinoma is most often associated with a paraneoplastic syndrome? a) adenocarcinoma b) adenoid cystic carcinoma c) bronchioloalveolar carcinoma d) squamous cell carcinomae) mesothelioma

A 64-year-old nonsmoking woman presents with shortness of breath and malaise. Chest x-ray reveals numerous, round, 1-3 cm densities throughout both lung fields. What is the most likely diagnosis?a) bronchioloalveolar carcinomab) bronchogenic adenocarcinomac) bronchogenic small cell carcinomad) metastatic carcinoma from breaste) metastatic carcinoma from cervix

An 80-year-old man dies following an acute myocardial infarction. At autopsy, the infarct is confirmed. In addition, he has large, irregular, whitish fibrocalcific plaques on the pleural surface of his diaphragm. What is the most likely reason for this latter finding?a) asbestosisb) chylothoraxc) bronchioalveolar carcinomad) many harmartomase) tuberculosi

A pleural effusion is clear, straw-colored, has a specific gravity of 1.012 and contains scattered leukocytes. Likely causes include a) congestive heart failureb) empyema c) pyothorax d) hemothoraxe) lymphatic obstruction

A 51-year-old woman presents with signs and symptoms of Cushing syndrome which is confirmed by finding of elevated ACTH levels in the serum. During a diagnostic workup, a solitary lung mass was identified. The pulmonary mass most likely represents a/ana) bronchial carcinoid tumorb) mesothelioma c) harmartoma d) small cell undifferentiated carcinomae) squamous cell carcinoma

A 55 yr old male comes to your office with ptosis and anhidrosis on the right side together with dyspnea and hemoptysis. A chest x-ray reveals a 5 cm mass. Which of the following is consistent with these findings.(A) a left hilar small cell carcinoma(B) a right sided Pancoast tumor(C) a left sided adenocarcinoma(D) a right sided squamous cell carcinoma(E) a left sided carcinoid tumor

Spontaneous pneumothorax (A) is seen mostly in women(B) occurs predominantly in young persons (C) signifies acute pulmonary infection (D) signifies chronic obstructive emphysema

The histologic type of bronchogenic carcinoma associated with the highest initial response to chemotherapy is

(A) adenocarcinoma(B) bronchioloalveolar carcinoma (C) large cell undifferentiated carcinoma(D) small cell undifferentiated carcinoma(E) squamous cell carcinoma

A 59-year-old woman who has smoked a pack of cigarettes each day for the past 40 years is found to have a 3 cm density in the right mid-lung field on routine x-ray. Biopsy of the lung lesion reveals malignant cells with intercellular bridges and keratin pearls. The most likely diagnosis is

(A) adenocarcinoma of the lung(B) metastatic carcinoma from the breast(C) metastatic carcinoma from the colon(D) squamous cell carcinoma(E) undifferentiated large cell carcinoma

A 59-year-old man with a stage IV bronchogenic small cell undifferentiated carcinoma exhibits unilateral enophthalmos, ptosis, miosis, and anhydrosis. What is the most likely structure invaded to give rise to this clinical appearance?

(A) esophagus(B) pericardium(C) phrenic nerve(D) recurrent laryngeal nerve(E) sympathetic ganglion

Centrilobular emphysema refers Centrilobular emphysema refers to a condition principally to a condition principally affecting the affecting the (A) lobar bronchi(A) lobar bronchi(B) segmental bronchi(B) segmental bronchi(C) terminal bronchioles(C) terminal bronchioles(D) respiratory bronchioles(D) respiratory bronchioles(E) alveolar ducts and alveoli(E) alveolar ducts and alveoli

Which of the following pulmonary Which of the following pulmonary functions will be most functions will be most compromised in a patient with an compromised in a patient with an emphysematous bleb that emphysematous bleb that ruptures into the pleural space? ruptures into the pleural space? (A) diffusion (A) diffusion (B) expiration (B) expiration (C) perfusion (C) perfusion (D) ventilation(D) ventilation

Histology from a bronchoscopic Histology from a bronchoscopic biopsy reveals prominent biopsy reveals prominent hypertrophy of bronchial mucous hypertrophy of bronchial mucous glands, chronic inflammation, glands, chronic inflammation, dysplastic squamous metaplasia dysplastic squamous metaplasia and fibrosis. These findings lead and fibrosis. These findings lead you to believe this patient most you to believe this patient most likely haslikely has(A) asthma(A) asthma(B) bronchiectasis (B) bronchiectasis (C) chronic bronchitis(C) chronic bronchitis(D) emphysema(D) emphysema(E) pulmonary fibrosis(E) pulmonary fibrosis

The patient with homozygous The patient with homozygous alpha 1-antitrypsin deficiency is alpha 1-antitrypsin deficiency is most likely to develop which type most likely to develop which type of lung disease? of lung disease? (A) panlobular emphysema (A) panlobular emphysema (B) chronic bronchitis (B) chronic bronchitis (C) centrilobular emphysema (C) centrilobular emphysema (D) bullous emphysema(D) bullous emphysema

The major physiologic abnormality The major physiologic abnormality in emphysema is in emphysema is (A) atelectasis (A) atelectasis (B) decreased elastic recoil of (B) decreased elastic recoil of lung lung (C) increased airway resistance (C) increased airway resistance (D) increased vital capacity (D) increased vital capacity (E) reduced total lung capacity(E) reduced total lung capacity

Emphysema is defined as dilation Emphysema is defined as dilation of structures distal to the of structures distal to the terminal bronchiole with alveolar terminal bronchiole with alveolar (A) destruction (A) destruction (B) edema (B) edema (C) fibrosis (C) fibrosis (D) inflammation (D) inflammation (E) scarring(E) scarring

A subpleural area of centrilobular A subpleural area of centrilobular emphysema usually occurring in emphysema usually occurring in the apex and involving an area the apex and involving an area greater than 2 cm is known as a greater than 2 cm is known as a (A) bleb (A) bleb (B) bulla (B) bulla (C) cyst (C) cyst (D) pneumatocele(D) pneumatocele

Pulmonary function tests of a 65-Pulmonary function tests of a 65-year-old man complaining of year-old man complaining of dyspnea, limitation of the dyspnea, limitation of the maximal expiratory air flow rates maximal expiratory air flow rates during forced expiration and an during forced expiration and an FEV1/FVC ratio of 63%. Which of FEV1/FVC ratio of 63%. Which of the following disorders would be the following disorders would be most likely?most likely?(A) emphysema(A) emphysema(B) hypersensitivity pneumonitis(B) hypersensitivity pneumonitis(C) interstitial pneumonia(C) interstitial pneumonia(D) pulmonary embolism(D) pulmonary embolism(E) Sarcoidosis(E) Sarcoidosis

Pulmonary function tests of a 65-Pulmonary function tests of a 65-year-old man complaining of year-old man complaining of dyspnea reveal limitation of the dyspnea reveal limitation of the maximal expiratory air flow rates maximal expiratory air flow rates during forced expiration. Which of during forced expiration. Which of the following disorders would be the following disorders would be most likely?most likely?(A) bronchiectasis(A) bronchiectasis(B) chronic passive congestion(B) chronic passive congestion(C) interstitial pneumonia(C) interstitial pneumonia(D) sarcoidosis(D) sarcoidosis(E) silicosi(E) silicosi

A patient presented to the A patient presented to the emergency room with asthma. emergency room with asthma. What cell is most likely to be What cell is most likely to be increased in the peripheral blood increased in the peripheral blood smear?smear?(A) basophil(A) basophil(B) eosinophil(B) eosinophil(C) lymphocyte(C) lymphocyte(D) monocyte(D) monocyte(E) neutrophil(E) neutrophil

A 30-year-old man is dead after A 30-year-old man is dead after having been found unresponsive having been found unresponsive at home. Autopsy finding shows at home. Autopsy finding shows hyperinflated lungs, an excess of hyperinflated lungs, an excess of bronchial goblet cells, and bronchial goblet cells, and infiltration of the airway walls by infiltration of the airway walls by eosinophils. The most likely cause eosinophils. The most likely cause of death isof death is(A) alpha-1-antitrypsin deficiency(A) alpha-1-antitrypsin deficiency(B) bronchopneumonia(B) bronchopneumonia(C) centrilobular emphysema(C) centrilobular emphysema(D) chronic bronchitis(D) chronic bronchitis(E) status asthmaticus(E) status asthmaticus

Which of the following is Which of the following is associated with an increased associated with an increased incidence of cancer? incidence of cancer? (A) silicosis (A) silicosis (B) stannosis (B) stannosis (C) asbestosis (C) asbestosis (D) berylliosis (D) berylliosis (E) siderosis(E) siderosis

A 30-year-old physician has a A 30-year-old physician has a positive skin test for tuberculosis. positive skin test for tuberculosis. Chest x-rays reveal a 1.5 cm Chest x-rays reveal a 1.5 cm subpleural parenchymal lesion subpleural parenchymal lesion just above the interlobar fissure just above the interlobar fissure between the upper and lower between the upper and lower lobes on the left This most likely lobes on the left This most likely representsrepresents(A) miliary tuberculosis(A) miliary tuberculosis(B) primary pulmonary (B) primary pulmonary tuberculosistuberculosis(C) progressive pulmonary (C) progressive pulmonary tuberculosistuberculosis(D) reactivation pulmonary (D) reactivation pulmonary tuberculosistuberculosis(E) tuberculous pneumonia(E) tuberculous pneumonia

A woman lives in Colorado where A woman lives in Colorado where she works as a school teacher. she works as a school teacher. She does not smoke but has She does not smoke but has developed a non-productive developed a non-productive cough, arthralgia, fatigue and cough, arthralgia, fatigue and weight loss. A transbronchial weight loss. A transbronchial biopsy reveals non-caseating biopsy reveals non-caseating granulomas. The most likely granulomas. The most likely diagnosis isdiagnosis is(A) adenocarcinoma(A) adenocarcinoma(B) chronic berylliosis(B) chronic berylliosis(C) histoplasmosis(C) histoplasmosis(D) sarcoidosis(D) sarcoidosis(E) tuberculosis(E) tuberculosis

70-year-old man has an upper 70-year-old man has an upper respiratory tract infection. A chest respiratory tract infection. A chest x-ray discloses consolidation of x-ray discloses consolidation of the lower lobe of his left lung. the lower lobe of his left lung. Which is the most likely Which is the most likely organism?organism?(A) Klebsiella pneumoniae (A) Klebsiella pneumoniae (B) Legionella pneumophila(B) Legionella pneumophila(C) Listeria monocytogenes(C) Listeria monocytogenes(D) Pseudomonas aeruginosa(D) Pseudomonas aeruginosa(E) Streptococcus pneumoniae(E) Streptococcus pneumoniae

Atherosclerosis of the pulmonary vessels is typically associated with (A) myocardial infarction (B) diabetes mellitus (C) polycythemia (D) pulmonary hypertension (E) obesity

Edema fluid in the lung is primarily removed by (A) phagocytosis (B) lymphatic drainage (C) coughing (D) reabsorption into capillaries (E) passive drainage

Which serum enzyme is most likely to be elevated in pulmonary infarction? (A) creatine phosphokinase (B) isocitric dehydrogenase (C) lactic dehydrogenase (D) hydroxybutyrate dehydrogenase (E) alkaline phosphatase

The presence of large atherosclerotic plaques in pulmonary arteries indicates (A) old pulmonary emboli (B) pulmonary hypertension (C) metastatic carcinoma (D) bronchiectasis (E) tuberculosis

Acute cor pulmonale is most often due to (A) pulmonary emboli (B) asthma (C) pulmonary edema (D) diffuse interstitial fibrosis

The vessel whose microscopic appearance most closely reflects the changes of pulmonary hypertension is the (A) pulmonary elastic artery (B) bronchial artery (C) small muscular pulmonary artery (D) pulmonary vein (E) superior vena cava

Pulmonary embolism is most likely to result in pulmonary infarction if the patient has (A) multiple small emboli (B) large saddle embolus (C) pre-existing congestive heart failure (D) atrial fibrillation (E) systemic hypertension

In pulmonary hypertension the most significant morphologic finding in the arterial system of the lungs is (A) loss of elastica (B) fibrinoid necrosis (C) replacement of media by fibrous tissue (D) formation of arteriovenous fistulae (E) hypertrophy of smooth muscle media

An anxious, hyperventilating 32-year-old pregnant woman presents with a history of sudden onset of dyspnea. She has tachycardia and a decreased PaO2 and PaCO2. Of the following, this most likely represents(A) acute bacterial pneumonia(B) acute mitral insufficiency(C) acute pleuritis(D) bronchial obstruction by aspirated foreign body(E) pulmonary thromboembolism

A 27-year-old woman died after a progressive 18 month course of severe dyspnea, fatigue, and cyanosis. Small atheromas were present in the pulmonary arteries. Which of the following can be predicted(A) diffuse hyaline membranes(B) diffuse hemorrhage(C) medial hypertrophy of pulmonary arterioles(D) multiple pulmonary emboli(E) severe atelectasis

A 75-year-old man suffered a massive myocardial infarction with left ventricular failure and cardiogenic shock. He died 2 days later. Which of the following would be the most likely finding at autopsy?(A) diffuse alveolar damage(B) mitral stenosis(C) normal lungs(D) pulmonary edema(E) pulmonary infarction

Bronchial carcinoid tumors are (A) benign (B) hamartomas (C) highly aggressive carcinomas (D) low-grade malignancies

Which lung tumor would have the best prognosis after definitive treatment? (A) squamous cell carcinoma (B) adenocarcinoma (C) small cell carcinoma (D) large cell carcinoma (E) bronchial carcinoid tumor

Which of the following lung tumors usually arises in small peripheral airways? (A) squamous cell carcinoma (B) adenocarcinoma (C) large cell carcinoma (D) bronchial carcinoid tumor

The most important factor in the pathogenesis of lung cancer is (A) air pollution (B) asbestos exposure (C) cigarette smoking (D) heredity (E) deficiency of alpha-1-antitrypsin

Malignant lesions in the lung are most likely to be (A) adenocarcinoma (B) bronchioloalveolar cell carcinoma (C) metastatic carcinoma (D) small cell undifferentiated carcinoma (E) squamous cell carcinoma

Centrilobular emphysema refers to a condition principally affecting the (A) lobar bronchi(B) segmental bronchi(C) terminal bronchioles(D) respiratory bronchioles(E) alveolar ducts and alveoli

The patient with homozygous alpha 1-antitrypsin deficiency is most likely to develop which type of lung disease? (A) panlobular emphysema (B) chronic bronchitis (C) centrilobular emphysema (D) bullous emphysema

Which of the following lab results explains the early onset of emphysema?(A) low serum alpha-1-antitrypsin level, PiMM phenotype(B) low serum alpha-1-antitrypsin level, PiMZ phenotype(C) low serum alpha-1-antitrypsin level, PiZZ phenotype(D) normal serum alpha-1-antitrypsin level, PiMM phenotype(E) normal serum alpha-1-antitrypsin level, PiZZ phenotype