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07-04-2006, 12:04 PM
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Pulmonary block 2 (Q46-85)
Question 46 A 48 year old man with no history of major medical illnesses has had gradually worsening dyspnea for the past 13 months. He has no cough or hemoptysis. He is afebrile. He is a non-smoker. He is a corporate attorney. Spirometry reveals a normal FEV1/FVC ratio with decreased FVC. The DLCO is decreased. Sputum cytology shows no atypical cells. The pathologic finding in the lungs most likely to be present in this setting is:
A Honeycombing fibrosis B Bronchial destruction with dilation C Apical bullae D Increased bronchial submucosal glands E Mucosal eosinophil infiltration NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 47 A 47 year old female develops acute renal failure, and a renal biopsy reveals a crescentic glomerulonephritis. She has an anti-neutrophil cytoplasmic autoantibody test that is positive. A chest radiograph reveals bilateral small nodular infiltrates. A sputum gram stain shows normal flora. A sputum cytology shows no abnormal cells, but numerous hemosiderin-laden macrophages are present. Which of the following pulmonary pathologic findings is most likely to be present: A Bronchial chronic inflammation B Recurrent thromboembolism C Necrotizing vasculitis D Pleural effusions E Non-caseating granulomas NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 48 A 29 year old male has been HIV positive for the past 8 years. His last HIV-1 RNA level was 68,000 copies/mL. He now develops fever, non-productive cough, and dyspnea over several days' time. On admission to the hospital, he has a chest radiograph that reveals extensive bilateral infiltrates. A bronchoalveolar lavage is performed. Which of the following infections is most likely to be present: A Cryptococcus neoformans B Aspergillus fumigatus C Pneumocystis carinii D Hemophilus influenzae E Mycobacterium tuberculosis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 49 A 47 year old female has a 1 cm irregular mass with microcalcifications identified on mammography in the right breast. She has right axillary lymphadenopathy on physical examination. She also has shortness of breath. Her vital signs show T 36.6 C, P 81, R 26, and BP 130/75 mm Hg. A chest radiograph reveals large pleural effusions bilaterally. A thoracentesis is performed on the right and the fluid obtained is grossly bloody. Which of the following findings is most likely to be made on examination of this fluid: A Gram negative rods B Clusters of carcinoma cells C Large numbers of small lymphocytes D Acid fast bacilli E Atypical mesothelial cells NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 50 A humorist who conducted his orchestra with a loaded revolver or toilet plunger toured the U.S. for years in the 40's and 50's with a heavy schedule of appearances. He became progressively dyspneic in his early 50's and was unable to work. He began to lose weight. Physical examination showed that he had an increased AP diameter to his chest. He used accessory muscles for respiration. There was hyperresonance by percussion along with decreased fremitus. Pulmonary function testing revealed a decreased FEV1 and FEV1/FVC ratio. A chest radiograph showed increased lung volumes with flattening of the diaphragms. He died from pneumonia at age 54. Which of the following risk factors was most likely responsible for his underlying pulmonary disease: A Snorting cocaine B Drinking vodka C Promiscuity D Smoking cigarettes E Poor diet NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 51 A 43 year old infertile male with chronic diarrhea has had multiple pulmonary infections with Pseudomonas aeruginosa and Pseudomonas cepacia for many years. He succumbs to one of these infections. At autopsy, his lungs demonstrate widespread bronchiectasis. A mutation involving which of the following genes is most likely responsible for these findings: A Fibrillin B Spectrin C FGFR D CFTR E Beta-myosin NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 52 A 45 year old male has increasing dyspnea. A chest radiograph reveals large bilateral pleural effusions. A right thoracentesis is performed, and 500 cc of bloody fluid is obtained. These findings are LEAST often associated with: A Congestive heart failure B Tuberculosis C Metastatic carcinoma D Bronchogenic carcinoma E Pulmonary infarction NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 53 A 60 year old woman has been a cigarette smoker since the age of 18, averaging a pack a day of unfiltered cigarettes. She works as a dispatcher for a trucking company. She has had a chronic cough for many years, but she has several episodes of hemoptysis in the past two weeks. A transbronchial lung biopsy reveals clusters of small, hyperchromatic cells with scant cytoplasm. A chest radiograph shows an ill-defined hilar mass. Which of the following laboratory test findings is most likely to be present. A Positive antinuclear antibody B Hyperbilirubinemia C Hypercalcemia D Hyponatremia E Polycythemia NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 54 A 30 year old woman has smoked 1 pack of cigarettes per day for the past 13 years. Currently, her pulmonary function studies are normal. Aside from occasional bouts of coughing, she has no major problems. In order to provide motivation for her to quit smoking, you advise her that she can expect to benefit from all of the following EXCEPT: A Diminshed risk for lung cancer B Reversal of emphysematous changes C Abatement of chronic bronchitis D Lower risk for lung infections E Decreased risk for lung cancer in close family members NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 55 An infant has several episodes of pneumonia with Hemophilus influenzae and Enterococcus. A radiograph reveals a localized area of consolidation near the base of the right lung. Angiography reveals that this segment of lung is supplied by systemic, not pulmonary, arterial blood. The most likely explanation for these findings is: A Pulmonary sequestration B Chronic abscessing pneumonia C Congenital cystic adenomatoid malformation D Bronchogenic cyst E Cystic fibrosis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 56 A 27-year-old female develops worsening dyspnea and syncope on exertion over a 2 year period. On physical examination her lungs are clear to auscultation. Her heart rate is regular with no murmurs. She died suddenly. Autopsy reveals marked right ventricular hypertrophy, marked pulmonary atherosclerosis, and plexiform pulmnary arteriopathy. What is the probable underlying disease: A Primary atypical pneumonia B Goodpasture's syndrome C Systemic lupus erythematosus D Primary pulmonary hypertension E Diabetes mellitus NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 57 A 48 year old female with a 5 kg weight loss with malaise and increasing dyspnea for the past month has a chest radiograph that reveals a large right pleural effusion. A thoracentesis is performed, and 650 cc of milky white fluid is obtained. The most probable cause for this finding is: A Mediastinal malignant lymphoma B Penetrating chest trauma C Tuberculosis D Congestive heart failure E Systemic lupus erythematosus NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 58 A 52-year-old transit authority employee presents with shortness of breath and dry cough which have been worsening over several months. He is unable to pinpoint the exact onset of these symptoms. Which of the following is most important for diagnosis of a treatable etiology for his symptoms: A Physical examination B Pulmonary function tests C Chest x-*** D History E Transbronchial biopsy NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 59 A 31 year old male is involved in a motor vehicle accident with laceration of the brachial artery. When paramedics arrive on the seen, he has cold, pale skin and a barely obtainable blood pressure. On admission to the hospital, he has a hematocrit of 15% and is given 4 units of packed red blood cells. Over the next few days he develops decreasing oxygen saturations measured by arterial blood gases. He is intubated, but requires increasing ventilatory pressures with increasing FIO2. Two weeks following the accident, his chest radiograph shows increasing infiltrates. He remains afebrile. Which of the following findings best typifies the probable microscopic appearance of his pulmonary parenchyma at this point in time: A Proliferation of type II pneumonocytes B Honeycomb lung C Hyaline membranes D Intra-alveolar edema E Vascular thrombosis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 60 Which of the following statements regarding surgical therapy for intrathoracic neoplasms is INCORRECT: A Small cell anaplastic carcinomas are rarely resected because of early metastasis B Some squamous cell carcinomas are resectable because they remain localized C Most mesotheliomas are resectable because they involve the pleura D Adenocarcinomas are often resectable because they are peripheral in location E A pulmonary hamartoma is usually resectable NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 61 A 59 year old man is a smoker with a chronic cough. He has recently noted hemoptysis. He brings in three refrigerated sputum specimens collected at home on successive days. He produced the specimen within a few minutes of waking and before eating breakfast. Examination of the specimens microscopically reveals bacterial colonies, squamous epithelial cells, budding yeasts, and mucus. No alveolar macrophages are present. What is the most appropriate statement regarding these findings: A A bronchoalveolar lavage should have been performed B This is not an adequate specimen for diagnosis C This type of specimen is best collected later in the day D He was subjected to a risk for pneumothorax E Collecting this many specimens was not cost-effective NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 62 A 47 year old woman was bothered by a chronic non-productive cough for several months. A chest radiograph showed reticulonodular infiltrates, but no masses. A sputum gram stain showed normal flora, and sputum cytology showed no atypical cells, but there were abundant hemosiderin-laden macrophages. Laboratory findings included sodium 145 mmol/L, potassium 4.5 mmol/L, chloride 101 mmol/L, CO2 27 mmol/L, glucose 89 mg/dL, urea nitrogen 29 mg/dL, and creatinine 3.3 mg/dL. A CT guided needle biopsy of the lung was performed, and a necrotizing vasculitis involving the peripheral arteries was present. Which of the following serum laboratory test findings is she most likely to have: A Antinuclear antibody titer of 1:512 B Rheumatoid factor titer of 60 IU/mL C Antineutrophil cytoplasmic autoantibody titer of 1:256 D Ribonucleoprotein antibody titer of 1:512 E Antistreptolysin O titer of 1:256 NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 63 The acute onset of fever, cough, and dyspnea occurs after a day's work in an office building. The affected temporary secretary has this same problem each time she works in this building over the past 6 months. Transbronchial biopsy is performed after she is hospitalized with respiratory distress. The histologic findings include focal peribronchial mononuclear interstitial infiltrates with some macrophages. Which of the following conditions is she most likely to have: A Influenza A pneumonia B Diffuse alveolar damage C Pneumocystis carinii pneumonia D Hypersensitivity pneumonitis E Extrinsic asthma NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 64 52 year old chronically ill male has a history of chronic alcoholism. He has had a 10 kg weight loss for the past two months. He has a chronic cough which has been blood-tinged on several occasions. He has a low grade fever and night sweats. He is found dead in his apartment by a neighbour. At autopsy, his lungs are filled with hundreds of 1 to 3 mm firm rounded tan nodules. Which of the following infectious agents is most likely to produce this grossly apparent pattern: A Pneumocystis carinii B Mycobacterium tuberculosis C Respiratory syncytial virus D Streptococcus pneumoniae E Aspergillus fumigatus NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 65 A 29 year old woman has a positive double stranded DNA test along with myalgias and arthralgias. A urinalysis reveals red blood cell casts in urine. Her serum urea nitrogen is 52 mg/dL with creatinine of 7.1 mg/dL. She is treated with corticosteroid therapy. A month later, she became febrile. She again has cough with production of a small amount of blood-streaked whitish sputum. A chest radiograph now showed multiple 1 to 2 cm pulmonary nodules. A CBC shows Hgb 12.2 g/dL, Hct 36%, MCV 89 fL, platelet count 215,000/microliter, and WBC count 2,200/microliter with differential count of 40 segs, 5 bands, 35 lymphs, 15 monos, 3 eosinophils, and 2 basophils. Which of the following infectious agents is most likely to be producing the second chest radiographic pattern: A Staphylococcus aureus B Aspergillus flavus C Pneumocystis carinii D Adenovirus E Mycobacterium avium-complex NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 66 A 50 year old male has progressive dyspnea over the course of 18 months. He remains afebrile. A chest radiograph reveals increased interstitial markings, but no masses and no areas of consolidation. A bronchoalveolar lavage reveals no infectious organisms. A transbronchial biopsy is performed. The high power microscopic appearance on the biopsy reveals extensive interstitial fibrosis and residual dilated air spaces lined by bronchial epithelium. These findings are most characteristic for: A Smoking B Congestive heart failure C Bleomycin chemotherapy> D Chronic bronchitis E Diffuse alveolar damage NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 67 Three weeks in hospital after laparotomy for a perforated duodenal ulcer complicated by peritonitis, a 56-year-old male with a history of congestive heart failure has a sudden episode of pleuritic chest pain on the left. His status had been improving up to that point. The most likely cause is: A Lobar pneumococcal pneumonia B Pulmonary infarction C Left upper lobe abscess D Bronchiectasis E Cytomegalovirus pneumonitis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 68 A chest radiograph demonstrates a 6-cm hilar mass in a 63-year-old smoker who has recently noted blood-tinged sputum. The LEAST likely pathologic finding that could appear in this setting is: A Endogenous lipid pneumonia B Squamous cell carcinoma C Hypercalcemia D Bronchiectasis E Bronchioloalveolar carcinoma NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 69 A 73-year-old healthy female has had a fever with non-productive cough for a week. She reports no hemoptysis or chest pain. A chest radiograph reveals bilateral diffuse pulmonary interstitial infiltrates but no nodules or masses. If these infiltrates are composed primarily of small lymphocytes, and there is minimal pulmonary edema, which of the following infectious agents is most likely to be present: A Streptococcus pneumoniae B Candida albicans C Influenza A D Actinomyces israeli E Mycobacterium kansasii NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 70 There is sudden onset of wheezing with dyspnea in a 13 year old girl. She had a similar episode a month ago. She is brought to the emergency room. Her breathing appears to have a prolonged expiratory phase with wheezing sounds. An arterial blood gas shows hypoxemia, hypercapnia, and acidosis. A chest radiograph shows clear lung fields. The most likely accompanying laboratory finding is: A Elevated sweat chloride B Numerous sputum eosinophils C Decreased CD4 lymphocyte count D Increased serum alkaline phosphatase E Positive tuberculin skin test NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 71 A previously healthy 4 month old infant is found in the crib cold and blue by distraught parents. The baby was born at term with Apgar scores of 9 and 10. No anomalies were noted. The baby has been gaining weight and obtaining developmental milestones normally. The baby was fine only an hour before he was found dead. The medical examiner finds no gross abnormalities at autopsy. Which of the following statements best describes this situation: A Bronchopulmonary dysplasia will be found microscopically B Scene investigation revealed that the infant was sleeping supine on a hard mattress C The immediate cause of death was status asthmaticus D Viral and bacterial lung cultures showed no growth E Both parents are found to be carriers of a cystic fibrosis gene. NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 72 A 39-year-old female has increasing dyspnea for several years. Everyone in her family is a non-smoker, but she and her sister have had similar symptoms. A chest radiograph that shows increased lung volumes but no infiltrates or masses. A chest CT scan demonstrates large loculated air spaces at the lung bases. Pulmonary function testing shows a decreased FEV1 and FEV1/FVC ratio. If the major pathologic change is acinar enlargement from the level of the respiratory bronchiole to the terminal blind alveoli, then the most likely etiology for these findings is: A Multiple infections with respiratory viruses B Environmental exposure to organic dusts C Alpha-1-antitrypsin deficiency D Congenital cystic adenomatoid malformation E Non-atopic asthma NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 73 A 47-year-old dentist who has been in good health all his life develops progressive dyspnea over a period of 18 months. He develops cor pulmonale and death ensues. The most probable underlying cause of death is: A Diabetes mellitus B Idiopathic pulmonary fibrosis C Systemic lupus erythematosus D Hypersensitivity pneumonitis E Protein S deficiency NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 74 An eight year old boy infected with Mycobacterium tuberculosis is most often going to have: A A cough with sputum 4+ positive for acid fast bacilli B Cavitary upper lobe lung lesions on chest radiograph C Miliary spread to the liver and spleen D Enlarged hilar lymph nodes with caseous necrosis E Intestinal ulcerations NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 75 Hemoptysis for several weeks results in a workup for a 70 year old man, a non-smoker, that reveals a 6 cm left perihilar cavitary mass by chest CT scan. Sputum cytologic examination reveals atypical cells present consistent with squamous cell carcinoma. A mediastinoscopy is performed, and the mass appears to extend into the the mediastinum, but not to the opposite lung. Sampling of enlarged hilar and scalene lymph nodes reveals metastatic squamous cell carcinoma. He most likely has a: A Resectable lesion B Stage of T1 C Probable 5 year survival of 80% D History of radon gas exposure E Positive antinuclear antibody test NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 76 A 35-year-old HIV positive male has had a previous bout of Pneumocystis carinii pneumonia and now has a CD4 lymphocyte count of 69/microliter. He is at LEAST risk for a pulmonary infection with: A Respiratory syncytial virus B Mycobacterium avium-complex C Staphylococcus aureus D Aspergillus fumigatus E Mycobacterium tuberculosis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 77 Two years following orthotopic cardiac transplantation, a 44-year-old male develops fever and cough after his immunosuppressive therapy was increased to treat acute rejection. His symptoms do not improve after several months. Chest radiograph reveals right middle lobe infiltrates with abscess formation. A bronchoalveolar lavage is most likely to yield: A Acid fast bacilli B Clusters of gram positive cocci C Gram negative rods D Long filamentous gram positive organisms E Large cells with intranuclear inclusions NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 78 A 28 year old man has had periods of fever along with dyspnea over the past month. These symptoms seem to be worse when he is at home. A physical examination reveals lungs clear to auscultation. A chest radiograph reveals an ill-defined pattern of interstitial markings. A chest CT scan shows scattered small nodular densities in all lung fields. A course of antibiotic therapy has no effect. A transbronchial biopsy shows small patchy areas of chronic interstitial inflammatory infiltrates associated with ill defined interstitial granulomas. Special stains for fungi and acid fast bacilli are negative. Exposure to which of the following environmental agents best accounts for these findings: A Silica dust B Tobacco smoke C Radon gas D Smog E Mold spores NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 79 Following allogeneic bone marrow transplantation for acute lymphocytic leukemia, an 18 year old male has worsening respiratory distress. He requires intubation and mechanical ventilation. Sputum cultures and a bronchoalveolar lavage fail to reveal an infectious agent as the cause for his worsening pulmonary function. A lung biopsy is performed and demonstrates hyaline membranes lining alveoli along with alveolar macrophages. These findings are most consistent with: A Cystic fibrosis B Diffuse alveolar damage C Goodpasture's syndrome D Hyaline membrane disease E Idiopathic pulmonary fibrosis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 80 An asymptomatic 45-year-old female has a chest radiograph taken and a peripheral 3 cm nodule with irregular calcifications is present in the right upper lobe. A fine needle aspiration of this lesion is performed. However, the pathologist has difficulty putting the needle into the lesion, and it bounces off as though the lesion were a ping-pong ball. A small amount of tissue with epithelial cells, connective tissue, and cartilage is obtained. A thoracotomy is performed with a wedge resection. Grossly, the mass is very firm, with a tan, focally gritty cut surface. What is this lesion most likely to be: A Pulmonary hamartoma B Abscess C Adenocarcinoma D Ghon complex E Squamous cell carcinoma NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 81 Over the past 15 years, a 60 year old man has had worsening dyspnea. He is afebrile. Pulmonary function studies show a low FVC and a normal FEV1/FVC ratio. Chest radiographs over the past 10 years have demonstrated increasingly larger nodular opacifications in both lungs. The latest film shows almost complete "white-out" of the right lung. Which of the following environmental exposures is most likely to produce these findings: A Tobacco smoke B Wood dust C Silica D Nickel E Hydrocarbons NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 82 A 26 year old woman presents with a 3 day history of increasing shortness of breath. She has a non-productive cough. Vital signs shows T 38.9 C, P 95, R 28, BP 110/60 mm Hg. A bronchoalveolar lavage is performed and cytologically the specimen demonstrates the appearance of numerous cysts of Pneumocystis carinii with Gomori methenamine silver stain. With which of the following additional laboratory findings is this most likely to appear: A Absolute neutrophil count of 10,000 B Positive monospot test C CD4 lymphocyte count of 28 D Positive pregnancy test E Hemoglobin SS on hemoglobin electrophoresis NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 83 A 55-year-old male has smoked 2 packs of cigarettes per day for many years. He has had a worsening cough for the past several months. In the past couple of weeks he has occasionally noted blood-tinged sputum. Otherwise, he has no major health problems. Which of the following procedures should be done first to begin the workup of his disease: A Sputum cytology B Bronchoalveolar lavage C Fine needle aspiration D Pleural fluid cytology E Arterial blood gases NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU Question 84 A 66-year-old female has had Alzheimer's disease for a decade and has become more and more demented. She is finally unable to care for herself and is mainly bedridden, except for short periods in which she is placed in a wheelchair. She becomes febrile and then dies at home. The probable immediate cause of death is: A Cytomegalovirus pneumonia B Respiratory syncytial virus pneumonia C Chronic abscess with Nocardia D Pneumococcal pneumonia E Methicillin resistant Staphylococcus NEXT QUESTION - - INDEX OF QUESTIONS - - EXAM MENU
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M.D., PGY-1 Internal Medicine / future interests - Infectious Diseases Fellowship     
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03-05-2008, 03:46 PM
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Question 50 A humorist who conducted his orchestra with a loaded revolver or toilet plunger toured the U.S. for years in the 40's and 50's with a heavy schedule of appearances. He became progressively dyspneic in his early 50's and was unable to work. He began to lose weight. Physical examination showed that he had an increased AP diameter to his chest. He used accessory muscles for respiration. There was hyperresonance by percussion along with decreased fremitus. Pulmonary function testing revealed a decreased FEV1 and FEV1/FVC ratio. A chest radiograph showed increased lung volumes with flattening of the diaphragms. He died from pneumonia at age 54. Which of the following risk factors was most likely responsible for his underlying pulmonary disease:
A Snorting cocaine B Drinking vodka C Promiscuity D Smoking cigarettes E Poor diet
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03-05-2008, 05:22 PM
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Quote:
so i would choose D
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