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Question 85 The chest cavity opened at autopsy in a premature infant born at 32 weeks gestation contains lungs that appear quite small. The Apgar scores were 1 at 1 minute and 3 at 5 minutes. The infant was intubated but could not be adequately ventilated and died at 30 minutes of age. Which of the following diagnoses best explains these findings:
A Tracheoesophageal fistula
B Bronchopulmonary dysplasia
C Cystic fibrosis
D Bilateral multicystic renal dysplasia
E Sudden infant death syndrome
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Question 86 A 50 year old heart transplant recipient has recently been treated with increasing dosages of imunosuppressive medications because an endomyocardial biopsy demonstrated moderate acute rejection. He then develops a fever and cough with left lingular consolidation seen by chest radiograph. This persists for over six weeks, and a bronchopleural fistula develops. His course is then complicated by headaches, and head CT scan reveals the presence of several brain abscesses. Which of the following organisms is most likely to be the etiology for these findings:
A Pneumocystis carinii
B Streptococcus pneumoniae
C Cytomegalovirus
D Nocardia asteroides
E Candida albicans
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Question 87 A 26 year old male is involved in a motorcycle accident. Paramedics arrive on the seen to find him in severe respiratory distress. He is ventilated by Ambu bag on the way to the hospital. The chest radiograph taken soon after arrival at the hospital shows that the mediastinum is shifted to the left and the right lung fields are more lucent than those on the left. Which of the following diagnostic findings is he most likely to have:
A Sputum with increased numbers of eosinophils
B Echocardiogram showing a large tricuspid valvular vegetation
C Rush of air upon insertion of thoracentesis needle
D Areas lacking perfusion on a V/Q scan
E Aspirated foreign body on bronchoscopy
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Question 88 Non-caseating granulomas are found on a transbronchial biopsy in a 45 year old female certified public accountant who presented with the insidious onset of increasing dyspnea. A chest radiograph demonstrates nodular infiltrates and marked hilar adenopathy. She most likely has:
A Asbestosis
B Idiopathic pulmonary fibrosis
C Coccidioidomycosis
D Hypersensitivity pneumonitis
E Sarcoidosis
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Question 89 A premature, low birth weight neonate develops respiratory distress syndrome (RDS) soon after birth, with grunting and retractions. A radiograph reveals poor aeration with "white out" of all lung fields. Despite intubation and positive pressure ventilation, the baby expires. At autopsy, the lungs are grossly solid. Microscopically, there are extensive pink hyaline membranes. The babys condition is characterized by each of the following statements EXCEPT:
A Fetal lung maturity is assessed on ultra-sound examination of the fetus prior to birth
B This disease may be prevented by administering corticosteroids to mother prior to birth
C Even if baby is resuscitated, there is a risk for development of bronchopulmonary dysplasia
D This disease is made more likely at 35 weeks gestation if mother has gestational diabetes mellitus
E Administration of exogenous surfactant at birth can be helpful in preventing this disease
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Question 90 While obtaining informed consent for a fine needle aspiration of the right lung to obtain a tissue diagnosis of a lower lobe mass in a 58 year old male, the physician giving informed consent states that the most common problem associated with this procedure is:
A Pneumothorax
B Hemothorax
C Inability to determine the cell type of a malignancy
D High cost
E Chronic pain following the procedure
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Question 91 A 51 year old woman has had fever with night sweats for the past three months. She has had a worsening non-productive cough for several weeks. A chest radiograph shows small nodules 0.5 cm or less in size, scattered through all lung fields, with a normal size heart, but prominent hilar lymphadenopathy. On bronchoscopy, no endobronchial lesions are noted. A transbronchial biopsy shows non-caseating granulomas. Bacterial, fungal, and mycobacterial cultures from the biopsied tissue show no growth. Which of the following pharmacologic therapies will be most efficacious in treating this patient:
A Prednisone
B Ciprofloxacin
C Isoniazid
D Cytoxan
E Acetaminophen
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