Pulmonary Pathology

Edema 984-80. A. B. C. D. Pulmonary edema would be least likely in: 67 year old quartz miner hit by a truck 38 year old man with congestive heart failure 24 year old overdosed heroin addict 19 year old male mountain climber who collapsed and died on Mount Whitney

9426. Pulmonary edema is a common finding during some stage in all of the following diseases EXCEPT: A. Mitral valve stenosis B. Renal failure C. Early Klebsiella pnewnoniae pneumonia D. Chronic bronchitis E. ARDS 9567. A. B C. D. E. Pulmonary edema is least likely in: Left sided congestive heart failure Intestinal malabsorption Mycoplasma pneumonia Alcoholic cirrhosis Aspiration pneumonia

994-82. Pulmonary edema would be least likely in A. Peripheral scar adenocarcinoma B. Left sided congestive heart failure C. Adult respiratory distress syndrome D. Right lower lobe bronchopneumonia E. Liver failure with hypoalbuminemia 9662. Intraalveolar pulmonary edema is typically found in all EXCEPT: A acute pneumococcal pneumonia B ARDS C left ventricular heart failure D usual interstitial pneumonia 9663. Intralveolar pulmonary edema, hyaline membranes, red blood cells and neutrophils would LEAST likely be found in the lung biopsy from a: A. 27 year old male with cough, productive sputum, fever and Gram positive diplococci in his sputum B 52 year old retired quartz miner with chronic non-productive cough C. 64 year old 40 pack year smoker with chronic cough, with recent yellow-red sputum production associated with fever and pleuritic chest pain D 6 year old male who aspirated a peanut 24 hours ago 9760. The histological finding of pulmonary edema is least likely in: A Early S. pneumoniae pneumonia B Acute left heart failure C Acute asthma D High altitude sickness E Liver cirrhosis

Courtesy of TTUHSC School of Medicine Peer Tutors

2
9768. Granulomas are typical or common in all of the following except: A Sarcoidosis B Hypersensitivity C Byssinosis D Pulnonary alveolar proteinosis E Berylliosis ARDS 984-79. A. B. C. D. E. The least likely finding in acute or healing ARDS: Hyaline membranes Type 2 pneumocyte proliferation Alveolar sac atelectasis Intraalveolar clusters of neutrophils Interstitial fibrosis

9425. All of the following pathological findings are common in ARDS EXCE?T: A. Abscesses B. Chronic interstitial inflammation C. Hyaline membranes D. Proteinaceous intra_alveolar exudate E. Type II pneumocyte proliferation 9564. The least likely cause of adult respiratory distress syndrome: A. Smoke inhalation B. Right middle lobe mycoplasma pneumonia C. Hemorrhagic shock D. Disseminated intravascular coagulation E. Aspiration of gastric contents 9565. A. B. C. D. E. Emboli 984-78. A. B. C. D. E. The pathological picture of early adult respiratory distress syndrome: Mucus plugs, goblet cell metaplasia, eosinophils Pulmonary edema, hemosiderin laden macrophages, lymphadenopathy Pulmonary edema, abscesses, atelectasis Pulmonary edema, hyaline membranes, neutrophis and/or macrophages Interstitial lymphoectes, and fibrosis, multinucle giant cells

Patient with most likely combination of history; end result of pulmonary embolus: 25 year old male athlete with superficial leg bruise; sudden death 25 year old male athlete with superficial leg bruise; asymptomatic 47 year old obese female after 17 hour long airline flight; acute shortness of breath 47 year old obese female after 17 hour long airline flight; asymptomatic 47 year old man with colon cancer; cor pulmonale

9423. The patient MOST likely to develop a pulmonary infarction after a pulmonary embolus: A. A 35 year old athlete on crutches after an ankle fracture B. A 65 year old chronic smoker hospitalized for two weeks after an accident producing multiple leg and pelvic fractures A 10 month old boy hospitalized with RSV pneumonitis A 32 year old chronic smoker hospitalized for 2 days for treatment of a gastric ulcer

Courtesy of TTUHSC School of Medicine Peer Tutors

E.

A patient hospitalized for one week with pancreatitis, found to have a Ghon's complex on a routine chest Xray

9516. Identify: A. Scar carcinoma B. Abscess in bronchopneumonia C. Pulmonary infarction D. Silica nodule E. Gohn complex 994-85. The patient most likely to develop a pulmonary embolus: A. 62 year old man with pancreatic cancer who has been hospitalized for a pathological fracture of his femur for two weeks B. 27 year old pregnant but otherwise healthy woman C. 10 year old boy with broken humerus D. 45 year old business man after 17 hour plane ride from Japan E. 27 year old medical student who attends every lecture and lives in the library 9761. The most common source and most common clinical consequence of pulmonary embolism : A Deep veins of legs; sudden death B Deep veins of legs; pulmonary infarction C Deep veins of legs; clinically silent D Inferior vena cava; clinically silent Superior vena cava; sudden death 994-84. The most common source of pulmonary emboli: A. Axillary veins B. Superficial leg varicosities C. Deep veins of legs D. Hypogastric veins E. Superior vena cava 9566. A. B. C. D. E. The most common source of a pulmonary embolus: Hypogastric veins Deep veins of legs Deep veins of arms Mural thrombus of right atrium Mural thrombus of left atrium

9652. A 55 year old business woman from Australia has recently flown from Melbourne to Lubbock for a business meeting. Two days into the meeting she develops chest discomfort and shortness of breath. In the emergency room, her CXR reveals atelectasis in the right base and an ABG reveals hypoxemia (low oxygen level). You diagnose her as having a pulmonary embolus after seeing multiple, bilateral areas of ventilation-perfusion mismatching on a V/Q scan (ventilation/perfusion scan). The immediate physiological abnormality is decreased perfusion to areas of normal ventilation which does not cause hypoxemia. With the abnormality noted on the CXR, the hypoxemia is secondarv to: A increased dead space (areas of high ventilation to perfusion ratio) B shunting (areas of low ventilation to perfusion ratio) C a diffusion defect D hypoventilation 9718. Identify this lesion. A Cavitated squamous cell carcinoma B Caseating necrosis in tuberculosis
Courtesy of TTUHSC School of Medicine Peer Tutors

C D E

Pulmonary embolus with infarction Chronic bronchitis Bronchiectasis

9756. A 55 year old business woman from Australia has recently flown from Melbourne to Lubbock for a business meeting. Two clays into the meeting she develops chest discomfort and shortness of breath. In the emergency room, her arterial blood gases (ABG) reveals hypoxemia (low oxygen level) and a slightly low PC02. You see multiple, bilateral areas of ventilation-perfusion mismatching on a V/Q scan (ventilation perfusion scan). The most likely diagnosis: A Adult Respiratory Distress Syndrome B Pulmonary Emboli C Pulmonary hypertension D Asthma Pulmonary HTN 984-81. A. B. C. D. Pulmonary hyptertension is least likely in: Long surviving cancer patient with history of pulmonary emboli Chronic bronchitis Rheumatoid arthritis Primary tuberculosis

994-86. Pulmonary hypertension is an unlikely complication in A. Large ventricular septal defect B. Mitral stenosis C. Chronic bronchitis D. Right middle lobe bronchopneumonia E. Rheumatoid vasculitis 9431. A. B. C. D. E. Pulmonary hypertension is LEAST likely to occur in which of the following: A 60 year old man with chronic bronchitis A 35 year old male with Wegener's necrotizing granulomatosis and vasculitis A 50 year old female non_smoker with an adenocarcinoma of the lung A 5 year old with congenital cyanotic heart disease A 50 year old inhabitant of Nepal, near Mt. Everest

9571. Histological changes in pulmonary hypertension are most consistently found in: A. Segmental pulmonary arteries B. Arterioles and small arteries C. Alveolar capillaries D. Pulmonary venules E. Segmental pulmonary veins 9735. Cor pulmonale may be caused by all of the following conditions except: A Cystic fibrosis B Pulmonary embolism C Chronic obstructive pulmonary disease D Mitral stenosis E Diffuse pulmonary interstitial fibrosis

Courtesy of TTUHSC School of Medicine Peer Tutors

9759. A 21 year old college woman reports progressive dyspnea on exertion for the past 8 months. She denies a cough or wheezing. She has smoked one half of a pack of cigarettes a day for the past two years. There is no history of lung disease in her family. Her spirometry and lung volumes are within the predicted range. On an exercise test she has significant oxygen desaturation. Her chest x-ray reveals normal lung parenchyma but enlarged pulmonary arteries bilaterally. Your diagnosis and the expected diffusion capacity: A Primary pulmonary hypertension; normal diffusion capacity B Primary pulmonary hypertension; decreased diffusion capacity C primary pulmonary hypertension; increased diffusion capacity D Pulmonary fibrosis; normal diffusion capacity E pulmonary fibrosis; increased diffusion capacity CF 9410. A 15 year old female dies after years of respiratory and gastrointestinal problems, the former manifested by multiple pneumonias and the latter by multiple vitamin deficiencies. The identity of the lung process in this picture and the most likely underlying disease: A. Lobar pneumonia; bacterial endocarditis B Metastatic small cell carcinoma C. Bronchiectasis; chronic peanumt aspiration D. Bronchiectasis; cystic fibrosis E. Legionellosis 9432. Mucus Plugs are common findings in all but: A. Chronic bronchitis B. Asthma C. Panlobular emphysema D. Cystic fibrosis Interstital Lung Diease 984-86. A. B. C. D. 949. A. B. C. D. E. These pulmonary diseases often respond to steroids, except: Bronchiolitis obliterans-obstructive pneumonia [BOOP] Asthma Desquamative interstitial pnuemonia Idiopathic pulmonary fibrosis [usual interstitial pneumonia]

Identify the lesion Tuberculosis Squamous cell carcinoma Pulunonary interstitial fibrosis, idiopathic Lobar pneumonia Pulmonary edema

994-87. Honeycomb lung: A. Bee keepers pneumoconiosis

Courtesy of TTUHSC School of Medicine Peer Tutors

B. C. D.

End stage fibrosing lung disease End stage pulmonary hypertension End stage emphysema E. Bronchiectasis

95105 A B. C. D. E.

Idiopathic pulmonary fibrosis Increased IL_2 production by T lymphocytes associated with uveitis and erythema nodosum. Massive retraction of lungs toward the hila and peribronchiolar deposition of particles by macrophages Associated with pancreatitis and esophageal rupture Chylous pleural effusions and adenosine receptor blockade Increased TGF_ integrins and matrix proteins resulting in enhanced collagen deposition

9649. A 50 year old gentleman comes to your medical office complaining of progressive dyspnea on exertion. On physical exam you hear inspiratory crackles. His spirometry reveals a forced vital capacity (MC) that is 56% of predicted, and a forced expired volume in one second (FEV1) that is 53% of predicted. Your tentative diagnosis is: A. asthma B emphysema C pulmonary fibrosis D chronic bronchitis 9753. A 50 year old gentleman comes to your medical office complaining of progressive dyspnea on exertion. On physical exam you hear inspiratory crackles. His spirometry reveals a forced vital capacity (FVC) that is 56% of predicted, a forced expired volume in one second (FEV1) that is 53% of predicted. Your tentative diagnosis is: A. Asthma B Emphysema C Pulmonary Fibrosis D Chronic Bronchitis 9427. A 35 year old black female non_smoker is found to a diffuse interstitial pattern as well as massively finding on a biopsy from have a with many small parenchymal nodules on her chest Xray, enlarged hilar lymph nodes. The most likely pathological peripheral lung:

Courtesy of TTUHSC School of Medicine Peer Tutors

1.
B. C. D. E.

Intranuclear viral inclusions in Type U pneumocytes Non caseating granulomata with interstitial chronic inflammation and fibrosis Polymorphonucleocytes and edema fluid in alveolar sacs Infarcted lung parenchyma Malignant squamous cells

984-110. A 45 year old woman comes to your medical office complaining of progressive dyspnea on exertion. On physical exam you hear inspiratory crackles. Her spirometry reveals a forced vital capacity (FVC) that is 56% of predicted, a forced expired volume in one second (FEV1) that is 53% of predicted. Your tentative diagnosis is: A. Asthma B. Emphysema C. Pulmonary Fibrosis D. Chronic Bronchitis 9666. The LEAST likely diagnosis of a solitary 3 cm lung density: A abscess B bronchioloalveolar carcinoma C tuberculosis D scleroderma E histoplasmosis

A B C D CA

9758. A 65 year old male patient presents to your clinic complaining of shortness of breath. His sense of shortness of breath has been increasing slowly over the past few years. On physical exam his respiratory rate is 28 breaths per minute and the breaths appear to be shallow. He has inspiratory crackles and clubbing of the fingers. Chest x-ray has a reticular-nodular pattern predominantly in the bases of both lungs with a "honeycomb" appearance. On physiological testing of his lungs you would expect to find: An obstructive pattern on spirometry Decreased lung compliance A normal diffusing capacity Increased total lung capacity

994-59. The most common cause of cancer death in the United States is A. Cancer of pancreas B. Cancer of lung C. Cancer of prostate D. Cancer of breast 984-90. A. B. C. D. E. Malignant mesotheliomas: Causally related to cigarette smoking Often have a biphasic epithelioid - spindle cell histological pattern Arise from pleural plaques Respond rapidly and well to chemotherapy Causally related to silica crystals

Courtesy of TTUHSC School of Medicine Peer Tutors

8
984-88. A 65 year old woman, a 40 pack year smoker, presented with unexplained weight loss, fever and a cough productive of a blood tinged yellow sputum. A 5 to 6 cm centimeter cavitated area of radiodensity with an "air fluid" level in the right upper lobe was found. Other lab studies were normal except for an elevated white blood cell count with a neutrophil predominance and an elevated serum calcium. CT scans and other radiographic studies showed no evidence of other visceral or focal bone abnormalities. The most likely diagnosis: A. Fibrocaseous tuberculosis B. Sarcoidosis C. Squamous cell carcinoma D. Small cell undifferentiated carcinoma E. Histoplasmosis 994-89. A 65 year old 50 pack year white male smoker presents with hemoptysis and is found to have a central six centimeter lung mass with enlarged lymph nodes. A workup demonstrates no evidence of liver, brain or bony metastasis. His serum calcium is elevated. A bronchoscopic biopsy is done. You give it to the pathologist without any clinical history. Based on your information, you make a five dollar bet on the diagnosis because you know it will most likely be: A. Small cell undifferentiated carcinoma B. Squamous cell carcinoma C. Adenocarcinoma D. Large cell undifferentiated carcinoma 33. A. B. C. D E. The most common lung tumor found peripherally: Squamous cell carcinoma Adenocarcinoma Small cell undifferentiated carcinoma Bronchial adenoma Large cell undifferentiated carcinoma

38. A 55 year old long term smoker presents with a left solitary central pulmonary mass, enlarged left hilar lymph nodes, multiple lesions in his liver, and Cushingoid features [truncal obesity, moon facies, etc]. He is found to have an elevated serum cortisol level, thought to be secondary to an ACTh{ like substance secreted by his lesion. A bronchoscopic biopsy of the mass would most likely show: A. Caseating granulomata with acid fast bacilli on special stains B. Nests of cells with bland, uniform nuclei and cytoplasrnic neurosecretory granules on electron micrographs C. Irregular glandular structures with hyperchromatic and pleomorphic nuclei, abnormal mitoses, and evidence of cells infiltrating bronchial cartilage D. Fibrous nodules with birefringent crystals E Sheets of cells with small pleomorphic nuclei with minimal cytoplasm and no evidence of glandular differentiation 9572. The lung tumor most commonly associated with Cushing's syndrome: A. Squamous cell carcinoma B. Adenocarcinoma C. Small cell undifferentiated carcinoma D. Bronchial adenoma E. Large cell undifferentiated carcinoma
Courtesy of TTUHSC School of Medicine Peer Tutors

9
9775. Lambert Eaton syndrome C A Rheumatoid arthritis in coal miner's pneumoconiosis B Uveoparotid sarcoid C Small cell undifferentiated lung carcinoma D Pneumocystis carinii pneumonia E Pulmonary alveolar proteinosis 9777. Syndrome inappropriate ADH secretion [SIADH] C A Rheumatoid arthritis in coal miner's pneumoconiosis B Uveoparotid sarcoid C Small cell undifferentiated lung carcinoma D Pneumocystis carinii pneumonia E Pulmonary alveolar proteinosis 968. Your diagnosis based on the gross and microscopic photos from a 66 year old man: A bronchial adenoma B small cell undifferentiated carcinoma C squamous cell carcinoma D adenocarcinoma E hamartoma 9653. Cigarette smoking is not associated with an increased incidence of: A squamous cell carcinoma of the lung B small cell undifferentiated carcinoma of the lung C adenocarcinoma of the lung D malignant mesothelioma E centrilobular emphysema 9664. Hilar or peribronchial node enlargement on chest X-Ray is common in all of the followingEXCEPT A silicosis B squamous cell carcinoma of the lung C asbestosis D sarcoidosis E tuberculosis 9666. The LEAST likely diagnosis of a solitary 3 cm lung density: A abscess B bronchioloalveolar carcinoma C tuberculosis D scleroderma E histoplasmosis 9719. This is a chest radiograph [CXR] and diagnostic histology from a 63 year old man who presented with an incidental finding of hypercalcemia. Your diagnosis:(Note:there are 2 Slice of Life Images to this ?) A Adenocarcinoma B Sarcoidosis C Squamous cell carcinoma D Small cell undifferentiated lung carcinoma E Tuberculosis

Courtesy of TTUHSC School of Medicine Peer Tutors

994-88. The lung carcinoma most sensitive to chemotherapy but also most likely to present with distant metastasis: A. Small cell undifferentiated carcinoma B. Squamous cell carcinoma C. Adenocarcinoma D. Large cell undifferentiated carcinoma 9770. 63 year old 45 pack year cigarette smoker with left ptosis and miosis and left apical lung lesion on CXR E A Caseating granulomata with positive AFB stains B Non caseating granulomata; stains negative for fungus or AFB C Interstitial fibrosis; ferruginous bodies; pleural plaques D Nodules of hyalinized fibrous tissue with small birefringent [i.e seen in polarized light] crystals E Sheets of small cells with little cytoplasm and closely crowded/ molded atypical nuclei Asbestosis

10

984-87. A 67 year old man presented with a slowly worsening shortness of breath and a recent episode of hemoptysis. A nonsmoker, he had been a construction worker for years. Findings from radiographic exams and an exploratory left thoracotomy revealed a 4 centimeter left lower lobe lung mass in the background of diffuse interstitial fibrosis which was more prominent in the lower lobes. Plaques of candle wax -like fibrous tissue were found on the diaphragmatic pleural surface. The most likely histological findings of diffuse disease: solitary nodule A. Idiopathic interstitial fibrosis: tuberculosis B. Coal miner's pneumoconiosis: progressive massive fibrosis C. Asbestosis: Primary adenocarcinoma D. Silicosis: Rheumatoid arthritis E. ARDS: fungal ball in old abscess cavity 9421. This is foreign body commonly found in the lung of persons with A. Wegener's granulomatosis B. Small cell carcinoma C. Asbestosis D. Silicosis E. Tuberculosis E. Type II pneumocyte proliferation

9517. Identify: A. Ferruginous body B. Silica crystal C. Mycobacterium D. Curschmanns spiral E. Charcot Lyden crystals' 994-109. Asbestosis (B) A. Asteroid body
Courtesy of TTUHSC School of Medicine Peer Tutors

B. C. D. E.

Ferruginous body Charcot Leyden crystals Eaton Lambert syndrome Gohn complex

11

9574. The disease least likely to present as a solitary pulmonary nodule: A. Abscess B. Squamous cell carcinoma C. bronchial carcinoid D histoplasmosis E asbestosis 967. Your identification of this object and its disease association: A Ferruginous body - sarcoidosis B Ferruginous body - asbestosis C Boll weevil- byssinosis D Silica- silicosis E Neurosecretory granule - carcinoid 9769. 43 year old man, a chronic smoker, with a 15 year history of industrial exposure to asbestos being evaluated for chronic cough; increased interstitial marking bilateral lower lobes with no evidence of nodules or masses on Chest xray (CXR) or CT scan C A Caseating granulomata with positive AFB stains B Non caseating granulomata; stains negative for fungus or AFB C Interstitial fibrosis; ferruginous bodies; pleural plaques D Nodules of hyalinized fibrous tissue with small birefringent [i.e. seen in polarized light] crystals E Sheets of small cells with little cytoplasm and closely crowded/ molded atypical nuclei 9762. Atelectasis is a common finding in all of the following except: A Neonatal respiratory distress syndrome B Cystic fibrosis C Asthma D Asbestosis E Bronchopneumonia 9518. This histological finding would most likely be found in: A. A 30 year old African_American woman with hilar lymphadenopathy and multiple small lung nodules B. A 50 year old Chinese barber with flu syndrome C. A 65 year old coal miner D. 17 year old AIDS patient A 82 year old 100 pack year smoker with weight loss and Homer's syndrome E. A 82 year old 100 pack year smoker with weight loss and Hornerss syndrome.

A 70 year old male presents to your office with complaints of a nonproductive cough and dyspnea on exertion. Pulmonary function tests reveal: % Predicted 75% , decreased

FEV1

Courtesy of TTUHSC School of Medicine Peer Tutors

FVC

80%,

decreased FEV1/FVC normal TLC 75 Dlco 50

12

95109. Which of the following is the likely association? A. Swollen right knee 5 years prior B. Minimal change disease on renal biopsy C. Recent exposure to chlorine gas D. Employment as an insulation worker for the past 40 years E. History of abdominal pain and recurrent peptic ulcer 9435. The LEAST likely finding in the lungs from an autopsy done on a life long asbestos mine worker who is a non_smoker: A. Menocacinoma of the lung B. Centrilobular emphysema C. Ferruginous bodies in the lung D. Diffuse interstitial fibrosis of the lower lobes with pleural plaques E. Malignant mesothelioma Silicosis 95103 Silicosis Increased II__2 production by T lymphocytes associated with uveitis and erythema nodosum. Massive retraction of lungs toward the hila and peribronchiolar deposition of particles by macrophages C. Associated with pancreatitis and esophageal rupture D. Chylous pleural effusions and adenosine receptor blockade E. Increased TGF_ integrins and matrix proteins resulting in enhanced collagen deposition A. B. 9664. Hilar or peribronchial node enlargement on chest radiograph is common in all of the following EXCEPT: A B C silicosis squamous cell carcinoma of the lung asbestosis

Courtesy of TTUHSC School of Medicine Peer Tutors

D E

sarcoidosis tuberculosis

13

9772. 72 year old male quartz miner with multiple small upper lobe lung nodules bilaterally on CXR D A Caseating granulomata with positive AFB stains B Non caseating granulomata; stains negative for fungus or AFB C Interstitial fibrosis; ferruginous bodies; pleural plaques D Nodules of hyalinized fibrous tissue with small birefringent [i.e.seen in polarized light] crystals E Sheets of small cells with little cytoplasm and closely crowded/ molded atypical nuclei

TB 984-104.Tuberculosis A. Legg-Calve-Perthes' disease B. Pott's disease C. Ollier's syndrome D. Albers- Schonberg disease E. Shepard's crook deformity 994-91. Primary tuberculosis is best characterized by which pattern:

Courtesy of TTUHSC School of Medicine Peer Tutors

14 2.
B. C. D. E. Miliary involvement of multiple organs Multiple 3 cm nodules of the bilateral lower lobes Small calcified nodule in lung field with calcified mediastinal lymph node Bilateral apical fibrocaseous disease 6 cm upper lobe mass

984-103.Primary tuberculosis A. Charcot Leyden crystals B. Hamman Rich syndrome C. Gohn's complex D. Schaumann body E. Kulchitsky cell 994-110. Tuberculosis (E) A. Asteroid body B. Ferruginous body C. Charcot Leyden crystals D. Eaton Lambert syndrome E. Gohn complex 984-89. A. B. C. D. E. Granulomas are characteristic of all except Tuberculosis Hypersensitivity pneumonitis Histoplasmosis Sarcoidosis Asbestosis

9439. The disease MOST likely to present as a solitary pulmonary nodule: A Asthma B. Panacinar emphysema C. Tuberculosis D. Hypersensitivity pneumonitis E. Asbestosis 9664. Hilar or peribronchial node enlargement on chest radiograph is common in all of the following EXCEPT: A B C D E silicosis squamous cell carcinoma of the lung asbestosis sarcoidosis tuberculosis

9666. The LEAST likely diagnosis of a solitary 3 cm lung density: A abscess B bronchioloalveolar carcinoma C tuberculosis
Courtesy of TTUHSC School of Medicine Peer Tutors

D E

scleroderma histoplasmosis

15

9771. 47 year old homeless woman with productive cough, mild hemoptysis and bilateral apical lung lesions on CXR and possible history of fever A Caseating granulomata with positive AFB stains B Non caseating granulomata; stains negative for fungus or AFB C Interstitial fibrosis; ferruginous bodies; pleural plaques D Nodules of hyalinized fibrous tissue with small birefringent [i.e. seen in polarized light] crystals E Sheets of small cells with little cytoplasm and closely crowded/molded atypical nuclei Sarcoidosis 984-100.Sarcoidosis [D] A. Charcot Leyden crystals B. Hamman Rich syndrome C. Gohn's complex D. Schaumann body E. Kulchitsky cell 984-89. A. B. C. D. E. Granulomas are characteristic of all except Tuberculosis Hypersensitivity pneumonitis Histoplasmosis Sarcoidosis Asbestosis

95104. Sarcoidosis A. Increased II__2 production by T lymphocytes associated with uveitis and erythema nodosum. B. Massive retraction of lungs toward the hila and peribronchiolar deposition of particles by macrophages C. Associated with pancreatitis and esophageal rupture D. Chylous pleural effusions and adenosine receptor blockade E. Increased TGF_ integrins and matrix proteins resulting in enhanced collagen deposition 9776. Miculicz's syndrome A Rheumatoid arthritis in coal miner's pneumoconiosis B Uveoparotid sarcoid C Small cell undifferentiated lung carcinoma D Pneumocystis carinii pneumonia E Pulmonary alveolar proteinosis 9768. Granulomas are typical or common in all of the following except: A Sarcoidosis B Hypersensitivity C Byssinosis D Pulmonary alveolar proteinosis E Berylliosis

994-107. Sarcoidosis (B)

Courtesy of TTUHSC School of Medicine Peer Tutors

A. B. C. D. E.

Kulchitsky cells Schaumann body Aschoff body Osler node Pacinian corpuscle

16

994-92. 27 year old Afro American female, previously healthy, presents with a 6 month history of increasing shortness of breath. A panel of laboratory tests reveals only moderate hypercalcemia. Her chest xray shows an interstitial lung pattern which is finely nodular, as well as large mediastinal lymph nodes. Her other studies, including bone scans and a total body CT scan, show no extrapulmonary lesions. The most likely histological finding on bronchoscopic biopsy, with the resultant diagnosis: A. Fibrous nodules with birefringent crystals: asbestosis B. Noncaseating granulomata: sarcoidosis C. Arterial intimal fibrosis and medial hypertrophy: pulmonary hypertension D. Interstitial lung fibrosis with ferruginous bodies: silicosis E. Sheets of neutrophils in a necrotic cavity: squamous cell carcinoma Asthma 984-112.A 22 year old college student presents to the clinic complaining of wheezing and shortness of breath mainly with exercise. His symptoms occasionally wake him up at night but are more noticeable when he jogs. His spirometry reveals an obstructive ventilatory defect with improvement in values after he has used a bronchodilator. His CXR is within normal limits. Your diagnosis is asthma. Besides a bronchodilator, you feel he needs to be on which other type of medicine? A. Antibiotic B. Antihistamine C. Cough suppressant D. Anti-inflammatory medicine 994-111. Asthma ( C) A. Asteroid body B. Ferruginous body C. Charcot Leyden crystals D. Eaton Lambert syndrome E. Gohn complex 984-101.Asthma A. Charcot Leyden crystals B. Hamman Rich syndrome C. Gohn's complex D. Schaumann body E. Kulchitsky cell 9441. Mucus Plugs are common findings in all but: A. Chronic bronchitis B. Asthma C. Panlobular emphysema D. Cystic fibrosis

Courtesy of TTUHSC School of Medicine Peer Tutors

17
9568. A B C D E Curschmann's spirals are common sputum findings in: Allergic asthma Tuberculosis Farmer's lung Viral pneumonia Sarcoidosis

9651. A 22 year old college student presents to the clinic complaining of wheezing and shortness of breath mainly with exercise. His symptoms occasionally wake him up at night but are more noticeable when he jogs. His spirometry reveals an obstructive ventilatory defect with improvement in values after he has used a bronchodilator. His CXR is within normal limits. Your diagnosis and the tissue of the lung involved: A UIP - lung interstitium B bronchiectasis - lung interstitium C pulmonary embolus - pulmonary vasculature D asthma- airways 9655. The LEAST likely mucosal finding in asthma in a 13 year old female: A goblet cell hyperplasia B eosinophils C squamous dysplasia D mucus gland hyperplasia E vasodilitation 9755. A 22 year old college student presents to the clinic complaining of wheezing and shortness of breath mainly with exercise. His symptoms occasionally wake him up at night but are more noticeable when he jogs. His spirometry reveals an obstructive ventilatory defect with improvement in values after he has used a bronchodilator. His CXR is within normal limits. Your diagnosis is: A Adult Respiratory Distress Syndrome B Pulmonary Emboli C Pulmonary hypertension D Asthma 9763. The pathological finding least likely in asthma: A Mucosal eosinophils B Curschmanns spirals C Atelectasis D Mucosal edema E Type II pneumocyte proliferation 9428. Charcot_Leyden crystals are common sputum findings in: A. Allergic asthma B. Aspirin sensitive idiosyncratic asthma C. Farmer's lung D. Viral bronchitis E. Aspiration pneumonia Test 9581. A.

3.
C.

Carbon monoxide: Is the least abundant pollutant (by weight) in urban atmospheres Is a component of cigar smoke but not of cigarette smoke Reduces arterial oxygen tension

Courtesy of TTUHSC School of Medicine Peer Tutors

D E. 9582. A. B. C. D. E.

Commonly results in myocardial hypertrophy and impaired mental skills May be used to estimate pulm. diffusion capacity as its transfer isnt dependent on blood flow All of the following statements about TGF_~ are correct except: Production is markedly increased when pulmonary endothelial cells are placed under hypoxic conditions Is a cytokine having at least 3 isoforms (1,2,3) Probably acts by autocrine and paracrine activity Stimulates protesse activity and synthesis of matrix proteins, fibronectin, and Type I collagen Activity is highest in caudate and putamen

18

9650. A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigarettes a day and has done so for the past 44 years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse wheezing throughout both lung fields. She thinks she has chronic bronchitis but you feel she has emphysema. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnoses. Which of the following tests would help you the most in differentiating emphysema from obstructive chronic bronchitis? A chest Xray B lung volumes C diffusing capacity D arterial blood gas 9754. A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigarettes a day and has done so for the past 44 years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse wheezing throughout both lung fields. She thinks she has chronic bronchitis but you feel she has emphysema. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnosis. Which of the following tests would help you the most in differentiating emphysema from obstructive chronic bronchitis? A Chest X-ray B Lung Volumes C Diffusing Capacity D Arterial Blood Gas 9757. You are given partial pulmonary function test results on a patient with shortness of breath. The FEV1 is reduced. You are unable to find the FVC. Based on the reduced FEV1 you conclude that your patient may have: A Emphysema B Chronic bronchitis C Asthma D Pulmonary fibrosis E Any one of the above 984-114.You are given partial pulmonary function test results on a patient with shortness of breath. The FEV1 is reduced. You are unable to find the FVC. Based on the reduced FEV1 alone, you conclude that your patient may have: A. Emphysema B. Chronic bronchitis C. Asthma D. Pulmonary fibrosis E. Any one of the above

Courtesy of TTUHSC School of Medicine Peer Tutors

19

984-115.A 65 year old male patient presents to your clinic complaining of shortness of breath. His sense of shortness of breath has been increasing slowly over the past few years. On physical exam his respiratory rate is 28 breaths per minute and the breaths appear to be shallow. He has inspiratory crackles and clubbing of the fingers. Chest x-ray has a reticular-nodular pattern predominately in the bases of both lungs with a "honey-comb appearance. On physiological testing of his lungs you would expect to find: A. An obstructive pattern on spirometry B. Decreased lung compliance C. A normal diffusing capacity D. Increased total lung cvapacity Muscous Plug 95 79. A. B. C. D. Mucus plugs are common findings in all but: Chronic bronchitis Congenital bronchiectasis Centrilobular emphysema Cystic fibrosis

9441. Mucus Plugs are common findings in all but: A. Chronic bronchitis B. Asthma C. Panlobular emphysema D. Cystic fibrosis Atelectasis 984-113.A 55 year old business woman from Australia has recently flown from Melbourne to Lubbock for a business meeting. Two days into the meeting she develops sudden onset of chest discomfort and shortness of breath. In the emergency room, her CXR reveals atelectasis (alveolar collapse) in the right base and an ABG reveals hypoxemia (low oxygen level) and a slightly low PCO2. Her EKG is within normal limits. To confirm your suspected diagnosis, which test would you order next? A. Pulmonary function tests B. Ventilation-Perfusion scan C. Chest CT D. Methacholine challenge (bronchoprovocation tests) 9424. The disease LEAST likely to produce atelectasis A. Sarcoidosis B. Squamous cell carcinoma C. Chronic bronchitis D. Cystic fibrosis E. Mycoplasma interstitial pneumonitis 9563. A. B C D Atelectasis would be least likely in patients with: An empyema Cystic fibrosis Pulmonary embolus Chronic bronchitis

Courtesy of TTUHSC School of Medicine Peer Tutors

A pneumothorax

20

9656. Dr. Sleepydoze, wise old pathologist, inhales his upper dentures and completely obstructs his right lower lobe main bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobectomy was neccesary. The LEAST likely pathological finding in light of the history: A atelectasis B bronchopneumonia C empyema D bronchiectasis E emphysema 9762. Atelectasis is a common finding in all of the following except: A Neonatal respiratory distress syndrome B Cystic fibrosis C Asthma D Asbestosis E Bronchopneumonia 994-83. Atelectasis complicates both ARDS and neonatal respiratory distress syndrome because: A. Both are complicated by pleural effusions which compress the lung B. Hyaline membranes glue the alveolar wall together C. Insufficient surfactant causes loss of surface tension and alveolar collapse D. Bronchial mucus plugs obstruct airways E. Secondary pulmonary hypertension causes atelectasis LUNG 984-82. A. B. C. D. E. Mechanical and biochemial endothelial injury is associated with: Decreased prostocycline and nitric oxide with vasodilation Decreased prostocycline and nitric oxide with vasoconstriction Decreased prostocycline and nitric oxide with decreased platelet adhesion Increased prostocycline and nitric oxide with vasodilation Increased prostocycline and nitric oxide with vasoconstriction

9570. The finding least attributable to a long time history of cigarette smoking: A. Goblet cell hyperplasia B. Malignant mesothelioma C. Centrilobular emphysema D. Squamous metaplasia of bronchi E. Right ventricular hypertrophy Emphysema 984-77. A. B. C. Patients with panacinar emphysema Have diffuse interstitial lung fibrosis May have related portal hypertension Characteristically show mucus gland hyperplasia with an increase in the Reid index

Courtesy of TTUHSC School of Medicine Peer Tutors

D.

Have plexiform vascular lesions and medial hypertrophy of pulmonary arterial vessels by 25

21

9447. Which of these features of emphysema is the most damaging to pulmonary function? A. Destruction of alveolar walls and loss of alveolar capillaries B. Destruction of alveolar walls and loss of respiratory gas exchange area C. Destruction of alveolar walls and loss of lung elasticity D. Both A and B. E. Both B. and C.

9458. A B. C. D. E.

The so-called pink puffer" type of emphysema patient is characterized by: Absence of dyspnea because his partial pressure of oxygen in arterial blood is practically normal Presence of dyspnea because his partial pressure of oxygen in arterial blood is practical1y normal Low production of sputum Both A. and C. Both B. and C.

9650. A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigarettes a day and has done so for the past 44 years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse wheezing throughout both lung fields. She thinks she has chronic bronchitis but you feel she has emphysema. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnoses. Which of the following tests would help you the most in differentiating emphysema from obstructive chronic bronchitis? A chest Xray B lung volumes C diffusing capacity D arterial blood gas 9766. You receive a one cm thick but very holey left lung section reported to be from a 74 year old man run over by the ambulance at the entrance to the Emergency Room. No clinical history is available. The holes predominate in the upper sections of the lobes, especially the upper iobe. The tissue is like a dishrag, hanging limply over your hand as you examine it. No palpable areas of consolidation are noted. The remaining tissue varies from brown to almost black. The most likely microscopic finding: A Sheets of intraalveolar neutrophils with focal necrosis of interstitial tissue B Thick and thin bands of fibrous scar tissue with few residual alveolar spaces C Loss of much of the alveolar walls, with those remaining being thin D Multiple intraparenchymal nodules of squamous cells with marked nuclear pleomorphism E Caseating granulomata, multiple 9656. Dr. Sleepydoze, wise old pathologist, inhales his upper dentures and completely obstructs his right lower lobe main bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobectomy was neccesary. The LEAST likely pathological finding in light of the history: A atelectasis B bronchopneumonia C empyema D bronchiectasis E emphysema Centrolobar
Courtesy of TTUHSC School of Medicine Peer Tutors

994-113. Predominance in upper lobes of lung (A) A. Centrilobular emphysema B. Panlobular emphysema C. Both D. Neither 994-114. Bronchiolar wall fibrosis (C) A. Centrilobular emphysema B. Panlobular emphysema C. Both D. Neither

22

948. Identify the lesion: A. Centrilobular emphysema B. Caseating granuloma C. Squamous cell carcinoma D. Panacinar emphysema E. Pleural plaque 9429. Characteristics of centrilobular emphysema include all of the following EXCEPT: A. Elastase injury to respiratory/terminal bronchioles B. Liver cirrhosis C. Injury predominates in upper lung lobes D. History of cigarette smoking E. Loss of alveolar septa 9610. A B C D E Identify this high power gross photo of lung: abscess centrilobular emphysema chronic bronchitis silicosis sarcoidosls

Panlobar 9569. A B. C. D. E. Characteristics of paniobular emphysema include all of the following except: Elastase tissue injury Liver cirrhosis Injury predominates in lower lung lobes early on Hereditary enzyme deficiency Mucus gland hyperplasia

9657. Alpha-l-antitrypsin deficiency is most closely associated with: A panlobular emphysema B centrilobar emphysema C sullous emphysema D scar emphysema COPD 984-111. A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigaretes a day and has done so for the past 44
Courtesy of TTUHSC School of Medicine Peer Tutors

A. B. C. D.

years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse23 wheezing throughout both lung fields. She thinks she has asthma but you feel she has COPD. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnosis. Which of the following tests would help you the most in differentiating COPD from asthma? Chest X-ray Lung Volumes Diffusing Capacity Arterial Blood Gas

9457. A. B. C. D. E.

In chronic obstructive pulmonary disease (emphysema with chronic bronchitis), the increased resistance to expiration in the airways: Is due to expiratory collapse of the bronchi Is due to accumulation of mucus in the bronchi leads to an increased residual volume Both A. and C. Both A. and B. and C.

9460 Cyanosis, if present in a patient with chronic obstructive pulmonary disease (emphysema with chronic bronchitis)... A. Is caused by hypoventilation B. Is caused by non_uniformity in V/Q relationships C. Is more often present in the prevalently bronchitic type of patient D. Both A. and C. E. Both B. and C. 9461 The prevalently bronchitic type of stable patient with chronic obstructive pulmonary disease (emphysema with chronic bronchitis) suffers from: A. Uncompensated metabolic acidosis B. Partially compensated metabolic acidosis C. Uncompensated respiratory acidosis D. Compensated respiratory acidosis E. Compensated respiratory alkalosis 9611. A B C D The patient most likely to develop this pathological process: 27 year old discus thrower hit by stray javelin with penetrating chest wound 78 year old 40 pack year smoker with chronic obstructive pulmonary disease with leg pain 16 year old boy, a cigarette smoker, after 8 hour plane ride 25 year old female non smoking medical student, on birth control pills, after studying for this exam for three days straight

9459. A. B. C. D. E.

The increased vascular resistance to flow in the lungs of a patient with chronic obstructive pulmonary disease (emphysema with chronic bronchitis) Is usually negligible Is caused by combination of loss of capillaries and of hypoxic vasoconstriction May cause cor pulmonale Both A and B. Both B. and C.

Courtesy of TTUHSC School of Medicine Peer Tutors

24
Infxn 969. A B C D E This chest radiograph shows a classic air-fluid level in an area of consolidation of the lung. The LEAST likely histological finding in the tissue from the edge and inside the area of cavitation is: keratin debris and pleomorphic squamous cells necrotic material, neutrophils and Gram positive and negative organisms hyphal fragments and fruiting heads caseous necrotic material, acid fast bacilli and multinucieated giant cells proliferating Type II pneumocytes and ferruginous bodies

9765. A pleural empyema is least likely in: A Adenovirus pneumonia B S. aureaus pneumonia C S. pneumoniae pneumonia D H. influenza pneumonia E P. aeroginosa pneumonia Bronchitis 984-83. A. B. C. D. E. Chronic bronchitis is defined as Mucus gland hyperplasia of bronchi Mucus gland hyperplasia of bronchioles Chronic productive cough for three months in two consecutive years Goblet cell hyperplasia in terminal bronchioles Goblet cell metaplasia in terminal bronchioles

9661. The Reid index is used by some in describing the histological findings in: A chronic bronchitis B centrilobular emphysema C congenital bronchiectasis D usual interstitial pneumonia E bronchial adenoma Pnumonia 984-102.Usual interstitial pneumonia A. Charcot Leyden crystals B. Hamman Rich syndrome C. Gohn's complex D. Schaumann body E. Kulchitsky cell 984-91. A. B. C. D. 984-85. A. B. C. D. E. Streptococcal pneumonia Always presents as a lobar pneumonia Characterized by granulomatous interstitial inflammation Most common cause of bacterial pneumonia Necrosis and abscess formation common The least likely cause of a radiographic picture of bronchopneumonia: Staphlococcus aureus Mycoplasma pneumoniae Hemophilus influenza Pseudomonas aeroginosa Escherichia coli

Courtesy of TTUHSC School of Medicine Peer Tutors

25
9434. Grey hepatization describes: A. What happens to an old alcoholic with liver disease B. What happens to livers after the age of 100 C. A classic stage in lobar pneumonia, with edema, red cell and neutrophil predominance in the intra_alveolar infiltrate D. A classic stage in lobar pneumonia, with fibrin predominance in the intra_alveolar infiltrate E. What Dr. Graham feels like after writing this exam 984-84. A. B. C. D. E. A 3 year old boy aspirates a peanut. The least likely pathological consequence: Bronchiectasis Lung abscess Atelectasis Bulla Bronchopneumonia

strep 994-90. A 72 year old man gives you a history of heavy long term asbestos exposure from mining. He has a 30 pack year smoking history. He complains of shortness of breath. You find a large right pleural effusion which obscures his right lung field so you cannot really seen that lung. Except for findings referrable to his pleural effusion, the remainder of his physical examination is normal for his age. You tap off bloody but watery, thin pleural fluid. He is found dead at home the next morning. At autopsy, an acute myocardial infarction is felt to be his immediate cause of death. The least likely cause of his pleural effusion: A. Malignant mesothelioma with malignant pleural effusion B. Reactivation tuberculosis with tuberculous pleural effusion C. Adenocarcinoma of the lung with malignant pleural effusion D. Lobar Streptococcal pneumonia and empyema 9658. The most common cause of pneumonia A Pneumocystic carinii B Staphlococcus pneumonia C Escherichia coli D Streptococcus pneumonia E Pseudomonas aeroginosa 9433. An asplenic patient is at most risk for serious infection from: A. Respiratory syncytial virus B. Streptococcus pneumoniae C. Mycobacterium tuberculosis D. Pneumocystis carinii E. Staphylococcus aureus 9660. LEAST likely organism in a lung abscess: A Bacteroides fragilis B Streptococcus pneumonia C Staphylococcus aureus D Escherichia coli
Courtesy of TTUHSC School of Medicine Peer Tutors

Pseudomonas malyophilia

26

9432. The pathological pattern LEAST likely to be found on a microscopic of the edge of a large empty lung cavity found in a patient who was found dead: A. Necrotic debris, lung tissue and neutrophils; large Gram positive anaerobic bacteria found on Gram stain B. Necrotic debris, lung tissue and neutrophils; Gram positive diplococci _ consistent with Streptococcus pneumoniae on Gram stain C. Necrotic debris, lung tissue and neutrophils; GMS stain shows Aspergillus in tissue and debris D. Caseating granulomata with acid fast bacilli on special stains E. Highly pleomorphic, hyperchromatic squamous cells with abnormal mitotic activity 9720. Your diagnosis and the radiologic findings based on routine H&E slide [first slide] and Gram stain of lung tissue in 45 year old woman: (Note: there are 2 Slice of Life Images to this question) A E. coli pneumonia; multiple separate radiodense nodules left lower lobe on CXR B S. pneumoniae pneumonia; uniform radiodensity whole left lower lobe on CXR C M. tuberculosis pneumonia: multiple tiny radiodense nodules left upper and lower lobes on CXR D P. aeroginosa pneumonia; multiple radiodense nodules, some with air fluid levels, in left lower lobe on CXR staph

9580. The least likely lung finding in Staphlococcal Bronchopneumonia of twoweeks duration: A. Ulcerated bronchial mucosa with eroded bronchial cartilage B. Localized foci of necrotic debris and neutrophils C. Focal parenchymal replacement by vascular fibrous tissue D. Interstitial multinucleated giant cells 9573. A 62 year old presents an area of pulmonary consolidation in the right upper lung field on chest X_ray. He has a 25 pack year history of smoking cigarettes. On subsequent scans, several small nodules are found in the left upper lung fields and hilar lymph node involvement is noted. The least likely option in your initial differential: A. Tuberculosis B. Histoplasmosis C. Sarcoidosis D. Lung carcinoma E. Streptococcal pneumonia lobar 9440. Pleuritis would be most likely in: A. Lobar pneumonia B. Early bronchopneumonia C. RSV viral pneumonitis D. Tuberculosis E. Sarcoidosis 9453.Lobar Pneumonia A. Often follows a viral infection of upper airways B. Usually begins with chills and a rapid development of high fever C. Is associated with tachypnea
Courtesy of TTUHSC School of Medicine Peer Tutors

and (often) dyspnea D. Both A and B. and C. E. Both B. and C.

27

9454. Tachypnea, if present in lobar pneumonia A. Is a sign of poor prognosis B. Is the most economic ventilatory process in an infected lung C. Is the most painless ventilatory process m a pleural affection D. Both A. and B. and C. E. Both A. and B. 9455. Deep cyanosis is almost always present in lobar pneumonia patients: A. True B. False 9456. Because high fever increases oxygen consumption, the cardiac output is always increased in patients with lobar pneumonia. This causes a striking increase in pulmonary artery pressure: A. True B. False Panlobar 9441. Mucus Plugs are common findings in all but: A. Chronic bronchitis B. Asthma C. Panlobular emphysema D. Cystic fibrosis 994-112. Associated liver cirrhosis in some patients (B) A. B. C. D. Fungal 9578. A. B. C. The pathological pattern most likely be found microscopically in the center of a solitary friable lung mass in a 50 year old man found dead from a stroke: Dense hyalized fibrous tissue; birefringent thin tapered crystals Ferruginous bodies Necrotic debris, neutrophils: fruiting heads and hyphac on special stains Centrilobular emphysema Panlobular emphysema Both Neither

Courtesy of TTUHSC School of Medicine Peer Tutors

D.

Anthracosis and fibrosis

28

Mycoplasma 9575. Cold agglutinins are found in a patient with a two day history of cough, fever and 'flu' symptoms. Your diagnosis from this differential: A. Pigeon breeders pneumonitis: B. Mycoplasma pneumonia C. Tuberculous bronchopneumonia D. Pneumocystis carinii pneumonia E. Herpes viral pneumonia A 9665. Pleural surface or pleural cavity involvement by a pathological lesion is LEAST likely in: A mycoplasma pneumonia B pulmonary infarction C streptococcus pneumonia pneumonia D asbestosis 9764. A 33 year old man presents with a history of coughing up copious foul smelling sputum for a week. He thinks he has had a fever, but he admits to being a binge drinker and passing out periodically. The least likely finding after further radiologic and lung biopsy histologic examination: A Solitary pulmonary abscess left lower lobe B S. aureus left lower lobe pneumonia C Bronchiectasis left lower lobe D Mycoplasma pneumonia right middle lobe 9430. The finding LEAST attributable to a long time history of cigarette smoking: A. Chronic bronchitis B. Squamous metaplasia of bronchi C. Centrilobular emphysema D. Gohn's complex E. Right ventricular hypertrophy

9650. A 62 year old woman presents to the clinic with a 2-3 year history of progressive shortness of breath and cough. She smokes about 2 packs of cigarettes a day and has done so for the past 44 years. The cough is usually productive of white sputum. On physical exam, she has mild diffuse wheezing throughout both lung fields. She thinks she has chronic bronchitis but you feel she has emphysema. Spirometry reveals an obstructed ventilatory pattern which is consistent with both diagnoses. Which of the following tests would help you the most in differentiating emphysema from obstructive chronic bronchitis? A chest Xray B lung volumes C diffusing capacity
Courtesy of TTUHSC School of Medicine Peer Tutors

arterial blood gas

29

9659. Ten to fifteen 1-2 cm nodular densities are found in both lower lung fields on a chest radiograph in a 55 year old man. The LEAST likely final diagnosis after further evaluation: A bronchopneumonia B metastatic colon carcinoma C primary tuberculosis D bronchioalveolar carcinoma E septic embolization 9573. A 62 year old presents an area of pulmonary consolidation in the right upper lung field on chest X_ray. He has a 25 pack year history of smoking cigarettes. On subsequent scans, several small nodules are found in the left upper lung fields and hilar lymph node involvement is noted. The least likely cption in your initial differential: A. Tuberculosis B. Histoplasmosis C. Sarcoidosis D. Lung carcinoma E. Streptococcal pneumonia 9656. Dr. Sleepydoze, wise old pathologist, inhales his upper dentures and completely obstructs his right lower lobe main bronchus. Wise but stubborn, he refuses surgical intervention for 2 weeks. By that time a right lower lobectomy was neccesary. The LEAST likely pathological finding in light of the history: A atelectasis B bronchopneumonia C empyema D bronchiectasis E emphysema 9767. The least likely to respond to steroids: A Progressive massive fibrosis B Acute lung transplant rejection C Chronic eosinophilic pneumonia D Desquamative interstitial pneumonia 9774. Caplan's syndrome A A Rheumatoid arthritis in coal miner's pneumoconiosis B Uveoparotid sarcoid C Small cell undifferentiated lung carcinoma D Pneumocystis carinii pneumonia E Pulmonary alveolar proteinosis

9778. The most common cause(s) of acute pancreatitis in the United States (is) are: A Alcoholic abuse and cholelithiasis B Hyperlipidemia C Trauma D Hyperparathyroidism 9434. A. B. Grey hepatization describes: What happens to an old alcoholic with liver disease What happens to livers after the age of 100

Courtesy of TTUHSC School of Medicine Peer Tutors

C.

A classic stage in lobar pneumonia, with edema, red cell and neutrophil predominance in the intra_alveolar infiltrate D. A classic stage in lobar pneumonia, with fibrin predominance in the intra_alveolar infiltrate E. What Dr. Graham feels like after writing this exam 9739. Classic picture includes chronic sinusitis and hematuria A Polyarteritis nodosa B Wegener's granulamatosis C Both D Neither 9741. Treated with cyclophosphamide C A Polyarteritis nodosa B Wegener's granulamatosis C Both D Neither 947. A common complication of this lesion A. Bronchopneumonia B. Pneumothorax C. Pulmonary infarction D. Superior vena cava syndrome E. Pericardial tamponade 9515. A microscopic picture most likely in: A. Squamous cell carcinoma B. Diffuse alveolar damage C. Grey hepatization D. Pneumococcal pneumonia E. Chronic bronchitis

30

96118.An eight year old child collapses at a picnic with a group of other children. Unfortunately, no adults are present, and none of the children attempt resuscitation. Emergency medical services does not attempt resuscitation when they arrive approximately thirty minutes after the incident, and the child is pronounced dead. At the postmortem examination, a portion of a hot dog (weiner) is found occluding the upper airway of the child, just below the level of the vocal cords. In your professional opinion. which one of the following statements is carrect: A The cause of death is asphyxia due to suffocation. B The cause of death is asphyxia due to choking. C The cause of death is asphyxia due to smothering. D The cause of death can not be determined from the information available.

9717 A B C D E

These microscopic lung findings would be most consistent with a history of: sudden onset of tachypnea and hypoxia not relieved by oxygen therapy fifteen year history of sandblasting occupational exposure change in mental status, finding of hyponatremia and Horner's syndrome AIDS with recent increase in shortness of breath over a week's time chronic cough productive of sputum for two years

Courtesy of TTUHSC School of Medicine Peer Tutors

31
9773. 27 year old Afro-American female with incidental finding of enlarged lymph nodes and a few possible bilateral lung nodules on CXR. A Caseating granulomata with positive AFB stains B Non caseating granulomata; stains negative for fungus or AFB C Interstitial fibrosis; ferruginous bodies; pleural plaques D Nodules of hyalinized fibrous tissue with small birefringent [i.e. seen in polarized light] crystals E Sheets of small cells with little cytoplasm and closely crowded/ molded atypical nuclei

Courtesy of TTUHSC School of Medicine Peer Tutors