review questions BOARDS.ppt

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review questions BOARDS.ppt

  1. 1. <ul><li>1. Multiple discrete nodules scattered throughout all lobes of the lungs is a pattern associated most frequently with which of the following? </li></ul><ul><li>metastatic carcinoma in the lung </li></ul><ul><li>bronchogenic carcinoma of the lung </li></ul><ul><li>c) bronchial carcinoid </li></ul><ul><li>d) hamartomas of the lung </li></ul><ul><li>e) large cell carcinoma </li></ul>
  2. 2. 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 mass b) Adenocarcinoma c) bronchioalveolar carcinoma d) Mesothelioma e) Pancoast tumor
  3. 3. Bronchial carcinoid tumors are a) benign b) hamartomas c) highly aggressive carcinomas d) low-grade malignancies e) are not amenable to surgical treatment
  4. 4. 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) Adenocarcinoma d) Mesothelioma e) Carcinoid tumor
  5. 5. 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 carcinoma e) mesothelioma
  6. 6. 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 carcinoma b) bronchogenic adenocarcinoma c) bronchogenic small cell carcinoma d) metastatic carcinoma from breast e) metastatic carcinoma from cervix
  7. 7. 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) asbestosis b) chylothorax c) bronchioalveolar carcinoma d) many harmartomas e) tuberculosi
  8. 8. A pleural effusion is clear, straw-colored, has a specific gravity of 1.012 and contains scattered leukocytes. Likely causes include a) congestive heart failure b) empyema c) pyothorax d) hemothorax e) lymphatic obstruction
  9. 9. 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/an a) bronchial carcinoid tumor b) mesothelioma c) harmartoma d) small cell undifferentiated carcinoma e) squamous cell carcinoma
  10. 10. 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
  11. 11. Spontaneous pneumothorax (A) is seen mostly in women (B) occurs predominantly in young persons (C) signifies acute pulmonary infection (D) signifies chronic obstructive emphysema
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. Which of the following pulmonary functions will be most compromised in a patient with an emphysematous bleb that ruptures into the pleural space? (A) diffusion (B) expiration (C) perfusion (D) ventilation
  17. 17. Histology from a bronchoscopic biopsy reveals prominent hypertrophy of bronchial mucous glands, chronic inflammation, dysplastic squamous metaplasia and fibrosis. These findings lead you to believe this patient most likely has (A) asthma (B) bronchiectasis (C) chronic bronchitis (D) emphysema (E) pulmonary fibrosis
  18. 18. 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
  19. 19. The major physiologic abnormality in emphysema is (A) atelectasis (B) decreased elastic recoil of lung (C) increased airway resistance (D) increased vital capacity (E) reduced total lung capacity
  20. 20. Emphysema is defined as dilation of structures distal to the terminal bronchiole with alveolar (A) destruction (B) edema (C) fibrosis (D) inflammation (E) scarring
  21. 21. A subpleural area of centrilobular emphysema usually occurring in the apex and involving an area greater than 2 cm is known as a (A) bleb (B) bulla (C) cyst (D) pneumatocele
  22. 22. Pulmonary function tests of a 65-year-old man complaining of dyspnea, limitation of the maximal expiratory air flow rates during forced expiration and an FEV1/FVC ratio of 63%. Which of the following disorders would be most likely? (A) emphysema (B) hypersensitivity pneumonitis (C) interstitial pneumonia (D) pulmonary embolism (E) Sarcoidosis
  23. 23. Pulmonary function tests of a 65-year-old man complaining of dyspnea reveal limitation of the maximal expiratory air flow rates during forced expiration. Which of the following disorders would be most likely? (A) bronchiectasis (B) chronic passive congestion (C) interstitial pneumonia (D) sarcoidosis (E) silicosi
  24. 24. A patient presented to the emergency room with asthma. What cell is most likely to be increased in the peripheral blood smear? (A) basophil (B) eosinophil (C) lymphocyte (D) monocyte (E) neutrophil
  25. 25. A 30-year-old man is dead after having been found unresponsive at home. Autopsy finding shows hyperinflated lungs, an excess of bronchial goblet cells, and infiltration of the airway walls by eosinophils. The most likely cause of death is (A) alpha-1-antitrypsin deficiency (B) bronchopneumonia (C) centrilobular emphysema (D) chronic bronchitis (E) status asthmaticus
  26. 26. Which of the following is associated with an increased incidence of cancer? (A) silicosis (B) stannosis (C) asbestosis (D) berylliosis (E) siderosis
  27. 27. A 30-year-old physician has a positive skin test for tuberculosis. Chest x-rays reveal a 1.5 cm subpleural parenchymal lesion just above the interlobar fissure between the upper and lower lobes on the left This most likely represents (A) miliary tuberculosis (B) primary pulmonary tuberculosis (C) progressive pulmonary tuberculosis (D) reactivation pulmonary tuberculosis (E) tuberculous pneumonia
  28. 28. A woman lives in Colorado where she works as a school teacher. She does not smoke but has developed a non-productive cough, arthralgia, fatigue and weight loss. A transbronchial biopsy reveals non-caseating granulomas. The most likely diagnosis is (A) adenocarcinoma (B) chronic berylliosis (C) histoplasmosis (D) sarcoidosis (E) tuberculosis
  29. 29. 70-year-old man has an upper respiratory tract infection. A chest x-ray discloses consolidation of the lower lobe of his left lung. Which is the most likely organism? (A) Klebsiella pneumoniae (B) Legionella pneumophila (C) Listeria monocytogenes (D) Pseudomonas aeruginosa (E) Streptococcus pneumoniae
  30. 30. Atherosclerosis of the pulmonary vessels is typically associated with (A) myocardial infarction (B) diabetes mellitus (C) polycythemia (D) pulmonary hypertension (E) obesity
  31. 31. Edema fluid in the lung is primarily removed by (A) phagocytosis (B) lymphatic drainage (C) coughing (D) reabsorption into capillaries (E) passive drainage
  32. 32. 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
  33. 33. The presence of large atherosclerotic plaques in pulmonary arteries indicates (A) old pulmonary emboli (B) pulmonary hypertension (C) metastatic carcinoma (D) bronchiectasis (E) tuberculosis
  34. 34. Acute cor pulmonale is most often due to (A) pulmonary emboli (B) asthma (C) pulmonary edema (D) diffuse interstitial fibrosis
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. Bronchial carcinoid tumors are (A) benign (B) hamartomas (C) highly aggressive carcinomas (D) low-grade malignancies
  42. 42. 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
  43. 43. 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
  44. 44. 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
  45. 45. 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
  46. 46. 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
  47. 47. 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
  48. 48. 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

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