Pulmonary Path Dr Bellot Part 2

18 Questions | By Chachelly | Updated: Mar 21, 2022 | Attempts: 378

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1.

The term "hypersensitivity pneumonitis" describes:
- A.
  
  Pulmonary tuberculosis resulting from atypical mycobacteria
- B.
  
  Immunologically mediated interstitial pneumonia related to occupational antigens
- C.
  
  Bronchial asthma
- D.
  
  A form of pneumonia exquisitely sensitive to treatment
- E.
  
  A form of rapidly progressive peumonitis almost exclusively confined to AIDS patients
2.

One of the more impressive pathological differences between viral and bacterial pneumonias is
- A.
  
  The involvement of small vs large bronchi
- B.
  
  Viral favors the right lobe, bacterial the left
- C.
  
  Intra-alveolar versus interstitial inflammatory process
- D.
  
  The severity of interstitial congestion
- E.
  
  The extent of alveolar destruction
3.

Following an episode of aspiration, a 60-year-old alcoholic developed severe respiratory distress. A lung biopsy is LIKELY to show
- A.
  
  Hyaline membrane formation
- B.
  
  Alveolar wall destruction
- C.
  
  Extensive interstitial polymorphonuclear infiltrate
- D.
  
  Replacement of alveolar lining cell by type 1 pneumonocytes
- E.
  
  Interstitial hemorrhage
4.

A 16-year-old Dominican boy with a history of asthma presents to his family physician with a cough for the past two weeks that is not improving with simple over-the-counter medications. On examination the physician finds that there is an area of dullness over the right apex, and also hears coarse crackles. The physician suspects tuberculosis. What other physical sign is MOST LIKELY to be present?
- A.
  
  Displacement of the trachea to the left
- B.
  
  Absence of voice transmission over the right apex
- C.
  
  Increased expansion on the right
- D.
  
  Bronchial breathing over the right apex
- E.
  
  In drawing of the lower ribs on inspiration
5.

A 69-year-old man with a long history of smoking and recent weight loss is discovered to have a lung tumor that is confirmed by biopsy to be malignant. Routine blood investigation also reveals hypercalcemia. The lung lesion is LIKELY to be:
- A.
  
  Large cell carcinoma
- B.
  
  Alveolar cell carcinoma
- C.
  
  Small cell ("Oat cell") carcinoma
- D.
  
  Adenocarcinoma
- E.
  
  Squamous cell carcinoma
6.

Pulmonary infarcts do not occur frequently. One of the more reasonable explanations is that
- A.
  
  The constant movement of the lungs prevents "lodgement" of the emboli in the pulmonary arterial system
- B.
  
  The bronchial artery supply is an effective "back-up" of the pulmonary arterial system
- C.
  
  Lung tissue is inherently resistant to ischemia
- D.
  
  Pulmonary emboli only very rarely occur
- E.
  
  A thromboembolus would need to be attached to the intimal surface of the artery to cause an infarct and this rarely occurs on the lung
7.

A 73-year-old man has observed increasing shortness of breath, chest pain and marked loss of weight over the past, three months. He does not smoke but gives a history of having worked in a naval shipyard about 35 years ago at which time his duties included applying asbestos insulation to the ship's plumbing. At this point, his physician suspects
- A.
  
  Hypersensitivity pneumonitis related to lead exposure
- B.
  
  Bronchial asthma
- C.
  
  Emphysema
- D.
  
  Mesothelioma
- E.
  
  Chronic bronchitis
8.

Hypersensitivity pneumonia is
- A.
  
  A form of chronic bronchitis
- B.
  
  Immunologically mediated interstitial pneumonia related to occupational antigens
- C.
  
  Another name for bronchial asthma
- D.
  
  A form of pneumonia exquisitely sensitive to antibiotic treatment
- E.
  
  A form of rapidly progressive peumonitis almost exclusively confined to AIDS patients
9.

A 65-year-old man with a long history of cigarette smoking died of cor pulmonale complicating severe emphysema. The type of emphysema is MOST LIKELY:
- A.
  
  Irregular
- B.
  
  Panacinar
- C.
  
  Centriacinar
- D.
  
  Paraseptal
- E.
  
  Interstitial
10.

All of the following are recognized causes of lung collapse (atelectasis) EXCEPT:
- A.
  
  Aspiration of vomitus in unconscious patients
- B.
  
  Sudden impaction of thromboemboli
- C.
  
  Tension pneumothorax
- D.
  
  Bronchial obstruction by a tumor
- E.
  
  Massive pleural effusion
11.

A 28-year-old man complains of recurrent chest infections and chronic productive cough since early childhood. He also gives a history of chronic sinusitis and was discovered to have dextrocardia with situs inversus. He has been married for five years but has no children. His pulmonary disease is MOST LIKELY to be
- A.
  
  Bronchiectasis
- B.
  
  Bronchopneumonia
- C.
  
  Bronchial asthma
- D.
  
  Centriacinar emphysema
- E.
  
  Tuberculosis
12.

A lung tumor which microscopically demonstrates cytologic features of malignancy as well as intercellular "bridges" and keratin "pearls" is LIKELY to be
- A.
  
  Adenocarcinoma
- B.
  
  Small cell carcinoma
- C.
  
  Hamartoma
- D.
  
  Large cell carcinoma
- E.
  
  Squamous cell carcinoma
13.

An asymptomatic 10-year-old child is discovered though routine chest radiograph to have a small subpleural nodule in the middle lung zone and enlarged mediastinal lymph nodes. She has been living under poor hygienic conditions in a decaying neighborhood with her mother who is a drug addict and who herself had been hospitalized previously following a bout of hemoptysis. The child MOST PROBABLY has:
- A.
  
  Primary tuberculosis
- B.
  
  Primary atypical pneumonia
- C.
  
  Bronchopulmonary sequestration
- D.
  
  Lobar pneumonia
- E.
  
  Fibrocavitory tuberculosis
14.

A 50-year-old pigeon-fancier complained of bouts of fever, shortness-of-breath, cough and chest tightness. He is a nonsmoker. A lung biopsy revealed poorly formed epithelioid granulomas. Of the following, the MOST LIKELY diagnosis is:
- A.
  
  Pneumoconiosis
- B.
  
  Chronic bronchitis
- C.
  
  Lobar pneumonia
- D.
  
  Hypersensitivity pneumonia
- E.
  
  Bronchopneumonia
15.

One of the commonest gross pathological findings in bronchial asthma is:
- A.
  
  Upper lobe cavitation
- B.
  
  Mucus plugs in bronchi
- C.
  
  Pleural effusion
- D.
  
  Pulmonary fibrosis
- E.
  
  Pulmonary sequestration
16.

A 75-year-old man who has lived in an overcrowded inner city neighborhood for 40 years complains of weight loss, hemoptysis and night sweats. His chest x-ray reveals numerous small opacities in both lungs and he has a positive PPD skin tests. He MOST LIKELY has:
- A.
  
  Histoplasmosis
- B.
  
  Fibrocavitary tuberculosis
- C.
  
  Squamous cell carcinoma
- D.
  
  Miliary tuberculosis
- E.
  
  Adenocarcinoma
17.

Pancoast's Syndrome: (Select ALL that apply)
- A.
  
  Specifically relates to a complication of small cell carcinoma
- B.
  
  Is the result of tumor production of ACTH
- C.
  
  Is often found in association with a pneumoconiosis
- D.
  
  Is the result of thoracic inlet infiltration by tumor
- E.
  
  Is the result of lung tumor metastases to the brain
18.

A 32-year-old woman on long-term steroid therapy for rheumatoid arthritis develops pneumonia within days of an upper respiratory influenza infection. A LIKELY pathological feature of this pneumonia is:
- A.
  
  Multiple lung microabscesses
- B.
  
  Hyaline membrane formation
- C.
  
  Grey hepatization
- D.
  
  Diffuse interstitial fibrosis
- E.
  
  Interstitial calcifications