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Block X Pathology Exam 1

By Beverly Peters,2014-06-26 19:42
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Block X Pathology Exam 1 ...

    Block X Pathology Exam 2

1) A 32-year-old HIV-positive woman presents with increasing dyspnea, non-productive cough

    and fever. A chest radiograph reveals some ill-defined bilateral infiltrates. She develops

    increasing hypoxemia. Which of the following microorganisms is most likely to produce these

    findings?

A) Streptococcus pyogenes

    B) Streptococcus pneumoniae

    C) Mycobacterium tuberculosis

    D) Pneumocystis carinii

    E) Mycoplasma pneumoniae

2) A 59-year-old man has an abrupt onset of 103? F temperature, dyspnea, a productive cough

    with “rusty” sputum and pleuritic chest pain. Physical examination reveals dullness to percussion

    and crackles in the right upper lung. A chest radiograph reveals a consolidation in the right upper lobe. Laboratory studies show a white blood cell count of 13,000 cells/mm

    3 (normal 4,000-

    11,000). Which of the following microorganisms is most likely to produce these findings?

A) Streptococcus pyogenes

    B) Streptococcus pneumoniae

    C) Mycobacterium tuberculosis

    D) Pneumocystis carinii

    E) Mycoplasma pneumoniae

    3) A 23-year-old previously healthy man has a non-productive cough, myalgia and headache for the past 7 days. Physical examination reveals a temperature of 37.5? C, erythema of the pharynx, end diffuse crackles on both lungs. A chest radiograph shows diffuse bilateral reticular infiltrates but no consolidation. Laboratory studies show a white blood cell count of 11.000 cells/mm3

    (normal 4,000-11,000). Which of the following microorganisms is most likely to produce these

    findings?

    A) Mycobacterium tuberculosis

    B) Streptcoccus pneumoniae

    C) Aspergillus fumigatus

    D) Pneumocystic carinii

    E) Mycoplasma pneumoniae

    4) A 50-year-old man develops profound neutropenia following chemotherapy for leukemia. He develops a cough with fever. A chest radiograph reveals multiple 1-3 cm nodules scattered throughout all lung fields. A bronchoalveolar lavage yields a sample that on cytology smear has numerous hyphae. Which of the following microorganisms is most likely to produce these findings?

A) Mycobacterium tuberculosis

    B) Streptococcus pneumoniae

    C) Aspergillus fumigatus

    D) Pneumocystic carinii

    E) Mycoplasma pneumoniae

    5) A 51-year-old man has a three months history of fever, night sweats and weight loss. In the past month he has experienced episodes of hemoptysis. He does not smoke. A chest radiograph reveals bilateral upper lobe cavitations. His HIV test is negative. He does not have a history of prior pulmonary disease. Which of the following microorganisms is most likely to produce these findings?

A) Strepococcus pyogenes

    B) Streptococcus pneumoniae

    C) Mycobacterium tuberculosis

    D) Pneumocystic carinii

    E) Mycoplasma pneumoniae

    6) Before the antibiotic era the mortality rate from lobar pneumonia was high, but some patients used to heal spontaneously, by “crisis”. In these patients the lung infection evolved through a

    classical sequence of morphological stages, which was not halted by antibiotic treatment. All the following are classical stages of lobar pneumonia except:

A) Gray hepatization

    B) Yellow hepatization

    C) Red hepatization

    D) Resolution

    E) Congestion

    7) Which of the following histological findings in the alveoli correspond to the gray hepatization stage of lobar pneumonia?

A) Edematous fluid with numerous bacteria

    B) Fibrinous exudate, numerous red blood cells, neutrophils and bacteria

    C) Fibrinous exudate, numerous macrophages, less numerous bacteria

    D) Purulent exudates, numerous neutrophils and bacteria

    E) Liquified fibrin which is removed by expectoration

    8) The pulmonary defense mechanism that is active in the alveolar level consists of:

A) Warming and moisturizing the inhaled air

    B) Trapping the inhaled particles

    C) Mucociliary clearance

    D) Macrophages

    E) Secretory IgA

    9) All the following are histological and functional feature of alveolar cells except:

A) Type I alveolar cells are squamous and extremely thin

    B) Type I alveolar cells have no regenerative capacity

    C) Type II alveolar cells are twice as numerous as type I alveolar cells D) Type II alveolar cells are specialized in gas transfer

    E) Type II alveolar cells are the source of surfactant

10) Which of the following component of surfactant is most responsible for the reduced alveolar

    surface tension?

A) Protein

    B) Glucose

    C) Phospholipid

    D) Sodium chloride

    E) Potassium chloride

11) Which is the most commonly accepted method for the assessment of the fetal lung maturity

    prior to birth?

A) Ultrasound examination of the fetus

    B) Lecithin to sphingomyelin ratio in the amniotic fluid

    C) Measurement of surfactant in the bronchioloalveolar lavage D) Measurement of surfactant in the venous blood

    E) Measurement of NaCl concentration of sweat

12) Inhaled air particles that are larger that 10µm in diameter tent to be trapped in the:

A) Alveoli

    B) Terminal bronchioles

    C) Respiratory bronchioles

    D) Trachea

    E) Nose

    13) Which of the following bacteria is most commonly found in the lesions of aspiration pneumonia?

A) Mixed flora, anaerobic and aerobic

    B) Gram-negative rods

    C) Gram-positive cocci in pairs

    D) Gram-positive cocci in chains

    E) Gram-positive filamentous bacteria

    14) Which of the following patients is least at risk for developing a lung carcinoma?

A) A 70-year-old patient who smokes

    B) A 56-year-old patient who smokes with a history of asbestos exposure 20 years ago C) A 50-year-old man who lives in a city with high atmospheric pollution D) A 45-0year-old woman who lives in a house with a high level of indoor radon E) A 52-year-old nonsmoking patient with tuberculosis

    15) Which of the following types of lung carcinoma is most likely to develop within a residual area of a peripheral scar tissue?

A) Small cell carcinoma

    B) Squamous cell carcinoma

    C) Large cell carcinoma

    D) Adenocarcinoma

    E) Bronchail carcinoid

    16) A lobular consolidation near the left lung hilum of a middle-aged man with a long history of smoking, did not respond to antibiotics. Sputum cytology is negative. However, a fine needle aspiration of the lesion is reported to contain small, ovoid cells that resemble oats, having hyperchromatic nuclei and almost no cytoplasm. The patient most likely has:

A) Small cell carcinoma

    B) Squamous cell carcinoma

    C) Large cell carcinoma

    D) Adenocarcinoma

    E) Bronchail carcinoid

    17) Which of the following is the primary causal factor of lung cancer?

A) Cigarette smoking

    B) Polycyclic hydrocarbons

    C) Radon exposure

    D) Asbestos exposure

    E) Diet low in vitamin A

    18) Lung cancer risk declines after cessation of smoking and approaches the lung cancer risk of nonsmokers in:

A) 6 months

    B) 1 year

    C) 5 years

    D) 8 years

    E) 15 years

    19) Asbestos is associated with the following respiratory diseases, except:

A) Pneumoconiosis

    B) Emphysema

    C) Lung carcinoma

    D) Malignant mesothelioma

    20) A 50-year-old man, a two-pack-per-day 30 year smoker, presents with persistent cough and shortness of breath. Sputum cytology findings are positive for bronchogenic carcinoma. The chest radiograph is unremarkable. Which is the most likely histologic type?

A) Adenocarcinoma

    B) Small cell carcinoma

    C) Large cell carcinoma

    D) Squamous cell carcinoma

    E) Carcinoid tumor

    21) Which of the following is the first leading cause of cancer death in the United States and worldwide?

A) Lung cancer

    B) Prostate cancer

    C) Colon cancer

    D) Leukemia

    E) Urinary bladder cancer

    22) A 51-year-old man, a non smoker and previously healthy, has a slight cough for about a week. Auscultation of the chest reveals clear lung fields. A chest radiograph is taken, which shows a subpleural "coin lesion" 2 cm in diameter in the right upper lobe. His family physician thinks that he may have lung cancer. Which of the following conditions are included in the differential diagnosis of a solitary coin lesion?

A) Bronchopneumonia

    B) Tuberculous granuloma

    C) Bronchiectasis

    D) Lobar pneumonia

    E) Silicosis

    23) Which of the following gross appearances most closely correspond to the lung adenocarcinoma?

A) Polypoid (exophytic) endobronchial lesion in the main bronchi

    B) Ulcerative endobronchial lesion in the main bronchi

    C) Honeycomb lung

    D) Central scarring with indrawing of the underlying pleura

    E) Multiple cavities in the apex of the upper lobes

    24) Categorization of a lung carcinoma as squamous cell requires the presence of:

A) Pearls

    B) Glandular structures

    C) Papillary structures

    D) Signet-ring cells

    E) Neuroendocrine granules

    25) Which of the following types of lung cancer shows neuroendocrine differentiation on electron microscopy?

A) Squamous cell carcinoma

    B) Adenocarcinoma

    C) Bronchioloalveolar carcinoma

    D) Small cell carcinoma

    E) Large cell carcinoma

    26) Paraneoplastic syndromes are defined as clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease. In a broad sense, these syndromes are collections of symptoms that result from substances produced by the tumor, and they occur remotely from the tumor itself. All the following are paraneoplastic syndromes induced by lung cancers except:

A) Polymyositis

    B) Eaton-Lambert syndrome

    C) Diabetes insipidus

    D) Horner syndrome

    E) Hypercalcemia

    27) Superior vena cava syndrome is characterized by tumorous compression/obstruction of the superior vena cava that manifests with edema of the face and/or upper extremities. More than

    80% of cases of superior vena cave syndrome are caused by lung cancer. Which of the following descriptions of advanced lung carcinoma is most commonly associated with superior vena cava syndrome?

    A) Lung cancer with extrapleural extension and involvement of cervical and thoracic nerves B) Lung cancer with involvement of the cervical sympathetic system

    C) Lung cancer with involvement of the mediastinal lymph nodes

    D) Lung cancer with endobronchial growth, bronchial obstruction and atelectasis E) Lung cancer with pleural and pericardial involvement

    28) Which of the following manifestations of lung carcinoma most closely corresponds to the Pancoast tumor?

A) Paralysis of the recurrent laryngeal nerve

    B) Bronchial obstruction with atelectasis

    C) Involvement of the lung apex with extension to parietal pleura and brachial plexus D) Tumorous obstruction of the superior vena cava

    E) Adrenal metastases with adrenal insufficiency

29) The sarcoid lesion differs from tuberculosis lesion in:

A) Granuloma formation

    B) Langhans’ giant cell

    C) Caseation

    D) Numerous epithelioid cells (histiocytes)

    E) Lymphocytes and plasma cells

    30) The form of tuberculosis that develops in a previously unexposed (unsensitized) individual is:

A) Miliary tuberculosis

    B) Primary tuberculosis

    C) Secondary tuberculosis

    D) Pulmonary tuberculosis

    E) Isolated organ tuberculosis

31) Secondary pulmonary tuberculosis is classically localized to the:

A) Apex of the upper lobe

    B) Apex of the right lower lobe

    C) Apex of the left lower lobe

    D) Right middle lobe close to pleura

    E) Basal lobes bilateral

    32) Which of the following organs is most commonly involved in sarcoidosis?

A) Skin

    B) Eyes and lacrimal glands

    C) Spleen

    D) Lungs and hilar lymph nodes

    E) Liver

    33) The best tissue to biopsy first for a diagnosis of sarcoidosis is:

A) Anterior part of the eye

    B) Tonsils

    C) Colonic mucosa

    D) Skeletal muscle

    E) Liver

34) Secondary tuberculosis is usually induced by:

A) Reactivation of dormant primary lesions

    B) Lymphogenous dissemination

    C) Hematogenous dissemination

    D) Drinking milk contaminated with Mycobacteria

    E) Infected needles

    35) A scalene lymph node biopsy showing caseating granulomas was taken from a 50-year-old Hispanic man who complains of fever 37.5?C, weigh loss and cough. Which of the following diseases is he most likely to have?

A) Tuberculosis

    B) Squamous cell carcinoma

    C) Bronchopneumonia

    D) Metastatic adenocarcinoma

    E) Candidiasis

    36) Which of the following gross descriptions corresponds to emphysema?

    A) Abnormal permanent enlargement of airspaces distal to terminal bronchiole B) Abnormal permanent enlargement of airspaces distal to terminal bronchiole and destruction of

     their walls

    C) Airless lung parenchyma because of the collapse of previously inflated lungs D) Incomplete expansion of the lungs

    E) Complete obstruction of bronchus lumen with resorption of the air trapped in the dependend

     alveoli

37) The major diffuse obstructive pulmonary diseases are:

    A) Asthma

    B) Bronchiectasis

    C) Pneumoconiosis

    D) Chrinic bronchitis

    E) Emphysema

    38) All the following are major types of emphysema except:

    A) Centriacinar

    B) Panacinar

    C) Distal acinar

    D) Adult lobar

    E) Irregular

    39) All the following factors are believed to play an important role in the pathogenesis of

    emphysema except:

    A) Influx of neutrophils

    B) Influx of macrophages

    C) Increase of antioxidants such as superoxide dismutase

    D) Smoking -antitrypsin deficiency 1E) α

    40) A 10-year-old girl is brought to the emergency room in respiratory distress. Her mother states that she developed a cold 4 days before and has had progressive difficulty breathing for the last 24 hours. This has happened previously, either after a respiratory infection or during the spring or fall, but her breathing problems usually improved within a few hours. Physical examination reveals a child in marked respiratory distress. She is afebrile, has a respiratory rate of 30/min, a pulse of 110/min with a regular rhythm, and blood pressure 100/70 mm Hg. She has marked indrawing of her respiratory muscles. The anteroposterior diameter of her chest is increased and there is hyper-resonance to percussion. Generalized inspiratory and expiratory wheezes are present. Her heart sounds are distant. No murmurs or abnormal heart sounds are present. These findings are most closely related to:

A) Emphysema

    B) Bronchial asthma

    C) Pulmonary thromboembolism

    D) Bronchopneumonia

    E) Adult respiratory distress syndrome

    41) Which of the following is the correct clinical definition of chronic bronchitis?

A) Persistent cough with sputum production for at least 1 month

    B) Persistent cough with sputum production for at least 3 months

    C) Persistent cough with sputum production for at least 6 months

    D) Persistent cough with sputum production for at least 3 months in at least 2 consecutive years E) Persistent cough with sputum production for at least 9 months

    42) Histologic sections of lung tissue from an individual with adult respiratory distress syndrome are most likely to reveal:

    A) Plexiform lesions within pulmonary arterioles

    B) Deposits of needle-like crystals from the membranes of eosinophils

    C) Infiltrating groups of malignant cells having intercellular bridges

    D) Irregular membranes composed of edema, fibrin, and dead cells lining alveoli E) Perivascular infiltrates of lymphoid cells

    43) Histologic sections of lung reveal the alveoli to be filled with fibrin nets, neutrophils and a gram-positive coccus that occurs in pairs. What is the most likely cause of this abnormality? A) Lobar pneumonia

    B) Congestive heart failure

    C) Asthma

    D) Pulmonary embolus

    E) Viral pneumonia

    44) A 23-year-old woman is found on prenatal testing to have an elevated hemoglobin A1C level. Her pregnancy is uncomplicated until the 29th week of gestation, when she has the onset of premature labor. The baby initially is normal, but within an hour he manifests severe respiratory distress and requires intubation with mechanical ventilation. Which of the following pharmacologic therapies administered to the mother prior to birth could have helped to prevent neonatal respiratory distress?

A) Corticosteroids

    B) Antibiotics

    C) Aspirin

    D) Lecithin

    E) Vitamins

45) The Reid index is:

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