Dr. Ammar C. Al-Rikabi
MULTIPLE CHOICE QUESTIONS IN:
Dr. Ammar C. Al-Rikabi
A 60-year-old man, a heavy smoker, presents
for advice to stop smoking. On physical
examination, he is thin and has a ruddy
complexion. He has a productive cough and a
barrel-shaped chest.
He sits leaning forward with his lips pursed to
facilitate his breathing. A diagnosis of
emphysema is made. Which of the following is
the most likely histologic finding in the lungs ?
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein- rich fluid into alveolar spaces
(C) Dilatation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilatation caused by
chronic infection, with bronchi filled with
mucus and neutrophils
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein- rich fluid into alveolar spaces
(C) Dilatation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilatation caused by
chronic infection, with bronchi filled with
mucus and neutrophils
A 60-year-old woman with a heavy smoking
history presents with chronic productive cough
that has been present for 3 consecutive
months over the past 2 consecutive years. On
physical examination, her skin has a bluish
tinge, and she is overweight. The patient is
diagnosed with chronic bronchitis. Which of
the following is the most likely histological
finding in this patient's lungs ?
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein-rich fluid into alveolar spaces
(C) Dilatation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilatation caused by
chronic infection, with bronchi filled with mucus
and neutrophils
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein-rich fluid into alveolar spaces
(C) Dilation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilation caused by
chronic infection, with bronchi filled with mucus
and neutrophils
A 65-year-old woman with a significant
smoking history presents with cough and
shortness of breath. Computed tomography of
the chest reveals a central mass near the left
mainstem bronchus. Biopsy of the mass is
performed. Histologic examination reveals
small round blue cells, and a diagnosis of
small cell carcinoma is made. Which of the
following is a frequent characteristic of this
form of lung cancer ?
(A) Generally amenable to surgical cure at time of
diagnosis
(B) More common in women, and a less clear relation to
smoking than other forms of lung cancer
(C) Secretes a parathyroid-like hormone
(D) Secretes either corticotrophin or antidiuretic
hormone
(E) Usually in a peripheral rather than in a central
location
(A) Generally amenable to surgical cure at time of
diagnosis
(B) More common in women, and a less clear relation to
smoking than other forms of lung cancer
(C) Secretes a parathyroid-like hormone
(D) Secretes either corticotrophin or antidiuretic
hormone
(E) Usually in a peripheral rather than in a central
location
A 50-year-old man dies of a respiratory illness
that had been characterized by dyspnea,
cough, and wheezing expiration of many
years' duration. Initially episodic, his "attacks"
had increased in frequency and at the time of
death had become continuous and intractable.
At autopsy, which of the following is the most
likely histologic finding in the lungs ?
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein-rich fluid into alveolar spaces
(C) Dilatation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilatation caused by
chronic infection, with bronchi filled with
mucus and neutrophils
(A) Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
(B) Diffuse alveolar damage with leakage of
protein-rich fluid into alveolar spaces
(C) Dilation of air spaces with destruction of
alveolar walls
(D) Hyperplasia of bronchial mucus-secreting
submucosal glands
(E) Permanent bronchial dilation caused by
chronic infection, with bronchi filled with
mucus and neutrophils
A 60-year-old man presents with dyspnea on
exertion and a nonproductive cough. He has
never smoked, but he worked as a shipbuilder,
with known asbestos exposure approximately
20 years ago. To which of the following
conditions is this patient especially
predisposed ?
(A) Acute respiratory distress syndrome
(B) Goodpasture syndrome
(C) Idiopathic pulmonary fibrosis
(D) Idiopathic pulmonary hemosiderosis
(E) Malignant mesothelioma of the pleura
(A) Acute respiratory distress syndrome
(B) Goodpasture syndrome
(C) Idiopathic pulmonary fibrosis
(D) Idiopathic pulmonary hemosiderosis
(E) Malignant mesothelioma of the pleura
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A 45-year-old woman with long-standing
rheumatoid arthritis complains of dry eyes
and dry mouth. Bilateral enlargement of the
parotids is noted on physical examination.
The syndrome described here is best
described as
Gastrointestinal tract
(A) autoimmune
(B) infectious
(C) metabolic
(D) metastatic
(E) primary neoplastic
Gastrointestinal tract
(A) autoimmune
(B) infectious
(C) metabolic
(D) metastatic
(E) primary neoplastic
Gastrointestinal tract
A 45-year-old man complains of "heartburn"
and burning epigastric pain, relieved by
antacids and triggered by eating spicy or
acidic foods or by assuming a recumbent
position. The patient smokes two packs of
cigarettes a day and consumes several
alcoholic drinks each evening. Which of the
following is the usual cause of this patient's
condition?
Gastrointestinal tract
(A) Columnar intestinal metaplasia of
esophageal squamous epithelium
(B) Excessive acid production in the
stomach
(C) Excessive nonsteroidal antiinflammatory drug use
(D) Helicobacter pylori infection
(E) Hiatal hernia and incompetent lower
esophageal sphincter
Gastrointestinal tract
(A) Columnar intestinal metaplasia of
esophageal squamous epithelium
(B) Excessive acid production in the
stomach
(C) Excessive nonsteroidal antiinflammatory drug use
(D) Helicobacter pylori infection
(E) Hiatal hernia and incompetent lower
esophageal sphincter
Gastrointestinal tract
A 60-year-old man presents with hematemesis,
melena, guaiac-positive stools, and signs of
circulatory collapse. He has a 20-year history of
burning midepigastric pain and tenderness
relieved by food, milk, or antacids. Also, he has
been taking high doses of nonsteroidal antiinflammatory drugs to relieve the pain of longstanding arthritis. Esophagogastroduodenoscopy
reveals a peptic ulcer in the upper duodenum.
Which of the following is an important association
of duodenal peptic ulcer disease ?
Gastrointestinal tract
(A) Barrett esophagus and columnar intestinal
metaplasia of esophageal squamous
epithelium
(B) Evolution into carcinoma is a likely sequela
(C) Helicobacter pylori infection
(D) Hiatal hernia and incompetent lower
esophageal sphincter
(E) Pernicious anemia and achlorhydria
Gastrointestinal tract
(A) Barrett esophagus and columnar intestinal
metaplasia of esophageal squamous
epithelium
(B) Evolution into carcinoma as a likely sequela
(C) Helicobacter pylori infection
(D) Hiatal hernia and incompetent lower
esophageal sphincter
(E) Pernicious anemia and achlorhydria
Gastrointestinal tract
A 65-year-old man presents with dysphagia,
weight loss, and anorexia. Physical
examination is normal.
Esophagogastroduodenoscopy with biopsy
of an esophageal lesion is performed,
revealing squamous cell carcinoma. Which
of the following is true regarding this
cancer?
Gastrointestinal tract
(A) Cigarette smoking and chronic alcohol use
are associated risk factors.
(B) Gastroesophageal reflux disease and Barrett
esophagus are associated risk factors.
(C) Histologic findings include disordered, backto-back submucosal glands.
(D) It most frequently arises in the lower third of
the esophagus.
(E) This cancer is characterized by an indolent
course, and long survival is common.
Gastrointestinal tract
(A) Cigarette smoking and chronic alcohol use
are associated risk factors.
(B) Gastroesophageal reflux disease and Barrett
esophagus are associated risk factors.
(C) Histologic findings include disordered, backto-back submucosal glands.
(D) It most frequently arises in the lower third of
the esophagus.
(E) This cancer is characterized by an indolent
course, and long survival is common.
Gastrointestinal tract
For the past week, a 65-year-old woman
has been treated for a severe infection with
broad-spectrum antibiotics, and she had
recovered well. However, over the past day
she has developed foul-smelling,
voluminous, greenish, watery diarrhea, as
well as abdominal pain and fever. She is
diagnosed with pseudomembranous colitis.
Which of the following is the mechanism
associated with this condition?
Gastrointestinal tract
(A) Aggregation of bacterial colonies on the
lumen, forming pseudomembranes
(B) Bacterial release of exotoxin, inducing
necrosis of the mucosa
(C) Physical invasion of bacteria into the
superficial mucosa, leading to
pseudomembrane formation
(D) Selective killing of Clostridium difficile bacteria
by antibiotics
(E) Spread of the previous infection to the colon
Gastrointestinal tract
(A) Aggregation of bacterial colonies on the
lumen, forming pseudomembranes
(B) Bacterial release of exotoxin, inducing
necrosis of the mucosa
(C) Physical invasion of bacteria into the
superficial mucosa, leading to
pseudomembrane formation
(D) Selective killing of Clostridium difficile bacteria
by antibiotics
(E) Spread of the previous infection to the colon
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Gastrointestinal tract
A 25-year-old obese woman who denies
any history of alcohol abuse presents with
severe abdominal pain radiating to the
back. Laboratory results indicate an
increase in serum amylase and lipase, with
a marked decrease in calcium. Which of the
following likely has caused this condition?
Liver and exocrine pancreas
(A) Abetalipoproteinemia
(B) Alcohol
(C) Cholelithiasis
(D) Cystic fibrosis
(E) Mumps
Liver and exocrine pancreas
(A) Abetalipoproteinemia
(B) Alcohol
(C) Cholelithiasis
(D) Cystic fibrosis
(E) Mumps
Liver and exocrine pancreas
A 23-year-old woman is involved in a minor
motor vehicle accident, prompting an
abdominal computed tomography scan, which
was read by the emergency department
radiologist as normal with the exception of a
questionable mass in the right lobe of the liver.
A subsequent fine-needle biopsy confirms the
presence of a liver adenoma. Which of the
following is associated with the development
of this lesion?
Liver and exocrine pancreas
(A) Hepatitis B
(B) Hepatitis C
(C) Oral contraceptives
(D) Polycythemia vera
(E) Polyvinyl chloride
Liver and exocrine pancreas
(A) Hepatitis B
(B) Hepatitis C
(C) Oral contraceptives
(D) Polycythemia vera
(E) Polyvinyl chloride
Liver and exocrine pancreas
While on an international medical rotation,
you encounter a pregnant woman in a rural
village in India who presents with fever,
jaundice, and malaise. The patient
unexpectedly expires. This is the second
case this month with a similar presentation.
Which of the following is the most likely
form of hepatitis?
Liver and exocrine pancreas
(A) Hepatitis A
(B) Hepatitis B
(C) Hepatitis C
(D) Hepatitis D
(E) Hepatitis E
Liver and exocrine pancreas
(A) Hepatitis A
(B) Hepatitis B
(C) Hepatitis C
(D) Hepatitis D
(E) Hepatitis E
Liver and exocrine pancreas
A 32-year-old woman seeking to become
pregnant visits her physician for a
prepregnancy examination. Routine
prenatal laboratory testing demonstrates the
following profile:
HBsAg (-), anti-HBsAg (+), anti-HBcAg (-),
anti-HBeAg (-), and HBV DNA (-). Which of
the following likely represents the status of
the patient?
Liver and exocrine pancreas
(A) Hepatitis B carrier
(B) Immunized against hepatitis B
(C) Infected and within the "window period"
(D) Infected with hepatitis B and highly
transmissible
(E) Recently infected with hepatitis B
Liver and exocrine pancreas
(A) Hepatitis B carrier
(B) Immunized against hepatitis B
(C) Infected and within the "window period"
(D) Infected with hepatitis B and highly
transmissible
(E) Recently infected with hepatitis B
Liver and exocrine pancreas
(A) Hepatitis B carrier
(B) Immunized against hepatitis B
(C) Infected and within the "window period"
(D) Infected with hepatitis B and highly
transmissible
(E) Recently infected with hepatitis B
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Liver and exocrine pancreas
A 3-year-old boy is brought to the
pediatrician because his mother noticed an
abnormal mass in his scrotum while
changing his diapers. Further workup
demonstrates elevated levels of serum αfetoprotein. Which of the following is the
most likely diagnosis?
Kidney and urinary tract
(A) Choriocarcinoma
(B) Endodermal sinus (yolk sac) tumor
(C) Hepatocellular carcinoma
(D) Leydig cell (interstitial) tumor
(E) Teratoma
Kidney and urinary tract
(A) Choriocarcinoma
(B) Endodermal sinus (yolk sac) tumor
(C) Hepatocellular carcinoma
(D) Leydig cell (interstitial) tumor
(E) Teratoma
Kidney and urinary tract
A 66-year-old man visits his family physician
with complaints of urinary frequency,
hesitancy, and dysuria. Digital rectal
examination reveals an enlarged prostate,
and the consistency is rubbery and nodular.
Serum prostate-specific antigen is modestly
increased. Which of the following is most
closely related to the pathogenesis of the
likely disorder described here?
Kidney and urinary tract
(A) Dihydrotestosterone
(B) Estrogen
(C) α-Fetoprotein
(D) Human chorionic gonadotropin
(E) Testosterone
Kidney and urinary tract
(A) Dihydrotestosterone
(B) Estrogen
(C) α-Fetoprotein
(D) Human chorionic gonadotropin
(E) Testosterone
Kidney and urinary tract
A 58-year-old African-American man presents to
the emergency department with severe back
pain. His history is negative for trauma and he
has no other complaints. He denies urinary
frequency, hesitancy, or dysuria. A digital rectal
examination confirms the presence of a firm,
hard, asymmetrical, and stony prostate. Imaging
of the spine suggests osteoblastic involvement of
the spine at lumbar vertebrae L3 - L4. In addition
to an increase in PSA, which serum marker might
also be elevated?
Kidney and urinary tract
(A) Alkaline phosphatase
(B) Androgens
(C) Carcinoembryonic antigen-125
(D) α -Fetoprotein
(E) Human chorionic gonadotropin
Kidney and urinary tract
(A) Alkaline phosphatase
(B) Androgens
(C) Carcinoembryonic antigen-125
(D) α -Fetoprotein
(E) Human chorionic gonadotropin
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Kidney and urinary tract
A 46-year-old man is referred to an endocrinologist because of the
recent onset of diabetes mellitus. However, his overall
appearance is striking, and on questioning, he describes marked
changes that have been occurring slowly over many years.
Comparison with old photographs reveals that he has developed
generalized coarseness of his facial features, including frontal
bossing, thickening of the nose, prognathism (enlargement and
increased prominence of the jaw), and macroglossia (enlargement
of the tongue). In addition, he has enlarged extremities, with
sausage-like fingers, and he says that he is no longer able to wear
his wedding ring and that his shoe size has increased. These
findings are characteristic of increased activity of which of the
following?
Endocrine glands and diabetes mellitus
(A) Corticotropin
(B) Dopamine
(C) Insulinlike growth factor- I
(D) Prolactin
(E) Thyroid-stimulating hormone
Endocrine glands and diabetes mellitus
(A) Corticotropin
(B) Dopamine
(C) Insulinlike growth factor- I
(D) Prolactin
(E) Thyroid-stimulating hormone
Endocrine glands and diabetes mellitus
A 23-year-old woman presents with tremor,
restlessness, heat intolerance, palpitation,
and unexplained weight loss. The thyroid is
symmetrically enlarged; the pulse is rapid;
the skin is moist and warm; and
exophthalmos( protrusion of the eye ball) is
apparent. This condition is considered to be:
Endocrine glands and diabetes mellitus
(A) autoimmune
(B) congenital
(C) iatrogenic
(D) infectious
(E) nutritional
Endocrine glands and diabetes mellitus
(A) autoimmune
(B) congenital
(C) iatrogenic
(D) infectious
(E) nutritional
Endocrine glands and diabetes mellitus
A 26-year-old primigravida develops
gestational diabetes and remains
hyperglycemic during the remainder of her
pregnancy. Which of the following
abnormalities in the newborn child is likely
related to the maternal hyperglycemia?
Endocrine glands and diabetes mellitus
(A) Ambiguous genitalia
(B) Cretinism
(C) Increased birth weight
(D) Sheehan syndrome
(E) Thyroglossal duct cyst
Endocrine glands and diabetes mellitus
(A) Ambiguous genitalia
(B) Cretinism
(C) Increased birth weight
(D) Sheehan syndrome
(E) Thyroglossal duct cyst
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Endocrine glands and diabetes mellitus
A 20-year-old woman presents with a skin rash.
The rash is localized to the extensor surfaces of
her elbows and knees, and is composed of
multiple well -demarcated circular to oval-shaped
plaques and papules covered by a silvery scale
overlying reddened erythematous skin. The
silvery scale can be scraped off, revealing
inflamed skin underneath. She states that several
family members have a similar rash. Which of the
following is the most likely diagnosis?
Skin Diseases
(A) Neurodermatitis (lichen simplex chronicus)
(B) Psoriasis
(C) Pemphigus vulgaris
(D) Bullous pemphigoid
(E) Dermatitis herpetiformis
Skin Diseases
(A) Neurodermatitis (lichen simplex chronicus)
(B) Psoriasis
(C) Pemphigus vulgaris
(D) Bullous pemphigoid
(E) Dermatitis herpetiformis
Skin Diseases
A 55-year-old man presents with a large,
black-colored, asymmetric skin lesion with
ill-defined borders on his back. He reports a
family history of malignant melanoma.
Which of the following clinical variants of
malignant melanoma has the poorest
prognosis?
Skin Diseases
(A) Lentigo maligna melanoma
(B) Superficial spreading melanoma
(C) Nodular melanoma
(D) Acral-lentiginous melanoma
Skin Diseases
(A) Lentigo maligna melanoma
(B) Superficial spreading melanoma
(C) Nodular melanoma
(D) Acral-lentiginous melanoma
Skin Diseases
A 70-year-old man presents with a scaling,
indurated, ulcerated nodule on the back of
his left hand. He states that the nodule has
been growing larger over time. The patient
has had much direct sun exposure in the
past. Which of the following is the most
likely histologic finding in this patient's skin
lesion?
Skin Diseases
(A) Invasion of the dermis by sheets and islands
of neoplastic epidermal cells, often with
"keratin pearls"
(B) Clusters of darkly staining basaloid cells, with
a palisading arrangement of the nuclei of the
cells at the periphery of the clusters
(C) Malignant melanocytes with numerous mitotic
figures
(D) Abnormal proliferation of the connective
tissue, with deranged arrangement of collagen
fibers
Skin Diseases
(A) Invasion of the dermis by sheets and islands
of neoplastic epidermal cells, often with
"keratin pearls"
(B) Clusters of darkly staining basaloid cells, with
a palisading arrangement of the nuclei of the
cells at the periphery of the clusters
(C) Malignant melanocytes with numerous mitotic
figures
(D) Abnormal proliferation of the connective
tissue, with deranged arrangement of collagen
fibers
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Skin Diseases