1. A 3-year-old girl presents to the emergency department with fever, hoarseness, a “seal bark-like” cough,
and inspiratory stridor. Her father states that she has had a cold for the past few days, with runny nose, nasal
congestion, sore throat, and cough. He is now concerned because her cough has become loud, harsh, and
brassy. Which of the following is the most likely cause of her ailment?
A. Fungus
B. Gram-negative bacteria
C. Gram-positive bacteria
D. Parasite
E. Virus
2. A 60-year-old woman with a heavy smoking history presents with chronic productive cough that has been
present for three consecutive months over the past two consecutive years. On physical examination, her skin
has a bluish tinge, and she is overweight. Which of the following is the most likely histologic 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. 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
3.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 lung?
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
4. A 25-year-old man presents with fever, malaise, headaches and muscle pain(myalgia). A chest x-ray reveals
bilateral infiltrates. You draw a tube of blood from the patient(the tube contains anticoagulant) and place the
tube in a cup of ice. After the blood has cooled, you notice that the red cells have agglutinated (not clotted).
This agglutination goes away after you warm up the tube of blood. This patient’s illness is most likely due to
infection with which of the following organisms?
A. Influenza A virus
B. Mycoplasma pneumoniae
C. Streptococcus pneumoniae
D. Pneumocystis pneumoniae
E. Mycobacterium tuberculosis
5. A 50-year-old woman has been immobilized in bed for several days after a motor vehicle accident. She had
been improving, but this morning she suffered the sudden onset of pleuritic chest pain, hemoptysis,
tachypnea, tachycardia, and dyspnea. What’s the likely basis of this set of findings?
A. Arterial thrombus originating in pulmonary blood vessels
B. Arterial thrombus originating in the lower extremities with migration to pulmonary veins
C. Deep venous thrombus of the lower extremities with embolization to branches of the
pulmonary artery
D. Mural thrombus originating in the left heart with migration to pulmonary blood vessels
E. Venous thrombus originating in pulmonary blood vessels
6. A 45-year-old woman with no smoking history presents with new onset of cough, shortness of breath, and
weight loss. Imaging reveals a peripherally located lung mass with no evidence of primary tumor elsewhere in
the body. On light microscopy, the tumor is comprised of poorly formed glands. What’s the most likely
biological or molecular findings for this patient?
A. Positive for synaptophysin immunostaining
B. Associated squamous dysplasia at the periphery of the tumor
C. Most likely already metastatic, therefore surgery is not recommended
D. Driven by tobacco-associated carcinogens
E. Positive for mutation in EGFR
7. While recovering in bed 1 week after an abdominal hysterectomy, a 42-year old woman develops acute
shortness of breath with hemoptysis. Physical examination finds the patient to be afebrile with moderate
respiratory distress, calf tenderness, and a widely split S2. Which of the following is the most likely diagnosis?
A. Atelectasis
B. Bacterial pneumonia
C. Pulmonary embolus
D. Pulmonary hypertension
E. Viral pneumonia
8. A 27-year-old man presents with a chronic productive cough. Pertinent medical history is that he has had
recurrent sinusitis and numerous lower respiratory tract infections since childhood. He has been married for
6 years and has no children, although he and his wife do not use any form of birth control. His chest X-ray
reveals the apex of the heart to be directed toward the right, and a CBC reveals a normocytic normochromic
anemia. Semen analysis reveals his spermatozoa to be immotile and lack the normal ATP-ase-containing
dynein arms. Without treatment, Which of the following changes is most likely to result from his disease?
A. Abnormal permanent dilation of the bronchi in the lungs
B. Destruction of the walls of the alveoli in the base of the lungs
C. Fatty metamorphosis of the hepatocytes in the liver
D. Hyperplasia of the smooth-muscle cells of the bronchioles in the lungs
E. Irreversible deposition of collagen in the subendothelial spaces in the liver
9. A 39-year-old woman presents with a cough and increasing shortness of breath. A chest x-ray is
interpreted by the radiologist as showing a right lower lobe(RLL) pneumonia. No mass lesions are seen. The
woman is treated with antibiotics, but her symptoms do not improve. On her return visit, the area of
consolidation appears to be increased. Bronchoscopy is performed. No bronchial masses are seen, but a
transbronchial biopsy is obtained in an area of mucosal erythema in the RLL. After the diagnosis is made, the
RLL is removed and a section from this specimen reveals well-differentiated mucus-secreting columnar
epithelial cells that infiltrate from alveolus to alveolus. Which of the following is the most likely diagnosis?
A. Adenocarcinoma
B. Carcinoid
C. Large-cell carcinoma
D. Small-cell carcinoma
E. Squamous cell carcinoma
10. Histologic sections(routine H&E stain) of lung reveal the alveoli to be filled with pale, nongranular pink
fluid. Neither leukocytes nor erythrocytes are present within this fluid. Which of the following is the most
common cause of this abnormality?
A. Bacterial pneumonia
B. Congestive heart failure
C. Lymphatic obstruction by tumor
D. Pulmonary embolus
E. Viral pneumonia
11. A 7-year-old boy accidentally inhales a small peanut, which lodges in one of his bronchi. A chest x-ray
reveals the mediastinum to be shifted toward the side of the obstruction. Which of the following pulmonary
abnormalities is most likely present in this boy ?
A. Absorptive atelectasis
B. Compression atelectasis
C. Contraction atelectasis
D. Patchy atelectasis
E. Hyaline membrane disease
12. A 53-year old man while in the hospital because of a serious motor vehicle accident develops signs of
respiratory failure. A chest x-ray reveals a complete “white-out” of both lungs, while a chest CT scan reveals
extensive bilateral ground-glass opacifications of the lung parenchyma consistent with diffuse alveolar
damage. Laboratory evaluation finds severe hypoxemia that does not improve with 100% oxygen. Which of
the following histologic abnormalities is most likely to be seen in a biopsy specimen taken from his lungs?
A. Charcot-Leydin crystals
B. Curschmann spirals
C. Ghon complexes
D. Hyaline membranes
E. Plexiform lesions
13. A 63-year-old man who is a long-term smoker presents with increasing shortness and dyspnea. He has
smoked more than two packs of cigarettes per day for more than 40 years. He denies having a productive
cough or any recent infections. Physical examination reveals a thin elderly appearing man in moderate
respiratory distress. While sitting he leans slightly forward and breathes quickly through pursed lips. He is
afebrile and his blood pressure is within normal limits. Examination of his chest reveals an increased
anteroposterior diameter and his lung are hyperresonant to percussion. His respiratory rate is increased, but
no clubbing or cyanosis is present. Chest x-ray reveals his heart to be of normal size, but there is
hyperinflation of his lungs. Laboratory examination reveals that while breathing room air, his arterial PO2 is
decreased but his arterial PCO2 is normal. Which of the following statements is an accurate association
concerning the pathogenesis of this man’s pulmonary disease?
A. Destruction of entire acinus caused panlobular emphysema
B. Destruction of the cilia on the respiratory epithelial cells resulted in bronchiectasis
C. Destruction of proximal acinus caused centrilobular emphysema
D. Hyperplasia of the respiratory smooth-muscle cells resulted in intrinsic asthma
E. Hyperplasia of the respiratory mucus glands caused chronic bronchitis
14. A 37-year-old woman presents with the acute onset of a productive cough, fever, chill, and pleuritic chest
pain. A chest x-ray reveals consolidation of the entire lower lobe of her right lung. She unexpectedly dies
before treatment due to a cardiac arrhythmia. Histologic examination of lung tissue taken at the time of
autopsy reveals multiple suppurative neutrophil-rich exudates filling the bronchi, bronchioles and alveolar
space. Hyaline membranes are not found. The majority of lung tissue from her right lower lung is involved in
this inflammatory process. Which of the following is the most likely diagnosis?
A. Bronchiectasis
B. Bronchopneumonia
C. Interstitial pneumonitis
D. Lobar pneumonia
E. Pulmonary abscess
15. A 67-year-old man who is a long-term smoker presents with weight loss, a persistent cough, fever, chest
pain, and hemoptysis. Physical examination reveals a cachectic man with clubbing of his fingers and dullness
to percussion over his right lower lobe. A chest x-ray reveals a 3.5-cm hilar mass on the right and
postobstructive pneumonia of the right lower lobe. Sputum cytology is suspicious for malignant cells.
Histologic examination of a transbronchial biopsy specimen reveals infiltrating groups of cells with scant
cytoplasm. No glandular structures or keratin production are seen. The nuclei of these cells are about twice
the size of normal lymphocytes and do not appear to have nucleoli. Which of the following is the most likely
diagnosis?
A. Adenocarcinoma
B. Hamartoma
C. Large-cell undifferentiated carcinoma
D. Small-cell undifferentiated carcinoma
E. Squamous cell carcinoma
16. A 44-year-old alcoholic man presents with fever and a productive cough with copious amounts of foulsmelling purulent sputum. Physical examination finds that changing the position of this individual produces
paroxysms of coughing. Which of the following is the most likely cause of this patients’ signs and symptoms?
A. Esophageal cancer
B. Esophageal reflux
C. Myocardial infarction
D. Pulmonary abscess
E. Pulmonary infarction
17. A 54-year-old man presents with several problems involving his face and pain in his shoulder. He states
that he has smoked 2 packs of cigarettes a day for almost 40 years. Physical examination reveals ptosis of his
left upper eyelid, constriction of his left pupil, and lack of sweating(anhidrosis) on the left side of his face. No
other neurologic abnormalities are found. Which of the following tumors is most likely to be present in this
individual?
A. A bronchioloalveolar carcinoma involving the left upper lobe
B. A small-cell carcinoma involving the hilum of his left lung
C. A squamous cell carcinoma involving the left mainstem bronchus
D. An adenocarcinoma involving the apex of his left lung
E. An endobronchial carcinoid tumor involving the right mainstem bronchus
18. A 25-year-old woman presents with a 6-month history of increasing fatigue and dyspnea. Physical
examination finds that she is in moderate respiratory distress and cyanosis is present. An echocardiogram of
her heart finds the thickness of the right ventricle to be increased, but the thickness of the left ventricle is
within normal limits. Elevation of the mean pulmonary arterial pressure is found and histologic sections from
a lung biopsy reveal plexiform lesions within the pulmonary arterioles. Hyaline membranes are not found nor
are areas of lung collapse present. Extensive workup finds an abnormality involving the BMPR2 signaling
pathway? What is the correct diagnosis?
A. Churg-Strauss syndrome
B. Hypersensitivity pneumonitis
C. Idiopathic pulmonary hemosiderosis
D. Primary pulmonary hypertension
E. Wegener granulomatosis
19. A 60-year-old man, a heavy smoker, presents for advice to stop smoking. On physical examination, he is
thin and ahs 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 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. 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
20. A 19-year-old woman presents with sudden, severe right-sided chest pain that developed shortly after
she had been placing heavy boxes on shelves in her garage. Physical examination reveals an afebrile woman
in mild respiratory distress. Breath sounds are markedly decreased on the right, and right lung is
hyperresonant to percussion. Which of the following is most likely present in this individual?
A. Pneumoconiosis
B. Pneumocystis infection
C. Bacterial pneumonia
D. Viral pneumonia
E. Pneumothorax
21. A 63-year old man who has a long history of smoking several packs of cigarettes a day presents with a
worsening cough and weight loss. A chest x-ray finds a solitary 3-cm mass in the lower lobe of his right lung.
This mass is resected surgically, and the pathologist diagnoses the lesion as a moderately differentiated
squamous cell carcinoma. Which of the histologic findings listed below is most consistent with this diagnosis?
A. Abundant mucin secretion
B. Dense collagen deposition
C. Neurosecretory granule formation
D. Extensive glandular differentiation
E. Prominent keratin production
22. Which of the following types of carcinomas is most likely to be found at the periphery of the lung in areas
of prior lung inflammation or injury
A. Adenocarcinoma
B. Clear cell carcinoma
C. Large cell carcinoma
D. Small cell carcinoma
E. Squamous cell carcinoma
23. Which of the following is the classic triad of signs and symptoms associated with Horner syndrome?
A. Cogwheel rigidity, flat facies, and akinesia
B. Fever, vomiting, and nuchal rigidity
C. Orthostatic hypotension, impotence, and excess salivation
D. Ptosis, miosis, and anhidrosis
E. Scanning speech, intention tremor, and nystagmus
24. Which is the most common cause and site of origin for pulmonary emboli?
A. Deep venous thrombosis
B. Long bone trauma
C. Mesenteric vein obstruction
D. Right ventricle stasis
E. Superficial leg hemorrhage
25. A 54-year old male smoker is diagnosed with chronic bronchitis. A biopsy of the bronchus is performed.
Which of the following is the most likely finding on histology?
A. Abundant mucus with plugging of the bronchioles
B. Alveolar destruction and enlargement
C. Interstitial fibrosis
D. Noncaseating granuloma
E. Diffusive atelectasis
26. A 46-year-old man complains of progressive dyspnea and cough. He has been hospitalized multiple times
over the last 2 years for respiratory distress. Bronchoscopy is performed with biopsy of the lung. Histologic
analysis reveals large airspaces distal to the terminal bronchioles. Which of the following is the most likely
diagnosis?
A. Asthma
B. Bronchiectasis
C. Bronchitis
D. Emphysema
E. Sarcoidosis
27. A 29-year-old woman is noted to have chronic dyspnea and easy fatigue with exertion. A chest radiograph
reveals hyperinflated lung fields without infiltrates. She denies a history of cigarette smoking. Which of the
following is the most likely etiology for her condition?
A.
α-Antitrypsin deficiency
B.
Second hand smoke
C.
Subclinical asthma
D.
Amyloidosis
E.
Silicosis
28. A 31-year-old woman presents to the emergency room with the acute onset of malaise, fever, and a
productive cough. A chest x-ray reveals consolidation of the right lower lobe along with air bronchograms,
and a Gram stain of her sputum shows a predominance of gram-positive lancet-shaped cocci in pairs and
chains. Which of the following is the most likely causative agent of this individual’s infectious disease?
A.
Hemophilus influenzae
B.
Klebsiella pneumoniae
C.
Pseudomonas aeruginosa
D.
Streptococcus pneumoniae
E.
Bacterium burgeri
29. A 26-year-old woman presents with the acute onset of fever, malaise, headaches, muscle pain, and a dry,
hacking nonproductive cough. Laboratory evaluation finds the presence of cold agglutinins in her serum,
mainly immunoglobulin M(IgM) anti-I cold agglutinins. Which histological changes would most likely be
present in the lung parenchyma of this individual?
A.
Eosinophils within the walls of the capillaries
B.
Lymphocytes with the walls of the alveoli
C.
Microthrombi within the lumen of the capillaries
D.
Neutrophils within the lumen of the alveoli
E.
Noncaseating granulomas in the walls of the alveoli
30. A 25-year-old HIV-positive man presents with a low-grade fever, a nonproductive cough, and increasing
shortness of breath. Routine histologic sections from a transbronchial biopsy reveal foamy frothy eosinophilic
material within the alveoli. Silver stains reveal the presence of numerous cup-shaped organisms with central
dark dots. Which of the following is the most likely diagnosis?
A.
Aspiration pneumonia
B.
Atypical pneumonia
C.
Organizing pneumonia
D.
Paragonimus pneumonia
E.
Pneumocystis pneumonia