RESPIRATORY MCQs
1. The type of emphysema associated with smoking is
a. Panacinar – a1 AT def
b. Centriacinar <- correct
c. Distal acinar – aka paraseptal, near pleura assoc w/ scars
d. Irregular - assoc w/ sacrs
e. None of the above
2. squamous cell lung carcinoma
a. has a 5 year survival rate of 60%
b. is most commonly associated with smokers <– closest correlation with smoking of all
c. is commonest peripherally – near hilus
d. is commonest in females – male 32%> female 25%
e. ?
3. Intrinsic asthma: - intrinsic = non-immune/non-atopic
a. Decreases vagal afferent responsiveness - increases
b. Is associated with atopy - …
c. is commonly triggered by viral infections <- correct
d. IgE levels are often elevated – no, that would be atopic
e. The airway is not hyperreactive – its is, of course
4. Lobar pneumonia
a. Is more common in the young and the elderly
b. Involves morphological changes of red to grey hepatisation <- correct
c. Not usually associated with a productive cough – it is
d. Is associated with immunosuppression
e. Rarely caused by streptococcus – S. pneumoniae is the most common cause of community
acquired
5. Chronic bronchitis is characterized by
a. Smooth muscle hypertrophy – there is some, but not the characteristic
b. Leukocyte infiltration
c. Mucous gland hypertrophy <– characteristic w/ definition persistent productive cough 3/12 in 2
consecutive years w/ no other cause
d. Increased size of goblet cells – goblet cell metaplasia
e. ?
6. All of the following cause compressive atelectasis EXCEPT:
a. Pneumothorax
b. Asthma <– causes resorptive due to muscus plugging
c. CCF
d. Peritonitis – not listed in the book, but if significant could compress the diaphragm?
e. Pleural effusion
7. Which is not true of bronchogenic cysts
a. They may become dysplastic – true, metaplasia is a rare but possible consequence
b. They occasionally cause pneumothorax – true (and occasionally mimic)
c. They have an epithelial layer - true
d. They may contain mucous - true
e. They are often associated with bronchioles <– no, they are rarely in communication with the
tracheobronchial tree at all
8. Chronic bronchitis major morphological change involves
a. Leukocyte infiltration
b. Decreased goblet cell number - metaplasia
c. Smooth muscle hypertrophy – some, but not major (brochiolitis)
d. Increased mucosal gland depth (REID index) <- mucus gland hypertrophy
e. Monocyte infiltration
9. Regarding bronchogenic carcinoma (= lung cancer)
a. It most often arises around the hilum of the lung <= correct but note, adenocarcinoma is the most
common type (F 47% > M 37%) and usually presents w/ peripheral lesions
b. Distant spread occurs solely by lymphatic spread
c. Metastasis are most common to the liver – adrenal, brain, liver and bone are common sites
d. Small cell carcinoma is the most common type – no adenocarcinoma is
e. Surgical resection is often effective for small cell carcinoma – no, it is usually metastatic at time of
diagnosis.
10. In emphysema
a. A deficiency of alpha 1 antitryptin is protective
b. Centriacinar destruction leads to obstructive overinflation -?
c. The protease-antiprotease mechanism is the most plausible explanation of the disease <- true
d. Smokers have an increased number of macrophages in the bronchi -? In the bronchi
e. Elastase activity is unaffected by oxygen free radicals
11. In chronic bronchitis
a. The hallmark is hypersecretion of mucous in the large airways <- true
b. There is a marked increase in goblet cells in the main bronchi – goblet metaplasia
c. Infection is a primary cause – secondary issue, smoking/airway irritation is primary
d. Cigarette smoke stimulates alveolar leukocytes
e. Dysplasia of the epithelium leads to emphysema
12. In bronchial asthma
a. Extrinsic asthma is initiated by diverse non-immune mechanisms
b. Sub-epithelial vagal receptors in respiratory mucosa are insensitive to irritants
c. IgG plays a role
d. Bronchial wall smooth muscle is atrophic
e. Primary mediators include eosinophilic and neutrophilic chemotactic factors
13. In bacterial pneumonia
a. Patchy consolidation of the lung is the dominant feature of bronchopneumonia <- true
b. A lobar distribution is a function of anatomical variations -?
c. Klebsiella pneumonia is a common virulent agent – most common cause of gram –ve i.e.
nosocomial
d. Alveolar clearance of bacteria is achieved by lymphocytes
e. The nasopharynx is inconsequential in defending the lung against infection
14. Regarding anatomical types of emphysema:
a. Panacinar is more common than centriacinar
b. Centriacinar is not common in smokers
c. Paraseptal emphysema is associated with alpha-1 antitrypsin deficiency
d. Spontaneous penumothorax is common in panacinar type
e. Distal portion of acinus is predominantly involved in paraseptal emphysema
15. Comparing the pulmonary oedema of CCF with ARDS, a defining characteristic of ARDS is:
a. Spontaneous resolution within 48 hours
b. Formation of hyaline membranes <- characteristic
c. A deficiency of surfactant
d. A distinct lobar pattern of consolidation
e. High pulmonary wedge pressures
16. Bacterial pneumonia:
a. May be predisposed to by immotile cilia syndromes (eg. Kartageners)
b. Is characterized by an acute (neutrophilic) suppurative exudates within alveolar spaces and
airways
c. Is a frequent cause of death in hospitalized patients
d. May be complicated by organisation
e. All of the above
17. Atypical pneumonia
a. Is characterized by exudates within the alveolar air spaces
b. Has a predominantly neutrophilic cell infiltrate
c. Has a mortality rate of 20% in non-epidemic cases
d. Is most often caused by cytomegalovirus
e. Is associated with the formation of hyaline membranes within the alveolar air spaces <- reflecting
the diffuse alveolar damage
18. Regarding pulmonary infections:
a. Respiratory tract infections are more frequent than infection of any other organ <- true
b. Patchy consolidation is uncommon with bronchopneumonia
c. Lobar pneumonia is more frequent than bronchopneumonia – apparently not
d. Haematogenous secondary seeding of lungs does not occur
e. Commonest infectious agents are H. influenzae and K. pneumoniae – S. pneumoniae and H.
influenzae
19. The following is not an obstructive airways disease
a. Emphysema
b. Pneumonia
c. Asthma
d. Bronchitis
e. Bronchiectasis
20. With respect to atelectasis
a. The mediastinum may shift away from the affected lung <– if compressive this is true
b. Obstructive atelectasis is commonest after trauma
c. Compressive atelectasis is commonly encountered in patients with chronic obstructive airways
disease
d. It is an irreversible disorder
e. It can develop when there is loss of pulmonary surfactant <- true
21. Regarding lung abscesses:
a. Aspiration most commonly results in abscesses in the left lung – right – more vertical right
bronchus
b. Anaerobic organisms are the exclusive isolates in 60% of cases <c. A central area of liquefactive necrosis develops – suppurative necrosis
d. Infected emboli from bacterial endocarditis typically affect the right lung – they are typically from
the (R) heart
e. Secondary empyema occurs in 50% of cases - ?
22. Regarding emphysema
a. The usual age of onset is 40-50 years
b. Copious sputum production is common
c. Cor pulmonale is a common feature
d. Airways resistance may be normal <e. CXR usually shows a large heart
23. Regarding bronchogenic carcinoma
a. It most often arises around the hilum of the lung – adenocarcinoma is most common, and lesions
usually peripheral
b. Distant spread occurs solely by lymphatic spread
c. Metastasis is most common to the liver
d. Small cell carcinoma is the most common type <- correct
e. Surgical resection is often effective for small cell carcinoma
24. All of the following are neoplastic syndromes associated with lung cancer EXCEPT:
a. Cushings syndrome
b. Syndrome of inappropriate ADH secretion
c. Hypocalcaemia – this is not a syndrome, but caused by calcitonin
d. Carcinoid syndrome
e. Hypertrophic osteoarthropathy – this is not due to a hormone (and paraneoplastic syndromes are
hormone or cytokine mediated)?
25. Which of the following is not a paraneoplastic syndrome associated with lung carcinoma?
a. Ectopic ADH secretion - true
b. Dermatomyositis - ?
c. Migratory thrombophlebitis - ?
d. Eaton-Lambert (myasthenic) syndrome – this is associated, but not paraneoplastic syndrome!
e. Thrombocytosis - ?
26. The features of bronchogenic carcinoma include
a. The classification of “oat cell” tumour withing the large cell type
b. High initial response to chemotherapy for small cell type <- true
c. The strongest correlation with cigarette smoking in the adenocarcinoma type – squamous cell
d. That 50% of small cell type occur in non-smokers – 87% occur in smokers (or recent smokers)
e. Histological deatures identical in small cell carcinomas and squamous cell types
27. In lobar pneumonia:
a. It is more common in the young and elderly
b. Get a change from red to grey hepatisation
c. Not usually associated with a productive cough
d. Rarely caused by streptococcus
e. Associated with immunosuppression
28. obstructive atelectasis
a. the mediastinum moves away from lesion
b. involves the reabsorption of air
c. is caused by pleural fluid
d. ?
e. ?
29. Asthma shows all EXCEPT
a. Thinning of basement membrane <b. Submucosal gland hypertrophy
c. Hypertrophy of smooth muscle
d. Charcot Leyden crystals
e. Cushmann’s spirals
30. Regarding the use of steroids in Asthma
a. They inhibit cytokines
b. Cause bronchodilation
c. Given nocte because of diurnal variation
d. ?
e. ?
31. The most common type of emphysema associated with cigarette smoking is
a. Centrilobular <= i.e. centriacinar
b. Panacinar
c. Paraseptal
d. Irregular
e. Compensatory
32. In regards to bacterial pneumonia
a. A predominantly interstitial pattern of inflammation is seen in some paediatric patients
b. Most lobar pneumonias are caused by pneumococci which enter the lung haematogenously
c. Congestion predominates in the first 72 houes
d. Complications are more common with bronchopneumonias
e. Organisation of exudates into a fibrotic scar tissue is not a complication
33. Chronic bronchitis
a. Is twenty times more common in heavy smokers – 90% of patients are smokers
b. Is present in any patient with persistent cough with sputum production for at least two months in
three consecutive years
c. Is characterized by early functional respiratory impairment
d. Can progress to cor pulmonale and cardiac failure <– true, or COPD or cancer
e. Is a disease of the large airways – there is increase in goblet cells in small airways
34. Regarding emphysema
a. The commonest type is panacinar form
b. In centrilobular form, the distal alveoli are spared <=
c. In panacinar form, the upper lobes of the lungs are mainly affected - bases
d. In centrilobular form, the lower lobes of the lungs are mainly affected – upper lobes, ep appical
e. There is no association between cigarette smoking and emphysema
35. Features of atopic asthma include all of the following EXCEPT:
a. IgE production by beta-cells
b. Induction of TH1 cells <= TH1 are for the cellular immunity T-cell activation
c. Release of IL-4 and IL-5 – these stimulate immune responses Il4 -> TH2 production and IL5 in B
cell and eosiniphil production. Note also IL-1, IL-6 (activate epithelium) and IL-8 (chemotatic)
d. Growth of mast cells
e. Activation of eosinophils
36. Restrictive lung disease is characterized by
a. Acute inflammation of alveolar interstitium
b. Increased compliance
c. Ground glass appearance on chest X-ray film <d. Long term complication of mesothelioma
e. Increased lung volume
37. ARDS is associated with all of the following EXCEPT:
a. Interstitial fibrosis
b. Pulmonary vein obstruction
c. Hypoxaemia responsive to oxygen therapy
d. Radiation injury
e. DKA
38. In the lungs
a. Bacterial invasion evokes exudative liquification - suppuration
b. Bronchopneumonia is commonly caused by Chlamydia organisms
c. 90-95% of lobar pneumonias are caused by Streptococcus pneumoniae <- true
d. grey hepatisation is the first stage of the inflammatory response
e. bronchopneumonia shows characteristic radiological appearance of radio-opaque well
circumscribed lobe
39. Pulmonary oedema
a. Contains a protein rich fluid in the alveolar spaces
b. Fluid accumulates especially in the dependent apical regions of the lower lobe
c. In a chronic state, can result in interstitial fibrosis
d. Is not associated with ARDS
e. Can result from increased hydrostatic pressure such as in the nephritic syndrome
40. Characteristic histologic findings of asthma include:
a. Thinning of the basement membrane of the bronchial epithelium - no
b. Oedema and an inflammatory infiltrate in the bronchial walls with a prominence of plasma cells
c. An increase in size of the submucosal glands <- true
d. Atrophy of the bronchial wall muscle
e. Undistended lungs because of occlusion of bronchioles
41. Regarding the pathogenesis of COPD:
a. Macrophage elastase function is inhibited by alpha1-antitrypsin – tissue elastase
b. Cigarette smoking activates the classic complement pathway
c. Microbiologic infections initiate the changes
d. Cmokers have decreased numbers of neutrophils in their alveoli
e. Chronic bronchitis is up to 10 times more common in heavy smokers <- true, 90% of patients are
smokers
42. Regarding bacterial pneumonia
a. Lobar pneumonia is most often caused by staphylococci
b. Coliform bacteria are unlikely to cause bronchopneumonia
c. Particles larger than 10mm are deposited in terminal airways of alveoli
d. Lobar distribution is an indication of the virulence of the organism <- true
e. During resolution, the transudate is digested by enzymes
43. emphysema
a. is defined clinically as persistent cough with sputum production for at least three months in at least
two consecutive years
b. is defined morphologically as the abnormal enlargement of air spaces proximal to the terminal
bronchioles
c. is a restrictive lung disease
d. has airway dilation and scarring as its major pathological change
e. develops earlier in smokers with an alpha 1 antitrypsin deficiency
44. Regarding asthma
a. The inflammatory infiltrate of bronchial walls is predominantly neutrophils
b. Hypertrophy of bronchial wall muscle reflects prolonged bronchoconstriction
c. It is triggered by IgG response
d. Sympathetic stimulation provokes bronchoconstriction
e. Bacteria are the most common provokers of an acute attack
45. Regarding malignant mesothelioma
a. It is asbestos related in more than 90% of cases – is asbestos related up to 90%
b. It has been found to contain adenovirus DNA sequence – simian virus 40 DNA sequene
c. Smoking increases the risk of developing mesothelioma – is doesn’t (in contrast to lung carcinoma)
d. 50% of patients die within 6 months of diagnosis – 50% within 12 months
e. can contain epithelioid and sarcomatoid cells <- true