Respiratory system pathology MCQs — Past Paper OmpathStudy

Respiratory system pathology mcqs — Questions and Answers Complete review bank: 45 questions recovered from all 32 source pages. 1. An 8-year-old boy at birth appeared to be a normal term baby, but his neontal course was complicated by the development of meconium ileus. His sweat chloride and immunoreactive trypsinogen are both found to be elevated. Throughout childhood he has experienced multiple increasingly severe bouts of pneumonia with a productive cough, often with Pseudomonas aeruginosa, and later Burkholderia cepacea, cultured from sputum. He is at greatest risk for development of which of the following pulmonary abnormalities? A. Adenocarcinoma B. Bronchiectasis C. Lymphangiectasis D. Pleural fibrous plaques E. Pneumocystis jiroveci pneumonia F. Pneumothorax Answer: B. The chronic lung disease of cystic fibrosis often includes bronchiectasis, a disease characterized by inflammation with obstruction and dilation and destruction of bronchi. This process is diffuse throughout the lungs. The loss of pulmonary vascular bed with progressive bronchiectasis can lead to pulmonary hypertension and cor pulmonale. The sweat chloride is a good screening test, and can be applied as well as immunoreactive trypsinogen, to select for additional genomic testing, but testing is confounded by hundreds of possible CFTR gene mutations. 2. A 70-year-old woman at an extended care facility for the past two years has increasing inability to perform activities of daily living. She can no longer recognize family members. She is lethargic and spends most of her days in a wheelchair or in bed. She develops an acute febrile illness and is noted to be coughing up increasing quantities of yellowish sputum. Her temperature is 38°C. A chest x-ray shows infiltrates involving the left lower lobe. A sputum sample shows numerous neutrophils and gram-positive diplococci. Which of the following infectious agents is most likely to cause her pulmonary disease? A. Pneumocystis jiroveci B. Listeria monocytogenes C. Cryptococcus neoformans D. Mycobacterium tuberculosis E. Legionella pneumophila F. Staphylococcus aureus G. Streptococcus pneumoniae H. Influenza A virus Answer: G. She has a lobar pneumonia, which is most often a community aquired pneumonia (the nursing home counts as a community venue), following a debilitating course of Alzheimer disease. The most common organism is Streptococcus pneumoniae (pneumococcus). 3. An 11-year-old girl has experienced dyspnea for the past 2 weeks. Her temperature is 37.3°C, pulse 85/minute, respiratory rate 30/minute, and blood pressure 110/60 mm Hg. On physical examination, her lung fields are clear to auscultation. Her heart rate is regular and no murmurs or gallops are heard. A chest radiograph shows prominent hilar lymphadenopathy along with a 1 cm peripheral right middle lobe nodule. No infiltrates are present. A sputum gram stain shows normal flora and routine bacterial culture reveals no pathogens. Which of the following conditions is she most likely to have? A. Hypersensitivity pneumonitis B. Mycobacterium tuberculosis infection C. Bronchial carcinoid tumor D. Infective endocarditis E. Goodpasture syndrome Answer: B. This is a description of the typical 'Ghon complex' of an initial, or primary, TB infection. The peripheral granuloma does not produce symptoms, but the enlarged lymph nodes may impinge upon airways. Most persons with a primary infection, however, are asymptomatic and the infection goes unnoticed. 4. On the 11th postoperative day following a radical prostatectomy for adenocarcinoma, a 70-year-old man is recovering uneventfully. He then ambulates to the bathroom, but upon returning to his bed he suddenly becomes extremely dyspneic and diaphoretic, with chest pain, palpitations, and a feeling of panic. Which of the following post-operative pulmonary complications has he most likely developed? A. Pulmonary edema B. Pleural effusion C. Atelectasis D. Thromboembolus E. Diffuse alveolar damage Answer: D. The activity of ambulation resulted in embolization of a thrombus that formed during his period of immobilization in leg or pelvic veins. The thrombus became an embolus and traveled up the vena cava, through the right heart, and to the pulmonary arterial tree of the lungs. 5. A 50-year-old woman has lived in Stockholm, Sweden all her life and worked as a seamstress. She is a non-smoker, but she has had increasing shortness of breath, fever, weight loss, and night sweats for the past 4 months. On physical examination her temperature is 37.6°C. There are fine rales auscultated in all lung fields. A chest radiograph reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. She demonstrates anergy by skin testing to mumps and Candida antigens. A transbronchial biopsy is performed that microscopically shows numerous small pulmonary interstitial non-caseating granulomas. Which of the following is the most likely diagnosis? A. Histoplasmosis B. Adenocarc