MCQ Book Questions

Q60382. A 10-year-old boy suffers head trauma and lies unconscious for 2 weeks. He is now intubated. His temperature rises to 38.7°C (103°F), and oxygenation becomes more diffi - cult. A chest X-ray reveals a pleural effusion and multiple abscesses in the lung parenchyma. Which of the following microorganisms is the most likely cause of this pulmonary infection?

Q60383. A 22-year-old man with AIDS complains of persistent cough, night sweats, low-grade fever, and general malaise. A chest X-ray reveals an area of consolidation in the periphery of the left upper lobe, as well as hilar lymphadenopathy. Sputum cultures show acid-fast bacilli. Which of the following is the most likely diagnosis?

Q60384. A 53-year-old man develops weakness, malaise, cough with bloody sputum, and night sweats. A chest X-ray reveals numerous apical densities bilaterally, some of which are cavi- tary. Exposure to Mycobacterium tuberculosis was documented 20 years ago, and M. tuberculosis is identifi ed in his sputum. Which of the following describes the expected lung pathology in this patient?

Q60385. A 48-year-old man with AIDS is admitted to the hospital with a fever of 38.7°C (103°F). The patient has a 2-week history of persistent cough and diarrhea. Laboratory studies show that the CD4+ cell count is less than 500/μL. A sputum culture reveals acid-fast organisms, which are further identifi ed as Mycobacterium avium-intracellulare. This patient’s pneumonia is characterized by extensive pulmonary infi ltrates of which of the following cell types?

Q60386. A 65-year-old man who is a heavy smoker complains of sud- den onset of malaise, fever, productive cough, abdominal pain, and muscle aches. A chest X-ray shows bilateral, diffuse, patchy, alveolar infi ltrates. Laboratory studies reveal that the patient is infected with Legionella pneumophila. This patient’s pneumonia is characterized by extensive pulmonary infi ltrates of which of the following cell types?

Q60387. A 16-year-old boy is rushed to the emergency room after sustaining a stab wound to the chest during a fi ght. Physi- cal examination reveals a 1-cm entry wound at the right 5th intercostal space in the midclavicular line. His temperature is 37°C (98.6°F), respirations are 35 per minute, and blood pressure is 90/50 mm Hg. A chest X-ray shows air in the right pleural space. Which of the following pulmonary conditions

Q60388. A 40-year-old woman with leukemia is treated with chemo- therapy. During treatment she develops increasing cough and shortness of breath. A chest X-ray shows diffuse lung infi l- trates. Sputum cultures are negative, and the patient does not respond to routine antibiotic therapy. An open lung biopsy is diagnosed by the pathologist as viral pneumonia. Which of the following histopathologic fi ndings would be expected in the lungs of this patient?

Q60389. A 38-year-old woman, who is being treated with corticos- teroids for systemic lupus erythematosus, presents with chronic nonproductive cough. She breeds pigeons for avian hobbyists. A chest X-ray reveals a 2-cm nodule in the upper lobe of the right lung. The lung nodule is resected. Histo- logic examination reveals granulomas and budding yeast forms, which stain positively for polysaccharides (mucicar- mine stain, shown in the image). What is the appropriate diagnosis?

Q60390. A 50-year-old woman presents with a 4-week history of fever, shortness of breath, and dry cough. She reports that her chest feels “tight.” The patient is a pigeon fancier. Blood tests show leukocytosis and neutrophilia, an elevated erythrocyte sedimentation rate, and increased levels of immunoglobulins and C-reactive protein. A lung biopsy reveals poorly formed granulomas composed of epithelioid macrophages and multi- nucleated giant cells. Which of the following is the appropri- ate diagnosis?

Q60391. A 55-year-old man is admitted to the hospital with increasing shortness of breath and dry cough for the past few years. He smokes 1.5 packs of cigarettes and drinks about four bottles of beer a day. He is constantly “gasping for air” and now walks with diffi culty because he becomes breathless after only a few steps. Prolonged expiration with wheezing is noted. Physical examination shows a barrel chest, hyperresonance on percus- sion, and clubbing of the digits. The patient’s face is puffy and red, and he has pitting edema of the legs. A chest X-ray discloses hyperinfl ation, fl attening of the diaphragm, and increased retrosternal air space. Which of the following is the appropriate diagnosis?

Q60392. A 62-year-old woman is rushed to the emergency room following an automobile accident. She has suffered internal injuries and massive bleeding and appears to be in a state of profound shock. Her temperature is 37°C (98.6°F), respira- tions are 42 per minute, and blood pressure is 80/40 mm Hg. Physical examination shows cyanosis and the use of acces- sory respiratory muscles. A CT scan of the chest is normal on arrival. Her condition is complicated by fever, leukocytosis, and a positive blood culture for staphylococci (sepsis). Two days later, the patient develops rapidly progressive respiratory distress, and a pattern of “interstitial pneumonia” can be seen on a chest X-ray. Which of the following is the most likely diagnosis?

Q60393. A 64-year-old woman who has suffered shock and sepsis experiences declining respiratory function and is placed on a ventilator. Despite intensive therapy, the patient dies 3 weeks later in respiratory failure. Histologic examination of the lungs at autopsy is shown in the image. Which of the following best describes the pathologic fi ndings in this autopsy specimen?

Q60394. An 8-year-old girl is brought into the physician’s offi ce in mild respiratory distress. She has a history of allergies to cats and wool, and her parents state that she has recurrent epi- sodes of upper respiratory tract infections. Physical examina- tion shows expiratory wheezes, use of accessory respiratory muscles, and a hyperresonant chest to percussion. Analysis of arterial blood gases discloses respiratory alkalosis, and the peripheral eosinophil count is increased. What is the appro- priate diagnosis?

Q60395. A 10-year-old boy dies following a severe episode of status asthmaticus. Histologic examination of the lung at autopsy is shown in the image. Which of the following best describes the pathologic features evident in this autopsy specimen?

Q60396. Which of the following best describes the expected histopathology of the lungs in the patient described in Question 22?

Q60397. A 35-year-old woman with a long history of dyspnea, chronic cough, sputum production, and wheezing dies of respiratory failure following a bout of lobar pneumonia. She was a non- smoker and did not drink alcoholic beverages. The lung at autopsy is shown in the image. Which of the following under- lying conditions was most likely associated with the patho- logic changes shown here?

Q60398. A 55-year-old man was admitted to the hospital with a chief com- plaint of increasing shortness of breath over the past several years. The patient was a heavy smoker over the past 40 years. Physical examination reveals cyanosis, elevated jugular venous pressure, and peripheral edema. A high-resolution CT scan shows bullae over both lungs. Chronic intra-alveolar exposure to which of the following proteins is most likely associated with the pathogenesis of chronic obstructive pulmonary disease in this patient?

Q60399. A 69-year-old retired man is brought to the emergency depart- ment because he experienced sudden onset of left-sided chest pain, which is exacerbated upon inspiration. He is taking no medications and has been in good health. Physical examina- tion reveals dyspnea and hemoptysis. Temperature is 38°C (101°F), pulse rate is 98 per minute, respirations are 35 per minute, and blood pressure is 158/100 mm Hg. A pleural fric- tion rub is present on auscultation. The left leg is markedly edematous, with a positive Homans’ sign. An ECG shows a normal sinus rhythm. A chest X-ray reveals a left pleural effu- sion. What is the most likely cause of this patient’s pulmonary condition?

Q60400. A 25-year-old black woman presents with a 3-month history of cough and shortness of breath on exertion. A chest X-ray reveals enlargement of hilar and mediastinal lymph nodes. Laboratory studies show elevated serum levels of angiotensin- converting enzyme and an increase in 24-hour urine calcium excretion. An open-lung biopsy is shown in the image. Stains for microorganisms in the tissue are negative. Which of the following is the most likely diagnosis?

Q60401. A 43-year-old woman with Sjögren syndrome and a 5-year history of cough and shortness of breath develops end-stage lung disease and dies of respiratory failure. Histologic exami- nation of the lung at autopsy is shown in the image. Which of the following is the most likely diagnosis?