MCQ Book Questions

Q60402. A 65-year-old coal miner is admitted for evaluation of chronic lung disease. The patient admits to smoking one pack of cigarettes a day for 40 years. On physical examination, he is noticed to have a barrel chest and use accessory muscles for inspiration. His face is puffy and red. He has 2+ pitting edema of the lower extremities. A chest X-ray is compatible with dif- fuse fi brosis, with some nodularity in central areas. Which of the following is the most likely diagnosis?

Q60403. A 30-year-old woman presents with shortness of breath and bloody sputum. Physical examination reveals pulmonary crackles and abdominal ascites. A chest X-ray shows bilat- eral pleural effusions and marked hyperinfl ation of the lungs. A CT scan of the chest discloses thin-walled, air-containing cysts in a diffuse symmetric pattern. A lung biopsy is shown in the image. The patient responds favorably to antiestrogen and antiprogesterone therapy. Which of the following is the most likely diagnosis?

Q60404. A 22-year-old man presents with a 6-month history of increas- ing shortness of breath and persistent cough with rusty spu- tum. A chest X-ray shows diffuse bilateral alveolar infi ltrates. Urine dipstick analysis reveals 2+ hematuria. A transbronchial lung biopsy is shown in the image. Linear deposits of IgG and complement C3 are detected in the alveolar basement mem- brane by immunofl uorescence. Which of the following is the most likely diagnosis?

Q60405. A 23-year-old man complains of nasal obstruction, sero- sanguinous discharge, cough, and bloody sputum. A chest X-ray shows cavitated lesions and multiple nodules over both lung fi elds. A CT scan discloses obliteration of several maxillary sinuses. Urinalysis reveals hematuria and RBC casts. Laboratory studies demonstrate anemia and elevated serum levels of C-ANCA. An open-lung biopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60406. A 55-year-old woman complains of sudden onset of fever, dry cough, and shortness of breath. She was seen for fl u-like symptoms 6 weeks ago. A chest X-ray shows bilateral patchy alveolar consolidations. An open-lung biopsy reveals narrow infl amed airways containing plugs of fi brous tissue (shown in the image). Which of the following is the most likely diagnosis?

Q60407. A 45-year-old woman with severe kyphoscoliosis presents with fatigue, shortness of breath on exertion, fainting spells, and bloody sputum. A CBC is normal. Physical examination shows splitting of the second heart sound with accentuation of the pulmonic component, distended neck veins with a

Q60408. A 28-year-old man presents with 6 days of fever and shortness of breath. His temperature is 38.7°C (103°F), respirations are 30 per minute, and blood pressure is 120/80 mm Hg. A chest X-ray reveals diffuse interstitial and alveolar infi ltrates. Spu- tum cultures are negative, and the patient does not respond to standard antibiotic therapy. A transbronchial lung biopsy is shown in the image. Which of the following is the appropriate diagnosis?

Q60409. A 68-year-old man complains of shortness of breath, hoarse- ness, productive cough, and bloody sputum of 2 weeks in dura- tion. He admits to smoking two packs a day for 45 years and drinks occasionally. Recently, he has experienced a signifi cant loss of appetite and weight loss. Physical examination shows pallor, cachexia, clubbing of the fi ngers, and barrel-shaped chest. A chest X-ray reveals a mass at the right lung apex. His- tologic examination of a transbronchial biopsy is shown in the image. What is the appropriate histologic diagnosis?

Q60410. A 53-year-old woman with a history of cigarette smoking pres- ents with a 3-month history of chest pain, cough, and mild fever. A chest X-ray reveals a peripheral mass in the left upper lobe. The surgical specimen is shown in the image. What is the most likely diagnosis? prominent V wave, a right ventricular third heart sound, and peripheral edema. A chest X-ray fi lm shows enlargement of the central pulmonary arteries. A transbronchial lung biopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60411. A 56-year-old man with a history of cigarette smoking pres- ents with diffi culty swallowing and a muffl ed voice. Laryngos- copy reveals a 2-cm laryngeal mass. If this mass is a malignant neoplasm, which of the following is the most likely histologic diagnosis?

Q60412. A 67-year-old woman with a history of smoking presents with a 3-week history of chest pain and bloody sputum. A chest X-ray reveals a bulky mass within the pulmonary parenchyma. An open-lung biopsy is shown in the image. Immunohistochemical stains for keratin and chromogranin are negative. What is the appropriate diagnosis?

Q60413. A 58-year-old man presents with a long history of persis- tent cough, chest pain, and recurrent pneumonia. He denies smoking or consuming alcohol. The patient subsequently dies of sepsis. Autopsy reveals malignant cells that diffusely infi ltrate the lung parenchyma. Histopathologic examina- tion of the lung shows well-differentiated, mucus-producing, columnar neoplastic cells lining the alveolar spaces (shown in the image). Neoplastic cells are not found in any other organ. What is the most likely diagnosis?

Q60414. A 52-year-old woman presents with a 1-year history of upper truncal obesity and moderate depression. Physical examina- tion shows hirsutism and moon facies. Endocrinologic stud- ies reveal hypokalemia, high plasma corticotropin levels, and increased concentrations of serum and urine cortisol. CT scan of the thorax demonstrates a hilar mass. A transbronchial lung biopsy is shown in the image. Electron microscopy discloses neuroendocrine granules within the cytoplasm of some tumor cells. What is the appropriate diagnosis?

Q60415. A 55-year-old man presents with increasing chest pain, bloody sputum, and weight loss over the past 3 months. A high- resolution CT scan reveals a mass circumscribing the right main bronchus, extending into its lumen. Histologic examina- tion of an open-lung biopsy is shown in the image. Electron microscopy shows numerous neuroendocrine granules within tumor cells. What is the appropriate diagnosis?

Q60416. A 35-year-old man complains of diffi culty swallowing and a tendency to regurgitate his food. Endoscopy does not reveal any esophageal or gastric abnormalities. Manometric stud- ies of the esophagus show a complete absence of peristalsis, failure of the lower esophageal sphincter to relax upon swal- lowing, and increased intraesophageal pressure. Which of the following is the most likely diagnosis?

Q60417. A 20-year-old woman presents with a 2-year history of diffi culty swallowing and increasing fatigue. A CBC shows iron-defi ciency anemia. Upper endoscopy reveals an annular narrowing in the upper third of the esophagus. A mucosal biopsy shows no evidence of infl ammation or neoplasia. Which of the following is the most likely diagnosis?

Q60418. A 45-year-old woman presents with general discomfort and increasing tightness in the skin of her face. She reports inter- mittent pain in the tips of her fi ngers when exposed to the cold. Physical examination shows “stone facies” and edema of the fi ngers and hands. Serologic tests for antinuclear and anti–Scl-70 antibodies are both positive. Which of the fol- lowing gastrointestinal manifestations is expected in this patient?

Q60419. A 54-year-old man with a long history of indigestion after meals and “heartburn” presents with upper abdominal pain. He was treated with proton-pump inhibitors for gastroesopha- geal refl ux 3 years previously. An endoscopic biopsy of the lower esophagus is shown in the image. Which of the follow- ing best describes these pathologic fi ndings?

Q60420. The patient described in Question 4 is at increased risk of developing which of the following diseases of the esophagus?

Q60421. Which of the following is the most important risk factor for development of the esophageal mass identifi ed in the patient described in Question 10?