Path 15b Flashcards

Which definition best describes pneumonia?

A. Infection of lung parenchyma

B. Inflammation of pleural space

C. Obstruction of pulmonary arteries

D. Collapse of distal airways

Which impairment can predispose a patient to pneumonia by reducing clearance of aspirated material?

A. Increased respiratory drive

B. Lack of cough reflex

C. Increased alveolar ventilation

D. Enhanced surfactant production

A patient develops pneumonia after airway epithelial injury. Which protective mechanism was most likely impaired?

A. Pulmonary vascular filtration

B. Alveolar gas diffusion

C. Mucociliary escalator

D. Pleural fluid drainage

Which airway abnormality can promote pneumonia by preventing normal secretion clearance?

A. Increased surfactant release

B. Pulmonary vasodilation

C. Increased respiratory rate

D. Mucus plugging

A patient with pneumonia develops fever and chills. According to these notes, what most directly explains these systemic findings?

A. Organisms enter bloodstream

B. Mucus obstructs bronchi

C. Pleural pressure decreases

D. Alveoli become hyperinflated

A patient with pneumonia produces thick yellow-green sputum. What does this appearance most strongly indicate?

A. Pulmonary edema

B. Purulent material

C. Pleural transudate

D. Airway hemorrhage

Which sputum description can occur when pneumonia produces blood-containing respiratory secretions?

A. Clear sputum

B. White sputum

C. Rusty sputum

D. Frothy sputum

A patient with pneumonia has sharp pain worsened by inspiration. Which inflammatory mediators contribute to this pleuritic pain?

A. Histamine and serotonin

B. Leukotrienes and thromboxane

C. Dopamine and norepinephrine

D. Bradykinin and PGE2

Why can pneumonia produce dullness to percussion over the affected lung?

A. Increased pulmonary air volume

B. Exudate replaces normal air

C. Bronchi become hyperinflated

D. Pleural pressure becomes positive

Which laboratory finding commonly supports an infectious cause of pneumonia?

A. Decreased platelet count

B. Reduced hematocrit

C. Elevated WBC count

D. Decreased serum sodium

Which combination is used to diagnose pneumonia according to these notes?

A. ECG and echocardiography

B. CT angiography and D-dimer

C. Spirometry and bronchoscopy

D. X-ray and cultures

Which microbiologic studies are specifically listed for evaluating pneumonia?

A. Blood and sputum cultures

B. Urine and stool cultures

C. CSF and blood cultures

D. Skin and sputum cultures

Which respiratory pattern is part of the clinical presentation of pneumonia?

A. Bradypnea

B. Tachypnea

C. Apnea

D. Cheyne-Stokes breathing

Which three radiographic patterns of pneumonia are described in these notes?

A. Lobar, bronchial, pleural

B. Lobar, bronchopneumonia, interstitial

C. Alveolar, pleural, vascular

D. Bronchial, vascular, interstitial

A chest X-ray shows pneumonia involving an entire pulmonary lobe. Which pattern is most likely?

A. Lobar pneumonia

B. Interstitial pneumonia

C. Bronchopneumonia

D. Atypical bronchitis

Which feature best characterizes bronchopneumonia?

A. Entire lobe involvement

B. Isolated pleural inflammation

C. Multifocal peribronchiolar involvement

D. Diffuse alveolar consolidation

A patient has inflammation primarily involving the pulmonary interstitium without air-sac consolidation. Which pattern is present?

A. Lobar pneumonia

B. Bronchopneumonia

C. Pleural pneumonia

D. Interstitial pneumonia

Which chest X-ray finding is most associated with interstitial pneumonia?

A. Increased lung markings

B. Complete lobar collapse

C. Pleural air collection

D. Isolated hilar mass

Which pneumonia pattern is also called atypical pneumonia?

A. Bronchopneumonia

B. Interstitial pneumonia

C. Lobar pneumonia

D. Aspiration pneumonia

Why are certain causes of interstitial pneumonia called atypical bacteria?

A. They cause lobar necrosis

B. They infect only bronchi

C. They require special growth media

D. They cannot infect humans

Besides atypical bacteria, which pathogens can cause interstitial pneumonia?

A. Helminths

B. Protozoa

C. Fungi

D. Viruses

Which organism is listed as the most common cause of lobar pneumonia?

______ ______

Which organism is listed as another cause of lobar pneumonia?

A. Chlamydophila

B. Mycoplasma pneumoniae

C. Klebsiella pneumoniae

D. Legionella

Which organism is also listed as causing lobar pneumonia?

A. Legionella

B. Chlamydophila

C. Mycoplasma pneumoniae

D. Haemophilus influenzae

What is the listed treatment for lobar pneumonia?

______

Which statement best describes bronchopneumonia etiology?

A. Usually viral

B. Mostly bacterial

C. Usually fungal

D. Mostly parasitic

Which atypical bacterium can cause interstitial pneumonia?

A. Klebsiella pneumoniae

B. Haemophilus influenzae

C. Mycoplasma pneumoniae

D. Streptococcus pneumoniae

Which organism is listed among bacterial causes of atypical pneumonia?

A. Streptococcus pneumoniae

B. Klebsiella pneumoniae

C. Haemophilus influenzae

D. Chlamydophila

Which organism is included among atypical pneumonia causes in these notes?

A. Legionella

B. Klebsiella

C. Streptococcus

D. Haemophilus

A chest X-ray shows multiple scattered areas centered around bronchioles. Which pattern is most likely?

A. Interstitial pneumonia

B. Lobar pneumonia

C. Bronchopneumonia

D. Pleural infection

Which pneumonia pattern typically lacks consolidation of the air sacs?

A. Lobar pneumonia

B. Bronchopneumonia

C. Bacterial lobar pneumonia

D. Interstitial pneumonia

Which organism is the most common cause of community-acquired pneumonia?

_____ _____

A patient aspirates enteric flora and develops lobar pneumonia. Which organism is most likely?

A. Klebsiella pneumoniae

B. Moraxella catarrhalis

C. Haemophilus influenzae

D. Staphylococcus aureus

An alcoholic develops severe lobar pneumonia after aspiration. Which organism is classically associated?

A. Pseudomonas aeruginosa

B. Streptococcus pneumoniae

C. Legionella pneumophila

D. Klebsiella pneumoniae

A patient with pneumonia produces thick currant-jelly sputum. Which pathogen is most likely?

A. Klebsiella pneumoniae

B. Legionella pneumophila

C. Streptococcus pneumoniae

D. Pseudomonas aeruginosa

What bacterial feature contributes to the thick sputum seen with Klebsiella pneumonia?

A. Intracellular replication

B. Thick mucoid capsule

C. Exotoxin production

D. Endospore formation

Which complication is commonly associated with Klebsiella pneumonia?

A. Pleural fibrosis

B. Pulmonary embolism

C. Lung abscess

D. Pneumothorax

Which organism is the most common cause of secondary pneumonia?

A. Staphylococcus aureus

B. Streptococcus pneumoniae

C. Klebsiella pneumoniae

D. Pseudomonas aeruginosa

Staphylococcus aureus pneumonia is particularly likely to follow which condition?

A. Pulmonary embolism

B. Viral respiratory infection

C. Pleural effusion

D. Chronic sinusitis

Which complication is commonly associated with Staphylococcus aureus pneumonia?

A. Pulmonary hypertension

B. Bronchiectasis

C. Lung abscess

D. Pneumothorax

A patient develops free pus within the pleural space after pneumonia. What complication has occurred?

A. Atelectasis

B. Hemothorax

C. Pneumothorax

D. Empyema

Which pneumonia pathogen is commonly associated with abscess or empyema?

_____ _____

A patient with COPD develops secondary bacterial pneumonia. Which organism should be strongly considered?

A. Staphylococcus aureus

B. Klebsiella pneumoniae

C. Haemophilus influenzae

D. Streptococcus pneumoniae

Which organism is associated with pneumonia in cystic fibrosis patients?

_____ _____

Which organism is associated with COPD and community-acquired infection?

_____ _____

A patient develops pneumonia after exposure to a contaminated water source. Which pathogen is most likely?

A. Klebsiella pneumoniae

B. Pseudomonas aeruginosa

C. Moraxella catarrhalis

D. Legionella pneumophila

Which patient is especially predisposed to Legionella pneumonia?

A. Patient with COPD

B. Patient with hypertension

C. Patient with diabetes

D. Patient with hyperthyroidism

Besides COPD, which state increases susceptibility to Legionella pneumonia?

A. Hypercoagulable state

B. Immunocompromised state

C. Hyperthyroid state

D. Hemolytic state

Which organism is intracellular and can be visualized with silver stain?

A. Staphylococcus aureus

B. Klebsiella pneumoniae

C. Legionella pneumophila

D. Streptococcus pneumoniae

A patient presents with pneumonia, diarrhea, and hyponatremia. Which organism is most likely?

A. Pseudomonas aeruginosa

B. Haemophilus influenzae

C. Moraxella catarrhalis

D. Legionella pneumophila

Which organism is the most common cause of atypical pneumonia?

_____ _____

A young adult living in close quarters develops atypical pneumonia. Which organism is most likely?

A. Mycoplasma pneumoniae

B. Influenza virus

C. Coxiella burnetii

D. Cytomegalovirus

Which population is classically associated with Mycoplasma pneumoniae infection?

A. Nursing-home residents

B. Transplant recipients

C. Military recruits

D. Veterinary workers

A college student living in a dormitory develops atypical pneumonia. Which pathogen is most likely?

A. Coxiella burnetii

B. Cytomegalovirus

C. Influenza virus

D. Mycoplasma pneumoniae

A patient with atypical pneumonia develops autoimmune hemolytic anemia. Which pathogen is most likely?

A. Mycoplasma pneumoniae

B. Chlamydia pneumoniae

C. Influenza virus

D. Coxiella burnetii

Mycoplasma-associated autoimmune hemolytic anemia involves IgM directed against what?

A. Platelet antigen

B. RBC I antigen

C. Neutrophil antigen

D. Alveolar antigen

Which skin complication can occur with Mycoplasma pneumoniae infection?

A. Erythema nodosum

B. Petechiae

C. Erythema multiforme

D. Urticaria

Which organism is the second most common atypical pneumonia cause in young adults?

A. Mycoplasma pneumoniae

B. Coxiella burnetii

C. Cytomegalovirus

D. Chlamydia pneumoniae

Which pathogen is the most common cause of pneumonia in infants?

A. Respiratory syncytial virus

B. Influenza virus

C. Cytomegalovirus

D. Mycoplasma pneumoniae

A transplant recipient receiving immunosuppressive therapy develops pneumonia. Which pathogen is associated with this setting?

A. Influenza virus

B. Cytomegalovirus

C. Coxiella burnetii

D. Chlamydia pneumoniae

Which viral pneumonia is commonly seen in elderly patients?

A. Cytomegalovirus

B. RSV

C. Influenza virus

D. Mycoplasma pneumoniae

Influenza pneumonia is especially common in which patients?

A. Healthy young adults

B. Only newborn infants

C. Farmers and veterinarians

D. Immunocompromised patients

A patient with preexisting lung disease develops viral pneumonia. Which virus is commonly associated?

A. Influenza virus

B. Cytomegalovirus

C. Respiratory syncytial virus

D. Epstein-Barr virus

Influenza infection increases the risk of secondary pneumonia from which organism?

A. Legionella pneumophila

B. Staphylococcus aureus

C. Coxiella burnetii

D. Mycoplasma pneumoniae

Which additional organism can cause secondary pneumonia following influenza?

A. Chlamydia pneumoniae

B. Coxiella burnetii

C. Haemophilus influenzae

D. Cytomegalovirus

A farmer develops pneumonia with high fever. Which pathogen is most associated with this presentation?

A. Mycoplasma pneumoniae

B. Influenza virus

C. Cytomegalovirus

D. Coxiella burnetii

Which occupational group is particularly associated with Coxiella burnetii infection?

A. Farmers and veterinarians

B. College students

C. Military recruits

D. Nursing-home residents

Coxiella burnetii infection is classically known as what?

A. Valley fever

B. Q fever

C. Scarlet fever

D. Rheumatic fever

Unlike typical rickettsial organisms, Coxiella burnetii does not require what for transmission?

A. Respiratory droplets

B. Contaminated water

C. Arthropod vectors

D. Direct skin contact

Which feature distinguishes Coxiella burnetii from many rickettsial infections?

A. Causes severe rash

B. Requires arthropods

C. Causes hemolysis

D. Does not produce rash

Which statement about Coxiella burnetii is correct?

A. It can cause pneumonia

B. It requires arthropod transmission

C. It commonly causes rash

D. It primarily affects infants

How is Coxiella burnetii transmitted according to these notes?

A. Mosquito bites

B. Inhaled spores

C. Sexual contact

D. Contaminated water

Which sequence correctly describes lobar pneumonia progression?

A. Resolution, congestion, red, gray

B. Red, congestion, gray, resolution

C. Congestion, red, gray, resolution

D. Gray, red, congestion, resolution

What primarily characterizes the congestion phase of lobar pneumonia?

A. RBC breakdown

B. Type II cell regeneration

C. Neutrophil disappearance

D. Pulmonary edema

During which lobar pneumonia phase do neutrophils and RBCs accumulate in exudate?

A. Red hepatization

B. Gray hepatization

C. Resolution

D. Congestion

Why is the term “hepatization” used in lobar pneumonia?

A. Liver enzymes become elevated

B. Lung becomes firm like liver

C. Infection spreads into liver

D. Hepatic blood enters lungs

What makes the lung firm during red hepatization?

A. Loss of surfactant

B. Fibrotic scar formation

C. Fluid-filled inflammatory exudate

D. Bronchial smooth muscle contraction

Which event produces the gray appearance during gray hepatization?

A. Neutrophil recruitment

B. Pulmonary edema

C. Type II cell proliferation

D. Breakdown of RBCs

Which phase follows red hepatization in lobar pneumonia?

A. Gray hepatization

B. Congestion

C. Resolution

D. Fibrosis

During which phase is damaged lung tissue regenerated?

A. Congestion

B. Resolution

C. Red hepatization

D. Gray hepatization

Which cells regenerate lung tissue during resolution?

A. Type I pneumocytes

B. Alveolar macrophages

C. Type II pneumocytes

D. Bronchial epithelial cells

A comatose patient develops aspiration pneumonia. Which factor most directly increased the risk?

A. Chronic hypertension

B. Impaired airway protection

C. Increased respiratory drive

D. Pulmonary vasodilation

Which patient is specifically listed as at risk for aspiration pneumonia?

A. Young athlete

B. Pregnant patient

C. Hypertensive patient

D. Patient with alcoholism

Aspiration pneumonia is commonly caused by which organisms?

A. Anaerobic oropharyngeal bacteria

B. Aerobic skin flora

C. Enteric viruses

D. Intracellular parasites

Which organism is listed as causing aspiration pneumonia?

A. Mycoplasma

B. Legionella

C. Bacteroides

D. Chlamydia

Which organism is among the aspiration pneumonia pathogens listed?

A. Staphylococcus

B. Fusobacterium

C. Mycoplasma

D. Coxiella

Which organism is listed among aspiration pneumonia causes?

A. Moraxella

B. Chlamydia

C. Coxiella

D. Peptococcus

Which organism is also listed as causing aspiration pneumonia?

A. Mycoplasma pneumoniae

B. Legionella pneumophila

C. Klebsiella

D. Cytomegalovirus

What is the classic presentation of aspiration pneumonia in these notes?

A. Right lower lobe abscess

B. Bilateral pleural effusions

C. Left apical cavitation

D. Diffuse interstitial markings

How is primary tuberculosis initially acquired?

A. Fecal-oral transmission

B. Arthropod transmission

C. Blood transfusion

D. Inhalation of bacteria

Which pathologic process characterizes primary tuberculosis?

A. Noncaseating granulomas

B. Focal caseating necrosis

C. Diffuse alveolar damage

D. Suppurative abscess formation

Primary tuberculosis classically produces caseating necrosis in which lung region?

A. Lower lobe

B. Upper lobe

C. Lung apex

D. Pleural cavity

Primary tuberculosis classically also involves which structures?

A. Cervical vertebrae

B. Renal glomeruli

C. Hilar lymph nodes

D. Pleural membranes

Fibrosis and calcification of primary TB foci produce what structure?

A. Pott lesion

B. Ghon complex

C. Miliary focus

D. Empyema

How do most patients with primary tuberculosis present?

A. Severe hemoptysis

B. Profound weight loss

C. High fever

D. Mostly asymptomatic

Primary tuberculosis infection eventually leads to which test result?

A. Negative sputum stain

B. Negative chest X-ray

C. Positive PPD

D. Positive heterophile test

Secondary tuberculosis is also known by which term?

A. Reactivated tuberculosis

B. Congenital tuberculosis

C. Primary tuberculosis

D. Latent pneumonia

Which condition predisposes a patient to secondary tuberculosis?

A. Hyperthyroidism

B. Hypertension

C. Iron deficiency

D. Immunosuppression

Which disease is specifically associated with secondary tuberculosis?

A. COPD

B. AIDS

C. Asthma

D. Diabetes insipidus

Which demographic factor predisposes to secondary tuberculosis?

A. Old age

B. Adolescence

C. Childhood

D. Pregnancy

Secondary tuberculosis usually affects which lung region?

A. Lower lobes

B. Middle lobes

C. Upper lobes

D. Hilar nodes

Which pathologic finding can occur in secondary tuberculosis?

A. Noncaseating granulomas

B. Multiple focal caseating necroses

C. Hyaline membrane formation

D. Diffuse pulmonary edema

Secondary tuberculosis can disseminate into which form?

A. Lobar pneumonia

B. Empyema

C. Lung abscess

D. Miliary tuberculosis

Which additional pulmonary pattern can secondary tuberculosis produce?

A. Interstitial fibrosis

B. Lobar hepatization

C. TB bronchopneumonia

D. Pulmonary infarction

Which symptom combination is typical of secondary tuberculosis?

A. Fevers and night sweats

B. Bradycardia and flushing

C. Diarrhea and hyponatremia

D. Wheezing and stridor

Which respiratory symptom strongly suggests secondary tuberculosis?

A. Dry cough

B. Inspiratory stridor

C. Purulent rhinorrhea

D. Cough with hemoptysis

Which constitutional finding commonly occurs in secondary tuberculosis?

A. Weight gain

B. Weight loss

C. Peripheral edema

D. Facial swelling

What is the most common organ involved in miliary tuberculosis spread?

A. Kidney

B. Liver

C. Spleen

D. Heart

Renal involvement from miliary tuberculosis classically causes what finding?

A. Gross proteinuria

B. Hemoglobinuria

C. Sterile pyuria

D. Glucosuria

Miliary tuberculosis classically spreads to which meningeal location?

A. Cerebral cortex

B. Base of brain

C. Spinal cord

D. Dural sinuses

Which lymph nodes are a classic site of miliary TB spread?

A. Hilar nodes

B. Inguinal nodes

C. Cervical nodes

D. Popliteal nodes

Which vertebral region is classically involved by disseminated tuberculosis?

A. Cervical vertebrae

B. Thoracic vertebrae

C. Sacral vertebrae

D. Lumbar vertebrae

Tuberculosis involving the lumbar vertebrae is called what?

A. Pott disease

B. Ghon disease

C. Paget disease

D. Still disease

Which cell type lines the pleura?

A. Mesothelial cells

B. Type I pneumocytes

C. Ciliated epithelial cells

D. Alveolar macrophages

Which structure is responsible for producing pleural fluid?

A. Alveolar macrophages

B. Mesothelial cells

C. Type II pneumocytes

D. Bronchial epithelial cells

A healthy pleural surface is normally lined by which tissue-associated cell type?

A. Endothelial cells

B. Squamous pneumocytes

C. Mesothelial cells

D. Goblet cells

A young adult suddenly develops a spontaneous pneumothorax. Which underlying event is most likely?

A. Pleural fluid accumulation

B. Penetrating chest injury

C. Mesothelial cell proliferation

D. Rupture of emphysematous blebs

Spontaneous pneumothorax is particularly associated with which population?

A. Young adults

B. Elderly adults

C. Neonates

D. Nursing-home residents

A chest X-ray shows pneumothorax with the trachea deviated toward the affected side. Which diagnosis best fits?

A. Pleural effusion

B. Spontaneous pneumothorax

C. Tension pneumothorax

D. Mesothelioma

In spontaneous pneumothorax, the trachea deviates in which direction?

A. Away from collapse

B. Toward mediastinum

C. Toward collapsed side

D. Without any deviation

A patient develops pneumothorax after a penetrating chest-wall injury. Which type is most likely?

A. Spontaneous pneumothorax

B. Simple pleural effusion

C. Mesothelioma

D. Tension pneumothorax

Which finding distinguishes tension from spontaneous pneumothorax in these notes?

A. Young adult presentation

B. Pleural fluid production

C. Contralateral tracheal deviation

D. Mesothelial cell lining

A patient has a tension pneumothorax with contralateral tracheal deviation. What management is indicated?

A. Chest tube

B. Observation

C. Antibiotic therapy

D. Bronchodilator therapy

Why is tension pneumothorax clinically important according to these notes?

A. Usually asymptomatic

B. It is a medical emergency

C. It resolves without treatment

D. It only affects young adults

Mesothelioma is a malignant neoplasm derived from which cells?

A. Alveolar epithelial cells

B. Bronchial epithelial cells

C. Mesothelial cells

D. Pulmonary endothelial cells

A patient with mesothelioma repeatedly develops fluid within the pleural space. Which presentation is this?

A. Lobar consolidation

B. Tension pneumothorax

C. Pulmonary abscess

D. Recurrent pleural effusion

Why can mesothelioma produce recurrent pleural effusions?

A. Mesothelial cells produce pleural fluid

B. Pneumocytes produce excess surfactant

C. Bronchioles secrete pleural fluid

D. Alveoli directly fill pleural space

Which additional finding can occur with mesothelioma?

A. Bilateral hilar adenopathy

B. Lung encasement by tumor

C. Apical cavitary lesions

D. Diffuse mucus plugging

A malignant tumor surrounds and encases the lung while causing recurrent pleural effusions. Which diagnosis is most likely?

A. Lobar pneumonia

B. Spontaneous pneumothorax

C. Mesothelioma

D. Bronchopneumonia

What is the prognosis of lung cancer?

_______

What is the second most common cause of lung cancer after smoking?

A. Radon

B. Asbestos

C. Arsenic

D. Histoplasma

Which description best characterizes radon?

A. Visible radioactive particle

B. Colorless, odorless gas

C. Volatile tobacco compound

D. Fibrous mineral particle

Radon arises as a decay product of which substance?

A. Uranium

B. Arsenic

C. Asbestos

D. Tobacco

Where does radon particularly accumulate after originating from soil?

A. Open outdoor fields

B. Ventilated upper floors

C. Pulmonary airways

D. Enclosed basement spaces

Which additional exposure is listed as a lung cancer risk factor?

A. Histoplasma

B. Tuberculosis

C. Asbestos

D. Influenza

Which cigarette-smoke component is particularly carcinogenic?

A. Pleural mesothelium

B. Polycyclic aromatic hydrocarbons

C. Pulmonary surfactant

D. Carbonic anhydrase

Which element in cigarette smoke is particularly carcinogenic?

A. Calcium

B. Sodium

C. Potassium

D. Arsenic

In the United States, lung cancer is the most common cause of what?

A. Cancer-related death

B. Respiratory infection

C. Pleural effusion

D. Pulmonary embolism

Which presentation is characteristic of lung cancer?

A. Diarrhea and hyponatremia

B. Fever and night sweats

C. Stridor and urticaria

D. Cough and weight loss

Which respiratory symptom may occur with lung cancer?

A. Rhinorrhea

B. Hemoptysis

C. Sneezing

D. Epistaxis

A lung tumor obstructs a bronchus and infection develops distally. What complication is most likely?

A. Miliary tuberculosis

B. Pleural fibrosis

C. Postobstructive pneumonia

D. Spontaneous pneumothorax

What is required to definitively diagnose lung cancer?

A. Biopsy

B. Chest X-ray

C. Sputum culture

D. PPD testing

Imaging reveals a solitary pulmonary nodule. What term describes this finding?

A. Ghon complex

B. Coin lesion

C. Pancoast syndrome

D. Pleural plaque

Which feature of a solitary pulmonary nodule is particularly concerning for malignancy?

A. Small diameter

B. Calcification

C. Progressive growth

D. Stable appearance

A pulmonary coin lesion may also result from which process?

A. Pneumothorax

B. Pulmonary edema

C. Pleural effusion

D. Granuloma formation

Which infection is listed as a cause of granulomatous coin lesions?

A. Tuberculosis

B. Influenza

C. Legionella

D. RSV

A Midwestern patient has a granulomatous pulmonary coin lesion. Which infection is specifically listed?

A. Coxiella

B. Klebsiella

C. Histoplasma

D. Mycoplasma

A calcified pulmonary coin lesion is found to contain lung tissue and cartilage. Which diagnosis fits best?

A. Adenocarcinoma

B. Bronchial hamartoma

C. Pancoast tumor

D. Mesothelioma

Which description best defines a hamartoma?

A. Metastatic malignant deposit

B. Granulomatous inflammatory lesion

C. Pleural mesothelial tumor

D. Disorganized native tissue mass

How does a hamartoma grow relative to surrounding tissue?

A. At the same rate

B. Much more rapidly

C. Only after infection

D. Only after smoking

Pleural involvement by lung cancer is classically associated with which tumor?

A. Bronchial hamartoma

B. Adenocarcinoma

C. Mesothelioma

D. Granuloma

A lung cancer patient develops distended neck veins, edema, and bluish discoloration of the face and arms. Which structure is obstructed?

A. Pulmonary artery

B. Recurrent laryngeal nerve

C. Sympathetic chain

D. Superior vena cava

A lung cancer patient develops new hoarseness. Which structure is most likely involved?

A. Phrenic nerve

B. Sympathetic chain

C. Recurrent laryngeal nerve

D. Superior vena cava

A lung cancer patient develops diaphragmatic paralysis. Which structure is most likely involved?

A. Vagus nerve

B. Phrenic nerve

C. Recurrent laryngeal nerve

D. Sympathetic chain

An apical lung tumor causes ptosis, miosis, and anhidrosis. Which syndrome is present?

A. Horner syndrome

B. SVC syndrome

C. Ghon complex

D. Pott disease

A central lung tumor in a male smoker is composed of poorly differentiated, highly aggressive small cells arising from neuroendocrine Kulchitsky cells. Which diagnosis is most likely?

A. Squamous cell carcinoma

B. Small cell carcinoma

C. Bronchial carcinoid tumor

D. Large cell carcinoma

A patient with a central small cell lung carcinoma develops multiple paraneoplastic manifestations. Which combination is classically produced by this tumor?

A. PTHrP and β-hCG

B. Serotonin and PTHrP

C. Insulin and glucagon

D. ACTH, ADH, calcium-channel antibodies

Small cell carcinoma can produce antibodies against presynaptic calcium channels. Which paraneoplastic syndrome results?

A. Lambert-Eaton syndrome

B. Horner syndrome

C. Carcinoid syndrome

D. Cushing disease

A smoker has a central, chromogranin-positive lung tumor. Additional findings include MYC amplification, anti-neuronal antibodies causing limbic encephalitis, cerebellar degeneration, opsoclonus, GI dysmotility, or polyradiculopathy. The tumor frequently spreads to the brain and is the most aggressive lung cancer. Which tumor is this?

A. Adenocarcinoma

B. Large cell carcinoma

C. Small cell carcinoma

D. Bronchial carcinoid

Why may prophylactic cranial irradiation be given in small cell lung carcinoma?

A. Prevents PTHrP production

B. Treats hilar cavitation

C. Frequent brain metastasis

D. Prevents carcinoid syndrome

Which statement correctly compares chromogranin staining in small cell carcinoma and bronchial carcinoid tumor?

A. Both positive; carcinoid stains stronger

B. Only small cell stains positive

C. Neither tumor stains positive

D. Only carcinoid stains positive

Which lung cancer is classically peripheral and characterized histologically by glands or mucin?

A. Squamous cell carcinoma

B. Adenocarcinoma

C. Small cell carcinoma

D. Large cell carcinoma

A male smoker develops a central hilar mass arising from a bronchus. Biopsy shows keratin pearls and intercellular bridges. Which diagnosis is most likely?

A. Squamous cell carcinoma

B. Adenocarcinoma

C. Small cell carcinoma

D. Large cell carcinoma

Which histologic finding defines squamous cell carcinoma in these notes?

A. Glands with mucin

B. Small neuroendocrine cells

C. Keratin pearls or intercellular bridges

D. Highly anaplastic glandular cells

A patient with central squamous cell lung carcinoma develops marked hypercalcemia. Which substance is most likely responsible?

A. ACTH

B. PTHrP

C. ADH

D. β-hCG

The “double C” association of squamous cell lung carcinoma refers to which findings?

A. Cough and cyanosis

B. Carcinoid and calcification

C. Congestion and consolidation

D. Hypercalcemia and cavitation

A smoker has a lung tumor composed of poorly differentiated, highly anaplastic cells without keratin pearls, intercellular bridges, glands, or mucin. The mass may occur centrally or peripherally. Which diagnosis is most likely?

A. Bronchial carcinoid

B. Adenocarcinoma

C. Squamous carcinoma

D. Large cell carcinoma

Large cell carcinoma responds poorly to chemotherapy. According to these notes, what treatment approach is preferred when possible?

A. Surgical removal

B. Cranial irradiation

C. Bronchial stenting

D. Observation only

Which paraneoplastic product may be secreted by large cell carcinoma?

A. PTHrP

B. ADH

C. β-hCG

D. Serotonin

A lung tumor is composed of well-differentiated neuroendocrine cells and is strongly chromogranin positive. It is unrelated to smoking and may occur centrally or peripherally. Which diagnosis is most likely?

A. Bronchial carcinoid tumor

B. Small cell carcinoma

C. Squamous cell carcinoma

D. Adenocarcinoma

When a bronchial carcinoid tumor occurs centrally, how can it appear within the airway?

A. Diffuse mucosal plaque

B. Cavitary hilar lesion

C. Peripheral glandular nodule

D. Polyp-like bronchial mass

Which lung tumor is the most common primary lung cancer in children and is generally a low-grade malignancy?

A. Adenocarcinoma

B. Small cell carcinoma

C. Bronchial carcinoid tumor

D. Squamous cell carcinoma

A patient with a bronchial carcinoid tumor develops flushing, diarrhea, and restrictive cardiomyopathy. Release of which vasoactive substance primarily causes this rare syndrome?

A. PTHrP

B. Serotonin

C. β-hCG

D. ADH

A bronchial carcinoid tumor may protrude into the bronchial lumen as which gross finding?

A. Cavitary apical lesion

B. Polyp-like bronchial mass

C. Diffuse pleural plaque

D. Peripheral cannon-ball nodule

Which immunohistochemical marker is positive in bronchial carcinoid tumors?

A. Chromogranin

B. PTHrP

C. β-hCG

D. Surfactant protein

Restrictive cardiomyopathy in carcinoid syndrome results from which process?

A. Myocyte hypertrophy

B. Coronary thrombosis

C. Endocardial fibrosis

D. Pericardial calcification

Bronchioloalveolar carcinoma is considered which type of lung malignancy?

A. Adenocarcinoma in situ

B. Squamous carcinoma

C. Small cell carcinoma

D. Large cell carcinoma

Which histologic pattern characterizes bronchioloalveolar carcinoma?

A. Keratin pearl formation

B. Small blue cell sheets

C. Growth along existing alveoli

D. Intercellular bridge formation

Which combination best characterizes bronchioloalveolar carcinoma?

A. Central, smoking-related, poor prognosis

B. Central, nonsmoking, poor prognosis

C. Peripheral, smoking-related, aggressive

D. Peripheral, nonsmoking, excellent prognosis

What imaging appearance may bronchioloalveolar carcinoma produce?

A. Pneumonia-like consolidation

B. Apical cavitary lesion

C. Pleural air collection

D. Cannon-ball nodules

Multiple cannon-ball nodules are seen throughout the lungs. Which statement best describes this finding?

A. Usually primary lung cancer

B. Usually bronchial carcinoid

C. Often breast or colon metastases

D. Usually bronchioloalveolar carcinoma

A patient with irreversible advanced pulmonary disease is evaluated for transplantation. Which group contains only common indications for lung transplant?

A. Asthma, pneumonia, sarcoidosis, COPD

B. Emphysema, IPF, CF, pulmonary HTN

C. Lung cancer, TB, COPD, asthma

D. PE, pneumonia, CF, bronchiectasis

Which pulmonary vascular disorder is a common indication for lung transplantation?

A. Acute pulmonary embolism

B. Pulmonary venous thrombosis

C. Secondary mild pulmonary HTN

D. Idiopathic/familial pulmonary HTN

Squamous cell lung carcinoma is strongly associated with deletions involving which tumor suppressor genes?

A. CDKN2A and TP53

B. RB and MYC

C. EGFR and ALK

D. KRAS and RET

Which lung cancer has the highest rate of TP53 mutations?

A. Adenocarcinoma

B. Carcinoid tumor

C. Squamous cell carcinoma

D. Mesothelioma

Small cell lung carcinoma frequently demonstrates which molecular abnormalities?

A. EGFR activation and KRAS loss

B. TP53/RB loss and MYC amplification

C. ALK deletion and RET loss

D. CDKN2A amplification and ROS loss

Which chromosomal deletion is particularly associated with small cell lung carcinoma?

A. Chromosome 3p deletion

B. Chromosome 5q deletion

C. Chromosome 13q duplication

D. Chromosome 21 deletion

Which oncogenic alteration is characteristic of small cell lung carcinoma?

A. BCL2 deletion

B. TTF-1 deletion

C. CDKN2A amplification

D. MYC amplification

Lung adenocarcinoma commonly contains gain-of-function mutations affecting which pathway?

A. Apoptotic caspase signaling

B. DNA mismatch repair

C. Growth factor receptor signaling

D. Complement activation

Which set contains growth-factor pathway genes commonly mutated in lung adenocarcinoma?

A. EGFR, ALK, ROS, MET, RET

B. TP53, RB, MYC, BCL2

C. CDKN2A, TP53, RB, MYC

D. APC, BRCA1, WT1, NF1

An adenocarcinoma lacks growth-factor receptor mutations. Which downstream gene is often mutated instead?

A. RB

B. KRAS

C. BCL2

D. CDKN2A

A pulmonary adenocarcinoma is evaluated by immunohistochemistry. Which marker is expressed by most tumors?

A. BCL2

B. CDKN2A

C. TTF-1

D. MYC

Thyroid transcription factor-1 normally plays an important role in what process?

A. Bronchial mucus secretion

B. Pleural fluid production

C. Pulmonary vasoconstriction

D. Normal lung development

Squamous cell carcinoma is often preceded by which sequence in bronchial epithelium?

A. Hyperplasia → adenoma → carcinoma

B. Metaplasia → dysplasia → carcinoma in situ

C. Fibrosis → calcification → carcinoma

D. Necrosis → metaplasia → adenoma

Which epithelial alteration commonly precedes squamous cell lung carcinoma?

A. Squamous metaplasia

B. Glandular hyperplasia

C. Mesothelial dysplasia

D. Neuroendocrine hyperplasia

Immunohistochemistry of small cell lung carcinoma commonly shows high levels of which anti-apoptotic protein?

A. MYC

B. RB

C. BCL2

D. KRAS

Most pulmonary neuroendocrine cell hyperplasias occur secondary to what process?

A. Airway fibrosis or inflammation

B. Pulmonary vascular thrombosis

C. Pleural mesothelial proliferation

D. Alveolar surfactant deficiency

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia may lead to which lesions?

A. Mesotheliomas and adenomas

B. Hamartomas and granulomas

C. Tumorlets and carcinoid tumors

D. Fibromas and lymphomas

Most patients with pulmonary carcinoid tumors are younger than what age?

A. 20 years

B. 40 years

C. 60 years

D. 80 years

A woman of childbearing age develops a pulmonary disorder characterized by abnormal perivascular epithelioid cell proliferation. Which diagnosis is most likely?

A. Mesothelioma

B. Pulmonary fibrosis

C. Bronchial carcinoid

D. Lymphangioleiomyomatosis

Perivascular epithelioid cells in lymphangioleiomyomatosis express markers characteristic of which cell types?

A. Fibroblasts and pneumocytes

B. Endothelium and mesothelium

C. Melanocytes and smooth muscle

D. Neutrophils and macrophages

Abnormal cell proliferation in lymphangioleiomyomatosis produces which pulmonary changes?

A. Cystic dilation and lymphatic obstruction

B. Lobar consolidation and cavitation

C. Pleural plaques and fibrosis

D. Bronchial metaplasia and dysplasia

Which organ is the most common site of metastatic neoplasms?

A. Brain

B. Lung

C. Liver

D. Bone

Direct extension of contiguous tumors into the lungs occurs most often from which malignancies?

A. Colon and breast carcinomas

B. Renal and thyroid carcinomas

C. Pancreatic and gastric carcinomas

D. Esophageal carcinoma and mediastinal lymphoma

A soft-tissue tumor is attached by a pedicle to the pleural surface and remains largely confined to the lung surface. Which diagnosis is most likely?

A. Mesothelioma

B. Bronchial carcinoid

C. Solitary fibrous tumor

D. Pulmonary adenocarcinoma

Homozygous deletion of CDKN2A/INK4a occurs in approximately 80% of which malignancy?

A. Small cell carcinoma

B. Mesothelioma

C. Adenocarcinoma

D. Carcinoid tumor

Which laboratory markers are significantly elevated in bacterial lung infections?

A. CRP and procalcitonin

B. Troponin and BNP

C. Bilirubin and alkaline phosphatase

D. CK-MB and myoglobin

A child develops pneumonia after a viral infection with descending laryngotracheobronchitis and airway obstruction from dense fibrin-rich neutrophilic exudates. Which pathogen is most likely?

A. Moraxella catarrhalis

B. Klebsiella pneumoniae

C. Coccidioides immitis

D. Haemophilus influenzae

Which statement correctly describes bacterial COPD exacerbations?

A. Moraxella ranks first

B. H. influenzae ranks first

C. Klebsiella ranks second

D. Coccidioides ranks second

Which pairing is correct regarding pulmonary infection?

A. Klebsiella—most common COPD exacerbation

B. Coccidioides—type I hypersensitivity

C. Klebsiella—commonest gram-negative pneumonia

D. Coccidioides—enhances lysosomal fusion