1. A 25-year-old male patient presents with acute renal failure, which is not amenable to dialysis. He has history of recurrent episodes of hemoptysis and chest radiograph shows focal lung consolidation. What type of antibodies can be responsible for his pulmonary and renal symptoms?
a. Anti smooth muscle antibodies
b. Anti neutrophil cytoplasmic antibodies
c. Antinuclear antibodies
d. Autoantibodies to type IV collage
e. Autoantibodies to type III collagen
2. A 55-year-old huqqa smoker presents with severe dyspnea and slight dry cough. He has a barrel-chest and expiration is prolonged. FEV1 is decreased. Chest X ray shows voluminous lungs overshadowing the heart. What is the principle pathogenetic mechanism for this patient’s lung disease?
a. Production of autoantibodies against alveolar basement membrane
b. Type IV Hypersensitivity
c. Vasculitis of pulmonary arterioles
d. Protease production by neutrophils and macrophages
3. Following renal transplantation a patient develops high-grade fever with chills and cough productive of mucopurulent sputum. Chest radiograph shows foci of consolidation. Which bacterial infection would you most suspect in this patient?
a. Staphylococcus aureus
b. Klebsiella pneumoniae
c. Pseudomonas
d. Streptococcus pneumoniae
e. Legionella pneumophilia
4. A resident in the surgery department is conducting a survey to identify risk factors for lung cancer in the local population. In which subset of patients is he likely to encounter the highest frequency of tobacco smokers?
a. Squamous cell carcinoma
b. Small cell carcinoma
c. Adenocarcinoma
d. Large cell carcinoma
e. Bronchoalveolar carcinoma
5. A Pathology resident is reviewing slides of cases of lung cancer reported during the last two years. He finds 20 cases of Squamous cell carcinoma, 12 cases of adenocarcinoma, 4 cases of small cell carcinoma, and 2 each of Bronchoalveolar carcinoma and large cell carcinoma. If he orders p53 staining on all these cases which tumor type is likely to be most frequently positive?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Small cell carcinoma
d. Bronchoalveolar carcinoma
e. Large cell carcinoma
6. A 32-year old female presents with severe respiratory distress. She has a protracted history of dyspnea on mild exertion for the past many years. Chest radiograph shows right ventricular enlargement. There is no history of congenital heart disease, interstitial lung disease or obstructive pulmonary disease. Serological tests for autoimmune conditions are negative. A lung biopsy shows marked medial hypertrophy and intimal fibrosis of pulmonary arterioles. What is the most likely cause for this patient’s symptoms?
a. Right sided cardiac failure
b. Emphysema
c. Good pasture syndrome
d. Primary pulmonary hypertension
e. Secondary pulmonary hypertension
7. A 4-year-old child, resident of Islamabad has seasonal bouts of breathing difficulty with prolonged cough productive of copious Mucinous secretions, each spring season. Peripheral smear shows eosinophlia during an episode and sputum exam reveal charcoat-laden crystals. What is the most potent mediator of bronchospasm in this patient?
a. TNF-a
b. Leukotrienes
c. Interleukins
d. Histamine
e. Prostaglandins
8. What is the common pathogenetic mechanism for all atypical (viral and Mycoplasmal) pneumonias?
a. Production of cross-reacting antibodies to alveolar basement membrane
b. Direct invasion of lung parenchyma by the causative organism
c. Hypersensitivity reaction to mycoplasmal/viral antigens
d. Attachment of organism to upper respiratory tract epithelium followed by necrosis and inflammation
e. Exotoxin production
9. ACTH and ADH production is associated with which histological subtype of lung cancer?
a. Squamous cell carcinoma
b. Adenocarcinoma
c. Small cell carcinoma
d. Carcinoid tumor
e. Large cell carcinoma
10. A 56-year-old male patient of lung cancer develops hoarseness of voice. This symptom is attributable to tumor invasion of:
a. Larynx
b. Trachea
c. Recurrent laryngeal nerve
d. Vagus nerve
e. Sympathetic chain
11. Following bilateral hip replacement surgery a 75-year-old female expires on the tenth post op day. The autopsy pathologist recovers a saddle embolus lying astride the main right and left pulmonary arteries. What is the most probable source of this embolus?
a. Pulmonary veins
b. Inferior vena cava
c. Renal veins
d. Deep veins of the leg
e. Mesenteric veins
12. In pathogenesis of Bronchiectasis the susceptibility to infections is due to:
a. Progressive fibrosis of lung parenchyma
b. Accumulation of thick and viscid secretions obstructing the airways
c. Chronic inflammation of airways leading to epithelial sloughing
d. Immunodeficient status
e. Repeated hospital admissions and exposure to nosocomial infections
13. A pathologist performing an autopsy on a 65-year-old male who died after an acute respiratory tract illness notices that the lower lobe of his left lung shows appears grayish brown, firmer than the rest of the lung and has dry cut surfaces. Histological sections from the same show fibromyxoid masses infiltrated by macrophages and fibroblasts. What will you label this lesion as?
a. Lung abscess
b. Squamous cell carcinoma
c. Gray hepatization
d. Red hepatization
e. Atelectasis
14. While examining a bronchoscopic biopsy a pathologist notices a tumor composed of cells smaller than lymphocytes with deeply staining nuclei and scanty cytoplasm. What is the likeliest diagnosis?
a. Adenocarcinoma
b. Large cell carcinoma
c. Squamous cell carcinoma
d. Bronchoalveolr carcinoma
e. Small cell carcinoma
15. During a thoracotomy performed for lung cancer, the surgeon notices a 3.5 cm tumor in hilar region of right lung involving the visceral pleura. How will this tumor be staged according to the International System for Staging of Lung cancer?
a. T1
b. TIS
c. T2
d. T3
e. T4
Answers
Answers
1. A 25-year-old male patient presents with acute renal failure, which is not amenable to dialysis. He has history of recurrent episodes of hemoptysis and chest radiograph shows focal lung consolidation. What type of antibodies can be responsible for his pulmonary and renal symptoms?
a. Anti smooth muscle antibodies
b. Anti neutrophil cytoplasmic antibodies
c. Antinuclear antibodies
d. Autoantibodies to type IV collage
e. Autoantibodies to type III collagen
2. A 55-year-old huqqa smoker presents with severe dyspnea and slight dry cough. He has a barrel-chest and expiration is prolonged. FEV1 is decreased. Chest X ray shows voluminous lungs overshadowing the heart. What is the principle pathogenetic mechanism for this patient’s lung disease?
a. Production of autoantibodies against alveolar basement membrane
b. Type IV Hypersensitivity
c. Vasculitis of pulmonary arterioles
d. Protease production by neutrophils and macrophages
3. Following renal transplantation a patient develops high-grade fever with chills and cough productive of mucopurulent sputum. Chest radiograph shows foci of consolidation. Which bacterial infection would you most suspect in this patient?
a. Staphylococcus aureus
b. Klebsiella pneumoniae
c. Pseudomonas
d. Streptococcus pneumoniae
e. Legionella pneumophilia
4. A resident in the surgery department is conducting a survey to identify risk factors for lung cancer in the local population. In which subset of patients is he likely to encounter the highest frequency of tobacco smokers?
a. Squamous cell carcinoma
b. Small cell carcinoma
c. Adenocarcinoma
d. Large cell carcinoma
e. Bronchoalveolar carcinoma
5. A Pathology resident is reviewing slides of cases of lung cancer reported during the last two years. He finds 20 cases of Squamous cell carcinoma, 12 cases of adenocarcinoma, 4 cases of small cell carcinoma, and 2 each of Bronchoalveolar carcinoma and large cell carcinoma. If he orders p53 staining on all these cases which tumor type is likely to be most frequently positive?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Small cell carcinoma
d. Bronchoalveolar carcinoma
e. Large cell carcinoma
6. A 32-year old female presents with severe respiratory distress. She has a protracted history of dyspnea on mild exertion for the past many years. Chest radiograph shows right ventricular enlargement. There is no history of congenital heart disease, interstitial lung disease or obstructive pulmonary disease. Serological tests for autoimmune conditions are negative. A lung biopsy shows marked medial hypertrophy and intimal fibrosis of pulmonary arterioles. What is the most likely cause for this patient’s symptoms?
a. Right sided cardiac failure
b. Emphysema
c. Good pasture syndrome
d. Primary pulmonary hypertension
e. Secondary pulmonary hypertension
7. A 4-year-old child, resident of Islamabad has seasonal bouts of breathing difficulty with prolonged cough productive of copious Mucinous secretions, each spring season. Peripheral smear shows eosinophlia during an episode and sputum exam reveal charcoat-laden crystals. What is the most potent mediator of bronchospasm in this patient?
a. TNF-a
b. Leukotrienes
c. Interleukins
d. Histamine
e. Prostaglandins
8. What is the common pathogenetic mechanism for all atypical (viral and Mycoplasmal) pneumonias?
a. Production of cross-reacting antibodies to alveolar basement membrane
b. Direct invasion of lung parenchyma by the causative organism
c. Hypersensitivity reaction to mycoplasmal/viral antigens
d. Attachment of organism to upper respiratory tract epithelium followed by necrosis and inflammation
e. Exotoxin production
9. ACTH and ADH production is associated with which histological subtype of lung cancer?
a. Squamous cell carcinoma
b. Adenocarcinoma
c. Small cell carcinoma
d. Carcinoid tumor
e. Large cell carcinoma
10. A 56-year-old male patient of lung cancer develops hoarseness of voice. This symptom is attributable to tumor invasion of:
a. Larynx
b. Trachea
c. Recurrent laryngeal nerve
d. Vagus nerve
e. Sympathetic chain
11. Following bilateral hip replacement surgery a 75-year-old female expires on the tenth post op day. The autopsy pathologist recovers a saddle embolus lying astride the main right and left pulmonary arteries. What is the most probable source of this embolus?
a. Pulmonary veins
b. Inferior vena cava
c. Renal veins
d. Deep veins of the leg
e. Mesenteric veins
12. In pathogenesis of Bronchiectasis the susceptibility to infections is due to:
a. Progressive fibrosis of lung parenchyma
b. Accumulation of thick and viscid secretions obstructing the airways
c. Chronic inflammation of airways leading to epithelial sloughing
d. Immunodeficient status
e. Repeated hospital admissions and exposure to nosocomial infections
13. A pathologist performing an autopsy on a 65-year-old male who died after an acute respiratory tract illness notices that the lower lobe of his left lung shows appears grayish brown, firmer than the rest of the lung and has dry cut surfaces. Histological sections from the same show fibromyxoid masses infiltrated by macrophages and fibroblasts. What will you label this lesion as?
a. Lung abscess
b. Squamous cell carcinoma
c. Gray hepatization
d. Red hepatization
e. Atelectasis
14. While examining a bronchoscopic biopsy a pathologist notices a tumor composed of cells smaller than lymphocytes with deeply staining nuclei and scanty cytoplasm. What is the likeliest diagnosis?
a. Adenocarcinoma
b. Large cell carcinoma
c. Squamous cell carcinoma
d. Bronchoalveolr carcinoma
e. Small cell carcinoma
15. During a thoracotomy performed for lung cancer, the surgeon notices a 3.5 cm tumor in hilar region of right lung involving the visceral pleura. How will this tumor be staged according to the International System for Staging of Lung cancer?
a. T1
b. TIS
c. T2
d. T3
e. T4
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