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1. A 68 yr old female hospitalized for 3 weeks after a cerebral infarction was improving and she was able to get up and move with assistance. A few minutes after ambulating to the bathroom, she experienced the sudden of onset of dyspnea. Despite resuscitative measures, she died 30 minutes later. The most likely mechanism for sudden death in this patient was:
a) atelectasis
b) hemorrhage
c)acute right heart failure
d) bronchoconstriction
e) edema

2. A 61 yr old female smoked cigarettes for 10 years but stopped smoking 5 yrs ago. She has experienced increasing dyspnea for months with a nonproductive cough. A chest radiograph shows promined hilar lymphadenopathy. A transbronchial biopsy is performed, and the microscopic findings include intersitital fibrosis and small noncaseating granulomas. One of the granulomas contains an steroid body in a giant cell. This disease in believed to be caused by:
a) delayed hypersensitivity response to an unknown antigen
b) immune complexes formed in response to inhaled antigens
c) diffuse alveolar damage (DAD)
d) smoke inhalation for many years
e) infection with atypical mycobacteria

3.Granulocytic hypersegmentation is MOST likely to be found in association with:
a) folic acid deficiency
b) infection
c) iron deficiency
d) malignancy
e) ingestion of a marrow-toxic agent

4. Which of the following statements regarding vascular tumors is NOT true:
a) capillary hemangiomas are most common of all vascular tumors
b) cytic hygromas are lesions typically occurring in the neck and axilla
c) strawberry hemangioma is a fast growing lesion appearing in the first few months of life
d)cavernous hemangiomas have a tendency to regress
e) glomus tumors are very painful

5. Which of the following is LEAST likely to be associated with cytic fibrosis?
a) intestinal obstruction
b) sinusitis
c) steatorrhea
d) dextrocardia
e) clubbing

6. Correct statements concerning the pathogenesis of alpha1-antitrypsin deficiency include all the following, EXCEPT:
a) emphysema results from an inability to inhibit alveolar destruction by neutrophils
b) clinical deficiency of alpha1-antitrypsin usually results from one several missense mutations that cause a truncated mRNA
c) the disease is inherited in a dominant fashon
d) mutation of the alpha1-antitrypsin gene of the S type produce less severe emphysema than do mutations of the Z type
e) treatment with purified alpha1 – antitrysin can raise the serum level to that associated with lung protection

7. A 58 yr old chronic alcoholic and heavy smoker presents with a 3 cm firm, right midcervical neck mass. An excicional biopsy reveals squamous cell carcinoma. Which of the following is the MOST appropriate approach at this time:
a) bronchoscopy, esophagoscopy and laryngoscopy
b) CT of the neck
c) CT of the brain
d) neck dissection
e) radiation therapy

8. A 47 yr old alcoholic comes to your office complaining of cough, chills and fever. He has a “cold” for 4 days and has been coughing up yellow-thick tenacious sputum. He denies shortness of breath and chest pain. Temp is 39.7 and expiratory rales are heard over both lung fields. Among the following the MOST likely diagnosis is:
a) Kiebsiella pneumonia
b) Pseudomonas pneumonia
c) Mycoplasma pneumonia
d) Pneumocysitis carini pneumonia
e) pulmonary tuberculosis

9. Each of the following is a significant cause of the lung abscess, EXCEPT:
a) empyema
b)antecedent primary bacterial pneumonia
c) septic emboli
d) aspiration of gastric contents
e) bronchogenic carcinoma

10. A 56 yr old male has a chest x-ray that demonstrates a 6cm perihalar mass. He has a cough. A sputum cytology report reads “ Atypical cells present suggestive of squamous cell carcinoma.” Which of the following is LEAST likely to be associated with these findings:
a) he has a history of asbestos exposure
b) he had prolonged formaldehyde exposure
c) his house has a high level of radon
d) he was previously treated for lung cancer
e) his wife smokes

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