A 48-year-old man with no history of major medical illnesses has had gradually worsening dyspnea for the past 13 months. He has no cough or hemoptysis. He is a non-smoker. He has always worked as a corporate attorney. He is afebrile. Spirometry reveals a normal FEV1/FVC ratio with decreased FVC. The DLCO is decreased. Sputum cytology shows no atypical cells. Which of the following pathologic findings is he most likely to have in his lungs?

A Honeycombing fibrosis

B Bronchial destruction and ectasia

C Apical bullae

D Increased bronchial submucosal glands

E Mucosal eosinophil infiltration

F Respiratory bronchiole dilation

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A 47-year-old woman develops nausea, cough, and fatigue over the past 3 days. On physical examination her temperature is 37.4 C and blood pressure 155/95 mm Hg. Laboratory studies show serum creatinine 2.8 mg/dL and urea nitrogen 28 mg/dL. Her antineutrophil cytoplasmic autoantibody test is positive. A renal biopsy is performed and on microscopic examination shows crescentic glomerulonephritis. A chest radiograph reveals bilateral small nodular infiltrates. A sputum gram stain shows normal flora. A sputum cytology shows no abnormal cells, but numerous hemosiderin-laden macrophages are present along with a background containing many RBCs. Which of the following pulmonary pathologic findings is most likely to be present in this woman?

A Bronchial chronic inflammation

B Thromboembolism

C Necrotizing vasculitis

D Pleural effusions

E Non-caseating granulomas

F Metastases

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A 29-year-old man has been HIV positive for the past 8 years. His HIV-1 RNA level a month ago was 48,000 copies/mL. He is unable to afford any medications. He now develops fever, non-productive cough, and dyspnea over the past 4 days. On physical examination he has a temperature of 37.6 C, pulse 92/minute, respiratory rate 24/minute, and blood pressure 100/60 mm Hg. A chest radiograph that reveals extensive bilateral infiltrates. A bronchoalveolar lavage is performed. Which of the following infectious agents is most likely to be present in this man?

A Cryptococcus neoformans

B Aspergillus fumigatus

C Pneumocystis carinii (jirovecii)

D Hemophilus influenzae

E Mycobacterium tuberculosis

F Aspergillus fumigatus

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A 47-year-old woman has had dyspnea for the past 2 months. On physical examination her vital signs show T 36.8 C, P 81/minute, R 20/minute, and BP 130/75 mm Hg. She has a right breast lump and right axillary non-tender lymphadenopathy. A chest radiograph reveals large pleural effusions bilaterally. Mammography reveals a 1 cm irregular right breast mass with microcalcifications. A thoracentesis is performed on the right and the 500 mL obtained is grossly bloody. Which of the following cytologic findings is most likely to be present on examination of this pleural fluid?

A Gram negative rods

B Clusters of carcinoma cells

C Large numbers of small lymphocytes

D Acid fast bacilli

E Atypical mesothelial cells

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A 58-year-old man has had worsening shortness of breath for the past 4 years. On physical examination he has an increased chest diameter. He has hyperresonance by percussion along with decreased tactile fremitus. Pulmonary function testing shows a decreased FEV1 and FEV1/FVC ratio. A chest radiograph showed increased lung volumes with flattening of the diaphragms. Exposure to which of the following environmental agents is the most likely risk factor for development of his pulmonary disease?

A Silica dust

B Mold spores

C Asbestos crystals

D Cigarette smoke

E Radon gas

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A 43-year-old man has had dyspnea and productive cough for the past 25 years. He has chronic diarrhea. He has had multiple pulmonary infections with Pseudomonas aeruginosa and Pseudomonas cepacia cultured. His quantitative stool fat is 10 gm/day. He succumbs to a pulmonary infection. At autopsy, his lungs demonstrate widespread bronchiectasis. A mutation involving which of the following genes is most likely responsible for this man's findings?

A Fibrillin

B Spectrin

C FGFR

D CFTR

E Beta-myosin

F HFE

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A 45-year-old man has had increasing dyspnea for the past month. On physical examination there is dullness to percussion at the lung bases. A chest radiograph reveals large bilateral pleural effusions. A right thoracentesis is performed, and 500 cc of serous fluid is obtained. Laboratory studies on this fluid show a cell count with 2 leukocytes/microliter, LDH 220 U/L, and protein 1.1 g/dL. Which of the following conditions is most likely to produce his findings?

A Congestive heart failure

B Tuberculosis

C Metastatic carcinoma

D Bronchogenic carcinoma

E Pulmonary infarction

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A 60-year-old woman has been a cigarette smoker since the age of 18, averaging a pack a day of unfiltered cigarettes. She works as a dispatcher for a trucking company. She has had a chronic cough for 15 years, but she has had several episodes of hemoptysis in the past two weeks. On physical examination there are no abnormal findings. A chest radiograph shows an ill-defined left hilar mass. A transbronchial lung biopsy is performed and microscopic examination shows clusters of small, hyperchromatic cells with scant cytoplasm. Which of the following laboratory test findings is most likely to be present in this woman?

A Hyperuricemia

B Hyperbilirubinemia

C Hypercalcemia

D Hyponatremia

E Polycythemia

F Hypoalbuminemia

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A clinical study is performed with adult subjects who have a 50 pack year or more history of smoking cigarettes and who stopped smoking. None of the subjects has used cigarettes for the past 5 years. This study group is compared with a control group of subjects who never smoked. Which of the following pulmonary diseases will most likely be found to have the greatest frequency in the prior smokers, compared to the control subjects?

A Bronchogenic carcinoma

B Centrilobular emphysema

C Chronic bronchitis

D Bronchopneumonia

E Myocardial infarction

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A male infant is born at term. During the first month of life the infant has had multiple episodes of respiratory distress from pneumonia with Hemophilus influenzae and Enterococcus. A radiograph reveals a localized area of consolidation near the base of the right lung. Angiography reveals that this segment of lung is supplied by systemic, not pulmonary, arterial blood. Which of the following is the most likely diagnosis?

A Pulmonary sequestration

B Chronic abscessing pneumonia

C Congenital cystic adenomatoid malformation

D Bronchogenic cyst

E Cystic fibrosis

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A 27-year-old woman develops worsening dyspnea and syncope on exertion over a 2 year period. On physical examination her lungs are clear to auscultation. Her heart rate is regular with no murmurs. She dies suddenly and unexpectedly. Autopsy reveals marked right ventricular hypertrophy, marked pulmonary atherosclerosis, and plexiform pulmonary arteriopathy. There is no interstitial fibrosis. Which of the following is the most likely diagnosis?

A Primary atypical pneumonia

B Goodpasture syndrome

C Systemic lupus erythematosus

D Primary pulmonary hypertension

E Diffuse scleroderma

F Wegener granulomatosis

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A 48-year-old woman has had malaise and increasing dyspnea with a 2 kg weight loss for the past month. On physical examination she is afebrile. A chest radiograph reveals a large right pleural effusion. A thoracentesis is performed, and 650 cc of milky white fluid is removed. Which of the following underlying conditions is she most likely to have?

A Mediastinal malignant lymphoma

B Penetrating chest trauma

C Tuberculosis

D Congestive heart failure

E Systemic lupus erythematosus

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A 20-year-old G2 P1 woman gives birth to a term girl infant following an uncomplicated pregnancy. During the first 6 hours of life, the infant exhibitis increased respiratory difficulty following feeding. A plain film radiograph shows bilateral pulmonary infiltrates that suggest aspiration. No masses are noted. A stomach bubble is seen below the diaphragm. Which of the following congenital anomalies is this infant most likely to have?

A Extralobar sequenstation

B Cystic adenomatoid malformation

C Diphragmatic hernia

D Tracheo-esophageal fistula

E Intralobar sequestration

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A 31-year-old man is involved in a motor vehicle accident with a deep laceration to his right arm. When paramedics arrive on the seen, he has cold, pale skin and a barely obtainable blood pressure. He is hemorrhaging from his right brachial artery. On admission to the hospital, he has a hematocrit of 15% and is given 4 units of packed red blood cells. Over the next 3 days he develops decreasing oxygen saturations measured by arterial blood gases. He is intubated, but requires increasing ventilatory pressures with increasing FIO2. Two weeks following the accident, his chest radiograph shows increasing infiltrates. He remains afebrile. Which of the following pathologic findings is he now most likely to have in his lungs?

A Diffuse alveolar damage

B Honeycomb lung

C Hyaline membranes

D Intra-alveolar edema

E Vascular thrombosis

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A 19-year-old primigravida gives birth at term to a male infant via an uncomplicated delivery. He has Apgar scores of 4 and 7 at 1 and 5 minutes following birth. He develops severe severe respiratory distress within the next 4 hours. A plain film radiograph reveals that there is a stomach bubble in the left chest, no apparent aerated lung on the left, and the heart displaced to the right. The infant is producing urine. Which of the following pathologic abnormalities is most likely to produce this infant's findings?

A Bronchopulmonary dysplasia

B Extralobar sequestration

C Diaphragmatic hernia

D Cystic adenomatoid malformation

E Tracheoesophageal fistula

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A 59-year-old man is a smoker with a chronic cough. He had blood-streaked sputum yesterday. He is directed to collect a series of sputum samples. He brings in three refrigerated sputum specimens collected at home on successive days. He produced the specimen within a few minutes of waking and before eating breakfast. Examination of the specimens microscopically reveals bacterial colonies, squamous epithelial cells, budding yeasts, and mucus. No alveolar macrophages are present. Which of the following is the most appropriate statement regarding these findings?

A A bronchoalveolar lavage should have been performed

B This is not an adequate specimen for diagnosis

C This type of specimen is best collected later in the day

D He was subjected to a risk for pneumothorax

E Collecting this many specimens was not cost-effective

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A 47-year-old woman has been bothered by a chronic non-productive cough for 4 months. On physical examination her temperature is 37.4 C. A chest radiograph shows reticulonodular infiltrates, but no masses. A sputum gram stain shows normal flora, and sputum cytology shows no atypical cells, but there are abundant hemosiderin-laden macrophages. Laboratory studies show sodium 145 mmol/L, potassium 4.5 mmol/L, chloride 101 mmol/L, CO2 27 mmol/L, glucose 89 mg/dL, urea nitrogen 29 mg/dL, and creatinine 3.3 mg/dL. A CT guided needle biopsy of the lung is performed and on microscopic examination shows a necrotizing vasculitis involving the peripheral pulmonary arteries. Which of the following serologic laboratory test findings is most likely to be positive?

A Antinuclear antibody

B Rheumatoid factor

C Antineutrophil cytoplasmic autoantibody

D Ribonucleoprotein antibody

E Antistreptolysin O

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The acute onset of fever, cough, and dyspnea occurs after a day's work in an office building. The affected 27-year-old temporary secretary has had this same problem each time she works in this building over the past 6 months. Transbronchial biopsy is performed after she is hospitalized with respiratory distress. The histologic findings include focal peribronchial mononuclear interstitial infiltrates with some macrophages. Which of the following is the most likely diagnosis?

A Influenza A pneumonia

B Diffuse alveolar damage

C Pneumocystis carinii (jirovecii) pneumonia

D Hypersensitivity pneumonitis

E Extrinsic asthma

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52-year-old chronically ill man has a history of chronic alcohol abuse. He has had a 5 kg weight loss for the past two months. He has a chronic cough which has been blood-tinged on several occasions during the past month, along with a low grade fever and night sweats. He is found dead in his apartment by a neighbour. At autopsy, his lungs are filled with hundreds of 1 to 3 mm firm rounded tan nodules. Which of the following infectious agents is most likely to produce this grossly apparent pathologic finding?

A Pneumocystis carinii (jirovecii)

B Mycobacterium tuberculosis

C Respiratory syncytial virus

D Streptococcus pneumoniae

E Aspergillus fumigatus

F Staphylococcus aureus

G Strongyloides stercoralis

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A 29-year-old woman has had myalgias and arthralgias for the past 7 months, but has worsening malaise and nausea for the past 3 weeks. On physical examination she has an erythematous macular facial rash. Laboratory studies show a positive double stranded DNA test. A urinalysis reveals red blood cell casts. Her serum urea nitrogen is 52 mg/dL with creatinine of 7.1 mg/dL. She is treated with corticosteroid therapy. A month later, she became febrile. She has a cough with production of a small amount of blood-streaked whitish sputum. A chest radiograph now showed multiple 1 to 2 cm pulmonary nodules. A CBC shows Hgb 12.2 g/dL, Hct 36%, MCV 89 fL, platelet count 215,000/microliter, and WBC count 2,200/microliter with differential count of 40 segs, 5 bands, 35 lymphs, 15 monos, 3 eosinophils, and 2 basophils. Which of the following infectious agents is most likely to be producing her last chest radiographic pattern?

A Staphylococcus aureus

B Aspergillus flavus

C Pneumocystis carinii (jirovecii)

D Adenovirus

E Mycobacterium avium-complex

F Nocardia asteroides

G Streptococcus pneumoniae

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A 47-year-old dentist who has been in good health all his life develops progressive dyspnea over a period of 18 months. On physical examination he is afebrile. A chest radiograph reveals increased interstitial markings, but no masses and no areas of consolidation, though the right heart border is prominent. A bronchoalveolar lavage reveals no infectious organisms. A transbronchial biopsy is performed and on microscopic examination shows extensive interstitial fibrosis and residual dilated air spaces lined by bronchial epithelium. Which of the following is the most likely diagnosis?

A Centrilobular emphysema

B Congestive cardiomyopathy

C Idiopathic pulmonary fibrosis

D Chronic bronchitis

E Diffuse alveolar damage

F Bronchiectasis

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A 56-year-old man with a history of congestive heart failure has been in the hospital for three weeks after laparotomy for a perforated duodenal ulcer complicated by peritonitis. On the 22nd hospital day he is now afebrile. His lungs are clear to auscultation, and he has no cough. Later that day he has a sudden episode of pleuritic chest pain on the left. Which of the following is the most likely cause for his sudden chest pain?

A Lobar pneumococcal pneumonia

B Pulmonary infarction

C Left upper lobe abscess

D Bronchiectasis

E Cytomegalovirus pneumonitis

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A 55-year-old healthy woman, a non-smoker, has noted some mild discomfort on inspiration on the left side of her chest for the past 3 weeks. She has no cough or dyspnea. On physical examination she is afebrile and her lungs are clear to auscultation. A chest radiograph shows a pleural mass over the left lower lung. There are no effusions and no infiltrates. A chest CT scan further defines the lesion as a pedunculated 3 x 10 xm mass with smooth borders that appears attached to the lung by a small pedicle. At thoracotomy, the mass is easily resected since it does not infiltrate surrounding structures. Microscopically, it is composed of cells resembling fibroblasts and forming abundant collagen. Which of the following is the most likely diagnosis?

A Metastatic fibrosarcoma

B Bronchoalveolar carcinoma

C Sarcoidosis

D Organizing empyema

E Solitary fibrous pleural mesothelioma

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A 73-year-old previously healthy woman has had a fever with non-productive cough for a week. She reports no hemoptysis or chest pain. On physical examination her temperature is 37.6 C. A chest radiograph reveals bilateral diffuse pulmonary interstitial infiltrates but no nodules or masses. These infiltrates are composed primarily of small lymphocytes, and there is minimal pulmonary edema. Which of the following infectious agents is most likely to cause these findings?

A Streptococcus pneumoniae

B Candida albicans

C Mycobacterium tuberculosis

D Actinomyces israeli israeli

E Mycobacterium kansasii

F Cytomegalovirus

G Influenza A virus

H Klebsiella pneumoniae

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A 13-year-old girl experiences the sudden onset of wheezing with dyspnea. She had a similar episode a month ago. She is brought to the emergency room. On physical examination her breathing appears to have a prolonged expiratory phase with wheezing sounds. An arterial blood gas shows pO2 87 mm Hg, pCO2 45 mm Hg, and pH 7.37. A chest radiograph shows clear lung fields. Which of the following laboratory findings is she most likely to have?

A Elevated sweat chloride

B Numerous sputum eosinophils

C Decreased CD4 lymphocyte count

D Increased serum alkaline phosphatase

E Positive tuberculin skin test

F Decreased alpha-1-antitrypsin

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A previously healthy 4 month old male infant is found in his crib cold and blue by distraught parents. The baby was born at term with Apgar scores of 9 and 10. No congenital anomalies were noted. The baby has been gaining weight and reaching developmental milestones normally. The baby was fine only an hour before he was found dead. The medical examiner finds no gross abnormalities at autopsy. Which of the following statements best describes this situation?

A Bronchopulmonary dysplasia is found microscopically

B Scene investigation reveals that the infant was sleeping supine on a hard mattress

C The immediate cause of death is status asthmaticus

D Viral and bacterial lung cultures show no growth

E Both parents are carriers of a cystic fibrosis gene.

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A 39-year-old woman has had increasing dyspnea for 5 years. Everyone in her family is a non-smoker, but she and her sister have had similar symptoms. On physical examination there is hyperresonance on percussion. A chest radiograph shows increased lung volumes but no infiltrates or masses. A chest CT scan demonstrates large loculated air spaces at the lung bases. Pulmonary function testing shows a decreased FEV1 and decreased FEV1/FVC ratio. Which of the following is most likely to produce her pulmonary disease?

A Multiple infections with respiratory viruses

B Environmental exposure to organic dusts

C Alpha-1-antitrypsin deficiency

D Congenital cystic adenomatoid malformation

E Non-atopic asthma

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A 61-year-old man has had progressive dyspnea for the past 5 years. He does not have a significant cough. He is afebrile. A chest x-ray shows increased interstitial markings along with pleural thickening and calcified diaphragmatic pleural plaques. The right heart border is prominent and the pulmonary arteries appear prominent. A sputum gram stain shows normal flora and sputum cytology reveals no atypical cells. Which of the following environmental exposures is most likely to be associated with his findings?

A Bird dust

B Asbestos

C Tobacco smoke

D Radon

E Chlorine

F Cotton fibres

G Mold spores

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A 40-year-old malnourished man has had fever for 3 weeks along with a severe non-productive cough. On physical examination his temperature is 38.2 C. A chest radiograph shows markedly enlarged hilar lymph nodes and a prominent reticulonodular pattern with many small nodules less than 5 mm in size. Small bilateral pleural effusions are present. A bronchoalveolar lavage is performed and yields acid fast bacilli. He is treated with a course of rifampin, isoniazid, ethambutol, and pyrazinamide and his condition improves. Which of the following organisms is most likely to cause his pulmonary disease?

A Cryptococcus neoformans

B Aspergillus niger

C Nocardia braziliensis< braziliensis

D Histoplasma capsulatum

E Actinomyces israeli

F Coccidioides immitis

G Mycobacterium tuberculosis

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A 70-year-old man, a non-smoker, has experienced hemoptysis for 2 weeks. On physical examination there are no abnormal findings. A chest CT scan shows a 6 cm left perihilar cavitary mass. Sputum cytologic examination reveals atypical cells present consistent with squamous cell carcinoma. A mediastinoscopy is performed, and the mass appears to extend into the the mediastinum, but not to the opposite lung. Sampling of enlarged hilar and scalene lymph nodes reveals metastatic squamous cell carcinoma. Which of the following is the most appropriate conclusion from these findings?

A He has a resectable lesion

B The stage of his neoplasm is T1

C His 5 year survival is 80%

D There is a history of radon gas exposure

E His antinuclear antibody test is positive

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A 31-year-old man falls off a ladder and lands on his left side. He has sharp pain on inspiration but is in stable condition. In hospital, left 5th and 6th rib fractures are noted along with a small pneumothorax. Two days later the man has marked subcutaneous swelling with crepitance of his chest wall and neck. This is not painful. A chest x-ray shows decreased size of the pneumothorax but there is a widened mediastinum. A left chest tube is placed and the extent of the subcutanous crepitance increases. Which of the following is the most likely diagnosis?

A Interstitial emphysema

B Obstructive overinflation

C Bronchiectasis

D Bronchopleural fistula

E Tension pneumothorax

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Two years following orthotopic cardiac transplantation, a 44-year-old man develops fever and cough after his immunosuppressive therapy was increased to treat an episode of acute cellular rejection. His symptoms do not improve over the next 2 months. A chest radiograph reveals right middle lobe infiltrates with abscess formation. Which of the following microscopic findings is most likely to be seen with a bronchoalveolar lavage?

A Acid fast bacilli

B Clusters of gram positive cocci

C Gram negative rods

D Long filamentous gram positive organisms

E Large cells with intranuclear inclusions

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A 28-year-old man has had periods of fever along with dyspnea over the past month. These symptoms seem to be worse when he is at home. A physical examination reveals lungs clear to auscultation. A chest radiograph reveals an ill-defined pattern of interstitial markings. A chest CT scan shows scattered small nodular densities in all lung fields. A 2 week course of antibiotic therapy has no effect. A transbronchial biopsy is then performed and on microscopic examination shows small patchy areas of chronic interstitial inflammatory infiltrates associated with ill-defined interstitial granulomas. Special stains for fungi and acid fast bacilli are negative. Exposure to which of the following environmental agents best accounts for his findings?

A Silica dust

B Tobacco smoke

C Radon gas

D Smog

E Mold spores

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Following allogeneic bone marrow transplantation for acute lymphocytic leukemia, a 19-year-old man has worsening respiratory distress for 2 days. He requires intubation and mechanical ventilation. Sputum cultures and a bronchoalveolar lavage fail to reveal an infectious agent as the cause for his worsening pulmonary function. A lung biopsy is performed and demonstrates hyaline membranes lining alveoli along with alveolar macrophages. These findings are most consistent with which of the following diagnoses?

A Cystic fibrosis

B Diffuse alveolar damage

C Goodpasture syndrome

D Hyaline membrane disease

E Idiopathic pulmonary fibrosis

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A 45-year-old woman has a routine health check-up. On physical examination there are no abnormal findings. A chest radiograph shows a peripheral 3 cm nodule with irregular calcifications in the right upper lobe. A fine needle aspiration of this lesion is performed. However, the pathologist has difficulty putting the needle into the lesion, and it bounces off as though the lesion were a ping-pong ball. A small amount of tissue with epithelial cells, connective tissue, and cartilage is obtained. A thoracotomy is performed with a wedge resection. Grossly, the mass is very firm, with a tan, focally gritty cut surface. Which of the following is the most likely diagnosis?

A Hamartoma

B Abscess

C Adenocarcinoma

D Ghon complex

E Squamous cell carcinoma

F Granuloma

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Over the past 15 years, a 60-year-old man has had worsening dyspnea. He is afebrile. Pulmonary function studies show a low FVC and a normal FEV1/FVC ratio. Chest radiographs over the past 10 years have demonstrated increasingly larger nodular opacifications in both lungs. The latest film shows almost complete "white-out" of the right lung. Which of the following environmental exposures is most likely to produce his pulmonary findings?

A Tobacco smoke

B Wood dust

C Silica

D Nickel

E Hydrocarbons

F Ozone

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A 26-year-old woman presents with a 3 day history of increasing shortness of breath. She has a non-productive cough. Vital signs shows T 38.9 C, P 95, R 28, BP 110/60 mm Hg. A bronchoalveolar lavage is performed and cytologically the specimen demonstrates the appearance of numerous cysts of Pneumocystis carinii (jirovecii) with Gomori methenamine silver stain. Which of the following laboratory test findings is she most likely to have?

A Absolute neutrophil count of 10,000

B Positive monospot test

C CD4 lymphocyte count of 28

D Positive pregnancy test

E Hemoglobin SS on hemoglobin electrophoresis

F Plasma cortisol of 48 microgm/dL

G Positive antinuclear antibody test

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A 55-year-old man has smoked 2 packs of cigarettes per day for 40 years. He has had a worsening cough for the past 5 months. In the past 2 weeks he has noted blood-tinged sputum. On physical examination no abnormal findings are noted. A chest x-ray shows a 6 cm right perihilar mass. Serum chemistries show sodium 144 mmol/L, potassium 4.2 mmol/L, chloride 103 mmol/L, CO2 25 mmol/L, glucose 76 mg/dL, creatinine 1.3 mg/dL, calcium 12.6 mg/dL, phosphorus 2.6 mg/dL, total protein 7.2 g/dL, albumin 4.5 mg/dL, and total bilirubin 0.9 mg/dL. Which of the following neoplasms is he most likely to have?

A Squamous cell carcinoma

B Carcinoid tumor

C Adenocarcinoma

D Small cell anaplastic carcinoma

E Bronchoalveolar carcinoma

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A 66-year-old woman has had Alzheimer disease for a decade and has become more and more demented. She is finally unable to care for herself and is mainly bedridden, except for short periods in which she is placed in a wheelchair. She becomes febrile and then dies at home. Which of the following infections is most likely to be her immediate cause of death?

A Cytomegalovirus interstitial pneumonia

B Respiratory syncytial virus interstitial pneumonia

C Nocardia braziliensis chronic abscessing pneumonia

D Streptococcus pneumoniae lobar pneumonia

E Methicillin resistant Staphylococcus aureus bronchopneumonia

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A 29-year-old G3 P2 woman gives birth to a male infant at 32 weeks gestation. The infant's Apgar scores are 1 at 1 minute and 3 at 5 minutes. The infant is intubated but cannot be adequately ventilated and dies at 30 minutes of age. The chest cavity opened at autopsy contains lungs that appear quite small. Which of the following is the most likely underlying cause of death?

A Tracheoesophageal fistula

B Bronchopulmonary dysplasia

C Cystic fibrosis

D Multicystic renal dysplasia

E Sudden infant death syndrome

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A 50-year-old orthotopic cardiac transplant recipient has been treated for 3 weeks with increasing dosages of imunosuppressive medications because an endomyocardial biopsy demonstrated moderate acute rejection. He now has a fever and cough. A chest x-ray shows left lingular consolidation. This persists for over six weeks, and a bronchopleural fistula develops. His course is then complicated by headaches, and head CT scan reveals the presence of several brain abscesses. Which of the following organisms is most likely to cause these findings?

A Pneumocystis carinii (jirovecii)

B Streptococcus pneumoniae

C Cytomegalovirus

D Nocardia asteroides

E Candida albicans

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A 26-year-old man is involved in a motorcycle accident. Paramedics arrive on the seen to find him in severe respiratory distress. He is ventilated by Ambu bag on the way to the hospital. The chest radiograph taken soon after arrival at the hospital shows that the mediastinum is shifted to the left and the right lung fields are more lucent than those on the left. Which of the following diagnostic findings is he most likely to have?

A Sputum with increased numbers of eosinophils

B Echocardiogram showing a large tricuspid valvular vegetation

C Rush of air upon insertion of thoracentesis needle

D Areas lacking perfusion on a V/Q scan

E Aspirated foreign body on bronchoscopy

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A 45-year-old woman who works as a certified public accountant presents with the insidious onset of increasing dyspnea along with low grade fever for 3 months. On physical examination she has a temperature of 37.5 C. A chest x-ray shows reticulonodular infiltrates and marked hilar lymphadenopathy. Non-caseating granulomas are found on a transbronchial biopsy. Which of the following is the most likely diagnosis?

A Asbestosis

B Idiopathic pulmonary fibrosis

C Coccidioidomycosis

D Hypersensitivity pneumonitis

E Sarcoidosis

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A 21-year old G2 P1 woman gives birth at 34 weeks gestation to a girl infant. On physical examination this infant is 1500 gm. The infant displays grunting and retractions. A radiograph reveals poor aeration with "white out" of all lung fields. Despite intubation and positive pressure ventilation, the baby expires. At autopsy, the lungs are grossly solid. Microscopically, there are extensive pink hyaline membranes. Which of the following maternal laboratory test findings prior to birth would have best predicted this outcome?

A Acetylcholinesterase

B Alpha-fetoprotein

C Bilirubin

D Estriol

E Glucose

F Lamellar body count

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While obtaining informed consent for a fine needle aspiration (FNA) of the right lung to obtain a tissue diagnosis of a lower lobe mass in a 58-year-old man, the physician giving informed consent provides a list of potential problems with the procedure to the patient. Which of the following is the most likely problem associated with FNA of the lung?

A Pneumothorax

B Hemothorax

C Inability to determine the cell type of a malignancy

D High cost

E Chronic pain following the procedure

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A 51-year-old woman has had fever with night sweats for the past 3 months. She has had a worsening non-productive cough for 2 weeks. A chest radiograph shows small nodules 0.5 cm or less in size, scattered through all lung fields, with a normal size heart, but prominent hilar lymphadenopathy. On bronchoscopy, no endobronchial lesions are noted. A transbronchial biopsy shows non-caseating granulomas. Bacterial, fungal, and mycobacterial cultures from the biopsied tissue show no growth. Which of the following pharmacologic therapies will be most efficacious in treating this patient?

A Prednisone

B Ciprofloxacin

C Isoniazid

D Cytoxan

E Acetaminophen

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