Week 1+2
Week 3
Week 4
Week 5
Week 6
100
Long-acting B2 agonists inhalers are used for treatment of these diseases.
What are Obstructive lung disease?
100
Surfactant is synthesized from
A. Embryonic stage
B. Pseudoglandular stage
C. Canalicular stage
D. Saccular stage
E. Alveolar stage
C. Canalicular stage
Synthesis begins ~20 weeks of gestation and achieve mature levels ~35 weeks of gestation.
100
High nicotine concentration seen with usual smoking saturates receptor and
causes _____ receptor responsiveness (desensitization) and _____ of
binding sites.
A. increased, upregulation
B. reduced, downregulation
C. increased, downregulation
D. reduced, upregulation
D. reduced, upregulation
High nicotine concentration seen with usual smoking saturates receptor and
causes reduced receptor responsiveness (desensitization) and upregulation of
binding sites.
100
A 55-year-old woman comes to the clinic because of 24 hours of palpitations, shortness of breath, and chest pain on inspiration. Five days ago she underwent mastectomy of the right breast due to ductal adenocarcinoma. Pulse is 112/min, temperature 98°F, respirations are 33/min, blood pressure is 110/77 mm Hg, and oxygen saturation is 90% on room air. An ECG shows sinus tachycardia. An x-ray of the chest is normal. Which set of arterial blood gas values presented in the table is most likely in this patient?
E.
Pleuritic chest pain, tachycardia, tachypnea, and hypoxia in the setting of recent surgery or malignancy or immobility suggests PE.
Patients with PE most often have an acute respiratory alkalosis.
100
An 85-year-old woman presents to the emergency department from home because of a 3-day history of fever, chills, pleuritic chest pain, and a productive cough with rust-colored sputum. She is not up to date on her recommended vaccinations. She is otherwise well. Temperature is 38°C (100.4°F), respirations are 20/min, and oxygen saturation is 94% on room air. Physical examination shows bronchial breath sounds, dullness to percussion, egophony, and increased tactile fremitus over the right lower lobe. X-ray of the chest shows lobar consolidation, and she is found to have a bacterial infection. Which of the following is the most likely diagnosis?
Community-acquired pneumonia from S. pneumoniae
Pleural effusion
Lung cancer
Hospital-acquired pneumonia from S. aureus
Community-acquired pneumonia from S. pneumoniae
This elderly patient most likely has community-acquired pneumonia based on her recent history of fever, chills, and a productive cough; her physical exam and the lobar infiltrate on x-ray of the chest. Since she is not institutionalized or described with any immunocompromise or chronic illness, community-acquired pathogens are most likely. She is also not up to date on her recommended vaccination for pneumonia.
200
A reid index of >60% and the following histology:
What are the histological findings of chronic bronchitis?
200
Which of the following drugs inhibits DNA gyrase in bacteria?
A. Isoniazid
B. Pyrazinamide
C. Moxifloxacin
D. Ethambutol
C. Moxifloxacin
Moxifloxacin (Fluoroquinolone class) is a bactericidal drug that inhibits DNA gyrase in bacteria. Adverse effects include QT prolongation and tendon rupture.
200
RAS is frequently mutated in cancer. These cancer-driving mutations
A. Prevent GTP hydrolysis by RAS
B. Accelerate GTP hydrolysis by RAS
C. Increase autophosphorylation of RAS
D. Prevent autophosphorylation of RAS
A. Prevent GTP hydrolysis by RAS
200
A 58-year-old woman presents to her physician for evaluation of a painless lump in the breast. Family history is significant for breast cancer in her mother and aunt. Physical examination shows a firm, nontender mass in the upper-outer quadrant of the left breast. Biopsy of the mass reveals small, glandular cells infiltrating with a stellate appearance. Which of the following is the most likely diagnosis?
a. Inflammatory Breast Cancer
b. Invasive Ductal Carcinoma
c. Invasive Lobular Carcinoma
d. Ductal Carcinoma In Situ
e. Fibroadenoma
b. Invasive Ductal Carcinoma
IDC presents as a firm mass and microscopically reveals small and glandular cells. ILC usually presents bilaterally and is characterized by ordered rows of cells. Inflammatory involves erythema and “peau d’orange”. DCIS would not be infiltrating, and fibroadenoma is normally mobile.
200
A 33-year-old woman is brought to the hospital due to shortness of breath. Five days ago, she developed fever, burning micturition, and back pain. She is now having trouble breathing at rest. She has no history of other serious illness. Temperature is 38.5°C (101.4°F), pulse is 140/min, respirations are 30/min, blood pressure is 105/60 mm Hg, and oxygen saturation is 84% on room air. On examination, the patient looks ill, has nasal flaring, and is using accessory muscles of respiration; decreased breath sounds and crackles are heard bilaterally on auscultation. An x-ray of the chest is shown. Which of the following is the most likely diagnosis?
Acute respiratory distress syndrome
Cardiogenic pulmonary edema
Interstitial lung disease
Lung cancer
Pleural effusion
Acute respiratory distress syndrome
ARDS is diagnosed in patients with acute hypoxic respiratory failure and diffuse pulmonary interstitial and alveolar infiltrates on radiographic imaging in the setting of an illness or other trigger known to precipitate ARDS.
300
A patient presenting with low bicarbonate and an anion gap of 30 mEq/L.
Using the acronym MUDPILES, you can determine common causes of this.
What is an example of metabolic acidosis with anion gap?
300
A 1 hour old girl is evaluated for dyspnea in the labor and delivery suite. She was born via emergency cesarean section at 30 weeks of gestation because her mother developed hypertension and edema. On examination, the newborn is noted to have cyanosis, tachypnea, and dyspnea, with costosternal retractions and nostril flaring.
Which of the following is the mechanism of this baby's most likely condition?
A. Increased alveolar surface tension
B. Maternal rubella infection
C. PDA
D. VSD
A. Increased alveolar surface tension
NRDS. Inadequate surfactant levels
B. Maternal rubella -> PDA. pulmonary stenosis
C. PDA -> if left untreated longer, causes Eisenmenger
300
Which of the following is due to defect in short patch DNA repair mechanism?
A. Hereditary breast cancer (BRCA 1,2)
B. MUTYH-associated polyposis colon cancer
C. Xeroderma pigmentosum
D. DNA damage by cisplatin
B. MUTYH-associated polyposis colon cancer
Base excision repair is short patch- 1 nucleotide repair tract.
A. Hereditary breast cancer (BRCA 1,2)
Homologous recombination
C. Xeroderma pigmentosum
Defect in NER
D. Cisplatin induces intrastrand crosslink and bends the helix axis. Repaired by NER.
300
A 65-year-old woman visits the physician after undergoing mastectomy of the right breast. Pathology results from the biopsy show a tumor that is estrogen receptor positive, progesterone receptor positive, and human epidermal growth factor receptor 2 negative. The physician prescribes a chemotherapeutic agent appropriate for the patient’s breast cancer pathology. The most likely prescribed medication disrupts which of the following hormonal pathways?
Conversion of androstenedione to testosterone
Conversion of testosterone to dihydrotestosterone
Secretion of luteinizing hormone
Conversion of testosterone to estradiol
- Secretion of follicle-stimulating hormone
4. Conversion of testosterone to estradiol
Aromatase inhibitors prevent conversion of testosterone to estrogens, which are commonly used to lower estrogen in hormone-responsive breast cancer in postmenopausal women.
300
75-year-old woman comes to the emergency department because of acute onset of fever, cough, and shortness of breath. She has a 2-month history of regurgitating food onto her pillow at night. Temperature is 38.8°C (101.8°F), pulse is 120/min, respirations are 24/min, and blood pressure is 115/85 mm Hg. X-ray of the chest is shown. Arterial blood gas analysis shows a PaO2 of 51 mm Hg. Which of the following is the most likely cause of this patient’s current symptoms?
Congestive heart failure
Damaged alveolar capillaries
Pneumothorax
Pulmonary embolism
Pulmonary fibrosis
Damaged alveolar capillaries
ARDS is commonly caused by pneumonia, sepsis, aspiration, trauma, and pancreatitis.
ARDS results from capillary damage from neutrophil cytokine and protease release. This leads to fluid extravasating from capillaries into the alveoli, damaging them.
400
An older male patient presents with dyspnea and no environmental exposures. This is the finding on his CT:
What is the common presentation and CT of Idiopathic Pulmonary Fibrosis?
400
A patient presents with productive cough, fever, night sweats and unintentional weight loss 9kg (19lb) for past 4 months. Xray showed upper lobe infiltrate. The patient does not smoke and all ion levels were normal.
What is the cause of this patient's disease?
A. Granulomas and lymphocytes surrounding a small artery
B. Squamous cell carcinoma
C. Multinucleated giant cells surrounding central caseation
D. Non-caseating, tightly formed granulomas with nodal aggregates of epithelioid cells
C. Multinucleated giant cells surrounding central caseation
Reactivation of TB causes fever, night sweats, weight loss, productive cough.
A. Granulomas and lymphocytes surrounding a small artery
causes upper respiratory & lung inflammation with cough and hemoptysis.
B. Squamous cell carcinoma is the most common tumor in male smokers and may produce PTHrP, which leads to hypercalcemia.
400
A 56-year-old man presents to his primary care physician with fatigue, fevers, weight loss, and production of blood-tinged sputum for 5 weeks. He smokes cigarettes regularly. Temperature is 38.2°C (100.8°F). Physical examination reveals dark stretch marks on his flanks and disproportionate weight distribution, particularly in the upper body. His serum glucose is 168 mg/dL. A CT of the chest reveals a mass located in the center of his left lung, and a bronchoscopic biopsy is performed.
Which of the following is the most likely finding of this patient’s biopsy?
A. Glandular pattern of cells
B. Nests of neuroendocrine cells
C. Small, dark blue cells with neuroendocrine origin
D. Keratin pearls and intercellular bridges
C. Small, dark blue cells with neuroendocrine origin
Cushing syndrome is a paraneoplastic syndrome associated with small cell lung cancer. Cushing syndrome manifests due to ectopic secretion of ACTH from rapidly growing tumor cells.
400
A 42-year-old woman is found to have a pulmonary embolus secondary to deep venous thrombosis. She receives heparin and warfarin while in the hospital and is discharged on 5 days of subcutaneous enoxaparin and 6 months of oral warfarin. This patient is most likely receiving concurrent enoxaparin due to which of the following effects of the warfarin?
Increased platelet aggregation
Increased vitamin K–dependent coagulation factors
Decreased vitamin K-dependent coagulation factors
Transient hypercoagulable state
Increased risk of bleeding
Transient hypercoagulable state
After initiating warfarin therapy, patient has normal function of coagulation factors but loss of protein C and S (which have shorter half-lives), causing an initial transient hypercoagulable state
400
A 75-year-old woman is brought to the emergency department by her daughter because of a 2-day history of malaise and new-onset confusion. The patient has been hemiplegic and bedridden following an ischemic stroke 4 months ago. She has type 2 diabetes mellitus and hypertension. Current medications include metformin, lisinopril, atorvastatin, and aspirin. She is oriented to person but not to place or time. Her temperature is 37.6°C (99.7°F), pulse is 102/min, respirations are 31/min, and blood pressure is 88/59 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 95%. Examination of the sacrum reveals an ulcer with exposed subcutaneous tissue and necrotic areas. The skin is warm and well-perfused. Arterial blood gas analysis shows a pH of 7.25, pCO2 of 30 mm Hg, and HCO3- of 14 mEq/L. Which of the following is the most appropriate next step in management?
CT head
Surgical debridement of the ulcer
IV vasopressin therapy
Superficial swab of the wound
IV broad-spectrum antibiotic therapy
IV broad-spectrum antibiotic therapy
This is sepsis, a medical emergency that should use early intervention of empiric broad spectrum antibiotic therapy and rapid IV fluid resuscitation. IV vasopressin is incorrect as it is used to treat septic shock, which is characterized by MAP < 65 mmHg despite adequate fluid therapy. This patient had a MAP of 69 mmHg before fluid therapy, so they didn’t meet the diagnostic criteria for septic shock.
500
An autosomal recessive disorder that targets dynein ATPases. Commonly found to cause bronchiectasis, as a part of Kartegener's Syndrome.
What is Primary Ciliary Dyskinesia?
500
A newborn girl is evaluated for dyspnea after being delivered via emergency cesarean section at 30 weeks of gestation because her mother developed hypertension and seizures. The newborn appears cyanotic. Respirations are 70/min and oxygen saturation is 68% on room air. There is nasal flaring, expiratory grunting, and intercostal retractions. No murmur is heard. Xray shows decreased lung volume and air bronchograms.
Which of the following is the primary cause of this neonate’s most likely diagnosis?
A. Delayed clearance of fluid
B. Impaired diffusion
C. Immature enteroendocrine cells containing argyrophilic granules
D. Diffuse atelectasis
D. Diffuse atelectasis
Decreased surfactant leads to alveolar collapse from increased surface tension, causing diffuse atelectasis.
B. Impaired diffusion
Pulmonary edema is a common cause of impaired diffusion. The most common causes of pulmonary edema in neonates are sepsis and heart failure due to cyanotic congenital heart disease.
C. Type II pneumocytes are cuboidal cells interspersed within walls of alveoli.
500
A 65-year-old woman comes to the clinic because of a drooping eyelid and occasional hemoptysis. She has a history of smoking. On physical examination, the swinging flashlight test shows her right pupil is 2 mm, and her left pupil is 5 mm. The patient’s right upper eyelid obstructs the view of the pupil. X-ray of the chest reveals a lung tumor.
Which additional finding is most likely to develop in this patient?
A. Mydriasis
B. Hyponatremia
C. Easy bruising
D. Jugular venous distention
D. Jugular venous distention
Apical lung tumors may compress the vena cava, causing facial swelling and jugular venous distention (superior vena cava syndrome)
B. High serum osmolarity (hypernatremia) is associated with dehydration or diabetes insipidus (low ADH or low ADH effect).
500
A 45-year-old woman comes to the physician after undergoing a lumpectomy and chemotherapy for estrogen-receptor–positive breast cancer. The patient’s treatment includes a hormonal therapy that will improve the breast cancer prognosis but may increase the risk of endometrial cancer. Which of the following is the most likely additional effect of this medication?
Acute kidney injury
Hyperkalemia and metabolic acidosis
Hyperstimulation of the ovaries
Inhibition of osteoclasts
Myelosuppression
Pulmonary fibrosis
Inhibition of osteoclasts
Tamoxifen (a selective estrogen receptor modulator) is an estrogen receptor antagonist that also inhibits osteoclasts and prevents bone loss (agonist effects in endometrium and bone).
500
A 58-year old woman is brought to the ED because of a 2-day history of increasing chest pain and SOB. She has had a productive cough with foul-smelling sputum for 1 week. Seven months ago, the patient had an ischemic stroke. She has gastritis and untreated HTN. She currently lives in an assisted-living community. She has smoked one pack of cigarettes daily for 40 years. She has a 20-year history of alcohol use disorder, but has not consumed any alcohol in the past 4 years. Her only medication is omeprazole. She appears to be in respiratory distress and speaks incoherently. Her temperature is 39.3 C (102.7 F), pulse is 123/min, respirations are 33/min, and BP is 155/94 mmHg. Auscultation of the lung shows rales and decreased breath sounds over the right upper lung field. Exam shows weakness and dressed sensation of the right upper and lower extremities. Babinski sign and facial drooping are present on the right. Arterial blood gas on room air shows: pH 7.48, PCO2 31 mmHg, PO2 58 mmHg, and O2 Sat 74%. A chest x-ray shows infiltrates in the right posterior upper lobe. Which of the following is the strongest predisposing factor for this patient’s respiratory symptoms?
Living in an assisted-living community
History of smoking
Past history of alcohol abuse
Untreated HTN
History of ischemic stroke
History of ischemic stroke
The patient’s fever, dyspnea, productive cough with foul-smelling sputum, hypoxemia, and infiltrates in right posterior upper lobe are suggestive of aspiration pneumonia
Stroke predisposes to aspiration pneumonia by possibly impairing swallowing and/or cough mechanism.