a = new Array(243);
var f = "<FONT FACE=ARIAL SIZE=2>"
a[0] = ""
a[1] = f + "(A) Incorrect. The incidence of lung cancer is not increased with cystic fibrosis."
a[2] = f + "(B) CORRECT. The chronic lung disease of cystic fibrosis often includes bronchiectasis, a disease characterized by inflammation with obstruction and dilation and destruction of bronchi. This process is diffuse throughout the lungs. The loss of pulmonary vascular bed with progressive bronchiectasis can lead to pulmonary hypertension and cor pulmonale."
a[3] = f + "(C) Incorrect. Dilation of lymphatics is an infrequent occurrence with mediastinal masses such as lymphomas."
a[4] = f + "(D) Incorrect. Pleural plaques are most frequently seen with pneumoconioses."
a[5] = f + "(E) Incorrect. Patients with cystic fibrosis usually have lung infections with bacteria such as Pseudomonas."
a[5.1] = f + "(F) Incorrect. Pneumonias with cystic fibrosis are unlikely to produce pneumothorax. No bullae form."
a[6] = f + "(A) Incorrect. <I>Pneumocystis carinii (jirovecii)</I> pneumonia is most often seen in immunocompromised patients and is typically bilateral and widespread in the lungs."
a[7] = f + "(B) Incorrect. Listeriosis is infrequent. Some cases occur in immune compromised persons. It can be a congenital infection."
a[8] = f + "(C) Incorrect. Cryptococcal infections typically occur more frequently in immunocompromised persons."
a[9] = f + "(D) Incorrect. Tuberculosis produces a granulomatous pattern of infection. In an adult, reinfection or reactivation is the most likely pattern, with upper lobe involvement."
a[10] = f + "(E) Incorrect. Legionella can produce a florid pneumonia, typically in all lobes, but it is not common."
a[10.1] = f + "(F) Incorrect. S. aureus is more likely to be a nosocomial infection and more likely to produce a bronchopneumonia with patchy infiltrates."
a[10.2] = f + "(G) CORRECT. She has a lobar pneumonia, which is most often a community aquired pneumonia (the nursing home counts as a community venue), following a debilitating course of Alzheimer disease. The most common organism is <I>Streptococcus pneumoniae</I> (pneumococcus)."
a[10.3] = f + "(H) Incorrect. Viral pneumonias are common in the elderly but produce interstitial pneumonitis with non-productive cough. However, viral pneumonias are often complicated by bacterial pneumonia."
a[11] = f + "(A) Incorrect. A hypersensitivity pneumonitis occurs in response to an inhaled antigen and produces small areas of interstitial inflammation throughout the lungs. Lymph nodes are not enlarged."
a[12] = f + "(B) CORRECT. This is a description of the typical 'Ghon complex' of an initial, or primary, TB infection. The peripheral granuloma does not produce symptoms, but the enlarged lymph nodes may impinge upon airways. Most persons with a primary infection, however, are asymptomatic and the infection goes unnoticed."
a[13] = f + "(C) Incorrect. A carcinoid tumor could produce focal obstruction with a pneumonia, but pulmonary neoplasms in children are rare. Most bronchial carcinoids act in a benign fashion without metastases."
a[14] = f + "(D) Incorrect. In children, congenital heart disease is the most likely risk factor for infective endocarditis, and most of these lesions will involve the left heart, with systemic embolization. Even if right-sided vegetations embolize, there should be multiple abscesses present."
a[15] = f + "(E) Incorrect. Goodpasture syndrome is rare at this age, and the pattern is that of diffuse pulmonary hemorrhage with hemoptysis."
a[16] = f + "(A) Incorrect. Pulmonary edema does not have this sudden an onset. The edema could result in dyspnea and a cough with frothy sputum. Orthopnea would be a signficant finding with edema."
a[17] = f + "(B) Incorrect. An effusion would take days to weeks to form. There could be dyspnea."
a[18] = f + "(C) Incorrect. Post-operative changes should have resolved after a week or so and would have a course of gradual improvement."
a[19] = f + "(D) CORRECT. The activity of ambulation resulted in sudden movement of a thrombus that formed during his period of immobilization in the leg or pelvic veins. The thrombus became an embolus and traveled to the lungs."
a[20] = f + "(E) Incorrect. DAD occurs following any severe lung injury. It does not have a sudden onset. It does not occur in patients who are up and about."
a[21] = f + "(A) Incorrect. Histoplasmosis is most common in the Mississippi and Ohio river valleys in the US. The dimorphic fungi tend to mimic tuberculosis and can have granulomas with central caseation."
a[22] = f + "(B) Incorrect. Adenocarcinoma should yield malignant cells, not granulomas, on biopsy."
a[23] = f + "(C) CORRECT. Sarcoidosis is typified by non-caseating granulomas. However, culture of the tissue and a careful search histologically should be made for organisms."
a[24] = f + "(D) Incorrect. UIP is the end result of a diffuse fibrosing alveolitis. Many cases are idiopathic. The end stage is a honeycomb lung. No granulomas are seen."
a[25] = f + "(E) Incorrect. Though berylliosis can produce sarcoid-like granulomas, it is very uncommon. An environmental history would be helpful."
a[25.1] = f + "(F) Incorrect. A miliary pattern of tuberculosis could produce a diffuse reticulonodular pattern, but the granulomas of tuberculosis are typically caseating."
a[25.2] = f + "(G) Incorrect. Persistent exposure to allergens may lead to 'farmer's lung' with small granulomas representing type IV hypersensitivity, but there is no good occupational history in this case."
a[26] = f + "(A) Incorrect. Wilson disease affects the liver and the CNS."
a[27] = f + "(B) Incorrect. Though cystic fibrosis commonly affects the lungs, it leads to the obstructive lung disease known as bronchiectasis."
a[28] = f + "(C) Incorrect. Alcoholism does not lead to emphysema (but many alcoholics also smoke)."
a[29] = f + "(D) CORRECT. AAT deficiency leads to lack of an anti-protease, which leads to development of emphysema, typically a panlobular type affecting lower lobes more severely."
a[30] = f + "(E) Incorrect. Intravenous drug users are at greater risk for infections and abscesses. The injected talc may form small foreign body granulomas in lung."
a[30.1] = f + "(F) Incorrect. A positive ANA can be associated with autoimmune diseases such as SLE. There is often type III hypersensitivity with deposition of antigen-antibody complexes at basement membranes, producing serositis and effusions, such as pleural effusions."
a[31] = f + "(A) CORRECT. Both squamous cell and oat cell carcinomas tend to be central in location. Squamous cell carcinomas of the lung are associated with hypercalcemia, though overall the oat cell carcinomas are best known for paraneoplastic syndromes."
a[32] = f + "(B) Incorrect. This is more typical of a bronchioloalveolar carcinoma."
a[33] = f + "(C) Incorrect. Such a peripheral mass would more likely be a granuloma, an adenocarcinoma or a hamartoma."
a[34] = f + "(D) Incorrect. The carina is an unusual site for a primary tumor."
a[35] = f + "(E) Incorrect. The findings do not suggest a mesothelioma."
a[36] = f + "(A) Incorrect. There is no propensity for a lung carcinoma, either primary or metastatic, to be in one lung or another. Lung cancers may have central cavitation if large, but usually not an air-fluid level. Large neoplasms can cause obstruction with pneumonia distal to the neoplasm."
a[37] = f + "(B) CORRECT. A	Lung abscesses can result from aspiration of oropharyngeal or nasopharyageal contents, where bacterial organisms as part of normal flora can be picked up and transported to the lungs. The straighter bronchus to the right lung is more likely to conduct aspirated material. With septicemia, multiple abscesses are more likely to be present."
a[38] = f + "(C) Incorrect. Chronic bronchitis is a clinical diagnosis made when a patient has a chronic productive cough."
a[39] = f + "(D) Incorrect. Bronchiectasis can occur from bronchial inflammation and destruction following obstruction and/or infection; cystic fibrosis is the best known disease to produce a widespread pattern of bronchiectasis. With obstruction, it depends upon the cause for the obstruction where the focus of bronchiectasis will be."
a[40] = f + "(E) Incorrect. Sequestrations are masses of lung tissue without a normal connection to the airways. They act as space occupying lesions and can cause obstruction."
a[41] = f + "(A) Incorrect. TB most often produces a granulomatous pattern of inflammation with reticulonodular densities, particularly in the upper lobes."
a[42] = f + "(B) Incorrect. Pneumococcus leads to alveolar filling with neutrophils."
a[43] = f + "(C) CORRECT. The typical appearance of a viral lung infection is chronic interstitial inflammation."
a[44] = f + "(D) Incorrect. Cryptococcus leads to granulomatous disease."
a[45] = f + "(E) Incorrect. MAI may produce poorly-formed granulomas."
a[46] = f + "(A) Incorrect. Silicosis increases the risk for lung cancer slightly by about 2 fold."
a[47] = f + "(B) Incorrect. Radon is probably the second leading cause of lung cancer. However, most cases of lung cancer in which exposure to radon gas has been identified also occur in smokers."
a[48] = f + "(C) CORRECT. Smoking remains the most frequent cause of lung cancer. Lung cancer does, however, occur in nonsmokers. A small cell anaplastic carcinoma, as in this patient, is virtually always seen in smokers."
a[49] = f + "(D) Incorrect. However, asbestos exposure increases the risk for lung cancer in smokers even more."
a[50] = f + "(E) Incorrect. Passive smoking could probably be right behind radon exposure as the second leading cause for lung cancer."
a[51] = f + "(A) Incorrect. Mycobacterial infection is unlikely in this setting, for there is still typically caseous necrosis and even poorly formed granulomas in an immunocompromised person with M. tuberculosis. M. avium-complex is less likely to produce florid pulmonary disease."
a[52] = f + "(B) Incorrect. Aspergillus often produces a fungus ball, or a defined mass, rather than infiltrates. It does not produce an acellular exudate."
a[53] = f + "(C) CORRECT. He is most likely to have <I>Pneumocystis carinii (jirovecii)</I> pneumonia in association with the acquired immunodeficiency syndrome. PCP has an exudate composed of the Pneumocystis cysts and trophozoites with little accompanying inflammation. The clinical findings in this case are typical as well."
a[54] = f + "(D) Incorrect. Pulmonary hemorrhage in the setting of AIDS is not common. The clinical features suggest an acute infection."
a[55] = f + "(E) Incorrect. This suggests listeriosis, a disease that can sometimes be seen in immunocompromised persons, but it is not common, and it produces focal abscesses or small granulomas, not foamy exudate."
a[56] = f + "(A) Incorrect. Though lung cancers are more common in persons who smoke, his findings are not explained by a mass lesion, and his symptoms have persisted for years."
a[57] = f + "(B) Incorrect. Congestive heart failure will produce pulmonary edema, if it is primarily left heart failure. If severe, there can be 'rusty' colored sputum."
a[58] = f + "(C) CORRECT. Chronic bronchitis is defined clinically as a person who has persistent cough with sputum production for at least 3 months in at least 2 consecutive years. Air pollution and smoking are key causes for chronic bronchitis."
a[59] = f + "(D) Incorrect. Attacks of asthma are quite intermittent, and there is usually not a great amount of sputum production."
a[60] = f + "(E) Incorrect. As a smoker, he is at risk for development of emphysema, but this does not explain his sputum production. Sometimes, smokers have elements of both emphysema and chronic bronchitis."
a[60.1] = f + "(F) Incorrect. Smoking can lead to severe bullous emphysema that can eventually involve a large amount of lung tissue, but a true panlobular pattern of emphysema is more typical for condtions such as alpha-1-antitrypsin deficiency."
a[60.2] = f + "(G) Incorrect. Bronchiectasis is not a typically complication of smoking."
a[61] = f + "(A) Incorrect. Byssinosis produces an asthma-like disease."
a[62] = f + "(B) Incorrect. Silicosis more typically produces a pattern of silicotic nodules in lung. Inorganic dusts often produce interstitial fibrosis."
a[63] = f + "(C) Incorrect. Increased iron in the lung is an uncommon form of pneumoconiosis. It is more likely to occur with hemochromatosis with iron overload."
a[64] = f + "(D) CORRECT. These findings are classic for exposure to asbestos. Pleural plaques are more frequent in this condition than in other pneumonconioses, particularly with calcification. Asbestosis is a form of pneumoconiosis that can lead to restrictive lung disease. In smokers, there is an increased risk for development of bronchogenic carcinomas."
a[65] = f + "(E) Incorrect. Berylliosis produces sarcoid-like granulomatous disease chronically, and an acute pneumonitis acutely."
a[65.1] = f + "(F) Incorrect. Mold spores produce an extrinsic allergic alveolitis, which rarely is severe enough to produce chronic lung disease. It does not produce pleural plaques."
a[66] = f + "(A) Incorrect. <I>Pneumocystis carinii (jirovecii)</I> pneumonia is a diffuse process and occurs in immunocompromised patients. Hemoptysis does not occur."
a[67] = f + "(B) Incorrect. Mesothelioma is rare; it is characterized by a bulky pleural mass in a person with prior asbestos exposure."
a[68] = f + "(C) Incorrect. Granulomatous inflammation is typical for mycobacterial and fungal infections; though a solitary granuloma may be present, it is usually not larger than 2 to 3 cm in size."
a[69] = f + "(D) CORRECT. The large central mass is consistent with a squamous cell carcinoma, which is seen mainly in smokers."
a[70] = f + "(E) Incorrect. Cytomegalovirus infections occur in immunocompromised patients. No mass is present."
a[71] = f + "(A) Incorrect. Aspergillus infection is not common. It is more likely to produce a fungus ball. Persons who are neutropenic are at greatest risk. The inflammatory reaction could vary from acute to mixed to granulomatous."
a[72] = f + "(B) Incorrect. A squamous cell carcinoma is usually a central mass lesion. It is unlikely that epithelioid cells would appear on biopsy."
a[73] = f + "(C) Incorrect. PCP in rare cases has a granulomatous pattern, but the granulomas would be small and unlikely to lead to hemoptysis."
a[74] = f + "(D) Incorrect. Small cell anaplastic carcinomas are centrally located. They are unlikely to be found with epithelioid cells."
a[75] = f + "(E) CORRECT. The hemoptysis suggests that the granulomas have eroded enough parenchyma and involved a bronchus. A granulomatous reaction is typical for <I>Mycobacterium tuberculosis</I>."
a[76] = f + "(A) Incorrect. A bronchopleural fistula typically occurs in the setting of a severe lung infection, not in a healthy person."
a[77] = f + "(B) CORRECT. Paraseptal emphysema is not common, but does account for a significant number of cases of spontaneous pneumothorax in young persons. It is not related to smoking. There are subpleural bullae that can burst, even with minimal trauma."
a[78] = f + "(C) Incorrect. Aspiration of a foreign body can lead to localized air trapping, but a pneumothorax is not common."
a[79] = f + "(D) Incorrect. Intrinsic asthma, usually seen in middle aged adults, can be set off by a variety of stimuli, including infections and exposure to cold. Pneumothorax does not typically result."
a[80] = f + "(E) Incorrect. Both chronic restrictive and obstructive lung diseases can reduce the pulmonary vascular bed to increase pulmonary arterial pressures that promote pulmonary atherosclerosis. The vessels do not rupture."
a[81] = f + "(A) Incorrect. A bacterial pneumonia, as a nosocomial infection, is likely to be accompanied by signs of sepsis."
a[82] = f + "(B) Incorrect. Chronic bronchitis develops and continues over months to years, probably from environmental agents."
a[83] = f + "(C) Incorrect. This is a process that takes at least weeks to months and is due to obstruction of airways in one or more parts of lung."
a[84] = f + "(D) Incorrect. Viral pneumonias are not likely to be acquired in hospital. They are often complicated by bacterial pneumonia."
a[85] = f + "(E) CORRECT. Diffuse alveolar damage (or ARDS as it is known clinically) is the final event following lung injury from a variety of serious illnesses or accidents. In this case, it was probably initiated by the hypotension ('shock lung') and potentiated by the 100% oxygen."
a[86] = f + "(A) Incorrect. An 'oat cell' carcinoma tends to spread very quickly and not remain localized. Moreover, it virtually always appears in persons with a history of smoking."
a[87] = f + "(B) CORRECT. The differential diagnosis of a solitary coin lesion most often includes lung cancer (adenocarcinoma most likely), granuloma, or hamartoma."
a[88] = f + "(C) Incorrect. Bronchiectasis with inflammation, destruction, and dilation of bronchi does not produce a round, discrete lesion."
a[89] = f + "(D) Incorrect. An exogenous lipid pneumonia from aspiration of a substance that is oily or contains much lipid is not typically localized."
a[90] = f + "(E) Incorrect. Silicosis from inhalation of dust for many years produces diffuse, scattered nodules in the lungs."
a[91] = f + "(A) Incorrect. An atypical pneumonia with Mycoplasma is unlikely to be confined to just the right lower lobe, and it would not yield atypical cells."
a[92] = f + "(B) CORRECT. This tumor can spread in a pneumonia-like pattern. The lack of a change over time and the absence of a response to antibiotics should suggest a non-infectious process."
a[93] = f + "(C) Incorrect. Sarcoid is likely to produce a granulomatous pattern, and the hilar lymph nodes are usually enlarged as well."
a[94] = f + "(D) Incorrect. An infarct is unlikely to yield atypical cells."
a[95] = f + "(E) Incorrect. Silicosis produces interstitial lung disease with silicotic nodules."
a[96] = f + "(A) Incorrect. Toxo is not common in lung. Toxo cysts contain bradyzoites, which are about 2 microns in size. There may be surrounding free tachyzoites of the same size as bradyzoites."
a[97] = f + "(B) Incorrect. <I>Candida</I> yields budding cells and pseudohyphae."
a[98] = f + "(C) CORRECT. CMV produces a cytopathic effect with enlarged cells having prominent intranuclear inclusions."
a[99] = f + "(D) Incorrect. PCP yields foamy material that appears acellular with H&E and Pap stains."
a[100] = f + "(E) Incorrect. TB produces a granulomatous reaction. There may be giant cells of the Langhans variety, but a BAL will probably not have much that is diagnostic without an AFB stain or culture."
a[100.1] = f + "(F) Incorrect. Influenza virus infections are not characteristic for immunocompromised patients. No characteristic inclusions can be seen in specimens."
a[100.2] = f + "(G) Incorrect. Respiratory syncytial virus infections are most common in young children and infants. They are not characteristic for immunocompromised patients. Inclusions are in the cytoplasm with this RNA virus."
a[101] = f + "(A) Incorrect. Silicosis produces an interstitial lung disease with a reticulonodular pattern with silicotic nodules."
a[102] = f + "(B) CORRECT. The symptoms and signs are classic. Sarcoidosis often involves the hilar lymph nodes."
a[103] = f + "(C) Incorrect. Pleural plaques are a typical finding for asbestosis."
a[104] = f + "(D) Incorrect. Special stains on the lung biopsy would have shown acid fast bacilli."
a[105] = f + "(E) Incorrect. UIP is a form of restrictive lung disease with interstitial fibrosis."
a[106] = f + "(A) Incorrect. Paraneoplastic syndromes are not generally associated with autoimmune diseases or markers."
a[107] = f + "(B) Incorrect. Thrombocytopenia is not a feature of a paraneoplastic syndrome."
a[108] = f + "(C) Incorrect. One form of paraneoplastic syndrome is Cushing syndrome from ectopic ACTH production, which should elevate the serum cortisol."
a[109] = f + "(D) CORRECT. He has a small cell anaplastic carcinoma with widespread metastases. The syndrome of inappropriate ADH producing hyponatremia is one form of paraneoplastic syndrome seen with this particular carcinoma."
a[110] = f + "(E) Incorrect. The turnover rate of lung cancers is generally not high enough to elevate the uric acid."
a[111] = f + "(A) CORRECT. Pulmonary abscesses typically have an air-fluid level. More virulent bacterial organisms such as <I>Staphylococcus aureus</I> are likely to cause such a complication of a bronchopneumonia."
a[112] = f + "(B) Incorrect. Fungus balls are usually firm masses that do not have central necrosis and/or cavitation."
a[113] = f + "(C) Incorrect. Although cavitation is a feature of secondary tuberculosis, air-fluid levels within the cavities are not frequent (due to the caseous nature of the necrosis)."
a[114] = f + "(D) Incorrect. Infection with <I>Mycoplasma pneumoniae</I> typically produces patchy infiltrates, but abscess formation is not likely to occur, and the process is more interstitial with mononuclear cells."
a[115] = f + "(E) Incorrect. Adenovirus produces an interstitial pneumonitis. However, viral pneumonias may be complicated by secondary bacterial pneumonias."
a[116] = f + "(A) Incorrect. Mycoplasma infection produces an atypical pneumonia with interstitial infiltrates. Obstruction of airways is unlikely."
a[117] = f + "(B) Incorrect. The obstruction with inflammation of cystic fibrosis leads to bronchiectasis."
a[118] = f + "(C) Incorrect. Most adenocarcinomas are peripheral and do not arise within a large bronchus."
a[119] = f + "(D) Incorrect. The silicotic nodules are small (a few millimeters) and do not obstruct bronchi."
a[120] = f + "(E) CORRECT. Most squamous cell carcinomas are located centrally and arise in bronchi, leading to obstruction of a large airway that can cause a lipid pneumonia. In this case, the breakdown of lung tissue distal to the mass yields an 'endogenous lipid pneumonia.'"
a[120.1] = f + "(F) Incorrect. Mesotheliomas arise in the pleura and are peripheral masses unlikely to obstruct proximal bronchi to produce a lipid pneumonia."
a[120.2] = f + "(G) Incorrect. Thromboemboli obstruct the pulmonary arterial system, not the bronchi."
a[121] = f + "(A) Incorrect. Mycoplasma produces an atypical pneumonia which often has a non-productive cough."
a[122] = f + "(B) Incorrect. With cystic fibrosis, there is bronchiectasis and multiple infections, so the sputum is often purulent."
a[123] = f + "(C) Incorrect. Extrinsic allergic alveolitis is produced, which is mainly an interstitial process. Extrinsic allergic alveolitis, or hypersensitivity pneumonitis, is acutely mediated by activation of complement from exposure to an allergen, but there is usually no eosinophila and the symptoms last longer than for asthma."
a[124] = f + "(D) CORRECT. In an acute asthmatic episode, there can be an outpouring of mucus which, along with some dehydration, can lead to the formation of mucus plugs. The asthmatic episodes are usually initiated by a type I hypersensitivity reaction, typically with exposure to an allergen such as pollen from goldenrod or other flowering plant. Up to 10% of children may be affected to some degree."
a[125] = f + "(E) Incorrect. Gastric contents will be liquid to semiliquid material. Aspiration is most typical for persons with neurologic impairment, though it can occur as an accident."
a[126] = f + "(A) Incorrect. Asthma produces bronchoconstriction for short periods of time. Infiltrates should not be present. Extrinsic asthma is a form of type 1 hypersensitivity reaction, with allergen attaching to IgE bound to mast cells."
a[127] = f + "(B) Incorrect. Interstitial fibrosis is a progressive process leading to restrictive lung disease. The course is not episodic."
a[128] = f + "(C) CORRECT. Birds make a lot of organic dust from their feathers. The result is an extrinsic allergic alveolitis. Getting away from the antigen (such as a vacation) will improve the situation. This is a form of type 3 hypersensitivity."
a[129] = f + "(D) Incorrect. In adults, the most common form of Langerhans cell histiocytosis is eosinophilic granuloma of lung, a process that produces larger nodules and is not episodic."
a[130] = f + "(E) Incorrect. Tuberculosis in an adult is typically the reactivation or reinfection type with upper lobe granulomas. Pulmonary disease caused by M. kansasii resembles that caused by M. tuberculosis in most cases. The cell-mediated immune response to tuberculosis is a form of type 4 hypersensitivity."
a[131] = f + "(A) Incorrect. Exposure to toxic gases produces an acute pneumonitis with injury to epithelium and edema."
a[132] = f + "(B) Incorrect. Silica dust produces nodules that diminish lung volumes and lead to a restrictive lung disease."
a[133] = f + "(C) Incorrect. CO poisoning has no significant effect on the lung, but CO binds more avidly to hemoglobin and leads to hypoxia."
a[134] = f + "(D) CORRECT. She has findings of emphysema, and smoking is the most likely underlying cause. The nicotine in the cigarette smoke is chemotactic for neutrophils, and cigarette smoke activates the alternative complement pathway, releasing more mediators for neutrophil recruitment. Neutrophil elastase can damage the lung parenchyma. Though neutrophils are not numerous in the lung with emphysema, the cumulative effect of even small numbers of neutrophils over many years leads to the tissue damage."
a[135] = f + "(E) Incorrect. Carbon dust leads to anthracosis, which is a benign process that virtually everyone on earth now develops. Large quantities of coal dust can produce progressive massive fibrosis, a restrictive lung disease."
a[136] = f + "(A) Incorrect. Wegener granulomatosus is a process that can lead to pulmonary vasculitis, though the peripheral arteries are typically involved, and more of a restrictive lung disease develops."
a[137] = f + "(B) Incorrect. Pulmonary thromboembolism is an acute process. It is not related to emphysema."
a[138] = f + "(C) Incorrect. A dissection does not occur in pulmonary arteries, as in the aorta, because the pressures are not as high, even with pulmonary hypertension."
a[139] = f + "(D) CORRECT. Cor pulmonale is the result of pulmonary hypertension, which is the major cause for pulmonary atherosclerosis. His emphysema has reduced the pulmonary vascular bed, promoting the hypertension. Note that the forces driving systemic atherosclerosis are not operative on the pulmonary arterial system."
a[140] = f + "(E) Incorrect. Aneurysms may complicate atherosclerosis, but the degree of atherosclerosis and the arterial pressures in the pulmonary system are not as marked as in the aorta."
a[141] = f + "(A) Incorrect. Squamous cell carcinomas are often associated with smoking. They are often bulky central masses."
a[142] = f + "(B) Incorrect. Oat cell carcinomas have a close association with smoking. Such cancers are not common in nonsmokers. They often metastasize early, so that the primary site (usually in a central location) is small when discovered."
a[143] = f + "(C) CORRECT. Peripheral lung cancers (adenocarcinoma and large cell carcinoma) show less of an association with smoking than central cancers (small cell and squamous cell carcinoma)."
a[144] = f + "(D) Incorrect. Asbestos exposure is a likely antecedent to pleural mesothelioma, which produces a bulky pleural mass."
a[145] = f + "(E) Incorrect. Carcinoid tumors are neuroendocrine neoplasms on the opposite end of the spectrum from oat cell carcinomas. Carcinoids tend to form masses within the larger bronchi."
a[146] = f + "(A) Incorrect. Although they are part of the systemic circulation, they supply little blood to lungs. They are small and not involved with systemic atherosclerosis. Their lack of occlusion with thromboembolization leads to hemorrhage into pulmonary infarcts."
a[147] = f + "(B) Incorrect. Aspergillus fungal organisms like to invade blood vessels and can lead to thrombosis, but this infection is typically seen in immunocompromised patients."
a[148] = f + "(C) Incorrect. Fat embolism typically occurs following trauma. The microscopic emboli do not produce infarction."
a[149] = f + "(D) Incorrect. A vasculitic process such as Wegener granulomatosis would be diffuse, not localized. The size of the arteries involved with most vasculitides is too small to cause an infarction, but could lead to pulmonary hypertension, however."
a[150] = f + "(E) CORRECT. An embolus to a medium-sized arterial branch is not large enough to kill the patient, but large enough to cause an infarction. Her bedridden state predisposes her to deep venous thrombosis and thromboembolism--the CVAs are due to separate systemic arterial problems--or the systemic and pulmonary embolization can be tied together by a hypercoagulable state, or more remotely by a 'paradoxical' embolus through a patent foramen ovale once the right sided-pressures increased following the initial pulmonary thromboembolic event."
a[151] = f + "(A) Incorrect. <I>Nocardia braziliensis</I>Infections occur in immunocompromised hosts and produce a chronic abscessing process."
a[152] = f + "(B) CORRECT. Mycoplasma affects the interstitium more, and is not an alveolar filling process. It is a cause for a 'primary atypical pneumonia' which is difficult to diagnose because this organism is not cultured by routine methods for bacterial organisms. The cold agglutinin titer is elevated in about half of cases and is a characteristic finding."
a[153] = f + "(C) Incorrect. <I>M. kansasii</I> produces a granulomatous disease similar to tuberculosis."
a[154] = f + "(D) Incorrect. RSV infections are more likely to occur in children. They do not respond to erythromycin therapy."
a[155] = f + "(E) Incorrect. Psitticosis is rare and can lead to a severe pneumonia known as ornithosis. It does not respond to erythromycin therapy."
a[155.1] = f + "(F) Incorrect. Adenovirus can produce interstitial infiltrates, but does not respond to erythromycin."
a[155.2] = f + "(G) Incorrect. Klebsiella is a gram negative bacterium that most often produces a bronchopneumonia with productive cough and neutrophilia."
a[156] = f + "(A) CORRECT. She has diabetes mellitus, which inhibits fetal lung development. At 29 weeks, the baby's lungs do not make sufficient surfactant. Corticosteroids administered to the mother help to speed up type II pneumonocyte production of surfactant in the baby. At birth, exogenous surfactant can be given to the neonate."
a[157] = f + "(B) Incorrect. Antibiotic therapy will not help to prevent hyaline membrane disease. It is unlikely that there is a congenital pneumonia in this emergent setting."
a[158] = f + "(C) Incorrect. Non-steroidal anti-inflammatory drugs will not help to improve fetal lung maturity."
a[159] = f + "(D) Incorrect. The lecithin-sphingomyelin (L/S) ratio is used as a measure of fetal lung maturity."
a[160] = f + "(E) Incorrect. Vitamin A helps to maintain epithelia, but it is not going to play a major role in surfactant production."
a[160.1] = f + "(F) Incorrect. Exogenous surfactant administered to the infant soon after birth can help prevent respiratory distress syndrome with hyaline membrane disease."
a[161] = f + "(A) Incorrect. In Goodpasture syndrome there is antibody directed at vascular basement membrane, leading to acute hemorrhage."
a[162] = f + "(B) CORRECT. Pulmonary hypertension and right heart failure can occur in the small number of cases in which recurrent thromboembolism takes place. The right heart failure that occurs then leads to hepatic passive congestion with centrilobular necrosis that is the cause for the increased transaminases."
a[163] = f + "(C) Incorrect. Hypertension in the systemic circulation is not accompanied by pulmonary arterial hypertension with predominantly right-sided heart failure with cor pulmonale."
a[164] = f + "(D) Incorrect. The episodes of bronchial asthma are short and typically do not lead to significant alteration to the pulmonary vasculature."
a[165] = f + "(E) Incorrect. Rheumatoid arthritis may be accompanied by formation of rheumatoid nodules in various tissues, including lung, but they are usually peripheral and not numerous."
a[166] = f + "(A) Incorrect. This produces a primary atypical pneumonia without abscess or alveolar filling."
a[167] = f + "(B) Incorrect. <I>Aspergillus</I> does not typically produce abscesses."
a[168] = f + "(C) Incorrect. MAI typically affects AIDS patients, and lung involvement is minimal."
a[169] = f + "(D) CORRECT. <I>Nocardia braziliensis</I> infection can persist and lead to chronic abscesses. It can complicate the course of immunocompromised patients."
a[170] = f + "(E) Incorrect. CMV does not produce abscesses."
a[170.1] = f + "(F) Incorrect. Pneumocystis pneumonia is rarely disseminated and most often produces a diffuse pneumonic consolidation with minimal inflammatory cell infiltration and no abscess formation."
a[171] = f + "(A) CORRECT. The pattern of lung involvement is the classical 'Ghon complex' of primary tuberculosis, which is seen more commonly in children, though only about 5% of cases are symptomatic. The enlarged hilar nodes can impinge upon central airways to produce obstruction."
a[172] = f + "(B) Incorrect. Candidiasis is seen in persons who are immunocompromised. A true <I>Candida</I> pneumonia is rare. <I>Candida</I> is more likely to colonize the upper respiratory tract."
a[173] = f + "(C) Incorrect. Fungal granulomatous disease can mimic tuberculosis but is less common overall and is more typically seen in adults."
a[174] = f + "(D) Incorrect. This is most likely to be seen in immunocompromised adults."
a[175] = f + "(E) Incorrect. Lung abscesses from B. fragilis are not common in healthy children. Abscesses usually complicate a previous pulmonary infection or occur with aspiration."
a[175.1] = f + "(F) Incorrect. Pneumococcal infections can produce a lobar pneumonia or bronchopneumonia."
a[175.2] = f + "(G) Incorrect. RSV can produce childhood pneumonias, but they are typically interstitial pneumonias."
a[176] = f + "(A) Incorrect. Although atelectasis can occur distal to bronchial obstruction, it would be unusual for a foreign body to occlude a mainstem bronchus. The resorption of air is not immediate."
a[177] = f + "(B) Incorrect. Occlusion of pulmonary arterial circulation does not collapse a lung."
a[178] = f + "(C) Incorrect. It is possible, but a neoplasm would more likely occlude just part of the bronchial tree."
a[179] = f + "(D) CORRECT. This would lead to pneumothorax with lung collapse. Such trauma is not infrequent, particularly in auto accidents."
a[180] = f + "(E) Incorrect. The bronchial obstruction is accompanied by inflammation, and the net result is bronchial dilation. Atelectasis is focal."
a[181] = f + "(A) CORRECT. The hyperinsulinism in the baby as a result of the high glucose impedes development of the type II pneumonocytes. By 36 weeks there should normally be sufficient surfactant to prevent hyaline membrane disease. Tests for fetal lung maturity include the L/S ratio, fluorescence polarization (fpol), and phosphatidyl glycerol (PG)."
a[182] = f + "(B) Incorrect. Hyperememsis is 'morning sickness' which makes the mother feel miserable, but does not affect fetal lung maturity."
a[183] = f + "(C) Incorrect. Iron deficiency leads to maternal and infantile anemia, but does not affect fetal lung maturity."
a[184] = f + "(D) Incorrect. Preeclampsia may lead to premature delivery, but at 36 weeks this infant's lungs should have sufficient surfactant production."
a[185] = f + "(E) Incorrect. SLE does not directly affect fetal lung maturity."
a[186] = f + "(A) Incorrect. Staphylococcal infections of the pharynx are not common in children."
a[187] = f + "(B) Incorrect. Hemophilus more typically produces an epiglottitis that may be obstructive. It can also lead to pneumonia and to meningitis."
a[188] = f + "(C) Incorrect. Diptheria is rare nowadays due to immunization. In the acute disease there is a pseudomembrane that is formed, not an abscess."
a[189] = f + "(D) Incorrect. This is the causative agent for whooping cough, which is rare because of immunization. There is a laryngotracheobronchitis, but rarely mucosal erosion."
a[190] = f + "(E) CORRECT. A peritonsillar abscess is usually a complication of a strep throat."
a[191] = f + "(A) Incorrect. Infarctions tend to be pleural based and resolve over weeks. The thromboemboli producing multiple infarctions should cause dyspnea and lead to cor pulmonale."
a[192] = f + "(B) Incorrect. Aspiration of a foreign body is an acute event that can produce focal atelectasis and/or pneumonia with possible abscess, not multiple masses."
a[193] = f + "(C) CORRECT. Multiple masses should suggest metastases, rather than a primary lung tumor. His lack of a cough or fever is against an infectious cause or aspiration."
a[194] = f + "(D) Incorrect. Nocardiosis is typically seen in immunocompromised patients and leads to abscess formation."
a[195] = f + "(E) Incorrect. Silicosis severe enough to produce lung nodules should lead to a restrictive lung disease with dyspnea."
a[196] = f + "(A) Incorrect. The lung lymphatics are not directly affected by emphysema."
a[197] = f + "(B) CORRECT. Alpha-1-antitrypsin (AAT) deficiency leads to a panacinar form of emphysema which involves the distal acinus beyond the respiratory bronchiole."
a[198] = f + "(C) Incorrect. The bronchial arteries supply systemic blood to the lung, primarily in the intersitium, and are not directly affected by emphysematous processes."
a[199] = f + "(D) Incorrect. The intersititium may appear more prominent with emphysema when there is collapse following loss of alveoli."
a[200] = f + "(E) Incorrect. Alpha-1-antitrypsin deficiency leads to a panacinar form of emphysema with the bulk of the damage distal to the respiratory bronchiole."
a[201] = f + "(A) Incorrect. A congenital pneumonia is unlikely to have developed in this rapid a time."
a[202] = f + "(B) Incorrect. These are findings of bronchopulmonary dysplasia, which may occur later in the course."
a[203] = f + "(C) CORRECT. The baby has been born prematurely, with incomplete lung development, and the lack of pulmonary surfactant production leads to hyaline membrane disease with respiratory distress in the newborn."
a[204] = f + "(D) Incorrect. Hemorrhage can occur with a coagulopathy in a newborn, but is unusual in this emergent situation."
a[205] = f + "(E) Incorrect. Lymphocytic infiltrates suggest a viral process, but congenital pneumonias are typically caused by bacterial organisms."
a[206] = f + "(A) CORRECT. She has an allergic bronchopulmonary aspergillosis. Her asthma is exacerbated by a type I hypersensitivity reaction to the fungus in the bronchi."
a[207] = f + "(B) Incorrect. Blastomycosis is an uncommon form of fungal disease that is likely to produce a granulomatous response."
a[208] = f + "(C) Incorrect. Candidiasis is more likely to be seen in immunocompromised patients."
a[209] = f + "(D) Incorrect. Wegener granulomatosis is not associated with asthma."
a[210] = f + "(E) Incorrect. CMV is seen in immunocompromised patients. CMV is not associated with eosinophilia."
a[211] = f + "(A) Incorrect. Diffuse alveolar damage (DAD) is an acute condition more likely to be seen in adults with severe lung injury."
a[212] = f + "(B) Incorrect. Asthma is not typically a neonatal disease, and asthma tends to be episodic, without development of chronic lung disease."
a[213] = f + "(C) Incorrect. Bronchiectasis is unusual at this age, because the bronchial obstruction and inflammation usually develop over months to years."
a[214] = f + "(D) Incorrect. A T-E fistula is a congenital anomaly that can predispose to aspiration and pneumonia, not to immediate respiratory distress following birth."
a[215] = f + "(E) CORRECT. The BPD is a complication of the treatment for neonatal respiratory distress. The positive pressure ventilation with the higher FIO2's, and the prolonged intubation, all contribute. Generally, these are premature infants who had a respiratory complication following birth, such as hyaline membrane disease."
a[216] = f + "(A) CORRECT. An inhaled object could obstruct a bronchus completely, with air resorbtion and collapse of lung distal to the point of obstruction. This produces a shunt defect with a V/Q mismatch. Since there is perfusion but no ventilation, even 100% oxygen will not make a difference. His hyperventilation has acutely produced an uncompensated respiratory alkalosis."
a[217] = f + "(B) Incorrect. Asthma can produce acute bronchoconstriction, but bilaterally."
a[218] = f + "(C) Incorrect. Paraseptal emphysema can produce focal bullae that can rupture, with sudden pneumothorax, but this is not common in a child."
a[219] = f + "(D) Incorrect. Thromboembolism affects the pulmonary arterial vasculature, not the airways."
a[220] = f + "(E) Incorrect. A carcinoid tumor can obstruct a bronchus, but usually not acutely, and such a tumor is rare in a child."
a[221] = f + "(A) Incorrect. Multiple organ failure does not lead to vasculitis, which is not common in the lung."
a[222] = f + "(B) CORRECT. Diffuse alveolar damage (DAD) is the pathologic term for adult respiratory distress syndrome (ARDS) that is the final common pathway for many acute lung injuries. DAD produces increasing interstitial thickening with mixed inflammation and features of an acute restrictive lung disease."
a[223] = f + "(C) Incorrect. With negative cultures, it is unlikely that her pneumonia is still present."
a[224] = f + "(D) Incorrect. Diffuse alveolar hemorrhage can occur in persons with organ transplants and coagulopathies, but is not a major feature of multiple organ failure."
a[225] = f + "(E) Incorrect. Bronchiectasis occurs over a longer period of time, with continuing inflammation and destruction of bronchi."