1. Which lung cancer is MOST LIKELY to have metastasized at the time of biopsy? A. adenoid cystic carcinoma B. common adenocarcinoma C. mesothelioma D. oat cell carcinoma (*) E. squamous cell carcinoma 2. A patient with situs inversus and respiratory disease is most likely to have which of the following? A. asthma B. bronchiectasis (*) C. bronchiolitis obliterans D. eosinophilic pneumonia E. pulmonary alveolar fibrosis 3. Enlarged mediastinal nodes with eggshell calcifications is pretty much diagnostic of: A. asbestosis B. eosinophilic granuloma C. sarcoidosis D. silicosis (*) E. tuberculosis 4. Here's one to think hard about. Which of the following is the best way to distinguish oat cell carcinoma from leukemia-lymphoma cells on a smear of spinal fluid? A. oat cells are carcinoma and stick together; leukemia cells (*) are leukocytes and will remain separate B. oat cells have abundant cytoplasm while leukemia cells usually do not C. oat cells have easy-to-see granules while leukemia cells do not D. oat cells lack the pseudopods that are typical of leukemia cells E. oat cell nuclear chromatin is extremely fine, unlike the coarse, clumpy chromatin of most acute leukemias 5. How does sarcoidosis cause hypercalcemia? A. conversion of vitamin D to its most active form (*) B. intense degradation of the skeleton C. production of angiotensin-converting enzyme D. production of parathormone-like substance E. sensitization of the dermis to ultraviolet radiation 6. Which molecule is the "usual suspect" in the self-perpetuating cycle of pulmonary hypertension? HINT: This fact has recently found empirical support by the success of the drug "bosentan". A. angiotensin B. endothelin 1 (*) C. leukotrienes D. nitric oxide E. prostaglandin E 7. Which is NOT considered to be a component of the remodeling of the asthmatic's airways? A. basement membrane thickening B. eosinophil aggregates (*) C. hyperplasia of the bronchial glands D. hypertrophy-hyperplasia of smooth muscle E. increased numbers of goblet cells 8. Abundant immunoblasts (i.e., very large lymphocytes with very large nucleoli) in a patient with ARDS is most suggestive of A. adenovirus B. hantavirus (*) C. measles virus D. paraquat E. scleroderma crisis 9. "Plain vanilla" (i.e., otherwise-undistinguished) granulomas are its most prominent feature: A. bagassosis B. berylliosis (*) C. byssinosis D. farmer's lung E. silicosis 10. You would be using the term "suffocation" most appropriately on a death certificate when: A. a child dies from being trapped in an abandoned (*) refrigerator B. a heroin user passes out with his face pressed into a waterbed C. a jealous husband compresses the other guy's larynx until he dies D. a jungle guide is squeezed to death by a 35 foot reticulated python E. an alcoholic in delirium tremens bites off his own tongue and has a caf‚ coronary from it (this really happened in one of my own cases) 11. ONE KODACHROME. Resected specimen of epiglottis, larynx, and trachea. What is the diagnosis? A. acute epiglottitis B. caf‚ coronary (*) C. diphtheria D. laryngeal carcinoma E. singer's nodule 12. FOUR KODACHROMES. What is the diagnosis? A. asthma B. bronchiectasis (*) C. carcinoma D. emboli E. Hamman-Rich 13. ONE KODACHROME. Lung. Your best diagnosis? A. adenocarcinoma B. ARDS C. primary pulmonary hypertension (*) D. respiratory syncytial virus E. squamous cell carcinoma 14. ONE KODACHROME. Lung. Look closely. What is the diagnosis? A. bleomycin lung B. bronchiolitis obliterans (BOOP) C. lipid pneumonia D. measles E. pneumocystis (*) 15. ONE KODACHROME. Lung, microscopic. What's the diagnosis? A. adenocarcinoma B. asthma C. idiopathic pulmonary fibrosis D. oat cell carcinoma E. squamous carcinoma 16. ONE KODACHROME. Lung. What's the diagnosis? A. aspergillosis (*) B. blastomycosis C. bronchiectasis D. tuberculosis E. squamous cell carcinoma 17. ONE KODACHROME. What's this? A. asthma B. herpes simplex (*) C. measles D. pneumocystis E. Q-fever (coxiella) 18. TWO KODACHROMES. Your best diagnosis? A. blastomycosis B. cryptococcus (*) C. histoplasmosis D. pneumocystosis E. tropical eosinophilic pneumonia 19. ONE KODACHROME. Upper airway structures? A. berylliosis B. carcinoma C. diphtheria (*) D. epiglottitis E. pertussis 20. ONE KODACHROME. Look closely. A. asthma B. bronchiectasis C. carcinoma D. emphysema E. lobar pneumonia (*) 21. TWO KODACHROMES. Which fungus? A. blastomycosis B. coccidioidomycosis C. cryptococcosis D. histoplasmosis E. mucormycosis (*) 22. THREE KODACHROMES. Your best diagnosis? A. adenocarcinoma B. sarcoidosis (*) C. silicosis D. squamous cell carcinoma E. tuberculosis 23. ONE KODACHROME. Upper airway. What's your diagnosis? A. cancer of the larynx B. diphtheria C. epiglottitis (*) D. manual strangulation E. tracheoesophageal fistula 24. THREE KODACHROMES. What's your diagnosis? A. asbestosis B. carcinoma C. sarcoidosis D. silicosis E. tuberculosis (*) 25. TWO KODACHROMES. What's this? A. acute respiratory distress syndrome B. bronchopneumonia (*) C. Goodpasture's syndrome D. Hamman-Rich E. sarcoidosis 26. TWO KODACHROMES. Your best call, on the gross? A. asthma B. lobar pneumonia C. pulmonary thromboembolus D. pulmonary fibrosis (*) E. squamous lung cancer 27. THREE KODACHROMES. What's your diagnosis? A. bronchioloalveolar cell carcinoma B. mesothelioma C. oat cell carcinoma D. silicosis E. tuberculosis 28. TWO KODACHROMES. What is the predominant tissue in these pulmonary hamartomas? A. cartilage (*) B. dense fibrous tissue C. mucous glands D. serous glands E. smooth muscle 29. TWO KODACHROMES. What's your best diagnosis? A. acute respiratory distress syndrome B. asbestosis C. bronchioloalveolar cell carcinoma (*) D. idiopathic pulmonary fibrosis E. squamous cell carcinoma 30. TWO KODACHROMES. What's this? A. adenocarcinoma B. large cell undifferentiated carcinoma C. mesothelioma D. metastatic osteosarcoma (*) E. squamous carcinoma BONUS ITEMS: 31. ONE KODACHROME. Lung. What's the diagnosis? [bone marrow embolus] 32. ONE KODACHROME. Read this chest x-ray. [pneumothorax] 33. ONE KODACHROME. Why did this patient have pulmonary edema? [cancer in lymphatics] 34. ONE KODACHROME. Ante-mortem thromboembolus or post-mortem clot? How did know? [lines of Zahn] 35. Explain briefly why inhaled coal particles tend to settle at the level of the respiratory bronchioles rather than in the distal alveoli. [air speed drops] 36. This one's for the pathology elite. Explain why a mesothelioma usually exhibits both spindle- cell and gland-like areas. [both epithelium and mesenchyme] 37. What is the most likely cause of "sudden infant death syndrome" when abundant hemosiderin- laden macrophages are found in the lungs? [smothering] 38. Why is emphysema due to tobacco smoking typically more severe in the upper lobes than in the lower lobes? [more smoke] 39. What's the most important paraneoplastic syndrome in patients with squamous cell lung cancer? [hypercalcemia] 40. Describe what you'd probably see at autopsy of a patient dying of the new coronavirus disease, "severe acute respiratory syndrome". Don't just say "infection" or "inflammation". Give me at least two of the three best answers. [edema, lymphocytes, hyaline membranes] NAME: _______________________ 15 points SEAT: ____________ UHS PATHOLOGY 2002-2003 Respiratory INSTRUCTIONS: You know the drill. If you are in the first group, leave as a group. No stragglers. The key will be posted as the second group is finishing. As usual, your exams will be returned to you. GOOD LUCK!