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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3981_Библиотеки_им_академика_М_И_Перельмана.pdf
Basic Sciences: Questions
9
A. Afibrinogenaemia
B. Disseminated intravascular coagulopathy
C. Haemophilia A
D. Vitamin K deficiency
E. vonWillebrand's disease
1.25 A 36-year-old woman with congenital bicuspid aortic valve underwent aortic
valve replacement with a mechanical prosthetic valve. Following commencement of
warfarin she developed skin necrosis. Deficiency of which of the following proteins may
be responsible for this disorder?
A. heparin cofactor II
B. plasmin
C. protein C
D. protein S
E. protein Z
1.26 Seven years following a cardiac transplant for dilated cardiomyopathy, a 46-
year-old male develops worsening congestive heart failure. He has had multiple episodes
of rejection, but a recent endomyocardial biopsy shows no evidence for rejection. The
most likely aetiology for his worsening cardiac function is:
A. Amyloidosis
B. Constrictive pericarditis
C. Coronary atherosclerosis
D. Cyclosporine toxicity
E. Cytomegalovirus myocarditis
1.27 A 15-year-old girl with a mitral valve that was repaired in infancy due to
congenital mitral cleft was seen in emergency department one month after an attack of
acute pharyngitis with severe febrile illness, prominent & changing heart murmurs &
petechiae. She was diagnosed with infective endocarditis. In this patient the most likely
pathogenic organism will be
A. Chlamydia
B. Haemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus faecalis
E. Streptococcus viridans
1.28 A 40-year-old man who has been a smoker for the last twenty years develops
gangrenous toes on his left foot. His blood pressure is 118/76. His serum cholesterol level
is 135 mg/dL and his serum glucose is 90 mg/dL. The left anterior tibial artery is
biopsied, which shows luminal thrombus & vasculitis. The most likely cause for this
patient’s clinical presentation is:
A. Giant cell arteritis
B. Kawasaki‘s disease
C. Monckeberg‘s arteriosclerosis
Shahzad G. Raja
10
D. Severe atherosclerosis
E. Thromboangiitis obliterans
1.29 A 57-year-old man was brought to the emergency department because of blood-
tinged sputum for 2 weeks. He had a 6-month history of exertional dyspnoea especially
when walking uphill or climbing stairs. He takes no medications & does not smoke
cigarettes. He is allergic to penicillin. On examination his blood pressure is 120/80 mm
Hg, pulse is 88/min, & respiratory rate is 16/min. There are crackles at both lung bases,
& a diastolic murmur can be heard at the cardiac apex. ECG shows a broad, notched P
wave in the limb leads. An x-ray film of the chest shows pulmonary vascular
redistribution to the upper lobes of the lungs. Which of the following is the most
appropriate next step in diagnosis?
A. Bronchoscopy
B. Coronary angiography
C. Echocardiography
D. Magnetic resonance imaging
E. Pulmonary artery catheterization
1.30 A baby was born with a complete failure of development of the spiral septum in
the heart. He is most likely to have
A. Aortic arch interruption
B. Atrioventricular septal defect
C. Overriding aorta
D. Persistent truncus arteriosus
E. Transposition of the great vessels
1.31 A 13-year-old boy was born with a large ventricular septal defect (VSD) that
was never surgically corrected. Now he has increasing dyspnoea with hypoxia and
cyanosis. The reason for these symptoms is
A. Acute myocardial infarction
B. Endocardial fibroelastosis
C. Left atrial thrombosis
D. Natural closure of the VSD
E. Reversal of shunt
1.32 A 16-year-old boy was identified in childhood as having an elevated sweat
chloride indicative of cystic fibrosis. This puts him at greatest risk for development of
A. Adenocarcinoma of the lung
B. Bronchiectasis
C. Lymphangiectasis
D. Pleural plaques
E. Pneumocystis carinii pneumonia
Basic Sciences: Questions
11
1.33 A patient was admitted through emergency department with lobar pneumonia.
Which of the following sets of findings is most often associated with lobar pneumonia?
A. Community acquired, Mycoplasma, Hodgkin's disease
B. Community acquired, S. pneumoniae, alcoholism
C. Congenital, E. coli, premature rupture of membranes
D. Hospital acquired, S. aureus, AIDS
E. Hospital acquired, Klebsiella, postoperative
1.34 You are asked to review the chest radiograph of an asymptomatic 10-year-old
child showing a subpleural nodule in the right mid-lung field and enlarged mediastinal
lymph nodes. After looking at the radiograph you feel that the child most probably has
A. Aspergillosis
B. Coccidioidomycosis
C. Primary tuberculosis
D. Secondary tuberculosis
E. Miliary tuberculosis
1.35 You are informed by the nurse in charge of cardiac surgical high dependency
unit that a 68-year-old woman on the 10th postoperative day following double valve
replacement ambulated to the bathroom, but upon returning to bed became extremely
dyspnoeic and diaphoretic. You should strongly suspect
A. Pleural effusion
B. Pneumonia
C. Post-operative atelectasis
D. Pulmonary embolus
E. Pulmonary oedema
1.36 A 58-year-old man is diagnosed with panlobular pulmonary emphysema. He
also has cirrhosis of the liver. Which of the following conditions could relate panlobular
pulmonary emphysema with cirrhosis of the liver in this man?
A. Alcoholism
B. Alpha-1-antitrypsin deficiency
C. Budd-Chiari syndrome
D. Cystic fibrosis
E. Wilson's disease
1.37 While doing a ward round in the intensive care unit you are asked to review a
chest radiograph of a 78-year-old man who was admitted unconscious 3 days ago
following a postoperative stroke after coronary artery bypass grafting. The radiograph
shows a 4 cm diameter mass lesion with air-fluid level in the right lung. The left lung is
normal. The chest radiograph appearance is most strongly suggestive of
A. Lung abscess
B. Bronchiectasis
C. Bronchopulmonary sequestration
D. Septicaemia
E. Squamous cell carcinoma
Shahzad G. Raja
12
1.38 Whilst working in the thoracic surgical outpatient clinic you come across a 68-
year-old male complaining of increasing dyspnoea for about a year. He has never
smoked. On further enquiry he divulged that he had worked for 5 years in a shipyard in
the 1950s. His chest radiograph revealed diaphragmatic pleural plaques and interstitial
lung disease. The clinical picture is suggestive of
A. Asbestosis
B. Berylliosis
C. Byssinosis
D. Silicosis
E. Siderosis
1.39 A 56-year-old male smoker complaining of persistent dry cough had a chest x-
ray which showed a 1.5 cm mass lesion in the left upper zone. Bronchoscopy revealed
this mass lesion to be involving the left superior segmental bronchus. Biopsies of the
mass were sent for histopathology. The histopathology report described polygonal pink
cells with dark, angular nuclei. The most likely diagnosis is
A. Adenocarcinoma
B. Bronchial carcinoid
C. Mesothelioma
D. Small cell anaplastic carcinoma
E. Squamous cell carcinoma
1.40 A 32- year-old male polytrauma victim with a large flail segment involving his
right chest was intubated and placed on a ventilator in the intensive care unit. He
required multiple blood transfusions and external fixation of his right femur and pelvis.
On day 5 he became progressively difficult to oxygenate despite increasing PEEP and
FiO
2
of 100%. He remained afebrile. His chest radiograph revealed bilateral fluffy
deposits. He died several days later. At autopsy, the lung showed hyaline membranes,
thickened alveolar walls, and type II pneumocyte proliferation. This man had
A. Acute respiratory distress syndrome
B. Bronchopneumonia
C. Bronchiectasis
D. Chronic bronchitis
E. Viral pneumonia
1.41 A 56-year-old male with persistent cough has a pneumonia-like area of
consolidation in the left lower lobe that does not respond to antibiotic therapy. A
bronchoalveolar lavage yields atypical cells. The most likely diagnosis is
A. Bronchioloalveolar carcinoma
B. Mycoplasma pneumonia
C. Pulmonary infarction
D. Sarcoidosis
E. Silicosis
Basic Sciences: Questions
13
1.42 A 35-year-old female with complaints of fever, weight loss, and progressively
increasing shortness of breath of six weeks duration had a chest radiograph which
showed prominent hilar lymphadenopathy and diffuse pulmonary interstitial disease.
She had a video assisted thoracoscopic (VATS) lung biopsy. Microscopic examination of
the lung biopsy showed non-caseating granulomas. She most likely has
A. Asbestosis
B. Interstitial pneumonitis
C. Sarcoidosis
D. Silicosis
E. Tuberculosis
1.43 A 62-year-old male heavy smoker with complaint of chronic cough, weight loss
and two episodes of haemoptysis over the last 2 months has developed truncal obesity,
easy bruisability, and osteoporosis. Which of the following pulmonary diseases is most
likely to be the cause for these findings?
A. Bronchial carcinoid
B. Bronchioloalveolar carcinoma
C. Large cell anaplastic carcinoma
D. Small cell anaplastic carcinoma
E. Squamous cell carcinoma
1.44 Of neoplasms that involve the lung, the most common are
A. Bronchial adenomas
B. Metastases
C. Peripheral adenocarcinomas in non-smokers
D. Small cell anaplastic carcinomas in smokers
E. Squamous cell carcinomas in smokers
1.45 A 55-year-old man has a serous pleural effusion. Which of the following
conditions is most likely to be associated with a serous pleural effusion?
A. Bronchogenic carcinoma
B. Congestive heart failure
C. Metastatic carcinoma
D. Pulmonary infarction
E. Tuberculosis
1.46 The most probable cause for chylothorax in an adult is
A. Congestive heart failure
B. Mediastinal malignant lymphoma
C. Penetrating chest trauma
D. Systemic lupus erythematosus
E. Tuberculosis
1.47 A 55-year-old male has smoked 2 packs of cigarettes per day for many years.
He has had a worsening cough for the past several months. In the past couple of weeks
he has occasionally noted blood-tinged sputum. Otherwise, he has no major health
Shahzad G. Raja
14
problems. Which of the following procedures should be done first to begin the workup
of his disease?
A. Sputum cytology
B. Bronchoalveolar lavage
C. Fine needle aspiration
D. Pleural fluid cytology
E. Arterial blood gases
1.48 A 50-year-old heart transplant recipient has recently been treated with
increasing dosages of immunosuppressive medications because an endomyocardial
biopsy demonstrated moderate acute rejection. About a month later he is diagnosed
with a chronic abscessing pneumonia that is involving the right middle lobe. Which of
the following organisms is most likely to be the aetiology?
A. Candida albicans
B. Cytomegalovirus
C. Nocardia asteroides
D. Pneumocystis carinii
E. Streptococcus pneumoniae
1.49 While obtaining informed consent for a fine needle aspiration of the right lung
to obtain a tissue diagnosis of a lower lobe mass in a 58 year old male, the radiologist
states that the most common problem associated with this procedure is:
A. Chronic pain following the procedure
B. Empyema
C. Haemothorax
D. Inability to determine the cell type of a malignancy
E. Pneumothorax
1.50 A bronchogram in a 35-year-old non-smoking female reveals an area of
localised bronchiectasis in the left mid-lung starting in a first segmental bronchus.
Which of the following conditions is most likely to be associated with the bronchogram
finding in this woman?
A. Bronchial carcinoid
B. Mesothelioma
C. Metastatic adenocarcinoma
D. Large cell undifferentiated carcinoma
E. Pulmonary hamartoma
1.51 A chest radiograph reveals a 3-cm right upper lobe peripheral coin lesion in a
healthy, asymptomatic 44-year-old male non-smoker. Which of the following conditions
is most likely to be responsible for this radiographic appearance?
A. Bronchial carcinoid
B. Mesothelioma
C. Metastatic adenocarcinoma
D. Large cell undifferentiated carcinoma
E. Pulmonary hamartoma
Basic Sciences: Questions
15
1.52 A 27-year-old man suffering from severe haemorrhage caused by a stab wound
to the left chest has a blood pressure of 70/33 mmHg, a heart rate of 140 beats/min, & a
weak pulse. Immediately following transfusion of 3 L of blood, his blood pressure rises
to 100/70 mmHg & his heart rate slows to 90 beats/min. Which of the following is
decreased due to transfusion of the blood?
A. Cardiac output
B. Right atrial pressure
C. Stroke volume
D. Total peripheral resistance
E. Pulmonary artery pressure
1.53 A 22-year-old male stab victim has a 30% decrease in cardiac output following
a haemorrhage in which he lost an estimated 20-30% of his blood volume. Which of the
following changes in pulmonary vascular resistance (PVR) & pulmonary artery
pressure (PAP) would be most likely to result from the decrease in cardiac output?
PVR PAP
A. decrease decrease
B. decrease increase
C. increase decrease
D. increase increase
E. no change no change
1.54 A 21-year-old man arrived in emergency department with a stab in right side of
chest. X-ray chest confirmed haemothorax. It was estimated that about 20% blood
volume had been lost due to acute haemorrhage. It is true to say that in this patient
A. Coronary arteries are constricted due to catecholamines
B. Plasma adrenaline stimulates hypothalamic thirst centre
C. Plasma vasopressin is increased in response to reduced extracellular fluid volume
D. Plasma aldosterone increase will lead to retention of potassium
E. The major acid-base abnormality will be hyperkalaemic alkalosis
1.55 A 53-year-old male arrived in cardiac intensive care unit following coronary
artery bypass grafting. He suddenly lost 500 ml of blood in the chest drains. It is true to
say that in this patient
A. The brain blood flow will be reduced
B. The mesenteric blood flow is increased
C. The lactic acid production will be reduced
D. The skin vessels are constricted
E. Veins are dilated
1.56 Which of the following compensatory factors is responsible for increasing the
blood pressure in a 32-year-old patient who is in shock with blood pressure of 50 mm
Hg?
A. Atrial stretch receptors
B. Baroreceptor reflex
C. Bainbridge reflex
Shahzad G. Raja
16
D. Carotid body chemoreceptors
E. Ischemic brain response
1.57 Which of the following peptides can increase blood pressure acutely & cause
hypokalaemia chronically?
A. angiotensin II
B. atrial natriuretic factor
C. desmopressin
D. endorphin
E. oxytocin
1.58 The following values were obtained in a 48-year-old male patient who
underwent diagnostic cardiac catheterization.
heart rate
70 beats/min
arterial [O
2
]
0.24 ml O
2
/min
venous [O
2
]
0.16 ml O
2
/min
whole body O
2
consumption
500 ml/min
pulmonary diastolic pressure
15 mm Hg
pulmonary systolic pressure
25 mm Hg
wedge pressure
5 mm Hg
What is the cardiac output?
A. 1.65 L/min
B. 4.55 L/min
C. 5.00 L/min
D. 6.25 L/min
E. 8.00 L/min
1.59 The following values were obtained in a 48-year-old male patient who
underwent diagnostic cardiac catheterization.
heart rate
70 beats/min
arterial [O
2
]
0.24 ml O
2
/min
venous [O
2
]
0.16 ml O
2
/min
whole body O
2
consumption
500 ml/min
pulmonary diastolic pressure
15 mm Hg
pulmonary systolic pressure
25 mm Hg
wedge pressure
5 mm Hg
What is the stroke volume?
A. 75 ml
B. 80 ml
C. 85 ml
D. 90 ml
E. 95 ml
1.60 The following values were obtained in a 48-year-old male patient who
underwent diagnostic cardiac catheterization.
Basic Sciences: Questions
17
heart rate
70 beats/min
arterial [O
2
]
0.24 ml O
2
/min
venous [O
2
]
0.16 ml O
2
/min
whole body O
2
consumption
500 ml/min
pulmonary diastolic pressure
15 mm Hg
pulmonary systolic pressure
25 mm Hg
wedge pressure
5 mm Hg
What is the pulmonary vascular resistance?
A. 1.5 resistance units (mm Hg/L/min)
B. 2.0 resistance units (mm Hg/L/min)
C. 2.5 resistance units (mm Hg/L/min)
D. 3.0 resistance units (mm Hg/L/min)
E. 3.5 resistance units (mm Hg/L/min)
1.61 A 48-year-old man needing aortic valve replacement underwent cardiac
catheterization as a part of preoperative assessment. He had oxygen consumption = 300
mL/min, arterial oxygen content = 20mL/100 mL blood, pulmonary arterial oxygen
content = 15 mL/100 mL blood, and heart rate = 100 beats/min. What is the stroke
volume in this patient?
A. 1 mL
B. 10 mL
C. 60 mL
D. 100 mL
E. 200 mL
1.62 A 68-year-old coal miner with decades of work related exposure to dust is
examined for pulmonary fibrosis. His FEV
1
is 75% (normal > 65%) and his arterial
oxygen saturation is 92%. His alveolar ventilation is 6000 mL/min at a tidal volume of
600 mL and a breathing rate of 12 breaths/min. Pathologic changes in lung compliance
and residual volume are also documented in this patient. Which of the following best
describes this patient’s lung compliance measured under static conditions?
A. change in distending pressure (P
alv
P
pl
) divided by change in lung volume
B. change in distending pressure (P
alv
- P
pl
) minus the change in lung volume
C. change in elastic recoil pressure (P
alv
P
pl
)
D. change in lung volume divided by-change in distending pressure (P
alv
P
pl
)
E. lung volume divided by recoil pressure (P
alv
P
pl
)
1.63 A 68-year-old coal miner with decades of work related exposure to dust is
examined for pulmonary fibrosis. His FEV
1
is 75% (normal > 65%) and his arterial
oxygen saturation is 92%. His alveolar ventilation is 6000 mL/min at a tidal volume of
600 mL and a breathing rate of 12 breaths/min. Pathologic changes in lung compliance
and residual volume are also documented in this patient. This patient’s residual volume
A. cannot be measured directly with a spirometer
B. is part of vital capacity
Shahzad G. Raja
18
C. is part of the expiratory reserve volume
D. is the volume at which the lungs tend to recoil outward
E. represents the resting volume of the lungs
1.64 A 68-year-old coal miner with decades of work related exposure to dust is
examined for pulmonary fibrosis. His FEV
1
is 75% (normal > 65%) and his arterial
oxygen saturation is 92%. His alveolar ventilation is 6000 mL/min at a tidal volume of
600 mL and a breathing rate of 12 breaths/min Pathologic changes in lung compliance
and residual volume are also documented in this patient. What is this patient’s anatomic
dead space?
A. 100 mL
B. 120 mL
C. 150 mL
D. 200 mL
E. 250 mL
1.65 A 26-year-old man was seen in emergency department following a stab injury
to his left chest in the third intercostal space in the mid-axillary line. He was
haemodynamically stable and his chest x-ray showed a pneumothorax. The most likely
response in this patient upon entry of air into the chest would be for the
A. lung to collapse inward and the chest wall to collapse inward
B. lung to collapse inward and the chest wall to spring outward
C. lung to expand outward and the chest wall to spring inward
D. lung to expand outward and the chest wall to spring outward
E. lung volume to be unaffected and chest wall to spring outward
1.66 Under normal conditions the amount of O
2
taken up is a function of pulmonary
blood flow; that is, normally, O
2
transfer is perfusion-limited. Which of the following
conditions would favor a diffusion limitation of O
2
transfer from alveolar to pulmonary
capillary blood?
A. breathing hyperbaric gas mixture
B. chronic obstructive lung disease
C. increased ventilatory rate
D. mild exercise
E. pulmonary oedema
1.67 A 37-year-old man received a gunshot wound to his brainstem. He died of
immediate respiratory failure as result of this injury. Which of the following statements
accurately describes the interaction of respiratory centres in the brainstem and their
effect on respiration?
A. Sectioning the brainstem above the pons, near the inferior colliculus of the midbrain
results in immediate respiratory arrest
B. The medullary rhythmicity centre is a discrete group of neurons whose rhythmicity is
abolished when the brain is transected above and below this area
C. Transection above the apneustic centre results in prolonged expiration and very short
inspiration