Lung, hepatobiliary, renal MCQ

1. Which of the following usually presents as nephrotic syndrome

a) Membranoproliferative glomerulonephritis
b) Focal segmental glomerulosclerosis
c) Post infectious glomerulonephritis
d) Membranous glomerulopathy

2. In renal failure

a) Chronic renal failure is when the GFR is <25%of normal and kidneys although able to
regulate volume are unable to regulate solute composition any longer
b) A GFR of <15% of normal, indicates end stage renal disease
c) Renal insufficiency is when the GFR is 20-25% of normal amd azotemia appears
d) A GFR of around 70% of normal is associated with increasing creatinine levels and indicates
diminished renal reserve

3. Focal segmental glomerulosclerosis is characterised by

a) In situ immune complex formation

b) Loss of foot processes
c) Lipid in tubules
d) Nephritis syndrome

4. Testicular torsion

a) Is caused by arterial obstruction

b) Is more common in older adult men
c) Requires surgery within 6hours to remain viable
d) Typicaly has an insidious onset

5. Phimosis is associated with

a) Carcinoma
b) Syphilis
c) Condyloma acuminatum
d) Hypospadias
6. Post streptococci glomerulonephritis in children

a) Commonly presents with smoky urine 1 month after the resolution of the sore throat
b) Anuria is commonly present
c) Cs serum concentration rises
d) 95% recover with simple conservative treatment aimed at maintaining sodium and water
balance

7. Renal artery stenosis

a) Is usually secondary to an occlusion of the artery by an atheromatous plaque

b) Fibromuscular dysplasia is the cause seen mostly in the female population
c) Uually is seen in people in their 6th decade of life
d) Bruits over the affected kidney are a common finding

8. Which bug can be associated with the production of magnesium ammonium phosphate stones?

a) Klebsiella
b) Streptococci
c) Enterococci
d) Staphylococci

9. Regarding acute respiratory distress

a) Neutrophils are thought to play an important role in its pathogenesis

b) It is thought that the sole cause is due to the compromised integrity of the microvascular
endothelium
c) The lungs become stiff late in the disease process
d) Resolution requires reabsorption of the transudate

10. Regarding obstructive pulmonary disorders

a) COPD is the result of smoking , however 20% of patients that develop the disease are non
smokers
b) In centrilobular emphysema the lower lobes are mostly affected
c) Paraseptal emphysema is associated with α1 antitrypsin deficiency
d) Irregular emphysema is usually asymptomatic and clinically insignificant
11. α1 antitrypsin

a) Is abnormal in 1% population of patients with emphysema

b) Is associated with the proteinase inhibitor locus found on chromosome 14
c) Is normally present in macrophages and secreted by neutrophils during inflammation
d) All the above are true

12. Which of the following is correct regarding obstructive pulmonary disease

a) Most heavy smokers develop the disease

b) Pulmonary function tests show a reduced forced expiratory volume at 1 sec
c) The source of airway obstruction in these diseases is narrowing of the small airways
d) Most acute exacerbations are due to pneumothorax formation

13. In chronic bronchitis

a) There is associated atypical metaplasia and dysplasia of the respiratory endothelium

b) As chronic bronchitis persists there is a marked increase in goblet cells predominately in the
large airways
c) Although there is marked gland hyperplasia the major changes seen are the increased
goblet cell numbers
d) The role of infection is a secondary feature in the pathogenesis of chronic bronchitis rather
than an initiating factor

14. Bronchiectasis

a) Has a rare complication of amyloidosis

b) is associated with reversible dilatation of bronchi and bronchioles
c) is most predominately seen in the upper lobes of the lung
d) is most severe in the more proximal bronchi/bronchioles

15. In atelectasis?

a) Usually occurs with partial obstruction of the distal airways

b) Mediastinum shifts toward the atelectic side
c) Is typically associated with bronchial neoplasms
d) Is never associated with congenital conditions
16. In haemodynamic pulmonary oedema

a) The most common attributing mechanism is decreased hydrostatic pressures

b) Is first seen in the hilar area of the lungs
c) In the acute phase , brown induration of the macrophages is present
d) Hydrostatic pressures are not usually elevated in association with microvascular injury based
oedema

17. Regarding pulmonary embolism and infarction

a) It accounts for 1% of all inpatient deaths

b) Only 25% of pulmonary emboli cause infarcts
c) 75% of pulmonary infarcts affect the upper lobes
d) Infarcts are usually multiple

18. In pulmonary hypertension, which is incorrect

a) It is usually idiopathic
b) Maybe associated with interstitial lung disease
c) Is said to occur when pulmonary pressures reach 25% of systolic blood pressure
d) Death is usually secondary to cor pulmonale

19. The most common form of asthma is

a) Occupational
b) Atopic
c) Exertional
d) Intrinsic

20. Regarding lung abscesses

a) Those due to aspiration usually occur on the left side

b) Those due to aspiration are usually multiple
c) Those due to pneumonia are usually basal
d) Those due to pneumonia are usually singular
21. The most prevalent chronic occupational disease is associated with exposure to

a) Silica
b) Hydrocarbons
c) Coal dust
d) Asbestosis

22. Asbestosis

a) Serpentine form is most strongly associated with mesothelioma formation

b) Asbestosis begins as fibrosis around the repiratory bronchiloles and alveolar ducts
c) The least common morphological manifestation is pleural plaques
d) Clinical symptoms commonly occur in less than 10years from first exposure

23. Sarcoidosis

a) Is more common in women

b) Cxr changes are found in 50% of cases
c) Clinical splenomegaly is seen in upto 50% of cases
d) Caseating granulomas are the hallmark histological feature

24. Carcinoid tumours

a) Represent 10% of all lung tumours

b) Are seen commonly in > 60years of life
c) More common in women
d) 20-40% are found in non smoking patients

25. Regarding community acquired pneumonias

a) H. Influenzae is the most common organism

b) The unencapsulate b form of H influenza is on the decrease since the introduction of
vaccination
c) Klebsiella pneumonia is the most frequent G+ve cause of bacterial pneumonia
d) H influenza is the most common organism in pneumonia in COPD exacerbations
26. In hepatorenal syndrome

a) it occurs in25% of patients with cirrhosis and ascites

b) is heralded by a decrease in blood urea nitrogen and an increase in creatinine
c) is usually associated with a stressor e.g. infection
d) prognosis is good especially in the rapid onset form

27. A post hepatic cause of portal hypertension is usually

a) cirrhosis
b) obstructive thrombosis
c) sarcoidosis
d) severe right heart failure

28. Unconjugated bilirubin

a) can be excreted in the urine once blood levels become high

b) is closely bound to serum albumin
c) is non toxic
d) is water soluble

29. Which lab finding is not seen in acute pancreatitis

a) Increased serum amylase

b) Increased serum lipase
c) Glycosuria
d) Hypercalcemia

30. All of the following are clinical findings/complications of hepatic failure EXCEPT

a) Fetor hepaticus is due to hyperammoniaemia

b) Palmer erythemia is associated with hyperestrogenaemia
c) Coagulopathy is due to impaired hepatic synthesis of clotting factors II, VII, IX,X
d) Hepatorenal syndrome is not associated with any morphological renal cause

31. The most common aetiology of hepatic cirrhosis is

a) Alcoholic liver disease

b) Viral hepatitis
c) Drug induced
d) Inherited storage disease
32. Which is true of hepatitis E INFECTION?

a) It is often associated with coinfection of hepatitis B

b) Has a mortality rate in pregnant woman of 40%
c) Is associated with chronic liver disease
d) Average post exposure incubation period is 6weeks

33. Fulminent hepatic failure is most commonly due to

a) Alcohol
b) Viral hepatitis
c) Drug/chemical toxicity
d) Liver ischaemia secondary to shock

34. The condition most frequently associated with hepatic vein thrombosis is

a) Polycythemia rubra vera

b) Pregnancy
c) Intrabdominal carcinoma
d) Oral contraceptive use