Sample questions / Respiratory

Organ system

Respiratory questions for Step 1

Work through respiratory vignettes that mix physiology, pathology and pharmacology, the way the exam does. Every explanation covers all five options.

ImmunologyEasy

Bronchiolitis obliterans in chronic GVHD

Eighteen months after an allogeneic marrow transplant, a 38-year-old woman has worsening breathlessness and dry cough. FEV1 has fallen from 95% to 40% with fixed obstruction. HRCT shows air trapping, and biopsy shows small airways blocked by concentric fibrosis. She is diagnosed with bronchiolitis obliterans from chronic GVHD.

Which immune process drives this airway destruction?

1. Complement-mediated damage
2. NK cell cytotoxicity
3. Eosinophilic inflammation
4. Recipient B cells producing autoantibodies
5. Donor T cells causing fibrosis

MicrobiologyEasy

Klebsiella pneumonia

A 40-year-old man with heavy alcohol use has fever, pleuritic pain and thick, bloody 'currant jelly' sputum. X-ray shows dense right upper lobe consolidation with a bulging fissure. Gram stain shows plump gram-negative rods with a large mucoid capsule.

What best explains the large amount of exudate?

1. Biofilm formation in the airways traps inflammatory cells and fluid
2. A thick mucoid polysaccharide capsule causes copious exudate and resists phagocytosis
3. Hemolysins destroy pulmonary capillary endothelium leading to hemorrhagic exudate
4. Lipopolysaccharide activates massive toll-like receptor 4 inflammatory cascade
5. The organism produces an exotoxin that directly increases vascular permeability

PathologyMedium

Bird fanciers lung

A 50-year-old woman who breeds birds has chronic dyspnea and cough with upper-lobe ground glass and fibrosis.

Which finding is most likely?

1. Lymphocytic infiltration with germinal centers
2. Eosinophilic infiltration with Charcot-Leyden crystals
3. Chronic granulomatous inflammation with giant cells
4. Neutrophilic infiltration with abscess formation
5. Plasma cell infiltration with Russell bodies

BiochemistryMedium

Benzo[a]pyrene TP53

A 65-year-old man with 40 pack-years develops lung cancer. Tumor sequencing shows G→T transversions in TP53.

Which carcinogen metabolite most likely caused this?

1. Vinyl chloride
2. Aflatoxin B1
3. Aromatic amines
4. N-nitrosamine
5. Benzo[a]pyrene diol epoxide

PharmacologyMedium

Inpatient CAP regimen

A woman with severe COPD is admitted with fever, purulent sputum and a lobar infiltrate, SpO2 89 percent. She once had angioedema to TMP-SMX. She has no MRSA or Pseudomonas risk factors.

Which empiric regimen is most appropriate?

1. Levofloxacin monotherapy
2. Doxycycline plus metronidazole
3. Azithromycin monotherapy
4. Piperacillin-tazobactam plus vancomycin
5. Ceftriaxone plus azithromycin

Other systems

Cardiovascular · Renal & Urinary · Gastrointestinal & Hepatobiliary · Nervous System · Endocrine · Reproductive · Hematology & Oncology · Musculoskeletal & Skin · Behavioral Health · Multisystem & General Principles ·