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1. General Principles & Basic Science MCQs

Practice Set 37 of 789

This practice set contains high-yield board review questions covering key concepts in 1. General Principles & Basic Science. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 721

Topic: Biology, Genetics & Bone Healing

During secondary bone healing, which phase is classically characterized by the highest peak of cellular proliferation, angiogenesis, and the formation of a fibrocartilaginous soft callus?

. Inflammatory phase
. Reparative phase
. Remodeling phase
. Hematoma formation phase
. Woven bone transformation phase

Correct Answer & Explanation

. Reparative phase

Explanation

The reparative phase features massive cellular proliferation, ingrowth of capillaries (angiogenesis), and the deposition of a fibrocartilaginous network that forms the soft callus. This soft callus eventually mineralizes into hard woven bone.

Question 722

Topic: Biology, Genetics & Bone Healing

A 35-year-old female presents with knee pain. Radiographs demonstrate an eccentric, expansile, lytic, epiphyseal lesion in the proximal tibia. Biopsy reveals numerous multinucleated giant cells within a stroma of mononuclear cells. If medical therapy is considered, denosumab would be used to target which of the following?

. Vascular Endothelial Growth Factor (VEGF)
. Receptor Activator of Nuclear factor Kappa-B Ligand (RANKL)
. Tumor Necrosis Factor alpha (TNF-alpha)
. Interleukin-6 (IL-6)
. CD20 receptor

Correct Answer & Explanation

. Receptor Activator of Nuclear factor Kappa-B Ligand (RANKL)

Explanation

The diagnosis is a Giant Cell Tumor of bone. Denosumab is a monoclonal antibody that binds and inhibits RANKL, which normally promotes the recruitment and maturation of the osteoclast-like giant cells that drive tumor osteolysis.

Question 723

Topic: Surgical Anatomy & Approaches

A 5-year-old boy falls on an outstretched hand. Radiographs confirm a completely displaced, extension-type supracondylar humerus fracture. Which nerve is most commonly injured in this specific fracture pattern?

. Ulnar nerve
. Radial nerve
. Anterior interosseous nerve (AIN)
. Musculocutaneous nerve
. Axillary nerve

Correct Answer & Explanation

. Anterior interosseous nerve (AIN)

Explanation

The anterior interosseous nerve (AIN), a branch of the median nerve, is the most frequently injured nerve in extension-type supracondylar humerus fractures. Injury manifests clinically as the inability to form an 'OK' sign.

Question 724

Topic: Biomechanics & Biomaterials

During laboratory biomechanical testing of a human tendon, the tendon is rapidly stretched to a specific length and held constantly at that length. Over time, the internal force required to maintain this stretch gradually decreases. What is this specific viscoelastic phenomenon called?

. Creep
. Stress relaxation
. Hysteresis
. Fatigue failure
. Young's modulus

Correct Answer & Explanation

. Stress relaxation

Explanation

Stress relaxation is a viscoelastic property where the stress (internal force) decreases over time when the material is held at a constant strain (length). Creep, conversely, is increasing deformation under a constant load.

Question 725

Topic: Biomechanics & Biomaterials

In orthopedic basic science, viscoelastic materials like ligaments and tendons exhibit 'creep' when loaded. Which of the following best defines the phenomenon of creep?

. Time-dependent continuous deformation under a constant load
. Time-dependent decrease in stress under a constant deformation
. The loss of energy during cyclical loading and unloading
. Failure of a material after repeated submaximal loading cycles
. Increased stiffness at higher rates of loading

Correct Answer & Explanation

. Time-dependent continuous deformation under a constant load

Explanation

Creep is the time-dependent deformation of a viscoelastic material when subjected to a constant load. Stress relaxation, conversely, is the decrease in stress over time under a constant deformation.

Question 726

Topic: Biology, Genetics & Bone Healing

A 70-year-old woman is started on alendronate for osteoporosis after a distal radius fracture. At the cellular level, what is the primary mechanism of action of this medication?

. Stimulation of osteoblast differentiation
. Inhibition of parathyroid hormone secretion
. Direct stimulation of osteoid mineralization
. Inhibition of osteoclast function and induction of apoptosis
. Upregulation of the RANKL pathway

Correct Answer & Explanation

. Inhibition of osteoclast function and induction of apoptosis

Explanation

Bisphosphonates like alendronate concentrate in bone and are ingested by osteoclasts. They primarily function by inhibiting the enzyme farnesyl pyrophosphate synthase, disrupting osteoclast function and inducing osteoclast apoptosis.

Question 727

Topic: Biology, Genetics & Bone Healing

A 35-year-old woman presents with knee pain. Radiographs show an eccentric, lytic epiphyseal lesion extending to the articular surface of the distal femur. Biopsy confirms mononuclear cells and multinucleated giant cells. Which targeted pharmacological therapy is specifically indicated for unresectable cases?

. Imatinib
. Denosumab
. Zoledronic acid
. Methotrexate
. Rituximab

Correct Answer & Explanation

. Denosumab

Explanation

Giant cell tumors of bone are driven by an overexpression of RANKL by the neoplastic mononuclear cells, which recruits osteoclast-like giant cells. Denosumab is a monoclonal antibody against RANKL and is highly effective for locally advanced or unresectable giant cell tumors.

Question 728

Topic: Biology, Genetics & Bone Healing

A 28-year-old female presents with severe knee pain. Radiographs reveal an eccentric, lytic epiphyseal lesion extending into the metaphysis of the distal femur with no sclerotic margins. Biopsy confirms a Giant Cell Tumor (GCT) of bone. If medical management with Denosumab is initiated, the drug exerts its primary therapeutic effect by inhibiting which of the following targets?

. The RANK receptor expressed on the surface of mononuclear stromal cells.
. RANKL produced directly by the multinucleated giant cells.
. RANKL produced by the neoplastic mononuclear stromal cells.
. Osteoprotegerin (OPG) secreted by surrounding reactive osteoblasts.
. Macrophage colony-stimulating factor (M-CSF) in the tumor microenvironment.

Correct Answer & Explanation

. RANKL produced by the neoplastic mononuclear stromal cells.

Explanation

In a Giant Cell Tumor of bone, the true neoplastic cells are the mononuclear stromal cells, which express abnormally high levels of RANKL. Denosumab binds directly to this RANKL, preventing it from activating the RANK receptor on the reactive, bone-resorbing multinucleated giant cells.

Question 729

Topic: 1. General Principles & Basic Science

Which one of the following statements about cystic fibrosis (CF) is true?

. Allergic bronchopulmonary aspergillosis is a recognised complication, occurring in 15% of adult CF patients
. Heterozygotes generally have clinically significant disease
. Neonatal screening for CF results in a better survival rate and reduced decline in lung function
. Reduced body mass index is an absolute contraindication for heart-lung transplantation
. The controlled intake of high-calorie food is the first line of management for patients with CF-related diabetes

Correct Answer & Explanation

. Allergic bronchopulmonary aspergillosis is a recognised complication, occurring in 15% of adult CF patients

Explanation

Correct Answer: A- Allergic bronchopulmonary aspergillosis is a recognised complication, occurring in 15% of adult CF patients Explanation Allergic bronchopulmonary aspergillosis is a recognised complication, occurring in 15% of adult CF patients The increasing incidence of allergic bronchopulmonary aspergillosis (ABPA) is a recognised phenomenon. Allergic bronchopulmonary aspergillosis (ABPA) is encountered in 1 in 6 adult CF patients. Manifestations of ABPA include asthma symptoms, flitting opacities on the chest X-ray, increased eosinophil count, and hyper- reactivity to the skin prick test and increased specific plasma IgE. The main treatment is high-dose corticosteroids initially, with a smaller maintenance dose. The duration of treatment ranges from a few months to few years. Antifungal agents may be used to allow a reduction in corticosteroid dose. Heterozygotes generally have clinically significant disease Heterozygotes generally have clinically significant disease is incorrect. Different mutations responsible for cystic fibrosis across different racial subtypes are responsible for slightly differing patterns of disease, but drawing definitive correlations between genotype and disease severity is difficult. Neonatal screening for CF results in a better survival rate and reduced decline in lung function Neonatal screening for CF results in a better survival rate and reduced decline in lung function is incorrect. The most common mutation in patients with cystic fibrosis (CF) is the delta- F508 mutation. There is no correlation between genotype, the range of manifestations, the age of onset of symptoms and the survival rate in CF. However, neonatal screening allows the early implementation of prophylactic therapeutic measures. Prospective and retrospective studies have demonstrated that neonates detected by screening have a better nutritional status than those who were discovered by investigation of symptoms. The age of acquisition of Pseudomonas aeruginosa and the decline in lung function were found to be comparable in the two groups. Reduced body mass index is an absolute contraindication for heart-lung transplantation Reduced body mass index is an absolute contraindication for heart-lung transplantation is incorrect. Heart-lung transplantation is offered to patients who exhibit a rapid decline in lung function despite optimal treatment, and to patients with respiratory failure. Moderately reduced body mass index (BMI) is an indication for transplantation. A severe reduction in BMI is a relative contraindication to transplantation because it is associated with reduced survival but it is not an absolute contraindication. The controlled intake of high-calorie food is the first line of management for patients with CF-related diabetes The controlled intake of high-calorie food is the first line of management for patients with CF-related diabetes is incorrect. Diabetes is now seen in almost 10% of CF patients over the age of 20 years, the main manifestations being weight loss, repeated respiratory infections and decline in lung function. The treatment of choice is subcutaneous insulin therapy. Calorie intake should not be restricted in CF patients, who are prone to malnutrition due to their pancreatic insufficiency.

Question 730

Topic: 1. General Principles & Basic Science
A 24-year-old HIV-positive man with a CD4 lymphocyte count of 150 cells/mm3 has been complaining of gradually worsening dyspnea associated with a non-productive cough and fever for the last 2 weeks. A chest X-ray shows bilateral diffuse ground-glass opacities. What is the diagnosis?
. Infectious mononucleosis
. Legionellosis
. Pneumocystis jirovecii pneumonia
. Toxoplasmosis
. Tuberculosis

Correct Answer & Explanation

. Pneumocystis jirovecii pneumonia

Explanation

Pneumocystis jirovecii pneumonia (PCP) typically presents with gradually increasing dyspnea and cough over several weeks in immunocompromised patients. Chest X-ray usually shows diffuse ground-glass opacities. The CD4 count of 150 cells/mm3 is highly consistent with this opportunistic infection.

Question 731

Topic: 1. General Principles & Basic Science

A 25-year-old patient with epilepsy aspirated gastric juice after a seizure (Mendelson syndrome). What is the most likely clinical symptom or sign?

. Bradypnoea
. Bronchospasm
. Laryngospasm
. Paradoxical breathing
. Tenderness to percussion

Correct Answer & Explanation

. Bronchospasm

Explanation

Correct Answer: B- Bronchospasm Explanation Bronchospasm Mendelson syndrome is an acute pneumonia caused by regurgitation of stomach contents and aspiration of chemical material, usually gastric juices. It can cause severe bronchospasm. The pneumonia develops rapidly, and within hours the patient can become tachypnoeic, hypoxic and febrile. There is minimal sputum. The condition often follows anaesthesia, when the gag reflex is depressed. Bradypnoea Bradypnoea is incorrect. Bradypnoea would not be the most likely result of aspiration of gastric juice. Laryngospasm Laryngospasm is incorrect. Laryngospasm would not be the most likely result of aspiration of gastric juice. Paradoxical breathing Paradoxical breathing is incorrect. Paradoxical breathing would not be the most likely result of aspiration of gastric juice. Tenderness to percussion Tenderness to percussion is incorrect. Tenderness to percussion would not be the most likely result of aspiration of gastric juice.

Question 732

Topic: 1. General Principles & Basic Science

Which one of the following conditions is most likely to be associated with obstructive spirometry and a normal

Tlco (transfer factor for carbon monoxide)?

. Asthma
. Emphysema
. Interstitial lung disease
. Pulmonary hypertension
. Sarcoidosis

Correct Answer & Explanation

. Asthma

Explanation

Correct Answer: A- Asthma Explanation Asthma Asthma is associated with airflow obstruction. Transfer factor is usually unaffected. The Tlco is sometimes increased in patients with bronchial asthma during an attack, but the cause of this change is not known. The other options are all incorrect. These conditions are all associated with a reduced transfer factor. The diffusion of carbon monoxide (CO) from the alveoli to the pulmonary blood is governed by the integrity of the alveolar membrane, the capillary blood volume, or both (the airโ€“blood barrier). A reduction in the diffusion capacity of CO is encountered in conditions affecting the capillary bed size (eg pulmonary emboli, pulmonary vasculitis) or conditions that cause changes in the characteristics of the alveolar membrane, such as diseases in which some form of intra-alveolar filling process has occurred and the airโ€“blood diffusion pathway is actually lengthened (eg pneumonia, pulmonary oedema, alveolar proteinosis). Similarly, the transfer factor for carbon monoxide (Tlco) is reduced in patients with infiltrative disorders of the lung that affect both the capillary bed size and the alveolar membrane integrity (eg sarcoidosis, interstitial lung diseases, collagen vascular diseases). Removal or destruction of lung tissue (eg post-surgery, emphysema) decreases both membrane and blood volume components and produces a low Tlco. An increase in Tlco results occasionally from an increase in capillary blood volume secondary to haemodynamic changes in the pulmonary circulation, an increase in pulmonary artrial or left atrial pressures (eg in congestive heart failure) or an increase in pulmonary blood flow (eg in artrial septal defect). Alveolar haemorrhage from any cause can result in a false increase of the Tlco despite the presence of an underlying diffusion defect. Emphysema Emphysema is incorrect. Emphysema is associated with a reduced transfer factor. Interstitial lung disease Interstitial lung disease is incorrect. Interstitial lung disease is associated with a reduced transfer factor. Pulmonary hypertension Pulmonary hypertension is incorrect. Pulmonary hypertension is associated with a reduced transfer factor. Sarcoidosis Sarcoidosis is incorrect. Sarcoidosis is associated with a reduced transfer factor.

Question 733

Topic: 1. General Principles & Basic Science
What are the NICE indications for home oxygen?
. Cor pulmonale and low PO2
. Ischaemic heart disease
. Low forced expiratory volume in 1 s (FEV1)
. Low PCO2
. Low PO2 during exacerbations

Correct Answer & Explanation

. Cor pulmonale and low PO2

Explanation

Correct Answer: A. Cor pulmonale and low PO2. The National Institute for Health and Care Excellence (NICE) states that the following are indications for considering long-term oxygen therapy (LTOT): Stable patients with a PaO2 of < 7.3 kPa when stable, or patients with a PaO2 of 7.3โ€“8.0 kPa who are stable but have an additional risk factor (e.g., secondary polycythaemia, nocturnal hypoxaemia, peripheral oedema, pulmonary hypertension). Oxygen should be used for at least 15 hours per day.

Question 734

Topic: 1. General Principles & Basic Science
A 29-year-old woman noticed shortness of breath and dry cough while jogging last winter. Her GP trialed a salbutamol inhaler that she says gave her some relief, although she now wakes up twice a week at 04:00 with a troublesome cough despite using the inhaler a number of times per day. On examination there is scattered wheeze and her peak flow is 460 (530 predicted). What is the most appropriate therapy?
. Ampicillin
. Oral steroids
. Salbutamol inhaler
. Salbutamol inhaler and inhaled steroids
. Theophylline

Correct Answer & Explanation

. Salbutamol inhaler and inhaled steroids

Explanation

Correct Answer: D. Salbutamol inhaler and inhaled steroids. This patient needs to move to step 2 of the British Thoracic Society (BTS) guidelines for asthma therapy (regular preventer therapy). Inhaled steroids should be considered for patients who have had exacerbations of asthma in the last 2 years, are using inhaled ฮฒ2-agonists three times a week or more, or are symptomatic three times a week or more, or waking one night a week.

Question 735

Topic: 1. General Principles & Basic Science

A 68-year-old man who has a long history of smoking presents to the Emergency Department with worsening shortness of breath. His general health has deteriorated over the past few months and recently he has been prescribed a salbutamol inhaler by his GP for cough and wheezing, particularly on exercise and at night. On examination he is lip pursing and has considerable wheeze on auscultation of the chest. He is pyrexial at 37.8 ยฐC and has purulent sputum. He can only manage a peak flow of 150 l/min. Arterial blood gas sampling reveals a Pao2 of 7.2 kPa. He is allergic to penicillin. Which of the following would be the most appropriate choice for antibiotic therapy in this man?

. Ciprofloxacin 500 mg bd orally
. Clarithromycin 500 mg bd IV
. Co-amoxiclav 1.2 g tds intravenously
. Metronidazole 500 mg tds orally
. Penicillin V 500 mg qds orally

Correct Answer & Explanation

. Clarithromycin 500 mg bd IV

Explanation

Correct Answer: B- Clarithromycin 500 mg bd IV Explanation Clarithromycin 500 mg bd IV This man has an exacerbation of chronic obstructive pulmonary disease (COPD). The most common causative pathogens are Haemophilus influenzae and Moraxella catarrhalis. The most appropriate antibiotic of the options listed would be a macrolide such as clarithromycin. It should be noted, however, that in patients taking theophyllines, concomitant use of macrolides can increase serum aminophylline levels. Other important acute treatments in this case would be repeated nebulisation with salbutamol and ipratropium 4- to 6-hourly, oxygen therapy and oral steroids. Non- invasive ventilation might be considered where the pH is 7.3 or less and the patient is not improving after 4 h of medical therapy. Ciprofloxacin 500 mg bd orally Ciprofloxacin 500 mg bd orally is incorrect. Ciprofloxacin will not adequately treat infection with Streptococcus pneumoniae, which is a common cause of respiratory infection in COPD. Co-amoxiclav 1.2 g tds intravenously Co-amoxiclav 1.2 g tds intravenously is incorrect. He is penicillin allergic, so this would not be an appropriate choice. Metronidazole 500 mg tds orally Metronidazole 500 mg tds orally is incorrect. Oral metronidazole is primarily used to treat Clostridium difficile infection. Absorption is poor in its oral form. Intravenous metronidazole is used to treat anaerobic infections, which are not a common cause of COPD exacerbations. Penicillin V 500 mg qds orally Penicillin V 500 mg qds orally is incorrect. He is penicillin allergic; this would not be an appropriate choice.

Question 736

Topic: 1. General Principles & Basic Science
Which one of the following does not increase the risk of death in patients with severe pneumonia?
. Age 49 years
. Atrial fibrillation
. Diastolic blood pressure < 60 mmHg
. Urea > 7 mmol/L
. White blood cell count < 4 ร— 10^9/L

Correct Answer & Explanation

. Age 49 years

Explanation

Correct Answer: A. Age 49 years. An age of 49 would not be associated with an increased risk of mortality from pneumonia. The risk factors for increased mortality in severe pneumonia (CURB-65 criteria) include age โ‰ฅ 65 years, confusion, urea > 7 mmol/L, respiratory rate โ‰ฅ 30/min, and systolic BP < 90 mmHg or diastolic BP โ‰ค 60 mmHg.

Question 737

Topic: 1. General Principles & Basic Science

A 43-year-old patient with rheumatoid arthritis has been referred to you because of increasing shortness of breath and dry cough. Which medication is most likely to be responsible for her symptoms?

. Gold
. Ibuprofen
. Methotrexate
. Oral corticosteroids
. Sulfasalazine

Correct Answer & Explanation

. Methotrexate

Explanation

Correct Answer: C- Methotrexate Explanation Methotrexate Methotrexate is an effective and moderately toxic disease-modifying anti-rheumatoid drug (DMARD). Pulmonary complications, in the form of pneumonitis (inflammation of the lung), are rare idiosyncratic reactions and are potentially lethal. The classical presentation is with rapid onset dyspnoea (shortness of breath), which may result in death after a few days. Therefore, patients should be advised to stop methotrexate if they experience dyspnoea or cough and to seek immediate medical attention. Gold Gold is incorrect. Gold has been superceded by newer and less toxic DMARDs. Side-effects from gold include dermatitis, stomatitis, haematuria, proteinuria including nephrotic syndrome and blood dyscrasias. Cases of pulmonary toxicity have been reported in the literature, but are relatively rare. Ibuprofen Ibuprofen is incorrect. Ibuprofen is not associated with pulmonary toxicity. Oral corticosteroids Oral corticosteroids is incorrect. Oral corticosteroids may increase risk of pulmonary infection but the description of respiratory symptoms in this case suggests a non- infective cause of pulmonary toxicity. Pulmonary toxicity due to a DMARD, in particular methotrexate is most likely. Sulfasalazine Sulfasalazine is incorrect. Sulfasalazine is associated with side-effects such as nausea and vomiting, rashes, arthralgia and hepatic dysfunction in up to 20% of patients. Sulphasalazine-induced pulmonary toxicity is rare.

Question 738

Topic: 1. General Principles & Basic Science
A patient who has had wheezy breathlessness for many years and who has previously been shown to have pulmonary infiltrates on chest X-ray and blood eosinophilia undergoes a high-resolution computed tomographic scan. This shows proximal bronchiectasis. Which of the following tests would be most useful in establishing the cause of her bronchiectasis?
. Aspergillus skin-prick test
. Bronchoscopy and bronchoalveolar lavage
. Histamine challenge test
. Measurement of total IgE
. Serum anti-neutrophil cytoplasmic antibody (ANCA)

Correct Answer & Explanation

. Aspergillus skin-prick test

Explanation

Correct Answer: A. Aspergillus skin-prick test. Allergic bronchopulmonary aspergillosis is characterized by asthmatic symptoms, peripheral blood eosinophilia, positive skin tests or circulating precipitins to Aspergillus fumigatus, abnormal chest X-ray, and raised total IgE. A proportion of patients develop proximal bronchiectasis as a consequence of mucus plugging. Of the options listed, the Aspergillus skin-prick test is the most specific investigation for allergic bronchopulmonary aspergillosis.

Question 739

Topic: 1. General Principles & Basic Science

A 72-year-old woman is admitted with an infective exacerbation of chronic obstructive pulmonary disease. On admission, her blood gases taken while breathing 28% oxygen are: pH 7.31, Pao2 7.9 kPa, Paco2 7.5 kPa. Which of the following best describes the blood gas picture?

. Compensated type I respiratory failure
. Compensated type II respiratory failure
. Decompensated type I respiratory failure
. Decompensated type II respiratory failure
. Partially compensated respiratory alkalosis

Correct Answer & Explanation

. Decompensated type II respiratory failure

Explanation

Correct Answer: D- Decompensated type II respiratory failure Explanation Decompensated type II respiratory failure The patientโ€™s blood gases show that she is hypoxic on oxygen โ€“ the Paco2 is elevated (Paco2> 6 kPa) and thepH is low. These confirm a respiratory acidosis. There is hypoxia combined with CO2 retention. The blood gas picture is therefore one of decompensated type II respiratory failure. The prognosis is poor unless treated appropriately. The treatment in this case should be non- invasive positive-pressure ventilation (NIPPV). Data from good-quality randomised controlled trials indicate that NIPPV should be recommended as the first-line intervention, coupled with standard medical care, in all suitable patients with respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease. A trial of NIPPV should be considered early in the course of respiratory failure, before severe acidosis develops, as a means of avoiding endotracheal intubation and reducing treatment failure and mortality. Compensated type I respiratory failure Compensated type I respiratory failure is incorrect. The terms compensated/decompensated in respiratory failure refer to compensation for hypercapnoea. There is nothing to compensate for in type 1 respiratory failure ie the CO2 is low or normal so these options do not make sense. Regardless the gases show type II respiratory failure (lowpO2 and raised pCO2). Compensated type II respiratory failure Compensated type II respiratory failure is incorrect. ThepH would be normal in compensated type II respiratory failure (i.e. pH 7.35-7.45). Decompensated type I respiratory failure Decompensated type I respiratory failure is incorrect. The terms compensated/decompensated in respiratory failure refer to compensation for hypercapnoea. There is nothing to compensate for in type 1 respiratory failure ie the CO2 is low or normal so these options do not make sense. Regardless the gases show type II respiratory failure (low pO2 and raised pCO2). Partially compensated respiratory alkalosis Partially compensated respiratory alkalosis is incorrect. The pH is acidotic. Respiratory alkalosis would be represented by a high pH (>7.45) and a low pCO2 (<4kPa)

Question 740

Topic: 1. General Principles & Basic Science
A 61-year-old man with a 40 pack-year smoking history presents with chronic cough, haemoptysis, and weight loss. Unfortunately his chest X-ray reveals a large mass at the left hilum, suggestive of a bronchial carcinoma. A raised calcium is noted on routine blood work-up. What type of carcinoma would best fit this clinical picture?
. Adenocarcinoma of the bronchus
. Bronchoalveolar-cell carcinoma
. Large-cell bronchial carcinoma
. Small-cell bronchial carcinoma
. Squamous-cell carcinoma of the bronchus

Correct Answer & Explanation

. Squamous-cell carcinoma of the bronchus

Explanation

Correct Answer: E. Squamous-cell carcinoma of the bronchus. Squamous-cell and small-cell bronchial carcinomas tend to occupy a central location. Squamous-cell carcinomas are more frequently associated with hypercalcaemia, so this is the correct answer in this case.

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