Exam Master Pulmonary
Which of the following asbestos-related respiratory diseases has calcified plaques; intensity proportional to exposure; and is only significant in that it indicates prior exposure? A Asbestosis B Pleural thickening C Benign effusions D Pleural mesothelioma E Bronchogenic carcinoma
B: Pleural thickening
A 12-year-old boy is investigated for difficulty with breathing; the difficulty has occured for several weeks. A chest X-ray reveals subpleural nodule in the right lung midfield as well as enlarged mediastinal lymph nodes. What is the most likely diagnosis? A Aspergillosis B Primary tuberculosis C Coccidioidomycosis D Secondary tuberculosis E Miliary tuberculosis
B: Primary tuberculosis
Peritoneal mesothelioma is caused by: A Asbestos B Talc C Silica D Coal E Iron
A: Asbestos
Which of the following paraneoplastic syndromes is associated with small cell carcinoma? A Dermatomyositis B Acanthosis nigricans C Necrolytic migratory erythema D Tylosis E Nephrotic syndrome F Ectopic production of antidiuretic hormone (ADH)
F: Ectopic production of antidiuretic hormone (ADH)
A 23-year-old man presents with a 5-day history of productive cough and blood-streaked sputum. Over the last several years, he has had similar symptoms 3 - 4 times a year; they were successfully treated with antibiotics. He has had a cough since childhood; recently, it has been productive (1 - 2 cups of yellow-green sputum). The patient is a non-smoker. He takes lipase, protease, and amylase for malabsorption. Coarse rhonchi and wheeze are heard. Chest X-ray shows bilateral nodular tissues and hyperinflation with increased interstitial markings. Question What is the most likely diagnosis? Answer Choices A Cystic fibrosis B Pneumonia C COPD D Bronchiectasis E Tuberculosis
A: Cystic fibrosis
A 25-year-old man presents at the hospital after a car collision. He is intubated and placed on a ventilator. He becomes progressively difficult to oxygenate despite increasing the PEEP and the oxygen supply to 100%. Patient remains afebrile. He dies several days later. At autopsy, the lung shows diffuse hyaline membranes in the alveoli, thickened alveolar walls, and many alveolar macrophages, but few neutrophils. Question What condition did this patient have? Answer Choices A Acute respiratory distress syndrome B Bronchopneumonia C Chronic bronchitis D Bronchiectasis E Viral pneumonia
A: Acute respiratory distress syndrome
Which of the following asbestos-related respiratory diseases has the characteristics of interstitial fibrosis; long latent period; clubbing; crackles? A Asbestosis B Pleural thickening C Benign effusions D Pleural mesothelioma E Bronchogenic carcinoma
A: Asbestosis
A 7-year-old boy presents with his mother with a 1-week history of wheezing and dyspnea on any exertion (with productive cough). On physical examination, bilateral rhonchi are heard. After a few days of treatment, spirometry is done on the patient. Total lung capacity (TLC) is 111% on spirometry. Pre-bronchodilators Post-bronchodilators FVC% 49 63 FEV1% 41 46 FEV1/FVC 49 55 What is the most likely diagnosis? A Asthma B Pneumonia C Pleural effusion D Kyphoscoliosis E Tuberculosis
A: Asthma
A 57-year-old man presents with a fever and productive cough. A brief history reveals a 60 pack-year smoking habit and worsening cough with occasional hemoptysis and dyspnea. He reports recent shoulder pain that radiates down the right arm in the ulnar distribution. On physical exam, the patient is thin, moderately distressed, and short of breath with tachypnea and oxygen saturation at 84%. Wheezing is noted. Chest CT scan findings are suggestive of lung carcinoma. The patient is admitted to the hospital for further evaluation. Question What would be most appropriate in the ensuing workup for lung carcinoma? Answer Choices A Bronchoscopy and biopsy B Endocrine evaluation for paraneoplastic phenomenon C Genetic testing for p53 mutation D High-resolution CT of chest E Transthoracic fine-needle aspiration biopsy
A: Bronchoscopy and biopsy
What concerning mycoplasmal pneumonia is true? Answer Choices A Bullous myringitis may be an associated finding B Fever, headache, and malaise are uncommon C Guillain-Barre syndrome is a common complication D Splenomegaly and lymphadenopathy are characteristic features E WBC count is usually more than 25,000/mm3
A: Bullous myringitis may be an associated finding
A 30-year-old woman presents because she recently had a PPD skin test; the transverse diameter of the induration was 14 mm. The patient denies ever having tuberculosis and she is asymptomatic now, but she expresses some anxiety about the result of the skin test. For the last 6 months, she has worked as a nurse for a long-term care facility. Her patient is a vent-dependent tetraplegic. On clinical examination, there are no abnormalities. Question What is the most appropriate next step? Answer Choices A Chest X-ray B Isoniazid prophylaxis C Reassurance D Respiratory isolation E Sputum examination
A: Chest X-ray
A 50-year-old male presents to his primary care physician for worsening dyspnea and progressive cough. He is a chronic smoker. On physical examination, he has cyanosis in his fingertips and he is using his accessory muscles to breath. Lung examination reveals course rhonchi throughout his chest wall. Chest X-ray shows increased bronchovascular markings and cardiomegaly. PFT reveals decreased FEV1, decreased FVC and decreased FEV1/FVC ratio, TLC is104. The peak flow rate is 170. Question What is the most likely diagnosis? Answer Choices A Chronic obstructive pulmonary disease (COPD) B Emphysema C Congestive heart failure D Pneumonia E Asbestosis
A: Chronic obstructive pulmonary disease (COPD)
A 34-year-old man has a rapidly developing cough, dyspnea and expectoration with blood-tinged sputum. On examination, the patient is toxic, febrile, and rhonchi are present. The patient has hyponatremia and proteinuria; a chest X-ray shows consolidation in the right hemithorax. Question What is the most likely diagnosis? Answer Choices A Pulmonary tuberculosis B Pleural effusion C Legionella pneumonia D Asbestosis E Septicemic plague
C: Legionella pneumonia
A 28-year-old man presents with a 2-hour history of chest tightness, coughing, and wheezing. The history determines that he has had many such attacks in recent years, usually brought on by emotional factors or exertion; the attacks are generally treatable by self-medication at home. He has a history of hay fever, and other members of the family have had similar symptoms. Physical examination reveals dyspnea, orthopnea, and cyanosis. High-pitched, sibilant rhonchi occur on inspiration and expiration, and some coarse crepitations are audible. Pulse is 130/min and regular. An emergency arterial PCO2 is 65 mm Hg. Question What will likely be shown by pulmonary function studies during an acute attack? Answer Choices A Decreased FEV1 B Increased vital capacity C Decreased residual volume D Decreased airway resistance E Increased arterial PO2
A: Decreased FEV1
Pulmonary function studies generally show in chronic obstructive lung disease (COPD): Answer Choices A Decreased VC and increased RV, FRC, and TLC. B Increased VC and decreased RV, FRC, and TLC. C Increased RV and decreased VC, FRC, and TLC. D Increased TLC and decreased RV, FRC, and VC. E Decreased TLC and increased RV, FRC, and VC.
A: Decreased VC and increased RV, FRC, and TLC.
Which of the following methods is best for detecting early, subclinical interstitial lung disease? A Diffusing capacity measurement B Spirometry C Arterial blood gas analysis D Body plethysmography E Measurement of blood oxygen-carrying capacity
A: Diffusing capacity measurement
Which of the following may be the first sign of a lung cancer of the superior sulcus? A Horner's syndrome B Anisocoria C Holmes-Adie pupil D Argyll Robertson pupils
A: Horner's syndrome
A 40-year-old man has been working 16 hours a day producing a documentary for television. He has a productive cough with yellow sputum production that has been increasing for several days. He has a fever, and the Gram stain of the sputum shows 4+ Gram-positive cocci in chains. Question What is the most likely diagnosis? Answer Choices A Lobar pneumonia B Interstitial pneumonitis C Miliary granulomata D Acute abscessing bronchopneumonia E Chronic abscessing pneumonia
A: Lobar pneumonia
A 55-year-old man presents with shortness of breath and a productive cough with yellow phlegm for 2 days; he has had blood-tinged sputum for the last 3 hours. He has smoked 2 packs of cigarettes for the past 35 years. He has a temperature of 102°, and rhonchi, wheeze, and crepitations are heard over the right hemithorax. A chest X-ray shows a dense lobar infiltrate in the right hemithorax. Question What is the most likely diagnosis? Answer Choices A Lobar pneumonia B Tuberculosis C Asthma D COPD E Acute bronchitis
A: Lobar pneumonia
Pneumomediastinum is most likely to be associated with which one of the following? A Mechanical ventilation B Viral pneumonia C Pulmonary embolism D Congestive heart failure E Bronchiectasis
A: Mechanical ventilation
A 50-year-old man who has smoked 1 pack-a-day of cigarettes since age 23 presents with a history of cough and dyspnea on exertion that has progressively worsened over the past several months. Chest x-ray reveals flattening of the diaphragms but no consolidations. Spirometry was performed, and the results are as follows: FEV1 60% predicted FVC 84% predicted FEV1/FVC 69% predicted Question Based on these findings, what is the most likely diagnosis? Answer Choices A Obstructive lung disease B Restrictive lung disease C Silicosis D Upper airway disease E Pneumonia
A: Obstructive lung disease
A 30-year-old man presents with dyspnea and chest pain, which is stabbing in nature and increases on deep inspiration. On examination, P is 100/min, and BP is 110/74 mmHg. Right lower half of the chest has decreased resonance to percussion; there are inaudible breath sounds in the lower right half of the chest, and pleural friction rub is heard. Chest X-ray shows a uniform dense opacity in the lower and lateral hemithorax on the right side. Question What is the most likely diagnosis? Answer Choices A Pleural effusion B Tuberculosis C Pneumonia D Pulmonary embolism E Pneumothorax
A: Pleural effusion
A 6-year-old boy develops a low-grade fever with no other symptoms. A chest X-ray shows a peripheral solitary mid-lung nodule and marked hilar lymphadenopathy. Of what are these findings suggestive? Answer Choices A Primary tuberculosis B Candidiasis C Aspergillosis D Reactivation of coccidioidomycosis E Lung abscess with Bacteroides fragilis
A: Primary tuberculosis
A 44-year-old healthy man, who is a non-smoker, has a 3-cm coin lesion in the right upper lobe. The lesion was revealed on his chest radiograph. The patient did not have any clinical symptoms. The fine-needle aspiration did not reveal any cells. Question What is the most likely tumor in this case? Answer Choices A Pulmonary hamartoma B Bronchial carcinoid C Mesothelioma D Metastatic adenocarcinoma E Large cell undifferentiated carcinoma
A: Pulmonary hamartoma
A 60-year-old man presents with worsening cough for several months; he has also experienced blood-tinged sputum for the past several weeks. He has been a chronic smoker for the past 40 years. Otherwise, he has no major health problems. Question In order to initiate the management of his disease, what should be done first? Answer Choices A Sputum cytology B Bronchoalveolar lavage C Fine-needle aspiration cytology D Pleural fluid cytology E Arterial blood gas analysis
A: Sputum cytology
A 67-year-old man presents with headache, body aches, shaking chills, and fever. His son brought him in and states that he found him unconscious in the bathroom. His son also reveals that members of the family had been stricken with an influenza-type illness. His father's symptoms had first appeared about 2 days ago; he noted feeling achy. His temperature is 40° C; CBC is remarkable for a WBC of 15,000/ul with a left shift, and chest X-rays are significant for multiple abscesses of various sizes. Blood cultures are drawn and are positive in less than 24 hours for Gram-positive cocci. The sputum Gram stain is significant for many WBC and many Gram-positive cocci in clusters (See Image). Question This clinical presentation is highly suggestive of an infection due to what organism? Answer Choices A Staphylococcus aureus B Streptococcus pyogenes C Enterococcus faecalis D Staphylococcus epidermidis E Streptococcus viridans
A: Staphylococcus aureus
A 66-year-old man with moderately well-controlled type 2 diabetes mellitus presents to his primary care provider for the management of pneumonia. His influenza test was negative. He is currently being treated with levofloxacin. He is afebrile; pulse is 93, blood pressure is 130/90 mm Hg, respirations are 18/min, and oxygen saturation is 92% on room air. Question What is the most common bacterial cause of this patient's pneumonia? Answer Choices A Streptococcus pneumoniae B Haemophilus influenzae C Staphylococcus aureus D Pseudomonas aeruginosa E Moraxella catarrhalis
A: Streptococcus pneumoniae
A 65-year-old Caucasian man presents with a history of acute shortness of breath. He has a past medical history of asthma and hypertension. He is also having blurry vision and has a drooping left eyelid. During his physical exam, you note that he has distended neck veins when he is sitting up. You estimate his jugular venous pressure to be about 15 cm of H2O. There is also left-sided ptosis and the left pupil is smaller than the right one. Question What diagnosis would explain this patient's symptoms? Answer Choices A Superior sulcus tumor B Atherosclerotic heart disease C Atrial fibrillation D Premature atrial contractions E Patient on ACEI for HTN
A: Superior sulcus tumor
A 50-year-old man presents with mental confusion, nausea, and vomiting. The patient admits to smoking 2 packs of cigarettes daily for 25 years. X-ray showed there was enlargement of the left hilum. Labs show: BUN: 8 mg/dl Serum sodium: 116 mEq/L (N=136-145) Serum Potassium: 4.2 mEq/L (N=3.5-5.0) Serum Chloride: 80 mEq/L (N=98-106) Serum CO2: 24 mEq/L (N=24-30) What statement concerning this patient is correct? A Urinary Na would be high, and urine osmolality would be inappropriately high B Urinary Na would be low, and the urinary osmolality would be inappropriately high C Due to vomiting, patient is having hyponatremia D Patient is having adrenal insufficiency E The findings may result from hypothalamic metastatic disease
A: Urinary Na would be high, and urine osmolality would be inappropriately high
Which of the following is true concerning pulmonary aspiration? Answer Choices A Use of endotracheal tubes with high-volume, low-pressure cuffs decrease the chance of aspiration B Signs and symptoms rarely become apparent less than six hours after aspiration has occurred C Initial radiographic changes following aspiration include acute infiltrates and pulmonary edema D Chest radiographs usually reveal significant findings immediately after aspiration E Aspiration of activated charcoal is benign
A: Use of endotracheal tubes with high-volume, low-pressure cuffs decrease the chance of aspiration
A 40-year-old man has a several-year history of a chronic cough; it is sometimes accompanied by fever and sputum production. Patient is a nonsmoker. The chest X-ray shows consolidation of the left lung field. A bronchogram shows bronchial dilatation and sacculation involving the first segmental bronchus and branches extending to the left lingular region. Question What is the most likely diagnosis? Answer Choices A Pulmonary hamartoma B Bronchial carcinoid C Mesothelioma D Metastatic adenocarcinoma E Large cell undifferentiated carcinoma
B: Bronchial carcinoid
A 25-year-old man presents with severe respiratory distress after taking aspirin for headache. Question What is the likely cause of his respiratory distress? Answer Choices A Fibrous pleural plaques B Bronchoconstriction C Bronchiolitis obliterans D Necrotizing vasculitis E Pulmonary atherosclerosis
B: Bronchoconstriction
Refer to the table. The findings in the chart are of the findings of spirometry in a 65-year-old woman who is a chronic smoker with a history of breathlessness on any exertion, productive cough, and frequent wheeze. TLC is 103. Question What is the most likely diagnosis? Answer Choices A Asthma B COPD C Sarcoidosis D Pneumonia E Asbestosis
B: COPD
A 55-year-old man with a 100 pack-year smoking history presents with dyspnea. The patient is cyanotic, restless, and confused. He has tachycardia, tachypnea, as well as peripheral and conjunctival hyperemia. Ophthalmoscopy shows papilledema. ABG shows PaO2 - 54mmHg, PaCO2 57mmHg and SaO2 76%. Chest X-ray shows hyperinflated lungs. Question What is the most likely diagnosis? Answer Choices A Pulmonary edema B Acute respiratory failure with COPD exacerbtion C Pneumothorax D Pneumonia E Asthma
B: Acute respiratory failure with COPD exacerbtion
A 40-year-old man presents with increasing dyspnea. After thorough examination and investigation it is found that he has panacinar emphysema, ascites, splenomegaly and caput medusae. Question What do the patient's findings suggest? Answer Choices A History of alcohol and tobacco abuse for many years B Alpha-1 antitrypsin deficiency C Extensive upper lobe involvement by the disease D Environmental exposure to organic dusts E Alveoli are normal, but respiratory bronchioles are not
B: Alpha-1 antitrypsin deficiency
During a routine X-ray examination for employment insurance purposes, the radiologist notices a rounded lesion in a pulmonary cavity on the right upper lobe of the pulmonary X-ray of a middle-aged man. The patient was treated for pulmonary cavitary tuberculosis (TB) 2 years ago; he has completed treatment, and he has not had any problems since. Question What late complication of TB is seen in this patient? Answer Choices A Fibrothorax B Aspergilloma C Broncholithiasis D Reactivation of TB E Bronchiectasis
B: Aspergilloma
A 22-year-old male college student presents with a 2-week history of low grade fever, sore throat, dry cough, and chest wall discomfort from coughing. He is on no medications, but he has a history of mild asthma not requiring chronic therapy. He has been under a lot of pressure at work and has not been sleeping well. He is concerned he might have pneumonia. Vitals include a temperature of 100.6°F, BP of 126/76 mm Hg, pulse of 82 beats/min, and RR of 20/min. Lung exam reveals coarse rhonchi throughout the lung fields, with rales in the right lower lobe and egophony demonstrated over the right lower lobe. The results of a PA and lateral chest X-ray reveal right lower lobe infiltration. Question What is the best empiric medication for this patient's illness? Answer Choices A Amoxicillin 875 mg twice daily for 10 days B Azithromycin 500 mg first dose, then 250 mg daily for 4 days C Cephalexin 500 mg 3 times daily for 10 days D Ciprofloxacin 500 mg twice daily for 10 days E Trimethoprim/sulfamethoxazole DS twice daily for 10 day
B: Azithromycin 500 mg first dose, then 250 mg daily for 4 days
What class of medications is contra-indicated in most asthmatic patients? Answer Choices A Anticholinergics B Beta-adrenergic antagonists C Quinolone antibiotics D Nitrates E Calcium channel blockers
B: Beta-adrenergic antagonists
A 56-year-old man presents with dyspnea on exertion. He also describes a chronic cough with sputum production, which he estimates has been present for 3 - 4 months of the year for the last 2 years. He is a heavy smoker. He works in a plastics plant where he is exposed to toluene diisocyanate. Examination of the chest reveals scattered crackles and some low-pitched wheezes on forced expiration. Chest radiograph is unremarkable, except for increased lung markings. Spirometry shows a normal forced vital capacity. Forced expiratory volume in 1 sec is 62% of normal, and the forced expiratory volume in 1 sec/forced vital capacity is 60% of normal. The forced expiratory volume in 1 sec increases 4% after bronchodilator administration. Question What is the most likely diagnosis? Answer Choices A Asthma B Chronic bronchitis C Emphysema D Interstitial fibrosis E Pneumoconiosis
B: Chronic bronchitis
A 30-year-old man presents with a neck mass at the midline (see image). He claims to have noticed it about 2 weeks prior; at that time it was significantly smaller in size. It has progressively enlarged since. The patient reports a 5-pound weight loss in the last 2 weeks. He denies having any fevers or headaches. Travel history is notable for a recent vacation in Arizona. The patient is afebrile. A chest radiograph is notable for apical scarring of the right lung. A PPD is performed. The neck mass is drained and drainage fluid is sent to the laboratory for culture (bacterial, fungal, and mycobacterial). The patient is instructed to return to the office in 2 days for a follow-up visit. The Gram stain, KOH, and acid-fast stains are all negative. The PPD is negative. 5 days later, fungal cultures become positive for a dimorphic fungus that is white and produces barrel-shaped arthroconidia at 25° C. Question What is the fungus diagnosis? Answer Choices A Aspergillosis B Coccidioidomycosis C Histoplasmosis D Blastomycosis E Cryptococcosis
B: Coccidioidomycosis
A 69-year-old man presents with dyspnea on exertion (climbing stairs and walking short distances) that has slowly progressed over the last year. He has fatigue, palpitations, intermittent retrosternal chest pain, lower extremity swelling, dizziness, and "feeling faint." Associated symptoms occur upon exertion. He denies fever, chills, weight changes, cough, abdominal pain, early satiety, nausea, vomiting, diarrhea, changes in urine color/odor, flank pain, hematuria, or dysuria. No cigarette, alcohol, or drug use. Cardiac exam shows increased pulmonic component of the second heart sound (P2), wide inspiratory splitting of S2 over the cardiac apex, right-sided S3 and S4 gallops, left parasternal lift, loud diastolic murmur increasing with inspiration and diminishing with Valsalva maneuver, prominent "A" waves in jugular venous pulsations, and increased JVD. Enlarged liver with hepatojugular reflux, peripheral edema, and ascites. EKG reveals peaked P waves, rightward axis deviation, and prominent R waves in the early V leads. Question What is the most likely diagnosis? Answer Choices A Myocardial infarction B Cor pulmonale C Primary biliary cirrhosis D Left ventricular heart failure E Pulmonary embolism
B: Cor pulmonale
A 48-year-old man presents with history of breathlessness. The chest X-ray shows diaphragmatic fibrous pleural plaques and interstitial fibrosis. What is the most likely histopathological finding possible in this case? A Noncaseating granulomas with asteroid bodies B Ferruginous bodies in the lung C Neutrophilic infiltrate D Dystrophic calcification E Necrotizing granulomas in bronchovascular distribution
B: Ferruginous bodies in the lung
A 40-year-old man presents with increasing breathlessness. The chest X-ray reveals diaphragmatic fibrosis, pleural plaques and interstitial fibrosis. What is the histopathological finding most likely to be found in this patient? Answer Choices A Noncaseating granulomas with asteroid bodies B Ferruginous bodies in the lungs C Dystrophic calcification D Neutrophilic infiltration E Bronchovascular distribution of necrotizing granulomas
B: Ferruginous bodies in the lungs
A 45-year-old man presents with increasing cough and dyspnea over several months. He has also had increased serum urea, nitrogen, and serum creatinine. A chest X-ray shows multiple bilateral small nodules. A transbronchial biopsy shows necrotizing granulomatous inflammation involving small peripheral arteries. Question What is the most likely diagnosis? Answer Choices A Goodpasture's syndrome B Granulomatosis with polyangiitis (GPA) C Idiopathic pulmonary hemosiderosis D Acute bacterial pneumonia E Recurrent multiple pulmonary emboli
B: Granulomatosis with polyangiitis (GPA)
A 34-year-old secretary working temporarily in an office building presents with acute onset of fever, cough and dyspnea. Over the past 6 months, she has had the same problem every time she works in the office building. She is hospitalized for respiratory distress, and a transbronchial biopsy is performed. The histological findings include focal peribronchial mononuclear interstitial infiltrates with some macrophages. Question What condition is she most likely infected with? Answer Choices A Influenza A pneumonia B Hypersensitivity pneumonitis C Diffuse alveolar damage D Pneumocystis carinii pneumonia E Extrinsic asthma
B: Hypersensitivity pneumonitis
A 60-year-old man presents with painful knees. He denies any trauma. He also reports that he has noticed that his fingertips have changed their shape; his wife attributes it to his long-standing habit of cigarette smoking. On examination, he has finger and toe clubbing. There is also tenderness on palpation of the knees, but no swelling. X-rays of the knee reveal periosteal elevation. A chest radiograph reveals a rounded opacity in the right lung field. Question What is the most likely diagnosis? Answer Choices A Lambert-Eaton myasthenic syndrome B Hypertrophic pulmonary osteoarthropathy C Horner syndrome D Ectopic adrenocorticotropic hormone (ACTH) secretion E Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B: Hypertrophic pulmonary osteoarthropathy
A 30-year-old man presents with a 15-day history of fever and worsening dry cough, headache, and scratchy sore throat. The general appearance is non-toxic. On examination, he has a erythematous tympanic membrane, mild pharyngeal erythema with no exudates, and no cervical lymphadenopathy. Chest auscultation reveals rhonchi and rales scattered over the chest wall. A chest X-ray shows plate-like atelectasis and nodular infiltrate. Question What is the most likely diagnosis? Answer Choices A Viral pneumonia B Mycoplasma pneumoniae C COPD D Bronchiectasis E Tuberculosis
B: Mycoplasma pneumoniae
A 12-year-old boy presents with sudden onset of dyspnea with wheezing. The patient had a similar appearance a month ago. An arterial blood gas shows hypoxemia, hypercapnia, and acidosis. The chest x-ray shows clear lung fields. He is afebrile. Question What is the most likely accompanying laboratory finding in this case? Answer Choices A Elevated sweat chloride B Numerous sputum eosinophils C Decrease CD4 lymphocyte count D Elevated white blood cell count E Positive tuberculin skin test
B: Numerous sputum eosinophils
A 60-year- male presents to the emergency room for progressive shortness of breath and a productive cough. He has been a heavy smoker for the past 40 years and states his cough is worsening each day with about 1/2 cup of sputum production. He was hospitalized 3 times in the past year for pneumonia. He is currently on 5 mg salbutamol, 250-mcg ipratropium 4 hourly by nebulizer, slow-release theophylline 300-mg b.i.d., and prednisolone 10 mg daily.On examination, the patient appears tired, T 100.5°F, P 100/m, BP 110/70 mm Hg, RR 25/min, SpO2 89% on room air. Chest x-ray shows consolidation and features of chronic bronchitis. Question Immediate treatment of this patient should include which of the following? Answer Choices A Oral steroid B Parenteral antibiotic C Endotracheal intubation D Nicotine patch to help cessation of smoking E IV fluids
B: Parenteral antibiotic
A 52-year-old man presents to discuss the results of his recent lung biopsy. You saw him 3 weeks earlier due to his experiencing dyspnea. He has no other significant past medical history. His chest X-ray reveals a 3-centimeter (diameter) mass in the right upper lobe near the hilum and slight hilar adenopathy. A CT scan of his chest, abdomen, pelvis, and head reveals only the mass seen on X-ray. His blood counts and chemistries are normal. He underwent bronchoscopic biopsy of the lesion, which reveals small cell lung cancer. Question What is the most appropriate course of treatment? Answer Choices A Radiation only B Radiation and chemotherapy C Radiation followed by surgical resection D Surgical resection only E Comfort care measures only
B: Radiation and chemotherapy
A 50-year-old man presents with several months' history of increasing shortness of breath, fever, weight loss, and night sweats. The patient is a non-smoker who works in cotton fields. A chest X-ray reveals lymphadenopathy and reticulonodular pattern in all lung fields. A transbronchial biopsy is performed and microscopically demonstrates non-necrotizing granuloma. What is the most likely diagnosis? A Adenocarcinoma B Sarcoidosis C Histoplasmosis D Unusual interstitial pneumonitis E Berylliosis
B: Sarcoidosis
A 45-year-old man presents with a fever accompanied by a productive cough. He has had the symptoms for several weeks. His temperature rises in the evenings, and he has experienced weight loss. The chest X-ray shows upper lobe cavitary lesions. Question What is the most likely diagnosis? Answer Choices A Goodpasture's syndrome B Secondary tuberculosis C Pneumocystis carinii pneumonia D Asbestosis E Cor pulmonale
B: Secondary tuberculosis
A thin 26-year-old woman presents with sudden onset of dyspnea, non-productive cough, and vague chest pain radiating to the left shoulder. She is a soccer player, and her symptoms initially occurred 24 hours ago during her usual 5-mile training run. PMH is unremarkable. EKG shows sinus tachycardia, 105 bpm. Respiratory rate equals 30 breaths per minute. Decreased breath sounds and hyperresonance are noted on the left thorax; otherwise, the physical exam is unremarkable. What is the most likely diagnosis? A Myocardial infarction B Spontaneous pneumothorax C Exercise-induced asthma D Dissecting aortic aneurysm E Atypical pneumonia
B: Spontaneous pneumothorax
A 56-year-old man presents with fatigue, fever, chills, and a productive cough. Symptoms began 3 days ago. The patient is drenched in sweat and has shaking chills. The patient has a 2 pack/day smoking habit. He has dyspnea (respiratory rate of 23/min) and pleuritic chest pain to his left side. Crackles are heard over the right middle, left middle, and left lower lung fields. X-rays are significant for right lower lobe, left lingular, and left lower lobe infiltrates. The patient has an elevated body temperature of 40.0° C. Sputum is collected for culture and Gram stain that is brown-green in color. A CBC and blood cultures are also ordered. The CBC results are significant for an elevated WBC of 14.0 x 109/L with a neutrophilic left shift on the differential. The sputum Gram stain contains >25 WBCs per lower-power field with no epithelial cells and many Gram-positive diplococci (refer to the image). The next day, the culture grows 4+ of an alpha hemolytic organism that is catalase negative and bile salt soluble. Blood cultures also turn positive that next day for Gram-positive diplococci. Question What is causing the pneumonia with septic complications? Answer Choices A Haemophilus influenzae B Streptococcus pneumoniae C Chlamydia pneumoniae (TWAR) D Candida albicans E Moraxella catarrhalis
B: Streptococcus pneumoniae
Which of the following is the most likely to cause an exacerbation of bronchospasm in a patient with asthma? A Phosphate B Sulfite C Sulfate D Carbonate E Fluoride
B: Sulfite
A patient was admitted with pneumothorax after a thoracic procedure. What is the most likely cause of the pneumothorax? A Thoracocentesis B Transthoracic needle aspiration C Pleural biopsy D Subclavian venous catheterization E Intercostal nerve block
B: Transthoracic needle aspiration
A 45-year-old chronic smoker presents with increasing exertional breathlessness. The patient has a productive cough. The patient is diagnosed with panacinar emphysema. He is also found to have cirrhosis of the liver. Question What underlying disease could relate panacinar pulmonary emphysema to cirrhosis of the liver? Answer Choices A Wilson's disease B Cystic fibrosis C Alpha-1 anti-trypsin deficiency D IV drug use E Alcoholism
C: Alpha-1 anti-trypsin deficiency
A lung abscess is most likely to be the result of infection with what type of organism? A Streptococcus pneumoniae B Respiratory syncytial virus C Anaerobic bacteria D Pneumocystis carinii E Haemophilus influenzae
C: Anaerobic bacteria
Which of the following asbestos-related respiratory diseases is hemorrhagic; asymptomatic; and has spontaneous remission and recurrence? A Asbestosis B Pleural thickening C Benign effusions D Pleural mesothelioma E Bronchogenic carcinoma
C: Benign effusions
A 40-year-old man presents with a 5-day history of cough and purulent sputum without fever. The patient has had recurrent attacks of cough with sputum production since childhood. He was born several weeks premature. He does not smoke and works as a computer programmer. He reports no other systemic problems. The patient is afebrile and has grade III finger clubbing. Rales are present all over the chest on auscultation. The chest X-ray shows a characteristic honeycomb appearance. Question What is the most likely diagnosis? Answer Choices A COPD B Tuberculosis C Bronchiectasis D Pneumonia E Cystic fibrosis
C: Bronchiectasis
Dornase alpha (Pulmozyme) is a marketed form of deoxyribonuclease I that is approved for treatment of which of the following? A Chronic bronchitis B Bronchiectasis C Cystic fibrosis D Bacterial pneumonia
C: Cystic fibrosis
40-year-old female presents with shortness of breath on exertion that has been worsening over the past few months. She also has lost 10 pounds unintentionally in the past month. She works on a farm and notices her shortness of breath is worse while working. She denies any other symptoms. Her physical examination is normal except for a few scattered inspiratory crepitations. It is suspected that she has restrictive lung disease. Question What will her spirometry findings be if this diagnosis is correct? Answer Choices A Decreased FEV1, decreased FVC and decreased FEV1/FVC ratio B Decreased FEV1, increased FVC and decreased FEV1/FVC ratio C Decreased FEV1, decreased FVC and normal or increased FEV1/FVC ratio D Normal FEV1, decreased FVC and increased FEV1/FVC E Entirely normal
C: Decreased FEV1, decreased FVC and normal or increased FEV1/FVC ratio
A 52-year-old man presents with a 2-year history of worsening dyspnea and a 1-month history of dry cough. The patient gives no history of fever, chills, chest pain, or wheezing. History is significant for smoking (25 cigarettes/day for more than 22 years). Pulmonary function tests (PFT) reveal a decrease in forced expiratory volume in 1 second (FEV1) along with reduction of FEV1/FVC (forced vital capacity) ratio. The patient's chest X-ray is below. Refer to the image. Question These findings are characteristic of what condition? Answer Choices A Heart failure B Chronic bronchitis C Emphysema D Bronchiectasis E Pleural effusion
C: Emphysema
A 44-year-old man came to the ER after a motor vehicle accident. He has multiple and extensive internal and bone injuries. Exploratory laparotomy was done 2 hours later and splenectomy was performed. The patient also undergoes bone reduction and internal fixation of both femurs. The patient's condition is stabilized after a week. The patient then suddenly complains of shortness of breath and dies. What is the most likely diagnosis? Answer Choices A Myocardial infarction B Pneumothorax C Fat embolism D Pneumonia E Heart failure
C: Fat embolism
A 42-year-old man with AIDS presents with persistent fever, weight loss, and pancytopenia. The CBC reveals a white count of 1,500/uL, a platelet count of 25,000/uL, and a hemoglobin level of 8.0g/dL. The body temperature is 38.6° C. A bone marrow aspirate is performed; it reveals pancytopenia, granulomas, and the presence of yeast forms. The bone marrow is cultured for fungus, and the patient is put on intravenous amphotericin B therapy. 2 weeks later, a white-colored fungus grows out that produces characteristic tuberculate macroconidia (refer to the image). Question What is the most likely diagnosis? Answer Choices A Aspergillosis B Coccidioidomycosis C Histoplasmosis D Blastomycosis E Cryptococcosis
C: Histoplasmosis
A 60-year-old woman presents with pyrexia, malaise, and dry cough. 15 days ago, the patient had an upper respiratory tract infection with pyrexia. The chest shows an interstitial pattern of lymphocytic inflammatory infiltrate. Question What pulmonary infection is causing the patient's symptoms? Answer Choices A Streptococcus pneumoniae B Candida albicans C Influenza A D Actinomyces Israeli E Mycobacterium kansasi
C: Influenza A
A 55-year-old woman was diagnosed with small cell cancer of the lung 2 months ago; she now presents with increasing dysphagia, respiratory difficulties, and weakness of the upper limb. Her vital signs are pulse 85/min, BP 120/90 mm Hg, resp. 12/min, and temp. 37.7° C. On examination, she has ptosis of both eyes, and she reports diplopia. Her pupillary responses are normal. The strength in the muscles of her arm on testing is 2/5; on repeated testing, the strength improves to 4/5. Sensation is intact in both upper limbs. Of the following treatments, what would be most effective in treating the patient's symptoms? A Neostigmine B Atropine C Plasmapheresis D Amikacin E Cisapride
C: Plasmapheresis
A 60-year-old man presents with shortness of breath, wheezing, and a feeling of tightness in the chest. He is a non-smoker with no past history of asthma. ECG reveals myocardial ischemia. The patient is anxious and tachypneic. Blood pressure is elevated. Chest sounds reveal rales and rhonchi. There is wheezing and pink frothy sputum. Heart sounds reveal S3 gallop. Chest X-ray shows increased vascularity bilaterally and distended pulmonary artery. Question On the basis of the above clinical picture, what is the most likely diagnosis? Answer Choices A Pneumonia B Asthma C Pulmonary edema D Pleural effusion E COPD
C: Pulmonary edema
A 50-year-old African American woman presents with a history of fever, weight loss, and dyspnea. The chest X-ray shows prominent hilar adenopathy and diffuse pulmonary interstitial disease. The microscopic examination of a lung biopsy does not show bacteria, viral inclusions, or fungi. What is the most likely diagnosis? A Silicosis B Tuberculosis C Sarcoidosis D Asbestosis
C: Sarcoidosis
"Eggshell" calcification of the hilar nodes is caused by: A Asbestos B Talc C Silica D Coal E Iron
C: Silica
The post-mortem examination of lungs of a 50-year-old man shows multiple firm nodules; they are 1 - 8mm in size, and they are scattered throughout, but they are more confluent in the upper lobes. These nodules demonstrate the microscopic appearance of many polarized needle-shaped crystals. Question What is the most likely cause of the features described? Answer Choices A Byssinosis B Berylliosis C Silicosis D Anthracosis E Farmer's lung
C: Silicosis
A 27-year-old man with multiple trauma fractures is transferred to the hospital ICU. The patient is intubated and sedated. His vitals are P 125 and BP 80/60 mm Hg. ABG reveals pH of 7.3, PaCO2 30, and PaO2 67 on a ventilator with pressure control. His Chest X-ray reveals dense infiltrate. Question What change is most likely to improve oxygenation in this patient? Answer Choices A Increase the minute ventilation B Decrease the minute ventilation C Change the ventilation mode to assist control D Add PEEP of 5 cm of water E Change the ventilator mode to pressure support
D: Add PEEP of 5 cm of water
A 26-year-old woman presents with a 12-hour history of wheezing. She was recently diagnosed with asthma by her family physician. Her asthma is not well controlled despite treatment with β2 agonists and prednisolone 60mg/day. She has had 3 - 4 ER visits over the past month since her diagnosis. She is obese, a non-smoker, and is 8 weeks postpartum. Her BP is 160/80; P is 120/min, and T is 99F. Pulse oximetry on room air is 72%. PFR is 36% of predicted. She has staccato speech, and there is mild central cyanosis. She is using her accessory muscles, and she is not agitated. On auscultation, she has a loud S1 and inspiratory wheeze is greater than expiratory wheeze. She has peripheral edema. Question You suspect a condition for which, in addition to admission, the following treatment is required? Answer Choices A Endotracheal intubation B Measurement of S. potassium to exclude hypokalemia C IV ketamine D Anticoagulants E ABG
D: Anticoagulants
After gastrectomy, a postoperative patient is found in the early morning with a temperature of 101° F (orally) and a pulse rate of 112. What is the most likely cause of the patient's symptoms? Answer Choices A Wound infection B Phlebitis C Urinary tract infection D Atelectasis E Anxiety syndrome
D: Atelectasis
A 40-year-old man is seen in the emergency room presenting with chest pain and difficulty breathing. He is febrile at a temperature of 38° C. His history is significant for the treatment 2 months prior of a non-productive cough. He was given oral erythromycin, but he failed to improve after 2 weeks. He was then put on oral ampicillin and his symptoms progressively worsened over the next month. The patient is originally from Western New York and had just moved into the area. The physical examination is remarkable for 2 cutaneous lesions, 1 on the neck and 1 on the left shoulder. He does not recall any previous injury to those 2 sites. A radiograph is performed of the chest, and it demonstrates consolidation of the right middle lobe. The patient is admitted to the hospital; a PPD test is performed. Bacterial, fungal, and mycobacterial cultures are ordered on a bronchoscopy specimen. A Gram stain, KOH, and acid-fast stain are all negative for this specimen. The PPD is negative; bacterial cultures are negative. Material is collected from the cutaneous lesion and also cultured for bacteria, fungus, and mycobacteria; this is also negative for bacteria. 2 weeks later the cutaneous lesion become positive for fungal growth. This fungus is dimorphic, and in the yeast form produces a large, round, budding yeast with a broad base connecting the mother cell to the daughter cell (refer to the image). The patient is started on IV amphotericin B therapy. All mycobacterial cultures are negative. Question What is the most likely diagnosis? Answer Choices A Aspergillosis B Coccidioidomycosis C Histoplasmosis D Blastomycosis E Cryptococcosis
D: Blastomycosis
A 40-year-old man coughs a large thick mucus plug after an episode of dyspnea with wheezing. The patient also gives a history of similar episodes in the past. These findings are typical for what type of disorder? A Mycoplasma pneumonia B Cystic fibrosis C Hypersensitivity pneumonitis D Bronchial asthma E Gastric content aspiration
D: Bronchial asthma
"Black lung" is caused by: A Asbestos B Talc C Silica D Coal E Iron
D: Coal
A 10-year-old girl presents with recurrent bronchitis. Her past history is significant for polypectomy, nasal polyps, failure to thrive, and repeated attacks of bronchitis. Examination reveals clubbing and diffuse rhonchi on respiratory auscultation. Investigations reveal subnormal lung function, decreased exercise tolerance, and a sweat chloride concentration of 62 mEq/L (normal: <40 mEq/L). Question What is the most likely diagnosis? Answer Choices A Pulmonary aspergilloma B Bronchial asthma C Pulmonary tuberculosis D Cystic fibrosis E Primary ciliary dyskinesia
D: Cystic fibrosis
A 40-year-old woman presents with a history of increasing dyspnea associated with weight loss. The patient was treated with mastectomy with chemotherapy 2 years ago for an infiltrating ductal carcinoma of the left breast. Question What might be the cause of her increasing dyspnea? Answer Choices A Pneumothorax B Hydrothorax C Chylothorax D Hemorrhagic effusion E Empyema
D: Hemorrhagic effusion
A 22-year-old woman presents with shortness of breath. She has a history of intermittent wheezing while exercising. On examination, you find that her pulse rate is increased; there are diffuse wheezes on pulmonary auscultation. Her oxygen saturation is 95%. Question What would be the most effective therapy in this patient? Answer Choices A I.V Aminophylline B I.M Theophylline C Inhaled cromolyn sodium D Inhaled albuterol E Inhaled beclomethasone
D: Inhaled albuterol
A 45-year-old man presents with a 3-day history of fever (maximum temperature of 103.5° F), chills, anorexia, diarrhea, and a non-productive cough. On general examination, pulse is 98/min, RR is 24/min, BP is 120/60 mm Hg, and temperature is 103.5° F. There are coarse basal crepitations and scattered rhonchi on examination of the lungs. Exam of other systems is normal. Chest X-ray (CXR) shows patchy alveolar infiltrates with consolidation in the lower lobe. Complete blood count reveals leukocytosis; sputum Gram stain reveals only a few polymorphonuclear (PMN) leukocytes, and no predominant pathogens. Question What is the most likely diagnosis? Answer Choices A Tuberculosis B Klebsiella pneumoniae C Cryptococcal pneumonia D Legionnaires' disease E Haemophilus influenzae
D: Legionnaires' disease
A 66-year-old African-American male with moderately well-controlled type II diabetes mellitus has been admitted to the general medical ward for the management of community-acquired pneumonia. He is currently being treated with intravenous levofloxacin. Presently, he is afebrile, pulse 93, blood pressure 130/90, respirations 18/min, and oxygen saturation 92% on room air. Question What is most accurate regarding the empiric selection of antibiotic therapy for this patient? Answer Choices A Intravenous penicillin G is considered the treatment of choice for the management of CAP B Levofloxacin is effective for the management of pneumonia caused by Gram-positive bacteria; however, it is not effective for pneumonia caused by Gram-negative or atypical bacteria C Levofloxacin is effective for the management of pneumonia caused by Gram-positive and Gram-negative bacteria; however, it will not provide adequate coverage against pneumonia caused by atypical bacteria D Levofloxacin provides adequate coverage for pneumonia caused by Gram-positive, Gram-negative, and atypical bacteria E Although levofloxacin provides adequate coverage against most causes of bacterial pneumonia, addition of a second antibiotic against anaerobes is indicated
D: Levofloxacin provides adequate coverage for pneumonia caused by Gram-positive, Gram-negative, and atypical bacteria
A 32-year-old wasted man is admitted to the hospital. He complains of losing weight for 4 months, and a non-productive cough. On examination, his vital signs show a mild fever, and slightly dyspnea with clear chest sounds. Mild hepatosplenomegaly and cervical adenopathy is noticed. Refer to the image. Question What is the most likely initial diagnosis? Answer Choices A AIDS B AIDS with Pneumocystis carinii pneumonia C Hodgkin's lymphoma D Miliary tuberculosis E Pulmonary tuberculosis
D: Miliary tuberculosis
A 43-year-old man presents in acute respiratory distress. He is a known HIV patient who has progressed to a full-blown AIDS infection. He has recently been undergoing chemotherapy, but the treatment has had no effect on the increased viral load level. He has a 2-week history of night sweats, severe fatigue, chills, and fever. His physical examination is remarkable for an enlarged liver (as detected by palpation) 5 cm below the costal margin. The patient has an elevated body temperature of 40° C. He has a decreased WBC count of 3,000/uL and a decreased Hgb of 6.8 g/dL. Electrolytes, chemistries, and urinalysis are normal. Blood and stool are obtained for mycobacterial cultures. After 20 days, the culture is positive for a mycobacterial species that grows in smooth, nonpigmented colonies. Question What is the most likely causative agent? Answer Choices A Mycobacterium kansasii B Mycobacterium marinum C Mycobacterium gordonae D Mycobacterium avium-intracellulare E Mycobacterium tuberculosis F Mycobacterium bovis
D: Mycobacterium avium-intracellulare
A 51-year-old man with a cardiac transplantation 20 days ago starts having fever for the past 5 days. He has developed an extensive pneumonia (abscess) involving the left lower lobe. A sputum Gram stain reveals normal respiratory tract flora. Question If he does not respond to antibiotic therapy over next 5 months, what is the most likely causative organism? Answer Choices A Mycoplasma pneumoniae B Aspergillus fumigatus C Mycobacterium avium-intracellulare D Nocardia brasiliensis E Cytomegalovirus
D: Nocardia brasiliensis
What asbestos-related respiratory disease is probably unrelated to smoking and has a median survival of 12 months? A Asbestosis B Pleural thickening C Benign effusions D Pleural mesothelioma E Bronchogenic carcinoma
D: Pleural mesothelioma
A 30-year-old man is a known COPD patient; he wakes at night with a sudden feeling of tightness on the left side of the chest, which is aggravated on deep breathing. Patient feels breathless and is cyanotic. On examination in the ER, there is expansion of only the right side of the chest. There is decrease in the breath sounds on the affected side. Chest X-ray shows mediastinal shift and deflated lung with translucency between this and the chest wall with no lung markings. Question What is the most likely diagnosis? Answer Choices A Myocardial infarction B Left lobar pneumonia C Tuberculosis D Pneumothorax E Emphysema
D: Pneumothorax
You suspect that the patient you are seeing has pulmonary embolism. What diagnostic technique is most specific to confirm your suspected diagnosis? A Chest X-ray B Arterial blood gas analysis C Perfusion lung scan You suspect that the patient you are seeing has pulmonary embolism. What diagnostic technique is most specific to confirm your suspected diagnosis? Answer Choices A Chest X-ray B Arterial blood gas analysis C Perfusion lung scan D Pulmonary angiography E Ventilation lung scan
D: Pulmonary angiography
A 44-year-old man is brought into the emergency department by paramedics. He is complaining of marked shortness of breath. He has a past medical history of diabetes and hypertension. His wife states that he has not been well for the last week, with decreased energy and fatigue. In addition, he has had a productive cough, which has worsened during the last 3 days. Physical exam reveals a quiet man in moderate to severe respiratory distress. Vital signs show: pulse 115; BP 90/50; respiration 18; Temp 38.2° C (100.7° F). HEENT shows dry mucous membranes. Lungs show decreased breath sounds and crackles on the left; cardiac exam is significant for tachycardia. Abdominal exam is nonspecific. No abnormal reflexes are noted. Initial laboratory studies show: Na 132; K 4.2; Cl 97; HCO3 25; Glucose 265. ABG reveals pH 7.26, pCO2 55; pO2 79; O2 saturation 90%. CBC shows a normal H/H with WBC count of 14K, the serum is reported as very lipemic. Chest X-ray shows an LLL consolidation. What is the most likely diagnosis? A Respiratory alkalosis B Metabolic alkalosis C Mixed respiratory acidosis and metabolic alkalosis D Respiratory acidosis E Metabolic acidosis
D: Respiratory acidosis
A 24-year-old woman with acute uveitis and erythema nodosum is found to have bilateral symmetric hilar adenopathy and paratracheal adenopathy with no pulmonary symptoms. Refer to the image. Question What is the most likely diagnosis? Answer Choices A Tuberculosis B AIDS C Lyme disease D Sarcoidosis E Rheumatoid arthritis
D: Sarcoidosis
A 24-year-old man came to the ER presenting with sudden shortness of breath while riding his bicycle. He has never had this before. He is athletic, works as a teacher, walks 10 miles every day, and gave no history of fever or palpitation. He is a smoker, smoking 10 cigarettes per day for the last 5 years. On examination, his heart rate was 120/min, regular rhythm, and no murmurs; breath sounds are heard all over the chest except at the upper left lung where it is hardly heard, and there is a hyperresonant note on percussion. What is the most likely diagnosis? Answer Choices A Pulmonary embolism B Panic attack C COPD exacerbation D Spontaneous pneumothorax E Bronchial asthma
D: Spontaneous pneumothorax
A 56-year-old man with no significant past medical history presents with weight loss and dyspnea on exertion. He has a 40 pack-year history of cigarette use. He is employed as a construction worker and states that he had exposure to asbestos working on a project last year. The project lasted 6 months, and he reports taking the appropriate respiratory precautions. His chest X-ray reveals a hilar cavitary mass 4 centimeters in diameter. Question What type of neoplasm does the patient most likely have? Answer Choices A Hamartoma B Bronchoalveolar carcinoma C Mesothelioma D Squamous cell carcinoma E Small cell carcinoma
D: Squamous cell carcinoma
For the optimal prevention of venous thromboembolism, which of the following is the most reasonable use of prophylactic heparin following major surgery such as total hip replacement? A Administration for 48 hours after surgery B Administration until the patient is ambulatory C Administration for 10 days or until the patient is discharged from the hospital, whichever comes first D Administration only to patients with a previous history of venous thromboembolism E Administration for 2-3 weeks after discharge from the hospital
E: Administration for 2-3 weeks after discharge from the hospital
A 60-year-old man presents with a 1-year history of increasing dyspnea. The patient used to work as a construction worker, and he is a chronic smoker. A chest radiograph shows diaphragmatic pleural plaques and interstitial lung disease. Question What is the most likely diagnosis? Answer Choices A Silicosis B Siderosis C Byssinosis D Berylliosis E Asbestosis
E: Asbestosis
A 40-year-old woman presents with flu-like symptoms (e.g., headache, fever, dry cough, and breathlessness without wheezing) after attending an office meeting. She experiences these symptoms every time she attends meetings in that particular office. From her symptoms, it can be concluded that she has hypersensitivity pneumonitis. Question What best represents hypersensitivity pneumonitis? Answer Choices A Coal mining B Chronic necrotizing infection C Long-term persistent cough with sputum production D Aspirin sensitivity E Farmer's lung
E: Farmer's lung
A 50-year-old woman presents for follow-up due to emphysema. She has a 40 pack-year history of smoking. She states that her dyspnea is getting slightly worse and she has lost about 5 pounds in recent months without trying. She is sent for a chest radiograph, PFTs, and a V/Q scan. Question What would be expected to be seen on these test results? Answer Choices A Hyperinflation of the lungs, normal lung compliance, and increased perfusion to low V/Q areas B Increased interstitial markings, increased total lung capacity, and increased perfusion to low V/Q areas C Hyperinflation of the lungs, reduced DLCO (diffusion capacity of the lung for CO), increased perfusion to low V/Q areas D Increased interstitial markings, normal lung compliance, and increased perfusion to low V/Q areas E Hyperinflation of the lungs, reduced DLCO, and high dead space ventilation
E: Hyperinflation of the lungs, reduced DLCO, and high dead space ventilation
A 20-year-old marine in boot camp develops meningitis. The patient had developed pharyngitis before he developed the meningitis. Which of the following organisms is responsible for the cause? Answer Choices A Group A beta hemolytic Streptococci B Corynebacterium diphtheriae C Bordetella pertussis D Haemophilus influenzae E Neisseria meningitidis
E: Neisseria meningitidis
A 30-year-old immunocompromised patient presents with a 2-week history of breathlessness and a nonproductive dry cough. The patient is afebrile, pulse is 100, and BP is 110/70 mm Hg. On auscultation, scattered rales all over the chest are heard. A chest X-ray shows diffuse air-space and interstitial shadowing in both lungs. The shadowing is more prevalent in the apical region. Question What is the most likely diagnosis? Answer Choices A Tuberculosis B Mycoplasma pneumoniae C Viral pneumonia D Streptococcus pneumoniae E Pneumocystis pneumoniae
E: Pneumocystis pneumoniae
Which of the following is most frequently involved in Wegener's granulomatosis? A Nervous system B Heart C Skin/muscle D Joints E Respiratory tract
E: Respiratory tract
