Rosh Review Pulmonology Fall 2017
The differential diagnosis of interstitial lung disease (ILD) includes which three major conditions?
lung malignancy, lung infection and congestive heart failure
What is the most common location of extrapulmonary TB?
lymph nodes
What is the most common cause of a massive pleural effusion (> 1.5-2 L)?
malignancy
What are the most common sites of hemorrhage in massive hemoptysis?
massive hemoptysis typically involves the bronchial or pulmonary arteries
What are the contraindications to using antenatal corticosteroid therapy?
maternal systemic infections, namely chorioamnionitis
What is a side effect of dapsone that can lead to hypoxia?
methemoglobinemia
What classification system is commonly used to quantify upper airway narrowing?
modified Mallampati classification
What is the most common presenting symptom of acute bronchitis?
mucopurulent cough
What is the recommended treatment for moderate to severe obstructive sleep apnea?
nasal route CPAP
Is administration of levalbuterol superior to albuterol?
no
What histopathological biopsy finding is typically seen in patients with sarcoidosis?
non-caseating granulomas
What arterial blood gas finding is concerning for impending respiratory failure in an asthmatic?
normal, elevated, or rising carbon dioxide
What is the common side effect of Rifampin?
orange discoloration of body fluids
What is the typical clinical presentation for sarcoidosis?
uveitis, dry cough, subcutaneous nodules, lupus pernio, and elevated ESR
What is the most common cause of pleuritic chest pain?
viral pleuritis
What is the prognosis for a patient with dilated cardiomyopathy?
Approximately 1/3 worsen and die, 1/3 recover completely, and 1/3 have residual cardiac dysfunction.
In the U.S., what is the prevalence of COPD?
15 million
How long is the recommended course of oseltamivir?
7-10 days
A 65-year-old obese man presents to your office with complaints of snoring and fatigue. His wife makes him sleep in a separate room because of his loud snoring and gasping for air in his sleep. Which of the following is the most appropriate therapy? A. CPAP therapy B. Modafinil C. oxygen therapy D. Theophylline
A. CPAP therapy
What is the choroidal tubercle?
A granuloma in the choroid of the retina that is specific for disseminated TB.
What is the significance of a high amylase level in a pleural fluid sample?
A high amylase level usually indicates the presence of pancreatitis, esophageal rupture or malignancy.
What is Caplan's syndrome?
A patient, typically a coal miner, with rheumatoid arthritis who acquires any of the pneumoconioses.
What is the most common form of lung cancer?
Adenocarcinoma
What is aspiration pneumonia?
An alveolar space infection resulting from the inhalation of pathogenic material from the oropharynx.
What is a saddle PE?
An embolus that lodges in the bifurcation formed by the main pulmonary artery and right and left pulmonary arteries.
What is another name for croup?
Laryngotracheobronchitis
What is acanthosis nigricans associated with?
The malignant form is associated with internal malignancy. The benign form is associated with obesity and endocrine problems.
In a patient with AIDS, what medication is given prophylactically at a CD4 count of less than 100 cells/μL to prevent infection with toxoplasmosis gondii?
Trimethoprim/sulfamethoxazole
What is the imaging test of choice if a large or loculated effusion is suspected?
U/S
How soon after blood transfusion initiation will anaphylaxis occur?
Within minutes. It is triggered by presence of IgA antibodies in IgA-deficient patients.
What conditions make up the atopic triad?
asthma, allergic rhinitis, atopic dermatitis
What is a potential neurological complication of pertussis infection?
seizures
Which of the following HIV-positive patients suspected of having Pneumocystis pneumonia (PCP) should receive prednisone before treatment with trimethoprim/sulfamethoxazole? A. 10-year-old with a normal chest x-ray and a PaO2 of 65 mm Hg B. 15-year-old with diffuse interstitial infiltrates on chest x-ray, a pulse oximetry of 92% and PaO2 of 80 mm Hg C. 20-year-old with diffuse interstitial infiltrates on chest x-ray and an A-a gradient of 25 mm Hg D. 18-year-old with diffuse interstitial infiltrates on chest x-ray, a pulse oximetry of 94% on room air, PaO2 of 75 mm Hg, and an A-a gradient of 10 mm Hg
A. 10-year-old with a normal chest x-ray and a PaO2 of 65 mm Hg
A 43-year old man presents complaining of a two-week history of gradually worsening dry cough, fatigue and occasional shortness of breath. He has "felt warm" but has not checked his temperature. Review of systems is notable for mild diarrhea and decreased appetite, though he is drinking fluids well. He denies chronic medical problems and takes no medications. He does not smoke. His temperature is 100.6°F; pulse 112; BP 122/78; RR 24; pulse oximetry is 92% on room air. He appears tired, though is not ill-appearing. Lung-fields sound clear on auscultation, though a chest X-ray is obtained which demonstrates diffuse infiltrates. What is the most appropriate treatment for his condition? A. Azithromycin B. Metronidazole C. Olsetamivir D. Piperacillin and Tazobactam
A. Azithromycin
A two-year-old boy who is new to your practice is brought to the clinic because of coughing. For the past two weeks, he has had rhinorrhea and coughing. However, the coughing has become worse with more frequent coughing fits and episodes of vomiting. You review his previous records and note that the parents have refused immunizations. On physical examination, his temperature is 38 degrees Celsius, respiratory rate is 35, and lungs are clear to auscultation. During the examination, you note that the boy has a long series of coughs followed by a whoop. Which of the following is the most likely etiologic agent causing the illness? A. Bordetella pertussis B. Human metapneumovirus C. Mycoplasma pneumonia D. Respiratory syncytial virus
A. Bordetella pertussis
A patient presents with acute dyspnea and pleuritic chest pain. You suspect pulmonary embolism. Which of the following is the most appropriate test to confirm the diagnosis of a pulmonary embolus? A. CT angiography B. D-dimer assay C. ECG D. ventilation-perfusion scan
A. CT angiography
A 46-year-old man presents with right eye pain and a change in his vision. He was recently diagnosed with tuberculosis and started on a 4-drug regimen. Based on his history and physical exam findings, you are concerned for optic neuritis. Which of the following medications is likely responsible for his symptoms? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampin
A. Ethambutol
A 65-year-old undomiciled man presents to your emergency department with complaints of fever, productive cough, and shortness of breath. He has a 40-pack-year history of smoking and daily alcohol consumption. His chest radiograph demonstrates a right upper lobe lung infiltrate with an air-fluid level. What is the most likely etiology for this finding? A. Klebsiella pneumoniae B. Legionella pneumophilia C. Mycoplasma pneumoniae D. Streptococcous pneumoniae
A. Klebsiella pneumoniae
A 45-year-old woman presents to the Emergency Department with a fever, productive cough, and diarrhea. Her chest X-ray shows a patchy unilobar infiltrate and her sodium is 127 mmol/L. Which of the following organisms is most likely to be responsible for these symptoms? A. Legionella pneumophila B. Pseudomonas aeruginosa C. Staphylococcus aureus D. Streptococcus pneumoniae
A. Legionella pneumophila
A 55-year-old obese man presents to the clinic complaining of fatigue and poor concentration for the past six months. His wife reports that he snores nightly and often sounds like he gasping for air. Which of the following would most likely be found on physical exam? A. a large neck circumference B. coarsening of facial features C. increased skin pigmentation D. moon facies
A. a large neck circumference
A 53-year-old man comes to the emergency department complaining of a 5-day history of a cough and shortness of breath. His temperature is 37.6°C (99.8°F). Auscultation of the lungs shows rhonchi and wheezing. Chest X-ray shows thickening of the bronchial walls in both lower lobes. Laboratory studies show a slightly elevated white blood count. Which of the following is the most likely diagnosis? A. acute bronchitis B. asthma C. influenza D. pneumonia
A. acute bronchitis
What is the most common cause of minor hemoptysis in the Emergency Department? A. acute bronchitis B. pneumonia C. pulmonary embolism D. tuberculosis
A. acute bronchitis
A 17-year-old girl with a history of asthma presents to your office with complaints of wheezing and shortness of breath. She says that in the past month she has experienced symptoms approximately 3-4 times per week requiring use of her short-acting beta agonist inhaler. She has also woken up at night four times during the month with shortness of breath and occasionally gets dyspneic on her daily walk. Which of the following is the most effective management? A. add a low dose inhaled glucocorticoid B. add a low dose inhaled glucocorticoid plus long-acting beta agonist C. continue use of short-acting beta agonist only D. start an oral course of glucocorticoids
A. add a low dose inhaled glucocorticoid
A 16-year old boy with a history of asthma presents to the ED with severe shortness of breath and audible wheezing. He uses an inhaled corticosteroid and a long acting beta-2-agonist at home daily. However, he has had to use his short acting beta-2-agonist roughly every hour for the past day. In the ED, his vital signs are BP 114/72, HR 106, RR 28, oxygen saturation 94% on room air, and temperature 99.0°F. Diffuse wheezing is appreciated and intercostal retractions are observed. After oxygen is initiated, what is the next step in management for this patient? A. begin nebulized albuterol B. give epinephrine C. give systemic corticosteroids D. prepare for intubation
A. begin nebulized albuterol
Which of the following is the most common cause of cor pulmonale? A. chronic obstructive pulmonary disease B. connective tissue disorders C. left-sided cardiac disease D. right ventricular hypertrophy
A. chronic obstructive pulmonary disease
A 13-year-old boy presents to your ED with worsening cough and exercise intolerance. The triage note says he has seen his primary care physician twice over the last month and was given albuterol which has not improved his symptoms. His vital signs show a temperature of 37.2°C, heart rate of 110 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 110/82 mm Hg, and pulse oximetry of 93% on room air. A chest X-ray obtained from triage is shown above. Which of the following findings do you expect on your physical examination? A. coarse crackles B. pleural friction rub C. rhonchi D. stridor
A. course crackles
A 17-year-old girl with a history of well-managed cystic fibrosis is being evaluated for a steadily worsening chronic cough with shortness of breath and wheezing. She is producing copious purulent malodorous sputum and occasional hemoptysis. Crackles are heard at her bilateral lung bases. Which of the following findings would be most expected on this patient's chest radiograph? A. dilated, thickened bronchi with "tram-track" marks B. low lung volumes and ground glass opacities C. lung hyperinflation with flattening of the diaphragm D. normal chest radiograph
A. dilated, thickened bronchi with "tram-track" marks
A 16-year-old male presents to the ED complaining of 3 days of nasal rhinorrhea, cough, myalgias, and generalized malaise. After a coughing episode yesterday, he developed pleuritic chest pain radiating to the left neck. His vital signs are BP 130/70 mm Hg, HR 76, RR 16, T 36.6°C and pulse oximetry 98% on room air. CXR reveals air outlining the right pulmonary artery and streaky lucencies in mediastinal structures bilaterally. Which of the following is the most appropriate next step in management? A. discharge home with close follow-up B. endoscopy C. needle decompression D. tube thoracostomy
A. discharge home with close follow-up
A 47-year-old woman, with no past medical history and no hospitalizations, presents with cough, green sputum, and fever. Her vitals are T 100.7°F, HR 94, BP 123/76, RR 18, oxygen saturation 97%. She is well appearing and her blood work (CBC and BMP) is unremarkable. A chest X-ray shows a left lower lobe infiltrate. Which of the following represents the best management for this patient? A. discharge home with oral antibiotics and follow up B. draw blood cultures and discharge home on oral antibiotics C. order a chest CT D. start IV antibiotics, draw blood cultures, and admit
A. discharge home with oral antibiotics and follow up
An eight-year-old boy comes in your clinic for follow-up. Two days ago, he was diagnosed with pneumonia and started on amoxicillin-clavulanic acid. However, fever and cough persisted and is accompanied by decreased appetite, chest pain, and difficulty breathing. You suspect a complicated pneumonia. Which of the following physical exam findings is consistent with pleural effusion? A. dullness to percussion B. early inspiratory crackles C. trachea deviates away from affected side D. vesicular breath sounds
A. dullness to percussion
A patient with acute pancreatitis is noted to have a pleural effusion on chest radiography. Which of the following findings would you expect to find on pleural fluid analysis? A. elevated amylase concentrations B. elevated triglyceride concentrations C. low glucose concentrations D. low pH of pleural fluid
A. elevated amylase concentrations
A 48-year-old man with a history of HIV presents to your office with complaints of fever, cough and shortness of breath. Laboratory testing reveals a CD4 count of 130 cells/microL. Which of the following findings is most likely to be seen on chest X-ray? A. ground glass opacification B. Hampton's hump C. honeycombing D. Kerley B-lines
A. ground glass opacification
Which of the following characteristics of transfusion-related acute lung injury (TRALI) differentiates it from transfusion-associated circulatory overload (TACO)? A. high fever B. hypertension C. hypoxemia D. pulmonary edema
A. high fever
What lab abnormality is commonly seen in sarcoidosis? A. hypercalcemia B. hypocalcemia C. hypophosphatemia D. neutropenia
A. hypercalcemia
A 16-year-old boy with a history of asthma presents complaining of increasing episodes of evening and daytime symptoms. He is on a short acting inhaled beta agonist on an as needed basis. He presently needs to use his short acting beta agonist daily. Which of the following is the most appropriate addition to this patient's medication regimen? A. inhaled corticosteroid B. leukotriene inhibitor C. LABA inhaler D. methylxanthine oxidase inhibitor
A. inhaled corticosteroid
A 27-year-old man with a history of asthma presents to your office for his annual exam. He reports that in the past month he has experienced wheezing and shortness of breath about once per week which resulted in using his rescue inhaler. He woke up once because of coughing. He has a peak flow meter and home readings have been 85-90% of his personal best. Which of the following best describes the classification of his asthma? A. intermittent B. mild persistent C. moderate persistent D. severe persistent
A. intermittent
A 33-year-old man presents to the ED with several weeks of cough, pleuritic chest pain, weight loss, and night sweats. The patient drinks a 6-pack of beer daily. Vital signs are BP 145/75, HR 88, RR 18, and T 37.7°C. Pulmonary exam reveals crackles and decreased breath sounds on auscultation. You obtain the radiograph seen above. Which of the following is the most likely diagnosis? A. lung abscess B. neoplasm C. septic pulmonary emboli D. tuberculosis
A. lung abscess
A 58-year-old man with a history of obesity presents to your office with a complaint of daytime sleepiness. He says that his wife sleeps in a different room because of his snoring nighttime restlessness and getting up to urinate 2-3 times per night. Which of the following is the most appropriate diagnostic test? A. polysomnography sleep study B. post-void residual testing C. PFTs D. upper airway MRI
A. polysomnography sleep study
What is the difference between aspiration pneumonitis and aspiration pneumonia?
Aspiration pneumonitis is an inflammatory reaction which results from the aspiration of gastric acidic fluid from the stomach. Aspiration pneumonia is a bacterial pneumonia caused by aspiration.
Which ethnic group has a high rate of cystic fibrosis and should be recommended for prenatal screening?
Ashkenazi Jews
What drugs are commonly associated with an asthma exacerbation?
Aspirin and beta-blockers
Name two steroid-sparing alternative medications used for pulmonary sarcoidosis.
Azathioprine and Methotrexate
Which of the following treatments is most appropriate for a patient with acutely symptomatic sarcoidosis? A. lung transplantation B. Prednisone C. Theophylline D. Tiotropium
B. Prednisone
A 12-year-old girl presents to the clinic with one day of cough, fever to 102°F, and extreme fatigue. She is awake and alert but appears tired. Her oxygen saturation is 95 percent, and respiratory rate is 15 breaths per minute. Lung auscultation reveals fine crackles in the left upper lobe. Which of the following is treatment of choice? A. Ampicillin B. Azithromycin C. Cefotaxime D. Clindamycin
B. Azithromycin
A mother who is at 31 weeks gestation is at high risk of preterm delivery. Which of the following is given prenatally to prevent the risk of infant respiratory distress syndrome? A. Albumin B. Betamethasone C. Phosphatidylglycerol D. Sphingomyelin
B. Betamethasone
A 55-year-old man presents complaining of a 2-day history of cough, fatigue and fever which came on suddenly. He denies chronic medical problems and takes no medications. He does not smoke. He is ill-appearing, though in no distress. His temperature is 101.6°F; pulse 112; BP 122/78; RR 24; and pulse oximetry 92% on room air. Physical exam is remarkable for rales along the right side of his lung fields. What is the most appropriate next step in diagnosing his condition? A. acid-fast bacillus smear B. CXR C. CBC D. sputum gram stain and culture
B. CXR
A 7-year-old boy is brought by his mother to the clinic because of coughing. For the past week, he has had a nonproductive cough. On physical examination, vital signs are normal, with erythematous posterior pharynx, and clear breath sounds. Complete blood count is normal. Chest radiograph reveals perihilar infiltrates. Polymerase chain reaction from the boy's nasopharyngeal specimen comes back positive for Mycoplasma pneumoniae. Which of the following is the most appropriate therapy? A. Amoxicillin B. Clarithromycin C. Levofloxacin D. Oseltamivir
B. Clarithromycin
A 56-year-old man comes to the clinic complaining of a 6-day history of a mucopurulent cough and shortness of breath. His temperature is 37.6°C (99.8°F). Auscultation of the lungs reveals rhonchi and wheezing. Chest X-ray shows thickening of the bronchial walls in both lower lobes. Laboratory studies show a slightly elevated white blood count. Which of the following medications is most appropriate to administer for this patients cough? A. Aspirin B. Dextromethorphan C. Penicillin D. Prednisone
B. Dextromethorphan
A 36-year-old veterinarian presents with myalgias, dry cough, and severe headache. His vital signs include blood pressure 138/74 mm Hg, heart rate 82 beats/minute, temperature 39°C, and oxygen saturation 94% on room air. He has hepatosplenomegaly on abdominal exam. His chest X-ray shows patchy perihilar infiltrates. What of the following is the most appropriate antibiotic for this patient? A. Amoxicillin-clavulanate B. Doxycycline C. Levofloxacin D. Trimethoprim-sulfamethoxazole
B. Doxycycline
A 47-year-old woman with diabetes mellitus is found to have latent tuberculosis during a routine employee health purified protein derivative (PPD) test. She should receive supplementation with pyridoxine (vitamin B6) if her drug regimen contains which of the following medications? A. Ethambutol B. Isoniazid C. Pyrazinamide D. Rifampin
B. Isoniazid
Which of the following is the first line treatment for latent TB infection? A. Doxycycline B. Isoniazid C. Lamivudine/Zidovudine D. Penicillin
B. Isoniazid
You evaluate a 65-year-old patient for shortness of breath and note on exam decreased breath sounds at the left lung base. You are suspicious of a small pleural effusion. In which of the following views on the chest radiograph is the small pleural effusion most likely to be detected? A. Lateral B. Lateral decubitus left side down C. Lateral decubitus right side down D. Posterior-anterior (PA)
B. Lateral decubitus left side down
What type of cancer is classically associated with asbestos exposure? A. Large cell carcinoma B. Mesothelioma C. Small cell carcinoma D. Squamous cell carcinoma
B. Mesothelioma (80% of cases are due to chronic asbestos exposure)
A 26-year-old gravida 3 para 2 at 12 weeks gestation presents with fever, myalgias, headache, and malaise. There have been multiple cases of influenza in the community and her influenza swab is positive. Which one of the following is recommended by the Centers for Disease Control and Prevention in this situation? A. Acyclovir B. Oseltamivir C. Rimantadine D. supportive therapy only
B. Oseltamivir
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to your office for her annual exam. She has had her hepatitis B vaccination, but wants to know if she needs any additional vaccinations because of her new diagnosis. Which of the following is the most appropriate next step in her management? A. administer annual influenza vaccine only B. administer pneumococcus and annual influenza vaccines C. administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole D. the patient does not need any additional vaccines since she is up to date
B. administer pneumococcus and annual influenza vaccines
Which of the following best describes cor pulmonale? A. altered structure and function of the left ventricle B. altered structure and function of the right ventricle C. congenital heart disease D. right-sided heart disease due to left-sided heart disease
B. altered structure and function of the right ventricle
A 22-year-old man presents with an asthma exacerbation. Which of the following is true regarding treatment modalities? A. anticholinergic agents promote bronchodilation by decreasing cyclic adenosine monophosphate B. beta-2-agonists promote bronchodilation by increasing cyclic adenosine monophosphate C. the onset of action for beta-2-agonists is 10 minutes D. the peak effect of corticosteroids occurs within 3-5 hours
B. beta-2-agonists promote bronchodilation by increasing cyclic adenosine monophosphate
A 47-year-old woman presents with several months of a persistent cough that recently resulted in hemoptysis. A review of system also confirms episodes of diarrhea, rash, and flushing. Physical exam is normal with the exception of focal wheezing over the right upper lobe. Which of the following is the most likely diagnosis? A. alpha-1-antitrypsin deficiency B. carcinoid tumor C. pulmonary hypertension D. pulmonary tuberculosis
B. carcinoid tumor
What is the most common symptom seen in acute bronchitis? A. chest pain B. cough C. fever D. sputum
B. cough
In a patient with suspected HIV infection and shortness of breath, which of the following findings is most suggestive of Pneumocystis jirovecii pneumonia? A. bradycardia despite relative volume depletion B. elevated serum lactate dehydrogenase C. hyponatremia D. unilateral lobar consolidation on chest radiograph
B. elevated serum lactate dehydrogenase (the greater the elevation of LDH, the worse the prognosis)
A 16-month-old boy and his adoptive parents present to your office with a complaint of cough and concern about the patient's weight. The parents indicate that they don't have much information about the patient's birth parents and since adopting him four months ago they have noticed daily shortness of breath, cough and wheezing. He is also a fussy eater and is in the second percentile of weight on the growth chart. Which lab finding is most consistent with the diagnosis? A. elevated exhaled nitric oxide testing B. elevated sweat chloride C. elevated white blood cell count D. positive skin allergy test
B. elevated sweat chloride
Which of the following is the most common cause of a pleural effusion in developed countries? A. bacterial pneumonia B. heart failure C. malignancy D. tuberculosis
B. heart failure
What finding on high resolution computed tomographic imaging of the chest is most consistent with idiopathic pulmonary fibrosis? A. ground glass patches B. honeycombing C. non-caseating granulomas D. solitary nodule
B. honeycombing
A 4-year-old is brought to the emergency department by his parents after they found him in the backyard shed choking and gagging. Before this event, he was otherwise healthy. His temperature is 101°F, heart rate is 95, blood pressure is 100/60, and respiratory rate 40. On exam, he appears sleepy but continues to cough. Pulmonary findings include moderate retractions and diffuse wheezes. A chest X-ray shows patchy infiltrates. What is the most likely diagnosis? A. foreign body aspiration B. hydrocarbon ingestion C. organophosphate ingestion D. status asthmaticus
B. hydrocarbon ingestion
A 19-year-old man presents with a sore throat and difficulty swallowing. He has had 4 days of worsening sore throat and fever but today he was unable to swallow any liquids. Physical examination reveals a muffled voice, difficulty tolerating saliva, and minimal pharyngeal erythema with a midline uvula. He also has tenderness over the hyoid bone. Which of the following managements is most likely indicated? A. inhaled racemic epinephrine and discharge home B. intravenous antibiotics and admission C. intravenous corticosteroids and discharge home D. needle aspiration of peritonsillar area
B. intravenous antibiotics and admission
A 68-year-old man presents for a wellness visit. He is a former smoker, having quit 3 years ago. He has a 35 pack-year history of smoking. He has no other comorbidities and is feeling well at the time of his visit. What screening needs to be performed with regard to lung cancer? A. CXR B. low-dose CT chest C. no screening is indicated D. PFTs
B. low-dose CT chest
An 18-year-old woman with a history of asthma presents to her primary care provider for follow-up. Currently she experiences symptoms of coughing, wheezing and shortness of breath 3 days a week and uses her rescue inhaler 3 days a week. She awakens at night with similar symptoms 3 times a month. She reports some minor interference with her daily routine. Which of the following options is an appropriate management plan at this time? A. high-dose inhaled corticosteroid and SABA prn B. low-does inhaled corticosteroid and SABA prn C. oral corticosteroid and SABA prn D. SABA prn
B. low-dose inhaled corticosteroid and SABA prn
A 55-year-old man, smoker, presents to the ED with hemoptysis and dyspnea for four weeks. His vital signs are T 37°C, BP 146/76 mm Hg, HR 85 bpm, RR 20 per minute, and oxygen saturation 96% on RA. His lung exam reveals distant breath sounds on the left side. His chest X-ray is shown above. What is the most likely cause of his hemoptysis? A. bronchitis B. lung cancer C. pneumonia D. PE
B. lung cancer
A 30-year old woman presents with shortness of breath. She has a history of asthma since childhood. She says that she uses her rescue inhaler 3 days each week. On average, she wakes up in the middle of the night with symptoms approximately three times a month. Her vital signs are BP 120/76, HR 112, RR 26, and oxygen saturation 92% on room air. The patient appears to be in mild distress with intercostal retractions present, and respiratory exam is remarkable for diffuse wheezing. This patient is diagnosed with an acute asthma exacerbation. Which of the following best classifies this patient's asthma? A. intermittent B. mild persistent C. moderate persistent D. severe persistent
B. mild persistent
Which of the following oxygen delivery methods provides the highest fraction of inspired oxygen? A. nasal cannula B. non-rebreather mask C. simple face mask D. venturi mask
B. non-rebreather mask
When diagnosing pneumonia in children, which of the following findings has the highest odds ratio? A. crackles B. oxygen saturation < 92% C. retractions D. temperature >38°C
B. oxygen saturation < 92%
A 29-year-old man with a history of HIV presents with shortness of breath and fever. He has a productive cough but denies hemoptysis. You obtain the chest radiograph seen above. Which of the following is true regarding the patient's diagnosis? A. elevated LDH is common B. spread is by the hematogenous route C. steroids should be administered prior to antibiotics if the PaO2 is <80 D. Trimethoprim-sulfamethoxazole is the treatment
B. spread is by the hematogenous route
An unimmunized 7-year-old boy without any previous medical history presents with fever and cough. The parents report that he has been coughing for 2 weeks. The patient has sudden fits of coughing followed sometimes by post-tussive emesis. Which of the following is an appropriate plan? A. albuterol nebulizer B. corticosteroid therapy C. macrolide antibiotic D. respiratory viral panel
C. macrolide antibiotic
A young woman with dyspnea on exertion presents for evaluation. She is subsequently diagnosed with sarcoidosis. Which of the following would you expect to appear in her lymph node biopsy report? A. acid-fast organisms B. congo red stain birefringence C. non-caseating granulomas D. Reed-Sternberg cells
C. non-caseating granulomas
A transudative pleural effusion is identified after thoracentesis. Which of the following clinical scenarios is most consistent with this type of effusion? A. 27-year-old woman with a lupus flare B. 47-year-old woman alcoholic with an elevated lipase C. 65-year-old man with an ejection fraction of 15% and pulmonary edema D. 72-year-old man recently diagnosed with lung cancer
C. 65-year-old man with an ejection fraction of 15% and pulmonary edema
A 58-year-old man presents with shortness of breath for 2 days. He complains of a six-month history of a dry cough, unintentional weight loss, and night sweats. He has no past medical history, but he has a 40 pack-year smoking history. In the ED, his vital signs are BP 132/76, HR 72, RR 16, oxygen saturation 96% on room air, and temperature 98.8°F. An ECG reveals no acute abnormality, and a chest X-ray shows a right middle lobe irregular mass and a right-sided pleural effusion. A thoracentesis is performed. What findings would be expected on pleural fluid analysis? A. Fluid:Blood LDH ratio < 0.6 B. Fluid:Blood Protein ratio < 0.5 C. Glucose < 60 mg/dL D. LDH < 200
C. Glucose < 60 mg/dL
A 65-year-old man presents with cough and progressive dyspnea on exertion. He has no significant cardiac disease. He worked as an asbestos remover for thirty years. Examination reveals crackles but no wheezing. Pulmonary imaging reveals multiple basilar round opacities and pleural plaques. This patient is most at risk for developing which of the following diseases? A. Loffler's syndrome B. Lofgren's syndrome C. Mesothelioma D. Multiple myeloma
C. Mesothelioma
Which of the following diagnoses should be considered when an unexplained isolated pleural effusion is found on chest radiograph? A. bacterial pneumonia B. CHF C. PE D. viral pleuritis
C. PE
A 72-year-old woman was hospitalized for atrial fibrillation with rapid ventricular rate. She is being discharged today on amiodarone for long term control of her dysrhythmia. Which of the following diagnostic studies should be followed as an outpatient? A. coagulation studies B. CBC C. PFTs D. renal panels
C. PFTs
What is the most common cause of croup? A. Adenovirus B. Haemophilus influenza type b C. Parainfluenza virus D. Streptococcus spp.
C. Parainfluenza virus
You are treating a 50-year-old coal-miner's hypertension with lisinopril. He has been complaining of 3-months of progressive dyspnea. You order a chest radiograph which shows bilateral upper lobe honeycombing. A high resolution computed tomogram shows multiple small, round opacities only in the upper lobes. The lower lobes appear normal. Which of the following is the most likely diagnosis? A. Goodpasture's syndrom B. Granulomatosis with polyangiitis C. Pneumoconiosis D. Scleroderma
C. Pneumoconiosis
A 33-year-old man presents with five days of gradual onset nonproductive cough, fatigue, and fever. He also notes a 15 pound weight loss over the last month. He is tachypneic with a heart rate of 105 beats/minute, temperature of 38.2oC, and an oxygen saturation of 89% on room air. On examination, white plaques are noted on his tongue and his lungs are clear on auscultation. His chest X-ray is shown above. Which of the following is the most likely causative agent? A. Influenza A B. Klebsiella pneumoniae C. Pneumocystis jirovecii D. Streptococcus pneumoniae
C. Pneumocystis jirovecii (PCP)
A 43-year-old man with asthma presents with wheezing. After 6 inhaled albuterol treatments he feels better and his lungs are clear. Which of the following is true regarding further management? A. intravenous corticosteroid is indicated B. intravenous magnesium sulfate is indicated C. oral corticosteroid is indicated D. oral respiratory antibiotic is indicated
C. oral corticosteroid is indicated
Which of the following complications can be prevented by simultaneously administering pyridoxine and isoniazid in a patient with tuberculosis exposure? A. color blindness B. hepatitis C. peripheral neuropathy D. renal failure
C. peripheral neuropathy
A 76-year-old woman with a history of chronic obstructive pulmonary disease presents to your office in December with complaints of fever, muscle aches, headache and malaise that started yesterday. Which of the following is the most appropriate next step in management? A. advise supportive care measures including acetaminophen B. begin a course of Azithromycin C. begin a course of Oseltamivir D. begin a course of Prednisone
C. begin a course of Oseltamivir
A 60-year-old man with a past medical history of tobacco use presents to clinic with a chief complaint of cough. The cough has been present for five months, and he now has difficulty breathing when walking to his mailbox. He also had a "coughing fit" similar to this last year lasting three to four months. What is the most likely diagnosis? A. acute bronchitis B. asthma C. chronic bronchitis D. emphysema
C. chronic bronchitis
A 35-year-old woman comes to the clinic complaining of difficulty seeing, blurred vision, eye pain, and cough. She describes the cough as being dry and nonproductive. She has no past medical history and takes no medications. Ophthalmologic examination shows uveitis. Chest X-ray reveals bilateral hilar adenopathy. Which of the following laboratory findings would also most likely be associated with this patient's condition? A. elevated C-reactive protein B. elevated ESR C. elevated serum angiotensin converting enzyme levels D. increased sweat chloride
C. elevated serum angiotensin converting enzyme levels
A 22-year-old woman presents with dyspnea. She has a history of asthma and noted increased difficulty breathing starting yesterday. She says she has been using her albuterol inhaler every 15 minutes for the last four hours without relief. What laboratory abnormality is likely to be found in this patient? A. hypocalcemia B. hypoglycemia C. hypokalemia D. hyponatremia
C. hypokalemia
A 65-year-old smoker with no documented cardiac disease presents with several months of worsening cough and exertional dyspnea. He denies exposure to inhalation toxins or dusts. Examination reveals bibasilar inspiratory crackles and fingernail clubbing. Spirometry reveals a restrictive lung pattern. A chest computed tomography scan is read as "honeycombing in the periphery and bases." A bronchoalveolar lavage report is only significant for lymphocytosis and a histological classification of usual interstitial pneumonia. Which of the following is the most likely diagnosis? A. chronic obstructive pulmonary disease B. community-acquired pneumonia C. idiopathic pulmonary fibrosis D. pneumoconiosis
C. idiopathic pulmonary fibrosis
Which of the following physiologic responses would occur after application of noninvasive positive pressure ventilation in a patient presenting with an acute exacerbation of chronic obstructive pulmonary disease? A. increased afterload B. increased alveolar dead space C. increased tidal volumes D. increased venous return
C. increased tidal volumes
A 27-gestational-week-old infant is delivered in the emergency department. The neonate is cyanotic, tachypneic and shows chest wall retractions. An emergent chest radiograph reveals a diffuse ground-glass appearance. Meconium aspiration is not suspected. Which of the following is the most likely diagnosis? A. erythroblastosis fetalis B. hydrops fetalis C. infant respiratory distress syndrome D. persistent pulmonary hypertension of the newborn
C. infant respiratory distress syndrome
Which of the following statements is true concerning aspiration pneumonitis? A. antibiotics should be administered early in the course B. corticosteroid administration decreases the incidence of associated lung injury C. it is caused by an inflammatory chemical injury D. the ABG is diagnostic
C. it is caused by an inflammatory chemical injury
Which of the following is true regarding active tuberculosis? A. cavitary lesion on CT of the chest is pathognomonic B. Isoniazid treatment for six months is adequate therapy C. it may have varied appearance on chest X-ray D. patients with active tuberculosis need droplet precautions
C. it may have varied appearance on chest X-ray
A 64-year-old man presents with a cough and shortness of breath for 2 weeks. His chest X-ray reveals blunting of the costophrenic angle. On physical exam, he has decreased breath sounds, dull percussion, and decreased tactile fremitus. Which of the following tests would indicate an exudative pleural effusion, likely secondary to pneumonia? A. pleural fluid to serum LDH ratio < 0.6 B. pleural fluid to serum protein ratio < 0.1 C. pleural fluid to serum protein ratio > 0.5 D. pleural fluid WBC 5,000 cells/mm^3
C. pleural fluid to serum protein ratio > 0.5
A 37-year-old man presents with cough and shortness of breath. Vital signs are T 102°F, BP 110/76, HR 108, RR 20, and oxygen saturation of 92% on room air. His CXR reveals dense consolidation with an air-fluid level inside a thick-walled cavitary lesion. Which of the following helps determine the causative organism? A. exposure to white powder B. history of smoking C. recent influenza infection D. residence in Connecticut
C. recent influenza infection
You are seeing an elderly man with new onset of peripheral edema, head fullness and neck venous engorgement. Initial testing shows normal left heart function. You suspect cor pulmonale. Which of the following tests is the most accurate in confirming this diagnosis? A. cardiac MRI B. EKG C. right heart catheterization D. ultrafast ECG-gated CT
C. right heart catheterization
A 33-year-old woman comes to the clinic complaining of blurred vision, cough, and fatigue. Her blood pressure is 135/90 mm Hg and temperature is 38.6°C (101.5°F). She has no past medical history. Physical examination shows several subcutaneous nodules on both lower extremities. Ophthalmologic examination shows uveitis. Chest X-ray shows bilateral hilar adenopathy and reticular opacities. Laboratory studies show leukopenia, eosinophilia, and an elevated erythrocyte sedimentation rate. Which of the following is the most likely diagnosis? A. asbestosis B. cystic fibrosis C. sarcoidosis D. tuberculosis
C. sarcoidosis
A 62-year-old man with a history of chronic obstructive pulmonary disease presents with cough, headache, dyspnea, and watery diarrhea that started six days ago. He was seen at a local urgent care four days ago and prescribed amoxicillin-clavulanate without improvement. He is ill-appearing with a fever of 38.7°C and inspiratory rales on auscultation. Which of the following results would be most consistent with his diagnosis? A. right upper lobe infiltrate with bulging fissure on CXR B. serum potassium 6 mEq/L C. serum sodium 128 mEq/L D. sputum gram stain with gram positive cocci in pairs
C. serum sodium 128 mEq/L
Which of the following is the most common electrocardiogram finding in an acute pulmonary embolism? A. right BBB B. S-wave in lead I, Q-wave in lead III, inverted T-wave in lead III (S1Q3T3) C. sinus tachycardia D. T-wave inversion in leads V1 through V4
C. sinus tachycardia
In which population is Klebsiella pneumonia most commonly seen in?
COPD, alcoholics and the elderly
What is the gold standard diagnostic test for spontaneous pneumomediastinum?
CT chest
What is a major complication of infant respiratory distress syndrome?
Chronic pulmonary disease, namely bronchopulmonary dysplasia, may result from the oxygen and ventilation actually used in its treatment.
An obese 34-year-old woman is brought to the Emergency Department with respiratory distress. Two months ago she was in the hospital for knee surgery. Paramedics report an acute onset of dyspnea and pleuritic chest pain. She also complains of a tender thigh on the same side of her knee surgery. She is tachycardic and tachypneic, and mildly hypotensive. Examination reveals decreased breath sounds but no hyperresonance. An emergent chest radiograph is relatively normal except for some mild atelectasis. Which of the following is the most likely diagnosis? A. acute bronchitis B. pleural effusion C. pneumothorax D. pulmonary embolism
D. pulmonary embolism
Which of the following is the initial treatment of choice in an overweight patient with moderate obstructive sleep apnea? A. albuterol nebulizer 30 minutes prior to sleep B. oral appliances C. tracheostomy D. weight loss and CPAP
D. weight loss and CPAP
A 58-year-old man presents to your office with complaints of chronic cough and difficulty breathing. He has smoked approximately 2 packs of cigarettes per day since he was 14 years old and has not seen a doctor in many years. You order spirometry testing, which shows airflow limitation (predicted FEV1 45%). Which of the following is the most appropriate therapy? A. Azithromycin B. Guaifenesin C. Prednisone D. Tiotropium
D. Tiotropium
A 26-year-old man presents with a 2-week history of fever and a cough. He was diagnosed with HIV four months ago and is not on any antiretroviral medications. His vital signs are BP 122/76, HR 78, RR 16, oxygen saturation 92% on room air, and temperature 99.2°F. Chest X-ray demonstrates diffuse interstitial infiltrates bilaterally. Given this presentation, it is suspected that he has pneumonia secondary to Pneumocystitis jiroveci. Which of the following antibiotics is used to treat suspected pneumonia caused by Pneumocystitis jirovecii? A. Azithromycin B. Clindamycin C. Penicillin D. Trimethoprim-sulfamethoxazole
D. Trimethoprim-sulfamethoxazole
A 25-year-old man presents for evaluation of fever and cough. He reports last week that he was diagnosed with influenza. In the last 2 days he developed a worsening cough productive of large amounts of sputum. Vital signs are T 101°F, HR 98, BP 120/60, RR 18, and 95% oxygen saturation on room air. His chest X-ray demonstrates a lobar infiltrate in the left lower lobe. Which of the following would you most likely expect to see on the patient's Gram stain? A. gram negative bacilli B. gram negative diplococci C. gram positive bacilli D. gram positive cocci in clusters
D. gram positive cocci in clusters
Which causative organism should be suspected in patients who have bronchiectasis secondary to cystic fibrosis?
Cystic fibrosis patients are often infected Pseudomonas aeruginosa and can benefit from long-term antipseudomonal antibiotics, such as inhaled aminoglycosides.
A new nursing home employee is being screened for tuberculosis and develops a 6 mm induration on his right volar forearm after injection of a purified protein derivative (PPD). This reading indicates prior tuberculosis exposure if he has had which of the following life circumstances? A. he is a former guard at a correctional facility B. he is a HIV-negative IV drug user C. he is a recent immigrant from Latin America D. he is an organ recipient on daily immunosuppressives
D. he is an organ recipient on daily immunosuppressives
A 72-year-old man is sent to the interventional radiology department by his primary care doctor to undergo a thoracentesis after a chest radiograph revealed a moderate left-sided pleural effusion. Analysis reveals a pleural fluid/serum protein ratio > 0.9 and a pleural fluid/serum LDH ratio > 0.8. Based on these findings, what is the most likely diagnosis? A. cirrhosis with ascites B. CHF C. hypoalbuminemia D. malignancy E. nephrotic syndrome
D. malignancy
A patient with significant dyspnea presents for evaluation. You order spirometric testing and obtain results consistent with restrictive pulmonary disease. Which of the following findings is most consistent with restrictive pulmonary disease? A. alveolar destruction B. bronchoconstriction C. excess mucus production D. parenchymal abnormalities
D. parenchymal abnormalities
Which of the following can cause an exudative pleural effusion? A. cirrhosis B. CHF C. nephrotic syndrome D. SLE
D. SLE
What is the most common causative organism in community acquired pneumonia? A. Klebsiella pneumoniae B. Mycoplasma pneumoniae C. Staphylococcus aureus D. Streptococcus pneumoniae
D. Streptococcus pneumoniae
Which of the following organisms is associated with pneumonia and bullous myringitis? A. Bordetella pertussis B. Haemophilus influenzae C. Streptococcus bovis D. Streptococcus pneumoniae
D. Streptococcus pneumoniae
A 16-year-old boy is taken to his doctor for snoring. His mother reports that his snoring keeps others in the house awake and that sometimes his breathing pauses during sleep with gasping or choking. His teachers report that he falls asleep frequently at school. On exam, he has a body mass index of 31 kg/m² and has enlarged tonsils. His symptoms are concerning for obstructive sleep apnea so the pediatrician refers him for an overnight polysomnography. Which of the following can be a longterm complication of obstructive sleep apnea? A. cerebrovascular accident B. lung scarring C. nasal polyps D. pulmonary hypertension
D. pulmonary hypertension
Which of the following is most appropriate in the treatment plan for a patient with idiopathic pulmonary fibrosis? A. Albuterol B. Azathioprine C. Bosentan D. pulmonary rehabilitation
D. pulmonary rehabilitation
Which of the following is a risk factor for pulmonary embolism? A. chronic obstructive pulmonary disease B. cirrhosis C. low BMI D. recent abdominal surgery
D. recent abdominal surgery
A 67-year-old woman presents with shortness of breath and a cough for 3 days. The patient admits to recently having a fever, chills, rhinorrhea, and myalgias for 10 days. She had one episode of diarrhea and has been nauseated. Her past medical history is positive for COPD. She does not smoke but she drinks two cans of beer daily. In the ED, her vital signs are BP 120/76, HR 108, RR 20, oxygen saturation 97% on room air, and temperature 101.2°F. A chest X-ray shows a left lower lobe consolidation. It is suspected that this patient has pneumonia caused by Staphylococcus aureus. Which aspect of this patient's history supports this suspicion? A. alcohol consumption B. gastrointestinal symptoms C. history of COPD D. recent viral symptoms
D. recent viral symptoms
A 4-year-old patient is brought to the emergency department by his parents after a choking incident that occurred one hour ago. The parents tell you that their son was eating steak, started to laugh and then began choking. Since the incident, he has been coughing and wheezing. Physical exam reveals unilateral diminished breath sounds with auscultation of the lungs. Which of the following is the most appropriate next step in management? A. begin a course of antibiotics and steroids B. CXR C. flexible bronchoscopy D. rigid bronchoscopy
D. rigid bronchoscopy
A 38-year-old man presents with fever, fatigue, cough, and increasing dyspnea. The patient denies chills or night sweats. On physical exam, lungs are clear to auscultation bilaterally. Hepatosplenomegaly is noted on abdominal exam. Chest X-ray findings include bilateral hilar adenopathy and diffuse reticular infiltrates. Labs reveal leukocytopenia, hypercalcemia, and elevated erythrocyte sedimentation rate. What is the most likely diagnosis in this patient? A. histoplasmosis B. Mycoplasma pneumonia C. pulmonary tuberculosis D. sarcoidosis
D. sarcoidosis
Which of the following is the most common dysrhythmia associated with the diagnosis of pulmonary embolism? A. atrial fibrillation B. AV-nodal reentrant tachycardia C. multifocal atrial tachycardia D. sinus tachycardia
D. sinus tachycardia
A 2-month-old boy presents with a fever and cough. Which of the following is suggestive of Chlamydial pneumonia? A. bullous myringitis B. diarrhea C. rusty-colored sputum D. staccato cough
D. staccato cough
A 42-year-old woman who spent two days hospitalized after she underwent an appendectomy three weeks ago presents with cough, green sputum and fever. Her vitals are T 100.7°F, HR 94, BP 123/76, RR 18, and oxygen saturation 97%. She is well appearing and her blood work (CBC and BMP) is unremarkable. A chest X-ray shows a left lower lobe infiltrate. Which of the following represents the best management for this patient? A. discharge home with oral antibiotics and follow up B. draw blood cultures and discharge home on oral antibiotics C. order a CT chest D. start IV antibiotics and admit
D. start IV antibiotics and admit
A 35-year-old woman comes to the urgent care clinic complaining of a 3-week history of difficulty seeing, blurred vision, eye pain, and cough. She describes the cough as being dry and nonproductive. She has no past medical history and takes no medications. Her blood pressure is 140/85 mm Hg and her temperature is 38.1°C (100.5°F). Ophthalmologic examination shows uveitis. Chest X-ray shows bilateral hilar adenopathy. Which of the following additional findings would also most likely be found in this patient? A. ferruginous bodies B. increased sweat chloride C. positive PPD skin test D. subcutaneous nodules
D. subcutaneous nodules
A 29-year-old woman presents to the ED complaining of pain on inspiration. Over the previous 3 days, she has experienced a low-grade fever, sore throat, and body aches. Auscultation of her lungs reveals normal breath sounds. Her CXR appears normal. Which of the following is the most appropriate next step in management? A. D-dimer B. Doxycycline C. inspiratory and expiratory radiographic views D. supportive care
D. supportive care
A 32-year-old woman presents to your office with a complaint of productive cough that started 6 days ago. She reports occasional wheezing, chest wall tenderness, and has been afebrile since the onset of symptoms. Her husband had similar symptoms and was prescribed azithromycin by his primary care provider. Which of the following is the most appropriate next step in management? A. order CXR B. prescribe a course of Azithromycin C. send a sputum sample for culture D. symptomatic treatment
D. symptomatic treatment
Which of the following is the most common sign seen in patients presenting with a pulmonary embolism? A. hemoptysis B. hypoxia C. swollen calf D. tachypnea
D. tachypnea
A full term male infant is delivered by cesarean section because of dystocia due to macrosomia. Apgar scores are 8 and 10. An hour after delivery he begins to have tachypnea without hypoxemia. A chest radiograph shows diffuse parenchymal infiltrates and fluid in the pulmonary fissures. The symptoms resolve without treatment within 24 hours. What is the most likely diagnosis? A. laryngomalacia B. meconium aspiration syndrome C. respiratory distress syndrome D. transient tachypnea of the newborn
D. transient tachypnea of the newborn
A 50-year-old man with a history of hypertension, diabetes and stage III chronic kidney disease with a GFR of 45, presents to the emergency department complaining of shortness of breath and stabbing chest pain for the past hour. Vital signs are BP 145/70, RR 36, HR 115, and pulse oximetry 89% on room air. An ECG reveals sinus tachycardia. Two days ago he returned to Los Angeles on a business trip from China. Which of the following is the most appropriate diagnostic test for this patient? A. chest CT angiography B. CXR C. pulmonary angiography D. ventilation/perfusion scan
D. ventilation/perfusion scan
Which antibiotic should be used if macrolide resistance is suspected or documented in a patient with atypical pneumonia?
Doxycycline or Fluoroquinolone
Which test should all patients with sarcoidosis have annually?
EKG: 5-25% of sarcoid patients will have conduction block and ventricular tachycardia
What medication is relatively contraindicated in hydrocarbon ingestion?
Epinephrine, due to the possibility of inducing ventricular fibrillation.
What is the antibiotic of choice for psittacosis in children and pregnant women?
Erythromycin
True or False: Bacterial infections are the most common cause of acute bronchitis?
FALSE (most commonly viral etiology)
What is the most common inherited risk factor for thromboembolic disease?
Factor V Leiden
What organism is associated with pneumonia in patients with COPD?
Haemophilus influenzae, Pseudomonas aeruginosa
Is Homan's sign a reliable examination finding in the evaluation of deep venous thrombosis?
Homan's sign is pain in the calf with dorsiflexion of the ankle. It is an insensitive and nonspecific sign of a deep venous thrombosis.
Why is airway compromise in epiglottitis less common in adults than in children?
In adults, there is an increased trachea diameter to epiglottis diameter making airway compromise unusual.
In what risk patients is a D-Dimer appropriate in the work up of pulmonary embolism?
In low risk patients, in whom a negative test effectively rules out pulmonary embolism.
When performing a thoracentesis, should the needle enter the thorax above or below the rib?
Insertion should occur above the rib to avoid the neurovascular bundle that lies along the inferior rib margin.
What are four common medications included in the regimen approved for the treatment of pulmonary tuberculosis?
Isoniazid, ethambutol, pyrazinamide, and rifampin are effective anti-tuberculosis drugs, with treatment courses ranging from 6-9 months depending on individual patient circumstances.
What role does magnesium sulfate play in asthma exacerbations?
It acts by relaxing bronchial smooth muscle and is indicated in severe asthma exacerbations. It has been shown to improve airflow obstruction and decrease hospital admissions.
What is the CURB-65 score?
It attempts to predict the severity of pneumonia to help determine inpatient vs. outpatient treatment.
What is Levine's sign?
It is when a patient describes their chest pain by holding their clenched fist over their chest. It is considered to be a sign of ischemic chest pain.
For which bacterial pneumonia are alcoholics at higher risk?
Klebsiella
What are the local and systemic side effects of inhaled corticosteroids?
Local: Cough, dysphonia, oropharyngeal candidiasis. Systemic: Adrenal suppression, osteoporosis, skin thinning, easy bruising and cataracts.
What is the most common atypical cause of pneumonia?
Mycoplasma
Is magnetic resonance angiography recommended in the diagnosis of PE?
No, its poor resolution caused by cardiopulmonary motion artifact limits its usefulness.
Name 2 clinical prediction rules that may be used to help determine whether a patient with CAP requires inpatient or outpatient management?
PORT/PSI (Pneumonia Severity Index) and the CURB 65
Which anti-fibrotic medication has modest benefit in slowing the progression of IPF?
Pirfenidone
What are the three laboratory criteria for an exudative effusion?
Pleural:Serum Protein >0.5; Pleural:Serum LDH >0.6; Pleural fluid LDH greater than 2/3 upper limit of normal for serum LDH
What organism is responsible for chest X-ray findings of bilateral perihilar infiltrates described as a "bat-wing" pattern?
Pneumocystis jirovecii
What qualifies as a complicated pneumonia?
Pneumonia involving a parapneumonic effusion or empyema, necrotizing pneumonia, lung abscess, or pneumatocele.
What should be co-administered with isoniazid?
Pyridoxine (vitamin B6) to prevent peripheral neuropathy.
What is the most common bacterial cause of pneumonia in hospitalized patients?
S. pneumoniae
What is the greatest risk factor for chronic obstructive pulmonary disease?
SMOKING!!!! (if you get this wrong, then you're a failure)
Does LDH elevation have a greater sensitivity or specificity for Pneumocystis jirovecii pneumonia?
Serum LDH has a greater sensitivity (approximately 90%) in Pneumocystis jirovecii pneumonia, but a poor specificity.
What diagnostic criteria is used in Light's criteria?
Serum protein and pleural fluid lactate dehydrogenase are used in Light's criteria, which is used to distinguish between transudative and exudative pleural effusions.
How common is short-term relapse in asthmatic patients discharged from the Emergency Department?
Short-term relapse (within 3 days) is fairly common at around 11%.
What is the preferred treatment of choice for a patient with acute bronchitis?
Since antibiotics are not indicated in the treatment of acute bronchitis, most cases are typically targeted toward symptomatic relief.
What pathogen causes pneumonia that is associated with bullous myringitis?
Streptococcus pneumoniae
What is the treatment of asbestosis?
Supportive care: oxygen, pulmonary rehabilitation, pneumococcal and influenza immunization and pulmonary function monitoring.
Carcinoid tumors are most likely to develop in which other organ system besides the pulmonary system?
These tumors tend to develop in the gastrointestinal tract and produce similar symptoms of carcinoid syndrome.
True or False: All patients with chronic obstructive pulmonary disease should be prescribed a short-acting bronchodilator?
True
Is a clot in the superficial femoral vein a DVT?
Yes, the superficial femoral vein is technically a deep vein.
Can Amiodarone be used in patients with heart failure?
Yes, this is one of the attractive features of using amiodarone over other antidysrhythmics.
What type of precautions are necessary for a patient with active/suspected tuberculosis?
airborne precautions
How is Pneumocystis jirovecii pneumonia transmitted?
airborne route
What is the most common cause of a lung abscess?
aspiration pneumonia
What is Sampter's triad?
asthma, nasal polyps, and allergy to Aspirin
What is a physiologic complication of noninvasive positive pressure ventilation?
barotrauma including pneumothorax
What is the prevalence of idiopathic pulmonary fibrosis in the U.S.?
between 14 and 43 per 100,000 persons
What is a classic chest x-ray finding for sarcoidosis?
bilateral hilar adenopathy
What is the most useful test to confirm a diagnosis of sarcoidosis?
biopsy of the affected organ
What is the most common cause of hemoptysis?
bronchitis (15-30% of cases)
What is the most common cause of cor pulmonale in the United States?
chronic obstructive pulmonary disease
What is the preferred form of management in patients with sarcoidosis?
corticosteroids (ex: Prednisone)
What treatment is recommended for asthma classified as mild persistent?
daily low-dose inhaled glucocorticoid
What is the most common complication of pneumonia in children?
dehydration
How can the patient be positioned to improve preoxygenation?
elevate the head of the bed
Would angiotensin-converting enzyme be elevated or decreased if it were measured in this patient?
elevated
What is the most common cause of pleural effusion in the U.S.?
heart failure
Is the lactate dehydrogenase level high or low in an exudate pleural fluid?
high
What is the preferred diagnostic study for OSA?
in-laboratory polysomnography
What is the blood pressure goal for patients with diabetes mellitus type 2?
less than 140/90 mmHg
At what CD4 count should prophylaxis for PCP be started?
less than 200 cells/mm^3
What is the gold standard test to diagnose OSA?
overnight polysomnography.
At what pH is a parapneumonic effusion or empyema suggested?
pH below 7.2
What are the classic symptoms of active tuberculosis?
persistent malaise, anorexia, weight loss, fever, night sweats, and a chronic cough are classic symptoms
With what cardiac dysrhythmia is the use of macrolide antibiotics associated?
prolongation of the QT segment
What are the mechanisms of pulmonary bleeding?
pulmonary hypertension, erosion into a blood vessel, and coagulopathy
What diagnostic test, although low sensitivity, is often used when influenza is suspected?
rapid influenza test (nasopharyngeal swab)
What are the two clinical situations that can lead to a false-negative D-dimer test result?
recent anticoagulation and subacute thrombosis (>7 days)
How is pertussis spread?
respiratory droplet
What are the classic EKG changes in a patient with cor pulmonale?
right axis deviation, R/S ratio >1 in V1 and <1 in V6, P-pulmonale (increased P wave amplitude in leads 2, 3 and aVF).
Where are most aspirated foreign bodies located?
right main bronchus
What causes OSA?
soft tissue collapse in the pharynx
A pleural effusion is most difficult to detect in which radiographic position?
supine
What is the treatment of choice for respiratory distress syndrome?
surfactant
What is the recommended antibiotic regimen to treat klebsiella pneumonia?
third-generation cephalosporin and aminoglycoside
Does health care associated pneumonia have a higher mortality than community acquired pneumonia?
yes
Does idiopathic pulmonary fibrosis have a genetic component?
yes
