Clinical
Select the most likely diagnosis for the following case:
A 66-year-old woman comes to the physician because of a 1-month history of episodic cough. She reports that the cough is nonproductive and worse when she lays down. She has smoked half a pack of cigarettes daily for 25 years. She has hypertension and coronary artery disease. Current medications include losartan, aspirin, and pravastatin. Her temperature is 37.3°C (99.1°F), pulse is 84/min, respirations are 21/min, and blood pressure is 144/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Pulmonary examination shows mild bibasilar crackles. Cardiac examination shows an S3 gallop. Spirometry shows an FEV1:FVC ratio of 88% and an FEV1 of 90%. The diffusion capacity of the lung (DLCO) is decreased.
A) Chronic bronchitis
B) Infectious pneumonia
C) Pulmonary fibrosis
D) Congestive heart failure
E) Emphysema
D) Congestive Heart Failure
A 35 year-old man presents with fever and cough. He reports chills for the last two days along with mild shortness of breath and as productive cough. His past medical history is significant for HIV, he is compliant with multi-agent antiretroviral therapy. His last CD4 cell count was 550/mm3. His vitals include BP 120/76, HR 92bpm, RR 18/min, and temp of 101.8 and oxygen saturation of 93% on room air. His pulmonary exam demonstrates crackles in the right lung. CXR shows focal consolidation in the right middle lobe that obscures the right heart border. Which of the following organisms is most like the cause of this patient's pneumonia?
A) Streptococcus pneumoniae
A girl is born, at term, to a G2P1 30-year-old woman. Apgar scores were 6 and 8 at 1 and 5 minutes, respectively. The pregnancy and delivery were uncomplicated, but the amniotic fluid appeared brown. Now, at 10 minutes of life, she develops tachypnea and her chest is barrel-shaped. Chest X-ray reveals diffuse, patchy infiltrates and flattened diaphragms. In addition to supplemental oxygen, which of the following is the appropriate management course?
A) Ampicillin and gentamicin
A female infant is born prematurely at 28 weeks’ gestation. Shortly after birth, she shows signs of dyspnea, cyanosis, and tachypnea. She is placed on a ventilator for assisted breathing, and a diagnosis of neonatal respiratory distress syndrome (hyaline membrane disease) is made. Which of the following is the cause of this syndrome?
A. Bronchopulmonary dysplasia
B. Intraventricular brain hemorrhage
C. Lack of fetal pulmonary maturity and deficiency of surfactant
D. Necrotizing enterocolitis
E. Patent ductus arteriosus
C) Lack of fetal pulmonary maturity and deficiency of surfactant
The platysma is a muscle of facial expression and is innervated by what nerve?
A. facial n.
B. hypoglossal n.
C. spinal accessory n.
D. recurrent laryngeal n.
A) facial n.
A 68-year-old man comes to the physician because of a 4-month history of episodic cough. He reports that the cough is nonproductive and worse at night and when he walks to buy groceries. He has not had chest pain, hemoptysis, palpitations, or heartburn. He smoked one pack of cigarettes daily for 30 years but quit 8 years ago when his granddaughter was born. He has hypertension and osteoarthritis of the right hip. Current medications include hydrochlorothiazide and celecoxib. His temperature is 37.1°C (98.8°F), pulse is 71/min, respirations are 19/min, and blood pressure is 139/85 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Pulmonary examination shows diffuse end-expiratory wheezing. Cardiac examination shows no murmurs, rubs, or gallops. Spirometry shows an FEV1:FVC ratio of 60% and an FEV1 of 65%. The diffusion capacity of the lung (DLCO) is normal.
A) Emphysema
B) Lung cancer
C) Bronchial Asthma
D) Bronchiectasis
E) Pulmonary fibrosis
C) Bronchial Asthma
A previously healthy 13-year-old boy presents with a 2-week history of nonproductive cough and low-grade fever. On examination, you note a normal respiratory rate and no evidence of respiratory distress but are surprised to hear inspiratory rales at the bilateral lung bases. Which of the following is the most likely cause of pneumonia in this adolescent?
A. Pneumocystis jiroveci
B. Staphylococcus aureus
C. Group B streptococcus
D. Bordetella pertussis
E. Mycoplasma pneumoniae
E) Mycoplasma pneumoniae
A 1-year-old previously healthy male infant is brought the emergency department because of a 4-day history of fever, poor feeding, and respiratory distress. His medical history is noncontributory. Physical exam shows mild peripheral cyanosis, inspiratory crackles, sibilant rhonchi, and nasal flaring. His temperature is 39.7°C (103.4°F), pulse is 160/min, respirations are 60/min, blood pressure is 100/50 mmHg, and pulse oximetry on room air shows an oxygen saturation of 90%. Upon hospital admission, the patient's clinical condition deteriorates despite optimal treatment. A chest radiograph is obtained and shown below
B) Bronchopneumonia (lobular pneumonia)
On your OB/GYN rotation, a male infant was born via cesarean section. His is immediately tachypneic and he is visibly retracting, grunting, and you notice cyanosis. His mother had no history of STI/STDs and was otherwise healthy and compliant with prenatal care. Upon physical exam, the lungs are clear to auscultation bilaterally with no abnormal breath sounds. A CXR reveals perihilar streaking and fluid in the interlobar fissures. The infant is diagnosed with transient tachypnea of the newborn. You are asked what your first step of treatment would be for this kiddo. You say
C) Supplemental O2
The visceral compartment of the neck is bound anteriorly by what fascia?
A) buccopharyngeal fascia
B) alar fascia
C) pretracheal fascia
D) prevertebral fascia
E) superficial fascia
C) pretracheal fascia
A 17 year old presents to the primary care clinic with four days of dry cough and malaise. She had a sore throat at the initial onset of her symptoms, but this has since improved. A number of her high school classmates are suffering from a similar illness. The patent has a history of mild-persistent asthma for which she takes daily inhaled corticosteroids. She has a temperature of 100.4 with the remainder of her vital signs within normal limits. CXR demonstrates diffuse, patchy interstitial opacities in both lungs. Which of the following medication sis most appropriate in this patient?
A) Azithromycin
A 25-year-old man presents with a progressive illness of several days’ duration characterized by nonproductive cough, fever, and malaise. A lateral view chest radiograph reveals plate-like atelectasis. Elevated titers of cold agglutinins are detected. Which of the following is the most likely type of pneumonia in this patient?
A. Bacterial pneumonia, most likely caused by S. pneumoniae
B. Hospital-acquired pneumonia, most likely caused by P. aeruginosa
C. Interstitial pneumonia, most likely caused by M. pneumoniae
D. P. jiroveci (carinii) pneumonia, most likely related to an immunocompromised state
E. Viral pneumonia, most likely caused by influenza virus
C) Interstitial pneumonia, most likely caused by M. pneumoniae
A premature baby is reviewed on the pediatric ward because of tachypnea and tachycardia immediately after birth. Loud grunting can be heard as the child makes an effort to breathe. Pulmonary examination shows decreased breath sounds and dullness to percussion bilaterally. Contractures of the limbs and clubbing of hands and feet are also observed. Which of the following abnormalities is the most likely cause of this newborns condition?
B) Oligohydramnios
A 3-year-old girl presents to the emergency department with fever, hoarseness, a “seal bark-like” cough, and inspiratory stridor. Her father states that she has had a cold for the past few days, with runny nose, nasal congestion, sore throat, and cough. He is now concerned because her cough has become loud, harsh, and brassy. Which of the following is the most likely cause of her ailment?
E) Virus
The visceral compartment of the neck is bound posteriorly by what fascia?
A) prevertebral fascia
B) alar fascia
C) pretracheal fascia
D) buccopharyngeal fascia
E) superficial fascia
D) buccopharyngeal fascia
A 30-year-old female who is 16-weeks pregnant is evaluated for fever and sore throat. Physical exam reveals tonsillar exudate and erythema. A rapid antigen detection test is positive for Streptococcus pyogenes (Group A strep). She has a history of anaphylaxis following exposure to a cefuroxime. Which of the following antibiotics is the best choice for this woman?
C) Azithromycin
A 62-year-old woman comes to the emergency department because of painful and difficult swallowing. Her voice has also become muffled. She has been well until last night and reports having intermittent fevers at home. The patient has smoked a pack of cigarettes a day since age 19 but is otherwise healthy. Her temperature is 39°C (102.2°F), blood pressure is 142/93 mm Hg, heart rate is 109/min, and respiratory rate is 18/min. On examination, the patient's neck is extended and she appears anxious. Her voice is muffled and there is inspiratory stridor. There is tender bilateral cervical lymphadenopathy and pain upon palpation of the hyoid. The remainder of the examination shows no abnormalities. Laboratory studies show a leukocyte count of 18,000/mm3 with 83% neutrophils. Which of the following is the most likely cause of this patient's presentation?
A) Adenovirus
B) Pseudomonas aeruginosa
C) Corynebacterium diptheriae
D) Streptococcus pyogenes
E) Parainfluenza virus
F) Haemophilus influenza type b
F) Haemophilus influenza type b
A 2-year-old toddler presents with a 3-day history of increasing inspiratory stridor, cough, and increased work of breathing. On examination, you confirm the inspiratory stridor and also note intercostal retractions and tachypnea with a respiratory rate of 44 breaths/minute. Which of the following is correct regarding the cause and management of the probable diagnosis?
A. Parainfluenza virus is the most likely cause.
B. Foreign body aspiration is unlikely because of the absence of a history of choking.
C. Corticosteroid therapy is contraindicated.
D. A “thumbprint sign” will be found on a lateral radiograph of the neck.
E. Antibiotics against Staphylococcus aureus are indicated.
A) Parainfluenza virus is the most likely cause
A 3 year old presents with difficulty breathing and will not lie down to be examined. You suspect acute bacterial epiglottitis and examine the child’s epiglottis, which is highly inflamed. Which vaccine are you most likely to find that the child is missing?
E) Haemophilus influenzae
The superficial muscles within the anterior triangle that lie between the mandible and the hyoid are termed:
A) infrahyoid muscles
B) suprahyoid muscles
C) sternohyoid muscles
D) Geniohyoid muscles
B) suprahyoid muscles
Trimethoprim is a structural analogue of a portion of _____________, and inhibits _________ enzyme.
A) PABA, dihydropteroate synthase
B) PABA, dihydrofolate reductase
C) dihydrofolic acid, dihydropteroate synthase
D) dihydrofolic acid, dihydrofolate reductase
D) dihydrofolic acid, dihydrofolate reductase
A 60-year-old man presents with fever and chills, productive cough with rusty sputum, pleuritic pain, and shortness of breath for the past several days. A complete blood count reveals neutrophilia and an increase in band neutrophils. A chest radiograph reveals consolidation involving the entire left lower lobe. Which of the following microorganisms is the most likely etiologic agent?
D) Streptococcus pneumoniae
A 9-year-old girl with asthma is brought to the office for the first time. On average, she uses her albuterol inhaler three times per week, but for the past 10 days, she has been wheezing both day and night and is using the inhaler three to four times per day. On examination, you note diffuse wheezing and moderate subcostal retractions. Which of the following is the next step in management?
A. Order a chest radiograph to assess for pneumonia.
B. Refer her to an allergist for allergen immunotherapy.
C. Start an oral leukotriene modifier.
D. Start a low-dose inhaled corticosteroid.
E. Start a short course of systemic corticosteroids.
E) Start a short course of systemic corticosteroids
Vocal Cord Dysfunction causes more difficulty on (inspiration/expiration). Vocal cord dysfunction is often misdiagnosed as _________.
A) inspiration, asthma
B) expiration, COPD
C) inspiration, COPD
D) expiration, asthma
A) inspiration, asthma
Which three muscles are innervated by cervical nerves via a branch of the ansa cervicalis?
A) sternothyroid m., sternohyoid m. omohyoid m.
B) sternothyroid m., sternohyoid m., thyrohyoid m.
C) sternothyroid m. omohyoid m., stylohyoid m.
D) omohyoid m., thyrohyoid m., stylohyoid m.
A) sternothyroid m., sternohyoid m. omohyoid m.