A
A 22-year-old college student presents with occasional episodes of wheezing and shortness of breath over the past 3 months, occurring once or twice a week. She reports no nocturnal symptoms. Her episodes often resolve on their own within minutes and are usually triggered by cold air or exercise. She has no comorbidities or allergies. Physical examination is normal . Spirometry: Normal lung function
Which of the following is the best initial treatment?
•Inhaled short-acting beta₂ agonist as needed
•Daily inhaled long-acting beta₂ agonist
•Daily oral leukotriene receptor antagonist
•Daily low-dose inhaled corticosteroid
•Inhaled short-acting beta₂ agonist as needed
A 69-year-old man develops acute shortness of breath, tachycardia, and mild chest discomfort two days after a laparoscopic colectomy for colon cancer. He reports bilateral calf tenderness. Physical examination shows clear lungs and mild left lower quadrant tenderness. HR 110, BP 135/78, Temp 37.2, Oxygen saturation 90% on room air . Laboratory testing reveals no leukocytosis.
•Atelectasis
•Pulmonary embolism
•Pneumonia
•Myocardial infarction
•Pulmonary embolism
A 53-year-old man comes to the office because of a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum. His temperature is 38.5°C (101.3°F), pulse is 96/min, respirations are 26/min, and blood pressure is 98/62 mm Hg. Examination shows increased fremitus and bronchial breath sounds over the right middle lung field. An x-ray of the chest shows consolidation of the right upper lobe. Which of the following is the most likely causal pathogen?
•Mycobacterium tuberculosis
•Pseudomonas aeruginosa
•Legionella pneumophila
•Streptococcus pneumoniae
•Streptococcus pneumoniae
What is The most important and initaial treatment for Chronic obstructive Pulmonary disease ?
•Azithromycin
•Stop Smoking
•Oxygen supplemnt
•Aminophylline
•Stop Smoking
A 46-year-old man presents with fatigue, low-grade fevers, and a productive cough occasionally streaked with blood for two months. He recently arrived from a region with high tuberculosis prevalence. Physical examination reveals crackles in the left upper lung field , Chest X-ray: Cavitary lesion in the left apex
•Which of the following isolation measures is most appropriate for this patient?
•Contact precautions with gowns and gloves
•Standard precautions only
•Droplet precautions with surgical masks
•Negative-pressure room with N95 respirators for staff
•Negative-pressure room with N95 respirators for staff
25-year-old man reports fatigue, as well as difficulty falling and staying asleep for the past year. He goes to bed at 10 p.m. every night, does not fall asleep until midnight, and awakens four to five times per night, usually to find that his bedding is disheveled. Upon waking , he feels unrefreshed. He reported symptoms include frequent snoring, worsening concentration and memory, and frequent depressed mood. no witnessed apneas, morning headaches, nocturnal paresthesias, or significant psychosocial stressors. his BMI is 31, and his neck circumference is 43 cm.
Which one of the following evaluations is most appropriate for this patient?
•A 2-week sleep diary completed by the patient
•Referral to an otolaryngologist for consideration of flexible laryngoscopy
•Multiple Sleep Latency Test
• In-laboratory polysomnography
• In-laboratory polysomnography
A 56-year-old man presents with sudden onset shortness of breath and hemoptysis two days after an open cholecystectomy. He reports mild right-sided chest discomfort. Physical examination shows no calf edema . Vitals : HR 112, BP 125/72, RR 28, SpO2 89% On room air . ECG: Sinus tachycardia without ischemic changes , Chest X-ray: Normal cardiac silhouette; no obvious consolidation
Which diagnostic test is most appropriate to confirm the most likely diagnosis?
•CT pulmonary angiography
•Conventional pulmonary angiography
•D-dimer measurement
•Lower extremity venous Doppler ultrasound
•CT pulmonary angiography
Which of the following is diagnostic of pulmonary arterial hypertension:
•Echocardiography.
•V/Q scan.
•Right heart catheterization.
•CT angiography
•Right heart catheterization.
A 29-year-old African-American woman comes to the physician because of a 4-month history of fever, progressive shortness of breath, and a dry cough. During this time, she has also had a 5-kg (11-lb) weight loss. Two months ago, she was in Kenya for several weeks to visit her family. Physical examination shows fine crackles and wheezing over both lung fields. Her serum calcium concentration is 11.8 mg/dL. An x-ray of the chest shows reticular opacities in both lungs and bilateral hilar lymphadenopathy.
Which of the following is the most likely underlying mechanism of this condition?
•Necrotizing inflammation
•Granulomatous inflammation
•Bronchial hyperresponsiveness
•Neoplastic transformation
•Granulomatous inflammation
70-year-old male heavy smoker patient has shortness of breath with obstructive pattern on pulmonary function tests with partial reversibility (less than 12%) and flow volume lobes showing scooped-out pattern with normal inspiratory portion, chest x-ray showed hyperinflated chest, what is the most likely diagnosis?
- Bronchial asthma
- Pneumonia
- Pulmonary embolism
- COPD
- COPD
A previously healthy 60-year-old man presents with progressively worsening shortness of breath for the past 2 months. He does not experience shortness of breath at rest. He also occasionally has a dry cough. He has smoked one pack of cigarettes daily for the past 40 years. He is vitally stable . Lung auscultation reveals a prolonged expiratory phase and end-expiratory wheezing.
Spirometry shows an FEV1:FVC ratio of 62% after bronchodilator inhalation, an FEV1 of 60% of predicted, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?
•Interstitial lung disease
•Chronic obstructive pulmonary disease
•Bronchiectasis
•Bronchial asthma
•Chronic obstructive pulmonary disease
56-year-old man presents with a productive cough for five months each year over the past two years. He has a 30 pack-year smoking history and mild dyspnea on exertion. He reports daily sputum production, occasionally streaked with blood. Scattered wheezes and coarse crackles are heard on auscultation.Saturation 94% On room air .
Which historical feature most strongly supports the classic definition of this patient’s primary condition?
•Nighttime breathlessness relieved by a short-acting bronchodilator
•Productive cough for at least three months annually over two successive years
•Recurrent hemoptysis requiring antibiotic treatment
•Daily sputum production lasting less than three months per year
•Productive cough for at least three months annually over two successive years
A 64-year-old man presents with a three-month history of progressive cough, occasional hemoptysis, and a 6-kg weight loss to the Outpatient Clinic. He has a 35-year smoking history and experiences mild shortness of breath on exertion. He denies fever, night sweats, or chills. Physical examination shows decreased breath sounds in the right upper zone. Laboratory tests show a normal white cell count and normal CRP. A sputum culture yields no growth of typical pathogens (see reports). Chest X-ray: Persistent right upper lobe consolidation unchanged after antibiotics Bronchoalveolar lavage: Atypical epithelial cells
Which of the following diagnoses best explains these findings?
•Organizing pneumonia
•Lung Abscess
•Bronchogenic carcinoma
•Pulmonary tuberculosis
•Bronchogenic carcinoma
A 34-year-old woman comes to the ER because of midsternal chest pain, shortness of breath, and cough with bloody sputum for the past 3 hours. The pain started after moving furniture at home and worsens when taking deep breaths. She has smoked one pack of cigarettes daily for the past 20 years. Current medications include an oral contraceptive. Her temp is 38.2°C , HR is 110/min, RR 20/min, and BP is 110/70 mm Hg. oxygen saturation 92% on room air . Examination shows decreased breath sounds over the left lung base. There is calf pain on dorsal flexion of the right foot. Examination of the extremities shows warm skin and normal pulses.
Further evaluation is most likely to show which of the following findings?
•Thrombus in the left atrium on TEE
•Wedge-shaped opacity on CT scan of the chest
•Widespread ST elevation on ECG
•Tracheal deviation on x-ray of the chest
•Wedge-shaped opacity on CT scan of the chest
A 24-year-old tall, slender man presents to the ER with sudden onset of left-sided chest pain and difficulty breathing that began one hour ago. The pain is sharp and worsens with inspiration. He denies trauma or recent illness. Examination shows decreased breath sounds on the left side, hyperresonance to percussion, and no wheezing . Vitals : HR 105, BP 122/76, RR 24, Temp 37, SpO2 94% On room air .
•Chest radiograph: Large lucent region in the left hemithorax with absent vascular markings
Which of the following is the most likely diagnosis?
•Pleural effusion
•Pulmonary embolism
•Pneumonia
•Spontaneous pneumothorax
•Spontaneous pneumothorax
A 72-year-old man is found unconscious with labored breathing and is brought to the hospital. He is diagnosed with a large subdural hematoma, and intubation is planned.
Which one of the following early interventions is most likely to minimize this patient’s risk for developing ventilator-associated pneumonia?
•Initiate prophylactic treatment with a respiratory fluoroquinolone
•Maintain the patient at a heavy level of sedation
•Keep the head of the patient’s bed elevated between 30 and 45 degrees
Use nasogastric intubation
•Keep the head of the patient’s bed elevated between 30 and 45 degrees