Pulmonology 11

A 3-year-old child has repeated lung infections. Which of the following is the preferred initial test to be performed for suspected cystic fibrosis?

A 22-year-old woman has asthma. Examination shows nasal polyps. Intake of which of the following is most likely to precipitate acute bronchospasm?

A 77-year-old man who has been on ventilator assistance for 2 weeks now has an extensive right lower lobe pneumonia. Which of the following is the most likely organism causing the pneumonia?

A 56-year-old woman has a 3 day history of fever, productive cough, and pleuritic chest pain. Examination shows a flat percussion note, decreased tactile fremitus, and decreased breath sounds over the lower right posterior chest. Which of the following is the most likely diagnosis?

A 50-year-old man has a 3 day history of fever, productive cough, and pleuritic chest pain. Examination shows a flat percussion note, increased tactile fremitus, and bronchial breath sounds over the lower left posterior chest. Which of the following is the most likely diagnosis?

The presence of which of the following differentiates chronic bronchitis from interstitial pulmonary fibrosis?

The presence of which of the following on examination of a 29-year-old man who has asthma is most likely to be associated with aspirin-induced wheezing?

A 4-year-old presents with fever, drooling and inspiratory retractions. The child sits leaning forward. Which of the following is initially indicated?

A 55-year-old man with a 55 pack-year history of smoking cigarettes has recently experienced an episode of hemoptysis along with his usual cough. On physical examination there are no abnormal findings. He has a sputum cytology examination shows atypical cells with hyperchromatic nuclei and orange-pink cytoplasm. Laboratory studies show a serum calcium of 11.3 mg/dL with phosphorus 2.1 mg/dL. Which of the following chest radiographic findings is this man most likely to have?

This 67-year-old female has been brought by her daughter complaining of abrupt onset of dyspnea and severe chest pain. The daughter states that the patient has been bed-ridden due to a right hip replacement approximately 3 weeks ago. Vital signs are BP: 140/88 mmHg right arm supine; pulse: 120 bpm (regular); respirations: 26 breaths/min (labored); temp: 99.2 degrees F (oral). Physical examination reveals an apprehensive female with a persistent cough and scant hemoptysis. Increased respiratory effort with slight intercostal retractions are noted. The chest wall is nontender. Auscultation reveals accentuation of P2 and right-sided, unilateral crackles with expiratory wheezing. No calf tenderness is present and Homan’s sign is negative. Which of the following is the most likely diagnosis?

A woman has anaphylaxis manifest by wheezing, flushing, swelling of the lips, and hypotension. In addition to epinephrine, corticosteroids, diphenhydramine, albuterol treatments and oxygen which of the following agents is used in the treatment of anaphylaxis?

A 45-year-old man who has suffers from chronic alcohol abuse has a 5 day history of fever and productive cough. Evaluation indicates that the patient has pneumonia with empyema, pus in the thorax. Which of the following is the preferred antibiotic treatment?

A 52-year-old woman with known systemic sclerosis has a 3 week history of increasing dyspnea, bilateral peripheral edema, anorexia, and nausea. Blood pressure 110/72 mm Hg, pulse 122/min/regular, and respirations 32/min. Examination reveals clear lungs, elevated jugular venous pressure, bilateral peripheral edema, and tender smooth hepatomegaly. Upon palpation of the chest for the PMI (point of maximal impulse) what is the expected finding?

A 77-year-old man who worked with asbestos in shipbuilding is at greatest risk of developing which of the following?

A 49-year-old male presents with a productive cough for the past five days. He denies a history of frequent respiratory infections but did smoke “one pack a day for about twenty years”. He quit fifteen years ago. He denies chest pain, dyspnea, chills, fever, leg edema or odor to the sputum. Pertinent positives include blood-tinged, clear colored sputum and intermittent cough with no relief from Robitussin cough syrup. He is afebrile and has normal vitals. Which one of the following is your most likely diagnosis?

A 42-year-old male with a history of HIV infection presents for a routine evaluation. He is due for a ppd test. When he returns for the reading, there is a reaction of 7 mm induration. He is asymptomatic and has a negative chest x-ray. Which of the following is the most appropriate next step in the management of this patient?

Which of the following is the inheritance pattern of cystic fibrosis?

Which of the following diagnostic studies is used in the basic evaluation of lung function pattern?

A 54-year-old male presents with poorly controlled hypertension. His wife reports that he snores loudly, and often has episodes of gasping, choking, and periods of time when it seems he is not breathing. Which of the following statements is true regarding this patient’s condition?

A 64-year-old female with a history of chronic bronchitis presents with a history of increasing cough, fever, and thick green sputum production for three days. On examination she is coughing frequently, but does not appear to be in any acute distress, her respirations are 16/minute and her pulse ox is 94% on room air. Coarse rhonchi and wheezes are heard throughout all lung fields. Her chest x-ray shows increased interstitial markings and peribronchial cuffing, but no evidence of pneumonia. Which of the following bacteria is most likely to be the causative organism of this patient’s condition?

Which of the following medications is used in provocative testing to diagnose asthma?

Which of the following represents a restrictive pattern of impairment during pulmonary function testing (PFT)?

Which of the following is the main treatment goal for patients diagnosed with either type of respiratory failure?

An 81-year-old female with a history of breast cancer presents with a complaint of shortness of breath. Examination reveals decreased breath sounds, dullness to percussion, and egophony over the right lung. Her oxygen saturation is 88% on room air, previous records show no evidence of lung disease. Which of the following is the most likely cause of her symptoms?

A 14-year-old female presents to the emergency room with an acute asthma attack. Her parents report that her usual quick relief medications are not helping her symptoms. She is obviously short of breath, with audible wheezing, and is unable to speak in complete sentences. Which of the following findings would be considered most ominous on physical exam?

Which of the following conditions is usually associated with an increased functional residual capacity?

A 7-year-old female presents with a 10 day history of cough and sputum production. On examination she appears well, has a temperature of 99.4o orally, and a SaO2 of 97% on room air. Rales are heard over the right and left lungs. A chest x-ray demonstrates interstitial infiltrates. Which of the following is the most appropriate treatment for this patient?

A 21-year-old male is admitted to the hospital for management of severe burns of his face and chest. On the second day of hospitalization he develops severe dyspnea. On examination his temperature is 98.2o, his respiratory rate is 34 breaths per minute and his SaO2 drops from 93% to 82%, and does not respond to supplemental oxygen. Rales are heard bilaterally on auscultation of the chest. A chest x-ray shows bilateral infiltrates. Which of the following is the most likely diagnosis?

A 5-year-old female is brought to the emergency room with acute shortness of breath after eating a peanut butter sandwich. On examination she is hypotensive, and tachypneic. There is angioedema, generalized urticaria and expiratory wheezing is heard. Which of the following is the most appropriate initial intervention?

A thin, 15-year-old male presents with acute chest pain, shortness of breath, and one-sided chest expansion.Auscultation of the chest reveals diminished breath sounds on the right side. Chest X-ray reveals a visceral pleural line. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?