Pulmonology 2

Which of the following is the most valuable procedure in evaluating the efficacy of treatment in an asthmatic patient?

A 4-year-old girl has had a sore throat, difficulty swallowing, and fever up to 39.5 degrees C (103.1 degrees F) for 12 hours. Physical examination reveals an anxious, toxic-appearing child with low-pitched inspiratory stridor, drooling, and mild inspiratory retractions. Which of the following is the most likely finding on xray?

Which of the following statements is true concerning the physiologic difference between a freshwater drowning versus a salt water drowning?

A 32-year-old female presents to your office with a dry cough, fever, sore throat, headache, myalgia and weakness for the past two days. The remainder of the history and physical exam is unremarkable. Which of the following is the most likely diagnosis?

A 26-year-old male with HIV and acute bilateral pneumocystis jiroveci pneumonia develops new onset atrial fibrillation. The most likely mechanism responsible for the atrial fibrillation is:

A stocky, 40-year-old male with a 20-pack/year cigarette history presents with a persistent severe cough for the past 3 months, productive of copious mucopurulent sputum. History reveals a similar cough as well as pneumonia twice last year. Physical exam reveals prolonged capillary refill in his nail beds, a normal AP chest diameter and scattered wheezes and rhonchi to auscultation. He is afebrile but EKG reveals evidence of right axis deviation, right ventricular hypertrophy. Chest films show increased markings. Your impression is:

Which of the following drugs should not be used to manage hypertension in a symptomatic asthmatic?

A 55-year-old man with diabetes of 10 years duration develops progressive lower extremity edema bilaterally and shortness of breath over a period of 3 weeks. Decreased tactile fremitus, flat percussion note, and absent breath sounds are heard over the lower 1/4 of both posterior lung fields. Urinalysis reveals 4+ proteinuria. The pulmonary findings are due to which of the following?

What is the most common cause of acute respiratory distress syndrome (ARDS)?

A 55-year-old 68-inch tall man weighing 298 pounds with a history of hypertension has excessive daytime sleepiness. He takes Vaseretic (enalapril + hydrochlorothiazide) for his blood pressure, consumes 1-2 beers per day at dinner, and has a 5 pack-year history of smoking. Which of the following is the most likely etiology of his daytime sleepiness?

Which of the following is not a likely complication in the management of patients with respiratory failure?

A patient diagnosed with hypoxic respiratory failure will have which of the following chest x-ray findings?

A 52-year-old male is admitted to the hospital with a diagnosis of pulmonary embolus and is already on heparin for anticoagulation. You make the decision to start him on Warfarin. How long will it take for the Warfarin to reach full therapeutic effect?

Which of the following is not a factor that affects the lung’s defense mechanisms for fighting off pathogens?

Atypical pneumonia presents with all the following findings except:

Which of the following laboratory tests is/are most diagnostic when evaluating a patient with suspected pneumonia?

Which of the following is not a technique for obtaining sputum that can yield a noncontaminated specimen?

Until laboratory test results are returned, pharmacologic treatment of patients with pneumonia begins:

A nonimmunocompromised patient diagnosed with viral pneumonia is currently treated with all of the following except:

Interstitial lung diseases affect all of the following areas of the lung except?

Which of the following results of a spirometry test on a 9-year-old child is indicative of moderate persistent asthma?

Which of the following is the most common etiology of mesothelioma?

A 62-year-old female comes to the office complaining of cough and shortness of breath. She states she has had a cold and cannot seem to recover from it. She is wheezing. She says she has smoked two packs of cigarettes a day for more than 40 years. She has pursed lips while breathing and a barrel chest. There are decreased bilateral breath sounds with wheezes and crackles. Lung function testing (spirometry) shows that the forced vital capacity (FVC) is reduced. The amount of air exhaled during the initial 1 second (FEV1) is reduced, and it is decreased to a greater degree than the entire FVC. Chest X-ray shows hyperinflated lungs with flattened diaphragm, hyperlucent lungs, and enlargement of the central pulmonary artery. Based on this information, from what condition is the patient most likely suffering?

An obese 40-year-old male comes to the office complaining of heartburn. He also states that he experiences dysphagia when eating certain foods, such as bread and meat. He also has a chronic dry cough, sometimes with wheezing. What is the most likely diagnosis?

In order to accurately diagnose the condition of pertussis, which of the following specimens must be analyzed by a laboratory?

A 62-year-old white female presents with sudden onset of crushing sub-sternal chest pain, shortness of breath, and hemoptysis. She underwent left hip arthroplasty two weeks ago. Electrocardiogram reveals sinus tachycardia at a rate of 115 beats per minute with no ST segment abnormality. Pulse oximetry reveals a level of 89% on room air. Laboratory findings include:

Troponin level > 0.1
D-dimer level 2.60
Blood Urea Nitrogen 38
Serum Creatinine 2.2
GFR 48

Which diagnostic study would you perform next?

A 22-year-old female presents to the emergency room with chest trauma, chest pain, and shortness of breath. The examination and chest X-ray reveal a tension pneumothorax. Due to the emergent nature of the situation, what is the first priority of treatment?

An elderly, gravely ill, 88-year-old woman with a history of sepsis presents in the intensive care unit with rapid onset of profound dyspnea. Physical examination reveals tachypnea, frothy pink sputum, diffuse crackles, and cyanosis. Chest X-ray reveals peripheral infiltrates with air bronchograms. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?

A 48-year-old male presents with productive cough, shortness of breath, fever, sore throat, headache, and body aches. Auscultation of the chest reveals expiratory rhonchi and wheezes. Chest X-ray was performed and was negative. Based on patient symptoms and physical examination, which of the following is the proper diagnosis?

A 46-year-old female presents with foul smelling, purulent sputum, hemoptysis, and chronic cough. She has had recurrent bouts of pneumonia. Auscultation of the chest reveals localized chest crackles and clubbing. High-resolution CT scan reveals dilated, tortuous airways. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?