Pulmonology 3

Which of the following is the most common etiologic agent of community-acquired pneumonia in the general population?

Multinodular infiltrates in the apex of the lung accompanied by cavitation as seen on chest x-ray is classically associated with which of the following?

Histoplasmosis is caused by:

A 12-year-old boy with cystic fibrosis has frequent lung infections. Which of the following is the most likely pulmonary complication?

Your patient is a 40-year-old male who had a positive PPD skin test on this year’s physical examination. His medical records indicate a prior negative PPD. Which of the following is the next step in the management of this patient?

The drug of choice for treating Pneumocystis carinii pneumonia (PCP) is:

A 22-year-old male with shortness of breath and a nonproductive cough presents to your office. You have seen the patient in the past and know he is a long time IV drug user. The patient’s temperature is 103.5 degrees F, respiration 40/minute, O2 sat 90% on non-rebreather mask and pulse 140/bpm. Physical exam reveals a thin dyspneic male in moderate respiratory distress, scattered rhonchi, and peripheral cyanosis. Chest x-ray reveals diffuse interstitial and alveolar infiltrates. LDH level is very high. The most probable diagnosis is:

A 58-year-old male returns from a business convention with anorexia, malaise, and a minimal cough that is nonproductive. He has a fever of 103.7 F, respirations are 22/min, and pulse rate 55 bpm. Exam reveals dry oral membranes and rales over the right base. Chest x-ray shows bilateral pulmonary infiltrates. WBC count is 17,000, Serum sodium is 124 mEq/L. What is the antibiotic of choice?

A 65 year-old smoker presents with multiple small 3 mm lesions scattered across both lungs, previous chest X-ray shows similar findings. What is the recommended follow up?

A 23-year old-male with a 1-week history of a URI presents to the office with sharp, lateral chest pain, increasing with inspiration. No history of cough. Lungs are clear to auscultation, no tenderness to palpation. CXR is normal. O2 saturation is 98%. Of the following, choose the best diagnosis and treatment.

The signature findings on a chest x-ray in interstitial lung disease progress over time. In the early stage of the disease, a chest x-ray can disclose a ground-glass appearance that changes to a honeycombed appearance due to all of the following processes except?

Treatment goals for patients diagnosed with interstitial lung disease should include all of the following except?

Which of the following is the therapeutic mainstay for interstitial lung disease?

A 72-year-old male presents with a complaint of progressively worsening dyspnea over several years. He reports that initially he noticed it only when he was doing heavy yard work, but now it seems to be occurring even when he is at rest. He has never been a smoker. He is a retired ship builder. On examination he appears thin and in no acute distress. There are fine inspiratory crackles in the lower lung fields bilaterally. On auscultation of his heart there is an accentuated pulmonary component of the second heart sound. A chest x-ray shows reticulonodular infiltrates and linear streaking at the bases of the lungs and pleural calcifications. Which of the following is the most likely diagnosis?

All of the following symptoms can be seen in patients with hypoxic respiratory failure or hypercapnic respiratory failure except?

Treatment goals for patients diagnosed with respiratory failure depend on all of the following except?

The patient with hypoxic respiratory failure may have x-ray findings that show which of the following?

The main treatment goal for patients diagnosed with either type of respiratory failure is:

Which of the following results in exacerbations of COPD but has an insignificant role in the etiology for development of COPD?

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

A 26-year-old male presents with spontaneous, acute chest pain and shortness of breath. Auscultation of the chest reveals diminished breath sounds on the right side. Chest X-ray reveals the accumulation of air in the pleural space without mediastinal shift. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?

A 58-year-old male presents with progressive shortness of breath and excessive cough with sputum production. Auscultation of the chest reveals decreased breath sounds, early inspiratory crackles, and prolonged expiration. Chest X-ray reveals hyperinflation and flat diaphragm. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?

A 9-year-old female presents with cough, excess sputum, sinus pain, nasal discharge, diarrhea, and abdominal pain. Physical examination reveals clubbing and apical crackles. Thin-section CT reveals bronchiectasis. Chest X-ray reveals hyperinflation and mucous plugging. Based on the patient’s presentation, history, and test results, which of the following is the most accurate diagnosis?

Which of the following types of bacteria is most likely to colonize the lungs and cause pneumonia in a patient with a history of alcohol abuse?

A 2-year-old female presents with a barking, seal-like cough, hoarseness, and a low-grade fever. Chest X-ray of this child shows a “steeple sign” at the midline. Based on the symptoms and the X-ray interpretation, which of the following is the most appropriate diagnosis?

A 15-year-old female patient states during a routine physical examination that she has been experiencing pain in the left, anterior side of her chest. The pain is sharp, comes on suddenly, and resolves completely after 10 to 30 seconds. It does not radiate, and is not accompanied by tachycardia, vertigo, syncope, or other symptoms. The patient states that she remains still and takes shallow breaths until the pain resolves. Based on the patient’s symptoms, the most likely diagnosis is?

A 68-year-old male presents with shortness of breath, retrosternal chest pain, weakness, fatigue, ascites, and cyanosis. Physical examination reveals narrow splitting and accentuation of the second heart sound and a systolic ejection click. Chest X-ray reveals enlarged pulmonary arteries. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

A 68-year-old African-American female presents with generalized weakness and fatigue, persistent low-grade fever, and shortness of breath. Lab work and radiographic exams lead to a diagnosis of sarcoidosis. Which of the following is the proper course of treatment for this disorder?

A 38-year-old male presents with cough, purulent sputum, shortness of breath, fever, and sweats. Auscultation of the chest reveals altered breath sounds and crackles. Cultures of respiratory secretion were positive for Streptococcus pneumonia. Chest X-ray of the patient reveals lobar infiltrates, air bronchograms, and pleural effusions. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

A 48-year-old female health-care worker presents with a six-day history of cough, sweats, fever, chest pain, and chills. Physical examination reveals altered breath sounds, crackles, and bronchial breath sounds. Culture of respiratory secretions was positive for Eschericia coli bacteria. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?