Pulmonology 7

A 31-year-old woman with known HIV infection has a 3 day history of fever and cough productive of brownish-red sputum. Exam shows increased tactile fremitus and dull percussion note over the lower portion of the left posterior chest. Chest radiograph shows lobar consolidation. Which one of the following is the most likely infecting organism?

A 12-year-old asymptomatic immigrant from a developing country has a routine tuberculin skin test. The reaction is 12 mm of induration. Chest X-Ray is normal. Proper management is:

A 66-year-old man who has chronic bronchitis related to cigarette smoking has increasing episodes of wheezing and dyspnea.  He is admitted for exacerbation of COPD.  Which of the following is the preferred inhaler for COPD?

The presence of which of the following differentiates chronic bronchitis from emphysema?

A 34-year-old woman has had a dry cough for 3 weeks. Vital signs are normal.  Erythema nodosum is present on the anterior surface of the legs. Chest x-ray shows enlargement of hilar nodes bilaterally. Which of the following is the most likely diagnosis?

A 64 year old male presents complaining of worsening dry cough and exertional dyspnea. Physical exam finds inspiratory crackles on auscultation and you note clubbing of his fingers. After initial work up, a CT scan of the chest is ordered and is shown below. Which of the following is the most likely diagnosis?

A 76 year old female presents with productive cough and fever. Her family states the symptoms began 10 days ago, but have progressively worsened with increasing shortness of breath and increasing fever over the last 4 days. Physical exam finds a visibly weak patient with pallor. Auscultation finds rhonchi, right greater than left, with diminished sounds in the right lower lobe. She becomes tachypneic and hypoxic and requires intubation. A portable chest X-ray is obtained and is shown below. What is the most likely diagnosis?

Ipratropium therapy is initiated in a 71-year-old woman who has chronic obstructive lung disease. Which of the following is the pharmacologic action of this medication?

A 25 year old thin male had sudden onset of pleuritic pain and mild shortness of breath while running and presented to the ER afebrile with stable vitals. He has now become acutely short of breath and his oxygen saturation has continued to quickly drop despite high flow oxygen. A portable chest X-ray is obtained and the results are shown below. What is the most likely diagnosis?

A 60-year-old man has a 2 week history of progressive weakness without nausea or vomiting. Serum sodium concentration is 124 mEq/L. Chest radiography shows a hilar mass with mediastinal adenopathy. Which of the following is the most likely diagnosis?

A 38-year-old male presents with a history of fever cough and central chest pain for 5 days. He reports that he had recently purchased an old home in Pittsburgh and while cleaning it out he had removed a bat’s nest from the attic. On examination he appears to be in moderateddistress, has a pulse rate of 108 beats per minute, respiratory rate of 22 per minute. There are generalized crackles heard on auscultation of his chest. Chest x-ray shows diffuse infiltrates. Which of the following organisms is the most likely cause of his illness?

A 78-year-old nursing home resident with a history of chronic obstructive pulmonary disease and congestive heart failure is transported to the emergency room for evaluation of new onset of fever and cough. Sputum gram stain shows grouped gram positive cocci. Chest x-ray reveals lobar consolidation with a cavitary lesion. Which of the following is the most likely organism responsible for this patient’s illness?

A 21-year-old college student presents with a history a mild cough for the past 10 days. He reports that he had mild upper respiratory symptoms at the onset of illness, however the cough has persisted. He reports that he has a significant headache. On examination he appears well, has a pulse rate of 84 beats per minute, respiratory rate of 16 breaths per minute and a temperature of 100.4o orally. Small bullae are noted on his tympanic membranes bilaterally. His neurologic exam is normal and there are no meningeal signs. Auscultation of his lungs reveals diffuse wheezes. An interstitial infiltrate is seen on chest x-ray. Which of the following is the most likely causative organism?

A 19-year-old college student reports to the student health clinic with a history of cough and fever. He reports a history of 2 weeks of upper respiratory symptoms prior to onset of the fever, in which he had significant sore throat and hoarseness which has persisted. On examination he appears well, has a respiratory rate of 14 breaths per minute, a pulse of 78 per minute and a temperature of 100.8o orally. His posterior oropharynx is moderately erythematous. Scattered inspiratory crackles are heard throughout on auscultation of his chest. Which of the following would be the most likely organism causing his illness?

A 68-year-old male presents with a history of several months of increasing shortness of breath. It is accompanied by an occasional cough with slight whitish sputum production. The shortness of breath seems to come on when he is doing yard work. He has smoked a ½ pack of cigarettes per day since he was 20 years old. He denies any weight loss. On examination he is thin, and in no apparent distress. His respirations are 16/minute. On auscultation there are decreased breath sounds and a prolonged expiratory phase. Spirometry reveals irreversible obstruction. Which of the following would be an expected finding on his chest x-ray?

A 6-month-old male presents for his 6 month well baby check. He has lost weight since his 4 month visit, and is below the 3rd percentile for his age. He is getting over an upper respiratory infection right now. He has been hospitalized twice since birth for respiratory illnesses. His mother reports that he eats well, and has large, foul smelling greasy stools. Which of the following tests should be performed on this child at this time?

A 58-year-old male presents for an annual physical. He is a retired construction worker and has a history of exposure to asbestos. He is asymptomatic, but a chest x-ray is performed and there is a 2 cm round nodule with smooth borders in the right upper lobe. There are no other pulmonary findings. Which of the following evaluations should be performed first?

A 48-year-old female presents with a history of frequent productive cough with copious amounts of foul odored sputum for two months. She reports that she has received three courses of antibiotics which have not been helpful. She is a cigarette smoker and has a history of recurrent respiratory infections since childhood. A chest x-ray is performed and shows ring lesions and tram track lesions. Which of the following is the most likely diagnosis?

A 58-year-old male with a history of chronic alcohol abuse and cirrhosis is brought to the emergency room following a syncopal episode while mowing the lawn. He reports that he has been experiencing frequent episodes of shortness of breath and chest pain over the past weeks. Chest x-ray shows enlarged central pulmonary arteries and an ECG shows evidence of right atrial enlargement and a right ventricular strain pattern. Which of the following is the most likely diagnosis?

A 67-year-old male with a history of chronic bronchitis presents with a history of increasing shortness of breath, fatiguability, and chest pain. On examination there is jugular venous distention, a right ventricular heave, ascites and 2+ edema in the extremities. His SaO2 is 83% on room air. Which of the following findings would most likely be seen on this patient’s ECG?

A 45-year-old white male presents with sudden onset of crushing sub-sternal chest pain and shortness of breath. Electrocardiogram reveals normal sinus rhythm at 78 beats per minute with no S-T segment abnormality. Pulse oximetry reveals a level of 89% on room air. Blood test results are as follows:

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Lung VQ scan showed normal ventilation and multiple perfusion defects. Based on the patient’s presentation and test results, which of the following is the most appropriate diagnosis?

In addition to oxygen therapy, chronic alveolitis associated with pneumoconioses, such as silicosis, is treated by which of the following medications?

Which of the following medications is the gold standard medicinal treatment for sarcoidosis?

A 62-year-old chronically ill male with a history of alcohol abuse presents with cough, purulent sputum, and rigors. The patient’s sputum is noted to be the color of currant jelly. Chest X-ray confirms the presence of pneumonia. Due to the presence of currant jelly–colored sputum, which of the fol- lowing pathogens is the most likely cause of this patient’s pneumonia?

A 68-year-old male presents with cough, dyspnea, fever, chest discomfort, and sore throat. Auscultation of the chest reveals expiratory wheezes. Chest X-ray is normal. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

Isoniazid, commonly referred to as INH, is a standard maintenance medication for treatment of tuberculosis. Which of the following vitamins should be administered concurrently with INH to reduce side effects associated with this therapy?

Which of the following describes the type of shock that results from tension pneumothorax or pulmonary embolism?

A 36-year-old male presents with cough, fever, night sweats, anorexia, and weight loss. Chest X-ray reveals homogenous infiltrates, paratracheal lymph node enlargement, and cavitations. Based on the patient’s presentation, physical examination, and test results, which of the following is the most appropriate diagnosis?

After a motor vehicle accident, a 58-year-old female presents with chest pain and shortness of breath. Her initial blood pressure is 140/90 mmHg. Suddenly, the patient’s blood pressure falls to 70/40 mmHg, heart rate rises to 140 beats per minutes, and mental status becomes altered. The patient’s chest X-ray reveals a left-side tension pneumothorax. The patient is most likely experiencing:

A normally healthy 42-year-old male presents with hemoptysis, cough, focal wheezing, and recurrent pneumonia. Bronchoscopy reveals a pink to purple well-vascularized central lesion.You diagnose this patient with a carcinoid tumor. Which of the fol- lowing is the most appropriate treatment for this disorder?