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Which of the following are the organisms most likely to produce epiglottitis in children under the age of three years?
A 19-year-old man who has cystic fibrosis has a 1 week history of increasing breathlessness, weight gain, and bilateral peripheral edema. Examination shows increased jugular venous pressure, bilateral scattered rhonchi, an enlarged, smooth, and tender liver, and 2+/4 bilateral ankle edema. Which of the following is the most likely diagnosis?
A known HIV seropositive patient presents to the emergency center with abrupt onset of pleuritic chest pain, fever, and a productive cough with blood-tinged sputum. Which of the following organisms would you most likely suspect?
A 15-year-old boy who has asthma is advised to use an inhalation spacer device when inhaling medication. Using the spacer will decrease the incidence of which of the following?
A 14-year-old asymptomatic boy has recently immigrated from a country known to have a high incidence of tuberculosis. After evaluation, latent tuberculous infection is diagnosed for which isoniazid therapy is initiated. The patient and parents should be advised that which of the following are the most likely symptoms to represent and adverse effect of the isoniazid?
A 59-year-old woman with a long history of cigarette smoking has newly diagnosed angina pectoris. Which of the following is the preferred inhaled medication for treatment of breathlessness from her lung disease?
A 45-year-old male presents with a 40 pack year smoking history complaints of a chronic cough productive of mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it to a “smoker’s cough”. He has been coughing up a lot of sputum lasting all winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination reveals a moderately obese male in no acute respiratory distress. Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. Which of the following is the most likely diagnosis?
A 14-year-old girl has asthma that is triggered by exposure to certain pollens. Which of the following is the mechanism of action of cromolyn sodium?
Which of the following is the most common sign/symptom of an acute pulmonary emboli with infarction?
A 66-year-old woman has had a worsening non-productive cough with malaise for the past week. Her temperature increases to 99.6 degrees F. A chest radiograph reveals diffuse bilateral pulmonary interstitial infiltrates in all lung fields. A sputum gram stain reveals normal flora and few neutrophils. She recovers over the course of the next two weeks. Infection with which of the following organisms most likely caused her illness?
A 28-year-old male presents with a complaint of acute shortness of breath. On examination his blood pressure is 90/62, he has distended neck veins and his trachea is deviated to the right. Breath sounds are absent on the left. Which of the following is the correct location to perform a needle decompression?
A 58-year-old male presents with an acute onset of shortness of breath for one day. He denies any previous symptoms. On examination there is decreased tactile fremitus and dullness to percussion over the bases. On chest x-ray there is blunting of the costophrenic angles bilaterally. Thoracentesis removes fluid that proves to be exudative in nature. Which of the following diagnoses is the most likely cause of the effusion?
A 48-year-old male presents to the emergency room with a complaint of drooping of his left eyelid for one day. On further questioning you learn that he has had left shoulder pain radiating down his arm for several weeks. On examination his left pupil is miotic, and there is a left supraclavicular mass. Which of the following is the most likely diagnosis?
A 59-year-old male presents to the emergency room with a history of headache and swelling of the head for several hours. On examination he appears very flushed and there is edema of his face, neck and upper extremities. The superficial veins of his head, neck and chest appear distended. Which of the following is the most likely etiology of his symptoms?
A 63-year-old male presents with a history of several weeks of cough and hemoptysis. He has had 3 episodes of pneumonia in year. Chest x-ray reveals a 4 cm pulmonary nodule that was not present on his last chest x- ray 6 months ago. The nodule is fully excised and biopsy reveals that the nodule is a bronchial carcinoid tumor. Which of the following statements is true regarding the future management of this patient?
A 36-year-old female presents to her primary care clinician with a complaint of shortness of breath. She states that it initially started when she was working out at the gym, but now seems to be present even when she is at rest. The symptoms have been steadily increasing over the past year. She has had a 15 pound weight loss during this time. She denies fever, chills, cough or night sweats. She has never smoked. Spirometry reveals an obstructive pattern that does not improve with administration of a bronchodilator. Her chest x-ray shows flattened diaphragms and multiple bullae. Which of the following laboratory tests should be evaluated in this patient?
A 2-month-old male is brought to the pediatrician’s office for evaluation of cough and wheezing. His mother reports that her other two children have had “colds” and she thought that he was just getting the same thing. She reports he had rhinorrhea and fever for two days, but this morning he awoke with cough and seemed to be having difficulty breathing. On examination he appears to be in moderate distress, is breathing 54 breaths per minute with nasal flaring and intercostal retractions. There is prolonged expiration and diffuse wheezes heard on auscultation. A chest x-ray shows hyperinflation of the chest. Which of the following is the most likely causative organism of this infant’s illness?
A 58-year-old male with pancreatic cancer is admitted for a pulmonary embolus. He is started on a bolus of heparin with a plan to titrate the dose according to his response. Which of the following ranges is the correct goal of treatment for this patient?
A 68-year-old female developed a pulmonary embolus following a femur fracture. She is discharged home on warfarin. She has no other underlying risk factors for DVT. How long should she remain on warfarin?
A 7-year-old female asthmatic patient presents for increasing asthma symptoms. She is currently taking budesonide 180 mcg twice daily and albuterol 2 puffs as needed. Her mother reports that she is requiring use of the albuterol at least 5 days out of the week, and awakens from sleep 3-4 nights with symptoms. Which of the following is the most appropriate next step in the management of this child?
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?
A 22-year-old female presents to the emergency room with acute onset of ipsilateral chest pain and shortness of breath. Chest X-ray reveals a large pneumothorax. Current vitals are stable with 96% O2 sat on room air. After starting the patient on supplemental oxygen, which of the following is the proper course of treatment?
A 25-year-old man who is addicted to heroin has a lung abscess caused by an infected vegetation embolus related to acute tricuspid valve endocarditis. Which of the following is the most likely organism causing the lung abscess?
A 34-year-old male presents with sudden “sharp” chest pain of his right chest and mild dyspnea. These symptoms began suddenly while he was sitting at home watching TV. He denies any trauma or precipitating events but he had been playing basketball as the center earlier today. He denies a history of similar symptoms. He does not take any medications on a regular basis. Vital signs show tachycardia and tachypnea with SpO2 of 87% on room air. Physical examination reveals a nontender chest wall with decreased breath sounds, decreased tactile fremitus, and hyperresonance in the right middle lobe area. What is the most likely cause of this condition?
A 59 year-old male is traveling to the mountains of Peru for a 6 week medical mission, he is requesting a medication to help prevent altitude sickness, what recommended medication do you prescribe?
A previously healthy 12-year-old boy presents to the emergency department with a three week history of a progressively worsening cough. He does not appear extremely ill. Oral temperature is 99.4 degrees F. Pulse oximetry results are 99% on room air. Physical exam is significant for a injected, bulging left eardrum, injection of the pharyngeal mucosa without exudates, and rales at the left posterior lung base. CXR shows a small area of patchy infiltrate but no evidence of effusion. Which of the following is the most appropriate therapy?
An infant male is born at 24 weeks gestation. Which of the following agents should be administered to reduce the incidence of hyaline membrane disease?
A 24-year-old prison guard presents with a complaint of 4 weeks of fatigue, cough, fever, and night sweats. He reports a 15 pound weight loss over this time as well. The cough was initially dry; however, it is now productive with blood streaked sputum. Rales are heard on pulmonary exam. Which of the following is most likely to be seen on his chest x-ray?
A 3-year-old female is brought to the emergency room for a severe cough. It has been going on for three days but is worse at night. Her mother reports that it is a very barky cough, but it seemed to improve when they took her outside to the car. On examination the child is in moderate distress with frequent coughing that has a barking like quality to it. Her respirations are 28/minute and her pulse rate is 124/minute. Which of the following is the most appropriate treatment for this patient?
A 7-year-old child is brought in to the emergency room for severe sore throat for one day. On examination you observe a child in moderate distress who sitting in the tripod position and is drooling profusely. Which of the following should be your next step in management of this patient?