Pulmonology 9

A 57-year-old man who has suffers from chronic alcohol abuse has a 3 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 most likely organism causing the pneumonia?

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 shows elevated jugular venous pressure, bilateral peripheral edema, and tender smooth hepatomegaly. Which of the following is the most likely diagnosis?

The basic effect of hyperventilation on the body is what?

A 45-year-old woman has a dry cough. Chest radiography shows bilateral hilar adenopathy. Serum angiotensin converting enzyme level is elevated. Which of the following is the most likely abnormality to be noted on physical examination?

A 36-year-old woman has a 5 day history of fever and productive cough. Examination shows dullness to percussion, decreased tactile fremitus, and decreased breath sounds over the lower left posterior chest. Which of the following is most likely present?

Upon auscultation of a patient’s lungs, there are harsh, hollow breath sounds which have a long inspiratory component in the region of the suprasternal notch. Throughout the periphery of the lung fields, softer breath sounds are heard. Which of the following best describes these findings?

A woman with chronic bronchitis has an acute respiratory infection causing the patient to be in severe respiratory distress. Which of the following is the most likely arterial blood gas values to be noted in the patient?

A 63-year-old woman has small cell carcinoma of the lung associated with the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). Which of the following is the most likely laboratory abnormality to be noted in the patient?

Which of the following occurs as a result of pulmonary hypertension?

Pulse oximetry may produce falsely high (normal) readings in the presence of what condition?

A 17-year-old man has fever and an incessant dry cough. A diagnosis of Mycoplasma pneumonia is made. Which of the following is the preferred initial therapy?

A 39-year-old woman presents with 2 months of dry cough and intermittent low-grade fever. She is a non-smoker and has no significant family history or past medical history. A purified protein derivative (PPD) test and HIV test were recently performed at work and was negative. On physical examination she is afebrile with stable vital signs. Lung auscultation reveals crackles in bilateral upper lobes. Chest x-ray shows hilar and mediastinal adenopathy, mild interstitial disease in the upper lung zones, and several small granulomas in both lungs. What is the most likely diagnosis?

Which of the following disease processes is most likely to cause the development of a lung abscess?

You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility?

A 4-year-old child is brought to the emergency department by his mother due to an acute onset of fever, throat pain, drooling, difficulty speaking, and inspiratory stridor. Which of the following is the most probable diagnosis?

A 13-year-old male is brought to the emergency room with a complaint of coughing and wheezing. He reports he choked on some popcorn at the movies earlier today. He had a brief episode of coughing and choking and then felt that he was fine. Several hours later he developed a recurrent cough and wheeze that has not stopped for the past 45 minutes. On examination he is in moderate distress, having difficulty speaking in complete sentences. There is inspiratory stridor and wheezing heard in the left side of the chest, and a chest x-ray shows that there is hyperexpansion of the right lung. Which of the following is the most appropriate next step?

A 28-year-old male is admitted to the burn unit with multiple second degree burns involving his chest and face. 24 hours after admission he develops acute onset of dyspnea and pleuritic chest pain. On examination his respiratory rate is 26 breaths per minute, his pulse is 118 beats per minute, and his SaO2 is 88% on room air. Diffuse rales are heard on auscultation. His symptoms worsen, despite treatment with supplemental oxygen. Chest x-ray reveals bilateral large infiltrates. CBC shows a mild leukocytosis and B type natriuretic peptide is normal. Which of the following is the most likely diagnosis?

A 3-year-old female is brought in by her parents for a routine follow up appointment for asthma. They report that she is using her albuterol inhaler for wheezing every day and awakens from sleep with symptoms at least one night out of the week. She is not taking any other medications. On examination she appears well. Her resperations are 14 breaths per minute and her chest is clear to auscultation. Which of the following would be the most appropriate next step in the management of this patient?

A 4-year-old female presents to the emergency department with a history of high fevers and cough for 1 day. She had been seen by her pediatrician 10 days earlier and diagnosed with influenza, but her symptoms had been slowly improving up until today. On examination she has a fever of 102.1o, a respiratory rate of 32 breaths per minute, and a heart rate of 128 beats per minute. There are decreased breath sounds and crackles over the right middle and lower lung fields. Chest x-ray shows a right lower lobe infiltrate. Which of the following organisms is the most likely cause of her pneumonia?

A 64-year-old male former smoker, with a 20 pack year smoking history is found to have a solitary pulmonary nodule which was not present on a chest x-ray taken one year ago. The radiologist comments that it has “popcorn” calcifications. Biopsy reveals that it is a hamartoma. Which of the following would be the most appropriate next step in the management of this patient?

A 55-year-old male presents with a complaint of progressively worsening dyspnea over the past 6 months. He reports mild cough with clear sputum production. On examination his respirations are 18 breaths per minute, his pulse is 88 per minute, and his SaO2 is 92% on room air. He is thin, and has decreased breath sounds throughout. Chest x-ray shows hyperinflation, flattened diaphragms and multiple blebs. Pulmonary function tests show a reduced FEV1 to FVC ratio. Which of the following would be the most appropriate treatment for this patient?

A 48-year-old female with a history of breast cancer presents to the emergency room with severe dyspnea that has developed over the past few days. Chest x-ray reveals large bilateral pleural effusions. Measurement of which of the following components of the fluid is helpful in differentiating between a transudative and an exudative effusion?

A 48-year-old male construction worker with a history of diabetes mellitus presents with a history of productive cough, fever, dyspnea and diarrhea. On examination he has a temperature of 101.4o, respirations of 18 breaths per minute, and a pulse rate of 106 beats per minute. There are decreased breath sounds and crackles on the right lower lung fields. Gram stain of the sputum shows few polymophonuclear leukocytes and no bacteria. His chest x-ray shows a right lower lobe cavitary lesion. Which of the following is the most likely cause of his pneumonia?

A 2-week-old female is brought to the emergency room for fevers, irritability and poor feeding. She was born at 38 weeks via uncomplicated spontaneous vaginal delivery. Chest x-ray reveals that she has a lobar pneumonia. Which of the following would be the most appropriate treatment?

A 34-year-old G1PO female presents with signs and symptoms of preterm labor at 30 weeks gestation. Administration of which of the following medications to her will most likely enhance fetal lung maturity and reduce the incidence of respiratory distress syndrome in the infant?

A 67-year-old male retired stone mason presents with a complaint of mild dyspnea on exertion. His examination is normal, but a chest x-ray shows multiple rounded opacities, and “eggshell calcification” of the peripheral hilar lymph nodes. Which of the following is the most likely diagnosis?

A 48-year-old cattle farmer presents with a complaint of gradual onset of cough, dyspnea on exertion, malaise, myalgias and a 15 pound weight loss over the past 4 months. His symptoms have progressively worsened over this time. On examination he appears thin, but in no apparent distress. There are bibasilar crackles on examination. Chest x-ray reticulo-nodular infiltrates. CT scan shows air trapping and ground glass attenuation. Pulmonary function tests show a mixed obstructive and restrictive pattern. Which of the following is the most likely diagnosis?

A 72-year-old retired construction worker presents with a complaint of dyspnea and right sided nonpleuritic chest pain for three months. On examination there is a 20 pound weight loss since his previous visit 6 months ago. There is dullness to percussion and decreased breath sounds on the right side. A chest x-ray shows pleural thickening and a small pleural effusion. Which of the following is the most likely diagnosis?

A 64-year-old male new patient presents for a “routine check-up.” He reports that he has had a chronic productive cough for that has been present for 4 years, and that his previous doctor had diagnosed him with chronic bronchitis and advised him to stop smoking and gave him an inhaler. He has continued to smoke and his symptoms have progressively worsened. On examination he is obese, and appears to be in no acute distress. On auscultation of the lungs coarse rhonchi are heard throughout. A chest x-ray shows diffuse interstitial markings. Which of the following laboratory abnormalities is most likely to be seen in this patient?

A 68-year-old male presents with a complaint of 6 weeks of progressive dyspnea on exertion and nonproductive cough. On examination he appears to be in mild distress, and has a respiratory rate of 24 breaths per minute. There are bibasilar crackles. A chest x-ray shows patchy reticular infiltrates, predominantly at the bases. Pulmonary function tests are performed and he has a reduced total lung capacity, and a normal FEV1/FVC ratio. Which of the following is the most likely diagnosis?