Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Neoplasm
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Question 1# Print Question

A 34-year-old male presented to the emergency department (ED) with a chief complaint of hemoptysis. His past medical history (PMH) was notable for recurrent pneumonias. Chest x-ray (CXR) demonstrated a right middle lobe infiltrate. Chest computed tomoghraphy (CT) revealed an endobronchial lesion at the level of the bronchus intermedius. Flexible bronchoscopy was notable for bloody secretions, and a broad-based lesion in the bronchus intermedius is shown in the figure below:

What is the next most appropriate step in management?

A. Forceps biopsy
B. Rigid bronchoscopy
C. Interventional radiology (IR) embolization
D. Human immunodeficiency virus (HIV) testing

Question 2# Print Question

A 59-year-old female presents to her primary care doctor with a chief complaint of progressive shortness of breath and nonproductive cough. She denies chest pain, palpitations, or wheezing. Her PMH is notable only for right-sided inflammatory breast cancer, diagnosed 1 year prior to presentation and treated with doxorubicin/cyclophosphamide/paclitaxel followed by x-ray telescope (XRT) and mastectomy. At rest, her room air saturation is 95% and other vital signs are normal. Chest CT is negative for pulmonary embolus but notable for patchy consolidation and ground glass opacities in the right lung as well as traction bronchiectasis. Her WBC is normal and sputum gram stain shows no organisms.

What is the most appropriate treatment?

A. Ceftriaxone and azithromycin
B. Cefepime and vancomycin
C. High-dose prednisone
D. Albuterol

Question 3# Print Question

A 46-year-old male with a remote history of resected stage IIA non– small-cell lung cancer presents to the emergency room with dyspnea and chest pain. He is tachycardic, tachypneic, and hypotensive. CXR shows mediastinal lymphadenopathy and bilateral pleural effusions. Bedside transthoracic echocardiogram (TTE) was performed and an image is shown below.

What is the next most appropriate step in management?

A. Heparin
B. Cardiac surgical consult
C. Aspirin, clopidogrel, and heparin
D. Fluid resuscitation

Question 4# Print Question

A 47-year-old male with a PMH of lung cancer presents with confusion and lethargy. He has postural hypotension and low central venous pressure on examination. There is no fever, cough, sputum, or rash. The remainder of the examination is notable only for tachycardia. CXR shows a right upper lobe mass similar to prior films and mediastinal lymphadenopathy and left lower lobe nodules. Serum creatinine is 2 mg/dL. Serum calcium is 18 mg/dL and electrocardiogram EKG is shown in the figure below:

What is the most appropriate treatment?

A. Measurement of serum albumin
B. Saline and furosemide
C. Pamidronate
D. Head CT

Question 5# Print Question

A 60-year-old female was diagnosed with right-sided proximal bronchogenic carcinoma and underwent right-sided pneumonectomy 8 months ago. She presents to the ED with a 1- month history of progressive dyspnea, cough, stridor, and occasional low-grade fevers. A CT chest was performed and shown in the two figures below:

What should be the next step in management?

A. Insertion of a chest tube
B. Barium swallow study
C. IV steroids
D. Surgery

Category: Critical Care Medicine-Pulmonary Disorders--->Neoplasm
Page: 1 of 2