Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Pulmonology
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Question 1# Print Question

A 68-year-old woman is hospitalized for an acute exacerbation of chronic obstructive pulmonary disease (COPD). She responds well to treatment and is discharged. At her follow-up appointment, she states that she has been compliant with treatment but has had 2 acute exacerbations in the last 9 months. In addition to COPD, her medical history is significant for hypertension, hyperlipidemia, and atrial fibrillation. She takes hydrochlorothiazide, simvastatin, diltiazem, and salmeterol. She also takes inhaled albuterol and ipratropium as needed. She does not smoke, is up to date with the appropriate vaccinations, and is undergoing pulmonary rehabilitation. Her vitals are taken: blood pressure 132/86 mmHg, heart rate 87 beats per minute, respiratory rate 16 breaths per minute, and oxygen saturation 94% on room air.

Which of the following is the most appropriate next step in management?

A. Add theophylline
B. Add inhaled fluticasone
C. Add oral prednisone
D. Start home oxygen therapy
E. No change

Question 2# Print Question

A 33-year-old alcoholic man is hospitalized for fever, chills, and cough productive of currant jelly sputum. Blood and sputum cultures are drawn, and a chest x-ray is consistent with lobar pneumonia. Urine toxicology screen and a serum ethanol level are negative. After being admitted and started on empiric antibiotics, he continues to decompensate and becomes more hypoxemic based on pulse oximetry. 

Which of the following choices best represents the pathophysiologic parameters seen in this patient? (Note: A–a gradient is Alveolar– arterial gradient; FiO2 is the fraction of inspired oxygen.)

A. (A)
B. (B)
C. (C)
D. (D)

Question 3# Print Question

A 62-year-old woman presents to the hospital with shortness of breath. She has a history of HIV infection and was recently hospitalized for PCP pneumonia and was discharged 3 days ago in stable condition on oral antibiotics. After discharge, she started to experience a headache and subsequently developed worsening shortness of breath. The rest of her medical history is significant for hypertension, diabetes, peripheral arterial disease, hypothyroidism, and gastroesophageal reflux disease (GERD). Her regular medications include aspirin, amlodipine, hydrochlorothiazide, metformin, levothyroxine, and pantoprazole. She has not been compliant with her antiretrovirals. Her allergies include trimethoprim–sulfamethoxazole and penicillin. She drinks alcohol moderately and has a 30 pack-year smoking history. On examination, she has a temperature of 37.6°C, blood pressure of 158/96 mmHg, heart rate of 86 beats per minute, and respiratory rate of 26 breaths per minute. There are no murmurs or jugular venous distention, and there are no wheezes or rales on pulmonary examination. There is blue discoloration of her digits and lips. An arterial blood gas shows a normal PaO2, although the blood has a brownish discoloration.

Which of the following is the most likely diagnosis?

A. Chronic obstructive pulmonary disease
B. Bronchiectasis
C. Acute respiratory distress syndrome
D. Carbon monoxide poisoning
E. Methemoglobinemia

Question 4# Print Question

A 19-year-old boy complains of difficulty breathing during exercise. He reports being in good physical shape, but occasionally experiences coughing and have to stop and catch his breath. This seems to occur more often in cold weather. The patient has no significant medical history other than seasonal allergies, and he takes no medication. He has some patchy dry skin over the elbows with some erythema and excoriations; otherwise the physical examination is normal. He is referred for spirometry, which is normal.

Which of the following is the most appropriate next step in management?

A. Albuterol challenge
B. Methacholine challenge
C. Chest x-ray
D. Allergen skin testing
E. Trial of albuterol

Question 5# Print Question

A 38-year-old woman presents to the hospital with fever, cough, and shortness of breath. On imaging, a lobar pneumonia is confirmed, but a lung mass is also noted. She is treated with antibiotics and at a later time the mass is biopsied via bronchoscopy. Eventually the patient is discharged to follow up as an outpatient. The biopsy report suggests a benign lesion, and the patient agrees to have the lesion followed with imaging. Several months later, the patient presents with difficulty breathing for a few weeks. Her vitals are normal, but inspiratory and expiratory stridor is heard along with rhonchi on lung auscultation. There are no wheezes or rales. Examination of the oropharynx is unremarkable. Spirometry with flow-volume loops shows a plateau during inspiration and expiration, with decreased peak inspiratory and expiratory flow.

What is the most likely diagnosis?

A. Subglottic stenosis
B. Carcinoid tumor
C. Viral bronchiolitis
D. Postobstructive pneumonia

Category: Q&A Medicine--->Pulmonology
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