Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Pulmonology
Page: 11

Question 51#Print Question

A 58-year-old man with no significant medical history presents to the Emergency Department for acute abdominal pain. He is given a diagnosis of acute gastroenteritis and is discharged. Before he leaves, he is told to follow up with his primary care provider because of a small right lung opacity discovered on his chest x-ray. The opacity is 2 cm and completely surrounded by lung parenchyma. The patient is upset because he eats healthy, exercises regularly, has never smoked, and gets an annual physical examination. He denies any fatigue, night sweats, weight loss, cough, or dyspnea, and he reports no previous chest imaging.

Which of the following should be done next in the diagnostic workup?

a. CT scan
b. Biopsy of the lesion
c. Surgical excision
d. Colonoscopy
e. Observation

Question 52#Print Question

A 58-year-old woman presents to the hospital with shortness of breath. There is dullness to percussion at her lung bases, and a thoracentesis is performed. The following results are obtained.

  • Total protein (serum)   6.8 g/dL
  • LDH (serum)   75 U/L
  • Glucose (serum)   120 mg/dL
  • Total protein (effusion)   2.0 g/dL
  • LDH (effusion)   25 U/L
  • Glucose (effusion)   90 mg/dL

Based on these findings, which of the following is the most likely underlying diagnosis?

a. Nephrotic syndrome
b. Rheumatoid arthritis
c. Tuberculosis
d. Lung cancer

Question 53#Print Question

A 68-year-old woman presents to the Emergency Department with shortness of breath and right upper quadrant pain. She has a long history of hypertension and COPD, for which she takes captopril and a variety of inhaled medications including ipratropium, albuterol, salmeterol, and fluticasone. Her vitals show a temperature of 37°C, blood pressure of 102/64 mmHg, heart rate of 108 beats per minute, respiratory rate of 30 breaths per minute, and oxygen saturation of 83% on room air. When speaking, she is gasping for air in between words and using accessory muscles of respiration. Her jugular veins are distended, and she has a right ventricular heave with an S4 and a holosystolic murmur at the left lower sternal border. Breath sounds are decreased bilaterally, with scattered wheezes and rhonchi heard over the lung fields without significant rales. In addition, there is hepatomegaly and pitting edema around the ankles. An ECG shows right axis deviation with a right bundle branch block.

Which of the following could have delayed the onset of this complication?

a. Digoxin
b. Diuresis with furosemide
c. Vaccination against pneumococcus and influenza
d. Home oxygen therapy

Question 54#Print Question

A 28-year-old woman with a history of asthma presents to the Emergency Department complaining of an “asthma attack.” She regularly uses inhaled albuterol and fluticasone, but is experiencing worsening shortness of breath for the past hour and is not responding to the albuterol inhaler. She broke her tibia in a skiing accident 1 week ago and an open reduction with internal fixation was performed. She takes oral contraceptive pills but denies using any other medications. On examination, her heart rate is 115 beats per minute, her respiratory rate is 28 breaths per minute, and her oxygen saturation is 94%. There are no murmurs or abnormal lung sounds. There is a cast on her right lower leg, and the right thigh above the cast is swollen and erythematous compared to the left thigh.

Which of the following is the most likely diagnosis? 

a. Pulmonary embolism
b. Fat embolism
c. Acute asthma exacerbation
d. Viral bronchitis

Question 55#Print Question

A 24-year-old man presents with a 1-day history of shortness of breath and hemoptysis. He denies any fever or malaise, and has no significant past medical history. He does not take any medications, smoke, or use illicit drugs; he has not traveled recently or been exposed to any sick contacts. His laboratory values are shown below.

  • Hemoglobin   11.5 g/dL
  • Sodium   143 mEq/L
  • Potassium   4.8 mEq/L
  • Chloride   111 mEq/L
  • Bicarbonate   22 mEq/L
  • Blood urea nitrogen   34 mg/dL
  • Creatinine   2.9 mg/dL

Urinalysis shows 1+ protein with red blood cells and red blood cell casts. There are pulmonary infiltrates on chest x-ray, and a renal biopsy shows linear deposits of IgG along the glomerular capillaries on immunofluorescence.

What other disease process has a similar pathophysiologic mechanism to this patient’s disease?

a. Pemphigus vulgaris
b. Shellfish allergy
c. Tuberculin skin test
d. Lupus nephritis

Category: Q&A Medicine--->Pulmonology
Page: 11 of 12