Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Pulmonology
Page: 3

Question 11#Print Question

A 62-year-old man presents to the clinic with dyspnea on exertion. He reports a progressive decline in his exercise tolerance over the last few years, and complains that he feels like he is always coughing up white mucus. He denies any fever, weight loss, hemoptysis, chest pain, or leg swelling. His medical history is significant for hyperlipidemia and GERD, for which he takes atorvastatin and omeprazole. He has smoked a pack of cigarettes daily for the past 40 years. He is afebrile with normal vitals. On examination, he has decreased breath sounds with a prolonged expiratory phase and scattered wheezes. There is hyper-resonance to percussion in bilateral lung fields. The rest of the examination is unremarkable, and he is referred for further testing with spirometry.

Which of the following represents the likely flow–volume loop in this patient (Figure below)? 

a. Option A
b. Option B
c. Option C
d. Option D

Question 12#Print Question

A 42-year-old woman presents with progressive fatigue over the past few weeks. She reports muscle fatigue, occasional double vision, and some difficulty breathing. She has no relevant past medical history and takes no medications. On examination, sustained upward gaze leads to muscle fatigue and bilateral ptosis. Pulmonary function testing is performed and is shown below.

  • FEV1    85% of predicted
  • Forced vital capacity (FVC)    85% of predicted
  • FEV1/FVC      105% of predicted
  • Total lung capacity (TLC)    70% of predicted
  • Diffusion capacity of the lung for carbon monoxide (DLCO)    100% of predicted

Which of the following is responsible for this patient’s pattern on pulmonary function testing?

a. Chronic obstructive pulmonary disease
b. Neuromuscular disease
c. Pulmonary fibrosis
d. Pulmonary hemorrhage

Question 13#Print Question

A 68-year-old woman with a history of hypothyroidism and COPD presents for follow-up with her primary care physician. She has no complaints and denies any recent fatigue, weight loss, increase in cough or sputum production, or chest pain. Her medications include inhaled ipratropium and levothyroxine. She is normotensive with an SaO2 of 92% on room air. On examination, her lungs are hyper-resonant to percussion with some scattered wheezes and rhonchi. She has clubbing of the digits, which was not present 1 year ago.

What is the most appropriate next course of action? 

a. Reassurance and regular follow-up
b. Home oxygen therapy
c. Pulmonary function tests
d. Chest imaging

Question 14#Print Question

A 46-year-old man with a history of ulcerative colitis is admitted to the hospital with abdominal pain and heavy rectal bleeding. Initial laboratory samples are drawn, and his hemoglobin is measured at 6 g/dL. He is given IV methylprednisolone and 2 units of packed red blood cells. Three hours later, the patient complains of shortness of breath and is given supplemental oxygen at an FiO2 of 30%. He appears anxious and is gasping for breath while speaking. There is no jugular venous distention or murmurs on cardiac examination. An arterial blood gas shows a PaO2 of 55 mmHg and a PaCO2 of 36 mmHg. A chest x-ray shows fluffy opacities in both lung fields with a normal cardiac silhouette

What intervention should be performed next?

a. Transfuse more units of packed red blood cells
b. Diuresis with furosemide
c. Intubation and positive end-expiratory pressure (PEEP)
d. Plasmapheresis

Question 15#Print Question

A 52-year-old man presents to his physician with complaints of cough and difficulty breathing during exercise. He also endorses weight loss and night sweats that he noticed over the past few months. The patient has a history of diabetes and takes metformin. He works at a stone quarry, does not smoke or drink alcohol, and does not use any illicit drugs. A chest x-ray shows multiple small nodules in the upper lobes of each lung and multiple areas of calcification around lymph nodes.

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

a. Measure serum angiotensin-converting enzyme
b. Systemic corticosteroids
c. Administer a tuberculin skin test
d. Lung biopsy

Category: Q&A Medicine--->Pulmonology
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