Your-Doctor Multiple Choice Questions (MCQ)

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Category: Medicine--->Pulmonary Disease
Page: 4

Question 16#Print Question

A 60-year-old man has had a chronic cough with clear sputum production for over 5 years. He has smoked one pack of cigarettes per day for 40 years and continues to do so. X-ray of the chest shows hyperinflation without infiltrates. Arterial blood gases show pH of 7.38, P CO2 of 40 mm Hg, PO2 of 65 mm Hg, O2 saturation of 93%. Spirometry shows an FEV1 /FVC of 45% without bronchodilator response. Which of the following is the most important treatment modality for this patient?

a. Oral corticosteroids
b. Home oxygen
c. Broad-spectrum antibiotics
d. Smoking cessation program
e. Oral theophylline

Question 17#Print Question

A 57-year-old man presents with hemoptysis and generalized weakness. His symptoms began with small-volume hemoptysis 4 weeks ago. Over the past 2 weeks, he has become weak and feels “out of it.” His appetite has diminished, and he has lost 10 lb of weight. He has a 45-pack year history of cigarette smoking. Physical examination is unremarkable. Laboratory studies reveal a mild anemia and a serum sodium value of 118 mEq/L. Chest x-ray shows a 5-cm left mid-lung field mass with widening of the mediastinum suggesting mediastinal lymphadenopathy. MR scan of the brain is unremarkable. What is the most likely cause of his symptoms?

a. Bronchial carcinoid
b. Adenocarcinoma of the lung
c. Small cell carcinoma of the lung
d. Lung abscess
e. Pulmonary aspergilloma

Question 18#Print Question

A 42-year-old woman presents with gradually worsening dyspnea over the preceding 6 months. She has a mild nonproductive cough. She previously had been diagnosed with systemic sclerosis (scleroderma) but her skin thickening has been stable. She controls her Raynaud syndrome with amlodipine and her esophageal reflux with daily omeprazole. She has no renal disease or hypertension. On physical examination, her RR is 22/minute and resting O2 saturation is 92%. She has thickened, hide-bound skin on the face, torso, and abdomen. Lung examination shows mild “Velcro” rales in the bases bilaterally. Neck veins are flat. Cardiac examination is normal with normal P 2 and no lift or heave. Chest x-ray shows increased interstitial lung markings and a normal heart size. What is the most important next step in evaluating this patient’s dyspnea?

a. Arterial blood gas
b. 2D echocardiogram
c. Measurement of autoantibodies including anti-topoisomerase (anti-Scl) antibodies
d. Barium swallow to detect micro-aspiration
e. Non-contrast high-resolution CT scan (HRCT) of chest

Question 19#Print Question

A 30-year-old quadriplegic man presents to the emergency room with fever, dyspnea, and a cough. He has a chronic indwelling Foley catheter. Recurrent urinary tract infections have been a problem for a number of years. He has been on therapy to suppress the urinary tract infections. On examination, the patient has a temperature of 38°C (100.4°F), HR 88, and BP 126/76. Mild wheezing is audible over both lungs. A diffuse erythematous rash is noted. The chest x-ray shows diffuse alveolar infiltrates. The CBC reveals a WBC of 13,500, with 50% segmented cells, 30% lymphocytes, and 20% eosinophils. Which of the following is the most likely diagnosis?

a. Sepsis with ARDS secondary to urinary tract infection
b. Healthcare-related pneumonia
c. Drug reaction to one of his medications
d. Acute exacerbation of COPD
e. Lymphocytic interstitial pneumonitis

Question 20#Print Question

A 35-year-old woman complains of slowly progressive dyspnea. Her past history is negative, and there is no cough, sputum production, pleuritic chest pain, or thrombophlebitis. She has taken appetite suppressants at different times. Physical examination reveals jugular venous distention, a palpable right ventricular lift, and a loud P2 heart sound. Chest x-ray shows clear lung fields. Oxygen saturation is 94%. ECG shows right axis deviation. A perfusion lung scan is normal, with no segmental deficits. Which of the following is the most likely diagnosis?

a. Primary pulmonary hypertension
b. Recurrent pulmonary emboli
c. Right-to-left cardiac shunt
d. Interstitial lung disease
e. Left ventricular diastolic dysfunction

Category: Medicine--->Pulmonary Disease
Page: 4 of 7