Your-Doctor Multiple Choice Questions (MCQ)

Category: Medicine--->Pulmonary Disease
Page: 6

Question 26#Print Question

A 68-year-old woman with a prior diagnosis of asthma presents to your clinic for a routine clinic visit. She complains of occasional palpitations and tremor. Her dyspnea is well controlled. Her past medical history is remarkable for hospitalization for mild congestive heart failure 2 months ago; she notes occasional postprandial acid reflux. Her medications include lisinopril, digoxin, furosemide, an intermittent short-acting inhaled beta agonist, and theophylline. She uses an over-the-counter pill (whose name she cannot remember) for the reflux symptoms. On examination her heart rate is 112 beats/minute. S1 and S2 are normal; she has a mild tremor of the outstretched hands. What is the best next step in her management? 

a. Chest x-ray to rule out exacerbation of congestive heart failure
b. Theophylline level
c. Spirometry before and after bronchodilator
d. Intermittent lorazepam 0.5 mg po tid
e. Discontinue beta agonist and substitute inhaled ipratropium

Question 27#Print Question

A 56-year-old woman presents with cough for the past 2 months and streak hemoptysis for the past 3 days. She denies dyspnea on exertion. She has smoked 2 packs of cigarettes a day for the past 35 years. She is otherwise healthy and has not lost weight. Physical examination is normal. Chest x-ray reveals a shaggy 3-cm nodule in the right mid-lung field. Transthoracic needle biopsy shows a squamous cell carcinoma. PET/CT scan confirms the hypermetabolic 3-cm nodule and shows a 1.5-cm ipsilateral hilar lymph node. Mediastinal lymphadenopathy, intraparenchymal metastases, pleural effusion and distant metastases are absent. Spirometry is normal. What is the best management option for this patient?

a. Surgical lobectomy
b. Radiation therapy
c. Combination chemotherapy
d. Endobronchial brachytherapy
e. Await development of symptoms such as pain or hemoptysis, then palliative radiation therapy or chemotherapy

Question 28#Print Question

A 43-year-old woman complains of gradually worsening dyspnea over the past year. She smokes 1 pack of cigarettes a day. She is trying to “cut back,” because her father, also a smoker, died at age 52 of emphysema. She works as an equestrian riding instructor, often with exposure to animals and hay, but has not noticed exacerbation of symptoms while at work. She has 3 healthy children, one of whom has childhood asthma. On examination, she is comfortable at rest. Her O2 saturation is 93%. She has no basilar crackles or wheezing, but her breath sounds are distant. Chest x-ray shows hyperexpansion especially prominent in the lung bases. Spirometry reveals FEV1 of 46% of predicted but near normal forced vital capacity (FVC). The ratio of FEV1 to FVC is 52%. In addition to advice about smoking cessation, what study would be most important to obtain? 

a. Sweat chloride
b. Diffusing capacity of carbon monoxide
c. High-resolution CT scan of the chest
d. Serum alpha-1 antitrypsin level
e. Hypersensitivity pneumonitis serology panel

Question 29#Print Question

A 69-year-old woman presents with complaint of chronic cough. She is a former smoker, but quit over 20 years ago. She is healthy except for hypertension, for which she takes amlodipine; she is on no other medications. The cough has been present for 6 months. She produces scant clear sputum in the morning and denies hemoptysis or weight loss. The cough is more prominent at night. It is not exacerbated by exercise or cold exposure. There is no exposure history to potential lung toxins. She denies runny nose, nasal allergies, or postnasal drip. She has occasional heartburn, promptly relieved by two tablets of calcium carbonate. Physical examination and PA/lateral chest x-ray are normal. What is the next best step in the evaluation of this patient?

a. Therapeutic trial of proton pump inhibitor
b. Bronchoscopy
c. CT scan of chest
d. Spirometry
e. Therapeutic trial of nasal corticosteroid and systemic decongestant

Question 30#Print Question

A 25-year-old healthy medical student celebrates the end of his third year with a camping and climbing trip to Colorado. He has a mild headache after flying to Denver; the next day he drives to a cabin at 10,000 ft, and the following day climbs to 13,500 ft with friends. During the climb, he becomes unduly short of breath and develops a cough productive of blood tinged sputum. He is evacuated to a clinic, where he is disoriented and in respiratory distress. His room air O2 saturation is 79%. His neck veins are flat and cardiac examination is normal except for tachycardia. He has bilateral crackles. What statement best characterizes this patient’s medical condition? 

a. Echocardiogram will show decreased left ventricular contractility
b. He is at risk of recurrence if he climbs at high altitude again
c. Nifedipine is the most important immediate treatment
d. Young age and physical fitness are protective factors
e. Acetazolamide is useful in preventing recurrence of this condition

Category: Medicine--->Pulmonary Disease
Page: 6 of 7