Pulmonary ROSH Review Exam Newest 2026
Questions and Correct Detailed Answers Already
Graded A+
A 19-year-old man presents with a sore throat and difficulty swallowing. He has
had 4 days of worsening sore throat and fever but today he was unable to
swallow any liquids. Physical examination reveals a muffled voice, difficulty
tolerating saliva, and minimal pharyngeal erythema with a midline uvula. He also
has tenderness over the hyoid bone. Which of the following managements is most
likely indicated?
Inhaled racemic epinephrine and discharge home
Intravenous antibiotics and admission
Intravenous corticosteroids and discharge home
Needle aspiration of peritonsilar area - CORRECT ANSWER-Correct Answer ( B )
Explanation:
This patient presents with symptoms and signs concerning for epiglottitis and
should have antibiotics started and admission for further monitoring. Epiglottitis
is a localized cellulitis of the supraglottic structures including the aryepiglottic
folds, arytenoids, lingual tonsils, epiglottis and base of the tongue. It may be
caused by viral or bacterial agents (Haemophilus influenzae type b is the most
common). Although incidence in pediatric populations has decreased with the H.
,influenzae vaccine, it is becoming more common in adults and can lead to rapid
airway obstruction. Patients usually present with dysphagia, odynophagia and
sore throat. Pain may be severe in relation to physical exam findings. Additionally,
patients frequently complain of a muffled voice. Fever is present in half of cases.
Physical examination typically reveals mild inflammation in the oropharynx and
may reveal tenderness to the neck over the hyoid bone. Epiglottitis is a clinical
diagnosis but may be aided by plain radiographs of the neck, which shows edema
of the epiglottis (thumb sign). An epiglottic width greater than 8 mm or an
aryepiglottic fold greater than 7 mm suggests epiglottitis. Definitive diagnosis can
be made with indirect laryngoscopy. Management in patients focuses on
protecting the airway when necessary starting IV antibiotics (ceftriaxone and
ampicillin-sulbactam are first-line) and admission for monitoring. Supportive care
with hydration is important as well
A 25-year-old man presents for evaluation of fever and cough. He reports last
week that he was diagnosed with influenza. In the last 2 days he developed a
worsening cough productive of large amounts of sputum. Vital signs are T 101°F,
HR 98, BP 120/60, RR 18, and 95% oxygen saturation on room air. His chest X-ray
demonstrates a lobar infiltrate in the left lower lobe. Which of the following
would you most likely expect to see on the patient's Gram stain?
Gram negative bacilli
Gram negative diplococci
,Gram positive bacilli
Gram positive cocci in clusters - CORRECT ANSWER-Correct Answer ( D )
Explanation:
The patient had a recent influenza infection and now presents with a lobar
infiltrate. Staphylococcus aureus pneumonia is classically associated with causing
post-influenza bacterial pneumonia. On Gram stain this is seen as Gram positive
cocci in clusters
Question: In which population is Klebsiella pneumonia most commonly seen in? -
CORRECT ANSWER-COPD, Alcoholics and the elderly.
Bacterial Pneumonia Overview - CORRECT ANSWER-Bacterial Pneumonia
S. pneumonia: most common, rusty colored sputum, rigors, gram+ paired lancets
Klebsiella: alcoholics, currant jelly sputum, bulging fissures,
S. aureus: IVDA, postinfluenza, elderly, gram+ cocci in clusters
H. influenzae: COPD, gram negative pleomorphic rods
Pseudomonas: cystic fibrosis, nursing home resident and cyanosis
Health care associated pneumonia: pseudomonas, MRSA
Outpatient, healthy: macrolide or doxycycline
, Outpatient, comorbidity: respiratory tract fluoroquinolone (RTF)
Inpatient: RTF
ICU: antipneumococcal ß-lactam (ceftriaxone or cefotaxime) + either azithromycin
or an RTF
You evaluate a 65-year-old patient for shortness of breath and note on exam
decreased breath sounds at the left lung base. You are suspicious of a small
pleural effusion. In which of the following views on the chest radiograph is the
small pleural effusion most likely to be detected?
Lateral
Lateral decubitus left side down
Lateral decubitus right side down
Posterior-anterior (PA) - CORRECT ANSWER-Correct Answer ( B )
Explanation:
Classic physical signs of a pleural effusion include diminished breath sounds,
dullness to percussion, decreased tactile fremitus, and occasionally a localized
pleural friction rub. Chest radiograph confirms the suspicion of pleural effusion.
The classic radiographic appearance of a pleural effusion is blunting of the
costophrenic angle on the upright chest radiograph
Questions and Correct Detailed Answers Already
Graded A+
A 19-year-old man presents with a sore throat and difficulty swallowing. He has
had 4 days of worsening sore throat and fever but today he was unable to
swallow any liquids. Physical examination reveals a muffled voice, difficulty
tolerating saliva, and minimal pharyngeal erythema with a midline uvula. He also
has tenderness over the hyoid bone. Which of the following managements is most
likely indicated?
Inhaled racemic epinephrine and discharge home
Intravenous antibiotics and admission
Intravenous corticosteroids and discharge home
Needle aspiration of peritonsilar area - CORRECT ANSWER-Correct Answer ( B )
Explanation:
This patient presents with symptoms and signs concerning for epiglottitis and
should have antibiotics started and admission for further monitoring. Epiglottitis
is a localized cellulitis of the supraglottic structures including the aryepiglottic
folds, arytenoids, lingual tonsils, epiglottis and base of the tongue. It may be
caused by viral or bacterial agents (Haemophilus influenzae type b is the most
common). Although incidence in pediatric populations has decreased with the H.
,influenzae vaccine, it is becoming more common in adults and can lead to rapid
airway obstruction. Patients usually present with dysphagia, odynophagia and
sore throat. Pain may be severe in relation to physical exam findings. Additionally,
patients frequently complain of a muffled voice. Fever is present in half of cases.
Physical examination typically reveals mild inflammation in the oropharynx and
may reveal tenderness to the neck over the hyoid bone. Epiglottitis is a clinical
diagnosis but may be aided by plain radiographs of the neck, which shows edema
of the epiglottis (thumb sign). An epiglottic width greater than 8 mm or an
aryepiglottic fold greater than 7 mm suggests epiglottitis. Definitive diagnosis can
be made with indirect laryngoscopy. Management in patients focuses on
protecting the airway when necessary starting IV antibiotics (ceftriaxone and
ampicillin-sulbactam are first-line) and admission for monitoring. Supportive care
with hydration is important as well
A 25-year-old man presents for evaluation of fever and cough. He reports last
week that he was diagnosed with influenza. In the last 2 days he developed a
worsening cough productive of large amounts of sputum. Vital signs are T 101°F,
HR 98, BP 120/60, RR 18, and 95% oxygen saturation on room air. His chest X-ray
demonstrates a lobar infiltrate in the left lower lobe. Which of the following
would you most likely expect to see on the patient's Gram stain?
Gram negative bacilli
Gram negative diplococci
,Gram positive bacilli
Gram positive cocci in clusters - CORRECT ANSWER-Correct Answer ( D )
Explanation:
The patient had a recent influenza infection and now presents with a lobar
infiltrate. Staphylococcus aureus pneumonia is classically associated with causing
post-influenza bacterial pneumonia. On Gram stain this is seen as Gram positive
cocci in clusters
Question: In which population is Klebsiella pneumonia most commonly seen in? -
CORRECT ANSWER-COPD, Alcoholics and the elderly.
Bacterial Pneumonia Overview - CORRECT ANSWER-Bacterial Pneumonia
S. pneumonia: most common, rusty colored sputum, rigors, gram+ paired lancets
Klebsiella: alcoholics, currant jelly sputum, bulging fissures,
S. aureus: IVDA, postinfluenza, elderly, gram+ cocci in clusters
H. influenzae: COPD, gram negative pleomorphic rods
Pseudomonas: cystic fibrosis, nursing home resident and cyanosis
Health care associated pneumonia: pseudomonas, MRSA
Outpatient, healthy: macrolide or doxycycline
, Outpatient, comorbidity: respiratory tract fluoroquinolone (RTF)
Inpatient: RTF
ICU: antipneumococcal ß-lactam (ceftriaxone or cefotaxime) + either azithromycin
or an RTF
You evaluate a 65-year-old patient for shortness of breath and note on exam
decreased breath sounds at the left lung base. You are suspicious of a small
pleural effusion. In which of the following views on the chest radiograph is the
small pleural effusion most likely to be detected?
Lateral
Lateral decubitus left side down
Lateral decubitus right side down
Posterior-anterior (PA) - CORRECT ANSWER-Correct Answer ( B )
Explanation:
Classic physical signs of a pleural effusion include diminished breath sounds,
dullness to percussion, decreased tactile fremitus, and occasionally a localized
pleural friction rub. Chest radiograph confirms the suspicion of pleural effusion.
The classic radiographic appearance of a pleural effusion is blunting of the
costophrenic angle on the upright chest radiograph
