Pulmonary ROSH Review Exam Newest 2026
Questions and Correct Detailed Answers Already
Graded A+
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to
your office for her annual exam. She has had her hepatitis B vaccination, but
wants to know if she needs any additional vaccinations because of her new
diagnosis. Which of the following is the most appropriate next step in her
management?
Administer annual influenza vaccine only
Administer pneumococcus and annual influenza vaccines
Administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole
The patient does not need any additional vaccines since she is up to date -
CORRECT ANSWER-Correct Answer ( B )
Explanation:
Patients with diabetes mellitus require regular monitoring and health
maintenance to prevent diabetes-related complications. Health maintenance for
these patients includes three vaccinations: annual influenza, pneumococcus
(repeated at age 65 if given prior to that age) and the hepatitis B three dose
series. Patients with diabetes mellitus require annual foot, dental and dilated eye
examinations, blood pressure monitoring, and smoking cessation counseling.
,Upon diagnosis, a serum creatinine should be drawn. Annual fasting serum lipids
and urinary albumin-to-creatinine ratios should be monitored. Hemoglobin A1C
should be obtained every 3-6 months with a goal of <7%.
Question: What is the blood pressure goal for patients with diabetes mellitus type
2? - CORRECT ANSWER-< 140/90.
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
Pleural Effusion
Transudate: CHF (most common)
Exudate: infection > malignancy, PE
↓ Breath sounds + dull percussion + ↓ tactile fremitus
Questions and Correct Detailed Answers Already
Graded A+
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to
your office for her annual exam. She has had her hepatitis B vaccination, but
wants to know if she needs any additional vaccinations because of her new
diagnosis. Which of the following is the most appropriate next step in her
management?
Administer annual influenza vaccine only
Administer pneumococcus and annual influenza vaccines
Administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole
The patient does not need any additional vaccines since she is up to date -
CORRECT ANSWER-Correct Answer ( B )
Explanation:
Patients with diabetes mellitus require regular monitoring and health
maintenance to prevent diabetes-related complications. Health maintenance for
these patients includes three vaccinations: annual influenza, pneumococcus
(repeated at age 65 if given prior to that age) and the hepatitis B three dose
series. Patients with diabetes mellitus require annual foot, dental and dilated eye
examinations, blood pressure monitoring, and smoking cessation counseling.
,Upon diagnosis, a serum creatinine should be drawn. Annual fasting serum lipids
and urinary albumin-to-creatinine ratios should be monitored. Hemoglobin A1C
should be obtained every 3-6 months with a goal of <7%.
Question: What is the blood pressure goal for patients with diabetes mellitus type
2? - CORRECT ANSWER-< 140/90.
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
Pleural Effusion
Transudate: CHF (most common)
Exudate: infection > malignancy, PE
↓ Breath sounds + dull percussion + ↓ tactile fremitus
