PULMONARY ROSH REVIEW EXAM LATEST 2024-2025 WITH
189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY GRADED A+ 100% GUARANTEED PASS!
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
CXR: blunting of the costophrenic angle
Question: A pleural effusion is most difficult to detect in which radiographic
position? - CORRECT ANSWER-Supine.
Which of the following complications can be prevented by simultaneously
administering pyridoxine and isoniazid in a patient with tuberculosis exposure?
Color blindness
Hepatitis
Peripheral neuropathy
Renal failure - CORRECT ANSWER-Correct Answer ( C )
Explanation:
Isoniazid (INH) inhibits the enzyme responsible for the conversion of pyridoxine
(vitamin B6) to one of its active metabolites, pyridoxal phosphate (PLP). This
depletion of vitamin B6 may lead to complications such as peripheral
neuropathy and seizures. Therefore, vitamin B6 should be administered
concomitantly to patients taking isoniazid. PLP is also a coenzyme required for
the synthesis of gamma-aminobutyric acid (GABA), an inhibitory
neurotransmitter. Decreased GABA formation in the setting of vitamin B6
deficiency may also contribute to seizures.
, Color blindness (A) is not a complication of INH. However, another commonly
used drug in TB, ethambutol, is associated with retrobulbar neuritis and red-
green color blindness. INH is metabolized by the liver and gets converted to an
ammonium molecule that can lead to hepatotoxicity (B). However, this is not
affected by vitamin B6 supplementation. Renal failure (D) is a complication of
pyridoxine overdose.
Question: What is the most common location of extrapulmonary TB? -
CORRECT ANSWER-Lymph nodes.
Pulmonary Tuberculosis (TB)
RFs: immunodeficiency, immigrant, close contact
Latent/primary TB: asymptomatic
Active/reactivation TB: fever, night sweats, weight loss, productive cough,
hemoptysis
Erythema nodosum
Primary TB CXR: Ghon focus
Active/reactivation TB: upper lobes, cavitary lesions
Dx: sputum smears for acid-fast bacilli (AFB), sputum/tissue culture for AFB
(gold standard)
PPD: gold standard for latent TB dx
Latent TB rx: 9 months of INH
Primary TB rx: rifampin, INH, pyraziniamide, ethambutol (RIPE)
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
189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWERS
ALREADY GRADED A+ 100% GUARANTEED PASS!
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
CXR: blunting of the costophrenic angle
Question: A pleural effusion is most difficult to detect in which radiographic
position? - CORRECT ANSWER-Supine.
Which of the following complications can be prevented by simultaneously
administering pyridoxine and isoniazid in a patient with tuberculosis exposure?
Color blindness
Hepatitis
Peripheral neuropathy
Renal failure - CORRECT ANSWER-Correct Answer ( C )
Explanation:
Isoniazid (INH) inhibits the enzyme responsible for the conversion of pyridoxine
(vitamin B6) to one of its active metabolites, pyridoxal phosphate (PLP). This
depletion of vitamin B6 may lead to complications such as peripheral
neuropathy and seizures. Therefore, vitamin B6 should be administered
concomitantly to patients taking isoniazid. PLP is also a coenzyme required for
the synthesis of gamma-aminobutyric acid (GABA), an inhibitory
neurotransmitter. Decreased GABA formation in the setting of vitamin B6
deficiency may also contribute to seizures.
, Color blindness (A) is not a complication of INH. However, another commonly
used drug in TB, ethambutol, is associated with retrobulbar neuritis and red-
green color blindness. INH is metabolized by the liver and gets converted to an
ammonium molecule that can lead to hepatotoxicity (B). However, this is not
affected by vitamin B6 supplementation. Renal failure (D) is a complication of
pyridoxine overdose.
Question: What is the most common location of extrapulmonary TB? -
CORRECT ANSWER-Lymph nodes.
Pulmonary Tuberculosis (TB)
RFs: immunodeficiency, immigrant, close contact
Latent/primary TB: asymptomatic
Active/reactivation TB: fever, night sweats, weight loss, productive cough,
hemoptysis
Erythema nodosum
Primary TB CXR: Ghon focus
Active/reactivation TB: upper lobes, cavitary lesions
Dx: sputum smears for acid-fast bacilli (AFB), sputum/tissue culture for AFB
(gold standard)
PPD: gold standard for latent TB dx
Latent TB rx: 9 months of INH
Primary TB rx: rifampin, INH, pyraziniamide, ethambutol (RIPE)
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
