PULMONARY ROSH REVIEW EXAM |
(WITH RATIONALES) NEWEST ACTUAL
EXAM COMPREHENSIVE QUESTIONS
AND VERIFIED ANSWERS GRADED A+ |
100% CORRECT | 2024 UPDATE!!
A 29-year-old man with a history of HIV presents with shortness of
breath and fever. He has a productive cough but denies hemoptysis.
You obtain the chest radiograph seen above. Which of the following is
true regarding the patient's diagnosis?
Elevated LDH is common
Spread is by the hematogenous route
Steroids should be administered prior to antibiotics if the PaO2 is <80
Trimethoprim-sulfamethoxazole is the treatment - ✔✔✔ Correct
Answer > Correct Answer ( B )
Explanation:
The chest radiograph demonstrates miliary tuberculosis (TB), or acute
disseminated tuberculosis. The term miliary was first used to describe
the pathologic lesions seen on radiography that appeared as small
millet seeds. Miliary TB occurs when the host is unable to contain a
recently acquired or a dormant TB infection. The condition was mostly
,seen in young children after primary infection but now is more
common in the elderly and in persons infected with HIV. Spread of the
mycobacteria occurs through the hematogenous route, which leads to
the multisystem nature of miliary TB. Clinically, patients develop many
of the similar signs and symptoms of active pulmonary TB—fever,
weight loss, anorexia, and weakness. Hemoptysis is uncommon. The
classic miliary pattern seen in the radiograph is present in
approximately 50% of cases. Hyponatremia is sometimes seen from the
development of SIADH. Mortality rates are higher than for other forms
of TB, which is likely due to a delay in treatment.
Elevated LDH (A) commonly occurs in Pneumocystis jiroveci
pneumonia. Also with Pneumocystis jiroveci pneumonia, steroids (C)
should be administered prior to antibiotics when the PaO2 is <70 or the
A-a gradient is >35. Trimethoprim-sulfamethoxazole (D) is the
treatment for Pneumocystis jiroveci pneumonia. Treatment of miliary
TB is the same as pulmonary TB.
Question: What is the most common bacterial cause of pneumonia in
hospitalized patients? - ✔✔✔ Correct Answer > S. pneumoniae.
Which of the following characteristics of transfusion-related acute lung
injury (TRALI) differentiates it from transfusion-associated circulatory
overload (TACO)?
High fever
Hypertension
,Hypoxemia
Pulmonary edema - ✔✔✔ Correct Answer > Correct Answer ( A )
Explanation:
Transfusion-related acute lung injury (TRALI) complicates transfusions
in 1 of every 5,000 units of PRBCs. Although rare, it is associated with
high mortality. The pathophysiology is thought to be due to an acute
neutrophilic response that leads to endothelial damage and massive
capillary leak in the pulmonary vasculature. The diagnosis is clinical
with patients presenting with signs and symptoms of acute lung injury
or acute respiratory distress syndrome. TRALI is characterized by
hypoxemia (oxygen saturation <90% on room air), and bilateral
pulmonary infiltrates presenting within 6 hours of blood transfusion.
There should not be any evidence of pulmonary artery hypertension or
generalized fluid overload. Hypotension, tachycardia, and fever are
common. Fever is not common in transfusion-associated circulatory
overload (TACO). Treatment of TRALI is supportive, with low tidal
volumes for mechanical ventilation and maintenance of euvolemia.
Despite the initial appearance of fluid overload, these patients are
normovolemic or intravascularly depleted secondary to the increase in
vascular permeability and extravasation. Diuresis may lead to further
deterioration and shock.
Question: What is the choroidal tubercle? - ✔✔✔ Correct Answer >
A granuloma in the choroid of the retina that is specific for
disseminated TB.
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)
Latent TB dx: PPD or interferon-gamma release assay
Latent rx: 9 months of INH
Primary rx: Rifampin, INH, Pyrazinamide, Ethambutol (RIPE)
A 26-year-old man presents with a 2-week history of fever and a cough.
He was diagnosed with HIV four months ago and is not on any
antiretroviral medications. His vital signs are BP 122/76, HR 78, RR 16,
oxygen saturation 92% on room air, and temperature 99.2°F. Chest X-
ray demonstrates diffuse interstitial infiltrates bilaterally. Given this
presentation, it is suspected that he has pneumonia secondary to
Pneumocystitis jiroveci. Which of the following antibiotics is used to
treat suspected pneumonia caused by Pneumocystitis jiroveci?
Azithromycin
Clindamycin
(WITH RATIONALES) NEWEST ACTUAL
EXAM COMPREHENSIVE QUESTIONS
AND VERIFIED ANSWERS GRADED A+ |
100% CORRECT | 2024 UPDATE!!
A 29-year-old man with a history of HIV presents with shortness of
breath and fever. He has a productive cough but denies hemoptysis.
You obtain the chest radiograph seen above. Which of the following is
true regarding the patient's diagnosis?
Elevated LDH is common
Spread is by the hematogenous route
Steroids should be administered prior to antibiotics if the PaO2 is <80
Trimethoprim-sulfamethoxazole is the treatment - ✔✔✔ Correct
Answer > Correct Answer ( B )
Explanation:
The chest radiograph demonstrates miliary tuberculosis (TB), or acute
disseminated tuberculosis. The term miliary was first used to describe
the pathologic lesions seen on radiography that appeared as small
millet seeds. Miliary TB occurs when the host is unable to contain a
recently acquired or a dormant TB infection. The condition was mostly
,seen in young children after primary infection but now is more
common in the elderly and in persons infected with HIV. Spread of the
mycobacteria occurs through the hematogenous route, which leads to
the multisystem nature of miliary TB. Clinically, patients develop many
of the similar signs and symptoms of active pulmonary TB—fever,
weight loss, anorexia, and weakness. Hemoptysis is uncommon. The
classic miliary pattern seen in the radiograph is present in
approximately 50% of cases. Hyponatremia is sometimes seen from the
development of SIADH. Mortality rates are higher than for other forms
of TB, which is likely due to a delay in treatment.
Elevated LDH (A) commonly occurs in Pneumocystis jiroveci
pneumonia. Also with Pneumocystis jiroveci pneumonia, steroids (C)
should be administered prior to antibiotics when the PaO2 is <70 or the
A-a gradient is >35. Trimethoprim-sulfamethoxazole (D) is the
treatment for Pneumocystis jiroveci pneumonia. Treatment of miliary
TB is the same as pulmonary TB.
Question: What is the most common bacterial cause of pneumonia in
hospitalized patients? - ✔✔✔ Correct Answer > S. pneumoniae.
Which of the following characteristics of transfusion-related acute lung
injury (TRALI) differentiates it from transfusion-associated circulatory
overload (TACO)?
High fever
Hypertension
,Hypoxemia
Pulmonary edema - ✔✔✔ Correct Answer > Correct Answer ( A )
Explanation:
Transfusion-related acute lung injury (TRALI) complicates transfusions
in 1 of every 5,000 units of PRBCs. Although rare, it is associated with
high mortality. The pathophysiology is thought to be due to an acute
neutrophilic response that leads to endothelial damage and massive
capillary leak in the pulmonary vasculature. The diagnosis is clinical
with patients presenting with signs and symptoms of acute lung injury
or acute respiratory distress syndrome. TRALI is characterized by
hypoxemia (oxygen saturation <90% on room air), and bilateral
pulmonary infiltrates presenting within 6 hours of blood transfusion.
There should not be any evidence of pulmonary artery hypertension or
generalized fluid overload. Hypotension, tachycardia, and fever are
common. Fever is not common in transfusion-associated circulatory
overload (TACO). Treatment of TRALI is supportive, with low tidal
volumes for mechanical ventilation and maintenance of euvolemia.
Despite the initial appearance of fluid overload, these patients are
normovolemic or intravascularly depleted secondary to the increase in
vascular permeability and extravasation. Diuresis may lead to further
deterioration and shock.
Question: What is the choroidal tubercle? - ✔✔✔ Correct Answer >
A granuloma in the choroid of the retina that is specific for
disseminated TB.
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)
Latent TB dx: PPD or interferon-gamma release assay
Latent rx: 9 months of INH
Primary rx: Rifampin, INH, Pyrazinamide, Ethambutol (RIPE)
A 26-year-old man presents with a 2-week history of fever and a cough.
He was diagnosed with HIV four months ago and is not on any
antiretroviral medications. His vital signs are BP 122/76, HR 78, RR 16,
oxygen saturation 92% on room air, and temperature 99.2°F. Chest X-
ray demonstrates diffuse interstitial infiltrates bilaterally. Given this
presentation, it is suspected that he has pneumonia secondary to
Pneumocystitis jiroveci. Which of the following antibiotics is used to
treat suspected pneumonia caused by Pneumocystitis jiroveci?
Azithromycin
Clindamycin
