PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWERS ALREADY GRADED A+ 100% GUARANTEED PASS!

PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWERS ALREADY GRADED A+ 100% GUARANTEED PASS! Practice questions for this set Learn 1 / 7 Study with Learn Local: Cough, dysphonia, oropharyngeal candidiasis. Systemic: Adrenal suppression, osteoporosis, skin thinning, easy bruising and cataracts. Choose matching term 1 One Step Further Question: What are the local and systemic side effects of inhaled corticosteroids? 2 Bacterial Pneumonia Overview 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… Terms in this set (189) 3 An eight-year-old boy comes in your clinic for follow-up. Two days ago, he was diagnosed with pneumonia and started on amoxicillin-clavulanic acid. However, fever and cough persisted and is accompanied by decreased appetite, chest pain, and difficulty breathing. You suspect a complicated pneumonia. Which of the following physical exam findings is consistent with pleural effusion? Dullness to percussion Early inspiratory crackles Trachea deviates away from affected side Vesicular breath sounds 4 A new nursing home employee is being screened for tuberculosis and develops a 6 mm induration on his right volar forearm after injection of a purified protein derivative (PPD). This reading indicates prior tuberculosis exposure if he has had which of the following life circumstances? He is a former guard at a correctional facility He is a HIV-negative injection drug user He is a recent immigrant from Latin America He is an organ recipient on daily immunosuppressives Don't know? 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… 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 ( 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? COPD, Alcoholics and the elderly. 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… Bacterial Pneumonia Overview 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 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… 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 ( 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? Supine. 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… 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 ( 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. 12/15/24, 2:15 PM PULMONARY ROSH REVIEW EXAM LATEST WITH 189 ACTUAL QUESTIONS AND CORRECT VERIFIED ANSWE… Question: What is the most common location of extrapulmonary TB? 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)