PULM Q AND A
WhichbuinterventionbuisbuthebucornerstonebuofbuARDSbutreatment?bu-buanswer--
Mechanicalbuventilation
Abupatientbupresentsbuwithbuincreasingbushortnessbuofbubreath.buOnbuexaminationbutherebu
arebudecreasedbubreathbusoundsbuonbutheburightbuwithbuhyperresonancebutobupercussion.b
uTherebuisbutrachealbudeviationbutobuthebuleft.buOfbuthebufollowingbuwhichbuinterventionbuisbui
ndicated?bu-buanswer--Needlebudecompression
Abu29buyearbuoldbuPAbuhasbubeenbuexposedbutobuabupatientbuwithbucavitarybupulmonarybutub
erculosisbu1bumonthbuago.buHebudeniesbuanybusymptoms.buHisbuphysicalbuexaminationbuisb
unormal.buAbutuberculinbuskinbutestbureactionbuisbupositivebunowbuatbu5mm.buHisbuskinbutestbu
onebuyearbuagobuwasbunegative.buAbuchestbuX-
raybuisbuwithinbunormalbulimitsbuandbuchemistrybupanelbuisbunormal.buThebumostbuappropriat
ebumanagementbuoptionbuforbuthisbupatientbuis:bu-buanswer--Isoniazide
Whichbuofbuthebufollowingbuisbumostbuappropriatebuforbuabuchildbuwithbususpectedbuforeignbu
bodybuaspiration?bu-buanswer--Bronchoscopy
InbuHIVbuinfectedbupersons,buabutuberculinbuskinbutestbureactionbuisbuconsideredbupositivebui
fbuitbuisbu-buanswer--Anbuindurationbugreaterbuorbuequalbutobu5mm
Abu74buyear-
oldbumalebuwithbuabuhistorybuofbucoronarybuarterybudiseasebuandbuatrialbufibrillationbupresent
sbutobuthebuclinicbuforbufollow-
upbuofbuhisbushortnessbuofbubreath.buPatient'sbumedicationsbuincludebuamiodaronebu(Cord
arone)buandbumetoprololbu(Lopressor).buHisbuchestbux-rayburevealsbupatchybuground-
glassbuinfiltrates.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?bu-
buanswer--Pulmonarybufibrosis
Abu42buy/
obufemalebuwasbuinitiallybuseenbuinbuthebuEDbuwherebushebuwasbudiagnosedbuwithbuinfluenz
abuandbudischargedbuwithbuabucoughbusuppressant.buShebupresentedbubackbufourbudaysbula
terbuforbuseverebuSOBbuandbuhypoxemia.buCXRbushowedbubilateralbuinterstitialbuinfiltratesb
uandbupatient'sbuSaO2buwasbubelowbu80%buonbu~100%buNRB.buWhatbuisbuthebumostbuappr
opriatebunextbustep?bu-buanswer--Intubationbuandbumechanicalbuventilation
Abu60buy/
obumalebuwhobuisbus/
pbuORIFbuofbuthebuleftbuhipbupresentsbuwithbuacutebuonsetbuofbushortnessbuofbubreathbuwithbu
exertion.buOnbuphysicalbuexam,buhebuappearsbuanxiousbuandbutachypneic.buHisbutemperat
urebuisbu37.8°Cbu(100°F),bupulsebuisbu120bubeatsbuperbuminute,burespirationsbuarebu24/
minbuandbulabored,buandbubloodbupressurebuisbu140/90bummbuHg.buLungsbuarebuclearbutobua
uscultationbubilaterally.buCardiacbuexamburevealsbuanbuincreasedbupulmonicbucomponentb
uofbuS2.buECGburevealsbuabuSbuwavebuinbuleadbuI,buabuQbuwavebuinbuleadbuIII,buandbuTbuwavebu
changesbuinbuleadbuIIIbu-buanswer--SpiralbuCTbuofbuthebuchest
,Abu22-year-
oldbumalebupresentsbuwithbuabu2buweekbuhistorybuofbuanbuURTI.buHebuhasbubeenbutakingbuam
oxicillinbuforbu6budays.buHebuisbustillbuc/
obumalaise,busorebuthroat,busubjectivebufever,buandbuabunonproductivebucough.buPhysicalbu
examburevealsbudiffusebucrackles.buWhatbuisbuthebuMOSTbuappropriatebuclassbuofbuantimic
robials.bu-buanswer--Macrolide
Abu24-year-
oldbuuniversitybustudentbucomesbutobuthebuStudentbuHealthbuServicebuwithbuabu3-
daybuhistorybuofbuabudrybuhackingbucoughbuthatbuwasbuinitiallybunonproductivebubutbuhasbube
comebuproductivebuofbuscant,buwhitebusputum.buAlsobuc/
obuofbumalaise,buheadache,bufever,bumusclebuaches,buandbupains.buShebuhadbunobuotherbuu
pperburespiratorybutractbusymptomsbubeforebuthisbuillnessbuHerburoommatebudevelopedbuth
ebusamebusymptomsbu2budaysbuago.buOnbuexamination,buthebupatientbuhasbuabutemperatur
ebuofbu39buC.buYoubuhearbuabufewbuscatteredbucracklesbuinbuthebuleftbulungbubase.buNobuother
buabnormalitiesbuarebufound.buWhatbuisbuthebumostbulikelybudiagnosisbuinbuthisbupatient?bu-
buanswer--Mycoplasmabupneumoniae
Abuchildbupresentsbuwithbuabubarkingbucoughbuandbumildbustridorbuafterbuhebuhadbuabulowbugr
adebufeverbuandbuthebuprodromebuofbuupperburespiratorybutractbusymptoms.buCXRbuisbubelo
wbu(steeplebusign).buThebumostbucommonbucausebuofbuthisbuconditionbuis:bu-buanswer--
Parainfluenzabuvirus
19buyrbuoldbuasthmabupatientbucomesbutobuyourbuofficebuwithbucomplaintsbuofbuwheezingbusy
mptomsbutwicebuperbuweek.buWhatbuisbuthebunextbubestbustepbuinbumanagement?bu-
buanswer--Shortbuactingbubetabuagonist
Whatbuisbuthebuinitialbudiagnosticbustepbuinbuabupatientbuwithbuabulargebupleuralbueffusion?bu-
buanswer--Thoracentesis
Abu21buyear-
oldbumalebupresentsbutobuthebuEDbuwithbuincreasingbudyspneabuandbupleuriticbuchestbupainb
uofbusuddenbuonsetbuafterbugettingbuhitbuinbuthebuleftbusidebuofbuthebuchestbuduringbuabubarbufig
ht.buExaminationburevealsbumoderateburespiratorybudistressbuwithbuabsencebuofbubreathbus
oundsbuandbuhyperresonancebutobupercussionbuonbuthebuleft,buwithbutrachealbudeviationbut
obutheburight.buWhichbuofbuthebufollowingbuisbuthebumostbuappropriatebunextbustep?bu-
buanswer--Insertbulargebuborebuneedlebuintobuleftbu2ndbuICSbustat
Forcedbuvitalbucapacityburefersbuto:bu-buanswer--
Measurementbuofbuthebuvolumebuofbuairflowbuexpiredbuwithbuthebupatientbubreathingbuasbuh
ardbuandbuasbufastbuasbupossible
Abu55-year-
oldbuwoman,buheavybucigarettebusmokerbupresentsbuwithbucomplaintsbuofbuleftbueyebuswelli
ng,budrybueyes,buandbuleftbushoulderbupain.buYoubunoticebuthatbuthebupatient'sbuleftbueyelidbui
sbudrooping,buherbuconjunctiabuarebudrybuandbuherbuleftbupupilbuappearsbusmallerbuthatbutheb
uright.buShebualsobuappearsbutobuhavebuleftbusidedbuanhidrosis.buShebualsobuhasbuseverebule
ftbushoulderbupainbuwithbucertainbumovements.buHerbuCXRbuisbuseenbubelowbu(obacitybuinbu
RUL,bushadowingbualongbuouterbubordersbuofbulungbufields):buConsideringbuthesebufinding
,sbuyoubususpectbu-buanswer--
Pancoast'sbuSyndromebufrombuabuBronchogenicbuCarcinoma
Abupatientbuundergoesbuanbuultrasound-
guidedbuthoracentesisbuafterbuhebuisbufoundbutobuhavebuabulargebuloculatedbupleuralbueffusi
onbuonbudecubitusbuchestbux-
ray.buThebufluidbuisbuamberbuandbucloudybuwithbuabupHbuofbu7.3,buLDHbu800IU/
L,buglucosebu65bumg/dl,butotalbuproteinbu5.5bug/dl,buWBCbu1,300/
mm3.buSerumbustudiesbudonebuthebusamebudaybuincludeabuLDHbuofbu155buIU/
L,buglucosebu99bumg/dl,buandbutotalbuproteinbu7.0bug/
dl.buCytology,bugrambustain,buandbuculturebuofbuthebupleuralbufluidbuarebupending.buWhichbuo
fbuthebufollowingbuisbuthebumostbuaccuratebustatementburegardingbuthebupleuralbufluidbuanaly
sis?bu-buanswer--Thebufluidbuisbuanbuexudate
Abu66-year-
oldbumanbuwithbuabuknownbuhistorybuofbuchronicbuobstructivebupulmonarybudisease(COPD)
bupresentsbutobuthebuclinicbuforbuevaluationbuofbuprogressivebushortnessbuofbubreath.buHebuh
adbuanbuupperburespiratorybuinfectionbu2buweeksbuago,buandbuthebusymptomsbuhavebugotte
nbuworse.buOnbuphysicalbuexamination,buyoubufindbuthatbuhebuisbuhavingbuanbuacutebuexacer
bationbuofbuhisbuCOPD.buOnbugeneralbusurveybuofbuthisbupatient,buyoubuwouldbuexpectbutobus
eebuhimbu-buanswer--Sittingbuupbuandbuleaningbuforwardbuwithbuarmsbubraced
Anbuasymptomaticbu60buyear-
oldbufemalebuwithbuabu30bupackbuyearbuhistorybuofbusmokingbupresentsbutobuthebuclinicburequ
estingbuabuchestbux-
raybutobucheckbuforbulungbucancer.buWhichbuofbuthebufollowingbudobuyouburecommend?bu-
buanswer--Nobutestingbuandbureferralbuforbusmokingbucessation
Abu68buy/
obumalebuisbudiagnosedbuwithbusmallbucellbulungbucancer.buWhichbuofbuthebufollowingbutreat
mentbuoptionsbucouldbubebuconsideredbuinbuthisbupatient?bu-buanswer--
Combinationbuchemotherapy
58-year-
oldbuchronicbualcoholbumalebupatientbuisbufoundbuwonderingbuonbuthebustreetbuandbubrought
butobuthebuemergencybudepartmentbubybuparamedics.buThebupatientbuhasbuabuhighbufever,bu
coughbuproductivebuofburedbucurrentbusputum,buandbudifficultybubreathing.buExaminationbu
ofbuthebuchestburevealsbuwheezesbuandburalesbuoverbuthebuleftbulowerbuzonebuandbuabuchestb
ux-
raybufilmbuconfirmsbupneumonia.buGrambustainbuofbuthebusputumburevealsburatherbulargebug
ram-
negativebubacteriabuandbumanybuwhitebubloodbucells.buWhichbuofbuthebufollowingbuisbuthebum
ostbulikelybupathogen?bu-buanswer--Klebsiellabupneumoniae
Abu14buyear-
oldbumalebupresentsbutobuthebuEDbuexperiencingbuabuseverebuasthmabuattack.buHisburespira
torybueffortbuisbushallowbuandbuhebuisbuusingbuaccessorybumusclesbutobubreathe.buAuscultati
onbuofbuhisbuchestburevealsbunobuaudiblebuwheezing.buVitalbusignsbuincludebuBPbu90/60bum
mHg,buPbu160bubpm,buRRbu52.buAnbuarterialbubloodbugasbu(ABG)buisbuordered.buNormalbuA
BGbuvaluesbuatbuyourbuinstitutionbuarebupHbu7.35-7.45,buCO2bu35-45,bupO2bu80-
, 95.buWhichbuofbuthebufollowingbuABGbufindingsbusuggestsbuthebupoorestbuprognosis?bu-
buanswer--pHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56
Abu34-
yearbuoldbublackbufemalebupresentsbutobuyourbuofficebuwithbusymptombuofbucough,budyspne
a,buandbulymphadenopathy.buPhysicalbuexambushowsbucervicalbuadenopathybuandbuhepat
omegaly.buHerbuCXRbuisbushownbubelow.buHowbushouldbuyoubupursuebuthebudiagnosis?bu-
buanswer--BronchoscopybuandbuTransbronchialbulungbubiopsy
Whichbuofbuthebufollowingbuisbuthebumostbulikelybucomplicationbuofbuabupneumoniabucausedb
ubybuMycoplasmabupneumoniae?bu-buanswer--Bullousbumyringitis
Abu40buy/
obumalebupresentsbuwithbushortnessbuofbubreath,bupainfulbuskinbunodules,bublurredbuvision,b
uandbumalaise.buCXRburevealsbubilateralbuhilarbuadenopathybuandburightbuparatrachealbuno
debuenlargement.buHistologybuofbuskinbuandbulungburevealsbuthebufindingbuofbunoncaseatin
gbugranulomas.buWhichbuofbuthebufollowingbuisbuthebubestbutreatmentbuoptionbuinbuthisbupati
ent?bu-buanswer--Oralbuprednisone
Abu22-year-
oldbumanbuisbubroughtbutobuthebuEDbuafterbubeingbufoundbuunconsciousbuinbuabuswimmingbu
pool.buThebupatientbuisbumildlybucyanotic.buThebuBPbuisbu80/50bummbuHg,buHRbuisbu60/
min,buandbuRRbuisbu26/
min.buHisbucorebubodybutemperaturebuisbu89buF.buPupilsbuarebu4bummbubilaterallybuandbureac
tive.buThebupatientbuisbumovingbuallbuextremitiesbuandburespondsbuappropriatelybutobuquesti
ons.buCracklesbuarebuheardbubilaterallybuonbulungbuauscultation.buPulsebuoximetrybureveal
sbuabusaturationbuofbu94%buonbu50%buO2.buCXRburevealsbubilateralbuperihilarbuinfiltratesbuwi
thbuabunormalbusizedbuheart.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?
bu-buanswer--Noncardiogenic bupulmonarybuedema
Abu30buyear-
oldbupatientbupresentsbuwithbuabuthreebuyearbuhistorybuofbuepisodicbuofbuwheezing,budyspne
abuandbudrybutobuminimallybuproductivebucough.buThesebuepisodesbuarebutypicallybuworsebu
atbunightbuandbuduringbuthebufallbuandbuspringbuseasons.buThebupatientbuadmitsbutobuabulongb
uhistorybuofbuallergiesbuandbutobaccobuuse.buExamburevealsbunumerousbunasalbupolyps,bux
eroticbuskinbuandbuexpiratorybuwheezesbuinbubilateralbulungbufields.buTherebuisbunobucyanosi
sbuorbuabnormalbuheartbusoundsbunoted.buHisbupulmonarybufunctionbutestburevealsbuabulowbu
FEV1/
FVCburatio.buWhichbuofbuthebufollowingbuclassbuofbumedicationsbuwouldbubebubestbutobutreatb
uanbuacutebuexacerbationbuofbuthisbudisorder?bu-buanswer--Betabuagonists
Abu46-year-
oldbuwomanbucomplainsbuofbusuddenbuanxietybuandbubreathlessness.buShebuhasbubeenbuat
bubedburestbuforbu2buweeksbuforbubackbupain.buShebuusesbuoralbucontraceptives.buAllbuofbutheb
ufollowingbuwouldbubebusuggestivebuofbuabupulmonarybuembolismbuEXCEPT:bu-buanswer--
Temperaturebuofbu103.1F
Whichbuofbuthebufollowingbuisbumostbuconsistentbuwithbuaburestrictivebulungbudiseasebuonbus
pirometry?bu-buanswer--DecreasedbuFVC
WhichbuinterventionbuisbuthebucornerstonebuofbuARDSbutreatment?bu-buanswer--
Mechanicalbuventilation
Abupatientbupresentsbuwithbuincreasingbushortnessbuofbubreath.buOnbuexaminationbutherebu
arebudecreasedbubreathbusoundsbuonbutheburightbuwithbuhyperresonancebutobupercussion.b
uTherebuisbutrachealbudeviationbutobuthebuleft.buOfbuthebufollowingbuwhichbuinterventionbuisbui
ndicated?bu-buanswer--Needlebudecompression
Abu29buyearbuoldbuPAbuhasbubeenbuexposedbutobuabupatientbuwithbucavitarybupulmonarybutub
erculosisbu1bumonthbuago.buHebudeniesbuanybusymptoms.buHisbuphysicalbuexaminationbuisb
unormal.buAbutuberculinbuskinbutestbureactionbuisbupositivebunowbuatbu5mm.buHisbuskinbutestbu
onebuyearbuagobuwasbunegative.buAbuchestbuX-
raybuisbuwithinbunormalbulimitsbuandbuchemistrybupanelbuisbunormal.buThebumostbuappropriat
ebumanagementbuoptionbuforbuthisbupatientbuis:bu-buanswer--Isoniazide
Whichbuofbuthebufollowingbuisbumostbuappropriatebuforbuabuchildbuwithbususpectedbuforeignbu
bodybuaspiration?bu-buanswer--Bronchoscopy
InbuHIVbuinfectedbupersons,buabutuberculinbuskinbutestbureactionbuisbuconsideredbupositivebui
fbuitbuisbu-buanswer--Anbuindurationbugreaterbuorbuequalbutobu5mm
Abu74buyear-
oldbumalebuwithbuabuhistorybuofbucoronarybuarterybudiseasebuandbuatrialbufibrillationbupresent
sbutobuthebuclinicbuforbufollow-
upbuofbuhisbushortnessbuofbubreath.buPatient'sbumedicationsbuincludebuamiodaronebu(Cord
arone)buandbumetoprololbu(Lopressor).buHisbuchestbux-rayburevealsbupatchybuground-
glassbuinfiltrates.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?bu-
buanswer--Pulmonarybufibrosis
Abu42buy/
obufemalebuwasbuinitiallybuseenbuinbuthebuEDbuwherebushebuwasbudiagnosedbuwithbuinfluenz
abuandbudischargedbuwithbuabucoughbusuppressant.buShebupresentedbubackbufourbudaysbula
terbuforbuseverebuSOBbuandbuhypoxemia.buCXRbushowedbubilateralbuinterstitialbuinfiltratesb
uandbupatient'sbuSaO2buwasbubelowbu80%buonbu~100%buNRB.buWhatbuisbuthebumostbuappr
opriatebunextbustep?bu-buanswer--Intubationbuandbumechanicalbuventilation
Abu60buy/
obumalebuwhobuisbus/
pbuORIFbuofbuthebuleftbuhipbupresentsbuwithbuacutebuonsetbuofbushortnessbuofbubreathbuwithbu
exertion.buOnbuphysicalbuexam,buhebuappearsbuanxiousbuandbutachypneic.buHisbutemperat
urebuisbu37.8°Cbu(100°F),bupulsebuisbu120bubeatsbuperbuminute,burespirationsbuarebu24/
minbuandbulabored,buandbubloodbupressurebuisbu140/90bummbuHg.buLungsbuarebuclearbutobua
uscultationbubilaterally.buCardiacbuexamburevealsbuanbuincreasedbupulmonicbucomponentb
uofbuS2.buECGburevealsbuabuSbuwavebuinbuleadbuI,buabuQbuwavebuinbuleadbuIII,buandbuTbuwavebu
changesbuinbuleadbuIIIbu-buanswer--SpiralbuCTbuofbuthebuchest
,Abu22-year-
oldbumalebupresentsbuwithbuabu2buweekbuhistorybuofbuanbuURTI.buHebuhasbubeenbutakingbuam
oxicillinbuforbu6budays.buHebuisbustillbuc/
obumalaise,busorebuthroat,busubjectivebufever,buandbuabunonproductivebucough.buPhysicalbu
examburevealsbudiffusebucrackles.buWhatbuisbuthebuMOSTbuappropriatebuclassbuofbuantimic
robials.bu-buanswer--Macrolide
Abu24-year-
oldbuuniversitybustudentbucomesbutobuthebuStudentbuHealthbuServicebuwithbuabu3-
daybuhistorybuofbuabudrybuhackingbucoughbuthatbuwasbuinitiallybunonproductivebubutbuhasbube
comebuproductivebuofbuscant,buwhitebusputum.buAlsobuc/
obuofbumalaise,buheadache,bufever,bumusclebuaches,buandbupains.buShebuhadbunobuotherbuu
pperburespiratorybutractbusymptomsbubeforebuthisbuillnessbuHerburoommatebudevelopedbuth
ebusamebusymptomsbu2budaysbuago.buOnbuexamination,buthebupatientbuhasbuabutemperatur
ebuofbu39buC.buYoubuhearbuabufewbuscatteredbucracklesbuinbuthebuleftbulungbubase.buNobuother
buabnormalitiesbuarebufound.buWhatbuisbuthebumostbulikelybudiagnosisbuinbuthisbupatient?bu-
buanswer--Mycoplasmabupneumoniae
Abuchildbupresentsbuwithbuabubarkingbucoughbuandbumildbustridorbuafterbuhebuhadbuabulowbugr
adebufeverbuandbuthebuprodromebuofbuupperburespiratorybutractbusymptoms.buCXRbuisbubelo
wbu(steeplebusign).buThebumostbucommonbucausebuofbuthisbuconditionbuis:bu-buanswer--
Parainfluenzabuvirus
19buyrbuoldbuasthmabupatientbucomesbutobuyourbuofficebuwithbucomplaintsbuofbuwheezingbusy
mptomsbutwicebuperbuweek.buWhatbuisbuthebunextbubestbustepbuinbumanagement?bu-
buanswer--Shortbuactingbubetabuagonist
Whatbuisbuthebuinitialbudiagnosticbustepbuinbuabupatientbuwithbuabulargebupleuralbueffusion?bu-
buanswer--Thoracentesis
Abu21buyear-
oldbumalebupresentsbutobuthebuEDbuwithbuincreasingbudyspneabuandbupleuriticbuchestbupainb
uofbusuddenbuonsetbuafterbugettingbuhitbuinbuthebuleftbusidebuofbuthebuchestbuduringbuabubarbufig
ht.buExaminationburevealsbumoderateburespiratorybudistressbuwithbuabsencebuofbubreathbus
oundsbuandbuhyperresonancebutobupercussionbuonbuthebuleft,buwithbutrachealbudeviationbut
obutheburight.buWhichbuofbuthebufollowingbuisbuthebumostbuappropriatebunextbustep?bu-
buanswer--Insertbulargebuborebuneedlebuintobuleftbu2ndbuICSbustat
Forcedbuvitalbucapacityburefersbuto:bu-buanswer--
Measurementbuofbuthebuvolumebuofbuairflowbuexpiredbuwithbuthebupatientbubreathingbuasbuh
ardbuandbuasbufastbuasbupossible
Abu55-year-
oldbuwoman,buheavybucigarettebusmokerbupresentsbuwithbucomplaintsbuofbuleftbueyebuswelli
ng,budrybueyes,buandbuleftbushoulderbupain.buYoubunoticebuthatbuthebupatient'sbuleftbueyelidbui
sbudrooping,buherbuconjunctiabuarebudrybuandbuherbuleftbupupilbuappearsbusmallerbuthatbutheb
uright.buShebualsobuappearsbutobuhavebuleftbusidedbuanhidrosis.buShebualsobuhasbuseverebule
ftbushoulderbupainbuwithbucertainbumovements.buHerbuCXRbuisbuseenbubelowbu(obacitybuinbu
RUL,bushadowingbualongbuouterbubordersbuofbulungbufields):buConsideringbuthesebufinding
,sbuyoubususpectbu-buanswer--
Pancoast'sbuSyndromebufrombuabuBronchogenicbuCarcinoma
Abupatientbuundergoesbuanbuultrasound-
guidedbuthoracentesisbuafterbuhebuisbufoundbutobuhavebuabulargebuloculatedbupleuralbueffusi
onbuonbudecubitusbuchestbux-
ray.buThebufluidbuisbuamberbuandbucloudybuwithbuabupHbuofbu7.3,buLDHbu800IU/
L,buglucosebu65bumg/dl,butotalbuproteinbu5.5bug/dl,buWBCbu1,300/
mm3.buSerumbustudiesbudonebuthebusamebudaybuincludeabuLDHbuofbu155buIU/
L,buglucosebu99bumg/dl,buandbutotalbuproteinbu7.0bug/
dl.buCytology,bugrambustain,buandbuculturebuofbuthebupleuralbufluidbuarebupending.buWhichbuo
fbuthebufollowingbuisbuthebumostbuaccuratebustatementburegardingbuthebupleuralbufluidbuanaly
sis?bu-buanswer--Thebufluidbuisbuanbuexudate
Abu66-year-
oldbumanbuwithbuabuknownbuhistorybuofbuchronicbuobstructivebupulmonarybudisease(COPD)
bupresentsbutobuthebuclinicbuforbuevaluationbuofbuprogressivebushortnessbuofbubreath.buHebuh
adbuanbuupperburespiratorybuinfectionbu2buweeksbuago,buandbuthebusymptomsbuhavebugotte
nbuworse.buOnbuphysicalbuexamination,buyoubufindbuthatbuhebuisbuhavingbuanbuacutebuexacer
bationbuofbuhisbuCOPD.buOnbugeneralbusurveybuofbuthisbupatient,buyoubuwouldbuexpectbutobus
eebuhimbu-buanswer--Sittingbuupbuandbuleaningbuforwardbuwithbuarmsbubraced
Anbuasymptomaticbu60buyear-
oldbufemalebuwithbuabu30bupackbuyearbuhistorybuofbusmokingbupresentsbutobuthebuclinicburequ
estingbuabuchestbux-
raybutobucheckbuforbulungbucancer.buWhichbuofbuthebufollowingbudobuyouburecommend?bu-
buanswer--Nobutestingbuandbureferralbuforbusmokingbucessation
Abu68buy/
obumalebuisbudiagnosedbuwithbusmallbucellbulungbucancer.buWhichbuofbuthebufollowingbutreat
mentbuoptionsbucouldbubebuconsideredbuinbuthisbupatient?bu-buanswer--
Combinationbuchemotherapy
58-year-
oldbuchronicbualcoholbumalebupatientbuisbufoundbuwonderingbuonbuthebustreetbuandbubrought
butobuthebuemergencybudepartmentbubybuparamedics.buThebupatientbuhasbuabuhighbufever,bu
coughbuproductivebuofburedbucurrentbusputum,buandbudifficultybubreathing.buExaminationbu
ofbuthebuchestburevealsbuwheezesbuandburalesbuoverbuthebuleftbulowerbuzonebuandbuabuchestb
ux-
raybufilmbuconfirmsbupneumonia.buGrambustainbuofbuthebusputumburevealsburatherbulargebug
ram-
negativebubacteriabuandbumanybuwhitebubloodbucells.buWhichbuofbuthebufollowingbuisbuthebum
ostbulikelybupathogen?bu-buanswer--Klebsiellabupneumoniae
Abu14buyear-
oldbumalebupresentsbutobuthebuEDbuexperiencingbuabuseverebuasthmabuattack.buHisburespira
torybueffortbuisbushallowbuandbuhebuisbuusingbuaccessorybumusclesbutobubreathe.buAuscultati
onbuofbuhisbuchestburevealsbunobuaudiblebuwheezing.buVitalbusignsbuincludebuBPbu90/60bum
mHg,buPbu160bubpm,buRRbu52.buAnbuarterialbubloodbugasbu(ABG)buisbuordered.buNormalbuA
BGbuvaluesbuatbuyourbuinstitutionbuarebupHbu7.35-7.45,buCO2bu35-45,bupO2bu80-
, 95.buWhichbuofbuthebufollowingbuABGbufindingsbusuggestsbuthebupoorestbuprognosis?bu-
buanswer--pHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56
Abu34-
yearbuoldbublackbufemalebupresentsbutobuyourbuofficebuwithbusymptombuofbucough,budyspne
a,buandbulymphadenopathy.buPhysicalbuexambushowsbucervicalbuadenopathybuandbuhepat
omegaly.buHerbuCXRbuisbushownbubelow.buHowbushouldbuyoubupursuebuthebudiagnosis?bu-
buanswer--BronchoscopybuandbuTransbronchialbulungbubiopsy
Whichbuofbuthebufollowingbuisbuthebumostbulikelybucomplicationbuofbuabupneumoniabucausedb
ubybuMycoplasmabupneumoniae?bu-buanswer--Bullousbumyringitis
Abu40buy/
obumalebupresentsbuwithbushortnessbuofbubreath,bupainfulbuskinbunodules,bublurredbuvision,b
uandbumalaise.buCXRburevealsbubilateralbuhilarbuadenopathybuandburightbuparatrachealbuno
debuenlargement.buHistologybuofbuskinbuandbulungburevealsbuthebufindingbuofbunoncaseatin
gbugranulomas.buWhichbuofbuthebufollowingbuisbuthebubestbutreatmentbuoptionbuinbuthisbupati
ent?bu-buanswer--Oralbuprednisone
Abu22-year-
oldbumanbuisbubroughtbutobuthebuEDbuafterbubeingbufoundbuunconsciousbuinbuabuswimmingbu
pool.buThebupatientbuisbumildlybucyanotic.buThebuBPbuisbu80/50bummbuHg,buHRbuisbu60/
min,buandbuRRbuisbu26/
min.buHisbucorebubodybutemperaturebuisbu89buF.buPupilsbuarebu4bummbubilaterallybuandbureac
tive.buThebupatientbuisbumovingbuallbuextremitiesbuandburespondsbuappropriatelybutobuquesti
ons.buCracklesbuarebuheardbubilaterallybuonbulungbuauscultation.buPulsebuoximetrybureveal
sbuabusaturationbuofbu94%buonbu50%buO2.buCXRburevealsbubilateralbuperihilarbuinfiltratesbuwi
thbuabunormalbusizedbuheart.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?
bu-buanswer--Noncardiogenic bupulmonarybuedema
Abu30buyear-
oldbupatientbupresentsbuwithbuabuthreebuyearbuhistorybuofbuepisodicbuofbuwheezing,budyspne
abuandbudrybutobuminimallybuproductivebucough.buThesebuepisodesbuarebutypicallybuworsebu
atbunightbuandbuduringbuthebufallbuandbuspringbuseasons.buThebupatientbuadmitsbutobuabulongb
uhistorybuofbuallergiesbuandbutobaccobuuse.buExamburevealsbunumerousbunasalbupolyps,bux
eroticbuskinbuandbuexpiratorybuwheezesbuinbubilateralbulungbufields.buTherebuisbunobucyanosi
sbuorbuabnormalbuheartbusoundsbunoted.buHisbupulmonarybufunctionbutestburevealsbuabulowbu
FEV1/
FVCburatio.buWhichbuofbuthebufollowingbuclassbuofbumedicationsbuwouldbubebubestbutobutreatb
uanbuacutebuexacerbationbuofbuthisbudisorder?bu-buanswer--Betabuagonists
Abu46-year-
oldbuwomanbucomplainsbuofbusuddenbuanxietybuandbubreathlessness.buShebuhasbubeenbuat
bubedburestbuforbu2buweeksbuforbubackbupain.buShebuusesbuoralbucontraceptives.buAllbuofbutheb
ufollowingbuwouldbubebusuggestivebuofbuabupulmonarybuembolismbuEXCEPT:bu-buanswer--
Temperaturebuofbu103.1F
Whichbuofbuthebufollowingbuisbumostbuconsistentbuwithbuaburestrictivebulungbudiseasebuonbus
pirometry?bu-buanswer--DecreasedbuFVC
