NBCE Part III review questions
./ ./ ./ ./
1. WHAT./IS./THE./MOST./LIKELY./DIAGNOSIS./IN./A./45-YEAR-
OLD./MALE./WEST./INDIAN./SEASONAL./WORKER./WITH./DYSPNEA,./HEMOPT
YSIS./AND./NIGHT./SWEATS./FOR./THE./PAST./THREE./MONTHS?
TUBERCULOSIS./ASTH
MA./SARCOIDOSIS
CONGESTIVE./HEART./FAILURE:./TB
2. WHAT./IS./THE./MOST./LIKELY./CAUSATIVE./ORGANISM./IN./THIS./PATIENT?
CHLAMYDIA./PNEUMONIAE./P
NEUMOCYSTIS./JIROVECI./ST
APHYLOCOCCUS./AUREUS
MYCOBACTERIUM./TUBERCULOSIS:./MYCOBACTERIUM./TUBERCULOSIS
3. WHICH./IS./THE./BEST./CULTURE./MEDIUM./FOR./THE./ABOVE./CAUSATIVE./O
RGANISM./IN./THIS./45-YEAR-
OLD./WEST./INDIAN./WORKER./WITH./DYSPNEA,./HEMOPTYSIS./AND./NIGHT./SW
EATS./FOR./THE./PAST./THREE./MONTHS?
LOWENSTEIN./JENSEN./
SABOURAUD./HEKTOE
N./AGAR
1.//./27
,MACCONKEY./AGAR:./LOWENSTEIN./JENSEN-./for./mycobacterium./species/TB
SABOURAUD-./used./for./fungi/yeast/mold
HEKTOEN./AGAR-
selective./for./gram./NEGATIVE./agents,./as./contents./(salt/dye)./prevent./gram./positive./a
./
ents./from./growing../Selective./for./salmonella/Shigella
MACCONKEY./AGAR-
selective./for./gram./negative./enteric./bacteria./such./as./E-
./
coli/staph/enterococcus/pseudomonas
4. EXAMINATION./OF./HIS./CHEST./REVEALS./STONY./DULL./PERCUSSION./
NOTES./IN./THE./BASE./OF./THE./RIGHT./LUNG.W
./ HICH./IS./THE./MOST./LIKELY./E
XPLANATION./OF./THIS./PHYSICAL./FINDING./IN./HIS./CHEST?
CONGESTIVE./HEART./FAILURE./
PLEURAL./EFFUSION./MESOTH
ELIOMA
SARCOIDOSIS:./PLEURAL./EFFUSION
2.//./27
, 5. WHAT./IST
./ HE./UNDERLYING./PATHOPHYSIOLOGY./OFT
./ HE./DYSPNEA./INT
./ HIS./P
ATIENT?
DIFFUSION./PROBLEM./INAD
EQUATE./VENTILATION./POO
R./LUNG./PERFUSION
ALTERED./HIGHER./CENTER./CONTROL:./INADEQUATE./VENTILATION
6. WHICH./RADIOLOGICAL./FINDING./WOULD./SUPPORT./THE./CAUSE./OF./THE./S
TONY./DULLNESS./INT
./ HE./BASE./OFT
./ HE./RIGHT./LUNG./OFT
./ HIS./PATIENTW
./ ITH./DY
SPNEA./AND./HEMOPTYSIS?
WIDENED./SUPERIOR./MEDIASTINUM
OBLITERATION./OF./THE./RIGHT./COSTOPHRENIC./ANGLE./
LARGE./RETROSTERNAL./WINDOW
CARDIOMEGALY:./OBLITERATION./OF./THE./RIGHT./COSTOPHRENIC./ANGLE
7. WHICH./IN./THE./CLINICAL./PICTURE./OF./THIS./PATIENT./IS./A./RED./FLAG?
IMMIGRANT. / SHORTNES
S./OF./BREATH./NIGHT./SW
EATS
COUGHING./UP./BLOOD:./COUGHING./UP./BLOOD
8. WHICH./IS./THE./RECOMMENDED./MANAGEMENT./FOR./THIS./PATIENT?
INFORM./HIS./EMPLOYER
REFER./HIM./TO./AN./ONCOLOGIST
SEND./HIM./URGENTLY./TO./THE./HOSPITAL
REFER./HIMT
./ OT
./ HE./DEPARTMENT./OF./HEALTH:./REFER./HIM./TO./THE./DEPART-
3.//./27
./ ./ ./ ./
1. WHAT./IS./THE./MOST./LIKELY./DIAGNOSIS./IN./A./45-YEAR-
OLD./MALE./WEST./INDIAN./SEASONAL./WORKER./WITH./DYSPNEA,./HEMOPT
YSIS./AND./NIGHT./SWEATS./FOR./THE./PAST./THREE./MONTHS?
TUBERCULOSIS./ASTH
MA./SARCOIDOSIS
CONGESTIVE./HEART./FAILURE:./TB
2. WHAT./IS./THE./MOST./LIKELY./CAUSATIVE./ORGANISM./IN./THIS./PATIENT?
CHLAMYDIA./PNEUMONIAE./P
NEUMOCYSTIS./JIROVECI./ST
APHYLOCOCCUS./AUREUS
MYCOBACTERIUM./TUBERCULOSIS:./MYCOBACTERIUM./TUBERCULOSIS
3. WHICH./IS./THE./BEST./CULTURE./MEDIUM./FOR./THE./ABOVE./CAUSATIVE./O
RGANISM./IN./THIS./45-YEAR-
OLD./WEST./INDIAN./WORKER./WITH./DYSPNEA,./HEMOPTYSIS./AND./NIGHT./SW
EATS./FOR./THE./PAST./THREE./MONTHS?
LOWENSTEIN./JENSEN./
SABOURAUD./HEKTOE
N./AGAR
1.//./27
,MACCONKEY./AGAR:./LOWENSTEIN./JENSEN-./for./mycobacterium./species/TB
SABOURAUD-./used./for./fungi/yeast/mold
HEKTOEN./AGAR-
selective./for./gram./NEGATIVE./agents,./as./contents./(salt/dye)./prevent./gram./positive./a
./
ents./from./growing../Selective./for./salmonella/Shigella
MACCONKEY./AGAR-
selective./for./gram./negative./enteric./bacteria./such./as./E-
./
coli/staph/enterococcus/pseudomonas
4. EXAMINATION./OF./HIS./CHEST./REVEALS./STONY./DULL./PERCUSSION./
NOTES./IN./THE./BASE./OF./THE./RIGHT./LUNG.W
./ HICH./IS./THE./MOST./LIKELY./E
XPLANATION./OF./THIS./PHYSICAL./FINDING./IN./HIS./CHEST?
CONGESTIVE./HEART./FAILURE./
PLEURAL./EFFUSION./MESOTH
ELIOMA
SARCOIDOSIS:./PLEURAL./EFFUSION
2.//./27
, 5. WHAT./IST
./ HE./UNDERLYING./PATHOPHYSIOLOGY./OFT
./ HE./DYSPNEA./INT
./ HIS./P
ATIENT?
DIFFUSION./PROBLEM./INAD
EQUATE./VENTILATION./POO
R./LUNG./PERFUSION
ALTERED./HIGHER./CENTER./CONTROL:./INADEQUATE./VENTILATION
6. WHICH./RADIOLOGICAL./FINDING./WOULD./SUPPORT./THE./CAUSE./OF./THE./S
TONY./DULLNESS./INT
./ HE./BASE./OFT
./ HE./RIGHT./LUNG./OFT
./ HIS./PATIENTW
./ ITH./DY
SPNEA./AND./HEMOPTYSIS?
WIDENED./SUPERIOR./MEDIASTINUM
OBLITERATION./OF./THE./RIGHT./COSTOPHRENIC./ANGLE./
LARGE./RETROSTERNAL./WINDOW
CARDIOMEGALY:./OBLITERATION./OF./THE./RIGHT./COSTOPHRENIC./ANGLE
7. WHICH./IN./THE./CLINICAL./PICTURE./OF./THIS./PATIENT./IS./A./RED./FLAG?
IMMIGRANT. / SHORTNES
S./OF./BREATH./NIGHT./SW
EATS
COUGHING./UP./BLOOD:./COUGHING./UP./BLOOD
8. WHICH./IS./THE./RECOMMENDED./MANAGEMENT./FOR./THIS./PATIENT?
INFORM./HIS./EMPLOYER
REFER./HIM./TO./AN./ONCOLOGIST
SEND./HIM./URGENTLY./TO./THE./HOSPITAL
REFER./HIMT
./ OT
./ HE./DEPARTMENT./OF./HEALTH:./REFER./HIM./TO./THE./DEPART-
3.//./27
