Rosh Pulmonology UPDATED ACTUAL Questions and CORRECT
Answers
1. PCP pneumonia CXR ground glass opacification
2. PCP pneumonia TX trimethoprin-sulfamethox-
azole
3. PCP pneumonia mc in what demographic HIV pt with CD4 count
<200
prophyaxis with trimetho-
prin-sulfamethoxazole if
CD4 <200
4. Kerley B line may be seen in pulmonary edema
the thickening of the lung
interstitium
5. PCP pneumonia will have an increase in this lab value LDH
6. A 43-year-old man presents complaining of a 2-week atypical pneumonia treat-
history of gradually worsening dry cough, fatigue, and ed with doxy, fq or
occasional shortness of breath. He has "felt warm" but macrolide
has not checked his temperature. Review of systems
,is notable for mild diarrhea and decreased appetite, High-dose amoxicillin, a
, though he is drinking fluids well. He reports no chronic penicillin, is the most ap-
medical problems and takes no medications. He does propriate choice for a pa-
not smoke. His temperature is 100.6°F, pulse 112 bpm, tient who has no co-
BP 122/78 mm Hg, RR 24 breaths per minute, and morbidities with com-
pulse oximetry is 92% on room air. He looks tired but munity-acquired bacterial
not ill. Lung fields sound clear on auscultation, but a pneumonia (CAP) if an
chest X-ray is obtained and shows diffuse infiltrates. atypical is not suspected.
What is the most appropriate treatment for his condi-
tion? In this case the patient
ADoxycycline presents with an insidi-
BMetronidazole ous onset, low grade tem-
COseltamivir perature, and diffuse in-
DPiperacillin-tazobactam filtrate's therefore doxycy-
cline would be prescribed
or a macrolide if local an-
tibiotic resistance is less
than 25% to treat an atyp-
ical pneumonia
7. A 37-year-old man presents with cough and shortness After a recent influen-
of breath. Vital signs are T 102°F, BP 110/76, HR 108, RR za infection, patients may
20, and oxygen saturation of 92% on room air. His chest develop a Staph au-
X-ray is shown above. Which of the following helps reus pneumonia. Of par-
determine the causative organism? ticular concern is com-
AExposure to white powder munity-associated methi-
BHistory of smoking cillin-resistant Staph au-
reus (CA-MRSA) after in-
, CRecent influenza infection fluenza especially in a
DResidence in Connecticut rapidly progressive pneu-
monia in younger, healthy
patients. Staph aureus
pneumonia often have
necrotizing features creat-
ing the cavitation and may
also lead to the develop-
ment of pneumatoceles.
8. A 26-year-old gravida 3 para 2 at 12 weeks gestation B
presents with fever, myalgias, headache, and malaise.
There have been multiple cases of influenza in the
community and her influenza swab is positive. Which
one of the following is recommended by the Centers
for Disease Control and Prevention in this situation?
AAcyclovir
BOseltamivir
CRimantadine
DSupportive therapy only
9. A previously healthy 27-year-old man presents to your A
office with a complaint of cold symptoms. He says that
initially he had sinus congestion and a sore throat, Acute bronchitis is a
which have since resolved, but he has also had a pro- common condition involv-
ductive cough for approximately 10 days that is keep- ing inflammation of the
ing him up at night. Physical exam reveals a temper- bronchi caused by upper
Answers
1. PCP pneumonia CXR ground glass opacification
2. PCP pneumonia TX trimethoprin-sulfamethox-
azole
3. PCP pneumonia mc in what demographic HIV pt with CD4 count
<200
prophyaxis with trimetho-
prin-sulfamethoxazole if
CD4 <200
4. Kerley B line may be seen in pulmonary edema
the thickening of the lung
interstitium
5. PCP pneumonia will have an increase in this lab value LDH
6. A 43-year-old man presents complaining of a 2-week atypical pneumonia treat-
history of gradually worsening dry cough, fatigue, and ed with doxy, fq or
occasional shortness of breath. He has "felt warm" but macrolide
has not checked his temperature. Review of systems
,is notable for mild diarrhea and decreased appetite, High-dose amoxicillin, a
, though he is drinking fluids well. He reports no chronic penicillin, is the most ap-
medical problems and takes no medications. He does propriate choice for a pa-
not smoke. His temperature is 100.6°F, pulse 112 bpm, tient who has no co-
BP 122/78 mm Hg, RR 24 breaths per minute, and morbidities with com-
pulse oximetry is 92% on room air. He looks tired but munity-acquired bacterial
not ill. Lung fields sound clear on auscultation, but a pneumonia (CAP) if an
chest X-ray is obtained and shows diffuse infiltrates. atypical is not suspected.
What is the most appropriate treatment for his condi-
tion? In this case the patient
ADoxycycline presents with an insidi-
BMetronidazole ous onset, low grade tem-
COseltamivir perature, and diffuse in-
DPiperacillin-tazobactam filtrate's therefore doxycy-
cline would be prescribed
or a macrolide if local an-
tibiotic resistance is less
than 25% to treat an atyp-
ical pneumonia
7. A 37-year-old man presents with cough and shortness After a recent influen-
of breath. Vital signs are T 102°F, BP 110/76, HR 108, RR za infection, patients may
20, and oxygen saturation of 92% on room air. His chest develop a Staph au-
X-ray is shown above. Which of the following helps reus pneumonia. Of par-
determine the causative organism? ticular concern is com-
AExposure to white powder munity-associated methi-
BHistory of smoking cillin-resistant Staph au-
reus (CA-MRSA) after in-
, CRecent influenza infection fluenza especially in a
DResidence in Connecticut rapidly progressive pneu-
monia in younger, healthy
patients. Staph aureus
pneumonia often have
necrotizing features creat-
ing the cavitation and may
also lead to the develop-
ment of pneumatoceles.
8. A 26-year-old gravida 3 para 2 at 12 weeks gestation B
presents with fever, myalgias, headache, and malaise.
There have been multiple cases of influenza in the
community and her influenza swab is positive. Which
one of the following is recommended by the Centers
for Disease Control and Prevention in this situation?
AAcyclovir
BOseltamivir
CRimantadine
DSupportive therapy only
9. A previously healthy 27-year-old man presents to your A
office with a complaint of cold symptoms. He says that
initially he had sinus congestion and a sore throat, Acute bronchitis is a
which have since resolved, but he has also had a pro- common condition involv-
ductive cough for approximately 10 days that is keep- ing inflammation of the
ing him up at night. Physical exam reveals a temper- bronchi caused by upper
