PULMONARY ROSH REVIEW EXAM
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A 72-year-old woman was hospitalized for atrial fibrillation with rapid
ventricular rate. She is being discharged today on amiodarone for
long term control of her dysrhythmia. Which of the following
diagnostic studies should be followed as an outpatient?
Chest X-ray
Coagulation studies
Complete blood counts
Renal panels - Ans>Correct Answer ( A )
Explanation:
Pulmonary function tests should be monitored for patients on
chronic amiodarone therapy. Amiodarone is a class III anti-arrhythmic
drug used to treat many common dysrhythmias. Annual chest
radiograph is are recommended when patients are on chronic
Amiodarone use. Pulmonary toxicity generally correlates more
closely with the total cumulative dose than the serum levels. It
usually occurs months to years after initiation. Several types of
pulmonary toxicity may result from chronic amiodarone therapy;
however, the most common is a chronic interstitial pneumonitis. A
non-productive cough and dyspnea are present in the majority of
affected individuals. If signs or symptoms develop the patient should
be referred for pulmonary function testing and amiodarone should
,be immediately discontinued. Other complications of chronic
amiodarone therapy include, but are not limited to, thyroid
dysfunction, both hypo- and hyperthyroidism, symptomatic hepatitis,
corneal microdeposits, optic neuropathy, or dermatologic
manifestation such as photosensitivity and blue-gray skin
discoloration. Thyroid function tests and hepatic panels are
recommended every six months. Dermatologic physical exams and
ophthalmologic eye evaluations are recommended as needed for
signs or symptoms. These complications are treated by either
reducing the dose and discontinuation.
Question: Can amiodarone be used in patients with heart failure? -
Ans>Yes, one of the attractive features of using amiodarone over other
antidysrhythmics.
A 45-year-old woman presents to the Emergency Department with a
fever, productive cough, and diarrhea. Her chest X-ray shows a patchy
unilobar infiltrate and her sodium is 127 mmol/L. Which of the
following organisms is most likely to be responsible for these
symptoms?
Legionella pneumophila
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae - Ans>Correct Answer ( A )
Explanation:
Legionella pneumophila is the most likely organism and causes
Legionnaires' disease. It is responsible for about 5% of all
pneumonias. Common symptoms include a fever, cough, diarrhea,
,and confusion. Chest X-ray findings vary but often show a patchy
unilobar infiltrate. Laboratory abnormalities are common with
hyponatremia being the classic finding. First-line treatment includes
either respiratory quinolones (e.g. levofloxacin) or macrolides (e.g.
azithromycin).
Streptococcus pneumoniae (D) is the most common cause of
community-acquired pneumonia (CAP). It presents classically with
fever, chills, productive cough, and pain and a lobar opacity on chest
X-ray. First-line treatment for inpatient management is a third-
generation cephalosporin (e.g. ceftriaxone or cefotaxime). Outpatient
pneumococcal pneumonia can be treated with amoxicillin or a
macrolide. Pseudomonas aeruginosa (B) is a common cause of
hospital-acquired pneumonia. It should be considered in patients
with cystic fibrosis, bronchiectasis, or an immunocompromised state.
Treatment can include an antipseudomonal penicillin (e.g.
piperacillin-tazobactam) or an antipseudomonal cephalosporins (e.g.
cefepime). Staphylococcus aureus (C) is a common cause of
healthcare-acquired pneumonia and is seen following influenza
infections. Treatment includes either vancomycin or linezolid since
methicillin resistance is common.
Question: What is the CURB-65 score? - Ans>It attempts to predict the
severity of pneumonia to help determine inpatient vs. outpatient
treatment.
Legionella Pneumonia
Patient will be complaining of fevers, malaise, myalgias, cough and GI
symptoms
, Labs will show leukocytosis, elevated liver transaminases and
hyponatremia
CXR will show unilateral patchy alveolar lower lobe infiltrates
Most commonly caused by gram-negative bacillus and is found in
aquatic environments
Treatment is azithromycin
A full term male infant is delivered by cesarean section because of
dystocia due to macrosomia. Apgar scores are 8 and 10. An hour after
delivery he begins to have tachypnea without hypoxemia. A chest
radiograph shows diffuse parenchymal infiltrates and fluid in the
pulmonary fissures. The symptoms resolve without treatment within
24 hours. What is the most likely diagnosis?
Laryngomalacia
Meconium aspiration syndrome
Respiratory distress syndrome
Transient tachypnea of the newborn - Ans>Correct Answer ( D )
Explanation:
This child had transient tachypnea of the newborn, the most
common cause of neonatal respiratory distress. It is a benign
condition due to residual pulmonary fluid remaining in the lungs after
delivery. Signs of respiratory distress such as tachypnea, nasal flaring,
grunting, retractions, hypoxia, and increased oxygen requirement
become evident shortly after birth. The disorder is transient, with
symptoms usually resolving within 72 hours after birth. Risk factors
include cesarean delivery, macrosomia, male gender, and maternal
asthma and diabetes mellitus. Chest radiography is the diagnostic
LATEST 2024/2025 WITH QUESTIONS AND
CORRECT VERIFIED ANSWERS ALREADY
GRADED A+ 100% GUARANTEED PASS!
A 72-year-old woman was hospitalized for atrial fibrillation with rapid
ventricular rate. She is being discharged today on amiodarone for
long term control of her dysrhythmia. Which of the following
diagnostic studies should be followed as an outpatient?
Chest X-ray
Coagulation studies
Complete blood counts
Renal panels - Ans>Correct Answer ( A )
Explanation:
Pulmonary function tests should be monitored for patients on
chronic amiodarone therapy. Amiodarone is a class III anti-arrhythmic
drug used to treat many common dysrhythmias. Annual chest
radiograph is are recommended when patients are on chronic
Amiodarone use. Pulmonary toxicity generally correlates more
closely with the total cumulative dose than the serum levels. It
usually occurs months to years after initiation. Several types of
pulmonary toxicity may result from chronic amiodarone therapy;
however, the most common is a chronic interstitial pneumonitis. A
non-productive cough and dyspnea are present in the majority of
affected individuals. If signs or symptoms develop the patient should
be referred for pulmonary function testing and amiodarone should
,be immediately discontinued. Other complications of chronic
amiodarone therapy include, but are not limited to, thyroid
dysfunction, both hypo- and hyperthyroidism, symptomatic hepatitis,
corneal microdeposits, optic neuropathy, or dermatologic
manifestation such as photosensitivity and blue-gray skin
discoloration. Thyroid function tests and hepatic panels are
recommended every six months. Dermatologic physical exams and
ophthalmologic eye evaluations are recommended as needed for
signs or symptoms. These complications are treated by either
reducing the dose and discontinuation.
Question: Can amiodarone be used in patients with heart failure? -
Ans>Yes, one of the attractive features of using amiodarone over other
antidysrhythmics.
A 45-year-old woman presents to the Emergency Department with a
fever, productive cough, and diarrhea. Her chest X-ray shows a patchy
unilobar infiltrate and her sodium is 127 mmol/L. Which of the
following organisms is most likely to be responsible for these
symptoms?
Legionella pneumophila
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pneumoniae - Ans>Correct Answer ( A )
Explanation:
Legionella pneumophila is the most likely organism and causes
Legionnaires' disease. It is responsible for about 5% of all
pneumonias. Common symptoms include a fever, cough, diarrhea,
,and confusion. Chest X-ray findings vary but often show a patchy
unilobar infiltrate. Laboratory abnormalities are common with
hyponatremia being the classic finding. First-line treatment includes
either respiratory quinolones (e.g. levofloxacin) or macrolides (e.g.
azithromycin).
Streptococcus pneumoniae (D) is the most common cause of
community-acquired pneumonia (CAP). It presents classically with
fever, chills, productive cough, and pain and a lobar opacity on chest
X-ray. First-line treatment for inpatient management is a third-
generation cephalosporin (e.g. ceftriaxone or cefotaxime). Outpatient
pneumococcal pneumonia can be treated with amoxicillin or a
macrolide. Pseudomonas aeruginosa (B) is a common cause of
hospital-acquired pneumonia. It should be considered in patients
with cystic fibrosis, bronchiectasis, or an immunocompromised state.
Treatment can include an antipseudomonal penicillin (e.g.
piperacillin-tazobactam) or an antipseudomonal cephalosporins (e.g.
cefepime). Staphylococcus aureus (C) is a common cause of
healthcare-acquired pneumonia and is seen following influenza
infections. Treatment includes either vancomycin or linezolid since
methicillin resistance is common.
Question: What is the CURB-65 score? - Ans>It attempts to predict the
severity of pneumonia to help determine inpatient vs. outpatient
treatment.
Legionella Pneumonia
Patient will be complaining of fevers, malaise, myalgias, cough and GI
symptoms
, Labs will show leukocytosis, elevated liver transaminases and
hyponatremia
CXR will show unilateral patchy alveolar lower lobe infiltrates
Most commonly caused by gram-negative bacillus and is found in
aquatic environments
Treatment is azithromycin
A full term male infant is delivered by cesarean section because of
dystocia due to macrosomia. Apgar scores are 8 and 10. An hour after
delivery he begins to have tachypnea without hypoxemia. A chest
radiograph shows diffuse parenchymal infiltrates and fluid in the
pulmonary fissures. The symptoms resolve without treatment within
24 hours. What is the most likely diagnosis?
Laryngomalacia
Meconium aspiration syndrome
Respiratory distress syndrome
Transient tachypnea of the newborn - Ans>Correct Answer ( D )
Explanation:
This child had transient tachypnea of the newborn, the most
common cause of neonatal respiratory distress. It is a benign
condition due to residual pulmonary fluid remaining in the lungs after
delivery. Signs of respiratory distress such as tachypnea, nasal flaring,
grunting, retractions, hypoxia, and increased oxygen requirement
become evident shortly after birth. The disorder is transient, with
symptoms usually resolving within 72 hours after birth. Risk factors
include cesarean delivery, macrosomia, male gender, and maternal
asthma and diabetes mellitus. Chest radiography is the diagnostic
