PULMONARY ROSH REVIEW EXAM
LATEST 2024-2025 WITH 189 ACTUAL
QUESTIONS AND CORRECT VERIFIED
ANSWERS ALREADY GRADED A+ 100%
GUARANTEED PASS!
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
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©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,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.
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
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
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©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,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
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©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, CXR: blunting of the costophrenic angle
Question: A pleural effusion is most difficult to detect in which radiographic
position? - ✔✔Supine.
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.
4|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
LATEST 2024-2025 WITH 189 ACTUAL
QUESTIONS AND CORRECT VERIFIED
ANSWERS ALREADY GRADED A+ 100%
GUARANTEED PASS!
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
1|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,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.
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
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
2|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
,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
3|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
, CXR: blunting of the costophrenic angle
Question: A pleural effusion is most difficult to detect in which radiographic
position? - ✔✔Supine.
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.
4|Page
©JOSHCLAY 2025/2026. YEAR PUBLISHED 2025.
