ICM Test Questions Solved Correctly Latest Update 2025 Graded A+
A 33-year-old woman comes to the emergency department complaining of sharp, pleuritic chest pain on
the right, 3 days following the onset of an upper respiratory infection which includes nasal drainage and
nonproductive cough. She has no significant past medical history and takes no medication except an oral
contraceptive. She does smoke occasionally and has not traveled recently. She has no family history of
venous thromboembolism. On physical examination she is not in respiratory distress, with no tachypnea
or tachycardia, though she is preventing full inspiratory effort due to pain. Her legs are not swollen. A
pregnancy test is negative. Which is the appropriate first step in ruling out a pulmonary embolism in this
patient? - Answers *D-dimer* lab test
- used clinically to rule out DVT (high sensitivity, low specificity)
- low pretest probability = D-dimer assay helps reliably exclude PE, eliminating needless anticoagulation
therapy
A 39-year-old man has a seizure in your clinic. On physical examination he is unresponsive and cyanotic.
Vital signs reveal a temperature of 38°C (100.5°F), heart rate of 110 beats per minute, and blood
pressure of 150/85 mm Hg. Lung examination reveals decreased breath sounds bilaterally. Heart
examination is normal and he has a gag reflex. Pulse oximetry reveals a hemoglobin saturation of 80%
on 100% oxygen. Which of the following is the most appropriate first step in management? - Answers
*Head tilt-chin maneuver*
- tongue may fall posteriorly to obstruct the oropharynx = major cause of airway obstruction
- may occur in patients with decreased level of consciousness and may be corrected by utilizing head tilt-
chin lift maneuver
A 65-year-old woman being treated for lung cancer presents with the sudden onset of pleuritic chest
pain and shortness of breath. She has been doing well until 3 days ago, when she noticed some swelling
of her left lower extremity. She is not a smoker and denies any recent trauma. On physical examination,
she is afebrile but has a respiratory rate of 32 breaths per minute. Her heart rate is 120 beats per minute
and her blood pressure is normal. An accentuated (loud) S2 is heard on heart auscultation. The left
lower extremity is swollen, tender to palpation, and erythematous. Lung examination and chest
radiograph are normal. Arterial blood analysis on room air shows a PCO2 of 30 mm Hg and a PO2 of 58
mm Hg. Which of the following is the most appropriate next diagnostic step? - Answers *Helical CT*
- PE signs and symptoms
- DVT = most common source of PE
- *Wells score = 8.5 = high pretest probability*
- helical CT = initial diagnostic test of choice for PE and is comparable to ventilation-perfusion (V/Q) scan
,- normal helical CT in *setting of high pretest probability* should be followed by further studies, such as
pulmonary arteriogram or venous ultrasonography of lower extremity
A thin 35-year-old woman presents with a 2-day history of cough. She complains of some mild dyspnea
and left-sided pleuritic chest pain. On physical examination, her temperature is 38.5°C (101.4°F) and her
respiratory rate is 26 breaths per minute. Her blood pressure is 110/65 mm Hg and her heart rate is 125
beats per minute. Which of the following physical examination findings would most likely be found if she
has an uncomplicated left-sided pneumonia? - Answers *Increased tactile fremitus on the left*
- patient has community-acquired pneumonia (CAP) via Streptococcus pneumoniae
- *patients with consolidation from pneumonia have dullness to percussion and increased tactile
fremitus (vibrations that are perceived on palpation)*
- on auscultation, instead of normal vesicular breath sounds, patients often have *bronchial breath
sounds* (like breathing through a straw, normally heard only over trachea) and inspiratory crackles, as
well as other findings like bronchophony (sounds like "99" are louder and clearer), egophony (long "e"
perceived as short "a," like a goat bleating), and whispered pectoriloquy (whispered sounds are louder
and clearer).
Areas of *atelectasis or pleural effusion* have ... - Answers *dullness to percussion with decreased
tactile fremitus*
Pleural effusion...
- decreased breath sounds
- dull percussion
- decreased fremitus
- tracheal deviation: or away from side of lesion (if large)
Atelectasis (bronchial obstruction)...
- decreased breath sounds
- dull percussion
- decreased fremitus
- tracheal deviation toward side of lesion
,Patients with obstructed airway develop... - Answers stridor, a high-pitched inspiratory sound
Best areas to listen for right middle lobe findings... - Answers 1. right anterior midclavicular line between
fifth and sixth ribs
2. right midaxillary line between fourth and sixth ribs
A 14-year-old adolescent presents with a history of chronic sinusitis and frequent pneumonias. He was
born at 38 weeks and had an uneventful delivery. On physical examination, the patient has normal vital
signs and is afebrile. He has mild frontal and maxillary sinus tenderness with palpation. Transillumination
of the sinuses is normal. Heart sounds are best heard on the right side of the chest. The boy is coughing
copious amounts of yellowish sputum. Which of the following is the most likely diagnosis? - Answers
Kartagener syndrome
- defect that causes cilia within respiratory tract epithelium to become immotile = predisposes patients
to frequent pneumonias
- situs invertus, chronic sinusitis (with formation of nasal polyps), and bronchiectasis
- cilia on sperm also affected = males infertile
A 44-year-old obese woman presents with the chief complaint of hemoptysis. She states that over the
last day she has coughed up approximately 10 mL of blood- streaked sputum. She denies fever, chills,
chest pain, or shortness of breath. She had a recent upper respiratory tract infection with cough and a
copious amount of sputum production. She has smoked one pack of cigarettes per day since high school.
Examinations of the pharynx and lungs are normal. Which of the following is the most likely diagnosis? -
Answers *Acute bronchitis* / chest cold
- *most common cause for nonmassive hemoptysis in smokers and nonsmoking patients with normal
chest radiograph* = acute or chronic bronchitis
- short-term inflammation of bronchi of lungs
- most common symptom = *cough*
- coughing up mucus, wheezing, shortness of breath, fever, chest discomfort
- risk factors = *tobacco smoke*, dust, air pollution
- prevention = not smoking and avoiding lugn irritants
, A 53-year-old woman presents with a 4-month history of cough productive of bloody sputum. She
denies fever, chills, and night sweats but has occasional flushing that she feels is secondary to
menopause. She has had two pneumonias over the last 3 years that required short-term hospitalization.
Physical examination reveals wheezing localized to the left midlung field. Chest radiograph is normal.
Which of the following is the most appropriate next diagnostic step? - Answers *Fiberoptic
bronchoscopy*
- carcinoid and bronchial gland tumors = bronchial adenoma but are actually low-grade malignant
neoplasms
- resistant to radiation and chemotherapy
- present before age 60
- common symptoms = hemoptysis, chronic cough, focal wheezing, recurrent pneumonia (via
obstruction and atelectasis)
- chest radiograph may be normal
- classic presentation = flushing, diarrhea, wheezing, hypotension
- tumors = centrally located --> fiberoptic bronchoscopy = tissue diagnosis of tumor in central airway
A man is stabbed and arrives at the emergency room within 30 minutes. You notice that the trachea is
deviated away from the side of the chest with the puncture. The most likely lung finding on physical
examination of the traumatized side is which of the following? - Answers *hyperresonance*
Tension pneumothorax...
- treachea deviating away from side of traumatized lung
- breath sounds = faint or distant
- percussion = hyperresonant
- fremitus = decreased
- increased air on affected side = in pleural space, not in the lung
- air enters pleural space but cannot exit
A 33-year-old woman comes to the emergency department complaining of sharp, pleuritic chest pain on
the right, 3 days following the onset of an upper respiratory infection which includes nasal drainage and
nonproductive cough. She has no significant past medical history and takes no medication except an oral
contraceptive. She does smoke occasionally and has not traveled recently. She has no family history of
venous thromboembolism. On physical examination she is not in respiratory distress, with no tachypnea
or tachycardia, though she is preventing full inspiratory effort due to pain. Her legs are not swollen. A
pregnancy test is negative. Which is the appropriate first step in ruling out a pulmonary embolism in this
patient? - Answers *D-dimer* lab test
- used clinically to rule out DVT (high sensitivity, low specificity)
- low pretest probability = D-dimer assay helps reliably exclude PE, eliminating needless anticoagulation
therapy
A 39-year-old man has a seizure in your clinic. On physical examination he is unresponsive and cyanotic.
Vital signs reveal a temperature of 38°C (100.5°F), heart rate of 110 beats per minute, and blood
pressure of 150/85 mm Hg. Lung examination reveals decreased breath sounds bilaterally. Heart
examination is normal and he has a gag reflex. Pulse oximetry reveals a hemoglobin saturation of 80%
on 100% oxygen. Which of the following is the most appropriate first step in management? - Answers
*Head tilt-chin maneuver*
- tongue may fall posteriorly to obstruct the oropharynx = major cause of airway obstruction
- may occur in patients with decreased level of consciousness and may be corrected by utilizing head tilt-
chin lift maneuver
A 65-year-old woman being treated for lung cancer presents with the sudden onset of pleuritic chest
pain and shortness of breath. She has been doing well until 3 days ago, when she noticed some swelling
of her left lower extremity. She is not a smoker and denies any recent trauma. On physical examination,
she is afebrile but has a respiratory rate of 32 breaths per minute. Her heart rate is 120 beats per minute
and her blood pressure is normal. An accentuated (loud) S2 is heard on heart auscultation. The left
lower extremity is swollen, tender to palpation, and erythematous. Lung examination and chest
radiograph are normal. Arterial blood analysis on room air shows a PCO2 of 30 mm Hg and a PO2 of 58
mm Hg. Which of the following is the most appropriate next diagnostic step? - Answers *Helical CT*
- PE signs and symptoms
- DVT = most common source of PE
- *Wells score = 8.5 = high pretest probability*
- helical CT = initial diagnostic test of choice for PE and is comparable to ventilation-perfusion (V/Q) scan
,- normal helical CT in *setting of high pretest probability* should be followed by further studies, such as
pulmonary arteriogram or venous ultrasonography of lower extremity
A thin 35-year-old woman presents with a 2-day history of cough. She complains of some mild dyspnea
and left-sided pleuritic chest pain. On physical examination, her temperature is 38.5°C (101.4°F) and her
respiratory rate is 26 breaths per minute. Her blood pressure is 110/65 mm Hg and her heart rate is 125
beats per minute. Which of the following physical examination findings would most likely be found if she
has an uncomplicated left-sided pneumonia? - Answers *Increased tactile fremitus on the left*
- patient has community-acquired pneumonia (CAP) via Streptococcus pneumoniae
- *patients with consolidation from pneumonia have dullness to percussion and increased tactile
fremitus (vibrations that are perceived on palpation)*
- on auscultation, instead of normal vesicular breath sounds, patients often have *bronchial breath
sounds* (like breathing through a straw, normally heard only over trachea) and inspiratory crackles, as
well as other findings like bronchophony (sounds like "99" are louder and clearer), egophony (long "e"
perceived as short "a," like a goat bleating), and whispered pectoriloquy (whispered sounds are louder
and clearer).
Areas of *atelectasis or pleural effusion* have ... - Answers *dullness to percussion with decreased
tactile fremitus*
Pleural effusion...
- decreased breath sounds
- dull percussion
- decreased fremitus
- tracheal deviation: or away from side of lesion (if large)
Atelectasis (bronchial obstruction)...
- decreased breath sounds
- dull percussion
- decreased fremitus
- tracheal deviation toward side of lesion
,Patients with obstructed airway develop... - Answers stridor, a high-pitched inspiratory sound
Best areas to listen for right middle lobe findings... - Answers 1. right anterior midclavicular line between
fifth and sixth ribs
2. right midaxillary line between fourth and sixth ribs
A 14-year-old adolescent presents with a history of chronic sinusitis and frequent pneumonias. He was
born at 38 weeks and had an uneventful delivery. On physical examination, the patient has normal vital
signs and is afebrile. He has mild frontal and maxillary sinus tenderness with palpation. Transillumination
of the sinuses is normal. Heart sounds are best heard on the right side of the chest. The boy is coughing
copious amounts of yellowish sputum. Which of the following is the most likely diagnosis? - Answers
Kartagener syndrome
- defect that causes cilia within respiratory tract epithelium to become immotile = predisposes patients
to frequent pneumonias
- situs invertus, chronic sinusitis (with formation of nasal polyps), and bronchiectasis
- cilia on sperm also affected = males infertile
A 44-year-old obese woman presents with the chief complaint of hemoptysis. She states that over the
last day she has coughed up approximately 10 mL of blood- streaked sputum. She denies fever, chills,
chest pain, or shortness of breath. She had a recent upper respiratory tract infection with cough and a
copious amount of sputum production. She has smoked one pack of cigarettes per day since high school.
Examinations of the pharynx and lungs are normal. Which of the following is the most likely diagnosis? -
Answers *Acute bronchitis* / chest cold
- *most common cause for nonmassive hemoptysis in smokers and nonsmoking patients with normal
chest radiograph* = acute or chronic bronchitis
- short-term inflammation of bronchi of lungs
- most common symptom = *cough*
- coughing up mucus, wheezing, shortness of breath, fever, chest discomfort
- risk factors = *tobacco smoke*, dust, air pollution
- prevention = not smoking and avoiding lugn irritants
, A 53-year-old woman presents with a 4-month history of cough productive of bloody sputum. She
denies fever, chills, and night sweats but has occasional flushing that she feels is secondary to
menopause. She has had two pneumonias over the last 3 years that required short-term hospitalization.
Physical examination reveals wheezing localized to the left midlung field. Chest radiograph is normal.
Which of the following is the most appropriate next diagnostic step? - Answers *Fiberoptic
bronchoscopy*
- carcinoid and bronchial gland tumors = bronchial adenoma but are actually low-grade malignant
neoplasms
- resistant to radiation and chemotherapy
- present before age 60
- common symptoms = hemoptysis, chronic cough, focal wheezing, recurrent pneumonia (via
obstruction and atelectasis)
- chest radiograph may be normal
- classic presentation = flushing, diarrhea, wheezing, hypotension
- tumors = centrally located --> fiberoptic bronchoscopy = tissue diagnosis of tumor in central airway
A man is stabbed and arrives at the emergency room within 30 minutes. You notice that the trachea is
deviated away from the side of the chest with the puncture. The most likely lung finding on physical
examination of the traumatized side is which of the following? - Answers *hyperresonance*
Tension pneumothorax...
- treachea deviating away from side of traumatized lung
- breath sounds = faint or distant
- percussion = hyperresonant
- fremitus = decreased
- increased air on affected side = in pleural space, not in the lung
- air enters pleural space but cannot exit
