PULM TOP Exam Guide Questions and
CORRECT Answers
A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1
day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday.
Which of the following findings will most likely be seen on physical examination of this patient?
A spoken "ee" heard as "ay"
B hyperresonant percussion note
C wheezes over the involved area
D vesicular breath sounds over involved area
also what does this patient have
spoken "ee" heard as "ay"
pneumonia
asbestosis xray findings
interstitial fibrosis and pleural thickening
15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever,
malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon
auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was
negative. Which of the following is the most likely diagnosis?
A acute bronchitis
B viral pneumonia
C mycoplasma pneumonia
D pneumococcal pneumonia
While the patient's clinical symptoms of dry cough and rhonchi support this diagnosis, the chest x-ray
would be normal or only show a mild increase in bronchovascular markings, not infiltrates.
,PULM TOP Exam Guide Questions and
CORRECT Answers
viral pneumonia
The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most
consistent with viral pneumonia.
Either __or __are indicated for prophylactic use against influenza A or B.
zanamivir
oseltamivir
A 3 month-old male presents with a hoarse cough and thick purulent rhinorrhea for the past 2 days. The
mother noted that yesterday he appeared to get worse and seemed to have increasing problems
breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory
rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory
phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-
ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most
appropriate intervention?
infant most likely has ___
next steps
This infant most likely has bronchiolitis. While most cases are mild and can be treated at home,
hospitalization is recommended for infants with hypoxia on room air, moderate tachypnea with feeding
difficulties and marked respiratory distress with retractions. Additionally hospitalization is
recommended for infants less than 2-3 months of age, a history of apnea or an underlying chronic
cardiopulmonary disease.
A 21 year-old male presents to the ED with increasing dyspnea and pleuritic chest pain of sudden onset
after getting hit in the left side of the chest during a bar fight. Examination reveals moderate respiratory
,PULM TOP Exam Guide Questions and
CORRECT Answers
distress with absence of breath sounds and hyperresonance to percussion on the left, with tracheal
deviation to the right. Which of the following is the most appropriate next step?
A. order a V/Q scan
B order a chest x-ray
C administer a sclerosing agent
D insert large bore needle into left 2nd ICS stat
insert large bore needle into left 2nd ICS stat
We have an expert-written solution to this problem!
A V/Q scan is indicated in suspected cases of
pulmonary embolism.
22 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks.
The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time
she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime
use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. Which
of the following is the most appropriate intervention at this time?
A Oral prednisone
B Oral theophylline
C Salmeterol inhaler
D Beclomethasone inhaler
Beclomethasone inhaler
This patient has progressed to mild persistent asthma. In addition to her inhaled beta2- agonist
(albuterol), she should be started on an anti-inflammatory agent. Inhaled corticosteroids, such as
beclomethasone, are preferred for long-term control. Other options may include cromolyn or
nedocromil.
, PULM TOP Exam Guide Questions and
CORRECT Answers
Oral corticosteroids, such as prednisone, are added to therapy in severe persistent asthma. While a
course of oral corticosteroids may be needed for mild exacerbations of asthma, they are not added until
inhaled corticosteroids have failed to control the symptoms.
We have an expert-written solution to this problem!
Patients with community-acquired pneumonia who require hospitalization on the general medical ward
are treated with an extended-spectrum beta-lactam antibiotic, such as ceftriaxone, with a macrolide,
such as ___. Addition of a macrolide is also recommended due to the patient's smoking history and
possible involvement of Hemophilus influenzae.
azithromycin
A 40 year-old alcoholic male presents with sudden onset of severe chills, fever, dyspnea and cough
productive of red mucoid sticky sputum. He appears ill looking with cyanosis. Examination reveals vital
signs: Temp - 102 degrees F; Pulse - 120 /minute and regular; 89 RR - 28/min; BP 90/62 mm Hg. Lungs
reveal minimal rales and dullness in the right upper lobe with decreased breath sounds. Chest x-ray
reveals right upper lobe consolidation with a bulging fissure. Gram stain reveals many white blood cells
and many gram- negative rods. Which of the following is the most appropriate drug of choice?
A Ticarcillin
B Cefotaxime
C Doxycycline
D. Clindamycin
Cefotaxime
This patient most likely has pneumonia caused by Klebsiella. A third generation cephalosporin, such as
cefotaxime, is the preferred antimicrobial therapy against Klebsiella pneumoniae. Alternative antibiotic
choices may include a carbapenem, beta-lactam/beta- lactamase inhibitor or a fluoroquinolone.
Which of the following is the greatest risk factor for the development of drug resistance in the
treatment of tuberculosis?
CORRECT Answers
A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1
day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday.
Which of the following findings will most likely be seen on physical examination of this patient?
A spoken "ee" heard as "ay"
B hyperresonant percussion note
C wheezes over the involved area
D vesicular breath sounds over involved area
also what does this patient have
spoken "ee" heard as "ay"
pneumonia
asbestosis xray findings
interstitial fibrosis and pleural thickening
15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever,
malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon
auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was
negative. Which of the following is the most likely diagnosis?
A acute bronchitis
B viral pneumonia
C mycoplasma pneumonia
D pneumococcal pneumonia
While the patient's clinical symptoms of dry cough and rhonchi support this diagnosis, the chest x-ray
would be normal or only show a mild increase in bronchovascular markings, not infiltrates.
,PULM TOP Exam Guide Questions and
CORRECT Answers
viral pneumonia
The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most
consistent with viral pneumonia.
Either __or __are indicated for prophylactic use against influenza A or B.
zanamivir
oseltamivir
A 3 month-old male presents with a hoarse cough and thick purulent rhinorrhea for the past 2 days. The
mother noted that yesterday he appeared to get worse and seemed to have increasing problems
breathing and trouble feeding. Examination reveals a temperature of 100.2 degrees F and respiratory
rate of 80/minute with nasal flaring and retractions. Lung examination reveals a prolonged expiratory
phase with inspiratory rales. He is tachycardic. Pulse oximetry reveals oxygen saturation of 89%. Chest x-
ray reveals hyperinflation with diffuse interstitial infiltrates. Which of the following is the most
appropriate intervention?
infant most likely has ___
next steps
This infant most likely has bronchiolitis. While most cases are mild and can be treated at home,
hospitalization is recommended for infants with hypoxia on room air, moderate tachypnea with feeding
difficulties and marked respiratory distress with retractions. Additionally hospitalization is
recommended for infants less than 2-3 months of age, a history of apnea or an underlying chronic
cardiopulmonary disease.
A 21 year-old male presents to the ED with increasing dyspnea and pleuritic chest pain of sudden onset
after getting hit in the left side of the chest during a bar fight. Examination reveals moderate respiratory
,PULM TOP Exam Guide Questions and
CORRECT Answers
distress with absence of breath sounds and hyperresonance to percussion on the left, with tracheal
deviation to the right. Which of the following is the most appropriate next step?
A. order a V/Q scan
B order a chest x-ray
C administer a sclerosing agent
D insert large bore needle into left 2nd ICS stat
insert large bore needle into left 2nd ICS stat
We have an expert-written solution to this problem!
A V/Q scan is indicated in suspected cases of
pulmonary embolism.
22 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks.
The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time
she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime
use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. Which
of the following is the most appropriate intervention at this time?
A Oral prednisone
B Oral theophylline
C Salmeterol inhaler
D Beclomethasone inhaler
Beclomethasone inhaler
This patient has progressed to mild persistent asthma. In addition to her inhaled beta2- agonist
(albuterol), she should be started on an anti-inflammatory agent. Inhaled corticosteroids, such as
beclomethasone, are preferred for long-term control. Other options may include cromolyn or
nedocromil.
, PULM TOP Exam Guide Questions and
CORRECT Answers
Oral corticosteroids, such as prednisone, are added to therapy in severe persistent asthma. While a
course of oral corticosteroids may be needed for mild exacerbations of asthma, they are not added until
inhaled corticosteroids have failed to control the symptoms.
We have an expert-written solution to this problem!
Patients with community-acquired pneumonia who require hospitalization on the general medical ward
are treated with an extended-spectrum beta-lactam antibiotic, such as ceftriaxone, with a macrolide,
such as ___. Addition of a macrolide is also recommended due to the patient's smoking history and
possible involvement of Hemophilus influenzae.
azithromycin
A 40 year-old alcoholic male presents with sudden onset of severe chills, fever, dyspnea and cough
productive of red mucoid sticky sputum. He appears ill looking with cyanosis. Examination reveals vital
signs: Temp - 102 degrees F; Pulse - 120 /minute and regular; 89 RR - 28/min; BP 90/62 mm Hg. Lungs
reveal minimal rales and dullness in the right upper lobe with decreased breath sounds. Chest x-ray
reveals right upper lobe consolidation with a bulging fissure. Gram stain reveals many white blood cells
and many gram- negative rods. Which of the following is the most appropriate drug of choice?
A Ticarcillin
B Cefotaxime
C Doxycycline
D. Clindamycin
Cefotaxime
This patient most likely has pneumonia caused by Klebsiella. A third generation cephalosporin, such as
cefotaxime, is the preferred antimicrobial therapy against Klebsiella pneumoniae. Alternative antibiotic
choices may include a carbapenem, beta-lactam/beta- lactamase inhibitor or a fluoroquinolone.
Which of the following is the greatest risk factor for the development of drug resistance in the
treatment of tuberculosis?
