Pulm Exam Questions With Complete Solutions
15M p/w c/o sore throat, HA, & mild cough that started 8 days
ago & has progressed to include a worsening cough &
increasing fatigue. His chest xray reveals B/L hilar infiltrates,
CBC (WNL) & a nasal secretions test positive for Mycoplasma
pneumoniae by PCR. What is the most appropriate therapy?
A. Amoxicillin
B. Cefuroxime
C. Clindamycin
D. Ciprofloxacin
E. Azithromycin Correct Answers E. Azithromycin
Mycoplasma pneumoniae is commonly treated w/ macrolides
such as Azithromycin, doxycycline, or respiratory
fluoroquinolones
18M presents to clinic d/t a recent positive TB screening test.
Which of the following steps should be taken to avoid
neurotoxicity a/w his prophylactic INH treatment?
A. perform an initial screening mental status exam
B. supplement w/ folic acid
C. supplement w/ pyridoxine (vitamin B6)
D. take meds on a full stomach
E. take the meds TID Correct Answers C. supplement w/
pyridoxine (vitamin B6)
,22M p/w 2 week Hx of an URI that hasnt improved after taking
amoxicillin x6days. He notes persistent sore throat, intermittent
fever, & a worsening nonproductive cough. Physical exam
reveals B/L diffuse crackles. What is the most likely causative
agent of his symptoms?
A. Strep pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pneumocystis jiroveci
E. Staph aureus Correct Answers C. Mycoplasma pneumoniae
Pt presentation is consistent w/ atypical PNA caused by
bacterium such as mycoplasma pneumonia, chlamydia
pneumonia, or legionella
Presentation of strep PNA = more acute w/ productive cough &
fever being early symptoms
Klebsiella pneumonia also presents w/ fever & a cough
classically noted to be productive of "currant jelly" sputum
Pneumocystis jiroveci causes PNA of insidious onset in
immunocompromised Pts
22M p/w 2-week Hx of URI that hasnt improved after taking
amoxicillin x6days. He notes persistent sore throat, intermittent
fever, & a worsening nonproductive cough. Physical exam
reveals B/L diffuse crackles. What is the most appropriate abx to
initiate after discontinuing the amoxicillin?
,A. Amoxicilin & clavulanic acid
B. Azithromycin
C. Cephalexin
D. Ciprofloxacin
E. Trimethoprim/Sulfamethoxazole Correct Answers B.
Azithromycin
Pt most likely has atypical PNA that responds best to macrolide
abx
25 y/o asymptomatic, non-smoking male p/w a 9mm solitary
pulmonary nodule, w/ dense central calcification on routine
chest x-ray. The nodule's appearance is smooth & calcified w/ a
well-defined edge. This same lesion was present on a work
physical x-ray two years ago. Which of the following is the möst
appropriate management step for this patient?
A. Positron emission tomograph to rule out malignancy
B. Resection of the pulmonary nodule
C. Thoracic MRI
D. Watchful waiting w/ serial imaging
E. Pulmonary function tests Correct Answers D. Watchful
waiting w/ serial imaging
Solitary pulmonary nodules are categorized based upon the
probability of malignancy. This patient is under the age of 30,
with previous documentation of the lesion and without evidence
of growth or change, which decreases the probability of
malignancy. In this case, watchful waiting is indicated. Risk
factors, such as advanced age, smoking, lesion growth or
appearance change, and history of prior malignancy increase
, malignancy probability, and indicate a need for more defined
evaluation.
25 year-old HIV+ white male p/w dyspnea & nonproductive
cough. Physical exam reveals a thin, dyspneic male in moderate
respiratory distress with minimal bibasilar crackles & peripheral
cyanosis. CXR reveals a diffuse interstitial infiltrate & his LDH
is elevated. Your most likely DX is:
A. Streptococcal pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pneumocystis juroveci
E. Staphlococal aureus Correct Answers D. Pneumocystis
juroveci
26M presents to clinic after developing a severe productive
cough, fever, chills, night sweats & wt loss. Which is the most
definitive diagnostic test for determining the presence of M
tuberculosis as the causative agent of his active pulmonary TB
& yield his results in < 24hrs?
A. Acid-fast bacilli smear of sputum
B. blood culture
C. mycobacterial culture of sputum
D. nucleic acid amplification of sputum
E. TB skin test Correct Answers D. nucleic acid amplification
of sputum
28M p/w hypotension, marked tachypnea, & severe dyspnea
following a fistfight. A PE reveals ecchymoses over the lateral
15M p/w c/o sore throat, HA, & mild cough that started 8 days
ago & has progressed to include a worsening cough &
increasing fatigue. His chest xray reveals B/L hilar infiltrates,
CBC (WNL) & a nasal secretions test positive for Mycoplasma
pneumoniae by PCR. What is the most appropriate therapy?
A. Amoxicillin
B. Cefuroxime
C. Clindamycin
D. Ciprofloxacin
E. Azithromycin Correct Answers E. Azithromycin
Mycoplasma pneumoniae is commonly treated w/ macrolides
such as Azithromycin, doxycycline, or respiratory
fluoroquinolones
18M presents to clinic d/t a recent positive TB screening test.
Which of the following steps should be taken to avoid
neurotoxicity a/w his prophylactic INH treatment?
A. perform an initial screening mental status exam
B. supplement w/ folic acid
C. supplement w/ pyridoxine (vitamin B6)
D. take meds on a full stomach
E. take the meds TID Correct Answers C. supplement w/
pyridoxine (vitamin B6)
,22M p/w 2 week Hx of an URI that hasnt improved after taking
amoxicillin x6days. He notes persistent sore throat, intermittent
fever, & a worsening nonproductive cough. Physical exam
reveals B/L diffuse crackles. What is the most likely causative
agent of his symptoms?
A. Strep pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pneumocystis jiroveci
E. Staph aureus Correct Answers C. Mycoplasma pneumoniae
Pt presentation is consistent w/ atypical PNA caused by
bacterium such as mycoplasma pneumonia, chlamydia
pneumonia, or legionella
Presentation of strep PNA = more acute w/ productive cough &
fever being early symptoms
Klebsiella pneumonia also presents w/ fever & a cough
classically noted to be productive of "currant jelly" sputum
Pneumocystis jiroveci causes PNA of insidious onset in
immunocompromised Pts
22M p/w 2-week Hx of URI that hasnt improved after taking
amoxicillin x6days. He notes persistent sore throat, intermittent
fever, & a worsening nonproductive cough. Physical exam
reveals B/L diffuse crackles. What is the most appropriate abx to
initiate after discontinuing the amoxicillin?
,A. Amoxicilin & clavulanic acid
B. Azithromycin
C. Cephalexin
D. Ciprofloxacin
E. Trimethoprim/Sulfamethoxazole Correct Answers B.
Azithromycin
Pt most likely has atypical PNA that responds best to macrolide
abx
25 y/o asymptomatic, non-smoking male p/w a 9mm solitary
pulmonary nodule, w/ dense central calcification on routine
chest x-ray. The nodule's appearance is smooth & calcified w/ a
well-defined edge. This same lesion was present on a work
physical x-ray two years ago. Which of the following is the möst
appropriate management step for this patient?
A. Positron emission tomograph to rule out malignancy
B. Resection of the pulmonary nodule
C. Thoracic MRI
D. Watchful waiting w/ serial imaging
E. Pulmonary function tests Correct Answers D. Watchful
waiting w/ serial imaging
Solitary pulmonary nodules are categorized based upon the
probability of malignancy. This patient is under the age of 30,
with previous documentation of the lesion and without evidence
of growth or change, which decreases the probability of
malignancy. In this case, watchful waiting is indicated. Risk
factors, such as advanced age, smoking, lesion growth or
appearance change, and history of prior malignancy increase
, malignancy probability, and indicate a need for more defined
evaluation.
25 year-old HIV+ white male p/w dyspnea & nonproductive
cough. Physical exam reveals a thin, dyspneic male in moderate
respiratory distress with minimal bibasilar crackles & peripheral
cyanosis. CXR reveals a diffuse interstitial infiltrate & his LDH
is elevated. Your most likely DX is:
A. Streptococcal pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pneumocystis juroveci
E. Staphlococal aureus Correct Answers D. Pneumocystis
juroveci
26M presents to clinic after developing a severe productive
cough, fever, chills, night sweats & wt loss. Which is the most
definitive diagnostic test for determining the presence of M
tuberculosis as the causative agent of his active pulmonary TB
& yield his results in < 24hrs?
A. Acid-fast bacilli smear of sputum
B. blood culture
C. mycobacterial culture of sputum
D. nucleic acid amplification of sputum
E. TB skin test Correct Answers D. nucleic acid amplification
of sputum
28M p/w hypotension, marked tachypnea, & severe dyspnea
following a fistfight. A PE reveals ecchymoses over the lateral
