PRIMARY CARE REVIEW:
PULMONARY Q AND A
Abu13buyear-
oldbumalebuwithbuknownbucysticbufibrosisbupresentsbutobuthebuemergencybudepartment,buac
companiedbubybuhisbuparents,buwithbuincreasedbucoughing,buwheezingbuandbulowbugradebu
fever.buRalesbuarebuaudiblebuonbuauscultationbuofbuthebulungs.buTreatmentbushouldbutargetb
uwhichbuofbuthebufollowingbuorganisms?
buHaemophilusbuinfluenzabu
buPseudomonasbuaeruginosabu
buMycoplasmabupneumoniaebu
buPneumocystisbujirovecibu-buanswer--Pseudomonasbuaeruginosa
Abu14buyear-
oldbumalebupresentsbutobuthebuEDbuexperiencingbuabuseverebuasthmabuattack.buHisburespira
torybueffortbuisbushallowbuandbuhebuisbuusingbuaccessorybumusclesbutobubreathe.buAuscultati
onbuofbuhisbuchestburevealsbunobuaudiblebuwheezing.buVitalbusignsbuincludebuBPbu90/60bum
mHg,buPbu160bubpm,buRRbu52.buAnbuarterialbubloodbugasbu(ABG)buisbuordered.buNormalbuA
BGbuvaluesbuatbuyourbuinstitutionbuarebupHbu7.35-7.45,buCO2bu35-45,bupO2bu80-95.bu
WhichbuofbuthebufollowingbuABGbufindingsbusuggestsbuthebupoorestbuprognosis?
bu
bupHbu=bu7.52,bupCO2bu=bu28,bupO2bu=bu80bu
bupHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56bu
bupHbu=bu7.44,bupCO2bu=bu38bupO2bu=bu90bu
bupHbu=bu7.60,bupCO2bu=bu18bupO2bu=bu80bu-buanswer--
pHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56
Abu15buyear-
oldbufemaleburecentlybudiagnosedbuwithbuasthmabuisbuplacedbuonbumometasonebu220bumc
gbuinhaledbudailybuandbualbuterolbu90bumcg/
spraybuMDIbu2bupuffsbuQ6Hbuprn.buWhichbuofbuthebufollowingbuisbumostbuusefulbutobumonitorb
uherbutreatment?
bu
buCXRbu
bu6buminutebuwalkbutestbu
bupeakbuexpiratorybuflowburatebu
bupulsebuoximetrybu-buanswer--peakbuexpiratorybuflowburate
Abu15buyear-
oldbumalebuwasbuseenbulastbuweekbuwithbucomplaintsbuofbusorebuthroat,buheadache,buandbu
mildbucough.buAbudiagnosisbuofbuURI
wasbumadebuandbusupportivebutreatmentbuwasbuinitiated.buHebureturnsbutodaybuwithbucomp
laintsbuofbuworseningbucoughbuandbuincreasingbufatigue.buAtbuthisbutime,buchestbux-
,rayburevealsbubilateralbuhilarbuinfiltrates.buAbuWBCbucountbuisbunormalbuandbuabucoldbuhema
gglutininbutiterbuisbuelevated.buThebumostbulikelybudiagnosisbuis:
bumycoplasmabupneumonia.bu
bupneumococcalbupneumonia.bu
bustaphylococcalbupneumonia.bu
butuberculosis.bu-buanswer--mycoplasmabupneumonia
Thebuinsidiousbuonsetbuofbusymptoms,buthebuinterstitialbuinfiltratebuonbuchestbux-
ray,buandbuelevatedbucoldbuhemagglutininbutiterbumakebumycoplasmabupneumoniaebuthebu
mostbulikely.
Abu16-year-
oldbuhighbuschoolbustudentbupresentsbuwithbuthebusuddenbuonsetbuofbusharpburight-
sidedbuchestbupainbuassociatedbuwithbushortnessbuofbubreath.buHebudeniesbuanybuhistorybuo
fbutrauma.buOnbuPE,buthebupatientbuisbuafebrilebuwithbuabuRRbuofbu28/
min.buHerbuBPbuisbu100/70bummbuHgbuandbuhisbuHRbuisbu120/
min.Neckbuexaminationburevealsbunobutrachealbudeviation.buOnbulungbuauscultation,buthebu
patientbuhasbudecreasedbufremitus,buhyperresonance,bu&budiminishedbubreathbusoundsbu
overbutheburightbuposteriorbuhemithoraxbuCXRbuisbuseenbubelow.buWhichbuofbuthebufollowing
buisbuthebumostbulikelybudiagnosis?bu
buSecondarybupneumothoraxbu
buTensionbupneumothoraxbu
buPulmonarybuembolusbu
buPneumoniabu
buSpontaneousbupneumothoraxbu-buanswer--Spontaneous bupneumothorax
Abu18bumonth-
oldbumalebupresentsbuwithbuhisbuparentsbuwhobureportbusymptomsbuofbuabubarkingbucoughbu
andbuintermittentbustridorbuthatbuhasbuworsenedbuoverbuthebupastbu12buhours.buTheybunotebu
improvementbuinbusymptomsbuwhenbuhebuwasbutakenbuoutdoorsbutobuthebucoolbunightbuair.bu
Whichbuofbuthebufollowingbuisbuthebumostbulikelybuorganismbucausingbuthisbupatient'sbusympt
oms?
buRubeolabuvirusbu
buInfluenzabuvirusbu
buAdenovirusbu
buPara-influenzabuvirusbu-buanswer--Para-influenza buvirusbu
Croupbuisbumostbuoftenbucausedbubybupara-influenzabuvirus
Abu19buyear-
oldbucollegebustudentbupresentsbutobuthebuemergencyburoombuforbusuddenbuonsetbuofbudysp
nea.buThebugeneralbusurveyburevealsbuthatbushebuisbu6'2"butallbuandbuweighsbu135bupounds.
buShebudeniesbufever,buchills,bucough,buorbusorebuthroat.buShebuisbuabunon-
smoker.buYoubususpectbuthatbushebuhasbua*bupneumothoraxbuWhatbufindingsbuwouldbuyoub
uexpectbuwithbupercussionbuofbuthebuthorax*bu-buanswer--
Increasedburesonancebu(hyperresonance)
, Abu19buyear-
oldbumalebupresentsbutobuthebuEDbucomplainingbuofbuabusuddenbuonsetbuofbudyspneabuandbu
leftbusidedbuchestbupain.buHebudeniesbufever,buchills,bucoughbuorbusorebuthroat.buGeneralbus
urveybushowsbuthatbuhebuisbu6bufeetbu2buinchesbutallbuandbuweighsbu135bulbs.buVitalbusignsbua
rebuBPbu86/60bummHg,buHRbu130bubpm,buRRbu28,butemp.bu98.6budegreesbuF.buWhichbuofbut
hebufollowingbuwouldbuyoubulikelybufindbuonbuexaminationbuofbuhisbuthorax?
buIncreasedbuanterior/posteriorbudiameterbu
buIncreasedbutactilebufremitusbuofbuleftbubasebu
buScatteredburalesbuthroughoutbu
buLeft-sidedbuhyperresonancebu-buanswer--Left-sidedbuhyperresonance
Abu2buyear-
oldbupresentsbuwithbusuddenbuonsetbuofbucoughbuandbustridor.buOnbuexaminationbuthebuchil
dbuisbuafebrilebuandbuappearsbunontoxicbuwithbuaburespiratoryburatebuofbu42bubreathsbuperbu
minute.buWhatbuisbuthebunextbustepbuinbuthebuevaluationbuofbuthisbupatient?bu-buanswer--
Chestbux-ray
Abu20buyear-
oldbumalebupresentsbuwithbucomplaintbuofbudifficultybubreathing,buchestbutightnessbuandbuw
heezebuduringbugymbuclass.buHebudeniesbusymptomsbuatbuanybuotherbutimes.buHebudeniesbu
nighttimebucoughbuorbushortnessbuofbubreath.buWhichbuofbuthebufollowingbuisbuthebufirstbuline
butherapybuforbuthisbupatient?
buShort-actingbubetabuagonistbubeforebuexercisebu
buLeukotrienebumodifiersbudailybu
buImmunotherapybu
buInhaledbucorticosteroidsbubeforebuexercisebu-buanswer--Short-
actingbubetabuagonistbubeforebuexercise
Abu20-year-oldbucollegebustudentbupresentsbuwithbuabu3-
mobuhistorybuofbuleftbusidedbupleuriticbuchestbupain,budyspneabuwithbuexertion,buandbunightbu
sweats.buHebuisbuabunonsmokerbuandbudoesbunotbuusebuillegalbudrugs.buHebuisbuheterosexu
al.buHeburecallsbuabunegativebuPPDbuwhenbuhebustartedbucollegebu2buyearsbuago.buOnbuPE,bu
hisbutemperaturebuisbu100.9buFbuandbuhisburespiratoryburatebuisbu24/
m.buLungbuexaminationburevealsbudecreasedbufremitus,budullnessbutobupercussion,buandbu
diminishedbubreathbusoundsbuoverbuthebuleftbuposteriorbulung.bu*Abupleuralbufrictionburubbuis
buaudiblebuatbuthebuleftbulungbubase.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagn
osis?*bu-buanswer--Pleuralbueffusion
Abu21buyear-
oldbucollegebustudentbupresentsbuwithbuabu3buweekbuhistorybuofbuslowlybuworseningbudrybuco
ugh,bugeneralizedbufatiguebuandbumostburecentlybulow-
gradebufevers.buHebudeniesbunasalbucongestion,busorebuthroatbuandbunauseabuandbuhasbun
obupastbuhistorybuofbupulmonarybudiseasebuorbutobaccobuuse.buHebudoesbunotebuthatbumany
buotherbudormburesidentsbuhavebuhadbusimilarbusymptomsbuoverbuthebupastbutwobumonths.bu
Examinationburevealsbumildbuinspiratorybucracklesbubutbuisbuotherwisebunormal.buChestbur
adiographbuisbuclearbuandbuCBCbuisbunormal.buWhichbuofbuthebufollowingbuisbuthebumostbulik
elybucausativebuorganism?
PULMONARY Q AND A
Abu13buyear-
oldbumalebuwithbuknownbucysticbufibrosisbupresentsbutobuthebuemergencybudepartment,buac
companiedbubybuhisbuparents,buwithbuincreasedbucoughing,buwheezingbuandbulowbugradebu
fever.buRalesbuarebuaudiblebuonbuauscultationbuofbuthebulungs.buTreatmentbushouldbutargetb
uwhichbuofbuthebufollowingbuorganisms?
buHaemophilusbuinfluenzabu
buPseudomonasbuaeruginosabu
buMycoplasmabupneumoniaebu
buPneumocystisbujirovecibu-buanswer--Pseudomonasbuaeruginosa
Abu14buyear-
oldbumalebupresentsbutobuthebuEDbuexperiencingbuabuseverebuasthmabuattack.buHisburespira
torybueffortbuisbushallowbuandbuhebuisbuusingbuaccessorybumusclesbutobubreathe.buAuscultati
onbuofbuhisbuchestburevealsbunobuaudiblebuwheezing.buVitalbusignsbuincludebuBPbu90/60bum
mHg,buPbu160bubpm,buRRbu52.buAnbuarterialbubloodbugasbu(ABG)buisbuordered.buNormalbuA
BGbuvaluesbuatbuyourbuinstitutionbuarebupHbu7.35-7.45,buCO2bu35-45,bupO2bu80-95.bu
WhichbuofbuthebufollowingbuABGbufindingsbusuggestsbuthebupoorestbuprognosis?
bu
bupHbu=bu7.52,bupCO2bu=bu28,bupO2bu=bu80bu
bupHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56bu
bupHbu=bu7.44,bupCO2bu=bu38bupO2bu=bu90bu
bupHbu=bu7.60,bupCO2bu=bu18bupO2bu=bu80bu-buanswer--
pHbu=bu7.27bupCO2bu=bu46bupO2bu=bu56
Abu15buyear-
oldbufemaleburecentlybudiagnosedbuwithbuasthmabuisbuplacedbuonbumometasonebu220bumc
gbuinhaledbudailybuandbualbuterolbu90bumcg/
spraybuMDIbu2bupuffsbuQ6Hbuprn.buWhichbuofbuthebufollowingbuisbumostbuusefulbutobumonitorb
uherbutreatment?
bu
buCXRbu
bu6buminutebuwalkbutestbu
bupeakbuexpiratorybuflowburatebu
bupulsebuoximetrybu-buanswer--peakbuexpiratorybuflowburate
Abu15buyear-
oldbumalebuwasbuseenbulastbuweekbuwithbucomplaintsbuofbusorebuthroat,buheadache,buandbu
mildbucough.buAbudiagnosisbuofbuURI
wasbumadebuandbusupportivebutreatmentbuwasbuinitiated.buHebureturnsbutodaybuwithbucomp
laintsbuofbuworseningbucoughbuandbuincreasingbufatigue.buAtbuthisbutime,buchestbux-
,rayburevealsbubilateralbuhilarbuinfiltrates.buAbuWBCbucountbuisbunormalbuandbuabucoldbuhema
gglutininbutiterbuisbuelevated.buThebumostbulikelybudiagnosisbuis:
bumycoplasmabupneumonia.bu
bupneumococcalbupneumonia.bu
bustaphylococcalbupneumonia.bu
butuberculosis.bu-buanswer--mycoplasmabupneumonia
Thebuinsidiousbuonsetbuofbusymptoms,buthebuinterstitialbuinfiltratebuonbuchestbux-
ray,buandbuelevatedbucoldbuhemagglutininbutiterbumakebumycoplasmabupneumoniaebuthebu
mostbulikely.
Abu16-year-
oldbuhighbuschoolbustudentbupresentsbuwithbuthebusuddenbuonsetbuofbusharpburight-
sidedbuchestbupainbuassociatedbuwithbushortnessbuofbubreath.buHebudeniesbuanybuhistorybuo
fbutrauma.buOnbuPE,buthebupatientbuisbuafebrilebuwithbuabuRRbuofbu28/
min.buHerbuBPbuisbu100/70bummbuHgbuandbuhisbuHRbuisbu120/
min.Neckbuexaminationburevealsbunobutrachealbudeviation.buOnbulungbuauscultation,buthebu
patientbuhasbudecreasedbufremitus,buhyperresonance,bu&budiminishedbubreathbusoundsbu
overbutheburightbuposteriorbuhemithoraxbuCXRbuisbuseenbubelow.buWhichbuofbuthebufollowing
buisbuthebumostbulikelybudiagnosis?bu
buSecondarybupneumothoraxbu
buTensionbupneumothoraxbu
buPulmonarybuembolusbu
buPneumoniabu
buSpontaneousbupneumothoraxbu-buanswer--Spontaneous bupneumothorax
Abu18bumonth-
oldbumalebupresentsbuwithbuhisbuparentsbuwhobureportbusymptomsbuofbuabubarkingbucoughbu
andbuintermittentbustridorbuthatbuhasbuworsenedbuoverbuthebupastbu12buhours.buTheybunotebu
improvementbuinbusymptomsbuwhenbuhebuwasbutakenbuoutdoorsbutobuthebucoolbunightbuair.bu
Whichbuofbuthebufollowingbuisbuthebumostbulikelybuorganismbucausingbuthisbupatient'sbusympt
oms?
buRubeolabuvirusbu
buInfluenzabuvirusbu
buAdenovirusbu
buPara-influenzabuvirusbu-buanswer--Para-influenza buvirusbu
Croupbuisbumostbuoftenbucausedbubybupara-influenzabuvirus
Abu19buyear-
oldbucollegebustudentbupresentsbutobuthebuemergencyburoombuforbusuddenbuonsetbuofbudysp
nea.buThebugeneralbusurveyburevealsbuthatbushebuisbu6'2"butallbuandbuweighsbu135bupounds.
buShebudeniesbufever,buchills,bucough,buorbusorebuthroat.buShebuisbuabunon-
smoker.buYoubususpectbuthatbushebuhasbua*bupneumothoraxbuWhatbufindingsbuwouldbuyoub
uexpectbuwithbupercussionbuofbuthebuthorax*bu-buanswer--
Increasedburesonancebu(hyperresonance)
, Abu19buyear-
oldbumalebupresentsbutobuthebuEDbucomplainingbuofbuabusuddenbuonsetbuofbudyspneabuandbu
leftbusidedbuchestbupain.buHebudeniesbufever,buchills,bucoughbuorbusorebuthroat.buGeneralbus
urveybushowsbuthatbuhebuisbu6bufeetbu2buinchesbutallbuandbuweighsbu135bulbs.buVitalbusignsbua
rebuBPbu86/60bummHg,buHRbu130bubpm,buRRbu28,butemp.bu98.6budegreesbuF.buWhichbuofbut
hebufollowingbuwouldbuyoubulikelybufindbuonbuexaminationbuofbuhisbuthorax?
buIncreasedbuanterior/posteriorbudiameterbu
buIncreasedbutactilebufremitusbuofbuleftbubasebu
buScatteredburalesbuthroughoutbu
buLeft-sidedbuhyperresonancebu-buanswer--Left-sidedbuhyperresonance
Abu2buyear-
oldbupresentsbuwithbusuddenbuonsetbuofbucoughbuandbustridor.buOnbuexaminationbuthebuchil
dbuisbuafebrilebuandbuappearsbunontoxicbuwithbuaburespiratoryburatebuofbu42bubreathsbuperbu
minute.buWhatbuisbuthebunextbustepbuinbuthebuevaluationbuofbuthisbupatient?bu-buanswer--
Chestbux-ray
Abu20buyear-
oldbumalebupresentsbuwithbucomplaintbuofbudifficultybubreathing,buchestbutightnessbuandbuw
heezebuduringbugymbuclass.buHebudeniesbusymptomsbuatbuanybuotherbutimes.buHebudeniesbu
nighttimebucoughbuorbushortnessbuofbubreath.buWhichbuofbuthebufollowingbuisbuthebufirstbuline
butherapybuforbuthisbupatient?
buShort-actingbubetabuagonistbubeforebuexercisebu
buLeukotrienebumodifiersbudailybu
buImmunotherapybu
buInhaledbucorticosteroidsbubeforebuexercisebu-buanswer--Short-
actingbubetabuagonistbubeforebuexercise
Abu20-year-oldbucollegebustudentbupresentsbuwithbuabu3-
mobuhistorybuofbuleftbusidedbupleuriticbuchestbupain,budyspneabuwithbuexertion,buandbunightbu
sweats.buHebuisbuabunonsmokerbuandbudoesbunotbuusebuillegalbudrugs.buHebuisbuheterosexu
al.buHeburecallsbuabunegativebuPPDbuwhenbuhebustartedbucollegebu2buyearsbuago.buOnbuPE,bu
hisbutemperaturebuisbu100.9buFbuandbuhisburespiratoryburatebuisbu24/
m.buLungbuexaminationburevealsbudecreasedbufremitus,budullnessbutobupercussion,buandbu
diminishedbubreathbusoundsbuoverbuthebuleftbuposteriorbulung.bu*Abupleuralbufrictionburubbuis
buaudiblebuatbuthebuleftbulungbubase.buWhichbuofbuthebufollowingbuisbuthebumostbulikelybudiagn
osis?*bu-buanswer--Pleuralbueffusion
Abu21buyear-
oldbucollegebustudentbupresentsbuwithbuabu3buweekbuhistorybuofbuslowlybuworseningbudrybuco
ugh,bugeneralizedbufatiguebuandbumostburecentlybulow-
gradebufevers.buHebudeniesbunasalbucongestion,busorebuthroatbuandbunauseabuandbuhasbun
obupastbuhistorybuofbupulmonarybudiseasebuorbutobaccobuuse.buHebudoesbunotebuthatbumany
buotherbudormburesidentsbuhavebuhadbusimilarbusymptomsbuoverbuthebupastbutwobumonths.bu
Examinationburevealsbumildbuinspiratorybucracklesbubutbuisbuotherwisebunormal.buChestbur
adiographbuisbuclearbuandbuCBCbuisbunormal.buWhichbuofbuthebufollowingbuisbuthebumostbulik
elybucausativebuorganism?
