Clin Med Practice Exam 1: Pulmonary

The given scenario suggests that the patient is experiencing symptoms of dyspnea and wet cough, along with an obstructive pattern in PFTs. The hyperinflation of the lungs and flattened diaphragm seen in the chest X-ray, along with arterial depletion at the lung bases, are indicative of a condition called alpha-1 antitrypsin deficiency. This is a genetic disorder that affects the production of a protein called alpha-1 antitrypsin, which helps protect the lungs from damage. Testing the serum level of alpha-1 antitrypsin is a logical step to confirm the diagnosis.

A lung abscess appears on a chest X-ray as a thick-walled solitary cavity surrounded by consolidation. This means that there is a thick wall surrounding a cavity in the lung, and the area around it appears consolidated, which indicates inflammation and infection. This is a characteristic finding of a lung abscess, which is a localized collection of pus in the lung tissue.

Congestive heart failure is not a cause of an exudative pleural effusion because exudative pleural effusions are typically caused by inflammation or infection, whereas congestive heart failure leads to a transudative pleural effusion. In congestive heart failure, increased pressure in the heart causes fluid to leak into the pleural space, resulting in a transudative effusion. Exudative pleural effusions, on the other hand, are caused by conditions such as infection (epyema), autoimmune diseases (SLE), and tuberculosis (TB), which lead to an increased permeability of blood vessels and the accumulation of inflammatory fluid in the pleural space.

The patient's symptoms of anorexia, weight loss, fatigue, bone pain, hoarseness, and anemia are consistent with the presentation of a Pancoast tumor. The additional findings of ptosis and a constricted pupil in the left eye, as well as diaphoresis only on the right side of her face, suggest Horner syndrome, which is commonly associated with Pancoast tumors. Superior vena cava syndrome, small cell carcinoma, and atelectasis do not explain the full range of symptoms and findings seen in this patient.

The statement "it includes ethambutol and pyrazinamide for the entire course of treatment" is false. While ethambutol and pyrazinamide are commonly used in the initial phase of tuberculosis treatment, they are usually discontinued after a few months. The continuation phase of treatment typically involves the use of isoniazid and rifampin for a total duration of 6-9 months. Therefore, it is incorrect to say that ethambutol and pyrazinamide are used for the entire course of treatment.

The appropriate treatment would be to use the same antibiotic that has successfully treated other patients in the hospital with pneumonia. This is because the patient's symptoms, such as low-grade fever, bronchial breath sounds, and consolidation on chest X-ray, are consistent with pneumonia. Using the same antibiotic that has worked for other patients would be a reasonable approach until the results of cultures are available to confirm the specific causative organism.

Stage II of non-small cell lung cancer is characterized by the involvement of lung tissue and nearby lymph nodes. In this stage, the cancer has spread to the lymph nodes within the lung but has not yet spread to distant parts of the body. This indicates a more advanced stage compared to Stage I, where the cancer is limited to the lung tissue only.

The patient presenting with symptoms such as headache, sore throat, earache, urticaria, rhonchi, rales, and lymphadenopathy suggests an atypical presentation of pneumonia. Mycoplasma pneumonia, also known as primary atypical pneumonia, is a common cause of respiratory infection characterized by these symptoms. The absence of consolidation in the lower lung zones on the chest x-ray further supports this suspicion. Upper respiratory infection, lung abscess, and pulmonary embolism are less likely to present with this combination of symptoms and findings.

Bronchiectasis is a condition characterized by the permanent enlargement of the airways in the lungs, leading to the accumulation of mucus and frequent infections. This can result in hemoptysis, the coughing up of blood, which can occur in large amounts. Therefore, bronchiectasis is the most likely condition to produce 200 cc of hemoptysis at a time or over 600 cc over 24 hours, compared to the other options of pulmonary embolism, cystic fibrosis, and atelectasis.

Equalization between the pressure of the pleura and the lungs would cause pneumothorax. Pneumothorax occurs when air enters the pleural space, causing the lung to collapse. Equalization of pressure between the pleura and the lungs would disrupt the normal pressure gradient, leading to air entering the pleural space and causing pneumothorax. Pleural effusion, pulmonary edema, and atelectasis are not directly related to equalization of pressure between the pleura and the lungs.

Mitral stenosis refers to the narrowing of the mitral valve, which is responsible for regulating blood flow from the left atrium to the left ventricle. When the mitral valve is stenosed, it obstructs the flow of blood, causing increased pressure in the left atrium and subsequently in the pulmonary veins. This increased pressure is transmitted to the pulmonary circulation, leading to pulmonary hypertension. Therefore, mitral stenosis can cause pulmonary hypertension by increasing pulmonary venous pressure.

After quitting smoking, it takes approximately 10 years for the risk of lung cancer to be reduced to half that of a smoker. This is because the harmful effects of smoking gradually decrease over time as the body repairs itself. It is important to note that quitting smoking is the most effective way to reduce the risk of lung cancer and other smoking-related diseases.

Diffuse panbronchiolitis is a chronic inflammatory disease that primarily affects the respiratory bronchioles. It is more commonly found in East Asian populations, particularly in Japan. The condition is characterized by persistent cough, sputum production, and dyspnea. The given answer of a 40-year-old Japanese man with a history of pansinusitis suggests that he may be at risk for diffuse panbronchiolitis due to his Japanese ethnicity and history of chronic sinusitis. The other options do not provide any specific risk factors for this condition.

Beta blockers are not typically used in the treatment of alpha-1-antitrypsin deficiency. This condition primarily affects the lungs and liver, and treatment focuses on managing symptoms and preventing further damage. Daily inhaled corticosteroids for maintenance help reduce inflammation in the airways, antibiotics are used to treat acute exacerbations of respiratory infections, and a flutter-valve device is used to help clear mucus from the airways. Beta blockers are commonly used to treat conditions such as high blood pressure and heart disease, but they are not directly related to the treatment of alpha-1-antitrypsin deficiency.

The Karnofsky scale is a tool used to measure the quality of life of patients. It assesses their ability to perform daily activities and their overall well-being. It is commonly used in healthcare settings, particularly in oncology, to evaluate the impact of diseases and treatments on patients' functioning and overall quality of life.

Smoking increases the risk of myocardial infarction (heart attack) due to its harmful effects on the cardiovascular system. When a patient smokes, their blood vessels constrict, their heart rate increases, and their blood pressure rises, all of which can lead to a heart attack. Therefore, to decrease the risk of myocardial infarction, a pre-op patient should be told to stop smoking at least 24 hours before the operation. This timeframe allows some time for the body to recover from the immediate effects of smoking and for the blood vessels to start returning to a healthier state.

Constrictive bronchiolitis is a condition that is not responsive to corticosteroids. Corticosteroids are commonly used to reduce inflammation in the airways, which is effective in treating conditions such as asthma, proliferative bronchiolitis, and bronchiolitis obliterans with organizing pneumonia (BOOP). However, constrictive bronchiolitis is characterized by the narrowing and scarring of the small airways, which is not primarily driven by inflammation. Therefore, corticosteroids are not effective in treating this condition.

The correct answer suggests that prophylaxis in patients her age will decrease the risk of cirrhosis and lower her chance of reactivation to less than 5%. This reassures the woman that there are measures she can take to reduce the risk of complications and reactivation of the infection. It implies that the infection is treatable and manageable, providing her with some peace of mind.

Strep. pneumoniae is not associated with acute bronchitis. Acute bronchitis is typically caused by viral infections, such as mycoplasma pneumoniae, chlamydia pneumoniae, or bordetella pertussis. Strep. pneumoniae is more commonly associated with pneumonia rather than bronchitis.

Surfactant is produced in both cuboidal cells and type II cells in the lungs. Type II cells are responsible for the majority of surfactant production, while cuboidal cells also contribute to its production. Surfactant is a substance that reduces surface tension in the alveoli, preventing them from collapsing and allowing for efficient gas exchange in the lungs.