Respiratory System Practice Quiz For Um/Fau
This test is a practice test designed for UM/FAU medical students getting ready for Respiratory test number two.
- 1.
Which of the following are physical defense systems of the lung?
- A.
Phagocytic, Immunologic, Cough reflex
- B.
Cough reflex, Sneeze reflex, Upper airway filtering, Immunologic
- C.
Immunologic, Phagocytic
- D.
Upper airway filtering, Cough and Sneeze reflexes, mucociliary escalator
- E.
Chuck Norris
Correct Answer
D. Upper airway filtering, Cough and Sneeze reflexes, mucociliary escalatorExplanation
The correct answer is "Upper airway filtering, Cough and Sneeze reflexes, mucociliary escalator." These are physical defense systems of the lung that help to protect against foreign particles and pathogens. The upper airway filtering refers to the nose and throat filtering out larger particles before they reach the lungs. The cough and sneeze reflexes help to expel irritants and pathogens from the respiratory tract. The mucociliary escalator is a mechanism where tiny hair-like structures called cilia move mucus and trapped particles out of the lungs. These physical defense systems work together to prevent harmful substances from entering and causing damage to the lungs.Rate this question:
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- 2.
A 64 year old former politician is seen by his primary care physician for pain on urination, wheezing, dyspnea, and cough productive of brown sputum. He admits to trying marijuana, but "didn't inhale." He is diagnosed with aspergilloma and chlamydia. Given that aspergillus particles are about 3.5 microns in diameter, in which part of the airway is the aspergillus likely to be lodged?
- A.
Alveolus
- B.
Capillary
- C.
Bronchiole
- D.
Trachea
Correct Answer
C. BronchioleExplanation
Alveolus isRate this question:
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- 3.
Which of the following patients would you expect to have the worst mucociliary function?
- A.
Young nonsmoker with influenza
- B.
Young smoker with rhinovirus
- C.
Smoker who lives in Mexico City
- D.
Old smoker with chronic bronchitis
- E.
Old ex-smoker who is an alcoholic
Correct Answer
D. Old smoker with chronic bronchitisExplanation
This one is probably debatable, as I gave every patient at least one condition that causes decreased mucociliary transport. I picked D as the correct answer because of the graph in Dr. Fischer's lecture that shows mucociliary transport lowest in smokers with bronchitis. Also, patient D has 3 strikes against him/her (age, bronchitis, smoking).Rate this question:
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- 4.
Which of these is not a phase of coughing?
- A.
Expiratory
- B.
Expressive
- C.
Compressive
- D.
Inspiratory
Correct Answer
B. ExpressiveExplanation
Coughing is a reflex action that helps to clear the airways of irritants or mucus. The phases of coughing involve different actions of the respiratory muscles. The expiratory phase refers to the forceful exhalation of air during a cough. The compressive phase refers to the compression of the airways to generate a strong cough. The inspiratory phase refers to the inhalation of air before the cough. However, the term "expressive" does not correspond to any specific phase of coughing. It does not describe any action or component of the coughing process.Rate this question:
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- 5.
A 50 year old male presents with productive cough, fever, and chills. His respiratory rate is 32. The medical student on duty orders a CBC and the results show a WBC count of 20,000. CXR shows a lobar consolidation. Blood cultures return positive for Streptococcus pneumoniae. Which of the following is/are true about S. pneumoniae?
- A.
Abcesses and cavitations are common
- B.
A blood culture is a highly sensitive test for S. pneumo
- C.
Produces a protease that can cleave IgG
- D.
The pneumovax vaccine can prevent all 84 serotypes
- E.
S. pneumo is alpha hemolytic and does not grow well in the presence of optochin
Correct Answer
E. S. pneumo is alpHa hemolytic and does not grow well in the presence of optochinExplanation
A: rare, B: 20-50% positive, C: splits IgA, D: vaccine prevents 25 most common serotypesRate this question:
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- 6.
Which of the following is/are true about Haemophilus influenza?
- A.
Gram-negative bacillus, lacks polysaccharide capsule
- B.
Colonizes upper respiratory tract, sputum sample is a highly specific test for H. flu
- C.
Clinically similar to other Community Acquired Pneumonias, nearly eliminated in young children due to vaccination
- D.
Rarely associated with COPD, requires blood containing medium for growth
Correct Answer
C. Clinically similar to other Community Acquired Pneumonias, nearly eliminated in young children due to vaccinationExplanation
A: polysaccharide capsule is main virulence factor, B: sputum commonly contaminated with H. flu, D: commonly seen in COPDRate this question:
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- 7.
This sample was isolated from a 75 year old woman in the ICU who has been on mechanical ventilation for 1 month following a viral infection. Which of the following would you, as an astute medical student, expect to see in this patient?
- A.
Positive sputum culture, negative blood culture
- B.
CXR with multiple nodular infiltrates, skin lesions
- C.
Catalase negative, coagulase positive
- D.
Diarrhea, dry cough, rigors
- E.
Myalgia, arthralgia, rash
Correct Answer
B. CXR with multiple nodular infiltrates, skin lesionsExplanation
Organism is Staph aureus.
A: sputum usually neg, blood usually pos, C: Cat and Coag positive, D: Typical presentation of Legionella, E: Typical of MycoplasmaRate this question:
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- 8.
A 70 year old woman presents to an inexperienced second year medical student with mild but persistent sinusitis, pharyngitis, and cough for the last few months. The symptoms began in the summer. CXR shows a streaky infiltrate. The patient denies diarrhea, myalgias, arthralgias or rash. Gram stain is unable to be attained but the wise old attending who already knows the diagnosis tells you that it would have been gram-negative. What is the most likely diagnosis?
- A.
Streptococcus pneumoniae
- B.
Klebsiella pneumonia
- C.
Mycoplasma pneumonia
- D.
Legionella pneumonia
- E.
Chlamydophila pneumonia
Correct Answer
E. ChlamydopHila pneumoniaExplanation
Subacute and prolonged symptoms and streaky infiltrate are suggestive of either Mycoplasma or Chlamydophila. Patient also denies symptoms that are unique within the pneumonias to either Legionella (diarrhea) or Mycoplasma (myalgia, arthralgia). Chlamydophila is more common in 65-79 age range, and is gram-negative.Rate this question:
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- 9.
Which of the following statements about antibiotic treatment of pneumonia is/are true?
- A.
Beta-lactams are only effective against organisms with a peptidoglycan cell wall, and are rarely subject to bacterial resistance
- B.
Carbapenems are effective against gram-negatives, anaerobes, and gram-positives and are generally resistant to beta-lactamase cleavage.
- C.
Monobactams are generally effective against gram-positives, but not gram negatives
- D.
Azithromycin binds irreversibly to the 30 S subunit of bacterial ribosomes, and is active against atypical pathogens such as M. pneumoniae and C. pneumoniae
- E.
Doxycycline binds irreversibly to the 50 S subunit of bacterial ribosomes and is effective against M. pneumoniae, S. pneumo, and Anthrax
Correct Answer
B. Carbapenems are effective against gram-negatives, anaerobes, and gram-positives and are generally resistant to beta-lactamase cleavage.Explanation
A: MRSA is common, C: It's the opposite, effective against negs not pos, D: AZ binds to 50S. E: Doxy binds to 30 SRate this question:
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- 10.
Which of these is/are causes of hypoxemic-hypercapnic respiratory failure?
- A.
Asthma
- B.
ALS
- C.
Idiopathic pulmonary fibrosis
- D.
Obesity
- E.
Pneumonia
Correct Answer(s)
A. Asthma
B. ALS
C. Idiopathic pulmonary fibrosis
D. ObesityExplanation
Pneumonia is more likely to cause type 1 hypoxemic respiratory failure.Rate this question:
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- 11.
A patient in the ICU has a PaO2 of 100 and an FiO2 of 40%. The patient also has a normal PA wedge pressure and bilateral infiltrates on x-ray. Which most accurately describes the most appropriate diagnosis and treatment of this patient?
- A.
Acute lung injury, requires treatment
- B.
ARDS, does not require treatment, send patient home
- C.
ARDS, requires treatment
- D.
Normal lung, send patient home
- E.
Acute lung injury, does not require treatment, send patient home
Correct Answer
A. Acute lung injury, requires treatmentExplanation
If PaO2/FiO2 ratio isRate this question:
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- 12.
Which of these patients would be indicated to receive mechanical ventilation?
- A.
80 kg male with a tidal volume of 320 mL
- B.
80 kg male with a tidal volume of 500mL
- C.
80 kg male with a vital capacity of 1550 mL
- D.
80 kg male with a PCO2 of 48
- E.
80 kg male with a a minute ventilation of 11 L/min
Correct Answer
A. 80 kg male with a tidal volume of 320 mLExplanation
Indications for ventilation: RR>35, TVRate this question:
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- 13.
Which of these is a disadvantage of pressure controlled ventilation?
- A.
Can control inspiratory pressure level and I:E ratio
- B.
Optimal patient synchronization
- C.
Reduced airway pressures
- D.
Unable to control minute ventilation
- E.
Less likely to induce pneumothorax
Correct Answer
D. Unable to control minute ventilationExplanation
Pressure controlled ventilation is a mode of mechanical ventilation where the inspiratory pressure is set and the ventilator delivers a constant pressure during inspiration. While pressure controlled ventilation allows for control of inspiratory pressure level and I:E ratio, it has the disadvantage of being unable to directly control minute ventilation. Minute ventilation is the amount of air that is moved in and out of the lungs in one minute and is determined by both the tidal volume and the respiratory rate. In pressure controlled ventilation, the minute ventilation is indirectly controlled by adjusting the inspiratory time and respiratory rate, but it is not directly controlled like in volume controlled ventilation.Rate this question:
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- 14.
Which of the following is not one of the common constitutional symptoms of reactivation TB?
- A.
Anorexia
- B.
Fever
- C.
Unintentional weight loss
- D.
Headache
- E.
Night sweats
Correct Answer
D. HeadacheExplanation
Headache is not one of the common constitutional symptoms of reactivation TB. Reactivation TB commonly presents with symptoms such as anorexia, fever, unintentional weight loss, and night sweats. While headaches can occur in some cases of TB, they are not considered one of the common constitutional symptoms.Rate this question:
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- 15.
Which statement is true regarding patients with latent TB infections?
- A.
Will not test positive on a PPD test
- B.
Not at increased risk for developing active TB later in life
- C.
They are currently contagious
- D.
Show normal symptoms of active TB
- E.
Should be treated with Isoniazid for 9 months
Correct Answer
E. Should be treated with Isoniazid for 9 monthsExplanation
Latent TB will test positive on PPD test, they are at increased risk of active TB, they are not contagious, and do not usually show symptoms.Rate this question:
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- 16.
Which statement is true regarding TB treatment regimens?
- A.
There is no resistance to the rifampin or isoniazid
- B.
After the initial phase of two months, if symptoms are gone, treatment is ended
- C.
Cavitation on CXR indicates a good prognosis
- D.
One touch of Tim Tebow's garment instantly cures TB
- E.
Rifampin, which inhibits RNA synthesis, and Isoniazid, which inhibits cell wall synthesis, are the 'anchors' of TB treatment
Correct Answer
E. Rifampin, which inhibits RNA synthesis, and Isoniazid, which inhibits cell wall synthesis, are the 'anchors' of TB treatmentExplanation
A: Multi-drug resistant TB is becoming a significant problem
B: Minimum treatment time is 6 months
C: Cavitation indicates active infection, so poor prognosis
D: I am sure that many believe this, but I haven't seen any RCT's on this topic yet
E: These two drugs are the most important parts of TB treatment (assuming no resistance is likely)Rate this question:
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- 17.
Which of the following pulmonary diseases is properly matched up with the CD4 count (cells/mm3) it is associated with in HIV patients?
- A.
Sinusitis: only at
- B.
PCP:
- C.
CMV:
- D.
Bacterial pneumonia: relationship with CD4 count not well established
- E.
TB: only at
Correct Answer
B. PCP:Explanation
Sinusitis and bronchitis can occur at any CD4, CMV usually occurs atRate this question:
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- 18.
True or false: A negative PPD test rules out TB in a patient with AIDS.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Due to immunosuppression, PPD can have false negative in AIDS pts so it doesn't rule out TBRate this question:
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- 19.
A 71-year-old male resident of Minnesota regularly spends several winter months in Arizona to play golf in the sun. Last March he experienced a gradual onset of fever and a headache, followed by a nonproductive cough, myalgia, and profound fatigue. His local physician diagnosed bronchopneumonia on chest x-ray and prescribed azithromycin. The antibiotic provided no benefit, and ultimately the patient received two more courses of different empiric antibiotics. He returned to Minnesota with continued cough and fatigue, even though the fever had abated somewhat. Two months following the initial onset of symptoms, a bronchoscopy was performed. What would you expect to see growing in culture?
- A.
Blastomycosis
- B.
Coccidiomycosis
- C.
Aspergillus
- D.
Cryptococcus
- E.
Staphylococcus aureus
Correct Answer
B. CoccidiomycosisExplanation
Coccidiomycosis is the endemic fungus in the SW US. Blasto is more common in the SE US, and Cryptococcus is seen in big cities with a lot of pigeons around. Aspergillus is possible, but not as likely considering the vignette and the lack of any distinctive x-ray changes. It is unlikely to be bacterial because repeated rounds of antibiotics did nothing for his symptoms.Rate this question:
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- 20.
A 34-year-old man with a history of sex with men presents with 3 weeks of worsening dyspnea associated with fevers and a non-productive cough. He is tachycardic, tachypneic and has a temperature of 100.5°F (38.1°C). His pulse oximetry is 86% on room air. He appears thin and in moderate respiratory distress. His lung examination is unremarkable. Patient lives in Arkansas, and denies recent travel. Chest x-ray shows bilateral symmetrical interstitial infiltrates. LDH is measured at 250 IU/L. A-a O2 gradient is elevated. What is the diagnosis?
- A.
Sarcoidosis
- B.
Coccidiomycosis
- C.
MAC
- D.
Streptococcus pneumoniae
- E.
Pneumocystis jiroveci
Correct Answer
E. Pneumocystis jiroveciExplanation
Sarcoidosis presents similarly to PCP, but has systemic involvement including skin nodules, Coccidiomycosis is unlikely due to lack of exposure, MAC is uncommon in HIV patients and more often presents with extrapulmonary symptoms, S. pneumo is unlikely due to the slow onset and interstitial infiltrates.Rate this question:
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- 21.
A: B: Which of these are suspicious for cancer?
- A.
A only
- B.
B only
- C.
A and B
- D.
Neither A nor B
- E.
What's cancer?
Correct Answer
C. A and BExplanation
Irregular spiculated masses are highly suspicious for cancer.Rate this question:
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- 22.
The patient with the above angiogram has a BP of 80/60, and is determined to be hemodynamically unstable. What treatment is indicated?
- A.
Aspirin
- B.
Thrombolytics
- C.
Supportive treatment only
- D.
Heparin
- E.
Medical marijuana
Correct Answer
B. ThrombolyticsExplanation
The angiogram shows a PE, and since the patient is hemodynamically unstable, thrombolytics are indicated unless there is a contraindication in order to prevent cardiac arrest. Heparin does not help dissolve an already existing clot.Rate this question:
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- 23.
Select each answer choice that would be part of the differential diagnosis for this patient.
- A.
Thyroid enlargement
- B.
Terrible lymphoma
- C.
Aneurysm
- D.
Neurogenic tumor
- E.
Thymoma
Correct Answer(s)
A. Thyroid enlargement
B. Terrible lympHoma
E. ThymomaExplanation
The four T's of anterior mediastinal masses: Thyroid, Terrible lymphoma, Thymoma, Teratoma. This image is actually a thyroid goiter.Rate this question:
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- 24.
Justin Bieber walks into your office and describes symptoms of hoarseness and lack of vocal control. Flexible laryngoscopy is performed yielding the above image. Which of the following treatments would you advise at this time?
- A.
Voice rest
- B.
Antacids
- C.
Speech therapy
- D.
A and C
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
This is a vocal cord nodule, which is the result of repetitive trauma. All three treatments mentioned above will help reduce symptoms and prevent recurrence.Rate this question:
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- 25.
What is the most common type of cancer in the head and neck?
Correct Answer
Squamous cell carcinomaExplanation
Squamous cell carcinoma is the most common type of cancer in the head and neck. It arises from the squamous cells that line the mucosal surfaces of the head and neck, such as the mouth, throat, and voice box. Risk factors for this type of cancer include tobacco and alcohol use, as well as infection with certain types of human papillomavirus (HPV). Squamous cell carcinoma can present with symptoms like a sore throat, difficulty swallowing, or a lump in the neck. Treatment options include surgery, radiation therapy, and chemotherapy.Rate this question:
- 26.
A 70 year old man with a 50 pack year history of smoking presents to the ED with a COPD exacerbation. ABGs are:pH: 7.24PO2: 30PCO2: 60HCO3: 34What is the acid base disturbance?
- A.
Respiratory alkalosis
- B.
Metabolic alkalosis
- C.
Respiratory acidosis
- D.
Metabolic acidosis
- E.
Normal
Correct Answer
C. Respiratory acidosisExplanation
High PCO2 and low pH means that it is a resp. acidosis. HCO3 is elevated as a normal compensatory response.Rate this question:
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- 27.
A patient has the following ABGs:pH: 7.40PO2: 75PCO2: 23HCO3: 15 (increased anion gap)What is/are the primary disturbance?
- A.
Compensated respiratory alkalosis
- B.
Compensated metabolic alkalosis
- C.
Respiratory acidosis and metabolic alkalosis
- D.
Respiratory alkalosis and metabolic acidosis
- E.
Respiratory alkalosis and metabolic alkalosis
Correct Answer
D. Respiratory alkalosis and metabolic acidosisExplanation
Normal pH with abnormal PCO2 and HCO3 means that there are at least 2 disturbances. Since PCO2 is low there is a respiratory alkalosis, and since the bicarb is low, there is a metabolic acidosis (of the increased anion gap variety).Rate this question:
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- 28.
Why is it more difficult for the lungs to compensate for a metabolic alkalosis than a metabolic acidosis?
- A.
The response to alkalosis is hypoventilation, which results in hypoxemia.
- B.
The lungs can't do anything to raise blood pH.
- C.
The statement is incorrect, it is actually the same.
- D.
The statement is incorrect, it is easier to compensate for a metabolic alkalosis then acidosis.
Correct Answer
A. The response to alkalosis is hypoventilation, which results in hypoxemia.Explanation
The response to alkalosis is hypoventilation, which means that the lungs decrease the rate and depth of breathing. This leads to a decrease in the amount of oxygen in the blood, resulting in hypoxemia. In contrast, in a metabolic acidosis, the lungs can compensate by increasing the rate and depth of breathing to eliminate excess carbon dioxide and increase blood pH. Therefore, it is more difficult for the lungs to compensate for a metabolic alkalosis than a metabolic acidosis.Rate this question:
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- 29.
A 3-month-old boy is referred by his pediatrician with intermittent inspiratory stridor and progressive feeding difficulties resulting in failure to thrive. The stridor has been present since he was 1 week old. His parents report that his noisy breathing is present more frequently and is particularly prominent when he is lying down, feeding, or crying. He has difficulty feeding and chokes frequently but has a normal cry. His mother reports that he feeds slowly and often has to stop several times during the feed to "gasp for breath." He has recently been diagnosed with GERD. Flexible laryngoscopy reveals the following image:What is the diagnosis?
- A.
Bronchiolitis
- B.
Asthma
- C.
Laryngomalacia
- D.
Tracheoesophageal fistula
- E.
Eisenmenger's syndrome
Correct Answer
C. LaryngomalaciaExplanation
Laryngomalacia is a floppy airway during inspiration due to cartilage underdevelopment. It resolves on its own usually.Rate this question:
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- 30.
What is the most common cause of bronchiolitis in children?
- A.
Parainfluenza
- B.
Rhinovirus
- C.
Adenovirus
- D.
Respiratory syncytial virus
- E.
Coronavirus
Correct Answer
D. Respiratory syncytial virusExplanation
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis in children. Bronchiolitis is an infection that affects the small airways in the lungs, causing inflammation and difficulty breathing. RSV is highly contagious and spreads through respiratory droplets. It is most common in infants and young children, especially during the winter months. RSV can cause symptoms such as coughing, wheezing, fever, and difficulty feeding. It is important to note that while other viruses like parainfluenza, rhinovirus, adenovirus, and coronavirus can also cause bronchiolitis, RSV is the most common culprit.Rate this question:
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- 31.
Patients A, C, D, and E would be expected to have which of the following presentations?
- A.
Polyhydramnios
- B.
Inability to pass NG tube
- C.
Gets better with feeding
- D.
A and B
- E.
All of the above
Correct Answer
D. A and BExplanation
Tracheoesophageal fistula can present with polyhydramnios, frothing at the mouth, coughing, cyanosis, respiratory distress, and gets worse with feeding. It is diagnosed by inability to pass an NG tube, which shows up as a coiled tube on x-ray.Rate this question:
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- 32.
Which of the following is seen in Chronic Lung Disease (aka Bronchopulmonary dysplasia)?
- A.
Mechanical injury
- B.
Oxygen toxicity
- C.
Infection and sepsis
- D.
Inflammation
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Chronic Lung Disease, also known as Bronchopulmonary dysplasia, is a condition that primarily affects premature infants who require mechanical ventilation and oxygen therapy. It is characterized by lung inflammation, which can be caused by mechanical injury from the ventilator, oxygen toxicity due to prolonged exposure to high levels of oxygen, and increased susceptibility to infections and sepsis. Therefore, all of the options mentioned in the question - mechanical injury, oxygen toxicity, infection and sepsis, and inflammation - are seen in Chronic Lung Disease.Rate this question:
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- 33.
A 1-year-old child presents with failure to thrive. By history, the child was born at the 50th percentile for weight, but has crossed multiple percentile lines despite having a ravenous appetite. The child has more bowel movements per day than other children of the same age, and the stools often look shiny and have an unusually foul smell. In addition, the child has been treated with multiple courses of antibiotics for a persistent, wet cough. On measurement, the child is small for age, with weight and length below the third percentile. His mother states that his skin tastes 'salty' when she kisses him. Which of the following would you also expect to see in this patient?
- A.
Obstructive pattern on flow-volume loop
- B.
Restrictive pattern on flow-volume loop
- C.
Bronchiectasis
- D.
Bacterial colonization
- E.
History of meconium ileus
Correct Answer(s)
A. Obstructive pattern on flow-volume loop
C. Bronchiectasis
D. Bacterial colonization
E. History of meconium ileusExplanation
The vignette describes a classic presentation of Cystic Fibrosis. A,C,D, and E are all seen in CF patients.Rate this question:
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- 34.
A 36-year-old woman presents with a 6-month history of gradually progressive dyspnea on exertion and fatigue. On physical exam, her vital signs are normal and she appears not to be in any distress. Her lungs are clear to auscultation. Her cardiac exam shows a prominent jugular V wave, an accentuated pulmonic component to the second heart sound (P2) and a high-pitched holosystolic murmur best heard at the left sternal border. Which of the following statements is most likely to be true about the pathogenesis of her condition?
- A.
She has elevated NO levels
- B.
She has elevated prostacyclin levels
- C.
She has elevated endothelin levels
- D.
There is no genetic factor in her disease
- E.
Her disease is the result of an occupational exposure
Correct Answer
C. She has elevated endothelin levelsExplanation
This vignette is supposed to describe idiopathic pulmonary hypertension. Current thoughts on IPH indicate that there is some genetic predisposition but that a 'second hit' is needed, much like in cancer. IPH is also associated with low NO and prostacyclin levels, and high endothelin levels.Rate this question:
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- 35.
What grade of pulmonary hypertension is this image?
- A.
I-II
- B.
III
- C.
IV+
Correct Answer
B. IIIExplanation
This slide shows the 'onion skin' appearance of grade 3 pulmonary HTN. The lumen is completely blocked but there is no fibrinoid necrosis.Rate this question:
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- 36.
What are the predominant features of this EKG, taken from a patient with pulmonary hypertension?
- A.
Left Axis deviation
- B.
P pulmonale in lead II
- C.
R/S ratio in V1 is
- D.
Digitalis effect
- E.
Atrial fibrillation
Correct Answer
B. P pulmonale in lead IIExplanation
This EKG shows signs of RVH: Right axis deviation, p pulmonale, and R/S ratio of >1Rate this question:
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- 37.
Which group of pulmonary hypertension is correctly matched with its definition?
- A.
Group 1 PAH: Pulmonary hypertension with left heart disease
- B.
Group 2 PH: Pulmonary Arterial Hypertension
- C.
Group 3 PH: Pulmonary hypertension associated with lung diseases and/or hypoxemia
- D.
Group 4 PH: Miscellaneous or caused by inflammation, obstruction, or extrinsic compression
- E.
Group 5 PH: Pulmonary hypertension due to chronic thrombotic and/or embolic disease
Correct Answer
C. Group 3 pH: Pulmonary hypertension associated with lung diseases and/or hypoxemiaExplanation
Correct matchings are as follows:
Group 1 PAH: Pulmonary Arterial Hypertension
Group 2 PH: Pulmonary hypertension with left heart disease
Group 3 PH: Pulmonary hypertension associated with lung diseases and/or hypoxemia
Group 4 PH: Pulmonary hypertension due to chronic thrombotic and/or embolic disease
Group 5 PH: Miscellaneous or caused by inflammation, obstruction, or extrinsic compressionRate this question:
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- 38.
Which of the following is characteristic of an exudate?
- A.
Pleural fluid LDH < 2/3 of the upper limits of normal serum LDH
- B.
Pleural fluid protein/serum protein > 0.5
- C.
Pleural fluid LDH/serum LDH < 0.6
- D.
Pleural fluid protein > 1.0 g/dL
- E.
Pleural fluid cholesterol < 45 mg/dL
Correct Answer
B. Pleural fluid protein/serum protein > 0.5Explanation
Light's criteria for an exudate are one or more of the following:
Pleural fluid protein/serum protein > 0.5
Pleural fluid LDH/serum LDH > 0.6
Pleural fluid LDH > 2/3 the upper limits of the normal serum LDH
Additional criteria include: Pleural fluid protein > 2.9 g/dL
Pleural fluid cholesterol > 45 mg/dL (does not by itself provide a definitive diagnosis of an exudate)Rate this question:
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- 39.
A 20-year-old man presents to the emergency department with complaints of left-sided chest pain and shortness of breath. He states that these symptoms began suddenly 4 days ago while he was working at his computer. He initially thought that he may have strained a chest wall muscle but, since the pain and dyspnea had not resolved, he decided to seek medical attention. He has no significant past medical history but has smoked cigarettes since the age of 16 years. His older brother suffered a pneumothorax at the age of 23 years. The patient's vital signs are normal. He appears in mild discomfort. X-ray is shown below:What physical exam findings would you expect to see in this patient?
- A.
Dullness to percussion
- B.
Egophany
- C.
Whispered pectoriloquoy
- D.
Hyperresonance to percussion
- E.
Increased tactile fremitus
Correct Answer
D. Hyperresonance to percussionExplanation
Pneumothorax would show hyperresonance to percussion and decreased tactile fremitus. Egophany, whispered pq, dullness to percussion, and increased tactile fremitus all indicate consolidation, not pneumothorax.Rate this question:
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- 40.
Which of the following would increase the likelihood of the condition depicted above the most?
- A.
Smoking
- B.
Asbestos exposure
- C.
Sandblasting
- D.
Smoking plus asbestos exposure
- E.
Smoking plus sandblasting
Correct Answer
D. Smoking plus asbestos exposureExplanation
This CT shows mesothelioma. Asbestos exposure is the major risk factor for this disease, but smoking in conjunction with exposure accelerates the disease process.Rate this question:
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- 41.
For a patient with a pulmonary embolism, which is the most likely acid-base disturbance?
- A.
Respiratory acidosis
- B.
Respiratory alkalosis
- C.
Metabolic acidosis
- D.
Metabolic alkalosis
- E.
Compensated respiratory acidosis
Correct Answer
B. Respiratory alkalosisExplanation
In patients with PE, you see:
Impaired gas exchange (hypoxemia)
Increased pulmonary vascular resistance (vascular obstruction)
Alveolar hyperventilation (hypocarbia)
So…most likely ABG: alkalemic pH, low pO2, low pCO2 (respiratory alkalosis)Rate this question:
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- 42.
A 65-year-old man presents to the ER with acute onset of SOB of 30 minutes' duration. Initially, he felt faint but did not lose consciousness. He is complaining of left-sided chest pain that worsens on deep inspiration. He has no history of cardiopulmonary disease. A week ago he underwent a total left hip replacement and, following discharge, was on bed rest for 3 days due to poorly controlled pain. He subsequently noticed swelling in his left calf, which is tender on examination. His current vital signs reveal a fever of 100.4°F (38.0°C), heart rate 112 bpm, BP 95/65, and an O2 saturation on room air of 91%. A second year medical student from the University of Miami (main campus) orders a D-dimer test. The results are negative. What is the significance of the D-dimer test result?
- A.
Rules out PE
- B.
Confirms the diagnosis of PE
- C.
No significance, cannot rule out PE
- D.
The student clearly went to the inferior campus at UM
- E.
C and D
Correct Answer
E. C and DExplanation
D-dimer can only rule out PE if the pre-test probability is low. Since this patient has a high probability of PE, the results of the test do nothing to rule out or in PE. The student would have known this had he gone to the regional campus and paid attention in Dr. L's class.Rate this question:
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Mar 22, 2023Quiz Edited by
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Aug 14, 2010Quiz Created by
Michaelfleming
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