A 21-year-old college student with no prior medical problems begins working as a laboratory technician. He subsequently presents because of several recent episodes of shortness of breath, cough, fever, chills, and malaise. Each episode has lasted several days. The patient is seen during the recovery phase of an episode of this type; findings at physical examination are normal. Chest x-ray reveals several ill-defined, diffuse, patchy infiltrates. The laboratory evaluation is positive only for an increased erythrocyte sedimentation rate. Pulmonary function studies display reduced lung volumes.
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4 | |
On further questioning, it is learned that these episodes begin on days when the patient is required to tend to experiments involving laboratory rats at the animal facility. What is the best treatment for this condition? |
| | A) | Inhaled cromolyn sodium |
| | B) | Prednisone |
| | C) | Inhaled beclomethasone |
| | D) | Discontinuation of visits to the animal facility |
| | E) | No treatment |
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5 | |
The primary pathophysiologic problem in idiopathic pulmonary fibrosis is believed to be |
| | A) | microorganism-mediated activation of pulmonary neutrophils |
| | B) | immune complex-mediated activation of alveolar macrophages |
| | C) | direct immune complex-mediated pulmonary interstitial damage |
| | D) | primary fibroblast proliferation |
| | E) | viral-mediated pulmonary epithelial damage |
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6 | |
Although asthma is a heterogeneous disease, a given individual with asthma would be most likely to |
| | A) | relate a personal or family history of allergic diseases |
| | B) | conform to a characteristic personality type |
| | C) | display a skin-test reaction to extracts of airborne allergens |
| | D) | demonstrate nonspecific airway hyperirritability |
| | E) | have supranormal serum immunoglobulin E |
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7 | |
A diagnosis of allergic bronchopulmonary aspergillosis in a person who has asthma and recurrent pulmonary infiltrates would be supported by which of the following findings? |
| | A) | Delayed, tuberculin-type skin-test reaction to Aspergillus fumigatus |
| | B) | The presence of eosinophilia |
| | C) | Immediate skin test reaction to A. fumigatus |
| | D) | Positive antinuclear antibody (ANA) serologic test |
| | E) | The presence of alveolar neutrophilia on bronchoalveolar lavage (BAL) |
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8 | |
A 22-year-old woman with a history of intermittent wheezing in response to exercise presents to the emergency room with shortness of breath. Her attack occurred during an aerobics class. At this point she is having obvious difficulty breathing and has diffuse wheezes on pulmonary examination. O2 saturation is 95% by pulse oximetry. The most effective treatment at this point would be |
| | A) | intravenous aminophylline |
| | B) | inhaled cromolyn sodium |
| | C) | inhaled albuterol |
| | D) | intravenous hydrocortisone |
| | E) | inhaled beclomethasone |
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9 | |
Both dyskinetic ciliary syndromes and cystic fibrosis lead to recurrent pneumonia, bronchitis, and eventually bronchiectasis. Which of the following manifestations is typical of Kartagener's syndrome? |
| | A) | Intestinal obstruction |
| | B) | Dextrocardia |
| | C) | Steatorrhea |
| | D) | Interstitial pulmonary fibrosis |
| | E) | Infertility |
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10 | |
A patient with advanced adult respiratory distress syndrome (ARDS) has suffered a pneumothorax after being exposed to 10 cmH2O positive end-expiratory pressure (PEEP). Which of the following modes of mechanical ventilation would be best? |
| | A) | Assist/control mode of ventilation |
| | B) | Synchronized intermittent mandatory ventilation |
| | C) | Pressure-control ventilation |
| | D) | Pressure-support ventilation |
| | E) | Continuous positive airway pressure |
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11 | |
A 45-year-old woman presents with fever and cough. She has had no past medical problems and was well until about 3 days ago. Physical examination is remarkable for a temperature of 39°C (102.2°F) and the presence of diffuse rales on chest examination. Except for an elevated white count with a left-shifted differential, her blood tests are normal. Chest radiography reveals patchy bilateral infiltrates. She is unable to produce sputum. She has resting hypoxemia and requires hospital admission. Which is the most reasonable choice of antibiotics at this time? |
| | A) | Penicillin G |
| | B) | Cefotaxime |
| | C) | Erythromycin |
| | D) | Ampicillin plus sulbactam |
| | E) | Ampicillin plus sulbactam plus erythromycin |
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12 | |
Which of the following statements concerning obstructive sleep apnea syndrome is true? |
| | A) | Men and women are equally affected. |
| | B) | Cor pulmonale and not systemic hypertension is usually seen. |
| | C) | Sedatives are often useful in the improvement of quality of sleep. |
| | D) | Estrogens are frequently useful in improving respiratory drive. |
| | E) | Personality changes may be the presenting complaint. |
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13 | |
One week after a right total hip replacement a 65-year-old woman develops the sudden onset of shortness of breath. A workup reveals normotension, a prominent second heart sound, hypoxemia, sinus tachycardia with new right axis deviation on the electrocardiogram, and a normal chest x-ray. Oxygen is administered. Impedance plethysmography is consistent with a large proximal clot in the left leg. Which of the following would be the most reasonable next step? |
| | A) | Performance of a pulmonary angiogram |
| | B) | Performance of perfusion scintigraphy |
| | C) | Administration of tissue plasminogen activator |
| | D) | Administration of heparin |
| | E) | Administration of warfarin |
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14 | |
Which of the following is associated with cystic fibrosis? |
| | A) | Impaired fertility due to immobile sperm |
| | B) | Systemic hypertension |
| | C) | Steatorrhea |
| | D) | Dextrocardia |
| | E) | Alveolar destruction |
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15 | |
To decrease the likelihood of drug toxicity, the theophylline dose should be reduced in a patient with asthma in which of the following circumstances? |
| | A) | Active tobacco user |
| | B) | Azithromycin use for Mycoplasma pneumonia |
| | C) | Augmented use for recurrent otitis media |
| | D) | Marijuana abuse |
| | E) | Phenobarbital use for a seizure disorder |
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16 | |
Which of the following is a known consequence of asbestos exposure? |
| | A) | The same increased risk of mesothelioma as cigarette use |
| | B) | Pleural effusions, often initially benign |
| | C) | An increased incidence of both adenocarcinoma of the lung and small cell carcinoma of the lung |
| | D) | Pleural mesothelioma but not peritoneal mesothelioma |
| | E) | An obstructive pattern, typically revealed by pulmonary function testing |
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17 | |
In which of the following clinical circumstances would it be appropriate to use a rigid bronchoscope instead of a flexible fiberoptic bronchoscope? |
| | A) | A 22-year-old man with known HIV infection who complains of shortness of breath and has diffuse interstitial infiltrates on chest x-ray |
| | B) | A 65-year-old man with a long history of smoking who has shortness of breath and right upper lobe collapse |
| | C) | A 33-year-old woman with a history of acute myeloid leukemia complaining of severe dyspnea who is currently 4 months after an allogeneic bone marrow transplant and has a reticulonodular pulmonary infiltrate |
| | D) | A 50-year-old woman with a heavy smoking history who currently complains of intermittent hemoptysis |
| | E) | A 28-year-old man with a history of acute myeloid leukemia who is currently 30 days after an allogeneic bone marrow transplant with a significant pulmonary hemorrhage and bilateral alveolar infiltrates on chest x-ray |
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18 | |
Which of the following is the most common initial symptom of byssinosis? |
| | A) | Wheezing |
| | B) | Dyspnea on exertion |
| | C) | Cough |
| | D) | Hemoptysis |
| | E) | Chest tightness |
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19 | |
A 27-year-old woman with a history of common variable immunodeficiency has had many upper and lower respiratory tract infections. She now presents with a third episode of recurrent cough and copious purulent sputum production, which is sometimes blood-tinged. She is afebrile, and her pulmonary exam is normal. Chest radiography reveals the presence of several parallel linear opacities and a few ringlike shadows. The diagnosis that most likely accounts for this patient's symptoms is |
| | A) | bronchiectasis |
| | B) | non-small cell lung cancer |
| | C) | Mycoplasma infection |
| | D) | viral pneumonia |
| | E) | pulmonary thromboembolism |
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20 | |
In which of the following situations would single-lung transplantation be contraindicated? |
| | A) | A 48-year-old man with chronic obstructive pulmonary disease and an FEV1 of 20% of the predicted value |
| | B) | A 50-year-old man with idiopathic pulmonary fibrosis, resting hypoxia, and a total lung capacity of 50% of the predicted value |
| | C) | A 23-year-old woman with primary pulmonary hypertension with a mean pulmonary artery pressure of 70 mmHg |
| | D) | A 23-year-old woman with cystic fibrosis and an FEV1 of 20% of the predicted value |
| | E) | A 25-year-old man with an 1-antitrypsin deficiency and resting hypoxia |
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21 | |
A 50-year-old male chronic alcoholic presents with a 2-week history of fever, night sweats, cough, productive sputum, and pleuritic chest pain. The patient has had a recent negative HIV test and has no other medical problems. Chest x-ray reveals a 3-cm cavitary lesion in the posterior segment of the left lower lobe. This cavity contains an air-fluid level. Which of the following is the most likely etiologic agent? |
| | A) | S. pneumoniae |
| | B) | H. influenzae |
| | C) | Mycobacterium tuberculosis |
| | D) | M. pneumoniae |
| | E) | Actinomyces |
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