Your-Doctor Multiple Choice Questions (MCQ)

Category: Medicine--->Pulmonary Disease
Page: 1

Question 1#Print Question

A 50-year-old patient with long-standing chronic obstructive lung disease develops the insidious onset of aching in the distal extremities, particularly the wrists bilaterally. There is a 10-lb weight loss. The skin over the wrists is warm and erythematous. There is bilateral clubbing. Plain film of the forearms reveals bilateral periosteal thickening, possible osteomyelitis, but no joint abnormality. Which of the following is the most appropriate management of this patient? 

a. Start vancomycin
b. Obtain chest x-ray
c. Aspirate both wrists
d. Begin methotrexate therapy
e. Obtain erythrocyte sedimentation rate

Question 2#Print Question

A 76-year-old woman presents with worsening dyspnea for the past 4 weeks. She has noticed fatigue, 10-lb weight loss, and occasional night sweats. On examination, she is in mild respiratory distress. Her RR is 22, and her BP is 134/76. She has mild generalized lymphadenopathy, with the largest node measuring 1.5 cm. Lung examination reveals bibasilar dullness without rales or wheezes. Her neck veins are not distended. CXR shows moderate left-sided pleural effusion. A thoracentesis is performed, revealing milky fluid. Pleural fluid protein and LDH demonstrate an exudative effusion. The pleural fluid cell count is 4800/mm3 with 14% neutrophils, 12% mesothelial cells, and 74% lymphocytes. Pleural fluid triglyceride is 170 mg/dL. What is the likely cause of this patient’s illness?

a. Tuberculosis
b. Lung cancer
c. Lymphoma
d. Congestive heart failure
e. Pneumonia with parapneumonic effusion

Question 3#Print Question

A 40-year-old alcoholic develops cough and fever. Chest x-ray, shown below, shows an air-fluid level in the superior segment of the right lower lobe. 

Which of the following is the most likely etiologic agent?

a. Streptococcus pneumoniae
b. Haemophilus influenzae
c. Legionella pneumophila
d. Anaerobes
e. Mycoplasma pneumoniae

Question 4#Print Question

A 30-year-old man is admitted to the hospital after a motorcycle accident that resulted in a fracture of the right femur. The fracture is managed with traction. Three days later the patient becomes confused and tachypneic. A petechial rash is noted over the chest. Lungs are clear to auscultation. Arterial blood gases show P O2 of 50, PCO2 of 28, and pH of 7.49. Which of the following is the most likely diagnosis? 

a. Unilateral pulmonary edema
b. Hematoma of the chest
c. Fat embolism
d. Pulmonary embolism
e. Staphylococcus aureus pneumonia

Question 5#Print Question

A 70-year-old patient with chronic obstructive lung disease requires 2 L/minute of nasal O 2 to treat his hypoxia, which is sometimes associated with angina. The patient develops pleuritic chest pain, fever, and purulent sputum. While using his oxygen at an increased flow of 5 L/minute, he becomes stuporous and develops a respiratory acidosis with CO2 retention and worsening hypoxia. What would be the most appropriate next step in the management of this patient?

a. Stop oxygen
b. Begin medroxyprogesterone
c. Intubate and begin mechanical ventilation
d. Treat with antibiotics and observe on the general medicine ward for 24 hours
e. Begin sodium bicarbonate

Category: Medicine--->Pulmonary Disease
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