Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Pulmonology
Page: 12

Question 56# Print Question

A 55-year-old Caucasian man is brought into the Emergency Department by his wife because of increasing shortness of breath. Symptoms developed gradually over the past few months are exacerbated by exertion, and are associated with a chronic dry cough. The patient’s medical history is significant for hypertension and rheumatoid arthritis, and he takes hydrochlorothiazide and daily NSAIDs. He has smoked 2 packs of cigarettes daily for the past 15 years and drinks alcohol moderately. His temperature is 36.7°C, blood pressure is 142/88 mmHg, heart rate is 94 beats per minute, respiratory rate is 24 breaths per minute, and oxygen saturation is 91% on room air. The physical examination is notable for bibasilar dry crackles, a right ventricular heave, clubbing of the digits, and mild pitting edema around the ankles. There is also some tenderness to palpation in the epigastric area. Testing the stool for occult blood is positive.

Which of the following could have prevented the development of this patient’s lung disease?

A. Adequate blood pressure control
B. Smoking cessation
C. Early initiation of disease modifying antirheumatic drugs (DMARDs)
D. Bronchodilator therapy
E. Colonoscopy

Question 57# Print Question

A 68-year-old man undergoes a left hip replacement and is recovering in the hospital afterward. As he stands up to walk with the physical therapist, he suddenly collapses. He undergoes initial resuscitation and is intubated, but he remains hypotensive despite heavy fluid resuscitation. The patient is tachycardic, but the rest of his cardiac and pulmonary examinations are normal. IV heparin is started and a CT angiogram is performed (Figure below).

What is the next step in management?

A. Coronary angiography
B. Start IV enoxaparin
C. Start IV alteplase
D. Thrombectomy
E. Placement of an inferior vena cava (IVC) filter

Question 58# Print Question

A 57-year-old man is involved in a motor vehicle collision and undergoes operative repair of several fractures. He does well during the procedures and his only complaint is postoperative pain. An arterial blood gas shows a PaO2 of 70 mmHg and a PaCO2 of 65 mmHg. He has a history of hypertension and stage 2 chronic kidney disease. His regular medications include aspirin and lisinopril. He appears drowsy on examination but his lungs are clear to auscultation bilaterally.

Which of the following is the most likely cause of this patient’s abnormal blood gas?

A. Medication effect
B. Pulmonary embolism
C. Postoperative atelectasis
D. Hospital-acquired pneumonia

Question 59# Print Question

A 73-year-old nursing home resident complains of severe difficulty breathing. The nursing home staff reports that she has had several episodes of pneumonia since she has been there and is often delirious during the night. She has a history of hypertension, diabetes, dementia, and chronic cough with daily sputum production. Her medications include metformin, hydrochlorothiazide, over-the-counter cough suppressants, and haloperidol as needed. She has a 10 packyear smoking history and quit 30 years ago. She has a temperature of 38.3°C, blood pressure of 104/62 mmHg, heart rate of 91 beats per minute, respiratory rate of 26 breaths per minute, and oxygen saturation of 94% on room air. The patient’s CT scan is shown below (Figure below).

Which of the following is the most likely cause of this patient’s lung findings?

A. Smoking history
B. Infection with Pseudomonas
C. Recurrent aspiration events
D. Antibodies against type IV collagen

Question 60# Print Question

An older man with a history of COPD presents for follow-up after being hospitalized with an acute exacerbation. He asks you what treatments are available to decrease his risk of death.

Which of the following therapies has been shown to reduce longterm mortality in this condition?

A. Guaifenesin
B. Oral prednisone
C. Home oxygen therapy
D. Ipratropium

Category: Q&A Medicine--->Pulmonology
Page: 12 of 12