Multiple Choice Questions (MCQ)

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Category: Medicine--->Pulmonary Disease
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Question 6# Print Question

A 34-year-old black woman presents to your office with symptoms of cough, dyspnea, and fatigue. Physical examination shows cervical adenopathy and hepatomegaly. Spleen tip is palpable. Her chest radiograph is shown below. Which of the following is the best approach in establishing a diagnosis? 

A. Open lung biopsy
B. Liver biopsy
C. Bronchoscopy and transbronchial lung biopsy
D. Mediastinoscopic lymph node biopsy
E. Serum angiotensin-converting enzyme (ACE) level

Question 7# Print Question

A 64-year-old woman is found to have a right-sided pleural effusion on chest x-ray. Analysis of the pleural fluid reveals pleural fluid to serum protein ratio of 0.38, a lactate dehydrogenase (LDH) level of 110 IU (normal 100-190), and pleural fluid to serum LDH ratio of 0.46. Which of the following disorders is most likely in this patient?

A. Bronchogenic carcinoma
B. Congestive heart failure
C. Pulmonary embolism
D. Sarcoidosis
E. Systemic lupus erythematosus

Question 8# Print Question

. A 25-year-old man presents to the clinic for evaluation of infertility. He has a life-long history of a productive cough and recurrent pulmonary infections. On his review of symptoms he has indicated chronic problems with abdominal pain, diarrhea, and difficulty gaining weight. He also has diabetes mellitus. His chest x-ray suggests bronchiectasis. Which is the most likely diagnosis?

B. Immunoglobulin deficiency
C. Cystic fibrosis
D. Whipple disease
E. Asthma

Question 9# Print Question

A 62-year-old automobile worker presents with gradually worsening exertional dyspnea over the preceding several months. Recently, he has noticed right pleuritic chest pain. He has hypertension, well controlled on amlodipine 5 mg a day. He takes no other medications. He has never noticed cough or wheezing while at work. He worked for 15 years in construction and demolition and for 20 years thereafter in the service department of an automotive dealership. He denies fever, chills, or night sweats. On physical examination, he is in no respiratory distress but has right basilar dullness. His finger oximetry reads 96% on room air. Chest x-ray reveals a moderate right pleural effusion and lateral pleural thickening on both sides. Thoracentesis shows reddish fluid, which on formal analysis, is an exudate with 45,000 RBCs/hpf. Cytology is negative. What is the most likely explanation for this patient’s symptoms?

A. Drug induced interstitial lung disease
B. Infection due to Mycobacterium tuberculosis
C. Hypersensitivity pneumonitis due to thermophilic actinomycetes
D. Occupational asthma due to isocyanates
E. Asbestos exposure

Question 10# Print Question

A 40-year-old man without a significant past medical history comes to the emergency room with a 3-day history of fever and shaking chills, and a 15-minute episode of rigor. He also reports a cough productive of yellow-green sputum, anorexia, and the development of right-sided pleuritic chest pain. Shortness of breath has been present for the past 12 hours. Chest x-ray reveals a consolidated right middle lobe infiltrate, and CBC shows an elevated neutrophil count with many band forms present. Which feature would most strongly support inpatient admission and IV antibiotic treatment for this patient?

A. Recent exposure to a family member with influenza
B. Respiratory rate of 36/minute
C. Recent sexual exposure to an HIV-positive patient
D. Purulent sputum with gram positive diplococci on Gram stain
E. Signs of consolidation (bronchial breath sounds, egophony) on physical examination

Category: Medicine--->Pulmonary Disease
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