Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Pulmonology
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Question 6# Print Question

A 27-year-old Asian man presents to the Emergency Department after coughing up a large amount of blood, which has never happened before. He has a history of oral and genital ulcerations that were diagnosed as herpes, but the lesions have never responded to antivirals. His family history is noncontributory, he does not smoke or use illicit drugs, and he has not traveled recently. He lives in an urban area and has never been imprisoned. On review of systems, he endorses some vision changes and occasional joint pain, but denies any recent illnesses, weight loss, night sweats, cough (prior to the hemoptysis), or hematuria. His examination is significant for oral and genital ulcerations that are painful to palpation, and examination of the eyes shows ciliary flush with some floating debris in the anterior chamber. His laboratory values show a normal BUN and creatinine.

Which of the following is the most likely diagnosis?

A. Granulomatosis with polyangiitis
B. Behçet disease
C. Pulmonary embolism
D. Bronchiectasis
E. Lung cancer

Question 7# Print Question

An older man with a history of COPD complains of worsening dyspnea and exercise intolerance, even after smoking cessation and an evidence-based pharmacologic regimen. The physician discusses the possibility of adding theophylline to the patient’s chronic regimen.

What potential adverse reaction should the patient be counseled about before starting this medication?

A. Bradycardia
B. Pulmonary fibrosis
C. Hypocalcemia
D. Seizures

Question 8# Print Question

A 24-year-old woman with a history of asthma complains of worsening chest tightness and cough. She currently has an albuterol inhaler that she uses as needed, but says that it does not help very much. She has no other medical problems and takes no other medications. The physical examination is unremarkable.

Which of the following is the most appropriate next step in management?

A. Add an inhaled corticosteroid
B. Add an inhaled anticholinergic
C. Education about proper use of inhalers
D. Workup for a different diagnosis

Question 9# Print Question

A 37-year-old Caucasian man presents with a several-month history of intermittent fevers, chills, chest tightness, and shortness of breath. The episodes typically occur on weekends and are most pronounced in the afternoon with improvement by the morning. He is a lawyer in California and does not smoke. He has no pets, has not traveled outside the country recently, and has had no sick contacts over this period. His father recently had a stroke, so the patient helps him manage his farm on the weekends. The patient has a temperature of 37.2°C, blood pressure of 128/84 mmHg, heart rate of 82 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 99% on room air. His physical examination is unremarkable. A chest x-ray is normal, and the patient elects to undergo lung biopsy that reveals multiple noncaseating interstitial granulomas.

What is the most likely diagnosis?

A. Chronic obstructive pulmonary disease
B. Sarcoidosis
C. Hypersensitivity pneumonitis
D. Silicosis
E. Coccidioidomycosis

Question 10# Print Question

A 33-year-old man presents to the hospital complaining of dyspnea. Over the past year he has had increasing shortness of breath while running that limits the distance he can run. In addition, he has a persistent cough that is bothering him, and during the past few days he has had increasing sputum production that was previously white and is now yellow. He has not visited a doctor yet because he does not have medical insurance. The patient denies any significant medical history but has a positive family history of emphysema. He smokes half a pack of cigarettes daily and drinks alcohol moderately. On examination, he has a temperature of 37.9°C, blood pressure of 122/76 mmHg, heart rate of 93 beats per minute, respiratory rate of 24 breaths per minute, and oxygen saturation of 92% on room air. He has scattered wheezes throughout both lung fields with a normal cardiac examination. A chest x-ray shows loss of interstitial lung markings primarily at the lung bases.

Which of the following is the mechanism by which this disease produces liver disease?

A. Failure to inhibit the destruction of connective tissue by elastase
B. Pulmonary artery hypertension leading to increased pressure in the hepatic vein
C. Direct hepatic injury resulting in Mallory bodies
D. Accumulation of abnormal proteins within hepatocytes

Category: Q&A Medicine--->Pulmonology
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