Diseases of the Respiratory System – Part 3

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Diseases of the Respiratory System – Part 3
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Select the ONE answer that is BEST in each case.

A 23-year-old man presents with coughing up blood and sputum. He gives a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is worse when lying down and in the morning. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. There are no hepatosplenomegaly or any palpable lymph nodes. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is sometimes seen in this condition?

Kartagener’s syndrome consists of situs inversus (with dextrocardia), bronchiectasis, and nasal polyps. The bronchiectasis results from impaired ciliary function.

 

See all quizzes of  the Diseases of the Respiratory System at here:

Part 1Part 2 | Part 3

41. A 23-year-old man presents with coughing up blood and sputum. He gives a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is worse when lying down and in the morning. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. There are no hepatosplenomegaly or any palpable lymph nodes. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is sometimes seen in this condition?
(A) lung cancer
(B) dextrocardia
(C) fungal infection
(D) carcinoid syndrome
(E) Hodgkin’s disease
42. A 27-year-old man presents with chest pain  and feeling unwell. He describes cough with blood-tinged sputum, chills, and fever of 2 days’ duration. Physical findings reveal dullness and moist rales in the left lower chest. His CXR is shown in Fig. 12–2. Which of the following is the most likely diagnosis? (A) pneumonia, left lower lobe
(B) atelectasis, left lower lobe
(C) PE
(D) tuberculosis
(E) sarcoidosis
43. A 40-year-old man is seen for an insurance assessment. He has no past medical history and feels well. His compete physical examination is normal. His biochemistry, complete blood count (CBC), ECG, and urinalysis are
also normal. His CXR is abnormal and presented in Fig. 12–3. Which of the following is the most likely diagnosis?
(A) hamartoma of the lung
(B) tuberculous granuloma of the left apex
(C) osteochondroma of the left 4th rib
(D) bronchogenic carcinoma
(E) pulmonary metastases
44. A 21-year-old man has a nonproductive cough, shortness of breath, and chest pain, which changes with breathing. He also has pain in the left arm. On examination, there is tenderness over the left shoulder, heart sounds are normal, and the lungs are clear. CXR reveals a lytic lesion in the left humerus and reticulonodular opacities in the upper and middles lobes (Fig. 12–4). The eosinophil count is normal. Which of the following is the most appropriate initial diagnostic test?
(A) lung biopsy
(B) humerus bone biopsy
(C) CT scan of chest
(D) bronchoscopy
(E) pulmonary function tests
45. The pulmonary function studies shown in Table 12–1 are of a 65-year-old man with severe dyspnea and cough. Which of the following is the most likely diagnosis?
(A) emphysema
(B) lobar pneumonia
(C) chronic bronchitis
(D) acute bronchitis
(E) CHF
46. A 33-year-old woman, otherwise perfectly well, presents with recurrent episodes of hemoptysis. She has no fever, weight loss, cough, or sputum production. Her physical examination is entirely normal. Her CXR, biochemisty, CBC, and coagulation profile are also normal. Which of the following is the most appropriate initial diagnostic test?
(A) echocardiogram
(B) gallium scan
(C) CT scan of chest
(D) bronchoscopy
(E) pulmonary function tests
47. A 34-year-old woman is complaining of progressive and worsening shortness of breath. Her symptoms first started 3 years ago, and she now gets dyspneic and fatigued while doing her activities of daily living. Her past
medical history is not significant and she not taking any medications. Physical examination reveals increased JVP and a reduced carotid pulse. Precordial examination reveals a left parasternal lift, loud P2, and right-sided S3 and
S4. There are no audible murmurs. CXR reveals clear lung fields and an ECG shows evidence of right ventricular hypertrophy. Pulmonary function tests are normal. Which of the following is the most likely diagnosis?
(A) asthma (without wheezing)
(B) primary pulmonary hypertension
(C) pulmonary veno-occlusive disease
(D) pulmonary leiomyomatosis
(E) “silent” tricuspid valve disease
48. An 83-year-old man with Parkinson’s disease presents with low-grade fever and cough for several weeks. Lately, he has been experiencing more rigidity and difficulty with his walking. He is on a levodopa/carbidopa combination for treatment for the past 5 years. On examination, his gait is shuffling and slow. He has a tremor in his left hand at rest, and there is cogwheel rigidity of the forearm. There are crackles in the left lower lung field. CXR reveals a lung abscess in the left lower lobe. Which of the following is the most likely bacteriologic diagnosis for the lung abscess?
(A) oropharyngeal flora
(B) tuberculosis
(C) Staphylococcus aureus
(D) Pseudomonas aeruginosa
(E) Candida albicans
49. A 28-year-old African American woman presents with mild dyspnea on exertion. She reports no coughing, sputum production, or wheezing symptoms, but has noticed a red tender rash on her shins. Physical examination
reveals hepatosplenomegaly, generalized lymphadenopathy, and tender erythematous nodules on her legs. CXR shows bilateral symmetric hilar adenopathy. Her pulmonary function tests reveal a mild restrictive pattern. Which of the following tests will most likely make a definitive diagnosis?
(A) tuberculin skin test
(B) bronchoscopy with transbronchial biopsy
(C) elevated ACE level
(D) serum hypercalcemia
(E) increased uptake on gallium scan
50. A 69-year-old woman has recently returned on an overnight flight from Europe. She now complains of vague chest discomfort and shortness of breath. On examination, she is comfortable, blood pressure 130/80 mm Hg, pulse 90/min, respirations 18/min, and oxygen saturation 97%. Her heart and lungs are normal on auscultation, and there is no edema or leg tenderness on palpation. A quantitative (ELISA) D-dimer assay is positive. Which of the following statements regarding the D-dimer assay is correct?
(A) it is sensitive but not specific
(B) it is specific but not sensitive
(C) it is neither specific nor sensitive
(D) a negative result suggests myocardial ischemia
(E) it is both sensitive and specific
51. A 24-year-old African American woman presents with mild dyspnea on exertion, fever, and a rash on her legs. Her symptoms have come on gradually and she reports no pleuritic chest pain, hemoptysis or sputum production. She has no significant past medical history, smokes 10 cigarettes/day and is not taking any medications. Physical examination reveals generalized lymphadenopathy and tender erythematous nodules on her legs. CXR shows
bilateral symmetric hilar adenopathy and reticulonodular changes in both lungs. She has a restrictive lung disease pattern on pulmonary function testing. Which of the following is the most likely diagnosis?
(A) Hodgkin’s disease
(B) tuberculosis
(C) rheumatic fever
(D) sarcoidosis
(E) rheumatoid arthritis (RA)
52. A 30-year-old man presents with coughing up blood and sputum. There is no associated dyspnea, fever, or pleuritic chest pain. His past medical history is significant for recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is usually worse when lying down
nd in the morning. He quit smoking 5 years ago and started when he was 18 years old. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is the most likely diagnosis?
(A) bronchiectasis
(B) chronic bronchitis
(C) disseminated pulmonary tuberculosis
(D) pulmonary neoplasm
(E) chronic obstructive emphysema
53. A 64-year-old woman is admitted to the hospital after the acute onset of left-sided weakness. She has had a large right cerebral stroke and is confined to bed. On the fifth hospital day, her oxygen saturation is noted to be reduced to 90% on room air. She feels fine, the neurologic weakness is unchanged, blood pressure is
130/90 mm Hg, and pulse 80/min. Examination of the chest reveals decreased fremitus, dullness to percussion, and absent breath sounds in the left lower lung. There is also a tracheal shift towards the left side. (SELECT ONE)

(A) acute asthmatic attack
(B) complete pneumothorax
(C) large pleural effusion
(D) atelectasis
(E) lobar pneumonia

54. A 72-year-old man with COPD develops acute shortness of breath and presents to the hospital. He appears uncomfortable: blood pressure is 120/90 mm Hg, pulse 100/min, oxygen saturation 85% on room air. On examination of the chest, there is absent fremitus, absent breath sounds, and hyperresonant percussion of the
right lung. The trachea is shifted to the left.
(SELECT ONE)

(A) acute asthmatic attack
(B) complete pneumothorax
(C) large pleural effusion
(D) atelectasis
(E) lobar pneumonia

55. A 45-year-old woman comes to the emergency department because of increased shortness of breath. Examination of the chest reveals decreased fremitus, low diaphragms, and prolonged expiration phase. (SELECT ONE)

(A) acute asthmatic attack
(B) complete pneumothorax
(C) large pleural effusion
(D) atelectasis
(E) lobar pneumonia

56. A 24-year old woman notices increasing shortness of breath after recent treatment for right lower lobe pneumonia. She has no fever, cough, or sputum production. On examination, the pertinent findings are decreased fremitus, dullness on percussion, and absent breath sounds of the right lower lung. In addition, the trachea has shifted to the left. (SELECT ONE)

(A) acute asthmatic attack
(B) complete pneumothorax
(C) large pleural effusion
(D) atelectasis
(E) lobar pneumonia

57. A 61-year-old man is not feeling well because of shortness of breath and left-sided chest pains that increase with breathing. His examination reveals increased fremitus, dull to percussion, and bronchophony on the left side. His heart sounds are normal. (SELECT ONE)

(A) acute asthmatic attack
(B) complete pneumothorax
(C) large pleural effusion
(D) atelectasis
(E) lobar pneumonia

58. A 66-year-old man with a 40-pack-per-year history of smoking is investigated for hemoptysis. CXR reveals a central 3-cm mass near the left bronchus. His serum biochemistry is abnormal for elevated calcium, but there is no boney metastasis on the bone scan. Biopsy of the mass is positive for a type of lung cancer associated with paraneoplastic hypercalcemia. (SELECT ONE)

(A) squamous cell carcinoma
(B) adenocarcinoma
(C) large cell carcinoma
(D) small cell carcinoma
(E) bronchioloalveolar carcinoma

59. A 55-year-old woman presents with symptoms of fever, chills, and colored sputum production. She is a former 40-pack-per-year smoker. Her CXR is abnormal for a 2-cm right hilar mass and right lower lobe infiltrate. She is started on antibiotics and a biopsy of the hilar mass is positive for a type of lung cancer responsive to cytotoxic chemotherapy. (SELECT ONE)

(A) squamous cell carcinoma
(B) adenocarcinoma
(C) large cell carcinoma
(D) small cell carcinoma

(E) bronchioloalveolar carcinoma

61. A 58-year-old woman has a witnessed generalized seizure. She has no prior history of seizures, and her only new symptoms are weight loss and anorexia. She looks unwell and cachectic, and the remaining examination is
normal. Her serum sodium is 112 mEq/L, osmolality 260 mOsm/kg, and urine osmolality 420 mOsm/kg. Her CXR is abnormal for a large left hilar mass. She has a 30-pack-peryear history of smoking. Biopsy of the mass is
positive for a lung cancer most commonly associated with ectopic endocrine syndromes.

(A) squamous cell carcinoma
(B) adenocarcinoma
(C) large cell carcinoma
(D) small cell carcinoma
(E) bronchioloalveolar carcinoma

62. A 58-year-old man comes to the emergency department because of left shoulder pain radiating down his left arm. His only risk factor for cardiac disease is hypertension and a 30-packper-year smoking history. On examination, his blood pressure is 150/90 mm Hg in both arms, pulse 100/min, and heart sounds are normal.
He also has ptosis of his left eyelid and a left pupil that is smaller than the right. ECG is normal, and a CXR shows a large left apical mass with 1st and 2nd rib destruction. A biopsy of the mass is consistent with lung cancer most
commonly associated with Pancoast’s syndrome. (SELECT ONE)

(A) squamous cell carcinoma
(B) adenocarcinoma
(C) large cell carcinoma
(D) small cell carcinoma
(E) bronchioloalveolar carcinoma

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