SAEM Pulm Questions and Answers 2023

SAEM Pulm Questions and Answers 2023 A thin 18 year old female complains of acute onset of sharp right-sided chest pain this morning. She has developed some mild shortness of breath during the morning and thought she should get it checked out. Her chest X-ray is shown in the Figure. The next course of action should be: [PICTURE OF LUNGS WITH RIGHT BLUNTED COSTODIAPHRAGMATIC ANGLE] 1.Electrocardiogram 2.Antibiotics 3.Chest tube placement 4.Needle decompression 3. Chest tube placement A 28 year old patient arrives after helicopter transfer from an outlying center, where he had been intubated for altered mental status after significant alcohol intoxication. There were no reported signs of chest trauma, but the patient now has decreased breath sounds on the left. His vital signs are stable. Based upon the chest X-ray in the figure, what is the next step in management of this patient? [PICTURE OF HYPERINFLATED RIGHT LUNG AND CLOUDY LEFT LUNG] Answers: 1.Endotracheal tube adjustment 2.Chest tube placement 3.Nasogastric tube placement 4.Needle decompression 1.Endotracheal tube adjustment Regarding the epidemiology of asthma in the United States, which of the following is true? Answers: 1.Etiology is thought to be genetic, not environmental 2.Incidence is comparable for Caucasians and African-Americans 3.More common in males than females in adult and pediatric populations 4.Prevalence increased in the 1980's, and then decreased in the 1990's 4.Prevalence increased in the 1980's, and then decreased in the 1990's Regarding pulsus paradoxus and asthma, which of the following statements is correct Answers: 1.Pulsus paradoxus is a fall in systolic blood pressure during inspiration 2.Pulsus paradoxus is pathognomonic for asthma 3.The absence of pulsus paradoxis in asthma rules out severe disease 4.The presence of pulsus paradoxis in asthma indicates severe disease 4.The presence of pulsus paradoxis in asthma indicates severe disease Which of the following is correct regarding the use of corticosteroids in acute asthma exacerbation? Answers: 1.Beneficial effects occur within the first hour of administration. 2.Inhaled steroids should be avoided 3.Intravenous steroids are superior to the oral route 4.Tapering is needed with all corticosteroid regimens 2.Inhaled steroids should be avoided Which of the following is true regarding the treatment of acute asthma exacerbation in the Emergency Department? Answers: 1.Anticholinergics by inhalation may be beneficial 2.Heliox should only be used in the intubated patient. 3.Intramuscular terbutaline is preferred over intravenous 4.Intravenous albuterol may be indicated 1.Anticholinergics by inhalation may be beneficial Which of the following drugs is MOST beneficial in an acute COPD exacerbation? Answers: 1.Beta adrenergic agonists such as albuterol 2.Steroids such as solumedrol 3.Methylxanthines such as theophylline 4.Mucokinetic agents such as acetylcysteine 1.Beta adrenergic agonists such as albuterol Regarding the pathogens involved in community-acquired pneumonia, which of the following is true? Answers: 1.Co-infection with multiple bacteria, such as Chlamydia and Strep pneumoniae commonly occur 2.Etiologic agents for patients admitted to the ICU with pneumonia most commonly include Neisseria meningitidis and Strep pneumoniae 3.Milder cases of community acquired pneumonia are frequently caused by Chlamydia 4.Q fever, caused by Coxiella burnetii, may present as pneumonia, particularly in patients exposed to rabbits 1.Co-infection with multiple bacteria, such as Chlamydia and Strep pneumoniae commonly occur Which of the following patients is the most likely to develop S. pneumoniae pneumonia? Answers: 1.59 year old woman who is a cigarette smoker. 2.61 year old man with hypertension 3.64 year old man with type 2 diabetes 4.65 year old woman with no past medical history 3.64 year old man with type 2 diabetes Regarding the etiology of viral pneumonia, which of the following is true? Answers: 1.Cytomegalovirus does not usually cause pneumonia in immunocompetent adults 2.Influenza virus is the most common cause of viral pneumonia in children 3.Parainfluenza virus is the most common cause of viral pneumonia in adults 4.Varicella zoster causes pneumonia more frequently in children than in adults 1.Cytomegalovirus does not usually cause pneumonia in immunocompetent adults Regarding mycobacterium tuberculosis (TB), which of the following is TRUE? Answers: 1.Worldwide, TB causes more deaths than any other infectious agent 2.Worldwide, approximately 45-50% of the population is infected with TB 3.In the United States, approximately 12-15% of the population is infected with TB. 4.In the United States, the incidence of TB has been steadily increasing since the 1950s. 1.Worldwide, TB causes more deaths than any other infectious agent Which finding is commonly associated with pneumonia caused by Klebsiella pneumoniae? Answers: 1.Absence of sputum 2.Encephalitis 3.Empyema 4.Low mortality 3.Empyema Which of the following patients presenting to the emergency department with a chief complaint of "shortness of breath" is most likely to have cavitary lesion with air-fluid levels on CXR? Answers: 1.64 year old female with history of congestive heart failure 2.54 year old male with history of recent myocardial infarction 3.43 year old homeless male with history of alcohol abuse 4.32 year old female who is 36 weeks pregnant ase in systolic blood pressure by more than 10 mmHg with inspiration 3.43 year old homeless male with history of alcohol abuse In the emergency department, regarding the disposition of patients diagnosed with pneumonia: Answers: 1.Patients over 50 years of age should be admitted 2.Patients under 2 years of age should be admitted 3.Patients with co-morbidities should be admitted 4.Patients with normal vital signs should be discharged home 3.Patients with co-morbidities should be admitted A 28 year old man is shot in the right chest. His vital signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. He has significant JVD, his trachea is deviated to the left, and he has decreased breath sounds on the right. The patient's diagnosis is: Answers: 1.Hypovolemic shock 2.Tension pneumothorax 3.Cardiac tamponade 4.Lung laceration 5.Spinal cord injury 2.Tension pneumothorax Which of the following are associated with a higher risk of spontaneous pneumothorax? Answers: 1.Cigarette smoking 2.Female gender 3.Physical exertion 4.Trisomy 21 1.Cigarette smoking A radiographic finding that may be seen in an elderly patient who aspirated food is: Answers: 1.Hyperinflation of the left lung 2.An opacity in the right middle lobe bronchus 3.Tension pneumothorax on the right, with leftward mediastinal shift 4.Visualization of the food bolus in the right mainstem bronchus 1.Hyperinflation of the left lung A 7 year old girl is brought in by her father complaining of difficulty breathing after being stung by a bee. She is otherwise in good health. Neither she nor her father recall whether she has been stung previously, but state she has never before had a reaction like this. Which of the following treatments would be inappropriate? Answers: ed racemic epinephrine venous antibiotics x by face mask erol nebulizer venous antibiotics Regarding the diagnosis of pulmonary embolism (PE), which is correct. Answers: 1.Autospsy studies indicate that approximately 30% of patients who die in the hospital have undiagnosed PE 2.By 80 years of age, one out of four people will develop deep venous thrombosis 3.One-year mortality of PE is 25% even with early diagnosis and treatment 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33%