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Pulmonary ROSH Review Questions and Answers (100% Pass)
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©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AMPulmonary ROSH Review Questions and Answers (100% Pass)
A 25-year-old man presents for evaluation of fever and cough. He reports last week that he was
diagnosed with influenza. In the last 2 days he developed a worsening cough productive of large
amounts of sputum. Vital signs are T 101°F, HR 98, BP 120/60, RR 18, and 95% oxygen
saturation on room air. His chest X-ray demonstrates a lobar infiltrate in the left lower lobe.
Which of the following would you most likely expect to see on the patient's Gram stain?
Gram negative bacilli
Gram negative diplococci
Gram positive bacilli
Gram positive cocci in clusters - ✔️✔️Correct Answer ( D )
Explanation:
The patient had a recent influenza infection and now presents with a lobar infiltrate.
Staphylococcus aureus pneumonia is classically associated with causing post-influenza bacterial
pneumonia. On Gram stain this is seen as Gram positive cocci in clusters
Question: In which population is Klebsiella pneumonia most commonly seen in? - ✔️✔️COPD,
Alcoholics and the elderly.
Bacterial Pneumonia Overview - ✔️✔️Bacterial Pneumonia
S. pneumonia: most common, rusty colored sputum, rigors, gram+ paired lancets
Klebsiella: alcoholics, currant jelly sputum, bulging fissures,
S. aureus: IVDA, postinfluenza, elderly, gram+ cocci in clusters
H. influenzae: COPD, gram negative pleomorphic rods
Pseudomonas: cystic fibrosis, nursing home resident and cyanosis
Health care associated pneumonia: pseudomonas, MRSA
Outpatient, healthy: macrolide or doxycycline
Outpatient, comorbidity: respiratory tract fluoroquinolone (RTF)
Inpatient: RTF
ICU: antipneumococcal ß-lactam (ceftriaxone or cefotaxime) + either azithromycin or an RTF
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
You evaluate a 65-year-old patient for shortness of breath and note on exam decreased breath
sounds at the left lung base. You are suspicious of a small pleural effusion. In which of the
following views on the chest radiograph is the small pleural effusion most likely to be detected?
Lateral
Lateral decubitus left side down
Lateral decubitus right side down
Posterior-anterior (PA) - ✔️✔️Correct Answer ( B )
Explanation:
Classic physical signs of a pleural effusion include diminished breath sounds, dullness to
percussion, decreased tactile fremitus, and occasionally a localized pleural friction rub. Chest
radiograph confirms the suspicion of pleural effusion. The classic radiographic appearance of a
pleural effusion is blunting of the costophrenic angle on the upright chest radiograph
Pleural Effusion
Transudate: CHF (most common)
Exudate: infection > malignancy, PE
↓ Breath sounds + dull percussion + ↓ tactile fremitus
CXR: blunting of the costophrenic angle
Question: A pleural effusion is most difficult to detect in which radiographic position? -
✔️✔️Supine.
Which of the following complications can be prevented by simultaneously administering
pyridoxine and isoniazid in a patient with tuberculosis exposure?
Color blindness
Hepatitis
Peripheral neuropathy
Renal failure - ✔️✔️Correct Answer ( C )
Explanation:
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
Isoniazid (INH) inhibits the enzyme responsible for the conversion of pyridoxine (vitamin B6) to
one of its active metabolites, pyridoxal phosphate (PLP). This depletion of vitamin B6 may lead
to complications such as peripheral neuropathy and seizures. Therefore, vitamin B6 should be
administered concomitantly to patients taking isoniazid. PLP is also a coenzyme required for the
synthesis of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Decreased
GABA formation in the setting of vitamin B6 deficiency may also contribute to seizures.
Color blindness (A) is not a complication of INH. However, another commonly used drug in TB,
ethambutol, is associated with retrobulbar neuritis and red-green color blindness. INH is
metabolized by the liver and gets converted to an ammonium molecule that can lead to
hepatotoxicity (B). However, this is not affected by vitamin B6 supplementation. Renal failure
(D) is a complication of pyridoxine overdose.
Question: What is the most common location of extrapulmonary TB? - ✔️✔️Lymph nodes.
Pulmonary Tuberculosis (TB)
RFs: immunodeficiency, immigrant, close contact
Latent/primary TB: asymptomatic
Active/reactivation TB: fever, night sweats, weight loss, productive cough, hemoptysis
Erythema nodosum
Primary TB CXR: Ghon focus
Active/reactivation TB: upper lobes, cavitary lesions
Dx: sputum smears for acid-fast bacilli (AFB), sputum/tissue culture for AFB (gold standard)
PPD: gold standard for latent TB dx
Latent TB rx: 9 months of INH
Primary TB rx: rifampin, INH, pyraziniamide, ethambutol (RIPE)
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to your office for
her annual exam. She has had her hepatitis B vaccination, but wants to know if she needs any
additional vaccinations because of her new diagnosis. Which of the following is the most
appropriate next step in her management?
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, ©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
Administer annual influenza vaccine only
Administer pneumococcus and annual influenza vaccines
Administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole
The patient does not need any additional vaccines since she is up to date - ✔️✔️Correct Answer (
B)
Explanation:
Patients with diabetes mellitus require regular monitoring and health maintenance to prevent
diabetes-related complications. Health maintenance for these patients includes three
vaccinations: annual influenza, pneumococcus (repeated at age 65 if given prior to that age) and
the hepatitis B three dose series. Patients with diabetes mellitus require annual foot, dental and
dilated eye examinations, blood pressure monitoring, and smoking cessation counseling. Upon
diagnosis, a serum creatinine should be drawn. Annual fasting serum lipids and urinary albumin-
to-creatinine ratios should be monitored. Hemoglobin A1C should be obtained every 3-6 months
with a goal of <7%.
Question: What is the blood pressure goal for patients with diabetes mellitus type 2? - ✔️✔️<
140/90.
A 36-year-old veterinarian presents with myalgias, dry cough, and severe headache. His vital
signs include blood pressure 138/74 mm Hg, heart rate 82 beats/minute, temperature 39°C, and
oxygen saturation 94% on room air. He has hepatosplenomegaly on abdominal exam. His chest
X-ray shows patchy perihilar infiltrates. What of the following is the most appropriate antibiotic
for this patient?
Amoxicillin-clavulanate
Doxycycline
Levofloxacin
Trimethoprim-sulfamethoxazole - ✔️✔️Correct Answer ( B )
Explanation:
Psittacosis is caused by Chlamydia psittaci, an obligate intracellular gram-negative organism. It
is harbored in avian species making bird owners, veterinarians, and pet-shop employees
particularly susceptible to infection. Patients present with high fevers, severe headache,
myalgias, nonproductive cough, and hepatosplenomegaly. Chest X-rays show patchy perihilar or
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