Physical exam of a 60-year-old male reveals perioral cyanosis with a normal respiratory rate and no use of accessory mus- cles. Chest percussion is resonant; auscultation demonstrates wheezes and coarse rhonchi that change in location and inten- sity after a cough. What is the most likely diagnosis...
Pulmonology – PANCE || with 100% Correct Answers.
Physical exam of a 60-year-old male reveals perioral cyanosis with a normal respiratory rate and no use of accessory mus- cles. Chest percussion is resonant; auscultation demonstrates wheezes and coarse rhonchi that change in location and inten- sity after a cough. What is the most likely diagnosis?
A. chronic asthma
B. chronicbronchitis
C. community-acquired pneumonia D. emphysema correct answers The answer is B [Pulmonology].
A. Asthmatics are not cyanotic unless the disease is very
severe. They typically have an increased respiratory rate and demonstrate expiratory wheezes rather than rhonchi.
B. This is the typical picture of chronic bronchitis-predominant COPD.
C. Patients with pneumonia typically present with productive cough and increased respiratory rate; chest percussion may be dull due to an infiltrate.
D. Patients with emphysema-predominant COPD display tachypnea, use of accessory muscles, and diminished breath sounds. They typically do not demonstrate rhonchi; cyanosis may develop
late in the disease.
During a wilderness emergency medicine training course, con- ducted in a remote location, a member of the group begins choking on a piece of food. The patient has lost the ability to cough and seems unable to breathe. What is the next best step in management?
A. blind sweep of the oral cavity B. emergent cricothyrotomy
C. emergent tracheostomy
D. initiate Heimlich maneuver correct answers The answer is D [Pulmonology].
A. Blind sweeps of the oral cavity are not recommended, as
they will most likely force the object to lodge deeper into
the trachea.
B. See D. Should the Heimlich maneuver prove unsuccess-
ful, a cricothyrotomy would be the best next step. C. See D.
D. The Heimlich maneuver should be tried before invasive procedures are undertaken, especially
in the setting where emergency services and sterile conditions are not available.
A 6-year-old presents with intermittent episodes of wheezing. Exam reveals expiratory wheezing
but no rales or rhonchi. She is developing well and is cooperative with the exam. She responds well to an albuterol treatment. What is the most effective method to monitor symptoms at home?
A. peak expiratory flow rate B. respiratory rate
C. pulse oximetry
D. blood pressure correct answers The answer is A [Pulmonology, Pediatrics].
A. Peak expiratory flow rate can be monitored at home using
an inexpensive handheld device.
B. Respiratory rate is unreliable and too subjective for moni-
toring asthma.
C. Pulse oximetry may be normal with mild asthma.
D. The only blood pressure abnormality related to asthma is pulsus paradoxus, which may occur with severe asthma.
A 7-year-old male presents with a history of frequent respira- tory infections with recurrent pulmonary infiltrates and failure to thrive. His cough is persistent and productive of thick, green sputum. A recent sputum culture was positive for Haemophilus influenzae and Staphylococcus aureus. Which of the following laboratory results is pathognomonic for his condition?
A. abdominal flat plate showing small intestinal air-fluid levels and small colon
B. chest radiography revealing hyperinflation and small airway obstruction
C. elevated sweat chloride levels
D. irreversible changes in FVC and FEV1 correct answers The answer is C [Pulmonology, Pediatrics].
A. The abdominal flat plate findings described are consistent
with meconium ileus, which may be seen in newborns
with cystic fibrosis.
B. Hyperinflation can also be seen in asthmatics.
C. Elevated sweat chloride values are the key to diagnosis of
cystic fibrosis. The values for the chloride (and sodium) concentrations in sweat vary with age, but typically a chlo- ride concentration of greater than 70 mEq/L discrimi- nates between patients
with cystic fibrosis and those with other lung diseases.
D. Pulmonary function testing in patients with cystic fibrosis is highly variable, and abnormal findings are generally irreversible.
Which of the following is the only intervention documented to improve survival in a patients suffering from chronic obstructive pulmonary disease (COPD)?
A. long-acting anticholinergics
B. oxygenonacontinuousbasis
C. patient-initiated COPD action plans D. smoking cessation correct answers The answer is B [Pulmonology].
A. Long-acting anticholinergics such as tioproprium or ipra- troprium have been shown to reduce
acute exacerbations but they do not improve survival.
B. Continuous oxygen therapy and in some cases continuous positive airway pressure (CPAP) have been found to favorably impact survival rates in COPD, especially in those patients hypoxic
at rest.
C. Evidence suggests that patient-driven COPD action plans reduce exacerbations but no clear data exist that they im- prove mortality.
D. COPD sufferers should be strongly encouraged to stop smoking; however, the behavior change will not improve survival rates.
A 36-year-old schoolteacher presents with an acute onset of fever, chills, malaise, headache, and congestion. She is cough- ing and sneezing. Conjunctivae are injected; pharyngeal mucosa is edematous and injected. What is expected on exam- ination of the lungs?
A. clear lung fields with good air exchange B. diffuseexpiratorywheezes
C. dullness and rhonchi at the bases
D. scattered crackles and inspiratory wheeze correct answers The answer is A [Pulmonology, Infectious Disease].
A. The lung exam in influenza is generally normal.
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