Respiratory Medicine Pulmonology Multiple Choice Questions 1

Respiratory Medicine Pulmonology Multiple Choice Questions 1

Respiratory Medicine Multiple Choice Questions 1

A 65 year old man complains of fever, chills, and coughing. The patient is a diabetic who admits to abusing alcohol. Physical examination shows a consolidation, which is reinforced by chest X-ray. Gram stain of the sputum demonstrates an encapsulated rod bacillus. The most likely first line drug therapy to treat this pneumonia is

A. Penicillin G.

B. Erythromycin.

C. Ceftriaxone. ✅

D. Aminoglycoside..

E. None of the above.

Question Explanation:

Although both Haemophilus influenzae and Klebsiella pneumoniae are two important Gram negative bacteria, which cause lobar consolidating pneumonias, only Klebsiella has been shown to be associated with alcohol abusers and diabetics. Haemophilus influenzae pneumonia occurs often in patients with a chronic cardiopulmonary disease. However, the first line drug therapy for the treatment of pneumonia secondary to either Klebsiella or Haemophilus influenzae infection is ceftriaxone. Penicillin is useful for Gram positive bacterial infections such as Streptococcus pneumoniae and Staphylococcus aureus. Erythromycin is useful for the treatment of klebsiella pneumonia.

What are predisposing factors associated with Adult Respiratory Distress Syndrome (ARDS)?

A. Bacteremia.

B. Multiple organ system damage.

C. Acute pancreatitis.

D. Diabetic ketoacidosis.

E. All of the above. ✅

Question Explanation:

ARDS is a clinical syndrome which includes hypoxic and hypercapnic respiratory failure. The pathogenesis of ARDS is not entirely defined. ARDS can be fatal. All of the choices are risk factors for developing ARDS.

Hypertrophic osteoarthropathy is most commonly associated with disorders of which of the following?

A. The central nervous system.

B. Calcium metabolism.

C. Osteoblasts.

D. The lungs. ✅

E. The stomach.

Question Explanation:

Diseases of the lungs are the most common cause of hypertrophic osteoarthropathy Disorders of the central nervous system, calcium metabolism, osteoblasts, and the stomach are not specifically associated with this condition.

A 40 year old mechanic has a new onset of wheezing. His medications include propranolol, Enalapril, hydrochlorothiazide, ranitidine and occasional pseudoephedrine for symptoms of allergic rhinitis. On exam, he appears comfortable. His BP is 134/88 mmHg, pulse is 68/min, and wheeze throughout both lung fields. The medication that is likely contributing to his wheezing is:

A. Enalapril

B. Hydrochlorothiazide

C. Propranolol ✅

D. Pseudoephedrine

E. Ranitidine

Question Explanation:

Propranolol, like other nonspecific beta blockers, may cause bronchospasm by blocking the beta receptors in the bronchial tree. Beta stimulation in the lungs produces bronchodilation, and its blockade leads to bronchoconstriction. In fact, propranolol is contraindicated in patients with known asthma or chronic obstructive pulmonary disease (COPD).

A 71 year old man has smoked for years despite a chronic productive cough. He notices blood in his sputum one day. CXR reveals a mass in one lung, which is biopsied. When assumed that this patient's cancer is etiologically related to his smoking, the diagnosis that is likely to be made by laboratory would be

A. Adenocarcinoma or Bronchioloalveolar carcinoma

B. Adenocarcinoma or small cell carcinoma

C. Bronchioloalveolar carcinoma or small cell carcinoma

D. Bronchioloalveolar carcinoma or Squamous cell carcinoma

E. Smell cell carcinoma or Squamous cell carcinoma ✅

Question Explanation:

Smoking does not increase the risk of all types of lung cancers to the same degree. Oat (small) cell carcinoma has a very strong association with smoking, with only 1% of cases occurring in nonsmokers. Squamous cell carcinoma is also strongly associated with smoking, because smoking predisposes for squamous metaplasia, a precancerous condition. The association of smoking with bronchogenic adenocarcinoma and with bronchioloalveolar carcinoma is much weaker.

A 19-year-old boy presents to the ER with severe shortness of breath. After evaluation he is diagnosed with asthma. Which one of the following drugs exerts its primary therapeutic benefit by bronchodilation in asthma?

A. Montelukast

B. Glucocorticoids

C. Cromolyn sodium

D. Theophylline

E. Albuterol ✅

Question Explanation:

Albuterol is a beta adrenergic agonist and causes bronchodilation. Cromolyn sodium stabilizes mast cells from degranulating in response to an allergen. Glucocorticoids act as a general immunosupressive. Theophylline acts to bronchodilate and improves mucociliary clearance.

A 27 year old woman had a dry cough that had been worsening for five months. She presented because of an acute bout of coughing associated with hemoptysis. CXR and follow-up CT scan of the lungs revealed a large anterior mediastinum mass. Which of the following is NOT associated with anterior mediastinum mass?

A. Thymoma.

B. Retrosternal thyroid tumor.

C. Germ cell tumor.

D. Neurogenic tumor. ✅

E. Teratoma.

Question Explanation:

Neurogenic tumors are the most common primary mediastinal neoplasm. However, they present most commonly as posterior mediastinal masses and majority are benign. Ten percent of primary mediastinal neoplasms are thymomas. They are usually present anteriorly and 25% are usually found to be malignant. Retrosternal thyroid tumors can present as an anterior, superior, and middle mediastinal mass. Germ cell tumors, bronchogenic cysts, aortic aneurysms, and pericardial cysts can all present as anterior mediastinal masses. Teratomas arise from the pericardium and often attach to the base of the great vessels. They are rare and occur most often in infants.

For which one of the following is desensitization with increasing doses of subcutaneous antigen injection NOT indicated?

A. Bee sting sensitivity.

B. Asthma. ✅

C. Tree allergy.

D. Mold allergy.

E. Dust allergy.

Question Explanation:

Desensitization is not indicated for asthma unless a known antigen is responsible for the bronchospasm. Allergies to bee venom, tree pollen, mold, and dust are all amenable, to desensitization.

A patient presents with chest wall pain. Which of the following is the most likely diagnosis?

A. Tietze's syndrome. ✅

B. Reiter's syndrome.

C. Ward-Romano syndrome.

D. Cryoglobulinemia.

E. Sarcoidosis.

Question Explanation:

Reiter's syndrome is an inflammatory condition that can present with urethritis, uveitis, and arthritis. Tietze's syndrome is an inflammatory costochondritis, demonstrated by chest wall pain. Ward Romano presents as long QT syndrome. Cryoglobulinemia can present with a vasculitis and glomerulonephritis. Sarcoidosis presents with hilar adenopathy and eye findings.

A woman aged 58 years with a long history of cigarette smoking and chronic cough presents with acute shortness of breath. She is found to have an acute respiratory alkalosis. Her arterial blood gas examination would most likely show

A. Hypoxemia. ✅

B. Hypercapnia.

C. Normal pH.

D. Normal oxygen level.

E. Hypoxia

Question Explanation:

A cigarette smoker with acute shortness of breath and respiratory alkalosis is most likely to have hypoxemia, which is the stimulation for the hyperventilation. The bicarbonate level and pCO2 should be low in this setting.

The pH is elevated by definition in alkalosis. Choice E is not correct.

A 25 year old woman presents with night sweats, hemoptysis, fever, weight loss, and anorexia. Her PPD is greater than 12 mm indurated. She lives in an urban shelter. The next appropriate step in management is

A. Isoniazid and vitamin B6

B. Place the patient in an isolation room, but there is no need for masks.

C. Radiation therapy

D. Obtain sputum for acid fast bacilli smears and cultures. ✅

E. Rifampin

Question Explanation:

This patient most likely has Mycobacteria tuberculosis, which can spread via the respiratory route if she is not isolated. She does not need chemoprophylaxis, but triple drug treatment. Obtaining sputum for cultures and sensitivities can guide treatment of this disease, especially in this day of multidrug resistance. Adding isoniazid alone with vitamin B6 will only permit future resistance. Placing the patient in an isolation room until the diagnosis is established is prudent, along with personal respiratory protective devices. Radiation therapy is contraindicated in pulmonary tuberculosis. If the patient had lung cancer, this would be a good choice. Rifampin alone is not a good choice; triple anti-tuberculosis therapy is indicated in suspected pulmonary tuberculosis.

All of the following conditions are associated with sleep apnea, EXCEPT

A. Chronic obstructive pulmonary disease

B. Muscular dystrophy

C. Pharyngeal tumors

D. Microglossia ✅

E. Alcoholism

Question Explanation:

Sleep apnea is an intermittent cessation of airflow at the mouth and nose during sleep. It may result from either obstructive or central abnormalities. Any lesion that obstructs upper airway flow, such as pharyngeal tumors, tonsillar hypertrophy, or obesity, may produce sleep apnea. The airway may also be narrowed by structural abnormalities, such as retrognathia and macroglossia. Alcohol functions as a co-factor because it depresses the function of the muscles of the upper airway. In central-sleep apnea, there is a transient abolition of the central drive to the ventilatory muscles. Ultimately, there is a blunting of the brain stem sensitivity to hypercarbia hypoxia. Peripheral neuromuscular disorders may also produce weakness in the respiratory muscles, which are often combined with desensitization of the brainstem respiratory centers.

Next