Respiratory Diseases Questions

A 72-year-old woman presents to the clinic for follow-up after being treated for respiratory infection at urgent care unit. She reports mild improvement in her symptoms following two courses of oral antibiotics. A recent chest radiograph reveals persistent right lower lobe infiltrate. A bronchoalveolar lavage demonstrates atypical cytology.
Which one of the following is the most likely diagnosis?

A 65-year-old man with history of well-controlled hypertension presents to the clinic requesting pharmacotherapy for smoking cessation. His medical history is significant for recent diagnosis of emphysema.
Which one of the following is the most common symptom of emphysema?

A 59-year-old man presents to the clinic with 2-month history of progressive right shoulder and arm pain, accompanied by fatigue and unintentional weight loss. On physical examination, he has right-sided ptosis. Cardiac auscultation reveals regular rate and rhythm, no murmurs. Chest examination is unremarkable.
Which of the following is the most likely type of cancer?

A 55-year-old male presents with dry cough and progressive exertional dyspnea for the past year. Physical examination reveals bilateral basal crackles and finger clubbing. Chest X-ray demonstrates bilateral reticular opacities predominantly in the lower lung zones.
Which of the following investigations has the highest diagnostic value in this case?

A 63-year-old obese man presents to the clinic complaints of excessive daytime sleepiness over the past several months. He has no significant past medical history. A sleep study confirms obstructive sleep apnea.
Which one of the following is the most appropriate next step in management?

A previously healthy 36-year-old woman presents to the clinic with 6-month history of episodic dyspnea, accompanied by cough and wheezing. She reports that her symptoms begin and resolve abruptly and have been partially responsive to salbutamol inhaler. Her examination and laboratory work, including spirometry, are all unremarkable.
Which one of the following is the most likely diagnosis?

A 73-year-old man with COPD presents to the clinic for progressive dyspnea over the past 3 months. He reports increasing orthopnea despite adherence to his prescribed tiotropium and fluticasone-salmeterol. His vital signs reveal oxygen saturation of 89% on room air. On examination, he has barrel-shaped chest, jugular venous distension to the angle of the mandible, 1+ pitting edema of the bilateral lower extremities, and quiet heart sound.
Which of the following interventions is most likely to reduce mortality in this patient?

A 55-year-old man presents with progressive dyspnea on exertion and productive cough over the past year. He has 30-pack-year smoking history. Vital signs are stable. Physical examination is within normal limits. Plain chest X-ray is normal.
Which one of the following is the most likely diagnosis?

A 25-year-old patient with spastic quadriplegic cerebral palsy is admitted for acute respiratory failure. The patient has weak cough reflex and history of recurrent aspiration pneumonia. The blood gas shows pH 7.25, PaCO2 60 mm Hg, and PaO2 48 mm Hg.
What is the most likely type of respiratory failure in this patient?

A 52-year-old male with rheumatoid arthritis presents with progressive dyspnea and non-productive cough over the past several months. He has 20-pack-year smoking history. Vital signs are within normal. Pulmonary function testing shows reduced lung volumes and normal FEV1/FVC ratio.
Which one of the following is the most likely diagnosis?

A 55-year-old male presents to the clinic with progressive shortness of breath over several weeks. He has significant smoking history. On evaluation, chest X-ray reveals massive right-sided pleural effusion.
Which one of the following is the most appropriate next step in management?

A 22-year-old female comes to the emergency department with headache, nausea, and dizziness following exposed to carbon monoxide. She denies loss of consciousness or shortness of breath. The arterial blood gas shows COHb level of 30 percent.
Which one of the following is the most appropriate next step in management?

A 17-year-old student with asthma presents for follow-up visit. She reports using her albuterol inhaler two to three times daily for the past month. She denies nighttime awakenings due to symptoms.
Which one of the following is the most appropriate next step in management?

A 71-year-old man presents with progressive dyspnea on exertion and wheezing over the past year. He has 40-pack-year smoking history. Physical examination reveals barrel-shaped chest. Spirometry reveals FEV1/FVC ratio < 0.7 with reduced vital capacity. Which of the following is most likely associated with his condition?

A heavy smoker 60-year-old man presents with left-sided chest pain and hemoptysis for 2 days. Vital signs show temperature of 38.2°C. On physical examination, he has hoarse voice, and both wrists are swollen and tender.
Which one of the following is the most likely diagnosis?

A 65-year-old male is emergently intubated orotracheally for acute respiratory failure secondary to pneumonia. Following intubation, the team must confirm correct endotracheal tube placement.
Which of the following best confirms correct endotracheal tube placement?

A 70-year-old man with well-controlled hypertension presents to the emergency department with acute confusion and irritability for 2 hours. The patient has right leg injury that left him immobile and bed-bound since 5 days ago. No recent fever or chest pain. An ECG demonstrates sinus tachycardia. Chest X-ray shows no abnormalities.
Which one of the following is the most likely diagnosis?

A 61-year-old man presents for evaluation of chronic cough. He reports daily morning cough productive of sputum for the past several years. He has 40 pack-year smoking history and reports progressive dyspnea on exertion. On examination, he is thin man with barrel-shaped chest with end-expiratory wheezes bilaterally.
Which of the following is the single best initial test to assess the severity of this patient’s disease?

A 25-year-old male with asthma presents to the emergency department with cough and dyspnea over the past 6 hours. Vital signs reveal heart rate of 110 bpm and respiratory rate of 22 bpm. Pulse oximetry shows 94% on room air. On examination, he is sitting upright and speaking in short phrases. Auscultation reveals expiratory wheezes in all lung fields.
Which of the following findings indicates acute severe asthma in this patient?

A 26-year-old woman with asthma presents to the clinic for follow-up visit. She reports using her albuterol inhaler three days weekly. She wakes up in the middle of the night with symptoms approximately six times monthly.
Which one of the following is the most appropriate next step in management?

A 20-year-old woman presents to the clinic with dyspnea on exertion, fatigue, low-grade fever, and migratory arthralgias for 2 weeks. On examination, she has tender, erythematous subcutaneous nodules measuring 2–3 cm in diameter over both shins. Chest auscultation reveals bilateral fine crackles at the lung bases.
Which one of the following is the most appropriate next step in management?

A 50-year-old man is hospitalized for acute pancreatitis. Three days later, he develops acute dyspnea. Vital signs show blood pressure of 115/80 mm Hg, heart rate of 110 bpm, and respiratory rate of 33 bpm. Pulse oximetry on room air shows 86% saturation. Physical examination reveals tachypnea with accessory muscle use and coarse crackles at both lung bases.
Given the concern for acute respiratory distress syndrome, which of the following is the most important initial test for determining prognosis?

A 67-year-old man with COPD presents for follow-up visit. He is hospitalized for exacerbations two times in the past six months despite using salmeterol 2 puffs twice daily and albuterol as needed. On physical examination, he has diffused expiratory wheezing and diminished breath sounds bilaterally.
Which one of the following is the most appropriate next step in management?