1 >>A diagnosis of allergic bronchopulmonary aspergillosis in a person who has asthma and recurrent pulmonary infiltrates would be supported by which of the following findings? ?
- (A) Delayed, tuberculin-type skin-test reaction to Aspergillus fumigatus
- (B) The presence of eosinophilia
- (C) Immediate skin test reaction to A. fumigatus
- (D) Positive antinuclear antibody (ANA) serologic test
2 >>A 22-year-old woman with a history of intermittent wheezing in response to exercise presents to the emergency room with shortness of breath. Her attack occurred during an aerobics class. At this point she is having obvious difficulty breathing and has diffuse wheezes on pulmonary examination. O saturation is 95% by pulse oxi- 2 metry. The most effective treatment at this point would be ?
- (A) intravenous aminophylline
- (B) inhaled cromolyn sodium
- (C) inhaled albuterol
- (D) intravenous hydrocortisone
3 >>Both dyskinetic ciliary syndromes and cystic fi- brosis lead to recurrent pneumonia, bronchitis, and eventually bronchiectasis. Which of the following manifestations is typical of Kartagener’s syndrome? ?
- (A) Intestinal obstruction
- (B) Dextrocardia
- (C) Steatorrhea
- (D) Interstitial pulmonary fibrosis
4 >>A patient with advanced adult respiratory distress syndrome (ARDS) has suffered a pneumothorax after being exposed to 10 cmH O positive end-expiratory pressure (PEEP). Which of the following modes of mechanical ventilation would be best? ?
- (A) Assist/control mode of ventilation
- (B) Synchronized intermittent mandatory ventilation
- (C) Pressure-control ventilation
- (D) Continuous positive airway pressure
5 >>A 48-year-old Haitian man presents with shortness of breath. Chest x-ray reveals a right pleural effusion extending about halfway up the chest. The patient has no other known medical problems and is on no medicines. The rest of the general physical examination is unremarkable. Diagnostic thoracentesis reveals the following: lactate dehydrogenase (LDH) 1.7 ?kat/L (100 U/L), glucose 6.4 mmol/L (150 mg/dL), and amylase 1.6 ?kat/L (90 U/L). Cell count reveals 1000 red cells per microliter and 1000 white cells per microliter (differential: 50% neutrophils, 25% lymphocytes, and 25% monocytes). A ventilation-perfusion lung scan is indeterminate on the right side because of the large effusion, but there are no ventilation-perfusion mismatches elsewhere. The next most appropriate step would be ?
- (A) pulmonary arteriogram
- (B) abdominal computed tomography (CT)
- (C) chest CT
- (D) needle biopsy of pleura
6 >>A 45-year-old woman presents with fever and cough. She has had no past medical problems and was well until about 3 days ago. Physical examination is remarkable for a temperature of 39� C (102.2� F) and the presence of diffuse rales on chest examination. Except for an elevated white count with a left-shifted differential, her blood tests are normal. Chest radiography reveals patchy bilateral infiltrates. She is unable to produce sputum. She has resting hypoxemia and requires hospital admission. Which is the most reasonable choice of antibiotics at this time? ?
- (A) Penicillin G
- (B) Cefotaxime
- (C) Erythromycin
- (D) Ampicillin plus sulbactam plus erythromycin
7 >>Which of the following statements concerning obstructive sleep apnea syndrome is true? ?
- (A) Men and women are equally affected.
- (B) Cor pulmonale and not systemic hypertension is usually seen
- (C) Sedatives are often useful in the improvement of quality of sleep
- (D) Personality changes may be the presenting complaint.
8 >>A 54-year-old man has a nonproductive cough and exertional breathlessness. He also notes low-grade fever, malaise, and a weight loss of 7 kg (15 lb) over 6 weeks. His white blood cell count is 13,500?L. He has a history of mild asthma. A chest x-ray discloses peripheral lung infiltrates. The most likely diagnosis is ?
- (A) idiopathic pulmonary fibrosis
- (B) alveolar proteinosis
- (C) polymyositis
- (D) chronic eosinophilic pneumonia
9 >>One week after a right total hip replacement a 65- year-old woman develops the sudden onset of shortness of breath. A workup reveals normotension, a prominent second heart sound, hypoxemia, sinus tachycardia with new right axis deviation on the electrocardiogram, and a normal chest x-ray. Oxygen is administered. Impedance plethysmography is consistent with a large proximal clot in the left leg. Which of the following would be the most reasonable next step? ?
- (A) Performance of a pulmonary angiogram
- (B) Performance of perfusion scintigraphy
- (C) Administration of tissue plasminogen activator
- (D) Dextrocardia
10 >>Expected results of the pulmonary function testing of the man described above would include ?
- (A) increased lung elastic recoil
- (B) increased total lung capacity
- (C) reduced functional residual capacity
- (D) increased vital capacity
11 >>Which of the following would be the most reasonable next step in the assessment of the patient described above? ?
- (A) Acid starch gel
- (B) Measurement of sweat chloride concentration
- (C) High-resolution CT scan
- (D) Exercise stress test
12 >>Which of the following statements concerning the pathogenesis of ?1-antitrypsin deficiency is true? ?
- (A) Emphysema results from an inability to inhibit alveolar destruction by neutrophils.
- (B) Clinical deficiency of ?1 -antitrypsin usually results 1 from one of several nonsense mutations that cause a truncated protein product.
- (C) The disease is inherited in a dominant fashion
- (D) Emphysema results from an inability to inhibit alveolar destruction by neutrophils
13 >>To decrease the likelihood of drug toxicity, the theophylline dose should be reduced in a patient with asthma in which of the following circumstances? ?
- (A) Active tobacco user
- (B) Azithromycin use for Mycoplasma pneumonia
- (C) Augmented use for recurrent otitis media
- (D) Marijuana abuse
14 >>Which of the following is a known consequence of asbestos exposure? ?
- (A) The same increased risk of mesothelioma as cigarette use
- (B) Pleural effusions, often initially benign
- (C) An increased incidence of both adenocarcinoma of the lung and small cell carcinoma of the lung
- (D) Pleural mesothelioma but not peritoneal mesothelioma
15 >>In which of the following clinical circumstances would it be appropriate to use a rigid bronchoscope instead of a flexible fiberoptic bronchoscope? ?
- (A) A 22-year-old man with known HIV infection who complains of shortness of breath and has diffuse interstitial infiltrates on chest x-ray
- (B) A 65-year-old man with a long history of smoking who has shortness of breath and right upper lobe collapse
- (C) A 33-year-old woman with a history of acute myeloid leukemia complaining of severe dyspnea who is currently 4 months after an allogeneic bone marrow transplant and has a reticulonodular pulmonary infiltrate
- (D) A 28-year-old man with a history of acute myeloid leukemia who is currently 30 days after an allogeneic bone marrow transplant with a significant pulmonary hemorrhage and bilateral alveolar infiltrates on chest x-ray
16 >>Which of the following is the most common initial symptom of byssinosi ?
- (A) Wheezing
- (B) Dyspnea on exertion
- (C) Cough
- (D) Chest tightness
17 >>A 27-year-old woman with a history of common variable immunodeficiency has had many upper and lower respiratory tract infections. She now presents with a third episode of recurrent cough and copious purulent sputum production, which is sometimes blood-tinged. She is afebrile, and her pulmonary exam is normal. Chest radiography reveals the presence of several parallel linear opacities and a few ringlike shadows. The diagnosis that most likely accounts for this patient’s symptoms is ?
- (A) bronchiectasis
- (B) non-small cell lung cancer
- (C) Mycoplasma infection
- (D) viral pneumonia
18 >>A 35-year-old man has had recurrent diarrhea for at least 5 years. About 7 years ago many reddish-brown macules appeared on his torso and extremities (see Plate L). Rubbing these lesions gently results in the formation of a wheal. He also has been bothered by severe generalized itching, which is made worse when he takes aspirin for his frequent headaches. He has lost 11.4 kg (25 lb) in the past few months. Biopsy of the lesion would reveal infiltration with ?
- (A) lymphoma cells
- (B) leukemic cells
- (C) neutrophil
- (D) mast cells
19 >>A 50-year-old male chronic alcoholic presents with a 2-week history of fever, night sweats, cough, productive sputum, and pleuritic chest pain. The patient has had a recent negative HIV test and has no other medical problems. Chest x-ray reveals a 3-cm cavitary lesion in the posterior segment of the left lower lobe. This cavity contains an air-fluid level. Which of the following is the most likely etiologic agent? ?
- (A) S. pneumoniae
- (B) H. influenzae
- (C) Mycobacterium tuberculosis
- (D) Actinomyces
20 >>A 55-year-old man presents with several months of dyspnea and a nonproductive cough. Physical examination reveals dry crackles at both lung bases. Chest radiography and high-resolution CT reveal a bibasilar reticular nodular pattern in the lung fields. Spirometry reveals reductions in total lung capacity, vital capacity, and residual volume. The carbon monoxide diffusion capacity is reduced to 35% of normal. Resting arterial hypoxemia is demonstrated on arterial blood-gas testing. Transbronchial biopsy results reveal an increase in inflammatory cells on the alveolar surface, predominantly macrophages, as well as diffuse intraalveolar fibrosis. The mainstay of therapy at this point would be ?
- (A) oral prednisone
- (B) oral cyclophosphamide
- (C) 4-week course of oral azithromycin
- (D) lung transplantation