Questions 159-161: Lung pathology

Question 159

A 32-year-old male presents to an acute care clinic with complaints of chest pain that is worse when he breathes in. The chest pain started about a day ago. A few hours ago he coughed up blood. Physical examination reveals some dullness to percussion in the left upper lobe and crackles are heard at that site. His only past medical history is that he broke his left tibia one week ago while skiing, and has had to wear a cast, which he reports has hindered his ability to get around like normal. Of the following, which laboratory test is most likely to be elevated?

A. D-Dimer
B. PTT
C. AST
D. Hct
E. Glucose

Question 160

A 23-year-old tall and thin male presents to the emergency room at 2 am, saying that he awoke due to a sudden pain in his chest that was worse when he breathed, and has had difficulty breathing since that time. Physical examination reveals hyperresonance to percussion on the left side of his chest, which is associated with decreased breath sounds and absence of tactile fremitus. Of the following, what is the most likely diagnosis?

A. Acute myocardial infarct
B. Aortic dissection associated with Marfan syndrome
C. Pneumothorax
D. Lobar pneumonia
E. Pulmonary thromboembolus

Question 161

A 16-year-old tall male is playing basketball with friends when he suddenly develops chest pain and shortness of breath. His friends take him to the emergency room where a physical examination reveals hyperresonance to percussion on the left side of his chest, which is associated with decreased breath sounds and absence of tactile fremitus. Of the following, what is the most likely underlying pathologic finding?

A. Ruptured pulmonary bleb
B. Inflammation of blood vessel
C. Tearing of large caliber blood vessel
D. Asymmetric thickening of myocardium
E. Thrombus in blood vessel

Questions 156-158: Lung pathology

Question 156

A 29-year-old male presents to an acute care clinic with complaints of a productive cough and fever to 38.7 degrees Celsius for the past 3 days, associated with some chest pain when he breaths and with chills. Physical examination reveals dullness to percussion on the left side of the chest. Crackles and a pleural rub are also heard at this location. A chest x-ray reveals consolidation of the left lung. A sputum culture is obtained and grows a pure sample of gram positive cocci in chains. Of the following, laboratory testing of this organism would reveal which of the following traits?

A. Not inhibited by optochin
B. Beta hemolytic
C. Bile soluble
D. Non-fermenter of glucose
E. Catalase positive

Question 157

Following a four day illness that was characterized by a high fever (up to 41 degrees Celsius) and severe muscle aches, a 29-year-old male presents to the emergency room with complaints of dyspnea with exertion, chest pain which is worse with expiration, and a productive cough. Physical examination reveals dullness to percussion on the left side of the chest. Crackles and a pleural rub are also heard at this location. A chest x-ray reveals consolidation of the left lung. A sputum culture is obtained and grows a pure sample of gram positive cocci in clusters. Of the following, laboratory testing of this organism would reveal which of the following traits?

A. Catalase negative
B. Coagulase positive
C. Alpha hemolysis
D. Non-fermenter of glucose

Question 158

A 73-year-old male with the history of a stroke 2 years ago that left him with residual motor difficulties in eating is brought to the emergency room by his family because over the past three weeks he had developed a productive cough with foul-smelling sputum. In addition, he has lost about 10 lb. and has an intermittent fever (although his temperature wasn’t taken). He has no history of tobacco use. A chest x-ray reveals an infiltrate in the lower lobe of the right lung. Of the following, what is the most likely diagnosis?

A. Community acquired bacterial pneumonia
B. Community acquired viral pneumonia
C. Aspiration pneumonia
D. Mycobacterium tuberculosis
E. Necrotic pulmonary neoplasm

Questions 153-155: Lung pathology

Question 153

A 29-year-old female presents to an acute care clinic with complaints of a productive cough and fever to 38.6 degrees Celsius for the past 4 days. Physical examination reveals dullness to percussion on the lower left side of the chest and crackles are heard at this location. A chest x-ray reveals consolidation of the lower lobe of the left lung. A sputum culture grows Streptococcus pneumoniae. Of the following, which is the most responsible for the physical examination findings?

A. Collapse of alveoli
B. Proteinaceous exudate on alveolar septae
C. Bacterial overgrowth
D. Lymphocytic infiltration of alveolar septae
E. Neutrophilic infiltration of alveolar airspaces

Question 154

A 34-year-old male presents to an acute care clinic with complaints of a productive cough and fever to 38.4 degrees Celsius for the past 3 days, associated with shaking chills and some chest pain when he breaths. Physical examination reveals dullness to percussion on the left side of the chest. Crackles and a pleural rub are also heard at this location. A chest x-ray reveals consolidation of the left lung. Of the following, if untreated, which complication is he most likely to develop?

A. Bronchogenic carcinoma
B. Amyloidosis
C. Fibrosis in the left pleural cavity
D. Alzheimer disease
E. Aortic dissection

Question 155

A 26-year-old male presents to the hospital with complaints of difficulty breathing, which has severely worsened over the past day. In the five days prior, he has had a fever, productive cough, and chills. In addition, his chest has hurt when he breathed in and with exertion he was short of breath. His friends told him to come to the emergency room two days ago, but he thought that he could wait it out. He has a temperature of 101 degrees Fahrenheit, heart rate of 108 bpm, blood pressure of 105/71 mmHg, and respiratory rate of 28 breaths per minute. Physical examination reveals dullness to percussion on the left side of the chest, accompanied by decreased breath sounds, and an absence of tactile fremitus. Of the following, what is the most likely diagnosis?

A. Pulmonary thromboembolus
B. Congestive heart failure associated with bicuspid aortic valve
C. Tension pneumothorax due to ruptured bleb
D. Empyema
E. Aspiration pneumonia with abscess formation

Questions 150-152: Lung pathology

Question 150

A 27-year-old male, who is a college instructor, presents to an acute care clinic with complaints of a productive cough for 3 days, a fever, and occasional difficulty breathing with exertion. He has no significant past medical history and does not smoke. A chest x-ray reveals consolidation of the lower lobe of the right lung. Of the following, what is the most likely etiology for his clinical presentation?

A. Bacterial infection
B. Parasitic infection
C. Mycobacterial infection
D. Aspiration
E. Neoplasm

Question 151

A 33-year-old female, who is a nurse at the hospital, presents to an acute care clinic with complaints of a productive cough for 2 days associated with shaking chills. She also reports a fever of 38.5 degrees Celsius. She has no significant past medical history and does not smoke. Her heart rate is 105 bpm, her respiratory rate is 26 breaths per minute, and her blood pressure is 82/61 mmHg, which is lower than normal for her. A chest x-ray reveals consolidation of the lower lobe of the left lung. A blood culture is positive. Of the following, which condition in her past medical history would represent the most important risk factor for her current presenting condition?

A. Fracture of the left tibia three years ago while skiing
B. Remote splenectomy after abdominal trauma
C. Head injury following rock climbing fall
D. Past episode of deep venous thrombosis
E. History of acute rheumatic fever

Question 152

A 24-year-old male who has smoked since he was 14 years old but has no other past medical history presents to an acute care clinic in July with complaints of a productive cough and fever to 38.4 degrees Celsius for the past 4 days. Physical examination reveals dullness to percussion on the lower left side of the chest and crackles are heard at this location. Of the following, what is the most likely diagnosis?

A. Community-acquired pneumonia
B. Chronic bronchitis
C. Pulmonary thromboembolus
D. Bronchogenic carcinoma
E. Aspiration pneumonia