63 year old lady, smokes a pack of cigarettes per day for the last 30 years. She had an accident a week back during which a chest CT done showed a single 1.8 cm spiculated mass in the right upper lobe of lung. CXR done a year back is normal. Next step in management?
A75-year-old woman on the second postoperative day has fever of 38.8°C (102°F) and is responsive to only sternal rub. BP is 85/45 mm Hg, pulse is 110/min, respiratory rate is 20/min, SpO2 is 97% on 4 L oxygen. Rales heard on inspiration. Her extremities are warm. Creatinine is 2.4mg/dl Cause of the patient’s shortness of breath?
A 44-year-old woman lost 20 pounds in the past 6 months. She has a history of intravenous heroin use and heavy alcohol use. She smoked a half a pack of cigarettes daily for 12 years but quit 10 years ago. Diagnostic thoracentesis shows: LDH is greater than two-thirds the upper limit of normal for the serum, LDH ratio is >0.6, Pleural WBC is elevated; 77% lymphocytes, Pleural fluid adenosine deaminase is elevated. Cause of the effusion?
A 49-year-old man presents with a chronic low-grade fever, night sweats, weight loss, and productive cough with occasional hemoptysis. He was diagnosed with HIV 10 months ago. CD4 count is 550/microL and a viral load is 100 copies/mL. A PPD skin test reveals 6 mm of induration. Chest X-ray shows upper lobe opacities in the apex of the right lung. Acid-fast staining of a sputum sample is positive. What is the appropriate treatment?
A 54-year-old has a 2-day history of shortness of breath with productive cough, fever, and mild chest pain when taking in a deep breath. Temperature is 38.1°C (100.6°F), rest of the vitals are unremarkable. Chest X-ray shows unilateral pleural effusion. Which of the following physical examination findings is most likely present?
A 70-year-old man has progressive shortness of breath, productive cough, and unintentional weight loss of 3 kg over several months. He has worked underground within the New York City subway system for the past 20 years. Physical examination is significant for mild wheezing in the lungs bilaterally. Lungs are hyperresonant to percussion. Spirometry demonstrates an FEV1:FVC ratio of 0.5 and an FEV1 that is 60% of expected. Which of the following is the most likely underlying diagnosis?
A 49-year-old woman has a productive, blood-tinged cough for 2 months associated with weight loss. She returned to the United States 1 month ago after a year-long stay in Indonesia. Temperature is 40.1°C (104.2°F). X-ray of the chest shows upper lobe cavitary lesions. Sputum acid-fast bacillus smear is positive. She has started on rifampin, isoniazid, pyrazinamide, and ethambutol therapy. Which of the following studies is most appropriate to obtain monthly to monitor?
A 64-year-old homeless man is found on the street gasping for air. Bystanders report that he got in the chest while driving his car. His pulse is 110/min, respirations are 38/min. There are diffuse crackles in both lung fields. Pulse oximetry shows an oxygen saturation of 84% and falling that does not improve with supplemental oxygen, and blood gas analysis shows a pH of 7.51, pO2 of 65 mm Hg, and pCO2 of 31 mm Hg. X-ray of the chest shows bilateral patchy infiltrates. BNP is normal. What is the most likely diagnosis?
A 39-year-old man has severe shortness of breath and gasping for air. He has had constant severe abdominal pain in the epigastric region for 3 days. He consumes alcohol regularly, with weekend binge drinking. Temperature is 101.3 F, pulse is 118/min, respirations are 32/min, BP is 86/42 mm Hg, and SpO2 is 83%. Auscultation shows rales in both lung fields. Abdominal examination shows diffuse tenderness to palpation with guarding. chest X-ray shows bilateral opacities. What is the underlying cause?
A 29-year-old man complains of a mild nonproductive cough. HIV test is positive and his CD4+ cell count is 186/mm³. X-ray of the chest shows diffuse bilateral interstitial infiltrates with a ground glass appearance. Next diagnostic step?
80-year-old woman with a history of recurrent UTI secondary to an indwelling Foley catheter. Urinalysis is positive for leukocyte esterase and nitrites. After 24 hours she develops worsening dyspnea. the temperature is now 37.3°C (99.1°F), pulse is 130/min, respirations are 28/min, blood pressure is 78/45 mm Hg, and SpO2 is 78% of room air. new rales in all lung fields. The jugular venous pressure is not elevated. Chest x-ray shows bilateral opacification. What is diagnosis?
A 40-year-old African-American woman has a 3-month history of chest pain, coughing, and shortness of breath. A plain x-ray shows bilateral hilar lymphadenopathy and interstitial infiltrates . PPD test is negative, but her serum angiotensin-converting enzyme level is elevated. Appropriate therapy is initiated. What is the adverse effect of the prescribed medication?
A 49-year-old man experiencing prolonged seizures causing increased confusion. He had been drinking one pint of “moonshine” a day however, he recently stopped consuming alcohol. respirations are 10/min, and BP is 142/90 mm Hg. He is intubated and mechanically ventilated. Twenty minutes later, arterial blood gas analyses reveal respiratory acidosis: pO2 is 75mmHg, pCO2 is 55mmHg. Next step in the management?
A 45-year-old woman has a cough and worsening shortness of breath. She has a history of Sjögren syndrome. On pulmonary examination, she has crackles in the bilateral lower lobes, no lower-extremity edema. A CT scan of the chest shows bilateral lower-lobe ground-glass opacities, nodules, and thin-walled cysts. A lung biopsy shows lymphocytes, plasma cells, and non-necrotizing granulomas with giant cells. What is diagnosis?
A 37-year-old woman presents with a 3-day history of a fever, cough, and night sweats, and diffuse joint pains. She returned from Arizona approximately 1 month prior. Rash is present on her arms and hands. What is a frequent site of an extrapulmonary manifestation of coccidioidomycosis?
A 41-year-old man has a 4-month history of facial pain, nasal congestion with intermittent nasal discharge, and diminished sense of smell. Physical examination shows tenderness to percussion over both maxillary sinuses, and on nasal endoscopic examination, the region of the middle meatus is edematous, with thick purulent drainage. Next step in management?
A 21-year-old college student with 5 years history of asthma presents with increasingly frequent episodes of shortness of breath. Compared to previous experienced symptoms she is experiencing more coughing and feeling chest tightness three to four times a week during the day and two to three times a month at night. Her symptoms are generally relieved by an albuterol inhaler. Next step in management?
A 66-year-old man presents with feeling fatigued and out of breath after walking up one flight of stairs and a persistent productive cough. He has smoked one pack of cigarettes per day for the past 40 years. Chest auscultation shows a prolonged expiratory phase and wheezing. Which set of pulmonary function test results is this patient likely to have?
A 67-year-old woman comes because of a 6-month history of intermittent, nonproductive cough throughout the day and 6.8 kg weight loss. She smoked for 4 years in her twenties but has not smoked any tobacco in over 40 years. She takes ibuprofen and acetaminophen for lower back pain. X-ray of the chest reveals a 2.8-cm mass in the periphery of the right upper lung. What is diagnosis?
A 34-year-old man comes for monthly follow-up during latent tuberculosis treatment. He feels nauseous most days and has decreased appetite since his last visit. He drinks one to two alcoholic drinks per day. He has tenderness on palpation of the epigastric area and right upper quadrant. Laboratory studies show elevated transaminases which were within normal ranges prior to initiation of therapy. Which of the following factors most increased the risk for developing this condition?
A 46-year-old Turkish immigrant presents with progressive shortness of breath worse on lying supine and nonproductive cough. On cardiac auscultation, low-pitched diastolic rumble is heard at the cardiac apex. Rales and rhonchi are heard on inspiration in both lung fields. ECG shows atrial fibrillation. Laboratory results revealed normal TSH, Troponin I and D-dimer .What is the most likely cause of shortness of breath?
A 24-year-old man had a car accident. The next day, he develops dyspnea, at which time his respirations are 35/min, oxygen saturation is 94% on 40% supplemental oxygen, pulse is 110/min, and blood pressure is 95/58 mm Hg. Examination of the lungs reveals inspiratory crackles and arterial blood gas analysis reveals respiratory alkalosis with a low pO2. chest x-ray shows bilateral opacities. What is the cause of his condition?
A 5-year-old immigrant boy has progressive difficulty in breathing. He has no asthma. He did not receive regular medical care prior. He has mild intercostal retractions, and inspiratory stridor is heard on lung examination. His temperature is 39.4°C (103°F), pulse is 119/min, respirations are 28/min, and oxygen saturation is 93%. What would have most likely prevented this condition?
A 21-year-old man presents with a sudden onset of shortness of breath and right-sided chest pain. He has smoked three packs of cigarettes per day for the past 10 years. He is a tall, thin male, respirations are 26/min. X-ray of the chest shows a large right-sided pneumothorax.Which features would be expected on physical examination?
A 69-year-old man has fatigue, loss of appetite, and a cough for 1 week. He reports a 4.5-kg (10-lb) weight loss over the past 2 months. He had a 50-pack-year history of smoking. An x-ray of the chest showed a 3.5-cm mass in the right lobe of the lung and widening of the mediastinum. A CT scan shows a right middle lobe mass close to the right mainstem bronchus and multiple enlarged lymph nodes around both bronchi. Next best test?
A 33-year-old male who recently immigrated from Mexico presents t with a history of a chronic nonproductive cough, fevers associated with night sweats. The patient appears to be cachectic and has bilateral clubbing. Respiratory examination reveals bilateral rales and bronchial breath sounds throughout lung fields. An x-ray of the chest shows diffuse pulmonary nodules. What is the most likely microorganism causing symptoms?
A 10-year-old girl with mild persistent asthma was started on albuterol inhaler as needed and fluticasone inhaler. She has reported no relief with the given medication. Her pulmonary function tests show FEV1:FVC = 68%. A methacholine challenge test is positive. Next step in management?
A 57-year-old man has reduced exercise tolerance. He works as a high school teacher but worked as a welder 20 years ago. X-ray shows pleural plaques and CT of the chest reveals fibrotic cystic changes. Bronchoalveolar lavage is positive for two asbestos bodies/ml. Which of the following findings on pulmonary function testing is most likely?
A 48-year-old woman presents with cough, hemoptysis, and wheezing and history of poorly controlled hypertension. She also has a history of asthma, somewhat controlled with albuterol and fluticasone/salmeterol; she is using his rescue inhaler more often despite being on this treatment. She also has occasional diarrhea and feeling flush, which has become more noticeable over the last 1 to 2 months. She does not smoke, blood pressure is 174/88 mm Hg. A CT scan of the chest shows a left upper lobe endobronchial lesion with associated atelectasis. What is diagnosis?
A 36-year-old HIV-positive man was recently hospitalized for a lung infection. He does remember the doctor telling him his lungs looked really bad on both sides on an x-ray. Which of the following immunizations is contraindicated in this patient at this time
A 21-year-old man develops shortness of breath and right-sided pleuritic chest pain. He has smoked 1 pack of cigarettes per day for the past 3 years. He also admits to IV drug use. heart rate is 103/min, respiratory rate is 24/min and oxygen saturation is 92% on room air. He is 75 inches tall and his BMI is 19 kg/m2. No breath sounds are appreciated on the patient’s right side and hyperresonance to percussion is noted on the right. What is the underlying cause of the current presentation?
A 69-year-old man has 6 months of productive cough with bloody sputum and a 11.3-kg (25-lb) unintentional weight loss with increasingly lethargic. He has smoked two packs of cigarettes per day for the past 50 years. His serum Na+: 125 mEq/L, Urine osmolality: 515 mOsm/kg Urinary Na+: 55 mEq/L X-ray of the chest shows a focal 5-cm perihilar mass lesion in the right lower lung that is corroborated by CT scan. What is the most likely diagnosis?
A 38-year-old woman with a past medical history of allergic rhinitis and gastroesophageal reflux has dyspnea, cough and sharp left-sided chest pain worsened by cough and deep inspiration for several months. Her medications include omeprazole, loratadine. Examination is notable erythematous tender nodules over the bilateral anterior tibial regions. What is the next step?
A 54-year-old man presented with a gradual onset of dyspnea on exertion and a dry cough. He has a 20-pack-year smoking history. ABG values are pH of 7.42, pCO2 is 42, and pO2 59. PFT reveals decreased total lung capacity. Carbon monoxide diffusion in the lungs is 50% of predicted value. A high-resolution CT scan of the chest demonstrates diffuse ground-glass opacities with some cystic changes. Lung biopsy reveals intraluminal macrophages with light brown pigmentation. What is the diagnosis?
An HIV-positive 38-year-old man has fatigue, cough, and night sweats. His recent travel history includes a trip to Arizona. His current CD4+ cell count is 46/mm³ and his viral load is 54,000/mL. CT scan of the chest shows diffuse bilateral nodular opacities. What is treatment?
A 71-year-old man presents with a 2-year history of stable exertional dyspnea. He worked in naval shipyards for 50 years, retiring 10 years ago. He has never smoked Lungs that are clear to auscultation. Pulmonary function testing results show reduced FEV1 and FVC with normal FEV1/FVC ratio. What is the most likely diagnosis?
A 44-year-old woman has nasal congestion and rhinorrhea of 18 months’ duration and is not associated with fever, facial pain, sneezing, itchy/watery eyes, or watery rhinorrhea. Her symptoms seem to worsen with weather changes, spicy foods, and strong odors. Nasal speculum examination reveals minimal erythema and edema of the turbinates bilaterally. Initial step in management?
A 19-year-old girl was hospitalized 1 month ago for suspected asthma exacerbation. She is currently taking albuterol inhaler once a week at the most and low-dose fluticasone daily. Medical history is significant for allergic rhinitis treated by over-the-counter antihistamines. Family history is significant for asthma in her mother. Spirometry shows improvements in FEV1 and FEV1:FVC ratio post bronchodilator. Next step in management?
A 74-year-old man presents with a history of exertional shortness of breath. He worked as a miner for fibers used in the insulation industry for 40 years, retiring 15 years ago. He denies any smoking history. A chest radiograph shows linear opacities at the lung bases and pleural plaques. A specimen from a bronchoalveolar lavage shows ferruginous body. What is diagnosis?
A 39-year-old woman comes with acute-onset chest pain and shortness of breath. Skin examination shows innumerable dome-shaped, skin-colored papules on his head, neck, and upper chest. The remainder of the examination is normal. X-ray of the chest shows a large left-sided pneumothorax. CT of the chest shows bilateral lower lobe, predominantly subpleural cysts that vary in size and shape. What is the most likely diagnosis?
A 45-year-old man comes with a 16-month history of facial pain described as “sinus pressure,” fatigue, and nasal discharge for which he has been taking antihistamines, intranasal steroid sprays, antibiotics with only brief improvement of symptoms. Physical examination shows nasal congestion with turbinate swelling; scant, thick nasal discharge; and mild tenderness over her maxilla bilaterally. Next step is?
A 45-year-old woman has fever, productive cough, dyspnea, and pleuritic chest pain. started suddenly last night. Her temperature is 38.5°C (101.3°F), RR is 22/min, and BP is 120/70 mm Hg. chest X-ray demonstrates a confluent left lower lobe. A sputum sample shows gram-positive diplococci bacteria in chains. What is most appropriate treatment?
A 33-year-old man presented with low-grade fever, chills, cough, and fatigue for 3 weeks. He has a history of Crohn disease, which is currently in remission with the use of chronic immunosuppressive therapy. X-ray of the chest reveals focal infiltrates and hilar lymphadenopathy. A Ziehl-Neelsen stain of his sputum sample shows red, acid-fast bacilli. What is infectious agent?
A 36-year-old farmer has persistent fever and cough for the past 2 weeks. He has not traveled outside of Mississippi in over 2 years. Respiratory examination reveals reduced breath sounds in all lung fields. X-ray of the chest shows patchy opacities on both lung fields. Fungal culture on Sabouraud agar at 25°C yields nonencapsulated mycelial forms and spores. Blood agar culture at 37°C yields yeast forms. What is most likely microorganisms?
A 38-year-old woman with a lung mass in the left lower lobe, recent onset of cough, no smoking history, and a 3.5-cm spiculated noncalcified mass on CT scan. What is the most likely diagnosis?
39-year-old woman with sarcoidosis for which taking steroid who presents with worsening hemoptysis, tachypnea, and a round pneumonic lesion in a pre-existent lung cavity on chest X-ray, despite a negative Purified Protein Derivative (PPD) testis. What is likely diagnosis?
A 75-year-old man presenting with difficulty breathing, cough, pink, frothy sputum, atrial fibrillation, hypertension, hyperlipidemia, aortic stenosis for which he is on medications include rosuvastatin, atenolol, warfarin. he admits he has been poorly compliant with medications. chest X-ray shows blunting of the costophrenic angles. pleural fluid analysis shows Protein: 2.9 g/dL LDH: 57 U/L and serum LDH: 125 U/L? What is the most likely etiology of the pleural effusion?
A 65-year-old man with a persistent productive cough, breathlessness, decreased breath sounds, prolonged expiratory phase, and a history of smoking and worked in coal mining. PFT reveal an FEV1 75% of predicted without significant bronchodilator reversibility and FEV1:FVC ratio of 60% with an increased vital capacity and reduced diffusion DLCO. What will be chest x-ray finding?
A 35-year-old woman presents to her physician with low-grade fevers and pain in both of her knees and ankles. On physical examination, she has notable bilateral parotid swelling, and over her shins there are tender red papules. Her knees and ankles appear swollen with a palpable fluid shift. Sr Calcium: 11.6 mg/dL. WBC: 3100/mm3 What is initial pharmacotherapy?
A 73-year-old man has progressive shortness of breath and chest discomfort. He worked as a shipbuilder for 35 years. Physical examination reveals clubbing of the fingers and scattered rales. X-ray of the chest shows calcified pleural plaques and interstitial fibrosis. What is diagnosis?
A 84-year-old man presents with hemoptysis, 4.5- to 6.8-kg weight loss. He has 40-pack-year smoking history. X-ray of the chest reveals a 3x4-cm 2x3-cm central mass in the right lung which is re-demonstrated on chest CT. On biopsy, large, irregular nuclei and coarse nuclear chromatin with large nuclei are seen with intercellular bridges. What is the paraneoplastic syndrome associated with the type of cancer?
A 67-year-old woman is hospitalized for an exacerbation of asthma where she is intubated for low oxygen. After 3 days, examination discloses coarse rhonchi at the base of the lung fields bilaterally. She is producing purulent sputum that grows many oxidase-positive gram-negative rods on culture. Next step in therapy?
A 77-year-old man suddenly develops dyspnea and right-sided chest pain 30 minutes ago while walking. His medical history is significant for COPD and has 10-pack-year smoking history. pulse is 116/min, respirations are 26/min and shallow, X-ray of the chest shows pneumothorax on right side. What is the pathogenesis of condition?
A 45-year-old woman presents with sharp right-sided chest pain, nonproductive cough with some blood and shortness of breath. She hasn family history of antithrombin III deficiency. RR is 36/min, BPis 136/88 mm Hg with tachycardia. spiral CT shows emboli in the right pulmonary vasculature. best initial step in management?
A 71-year-old man with dyspnea, cough with blood-tinged sputum, unintentional weight loss, a 50-pack-year smoking history, abdominal striae and moon facies, along with a truncal fat distribution, central lung nodule, and multiple solid hepatic masses on imaging. What is the most likely diagnosis ?
A 37-year-old African-American woman with diabetes comes with low blood sugar level (20 mg/dL), her insulin dosage had recently been adjusted due to poor control. Physical examination reveals white patches in her mouth that are easily scraped off. What is next step to manage her condition and prevent morbidity?
A 48-year-old man with history of type 2 DM without complications presented with numbness and burning sensation in both feet. Active tuberculosis was diagnosed and RIPE therapy was started one month ago. Neurologic examination revealed diminished sensation to light touch, pinprick, and vibration over the lower extremities bilaterally. sore and glossy tongue were observed. What could have most likely prevented the his neurologic symptoms?
A 56-year-old man has dyspnea, right chest pain worsens with inspiration, fatigue, fever, and occasional blood-tinged sputum. He has a 50-pack-year smoking history. On examination, he has decreased breath sounds at the right lung base with dullness to percussion; CT of the chest shows a fluid collection in the right lung base and a spiculated mass at the right hilum. Pleural fluid analysis revealed tubid fluid with lypmocytosis. cause of the effusion?
A 35-year-old man complains of right-sided chest pain and shortness of breath after fall. His vitals are unstable with hypotension, shallow respirations, no breath sounds on the right side. Palpation over the right supraclavicular area produces a crackling sound and jugular venous distention and tracheal deviation are noted. next step in management?
A 70-year-old has gradual onset shortness of breath and dry cough. He has smoked one pack of cigarettes per day for the past 3 years. He was a plumber for most of his Examination reveals end-inspiratory rales and digital clubbing. X-ray of the chest shows multiple calcified pleural plaques. What will prevent complications in this patient?
A 65-year-old man with COPD develops acute shortness of breath and a productive cough, fever, tachypnea. X-ray of the chest shows bilateral infiltrates and a small left-sided pleural effusion, he is on appropriate antibiotics. pO2/FiO2 ratio is 120. next step in management?
An 8-year-old girl has acute shortness of breath, wheezing, and history of eczema, she has received nebulized albuterol and IV methylprednisolone for respiratory distress with minimal improvement in symptoms and SpO2 of 95% on supplemental oxygen. Next step in management?
A 65-year-old man presented with muscle weakness noted in simple tasks, like combing his hair or rising from a chair which improves with repetitive actions, dry mouth, poor appetite, unintentional weight loss, nonproductive cough, a history of smoking, and imaging showing a right upper lobe mass with enlarged bilateral mediastinal lymph nodes. What is diagnosis?
A 56-year-old woman presents with sudden, sharp pain right sided chest pain, difficulty breathing. She had a 13-hour flight from China. Physical examination is significant for an accentuated pulmonic component of S2 and elevated JVD. X-ray of the chest shows no obvious abnormalities. CT-PE shows filling defects in the pulmonary vasculature, next step is management?
A 31-year-old smoker with HIV (last CD4+ cell count was 124/mm³)complains of persistent nonproductive cough and occasional shortness of breath. temperature is 39.4°C (103°F), respiratory rate is 24/min, oxygen saturation is 86% on room air, X-ray of the chest reveals diffuse bilateral radiopacities with minimal infiltrates. What is the most likely diagnosis?
A 42-year-old woman presented with acute-onset shortness of breath, chest pain, large left-sided pneumothorax, persistent air leak from the chest tube, and a CT scan showing a diffuse symmetric thin-walled cyst without nodules in the chest, along with an incidental finding of a renal angiomyolipoma and serum vascular endothelial growth factor-D is 972 pg/mL. What is the most likely diagnosis?
A 32-year-old African-American nurse works in a prison presented with difficulty breathing, dyspnea at rest, dry cough, fatigue, malaise, weight loss, fever, and chest x-ray showing bilaterally enlarged hilar nodes and lung nodules, with lung biopsy results consistent with noncaseating granulomas. What is the most appropriate treatment?
A 40-year-old man with HIV infection and a CD4+ cell count of 54/mm³ has nonproductive cough, fever, and exertional dyspnea. His temperature is 38°C, respiratory rate is 24/min, and pulse is 120/min.. Chest x-ray shows diffuse ground glass, interstitial infiltrates throughout both lungs. the most appropriate pharmacotherapy?
32-year-old man presented with chest pain, shortness of breath, low-grade fevers, cough. He has been a sex worker for the last 10 years and uses condoms inconsistently. Chest x-ray shows evidence of a left-sided pneumothorax. labs revealed decreased white blood cell count and an elevated lactate dehydrogenase. What is the most likely immediate cause?
A 35-year-old woman with fever, facial pain, epistaxis, confusion, blood-tinged purulent nasal discharge, and nasal biopsy showing necrotic tissue in the edematous nasal turbinates and septum. nasal biopsy showing necrotic tissue with branching, septated hyphae. She has been on s immunosuppressive regimen for liver transplant 4 months ago due sclerosing cholangitis. initial step in the management?
A 50-year-old woman develops dyspnea on the second day of admission after a head-on motor vehicle collision, which initially showed multiple rib fractures but normal lung parenchyma on X-ray but repeat x-ray shows opacification of the right lung. What is the most likely underlying cause?
69-year-old man has a long history of snoring, fatigue, daytime sleepiness, and progressive shortness of breath, along with elevated pulmonary artery pressure and right axis deviation on ECG, right heart catheterization reveals an elevated pulmonary artery pressure and a normal pulmonary capillary wedge pressure. If the condition of is left untreated, what is most likely to develop?
A 29-year-old African-American woman presents with syncope, right-sided parotid swelling, nonproductive cough, red, thickened papules on her back, and ECG findings consistent with a second-degree heart block, Mobitz type I, along with laboratory results indicating elevated calcium levels. What is associated with this disease?
A 65-year-old man presents with a recurrent cough with sputum in the morning that becomes dry by the evening, wheezing, shortness of breath during exercise. He has a chronic smoking history and works at a nuclear power plant. What is the most appropriate intervention?
A 23-year-old man presented with sudden-onset right-sided pleuritic chest pain, slightly diminished breath sounds on the right side, and a 2-cm pneumothorax on the right seen on chest X-ray. next step in the management?
A 67-year-old woman presented with severe left leg pain worsened by walking and standing, clubbing, unintentional weight loss, nonproductive cough, and tenderness on palpation of the distal left tibia. Imaging shows a focal 5-cm mass in the periphery of the left lower lung, with a CT scan demonstrating a 5.2-cm mass and a transthoracic needle biopsy of mass showed invasive neoplastic cells. What is the most likely diagnosis?
A 25-year-old African-American woman presented with fatigue, blurred vision, inability to move the right side of her face, pain, drooling, tearing, hypersensitivity to sound in the right ear, and a dry cough. X-ray of the chest shows bilateral hilar lymphadenopathy and laboratory findings showing elevated calcium levels. What is the most likely diagnosis?
A 39-year-old man has low-grade fever, loss of appetite, malaise, weight loss, bilateral lung field crackles, right upper quadrant tenderness, pale, yellowish lesions close to the optic disc, reticulonodular infiltrates on chest X-ray, and a positive purified protein derivative test. What is the most likely diagnosis?
A 49-year-old woman with sickle cell disease pressented with painful swallowing. Diagnose with HIV with a CD4+ cell count of 200/mm³, she responded to treatment with nystatin. What is the best way to prevent recurrence oral thrush?
A 34-year-old man presented with "cold" symptoms of congestion and rhinorrhea that progressed to facial pain and headache exacerbated when bending over, along with thick, foul-smelling rhinorrhea and mild tenderness over the right maxilla on physical examination. Temperature is 39.3°C (102.7°F). What is the most likely diagnosis?
A 65-year-old woman with a history of congestive heart failure, chronic obstructive pulmonary disease, and hypertension, presents to the emergency department with cough and shortness of breath at rest, along with coarse rales over both lung fields and expiratory wheezing in the lower lung fields, 2+ bilateral lower extremity pitting edema on examination. BNP level is elevated. Chest X-ray shows vascular congestion and an enlarged cardiac silhouette.What is appropriate therapy to relieve the symptoms?
A 20-year-old man with a 2-week history of mild cough, weight loss, low-grade fevers, and night sweats, who lives in Tennessee, explores caves on weekends, and has a positive urine antigen test for the causative agent. What is the most appropriate treatment?
A 50-year-old man has worsening daytime sleepiness. He weighs 110.2 kg (243 lb); BMI is 35 kg/m2,BP is 145/92 mm Hg. His polysomnography results shows an AHI of 33, with an obstructive apnea index of 21, central apnea index of 2, and hypopnea index of 10. What is the patient at greatest risk for if his condition remains untreated?
A 35-year-old man with complaints of cough, sweating for 2 weeks. He was released from prison 1 month ago. chest x-ray showing a cavity in the left lung apex, and the Ziehl-Neelsen staining results shows red, rod-shaped acid-fast bacilli. What is the most likely complication of adding the prescribed medications for the patient's infection?
A 76-year-old man presented with a chronic cough productive of clear sputum, worsening shortness of breath. He has a 50-pack-year smoking history. Physical examination shows hyperresonance to percussion of lungs bilaterally with scattered wheeze on auscultation. An x-ray shows hyperinflated lungs and a flattened diaphragm. Which of the following values is likely to be decreased?
A 27-year-old woman presents with nonproductive cough and fatigue, pain and stiffness of her bilateral wrists and hands. Physical examination reveals mild tenderness to the bilateral metacarpophalangeal joints. A few tender erythematous nodules are noted over the anterior tibial regions. A nontender spleen is palpated 6 cm below the left costal margin. X-ray of the chest showed bilateral hilar lymphadenopathy and diffuse pulmonary infiltrates. Her serum calcium elevated to 12. What is diagnosis? Options
A 33-year-old African-American woman presents with complaints of cough, shortness of breath, abdominal pain, frequent urination and depressed mood for several weeks, weight loss. Her abdomen is mildly tender to palpation. Several erythematous tender nodular lesions on the patient’s arms and legs are noted.What is diagnosis?
A 29-year-old archaeologist presents with a nonproductive cough, weight loss, low-grade fevers, and night sweats over the past 3 weeks. She had contact with bat droppings on a recent trip to the Tennessee caves. On examination, tender nodular lesions over both lower extremities. X-ray of the chest revealed focal mid-lung-field infiltrates. A polysaccharide antigen detection test was positive. What is the most likely pathogen?
A 58-year-old woman with diabetes found unresponsive. She has had fever, stuffy and runny nose with blood, sinus pain, and headache for the past 2 days. Her temperature is 39.4°C (103°F), vitals are unsatble. Urinalysis is positive for glucose and ketones. Examination of the nasopharynx reveals necrotic turbinates and palatal eschars. Staining of a mucus specimen with methenamine silver reveals broad, nonseptate hyphae with right-angle branching. What is pharmacologic treatment for this patient?
A 32-year-old man with a stab wound to the left chest presdnted with respiratory distress. On examination, his trachea is deviated to the right, jugular veins are distended bilaterally, absent breath sounds and hyperresonance to percussion on the left side, subcutaneous emphysema were observed. next step in management?
A 77-year-old woman presented with a dry cough and an unintentional weight loss of 6.8 kg (15 lb) over the past 8 months. She has never smoked. A CT scan shows solitary pulmonary nodule What is the most likely diagnosis?
A 35-year-old woman presented with 2-month history of nonproductive cough. The cough is worse at night and with exposure to cold air. She has occasional chest tightness and occasional wheezing, usually worse at night, early in the morning, or after exercise. BMI is 33.8 kg/m2. On examination the patient has bilateral wheezing and a prolonged expiratory phase.What is diagnosis?
A 35-year-old man with shortness of breath, wheezing during exercise, and a history of childhood inhaler use, who has a history of smoking, and shows pulmonary function testing results showed improvement of postbronchodilator FEV1/FVC ratio and FEV1values. What is the most likely diagnosis?
A 60-year-old man presented with fever, productive cough, and left-sided chest pain, he has decreased breath sounds and rales on lung auscultation, and has pleural fluid analysis showing an exudative effusion with a pH of 7.31 and LDH of 400 U/L, Glucose: 71 mg/dL an Gram stain and culture is negative, next step in management?
A 49-year-old granite quarry worker from 30 years reported persistent cough in yearly employee physical. Screening x-ray of the chest reveals a 1.5-cm (0.6-in) subpleural parenchymal lesion in the lateral aspect of the right lung, as well as enlarged hilar nodes, eggshell hilar calcifications, and multiple small nodules scattered throughout the upper lung fields. Acid-fast stain of sputum is positive for acid-fast bacilli. Exposure to which of the following substances made the patient susceptible to the infection?
