NMS Q&A Family Medicine

Pneumonia and Bronchitides 81(C) Congestive heart failure (CHF)(D) COPD(E) AsthmaUnless instructed otherwise, choose the ONE lettered answeror completion that is BEST in each case.14 A 25-year-old man who was previously healthy has arapid onset (over 10 hours, starting during midmorning)of severe sharp, stabbing, chest pain and atemperature of 102 F when he consults you at 6 pm .He has otherwise been in good health, does notsmoke, and denies any high-risk activities for HIVacquisition. He has no allergies. Physical examinationreveals a temperature of 102 F, a pulse of 110, and ablood pressure of 124/82. He appears to be in greatdistress, being both toxic and in much pain with eachinspiration. Chest examination reveals bronchophony,egophony, and dullness to percussion in the rightposterior chest. There are some “sticky” rales in thisarea also. There is no accessory muscle use, clubbing,or cyanosis, but there is definite splinting of the rightlung field with inspiration. A sputum Gram stainreveals gram-positive diplococci. Chest x-ray revealsa right lower lobe infiltrate. Which of the followingtherapeutic intervention is likely to benefit thispatient the most?(A) Penicillin(B) Trimethoprim/sulfamethoxazole(C) Postural drainage(D) Tetracycline(E) Cefadroxil15 A 19-year-old male college student has experienced agradual onset of a dry cough over a period of 1 week.He complains of headache. The white blood cellcount is 11,500 with normal differential except forthree band forms. Chest examination is negative forrales (“crackles”) and percussible dullness. The chestx-ray shows patchy bronchopneumonic infiltrates.Which of the following is the most likely cause of thiscondition?(A) S. pneumoniae(B) Klebsiella pneumoniae(C) M. pneumoniae(D) Gram-negative sepsis(E) Staphylococcus aureus16 A 65-year-old man has developed a cough with lowgradefever and comes to see you on the fourth day.He complains of headache and difficulty focusingmentally. His vital signs reveal an apparent sinus bradycardiaat 56. A complete blood count shows a lowgradeleukocytosis with an unremarkable differential;electrolytes manifest a hyponatremia at 128 mEq/L.Chest x-ray shows diffuse patchy infiltrates weightedtoward the bases. Which of the following is the mostlikely diagnosis?(A) Pneumococcal pneumonia(B) K. pneumonia(C) M. pneumonia(D) Legionella pneumonia(E) Viral pneumonia17 Which of the following scenarios would suggest alertnessto the possibility of an anaerobic organism as acause of pneumonitis?(A) Pneumonia in a long-time smoker with COPD(B) A stroke patient in the acute phase with bulbarsymptoms and dysphagia(C) A 45-year-old woman who had an influenzainfection 1 week earlier(D) A 30-year-old nonsmoker with a cough whorecently travelled to Arizona(E) A 34-year-old nonsmoker with AIDs18 In which of the following clinical situations would adetermination of alpha 1 protease inhibitor (formerlycalled alpha 1 antitrypsin) level be most appropriate?(A) There is a 75-year-old patient with severeemphysema and cor pulmonale. The person isnow home bound and on continuous O 2 withan FEV 1 of 0.9 L; the patient has markedhypoxemia, mild CO 2 retention, and a35-pack-year smoking history.(B) There is a 70-year-old male patient withincreasing shortness of breath for 10 years and a30-pack-year smoking history.(C) There is a 32-year-old patient with mildshortness of breath with heavy exertion for1 year and with a distant past history of1-pack-year smoking history.(D) There is a 48-year-old male patient with mildshortness of breath with exertion for 1 year anda 40-pack-year smoking history.(E) There is a 55-year-old patient with shortness ofbreath for 5 years who has a 20-pack-year.History of smoking, but who quit 5 years ago.Her husband smokes two packs of cigarettes perday in the house.19 Assuming no contraindications, which of the followingmedications is the first-line pharmacologic agentof choice in treating mild to moderate COPD?(A) Inhaled corticosteroids(B) Oral corticosteroids(C) Inhaled beta-agonist(D) Oral theophylline(E) Inhaled tiotropium bromide