Internal-Medicine

240 12: Diseases of the Respiratory System
5. A 31-year-old African American man presents
with dyspnea on exertion. He also has fever
and red tender rash on his shins. Physical
examination reveals fine inspiratory crackles
in both lower lung lobes and tender erythematous
nodules on his legs. CXR shows bilateral
hilar adenopathy and reticulonodular changes
in both lungs. Transbronchial biopsy reveals
noncaseating granulomas. Which of the following
is the most appropriate next step in
management?
(A)
(B)
(C)
(D)
(E)
aspirin
isoniazid (INH) and streptomycin
steroids
nitrogen mustard
no therapy
6. A 53-year-old man with a long respiratory history
is admitted to the hospital because of
increasing shortness of breath and sputum
production. He is started on antibiotics and
inhaled bronchodilators and anticholinergic
agents. The next day he is found in his room
confused and sleepy. A PCO 2
determination
reveals severe hypercarbia (PCO 2
70 mmHg).
Which of the following explanations regarding
his elevated PCO 2
is correct?
(A) occurs only with CO 2
inhalation
(B) does not occur in obstructive lung
disease
(C) does not occur in restrictive lung
disease
(D) may worsen with oxygen
administration
(E) occurs with chronic hypocapnia
7. A 63-year-old woman is seen in the emergency
room with acute shortness of breath. There is
no history of heart or lung problems in the past.
She was recently diagnosed with breast cancer
and is undergoing active treatment. On examination,
her blood pressure is 120/80 mm Hg,
pulse 100/min, and heart and lungs are
normal. There are no clinical signs of deep
venous thrombosis (DVT). Which of the following
investigations is most likely to rule out
a pulmonary embolism (PE)?
(A)
(B)
(C)
(D)
(E)
normal CXR
normal electrocardiogram (ECG)
normal ventilation-perfusion lung scan
normal ventilation scan
normal magnetic resonance image (MRI)
8. A 40-year-old woman has been complaining of a
3-year history of increasing dyspnea and fatigue.
She has no other medical illness. Physical examination
reveals increased jugular venous pressure
(JVP) with prominent c-v wave, and a
reduced carotid pulse. Precordial examination
reveals a left parasternal lift, loud P 2
, and rightsided
S 3
and S 4
. There are no audible murmurs.
CXR reveals clear lung fields and an ECG shows
evidence of right ventricular hypertrophy.
Pulmonary function tests show a slight restrictive
pattern. Primary pulmonary hypertension is
suspected. Which of the following is the most
appropriate test to confirm the diagnosis?
(A)
(B)
(C)
(D)
(E)
open lung biopsy
pulmonary angiography
cardiac catheterization
noninvasive exercise testing
electrophysiologic testing
9. A 63-year-old man is having symptoms of shortness
of breath. As part of his workup, an arterial
blood gas is done and the PCO 2
is 60 mm Hg.
Which of the following is the most likely cause
for the elevated PCO 2
?
(A)
(B)
(C)
(D)
(E)
ventilation-perfusion ratio inequality
right-to-left shunt
impaired diffusion
hypoventilation
carbon monoxide poisoning
10. A 56-year-old man is evaluated for chronic
cough. It is present most of the time and is progressively
getting worse over the past 3 years.
With the cough he usually has white to yellow
sputum that he has to expectorate. There is no
history of wheezing, asthma, congestive heart
failure (CHF), or acid reflux disease. He currently
smokes one pack a day for the past 25 years.
On examination, his chest is clear. CXR is
normal and his forced expiratory volume in