Internal-Medicine

Questions: 5–15 241
1 second (FEV1) and forced vital capacity
(FVC) on spirometry are normal. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
chronic obstructive pulmonary disease
(COPD)
early cor pulmonale
chronic bronchitis
asthma
emphysema
11. A 58-year-old man is recently diagnosed with
bowel cancer. He now complains of vague
chest discomfort and shortness of breath. On
examination, he is unwell, blood pressure
90/50 mm Hg, pulse 110/min, respirations
26/min, and oxygen saturation 88%. His lungs
are normal on auscultation, the JVP is 8 cm,
and P 2
is loud. There is no edema or leg tenderness
on palpation. A quantitative (ELISA)
D-dimer assay is positive, ECG reveals sinus
tachycardia, and cardiac enzymes are negative.
The lung scan is read as high probability for PE.
Which of the following tests is most likely to
help in guiding emergent therapy?
(A)
(B)
(C)
(D)
(E)
echocardiogram
CT scan
venous ultrasound of the legs
contrast phlebography
pulmonary function tests
12. A 40-year-old man has a routine CXR, which
reveals a posterior mediastinal mass. Which of
the following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
lipoma
neurogenic tumor
esophageal cyst
fibroma
bronchogenic cyst
13. A 35-year-old man is evaluated for symptoms of
shortness of breath. He reports no other lung or
heart disease. He smokes half pack a day for
the past 10 years. On examination, his JVP is
2 cm, heart sounds normal, and lungs are clear.
A CXR shows hyperinflation and increased
lucency of the lung fields. A chest CT reveals
bullae and emphysematous changes, while
pulmonary function tests show an FEV1/FVC
ratio of