Internal-Medicine

244 12: Diseases of the Respiratory System
27. A 23-year-old man is experiencing a flare of his
asthma. He is using his salbutamol inhaler
more frequently than usual and despite increasing
his inhaled steroids he is still short of
breath. Previously his asthma was considered
mild with no severe exacerbations requiring
oral steroids or hospitalization. With his flare,
he has recurrent episodes of bronchial obstruction,
fever, malaise, and expectoration of
brownish mucous plugs. On examination, there
is bilateral wheezing. The heart, abdomen, neurologic,
and skin exams are normal. CXR
reveals upper lobe pulmonary infiltrates; the
eosinophil count is 3000/mL, and serum precipitating
antibodies to Aspergillus are positive.
Which of the following is the most likely
diagnosis?
(A)
(B)
(C)
(D)
(E)
ascaris infestation
allergic bronchopulmonary aspergillosis
Churg-Strauss allergic granulomatosis
Löeffler’s syndrome
hypereosinophilic syndrome
28. A 34-year-old African American man presents
with mild dyspnea on exertion and joint discomfort
in his knees, wrists, and ankles. He also has a
fever and red tender rash on his shins. Physical
examination reveals hepatosplenomegaly, generalized
lymphadenopathy, and tender erythematous
nodules on his legs. CXR shows bilateral
symmetric hilar adenopathy. Which of the following
laboratory findings is not characteristic of
this condition?
following is also indicated in the management
of this condition?
(A)
(B)
(C)
(D)
(E)
meningococcal vaccination
yearly influenza vaccination
weight reduction if obese
Haemophilus influenzae B vaccination
pneumococcal vaccination
30. A 45-year-old woman has severe symptoms of
epigastric and abdominal pain after eating. A
trial of acid suppression therapy with proton
pump inhibitors (PPI) only partially improved
her symptoms. She undergoes elective outpatient
upper endoscopy, which is positive for a
small duodenal ulcer. Two hours later, she is
short of breath and complaining of severe anterior
chest pain, which is made worse with deep
inspiration. On examination, she looks unwell,
blood pressure is 150/90 mm Hg, pulse
110/min, and lungs are clear. Heart sounds are
normal but an extra “crunching” type sound is
intermittently heard. CXR demonstrates air
surrounding the heart. Which of the following
is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
acute pericarditis
acute cardiac ischemia
acute mediastinitis
aortic dissection
pneumothorax
31. Which of the following is most likely associated
with cystic fibrosis in an adult patient?
(A)
(B)
(C)
(D)
(E)
hyperglobulinemia
elevated ACE level
elevated sedimentation rate (ESR)
elevated serum calcium
normal gallium scan
(A)
(B)
(C)
(D)
(E)
spontaneous remission
good pancreatic exocrine function
hemoptysis
rectal polyps
normal sweat chloride
29. A 66-year-old man has progressive shortness of
breath due to COPD. He is currently able to
do his activities of daily living, but has trouble
walking more than one block. His physical
examination reveals hyperinflation, increased
resonance to percussion, and bilateral expiratory
wheezes. He is on appropriate medical
therapy for his stage of COPD. Which of the
32. A 55-year-old woman is in the intensive care
unit on a ventilator for hypoxemia following
“flash” pulmonary edema. Her PO 2
on the
blood gas prior to intubation was 44 mm Hg,
and now while breathing 100% oxygen on the
ventilator her repeat blood gas reveals a PO 2
of 80 mm Hg. Hypoxemia while receiving