Internal-Medicine

Questions: 27–37 245
100% oxygen indicates which of the following
problems?
(A)
(B)
(C)
(D)
(E)
ventilation-perfusion ratio inequality
right-to-left shunt
hypoventilation
impaired diffusion
interstitial lung disease
33. A 31-year-old man with severe kyphoscoliosis
due to cerebral palsy is experiencing worsening
shortness of breath with exertion. On examination,
he has a severe scoliosis to the left and
decreased air entry to that side. His right lung
is clear, JVP is 3 cm, and heart sounds are
normal. Pulmonary function tests are performed.
Which of the following is the most
likely abnormality to be seen on the pulmonary
function tests?
(A) increased total lung capacity (TLC)
(B) increased functional residual capacity
(FRC)
(C) decreased TLC
(D) increased compliance
(E) increased vital capacity (VC)
34. A 67-year-old woman has pulmonary function
tests performed to evaluate symptoms of dyspnea.
The most prominent finding is a reduction
of the ratio of FEV1/FVC. Which of the
following is the most likely diagnosis?
(A)
(B)
(C)
(D)
(E)
COPD
ankylosing spondylitis
pickwickian syndrome
scleroderma of the chest wall
lobar pneumonia
35. Which of the following statements concerning
asbestosis is correct?
(A)
(B)
(C)
the type of asbestos fiber is crucial in
determining whether asbestos-related
lung disease occurs
moderate rather than severe obstruction
to airflow is characteristic of asbestosis
mesothelioma is the common malignancy
associated with asbestosis
(D)
(E)
pleural effusions are invariably associated
with malignancy in asbestosis
short-term (i.e., 1–2 years) exposure can
result in serious sequelae decades later
36. A 52-year-old man develops sudden-onset
shortness of breath on postoperative day 4 after
a hemicolectomy for colon cancer. His surgery
went well with no operative complications. He
reports no cough, sputum, or pleuritic chest
pain. His blood pressure is 155/90 mm Hg,
pulse 100/min, temperature 37.8°C, lungs are
clear, and heart sounds normal. He has bilateral
pedal edema, but no discomfort in his legs. His
CXR and ECG are normal. A chest CT with contrast
reveals a thrombus in his right upper lobe
artery. Which of the following statements concerning
the management of this condition is
most likely correct?
(A)
(B)
(C)
(D)
(E)
continuous IV heparin or subcutaneous
low-molecular-weight heparin (LMWH)
therapy is indicated
urgent thrombolytic therapy is indicated
urgent inferior vena cava (IVC)
filter insertion is indicated
confirmation of the diagnosis with
bilateral ultrasound leg Dopplers
37. A 55-year-old woman presents with coughing
up blood and sputum. She gives a history of
recurrent pneumonias and a chronic cough
productive of foul-smelling purulent sputum.
The sputum production is worse on lying down
and in the morning. On physical examination,
she appears chronically ill with clubbing of
the fingers. Wet inspiratory crackles are heard
at the lung bases posteriorly. There are no
hepatosplenomegaly or any palpable lymph
nodes. CXR shows scaring in the right lower
lobe, which on chest CT scan is identified as
airway dilatation, bronchial wall thickening, and
grapelike cysts. Which of the following is a recognized
precursor to this patient’s condition?
(A)
(B)
(C)
(D)
(E)
bronchial asthma
cigarette smoking
lung infection and impairment of drainage
lung cancer
silicosis