Internal-Medicine

246 12: Diseases of the Respiratory System
38. A 50-year-old man presents with excessive daytime
sleepiness and a history of snoring. One
week ago, he fell asleep while driving his car
and got into a minor accident. On examination,
he is obese (body mass index [BMI] >30)
and his blood pressure is 160/90 mm Hg. His
lungs are clear and heart sounds are distant.
Which of the following is the most likely explanation
for the symptoms associated with this
condition?
(A)
(B)
(C)
(D)
(E)
related to cardiac dysfunction
neuropsychiatric and behavioral
pulmonary
gastrointestinal (GI)
musculoskeletal
39. Which of the following statements concerning
hypoxemia in COPD is correct?
(A)
(B)
(C)
(D)
(E)
erythrocytosis is an appropriate
compensation for hypoxemia, and
phlebotomy will worsen symptoms
nocturnal oxygen therapy is effective in
producing symptomatic and
hemodynamic improvement in severe
hypoxia
a PO 2
of 58 mm Hg is an indication for
continuous oxygen therapy
a PO 2
of 65 mm Hg or below is an
indication for supplemental oxygen
during air travel
continuous supplemental oxygen
improves functional ability but does not
alter the natural history of obstructive
airways disease with severe hypoxemia
40. A 58-year-old steam pipe worker presents with
a vague ache in the left chest and mild dyspnea
of several months’ duration. There is dullness
on percussion of the left chest associated with
diminished breath sounds. His CXR is shown
in Fig. 12–1. Which of the following is the most
likely diagnosis?
(A)
(B)
(C)
(D)
(E)
pleural metastases
Paget’s disease
mesothelioma and asbestosis
pleural effusion
multiple myeloma
41. A 23-year-old man presents with coughing up
blood and sputum. He gives a history of recurrent
pneumonias and a chronic cough productive
of foul-smelling purulent sputum. The
sputum production is worse when lying down
and in the morning. On physical examination,
he 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
sometimes seen in this condition?
(A)
(B)
(C)
(D)
(E)
Figure 12–1.
lung cancer
dextrocardia
fungal infection
carcinoid syndrome
Hodgkin’s disease
42. A 27-year-old man presents with chest pain
and feeling unwell. He describes cough with
blood-tinged sputum, chills, and fever of 2 days’
duration. Physical findings reveal dullness and
moist rales in the left lower chest. His CXR is
shown in Fig. 12–2. Which of the following is
the most likely diagnosis?