Internal-Medicine

250 12: Diseases of the Respiratory System
of the chest reveals decreased fremitus, dullness
to percussion, and absent breath sounds in
the left lower lung. There is also a tracheal shift
towards the left side. (SELECT ONE)
54. A 72-year-old man with COPD develops acute
shortness of breath and presents to the hospital.
He appears uncomfortable: blood pressure
is 120/90 mm Hg, pulse 100/min, oxygen saturation
85% on room air. On examination of the
chest, there is absent fremitus, absent breath
sounds, and hyperresonant percussion of the
right lung. The trachea is shifted to the left.
(SELECT ONE)
DIRECTIONS (Questions 53 through 62): Each set
of matching questions in this section consists of a
list of lettered options followed by several numbered
items. For each numbered item, select the
appropriate lettered option(s). Each lettered
option may be selected once, more than once, or
not at all. EACH ITEM WILL STATE THE NUM-
BER OF OPTIONS TO SELECT. CHOOSE
EXACTLY THIS NUMBER.
Questions 53 through 57
(A)
(B)
(C)
(D)
(E)
Figure 12–6.
acute asthmatic attack
complete pneumothorax
large pleural effusion
atelectasis
lobar pneumonia
For each patient with abnormal pulmonary physical
findings, select the most likely diagnosis.
53. A 64-year-old woman is admitted to the hospital
after the acute onset of left-sided weakness.
She has had a large right cerebral stroke and is
confined to bed. On the fifth hospital day, her
oxygen saturation is noted to be reduced to
90% on room air. She feels fine, the neurologic
weakness is unchanged, blood pressure is
130/90 mm Hg, and pulse 80/min. Examination
55. A 45-year-old woman comes to the emergency
department because of increased shortness of
breath. Examination of the chest reveals
decreased fremitus, low diaphragms, and prolonged
expiration phase. (SELECT ONE)
56. A 24-year old woman notices increasing shortness
of breath after recent treatment for right
lower lobe pneumonia. She has no fever, cough,
or sputum production. On examination, the
pertinent findings are decreased fremitus, dullness
on percussion, and absent breath sounds
of the right lower lung. In addition, the trachea
has shifted to the left. (SELECT ONE)
57. A 61-year-old man is not feeling well because of
shortness of breath and left-sided chest pains
that increase with breathing. His examination
reveals increased fremitus, dull to percussion,
and bronchophony on the left side. His heart
sounds are normal. (SELECT ONE)
Questions 58 through 62
(A)
(B)
(C)
(D)
(E)
squamous cell carcinoma
adenocarcinoma
large cell carcinoma
small cell carcinoma
bronchioloalveolar carcinoma
For each patient with lung cancer, select the most
likely cell type based on clinical description.