Mehlman pulm abscess, HP, COP 11-04 (1)

Question 1

Abcess. exceedingly HY on usmle.

Answer 1

.

Question 2

Abcess. cause?

Answer 2

USMLE wants “aspiration of oropharyngeal normal flora,” or “aspiration of oropharyngeal anaerobes” as the cause.

Question 3

Abcess. Q will give what info?

Answer 3

Q will give aspiration risk factor:
such as alcoholism, dementia (can cause loss of gag reflex), Hx of stroke (leading to dysphagia), or epilepsy

Question 4

Abcess. Q will mention what regarding teeth?

Answer 4

Q can also mention broken or missing teeth (hypodontia) as risk factor

Question 5

Abcess. how defined regarding xray?

Answer 5

Often described on NBME as pulmonary lesion with an air-fluid level.
This is buzzy, but not a mandatory descriptor. This refers to the top half of the circle being air, and the bottom being pus, the latter settling due to gravity.

Question 6

Abcess. what CP might be mentioned, smell?

Answer 6

The stem can say the patient has “foul-smelling sputum.” This descriptor is exceedingly HY and is synonymous with anaerobes on USMLE.

Question 7

Abcess. what microflora in mouth?

Answer 7

Oropharyngeal normal flora = Bacteroides (strictly anaerobic gram-negative rods); as well as Peptostreptococcus and Mobiluncus.

The latter two are not HY, but Bacteroides is. I mention all three, however, because the Q can say sputum sample shows “gram-negative rods, gram-positive cocci, and grampositive rods,” which refers to all three. But the bigger picture concept is, this
= mixed normal flora

Question 8

Abcess. Tx? Hy, usmle loves it

Answer 8

clindamycin

Question 9

Abcess.
If Q tells you patient was treated for pulmonary abscess + a year later there’s
still a lesion seen on CXR à answer = ?

Answer 9

“failure of maintenance of basement membranes.”

Question 10

Acute bronchopulmonary aspergillosis (ABPA). one sentence. Cp?

Answer 10

Presents as asthma-like presentation in patient with ­ sensitivity to aspergillus skin antigen

Question 11

HP. Case?Cp

Answer 11

Answer on USMLE for bilateral lung condition + fever in farmer who has exposure to hay (on new NBME).

Question 12

bilateral lung condition + fever in farmer who has
exposure to hay. Dx?

Answer 12

Hypersensitivity pneumonitis

Question 13

HP. when resolves fever?

Answer 13

They will tell you the fever self resolves after 2 days and he (farmer) now is afebrile.

Question 14

HP.

Byssinosis (pneumoconiosis from hemp) is wrong answer, since this won’t present with fever + classically presents in textile workers.

Answer 14

.

Question 15

Cryptogenic organizing
pneumonia (COP).
What pattern?

Answer 15

Idiopathic restrictive lung disease

Question 16

Cryptogenic organizing
pneumonia (COP). Cp?

Answer 16

Idiopathic restrictive lung disease where patient has pneumonia-like presentation that fails to improve with antibiotics. Not actual pneumonia.

Question 17

Idiopathic restrictive lung disease where patient has pneumonia-like presentation that fails to improve with antibiotics. Dx?

Answer 17

Cryptogenic organizing
pneumonia (COP).

Question 18

Cryptogenic organizing
pneumonia (COP).

Formerly known as bronchiolitis obliterans organizing pneumonia (BOOP).

Answer 18

.

Question 18

Cryptogenic organizing
pneumonia (COP).

Nonexistent yieldness on USMLE, but I mention it because you will sometimes see this as a wrong answer choice, particularly on hard 2CK Qs, and I’ve seen enough students erroneously pick it.

Answer 18

.