Respiratorio Flashcards
This man, whose former occupation carries a high risk of chronic inhalational exposure to asbestos, presents with weight loss, dyspnea, cough with hemoptysis, and circumferential pleural thickening on CT scan. The occupational history, symptoms, and findings are highly suggestive of malignant pleural mesothelioma.
These findings describe the histopathologic appearance of mesothelioma. Calretinin is a biomarker found in both benign and malignant tissue of mesothelial origin. Mesothelial cells are often polygonal in shape and have long, slender microvilli, which can be seen on electron microscopy, and psammoma bodies.
A 47-year-old man is brought to the emergency department 30 minutes after he was involved in a motor vehicle collision. On arrival, he is unconscious and unresponsive to painful stimuli. His pulse is 120/min, respirations are 10/min, and his blood pressure is 88/60 mm Hg. Infusion of 0.9% saline is begun, and intubation is attempted without success. Pulse oximetry on 20 L/min of oxygen via bag-mask shows an oxygen saturation of 78%. The most appropriate next step in the management involves passing a tube through an incision in which of the following structures?
In emergency situations where a patient cannot be effectively ventilated by the conventional bag and mask ventilation or endotracheal intubation, a cricothyroidotomy is the surgical procedure of choice to restore oxygenation. A cricothyroidotomy is performed by vertically incising the skin (superficial cervical fascia, investing layer of deep cervical fascia, and pretracheal fascia) and then horizontally incising the cricothyroid membrane.
A 51-year-old man with alcohol use disorder comes to the physician because of a fever and productive cough. An x-ray of the chest shows a right lower lobe consolidation and a diagnosis of aspiration pneumonia is made. The physician prescribes a drug that blocks peptide transfer by binding to the 50S ribosomal subunit. Which of the following drugs was most likely prescribed?
Clindamycin is a bacteriostatic antibiotic that inhibits bacterial protein synthesis by preventing peptide translocation at the 50S (large) ribosomal subunit. It targets anaerobic organisms and is commonly used for the treatment of aspiration pneumonia and lung abscess, which are typically polymicrobial. Clostridioides difficile colitis is a potential complication of clindamycin.
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Respiratory System: Block 1
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A 23-year-old woman with asthma is brought to the emergency department because of shortness of breath and wheezing for 20 minutes. She is unable to speak more than a few words at a time. Her pulse is 116/min and respirations are 28/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination of the lungs shows decreased breath sounds and scattered end-expiratory wheezing over all lung fields. Treatment with high-dose continuous inhaled albuterol is begun. This patient is at increased risk for which of the following adverse effects?
2
A 44-year-old man comes to the physician because of a 5-month history of persistent cough productive of thick, yellow sputum and worsening shortness of breath. One year ago, he had similar symptoms that lasted 4 months. He has smoked two packs of cigarettes daily for the past 20 years. Physical examination shows scattered expiratory wheezing and rhonchi throughout both lung fields. Microscopic examination of a lung biopsy specimen is most likely to show which of the following findings?
3
A 61-year-old woman comes to the physician because of a 5-day history of fever, headache, coughing, and thick nasal discharge. She had a sore throat and nasal congestion the week before that had initially improved. Her temperature is 38.1°C (100.6°F). Physical exam shows purulent nasal drainage and tenderness to percussion over the frontal sinuses. The nasal turbinates are erythematous and mildly swollen. Which of the following describes the microbiological properties of the most likely causal organism?
4
A male newborn born at 27 weeks’ gestation is evaluated for rapid breathing and hypoxia shortly after birth. His mother had no prenatal care. Cardiopulmonary examination shows normal heart sounds, intercostal retractions, and nasal flaring. An x-ray of the chest shows low lung volumes, air bronchograms, and diffuse ground-glass opacities. He is started on nasal continuous positive airway pressure. Further evaluation of this patient is most likely to show which of the following findings?
5
Two days after undergoing left hemicolectomy for a colonic mass, a 60-year-old man develops shortness of breath. His temperature is 38.1°C (100.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 120/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Cardiopulmonary examination shows decreased breath sounds and decreased fremitus at both lung bases. Arterial blood gas analysis on room air shows: pH 7.35 PaO2 70 mm Hg PCO2 40 mm Hg An x-ray of the chest shows collapse of the bases of both lungs. Which of the following is the most likely mechanism of this patient’s hypoxemia?
6
A 3900-g (8.6-lb) male infant is delivered at 39 weeks’ gestation via spontaneous vaginal delivery. Pregnancy and delivery were uncomplicated but a prenatal ultrasound at 20 weeks showed a defect in the pleuroperitoneal membrane. Further evaluation of this patient is most likely to show which of the following findings?
7
A 69-year-old man is brought to the emergency department by his wife because of fever, cough, diarrhea, and confusion for 2 days. He recently returned from a cruise to the Caribbean. He has a history of chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His temperature is 39.1°C (102.4°F), pulse is 83/min, and blood pressure is 111/65 mm Hg. He is confused and oriented only to person. Physical examination shows coarse crackles throughout both lung fields. His serum sodium concentration is 125 mEq/L. Culture of the most likely causal organism would require which of the following mediums?
8
A 3-year-old girl is brought to the physician by her parents because of a barking cough, a raspy voice, and noisy breathing for the last 3 days. Five days ago, she had a low-grade fever and runny nose. She attends daycare. Her immunizations are up-to-date. Her temperature is 37.8°C (100°F) and respirations are 33/min. Physical examination shows supraclavicular retractions. There is a high-pitched sound present on inspiration. Examination of the throat shows erythema without exudates. Which of the following is the most likely location of the anatomic narrowing causing this patient’s symptoms?
9
A 23-year-old man is admitted to the intensive care unit with acute respiratory distress syndrome due to influenza A. He has no history of serious illness and does not smoke. An x-ray of the chest shows diffuse bilateral infiltrates. Two weeks later, his symptoms have improved. Pulmonary examination shows fewer inspiratory crackles than at the time of admission. This patient is most likely to develop which of the following long-term complications?
10
A 45-year-old man with a 5-year history of worsening shortness of breath and cough comes to the physician for a follow-up examination. He has never smoked. His pulse is 75/min, blood pressure is 130/65 mm Hg, and respirations are 25/min. Examination shows an increased anteroposterior diameter of the chest. Diminished breath sounds and wheezing are heard on auscultation of the chest. An x-ray of the chest shows widened intercostal spaces, a flattened diaphragm, and basilar-predominant bullous changes of the lungs. This patient is at increased risk for which of the following complications?
11
A 33-year-old woman comes to the physician because of a 3-week history of fatigue and worsening shortness of breath on exertion. There is no family history of serious illness. She does not smoke. She takes diethylpropion to control her appetite and, as a result, has had a 4.5-kg (10-lb) weight loss during the past 5 months. She is 163 cm (5 ft 4 in) tall and weighs 115 kg (254 lb); BMI is 44 kg/m2. Her pulse is 83/min, and blood pressure is 125/85 mm Hg. Cardiac examination shows a loud pulmonary component of the S2. Abdominal examination shows no abnormalities. Which of the following is the most likely cause of this patient’s shortness of breath?
12
A 61-year-old man comes to the physician because of a 9-month history of progressive shortness of breath on exertion. Pulmonary examinations shows fine bibasilar end-inspiratory crackles. There is digital clubbing. Pulmonary functions tests show an FEV1:FVC ratio of 97% and a total lung capacity of 70%. An x-ray of the chest shows small bilateral reticular opacities, predominantly in the lower lobes. A photomicrograph of a specimen obtained on lung biopsy is shown. The patient most likely works in which of the following fields?
13
A 59-year-old man comes to the physician because of a 1-year history of progressive shortness of breath and nonproductive cough. Pulmonary examination shows bibasilar inspiratory crackles. An x-ray of the chest shows multiple nodular opacities in the upper lobes and calcified hilar nodules. Pulmonary functions tests show an FEV1:FVC ratio of 80% and a severely decreased diffusing capacity for carbon monoxide. A biopsy specimen of a lung nodule shows weakly birefringent needles surrounded by concentric layers of hyalinized collagen. The patient has most likely been exposed to which of the following?
14
A 54-year-old man comes to the emergency department because of a 3-week history of intermittent swelling of his left arm and feeling of fullness in his head that is exacerbated by lying down and bending over to tie his shoes. Physical examination shows left-sided facial edema and distention of superficial veins in the neck and left chest wall. Which of the following is the most likely cause of this patient’s symptoms?
15
A 69-year-old man comes to the physician because of a 4-month history of progressive fatigue, cough, shortness of breath, and a 6.6-kg (14.5-lb) weight loss. For the past week, he has had blood-tinged sputum. He is a retired demolition foreman. There is dullness to percussion and decreased breath sounds over the left lung base. A CT scan of the chest shows a left-sided pleural effusion and circumferential pleural thickening with calcifications on the left hemithorax. Pathologic examination of a biopsy specimen of the thickened tissue is most likely to show which of the following findings?
16
A 47-year-old man is brought to the emergency department 30 minutes after he was involved in a motor vehicle collision. On arrival, he is unconscious and unresponsive to painful stimuli. His pulse is 120/min, respirations are 10/min, and his blood pressure is 88/60 mm Hg. Infusion of 0.9% saline is begun, and intubation is attempted without success. Pulse oximetry on 20 L/min of oxygen via bag-mask shows an oxygen saturation of 78%. The most appropriate next step in the management involves passing a tube through an incision in which of the following structures?
17
A 51-year-old man with alcohol use disorder comes to the physician because of a fever and productive cough. An x-ray of the chest shows a right lower lobe consolidation and a diagnosis of aspiration pneumonia is made. The physician prescribes a drug that blocks peptide transfer by binding to the 50S ribosomal subunit. Which of the following drugs was most likely prescribed?
18
A 61-year-old man comes to the physician because of a 3-month history of worsening exertional dyspnea and a persistent dry cough. For 37 years he has worked in a naval shipyard. He has smoked 1 pack of cigarettes daily for the past 40 years. Pulmonary examination shows fine bibasilar end-expiratory crackles. An x-ray of the chest shows diffuse bilateral infiltrates predominantly in the lower lobes and pleural reticulonodular opacities. A CT scan of the chest shows pleural plaques and subpleural linear opacities. The patient is most likely to develop which of the following conditions?
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Question
A 61-year-old man comes to the physician because of a 3-month history of worsening exertional dyspnea and a persistent dry cough. For 37 years he has worked in a naval shipyard. He has smoked 1 pack of cigarettes daily for the past 40 years. Pulmonary examination shows fine bibasilar end-expiratory crackles. An x-ray of the chest shows diffuse bilateral infiltrates predominantly in the lower lobes and pleural reticulonodular opacities. A CT scan of the chest shows pleural plaques and subpleural linear opacities (asbestosis). The patient is most likely to develop which of the following conditions?
Bronchogenic carcinoma is the most common malignant pulmonary tumor in patients with asbestosis and the second most common carcinoma worldwide. This patient has two important risk factors, primarily a smoking history and a history of asbestos exposure
A 51-year-old man comes to the physician because of a 4-day history of fever and cough productive of foul-smelling, dark red, gelatinous sputum. He has smoked 1 pack of cigarettes daily for 30 years and drinks two 12-oz bottles of beer daily. An x-ray of the chest shows a cavity with air-fluid levels in the right lower lobe. Sputum culture grows gram-negative rods. Which of the following virulence factors is most likely involved in the pathogenesis of this patient’s condition?
Klebsiella pneumoniae possesses a capsular polysaccharide that acts as an antiphagocytic virulence factor and allows bacteria to evade host immune defenses. This pathogen is part of the natural flora of the gastrointestinal tract. In patients who are immunocompromised and patients who have an increased risk for aspiration events (e.g., due to chronic alcohol use), aspiration of Klebsiella can lead to destruction of alveoli, resulting in bloody sputum with a currant jelly appearance.
A 58-year-old man with chronic obstructive pulmonary disease and hypertension comes to the physician because of shortness of breath 3 days after starting propranolol. His temperature is 36.7°C (98.1°F), pulse is 64/min, respirations are 20/min, and blood pressure is 138/88 mm Hg. Auscultation of the lungs shows diffuse expiratory wheezes. In addition to discontinuing the propranolol (Beta-2 blockade can trigger bronchoconstriction, particularly in patients with COPD or asthma), which of the following drugs should be administered?
Albuterol is a short-acting beta-2 adrenergic agonist that induces relaxation of bronchial smooth muscle cells.
This patient has a high fever, respiratory compromise, cough with foul-smelling sputum, and infiltrates in the right lung, which is indicative of aspiration pneumonia.
Parkinson disease predisposes patients to aspiration pneumonia by impairing the swallowing and/or cough mechanism in up to 80% of those with late-stage disease. Aspiration is most likely to occur in the dependent portions of the lung (the superior segment of right lower lobe and the posterior segment of the right upper lobe when supine or the apical and posterior right lower lobe when upright)
A previously healthy 64-year-old woman comes to the physician because of a dry cough and progressively worsening shortness of breath for the past 2 months. She has not had fever, chills, or night sweats. She has smoked one pack of cigarettes daily for the past 45 years. She appears thin. Examination of the lung shows a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows decreased FEV1:FVC ratio (< 70% predicted), decreased FEV1, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?
Smoking causes over 90% of cases of COPD, which results in decreased FEV1/FVC, decreased FEV1, and increased TLC (due to increased lung compliance).
A tall, slender young man with nontraumatic, sudden, unilateral chest pain and dyspnea most likely has a primary spontaneous pneumothorax. Imaging confirms pneumothorax and the absence of any rib fractures.
Increased right-to-left pulmonary shunting is likely to be an immediate result of primary spontaneous pneumothorax. In this functional right-to-left shunt, alveoli in collapsed lung areas are not ventilated but are still perfused with deoxygenated blood from the right heart. Perfusion of the nonventilated alveoli results in decreased oxygenation of blood flowing to the left heart (right-to-left pulmonary shunting) and hypoxia
random doctor image
Headaches, facial numbness (due to cranial nerve involvement), recurrent epistaxis, weight loss, and lymphadenopathy are suggestive of malignancy. The biopsy of this patient’s mass shows undifferentiated nasopharyngeal carcinoma, which commonly occurs in adults of Southeast Asian descent. Epstein-Barr virus (EBV) is the primary causative agent in the pathogenesis of this condition. The patient most likely acquired the causal pathogen of his nasopharyngeal mass via which of the following routes of transmission?
EBV is mainly transmitted through saliva and respiratory secretions
