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PANCE Pulmonary Final Exam
Mod 3| Questions and Verified
Correct Answers| Latest Version
2026 - 2027| 100%Score.
A 19 yo male college student presents with a 4 day history of fever, headache, sore throat, myalgia, malaise and a nonproductive cough. On exam you not an erythematous pharynx without exudate. The lung exam is unimpressive. A chest X-ray reveals a right lower lobe patchy pneumonia. Which is the most likely cause? A: mycoplasma B: klebsiella C: Strep. Pneumoniae D: staph A: Mycoplasma A 40 yo female presents with a sudden onset of cough productive of blood speckled sputum, chest pain with a cough, shaking chills, high fever, and myalgias for the last 12 hours. On exam she appears acutely ill, is tachypneic, and coughing. Auscultation of the chest reveals crackles and CXR reveals unilateral lobar consolidation consistent with pneumonia. Which of the following is most likely the cause? A: Mycoplasma B: Strept pneumoniae C: Chlamydia D: aspiration pneumonia B: Strept pneumoniae
A 3 yo patient presents with sudden onset of coughing and wheezing that began at the dinner table this evening. Vital signs are pulse 120, respirations 26, temperature 98.6. You evaluate the patient and determine that the diagnosis is most likely a partial obstruction secondary to tracheal foreign body. What is the next step in the management of this patient? A: Chest pysiotherapy B: intubation C: Tracheostomy D: Bronchoscopy D: Bronchoscopy What is the most effective treatment of acute bronchitis in otherwise healthy adults? A: Empiric antibiotic therapy B: B2 agonist C: adequate hydration D: Steroid C: adequate hydration A 32 yo patient with a 3 week history of fever, malaise, weight loss, joint pain, and dry cough presents to your office. The CXR reveals bilateral hilar adenpathy with no parenchynal abnormalities. You suspect and would like to rule out sarcoidosis. How can the definitive diagnosis be made? A: Biopsy of the mediastinal nodes B: perform a bronchoalveolar lavage C: administer an intradermal purified protein deriviative D: measure serum angiotensin converting enzyme A: biopsy of mediastinal nodes
What is the treatment of choice for a known case of pneumococcal pneumonia in an area where antibiotic resistance is not a factor? A: dicloxacillin B: gentamycin C: Penicillin D: Ticarcillin E: Vancomycin C: Penicillin A 50 yo male presents with a history of persistent cough hemoptysis and weight loss over the past 6 months. He has smoked two packs per day for 30 years and also complains of shoulder and chest pain. On exam he is pale, febrile, and dyspneic upon exertion. The CXR shows hilar adenopathy. What is the most likely diagnosis? A: Asthma B: Bronchiectasis C: Bronchogenic Carcinoma D: COPD C: Bronchogenic carcinoma A patient recently diagnosed with TB is prescribed a treatment regimen that includes isoniazid. Which of the following is a side effect of isoniazid? A: Hyperuricemia B: Peripheral neuropathy C: red-orange urine D: Vestibular toxicity
B: Peripheral Neuropathy What radiologic findings are most suggestive of chronic silicosis? A: eggshell calcification of enlarged hilar lymph nodes B: pneumothorax and atelectasis C: Large nodules that appear primarily in the lower lobes D: Pleural thickening an plaques A: Eggshell calcification Which histological type of lung cancer has the lowest 5 year survival rate? A: bronchiolveolar B: Large Cell C: Small Cell D: Squamous Cell E: Adenocarcinoma C: Small Cell A patient with HIV disease is diagnosed with legionella. What is the drug treatment of choice? A: Cefuroxime B: Doxycycline C: Erthromycin D: Levofloxacin D: Levofloxacin
What is the mainstay bronchodilator treatment for mild intermittent asthma? A: Beta-adrenergic agents B: Theophylline C: Inhaled Steroids D: Leukotrienes A: Beta Adrenergic What is the characteristic prodrome of acute pneumonia caused by chlamydia? A: Headache and sore throat B: Low grade fever and rash C: sneezing and ear pain D: Sudden onset of fever and chills A: headache and sore throat What is considered the primary therapy for patients with PE? A: Anticoagulation with heparin B: Anti-embolization stockings C: Insertion of an inferior vena cava filter D: Thrombolysis with tissue plasminogen activator D: Thrombolysis A 79 yo women who is 7 days post a total hip replacement complains of sudden onset of dyspnea, cough, and restrosternal chest pain. On exam, she appears anxious with vital signs as follows: pulse 120, respiration 32, BP 138/92. A CXR demonstrates mild
bilateral atelectasis and an ECG is normal. What imaging modality will best confirm the diagnosis? A: Arteriography B: Contrast venography C: CT scan D: V/Q scan C: CT scan to diagnosis PE A 17 yo woman presents complaining of a nonproductive cough, postnasal drip, and nasal congestion. Examination reveals inflamed nasal turbinates, cobblestoning of the posterior pharynx, and diffuse bilateral end expiratory wheezes. Which lab test will provide the best inforamtion to assist in making the diagnosis? A: ABG B: CXR C: Peak Flow Measurements D: Spirometry D: Spirometry A 7 yo boy with a history of asthma presents with nocturnal cough occuring every night along with daily exacerbations of wheezing and shortness of breath. How would his asthma be classified. A:Mild intermittent B: Mild persistent C: moderate persistent D: Severe persistent D: Severe persistent
A 35 yo man is suspected of having a small right-sided pleural effusion. What imaging modality is most sensitive to detect a small amount of pleural fluid? A: Chest CT B: Lateral chest film C: left lateral decubitus chest film D: standard upright chest film A: Chest CT A 14 yo healthy male presents to the ED complaining of an acute onset of unilateral chest pain and dyspnea that occurred without a precipitating event. Examination reveals unilateral chest expansion, decreased tactile femitus and decreased breath sounds. What is the most likely diagnosis? A: Atypical pneumonia B: Pericarditis C: Pulmonary Embolism D: Spontaneous pneumonthorax D: spontaneous pneumonthorax What are the chest examination finding expected of a patient with a tension pneumothorax? A: decreased tactile fremitus; hyperresonant to percussion B: Increased tactile fremitus; dullness to percussion C: decreased tactile fremitus; dullness to percussion D: increased tactile fremitus; hyperresonant to percussion A: decreased tactile fremitus; hyperresonant to percussion
Which of the following chest fils will best demonstrate a small pneumothorax? A: expiratory B: Lateral decubitus C: lordotic D: oblique A: expiratory A 65 yo man presents with a chronic productive cough, dyspnea, and wheeze. Examination reveals cyanosis, distended neck veins, and a prominent epigastric pulsation. What is the most likely diagnosis? A: cor pulmonale B: chronic bronchitis C: COPD D: pneumonia A: cor pulmonale A 4 yo child is brough to the emergiency departement with a low-grade fever, barking cough, and respiratory stridor with activity but not a rest. On exam you note the cough and the absence of drooling. What is the most appropriate treatment for this child? A: dexamethasone IM B: endotracheal intubation and IV antibiotics C: inhaled budesonide D: Nebulized racemic epinephrine E: Supportive therapy with oral hydration
B: influenza A 4 yo child presents with a 2 week history of cough, rhinits, and sneezing without fever. IN the last 2 days the cough has become more severe and is now paroxysmal. The paroxysms with a lough high-pitched inspiratory sound. The child's history reveals that immunizations were not completed in infancy. What is the most likely diagnosis? A: Diphtheria B: H. influenza C: Legionella D: Pertussis E: TB D: pertussis What is the treatment of choice for early stage pertussis? A: chloramphenicol B: Erythromycin C: isoniazid D: Supportive therapy E: Ceftriazone B: Erythromycin What lab/diagnostic finding is consistent with Coal workers pneumoconiosis? A: ground glass abnormalities B: eggshell calcification of hilar lymph nodes C: Decreased FEV
D: Positive antinuclear antibodies C: decreased FEV What is the most appropriate treatment of idiopathic pulmonary fibrosis? A: colchicine in combo with broad spectrum Abx B: High dose steroids C: hospitalization, intubation and broad spectrum Abx D: Lung Transplantation E: Methotrexate with low dose steroids B: high dose steroid A patient diagnosed with lung cancer presents with a 4 cm tumor in the mainstem bronchus. The tumor is not within 2 cm of carina. There is no invasion of the visceral pleura or associated atelectasis There are no distant metastases or nodal involvement. What is the stage of the patients disease? A: 0 B: 1A C: 1B D: 2B C: 1B A preterm infant presents at 10 days of age. The mother complains that the infant is experiencing an increasing number of apneic episodes of 20-30 seconds associated with cyanosis. After careful history, physical exam, and workup, the decision is made to treat the infant. What is the most appropriate treatment for this infant? A: Corticosteroid
A: CXR
B: Elevated WBC C: epidemiologic and overal clinical data D: history of no influenza immunization E: presence of pneumona C: epidemiologic and clinical data What epidemiologic characteristic is consistent with RSV? A: Epidemics peak in January through March B: Incubation period is 14-21 days? C: infection almost universal by 6 months of age in urban settings D: spread by fecal oral transmission A: epidemics peak in Jan - March Which of the following recommendations for annual influenza immunizations is correct? A: healthy children aged O-6 months should be immunized B: live attenuated vaccine is contraindicated in children under 12 C: pregnant women in the second are third trimester should be immunized D: two doses of vaccine are recommended for children over 9 yo who are receiving the vaccine for the first time C: pregnant women should be immunized Imaging of the chest is an essential part of the workup of a patient with suspected occupational interstitial lung disease. What is the most likely diagnosis in a patient with a chest X ray that reveals a reticular linear pattern with basilar predominance?
A: asbestosis B: coal workers lung C: Silicosis D: Talcosis A: Asbestosis What is the name given to chest pain which is described as severe, knife-like, and worsened by coughing and or deep inspiration? A: ischemic B: neuralgic C: pleuritic D: visceral C: pleuritic A 7 yo previously healthy patient presents with acute onset of respiratory distress following ingestion of a piece of candy. Which of the following signs or symptoms is most ominous? A: aphonia B: cough C: drooling D: Stridor A: aphonia A 32 yo African american woman with a histroy of erythema nodosum presents with nonspecific complaints such as fatigue and malaise. Based on the fact that she is a smoker with theses symptoms, a CXR is ordered which demonstrates bilateral hilar
What is considered first line drug therapy for patients with COPD? A: steroids B: ipratropium bromide C: terbutaline D: theophylline B: ipratropium bromide A 3 yo child presnts tot he emergency room with a seal-like cough along with rinorrhea for several days. Examination reveals an afebrile child who exhibits stridor with expiratory wheezing while at rest. What is the recommended treatment A: Im dexamethosome B: IM diphenhydramine C: nebulized albuterol D: Nebulized racemic epinephrine D: Nebulized recemic epinephrine You can also click the terms or definitions to blur or reveal them
