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SAEM Pulm
A thin 18 year old female complains of acute onset of sharp right-sided chest pain this morning. She has developed some mild shortness of breath during the morning and thought she should get it checked out. Her chest X-ray is shown in the Figure. The next course of action should be: [PICTURE OF LUNGS WITH RIGHT BLUNTED COSTODIAPHRAGMATIC ANGLE] 1.Electrocardiogram 2.Antibiotics 3.Chest tube placement 4.Needle decompression - correct answer 3. Chest tube placement A 28 year old patient arrives after helicopter transfer from an outlying center, where he had been intubated for altered mental status after significant alcohol intoxication. There were no reported signs of chest trauma, but the patient now has decreased breath sounds on the left. His vital signs are stable. Based upon the chest X-ray in the figure, what is the next step in management of this patient? [PICTURE OF HYPERINFLATED RIGHT LUNG AND CLOUDY LEFT LUNG] Answers: 1.Endotracheal tube adjustment 2.Chest tube placement 3.Nasogastric tube placement 4.Needle decompression - correct answer 1.Endotracheal tube adjustment
Regarding the epidemiology of asthma in the United States, which of the following is true? Answers: 1.Etiology is thought to be genetic, not environmental 2.Incidence is comparable for Caucasians and African-Americans 3.More common in males than females in adult and pediatric populations 4.Prevalence increased in the 1980's, and then decreased in the 1990's - correct answer 4.Prevalence increased in the 1980's, and then decreased in the 1990's Regarding pulsus paradoxus and asthma, which of the following statements is correct Answers: 1.Pulsus paradoxus is a fall in systolic blood pressure during inspiration 2.Pulsus paradoxus is pathognomonic for asthma 3.The absence of pulsus paradoxis in asthma rules out severe disease 4.The presence of pulsus paradoxis in asthma indicates severe disease - correct answer 4.The presence of pulsus paradoxis in asthma indicates severe disease Which of the following is correct regarding the use of corticosteroids in acute asthma exacerbation? Answers: 1.Beneficial effects occur within the first hour of administration. 2.Inhaled steroids should be avoided
1.Co-infection with multiple bacteria, such as Chlamydia and Strep pneumoniae commonly occur 2.Etiologic agents for patients admitted to the ICU with pneumonia most commonly include Neisseria meningitidis and Strep pneumoniae 3.Milder cases of community acquired pneumonia are frequently caused by Chlamydia 4.Q fever, caused by Coxiella burnetii, may present as pneumonia, particularly in patients exposed to rabbits - correct answer 1.Co-infection with multiple bacteria, such as Chlamydia and Strep pneumoniae commonly occur Which of the following patients is the most likely to develop S. pneumoniae pneumonia? Answers: 1.59 year old woman who is a cigarette smoker. 2.61 year old man with hypertension 3.64 year old man with type 2 diabetes 4.65 year old woman with no past medical history - correct answer 3.64 year old man with type 2 diabetes Regarding the etiology of viral pneumonia, which of the following is true? Answers: 1.Cytomegalovirus does not usually cause pneumonia in immunocompetent adults 2.Influenza virus is the most common cause of viral pneumonia in children 3.Parainfluenza virus is the most common cause of viral pneumonia in adults
4.Varicella zoster causes pneumonia more frequently in children than in adults - correct answer 1.Cytomegalovirus does not usually cause pneumonia in immunocompetent adults Regarding mycobacterium tuberculosis (TB), which of the following is TRUE? Answers: 1.Worldwide, TB causes more deaths than any other infectious agent 2.Worldwide, approximately 45-50% of the population is infected with TB 3.In the United States, approximately 12-15% of the population is infected with TB. 4.In the United States, the incidence of TB has been steadily increasing since the 1950s. - correct answer 1.Worldwide, TB causes more deaths than any other infectious agent Which finding is commonly associated with pneumonia caused by Klebsiella pneumoniae? Answers: 1.Absence of sputum 2.Encephalitis 3.Empyema 4.Low mortality - correct answer 3.Empyema Which of the following patients presenting to the emergency department with a chief complaint of "shortness of breath" is most likely to have cavitary lesion with air-fluid levels on CXR? Answers:
3.Cardiac tamponade 4.Lung laceration 5.Spinal cord injury - correct answer 2.Tension pneumothorax Which of the following are associated with a higher risk of spontaneous pneumothorax? Answers: 1.Cigarette smoking 2.Female gender 3.Physical exertion 4.Trisomy 21 - correct answer 1.Cigarette smoking A radiographic finding that may be seen in an elderly patient who aspirated food is: Answers: 1.Hyperinflation of the left lung 2.An opacity in the right middle lobe bronchus 3.Tension pneumothorax on the right, with leftward mediastinal shift 4.Visualization of the food bolus in the right mainstem bronchus - correct answer 1.Hyperinflation of the left lung A 7 year old girl is brought in by her father complaining of difficulty breathing after being stung by a bee. She is otherwise in good health. Neither she nor her father
recall whether she has been stung previously, but state she has never before had a reaction like this. Which of the following treatments would be inappropriate? Answers: 1.inhaled racemic epinephrine 2.intravenous antibiotics 3.heliox by face mask 4.albuterol nebulizer - correct answer 2.intravenous antibiotics Regarding the diagnosis of pulmonary embolism (PE), which is correct. Answers: 1.Autospsy studies indicate that approximately 30% of patients who die in the hospital have undiagnosed PE 2.By 80 years of age, one out of four people will develop deep venous thrombosis 3.One-year mortality of PE is 25% even with early diagnosis and treatment 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% - correct answer 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% Which of the following is a risk factor for developing pulmonary embolism Answers: 1.Albumin deficiency 2.Alcohol use 3.Corticosteroid use
on room air and decreased breath sounds on the right. CXR is notable for a 3 x 4 cm opaque lesion in the right upper lobe that appears to be partially constricting the right mainstem bronchus. Which of the following is true regarding this man's condition and treatment? Answers: 1.He should be urgently intubated due to the partial constriction of the right mainstem bronchus 2.The lesion on CXR is worrisome for malignancy and warrants a chest CT 3.He should undergo urgent fluoroscopic-guided needle biopsy of the lesion to attain a diagnosis 4.Pulmonary angiogram is indicated to rule out pulmonary embolus - correct answer 2.The lesion on CXR is worrisome for malignancy and warrants a chest CT A 25 year old female presents with fever, productive cough, and shortness of breath. Physical exam reveals T101, RR 24 and SpO2 of 94%. Her left tympanic membrane is inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe pneumonia. The organism most commonly associated with this type of presentation is: Answers: 1.Legionella pneumoniae 2.Strep pneumoniae 3.H. influenzae 4.Mycoplasma pneumoniae 5.Moraxella catarrhalis - correct answer 4.Mycoplasma pneumoniae A 44 year old male presents with fever, cough and shortness of breath. He is a nonsmoker. He has a lobar infiltrate on CXR. The most likely cause of pneumonia is:
Answers: 1.Strep pneumoniae 2.viral 3.H. influenzae 4.Mycoplasma pneumoniae 5.Moraxella catarrhalis - correct answer 1.Strep pneumoniae A pneumonia caused by which of the following organisms is classically associated with currant jelly sputum? Answers: 1.Strep. pneumoniae 2.viral 3.H. influenzae 4.Mycoplasma 5.Klebsiella - correct answer 5.Klebsiella An 82 year old man presents from the nursing home with fever, cough, nausea, vomiting and diarrhea. His vitals signs are T 102, P 65, BP 100/50, RR 24, and SpO 92%. The most likely causative organism is: Answers: 1.Strep. pneumoniae 2.viral
