Pulmonary ROSH Review Latest Update -

Pulmonary ROSH Review Latest Update - 190 Questions and 100% Verified Detailed Correct Answers Guaranteed A+ Approved by Professor

13-year-old boy presents to your ED with worsening cough and exercise intolerance.The triage note says he has seen his primary care physician twice over the last month and was given albuterol which has not improved his symptoms. His vital signs show a temperature of 37.2°C, heart rate of 110 beats per minute, respiratory rate of 28 breaths per minute, blood pressure of 110/82 mm Hg, and pulse oximetry of 93% on room air. A chest X-ray obtained from triage is shown above. Which of the following findings do you expect on your physical examination?

Coarse crackles Pleural friction rub Rhonchi

Stridor - CORRECT ANSWER: Correct Answer ( A )

Explanation:

This patient has evidence of pulmonary venous congestion and cardiomegaly on X-ray, consistent with congestive heart failure (CHF) due to dilated cardiomyopathy. Dilated cardiomyopathy is the most common form of cardiomyopathy in children and the cause is unknown in about half of the cases. It causes dilation of all four cardiac chambers and significantly weakens systolic contraction leading to symptoms of congestive heart failure. These patients can present with both symptoms of left sided heart failure such as pulmonary coarse crackles, venous congestion, fatigue, or tachypnea and dyspnea on exertion, and right-sided congestive heart failure with hepatomegaly and peripheral edema. While peripheral edema may present as jugular venous distention and ankle edema in adults, this is less common in younger children who usually present with periorbital edema. Patients with new pulmonary venous congestion require a thorough cardiac work-up and admission to an intensive care unit. On auscultation, pulmonary edema is associated with coarse crackles, usually discontinuous and start early in inspiration and extend into expiration.

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Stridor (D) describes a high-pitched, monophonic sound made when breathing that is best heard over the anterior neck. It is associated with many conditions such as epiglottitis, croup, tracheitis, and foreign body obstruction.

16-year-old boy is taken to his doctor for snoring. His mother reports that his snoring keeps others in the house awake and that sometimes his breathing pauses during sleep with gasping or choking. His teachers report that he falls asleep frequently at school. On exam, he has a body mass index of 31 kg/m² and has enlarged tonsils. His symptoms are concerning for obstructive sleep apnea so the pediatrician refers him for an overnight polysomnography. Which of the following can be a longterm complication of obstructive sleep apnea?

Cerebrovascular accident Lung scarring Nasal polyps

Pulmonary hypertension - CORRECT ANSWER: Correct Answer ( D )

Explanation:

Children with obstructive sleep apnea (OSA) often are obese, have enlarged tonsils or have significant allergies. OSA can lead to abnormal growth and development, bedwetting, behavioral and learning problems, daytime sleepiness, and hyperactivity.Long-standing repetitive oxygen desaturations and hypercapnia episodes during sleep can lead to vascular remodeling and pulmonary hypertension which can lead to cor pulmonale (right ventricular hypertrophy). Treatment may include weight loss, managing allergic rhinitis, and removal of the adenoids and tonsils. Nonsurgical approaches to treatment include weight loss, CPAP, and bite guards that bring the lower jaw forward.Surgical treatments include uvulopalatopharyngoplasty, jaw surgery, or removal of the tonsils and adenoids.

17-year-old girl with a history of asthma presents to your office with complaints of wheezing and shortness of breath. She says that in the past month she has experienced symptoms approximately 3-4 times per week requiring use of her short- acting beta agonist inhaler. She has also woken up at night four times during the month with shortness of breath and occasionally gets dyspneic on her daily walk. Which of the following is the most effective management?

Add a low dose inhaled glucocorticoid 2 / 4

Add a low dose inhaled glucocorticoid plus long-acting beta agonist Continue use of short-acting beta agonist only

Start an oral course of glucocorticoids - CORRECT ANSWER: Correct Answer ( A )

Explanation:

Mild persistent asthma is defined as having symptoms more than twice per week but less than daily, 3-4 nocturnal awakenings per month, symptoms requiring the use of a short-acting beta agonist rescue inhaler more than two times per week, minor interference with activities of daily living, FEV1 measurements and FEV1/FVC ratio within normal limits and two or more asthma exacerbations requiring an oral course of corticosteroids per year. Treatment of asthma follows a step-wise plan depending on the severity of symptoms. Mild persistent asthma requires daily use of a long-term controlling medication and a low dose inhaled glucocorticoid. Use of a short-acting beta agonist rescue inhaler should also continue as needed.

17-year-old girl with a history of well-managed cystic fibrosis is being evaluated for a steadily worsening chronic cough with shortness of breath and wheezing. She is producing copious purulent malodorous sputum and occasional hemoptysis. Crackles are heard at her bilateral lung bases. Which of the following findings would be most expected on this patient's chest radiograph?

Dilated, thickened bronchi with "tram-track" marks Low lung volumes and ground glass opacities Lung hyperinflation with flattening of the diaphragm

Normal chest radiograph - CORRECT ANSWER: Correct Answer ( A )

Explanation:

Dilated, thickened bronchi are classic radiograph findings in patients with bronchiectasis, the most likely disease in this patient. The bronchi are often described as having "tram-track" or ring-like markings. Scattered, irregular opacities, atelectasis, or focal consolidations may also be noted. A suspicion of bronchiectasis based on radiographic findings and patient symptoms warrants a high-resolution CT scan which is a more precise diagnostic study. Bronchiectasis is suspected in patients who have a chronic cough, dyspnea, wheezing, and heavy production of purulent, foul-smelling sputum. Pleuritic chest pain, weight loss, and anemia are commonly associated. An exam usually reveals crackles at the lung bases and nail clubbing in severe disease. In the United States, the greatest percentage of patients with bronchiectasis develop it secondary to cystic fibrosis. Lung infections, tumor presence, and immunodeficiency 3 / 4

states are other less common causes. Antibiotics are usually needed with the choice being guided by sputum cultures. Haemophilus influenza, Streptococcus pneumonia, and Staphylococcus aureus are often isolated. In addition to proper antibiotic coverage, bronchiectasis should be treated with daily chest physiotherapy and inhaled bronchodilators.

27-year-old man with a history of asthma presents to your office for his annual exam.He reports that in the past month he has experienced wheezing and shortness of breath about once per week which resulted in using his rescue inhaler. He woke up once because of coughing. He has a peak flow meter and home readings have been 85-90% of his personal best. Which of the following best describes the classification of his asthma?

Intermittent Mild persistent Moderate persistent Severe persistent - CORRECT ANSWER: Explanation: Asthma severity is determined by monitoring patient symptoms over the past 2-4 weeks, determination of the patient's current lung function and number of asthma exacerbations that require oral glucocorticoids each year. A step-wise approach is used to classify asthma severity and determine approach to treatment. Intermittent asthma is defined as having two or fewer daytime symptoms per week, two or fewer nighttime awakenings due to symptoms in the past month, use of short-term beta agonist rescue inhaler less than two times per week, no impairment in activities of daily living (ADLs) between exacerbations, home readings of lung function within the normal range (greater than or equal to 80% of normal), and zero or one exacerbation requiring oral glucocorticoids in the past year.

33-year-old man presents to the ED with several weeks of cough, pleuritic chest pain, weight loss, and night sweats. The patient drinks a 6-pack of beer daily. Vital signs are BP 145/75, HR 88, RR 18, and T 37.7°C. Pulmonary exam reveals crackles and decreased breath sounds on auscultation. You obtain the radiograph seen above.Which of the following is the most likely diagnosis?

ALung abscess BNeoplasm

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