Answer 10

10.  Choice D is the correct answer.  This patient should likely be observed given he is a smoker, and had a recent intubation.  These make him high risk for relapse and morbidity and mortality.  In addition if he cannot afford his medications, this would make him high risk for discharge.  Social services should be involved in his care.

Question 10

10.  Your patient is a 34 year old male that presents with an acute asthma attack.  He has had Solumedrol 125 mg IV, and a two hour continuous aerosol of albuterol and is feeling better.  His lungs are clear, his vital signs are normal and he wants to go home.  Which of the following things to consider in his history before you discharge him home that may make you consider him high risk for discharge?

A.  He cannot pay for his medicine
B.  He is a smoker
C.  He was intubated 2 months ago
D.  All of the following make him high risk for discharge and should be observed

Answer 9

9.  Choice A is the correct answer.  Frothy red sputum tends to be pulmonary in origin because it mixes with edema.  In addition the pH is normal so this essentially excludes a GI etiology.  Another possibility but not likely is a nosebleed.  Blood from a nosebleed typically is not frothy.  

Question 9

9.  Your patient is a 50 year old that presents with blood in his mouth.  The blood is frothy, red with a normal pH.  Which of the following is the most likely source of the blood?

A.  Pulmonary
B.  Upper GI
C.  Stomach
D.  Duodenum

Answer 8

8.  Choice C is the correct answer.  This patient has over a 15 percent pneumothorax on the left side.  So observation is not appropriate.  This pneumothorax does not appear to have any blood so a 28 or 32 french is appropriate.  If there is a hemothorax a 36 or 40 French would be appropriate so it can drain effectively.  This finding on the left side is not a pneumonia or mass.  There is missing lung markings consistent with a pneumothorax.  

Question 8

8.  Your patient is a 24 year old male that presents with left sided chest pain and shortness of breath.  His vitals are as follows HR 112, RR 24, Temp 98.7, SaO2 94%.  His chest x ray is below.  Which of the following is the best management plan?

A.  Arrange for immediate bronchoscopy and biopsy
B.  Start on Levaquin 750 mg IV daily
C.  Insert a 28 French chest tube on the left side at the 4th or 5th interspace
D.  Observation and oxygen supplementation

Answer 7

7.  Choice D is the correct answer.  Bronchitis is the most common cause of hemoptysis in the US.  With pneumonia and tuberculosis you would expect some abnormal history or physical findings.   It would be unusual for a healthy 24 year old to develop bronchogenic carcinoma. 

Question 7

7.  Your patient is a 24 year old health male that presents with hemoptysis.  The remainder of his past medical history, exam, and vital signs are normal.  Which of the following is the most likely diagnosis?

A.  Pneumonia
B.  Tuberculosis
C.  Bronchogenic Carcinoma
D.  Bronchitis

Answer 6

6.  Choice C is the correct answer. These are transudate findings with pleural fluid.  The low serum protein, the low low LDH, and the low pleural fluid to serum LDH ratio.  CHF is the most common cause of transudate pleural effusions.

Question 6

6.  Your patient is a 54 year old that just underwent a thoracocentesis.  His results are as follows:  serum protein < 0.5,  LDH 100 IU/mL, specific gravity of < 1.016, ratio of pleural fluid LDH to serum LDH of < 0.6, and pleural fluid protein of 2 gram/dL.  Which of the following is the most likely diagnosis?


A.  Infection
B.  Pulmonary Embolism
C.  CHF
D.  Infarction