Pulmonology- Block 6

A 13-year-old female with asthma sees you for the first time in a year. The patient has a cough and you discover that she has not been taking her medications since you last saw her. She has been having symptoms 3–4 days a week and has been awakening at night about 3 times a month. Her FEV1 in the office is 90% of predicted. This patient’s asthma should be classified as

A 63-year-old female with corticosteroid-dependent COPD has developed pneumonia. Which one of the following pathogens should the antibiotic regimen cover in this patient that would be unlikely in someone with pneumonia and otherwise healthy lungs?

A 12-year-old male uses a short-acting bronchodilator three times per week to control his asthma. Lately he has been waking up about twice a week because of his symptoms. Which one of the following medications would be most appropriate?

A 64-year-old male presents with increasing dyspnea on exertion. He feels well otherwise and has no chronic medical problems. A physical examination is normal. Pulmonary function testing reveals normal spirometry, with no evidence of an obstructive or restrictive pattern. However, his lung carbon monoxide diffusing capacity (DLCO) is low. Based on these results, which one of the following is the most likely diagnosis?

A 19-year-old woman with cystic fibrosis presents with fever and a productive cough. She is tachycardic and tachypneic on presentation. She has not been hospitalized in over a year. The patient’s X-ray is shown above. What management is indicated?

Which of the following physiologic responses would occur after application of noninvasive positive pressure ventilation in a patient presenting with an acute exacerbation of chronic obstructive pulmonary disease?

A 25-year-old female with asthma uses her albuterol (Proventil, Ventolin) inhaler only before running, but reports waking up short of breath four times per month. She went to the emergency department recently for increased dyspnea during peak ragweed season and remained overnight until her symptoms improved. Which one of the following is the best treatment option now?

42-year-old female presents with a cough productive of blood-streaked sputum for the past 3 days. Her hemoptysis was preceded by several days of rhinorrhea, congestion, and subjective fever. She estimates the total amount of blood loss to be approximately 1 tablespoon. She is a nonsmoker and her past medical history is unremarkable. Vital signs are within normal limits, and other than an intermittent cough there are no abnormal findings on the physical examination. Which one of the following would be the most appropriate next step?

You see a 58-year-old female whom you suspect has COPD and you recommend formal testing in order to confirm this diagnosis. The cutoff most often used for COPD diagnosis on a spirometry test performed while the patient is stable (not experiencing an acute exacerbation of symptoms) is a postbronchodilator FEV1/FVC ratio of:

A 40-year-old male respiratory therapist presents for a health examination prior to hospital employment. His history indicates that as a child he lived on a farm in Iowa. His examination is unremarkable, but a chest radiograph is shown. No other findings are noted. A PPD skin test is negative. The findings in this patient are most likely a result of