A 45-year-old woman is evaluated in hospital.

Which of the following is most likely to be seen in this patient?

A) Muffled heart sounds
B) Pleural space exudate
C) Pleural space transudate
D) Ruptured subapical bleb
E) Whispered pectoriloquy

A 46-year-old man is evaluated in hospital. He has a history of COPD. A chest x-ray is shown.

Which of the following is the most likely explanation for this patient’s findings?

A) Adenovirus
B) Haemophilus influenzae type B
C) Mycoplasma pneumoniae
D) Staphylococcus aureus
E) Streptococcus pneumonia

A 61-year-old woman comes to the physician for a 4-month history of progressively worsening double vision and fatigue. Physical and neurologic examination show a partial ptosis of the right eyelid and a right pupil that is fixed at 1mm.

Which of the following is the most likely explanation for this patient’s findings?

A) Impingement of lower brachial plexus
B) Impingement of upper brachial plexus
C) Impingement of the C8 sympathetic chain
D) Loss of parasympathetic outflow
E) Reduction in oculomotor efferent outflow

A 59-year-old man comes to the physician for a 5-month history of progressively worsening shortness of breath. Physical examination shows diffuse dry inspiratory crackles. Blood pressure is 120/80.

Which of the following is most likely to be predominant in this patient’s pathology?

A) Aleveolar dead space
B) Anatomic dead space
C) Physiologic dead space
D) Shunt
E) V/Q elevation

A 62-year-old man undergoes elective abdominal surgery for colon cancer. Current medications are opioid analgesics for postoperative pain control. Approximately 24 hours later, he develops a fever of 38 C. He reports mild shortness of breath. He does not have chest pain, cough, or hemoptysis. Physical examination reveals decreased breath sounds at the lung bases bilaterally without crackles or wheezing. Oxygen sats are 95% on room air. Chest x-ray shows mild bibasilar opacities. Which of the following is the most likely cause of this patient’s fever?

A. Atelectasis
B. Postoperative pneumonia
C. Pulmonary embolism
D. Surgical site infection
E. Urinary tract infection

Which of the following is most likely to be seen in this patient?

A) Decreased alveolar-arteriolar oxygen gradient
B) Decreased intravascular oncotic pressure
C) Loud pulmonic component of S2
D) Normal pulmonary capillary wedge pressure
E) Reduced splenic size

A 57-year-old man comes to the physician for a follow-up examination. Spirometry shows a normal FEV1/FVC and reduced lung volumes. A pulmonary biopsy specimen is shown.

Which of the following is most likely to be seen in this patient?

A) Birbeck granules and lytic lesions
B) Granulomas
C) Neutropenia and splenomegaly
D) Rheumatoid arthritis
E) Supradiaphragmatic and pleural plaques

A 30-year-old man comes is evaluated in hospital. His father has a history of cirrhosis. His arterial bloods are shown:

pH                                             7.39
HCO3^–                                    24 mEq/L
O2 content                          Reduced
pO2                                         90 mmHg
pCO2                                      38 mmHg

Which of the following is the most likely explanation for this patient’s findings?

A) Alpha-1 antitrypsin deficiency
B) Anemia
C) Polycythemia vera
D) Salicylate poisoning
E) Ventilation/perfusion mismatch

A 52-year-old man comes to the physician for a 2-day history of mildly productive cough and low-grade fever. A chest x-ray is shown.

Which of the following best describes the most likely causal organism?

A) Gram-positive cocci in chains
B) Gram-positive cocci in clusters
C) Gram-positive diplococci
D) Gram-negative diplococci
E) Gram-negative rods

A 41-year-old man comes to the physician for a follow-up appointment. Which of the following is most likely to be seen in this patient?

A) CFTR mutations
B) Deficiency of anti-protease
C) Edentulism
D) Infection with cestode
E) Infection with nematode