Copy of Pulmonary Rotator Challenge

What is your experience level?

What is your specialty?

How many DAYS did you rotate on pulmonary?

How many cases (from the case packet) did you complete?

A 67-year-old man is diagnosed with emphysema. He describes dyspnea on exertion that requires him to walk slower than other people his age. He has never had a COPD exacerbation before. Laboratory testing reveals an eosinophil count of 100 but is otherwise unremarkable. Cardiac stress testing is negative. PFTs confirm an obstructive pattern consistent with COPD. Which of the following is the best inhaler to manage his symptoms?

How would you best classify COPD in a patient with symptoms only during significant exertion, an FEV1 of 55%, and an exacerbation that hospitalized them 1 month ago?

A 48-year-old woman with asthma presents with worsening wheezing and productive cough. She is breathing comfortably on room air. Diffuse mild wheezing is heard on the exam. A chest CT reveals the above findings. Laboratory testing reveals an eosinophil count of 900. Which of the following is the next best step in management?

You are evaluating a patient for dyspnea. Pulmonary function test results are below (represented as percent predicted pre-bronchodilator). Which of the following diagnoses is most consistent with these findings?

FVC: 72%

FEV1: 69%

FEV1/FVC ratio: 0.97

TLC: 74%

FRC: 122%

DLCO: 96%

A 38-year-old man who owns a small farm presents with a 6 month history of worsening cough and shortness of breath. He has never smoked. Chest CT demonstrates scattered ground glass opacities with centrilobular nodules in an upper-lobe predominant distribution. Which of the following conditions is most likely?

A 62-year-old woman presents to the emergency department for shortness of breath. Her heart rate is 128, blood pressure 122/70, and she is requiring 2L O2 by nasal cannula to maintain saturations >92%. CT reveals bilateral pulmonary emboli. Laboratory analysis shows a moderately elevated BNP. Bedside ultrasound shows mild to moderate dilation of the right ventricle. She is low risk for bleeding. Which of the following is the most appropriate treatment?

A patient with metastatic lung cancer presents with shortness of breath after an international flight. CT imaging reveals a segmental pulmonary embolism. They are hemodynamically stable and without evidence of right heart strain. They are deemed at moderate risk of bleeding. Which of the following is the most appropriate initial treatment strategy?

A patient is diagnosed with thrombosis of the superficial femoral vein. They are low risk for bleeding. Which of the following is the best next step in management?

A 42-year-old woman presents for fever, cough, and chest pain. She is hemodynamically stable and requires 4L O2 via nasal cannula to maintain a SpO2>92%. Chest X-ray demonstrates a large left-sided pleural effusion. Diagnostic thoracentesis is performed. A point-of-care device is used to obtain bedside lab results below. Which of the following is the best management strategy?

Pleural pH: 7.12

Pleural glucose: 56g/dL

Which of the following positive test parameters for a tuberculin skin test would best apply to a patient with HIV?

Which of the following patients meet USPSTF criteria for lung cancer screening?

A 62-year-old man presents for 8 weeks of cough. It is nonproductive and not associated with the time of day, positioning, or eating. His only animal exposure is his household cat of 6 months and he has never smoked. His medications are amlodipine and lisinopril, which he has been on for about three years without any apparent side effects. He describes a poor diet. Which of the following is the next best step in management?

Which of the following is the most effective smoking cessation regimen to aid in continued abstinence?

A 64-year-old man with a history of a seizure disorder and coronary artery disease is pursuing smoking cessation. His medications include levetiracetam, aspirin, and atorvastatin. Which of the following is the best treatment to aid in continued abstinence for this patient?

A 30-year-old patient with a history of recurrent respiratory infections and sinusitis presents with concerns of possible cystic fibrosis. What is the initial diagnostic test that should be ordered for this patient to assess for cystic fibrosis?