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Pulmonary ROSH Review Questions and Answers |100% Pass

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Pulmonary ROSH Review Questions and Answers |100% Pass A 25-year-old man presents for evaluation of fever and cough. He reports last week that he was diagnosed with influenza. In the last 2 days he developed a worsening cough productive of large amounts of sputum. Vital signs are T 101°F, HR 9...

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  • September 15, 2024
  • 151
  • 2024/2025
  • Exam (elaborations)
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  • ROSH
  • ROSH
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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM



Pulmonary ROSH Review Questions
and Answers |100% Pass


A 25-year-old man presents for evaluation of fever and cough. He reports last week that

he was diagnosed with influenza. In the last 2 days he developed a worsening cough

productive of large amounts of sputum. Vital signs are T 101°F, HR 98, BP 120/60, RR

18, and 95% oxygen saturation on room air. His chest X-ray demonstrates a lobar

infiltrate in the left lower lobe. Which of the following would you most likely expect to see

on the patient's Gram stain?




Gram negative bacilli

Gram negative diplococci

Gram positive bacilli

Gram positive cocci in clusters - Answer✔️✔️-Correct Answer ( D )

Explanation:

The patient had a recent influenza infection and now presents with a lobar infiltrate.

Staphylococcus aureus pneumonia is classically associated with causing post-influenza

bacterial pneumonia. On Gram stain this is seen as Gram positive cocci in clusters

Question: In which population is Klebsiella pneumonia most commonly seen in? -

Answer✔️✔️-COPD, Alcoholics and the elderly.

Bacterial Pneumonia Overview - Answer✔️✔️-Bacterial Pneumonia



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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM




S. pneumonia: most common, rusty colored sputum, rigors, gram+ paired lancets

Klebsiella: alcoholics, currant jelly sputum, bulging fissures,

S. aureus: IVDA, postinfluenza, elderly, gram+ cocci in clusters

H. influenzae: COPD, gram negative pleomorphic rods

Pseudomonas: cystic fibrosis, nursing home resident and cyanosis

Health care associated pneumonia: pseudomonas, MRSA

Outpatient, healthy: macrolide or doxycycline

Outpatient, comorbidity: respiratory tract fluoroquinolone (RTF)

Inpatient: RTF

ICU: antipneumococcal ß-lactam (ceftriaxone or cefotaxime) + either azithromycin or an

RTF

You evaluate a 65-year-old patient for shortness of breath and note on exam decreased

breath sounds at the left lung base. You are suspicious of a small pleural effusion. In

which of the following views on the chest radiograph is the small pleural effusion most

likely to be detected?



Lateral

Lateral decubitus left side down

Lateral decubitus right side down

Posterior-anterior (PA) - Answer✔️✔️-Correct Answer ( B )

Explanation:




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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM


Classic physical signs of a pleural effusion include diminished breath sounds, dullness

to percussion, decreased tactile fremitus, and occasionally a localized pleural friction

rub. Chest radiograph confirms the suspicion of pleural effusion. The classic

radiographic appearance of a pleural effusion is blunting of the costophrenic angle on

the upright chest radiograph




Pleural Effusion

Transudate: CHF (most common)

Exudate: infection > malignancy, PE

↓ Breath sounds + dull percussion + ↓ tactile fremitus

CXR: blunting of the costophrenic angle

Question: A pleural effusion is most difficult to detect in which radiographic position? -

Answer✔️✔️-Supine.

Which of the following complications can be prevented by simultaneously administering

pyridoxine and isoniazid in a patient with tuberculosis exposure?



Color blindness

Hepatitis

Peripheral neuropathy

Renal failure - Answer✔️✔️-Correct Answer ( C )

Explanation:




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