Pulmonary ROSH Review Exam || Most Recent Exam 2026
Actual Complete Real Exam Questions And Correct
Answers (Verified Answers) Already Graded A+ |
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A 19-year-old man presents with a sore throat and difficulty
swallowing. He has had 4 days of worsening sore throat and
fever but today he was unable to swallow any liquids. Physical
examination reveals a muffled voice, difficulty tolerating saliva,
and minimal pharyngeal erythema with a midline uvula. He also
has tenderness over the hyoid bone. Which of the following
managements is most likely indicated?
Inhaled racemic epinephrine and discharge home
Intravenous antibiotics and admission
Intravenous corticosteroids and discharge home
Needle aspiration of peritonsilar area - ANSWER-Correct
Answer ( B ) Explanation:
This patient presents with symptoms and signs concerning for
epiglottitis and should have antibiotics started and admission
for further monitoring. Epiglottitis is a localized cellulitis of the
supraglottic structures including the aryepiglottic folds,
arytenoids, lingual tonsils, epiglottis and base of the tongue. It
may be caused by viral or bacterial agents (Haemophilus
influenzae type b is the most common). Although incidence in
pediatric populations has decreased with the H. influenzae
vaccine, it is becoming more common in adults and can lead to
rapid airway obstruction. Patients usually present with
,dysphagia, odynophagia and sore throat. Pain may be severe in
relation to physical exam findings. Additionally, patients
frequently complain of a muffled voice. Fever is present in half
of cases. Physical examination typically reveals mild
inflammation in the oropharynx and may reveal tenderness to
the neck over the hyoid bone. Epiglottitis is a clinical diagnosis
but may be aided by plain radiographs of the neck, which
shows edema of the epiglottis (thumb sign). An epiglottic width
greater than 8 mm or an aryepiglottic fold greater than 7 mm
suggests epiglottitis. Definitive diagnosis can be made with
indirect laryngoscopy. Management in patients focuses on
protecting the airway when necessary starting IV antibiotics
(ceftriaxone and ampicillin-sulbactam are first-line) and
admission for monitoring. Supportive care with hydration is
important as well
Question: Why is airway compromise in epiglottitis less
common in adults than
in children? - ANSWER-In adults, there is an increased
trachea diameter to
epiglottis diameter making airway
compromise unusual.
Epiglottitis
Patient will be complaining of rapid onset of fever
and dysphagia
PE will show patient leaning forward, drooling,
inspiratory stridor
,Imaging will show
"thumbprint" sign
Most commonly caused by H. influenzae,
Streptococcus
Treatment is IV antibiotics and airway
management
Which of the following statements is true concerning aspiration
pneumonitis?
Antibiotics should be administered early in the course
Corticosteroid administration decreases the incidence of
associated lung injury
It is caused by an inflammatory chemical
injury The ABG is diagnostic - ANSWER-
Correct Answer ( C ) Explanation:
Aspiration pneumonitis is an inflammatory chemical injury of
the tracheobronchial tree and pulmonary parenchyma
produced from the inhalation of regurgitated gastric contents.
Aspiration pneumonitis can lead to aspiration pneumonia due
to the breakdown of the pulmonary defense mechanisms
caused by the chemical irritation. Aspiration pneumonitis is
usually associated with depressed level of consciousness that
allows for regurgitation of gastric contents and inhibits the
protective upper airway reflexes from preventing aspiration.
The classic patient has a depressed mental status due to
recreational or therapeutic drugs and regurgitates a large
volume of gastric contents. The elderly and those patients with
a history of stroke are also at increased risk for aspiration
, pneumonitis. Clinically, patients may have minor symptoms
(nonproductive cough and tachypnea). With larger aspirations,
patients may develop tracheobronchitis with bronchospasm,
bloody or frothy sputum, and respiratory distress. The chest
radiograph usually shows unilateral focal or patchy
consolidations in the dependent lung segments.
Question: What is aspiration pneumonia? - ANSWER-An
alveolar space
infection resulting from the inhalation of pathogenic
material from the
oropharynx.
Aspiration Pneumonitis
Inflammatory chemical injury
Inhalation of gastric contents
Can lead to aspiration pneumonia
Depressed level of consciousness
Unilateral focal/patchy consolidations in dependent lung
segments
Prophylactic antibiotics NOT recommended
When diagnosing pneumonia in children, which of the following
findings has the
highest odds
ratio?
Crackles
Oxygen saturation < 92%
Actual Complete Real Exam Questions And Correct
Answers (Verified Answers) Already Graded A+ |
Assured Success!! Newest Exam | Just Released!!
A 19-year-old man presents with a sore throat and difficulty
swallowing. He has had 4 days of worsening sore throat and
fever but today he was unable to swallow any liquids. Physical
examination reveals a muffled voice, difficulty tolerating saliva,
and minimal pharyngeal erythema with a midline uvula. He also
has tenderness over the hyoid bone. Which of the following
managements is most likely indicated?
Inhaled racemic epinephrine and discharge home
Intravenous antibiotics and admission
Intravenous corticosteroids and discharge home
Needle aspiration of peritonsilar area - ANSWER-Correct
Answer ( B ) Explanation:
This patient presents with symptoms and signs concerning for
epiglottitis and should have antibiotics started and admission
for further monitoring. Epiglottitis is a localized cellulitis of the
supraglottic structures including the aryepiglottic folds,
arytenoids, lingual tonsils, epiglottis and base of the tongue. It
may be caused by viral or bacterial agents (Haemophilus
influenzae type b is the most common). Although incidence in
pediatric populations has decreased with the H. influenzae
vaccine, it is becoming more common in adults and can lead to
rapid airway obstruction. Patients usually present with
,dysphagia, odynophagia and sore throat. Pain may be severe in
relation to physical exam findings. Additionally, patients
frequently complain of a muffled voice. Fever is present in half
of cases. Physical examination typically reveals mild
inflammation in the oropharynx and may reveal tenderness to
the neck over the hyoid bone. Epiglottitis is a clinical diagnosis
but may be aided by plain radiographs of the neck, which
shows edema of the epiglottis (thumb sign). An epiglottic width
greater than 8 mm or an aryepiglottic fold greater than 7 mm
suggests epiglottitis. Definitive diagnosis can be made with
indirect laryngoscopy. Management in patients focuses on
protecting the airway when necessary starting IV antibiotics
(ceftriaxone and ampicillin-sulbactam are first-line) and
admission for monitoring. Supportive care with hydration is
important as well
Question: Why is airway compromise in epiglottitis less
common in adults than
in children? - ANSWER-In adults, there is an increased
trachea diameter to
epiglottis diameter making airway
compromise unusual.
Epiglottitis
Patient will be complaining of rapid onset of fever
and dysphagia
PE will show patient leaning forward, drooling,
inspiratory stridor
,Imaging will show
"thumbprint" sign
Most commonly caused by H. influenzae,
Streptococcus
Treatment is IV antibiotics and airway
management
Which of the following statements is true concerning aspiration
pneumonitis?
Antibiotics should be administered early in the course
Corticosteroid administration decreases the incidence of
associated lung injury
It is caused by an inflammatory chemical
injury The ABG is diagnostic - ANSWER-
Correct Answer ( C ) Explanation:
Aspiration pneumonitis is an inflammatory chemical injury of
the tracheobronchial tree and pulmonary parenchyma
produced from the inhalation of regurgitated gastric contents.
Aspiration pneumonitis can lead to aspiration pneumonia due
to the breakdown of the pulmonary defense mechanisms
caused by the chemical irritation. Aspiration pneumonitis is
usually associated with depressed level of consciousness that
allows for regurgitation of gastric contents and inhibits the
protective upper airway reflexes from preventing aspiration.
The classic patient has a depressed mental status due to
recreational or therapeutic drugs and regurgitates a large
volume of gastric contents. The elderly and those patients with
a history of stroke are also at increased risk for aspiration
, pneumonitis. Clinically, patients may have minor symptoms
(nonproductive cough and tachypnea). With larger aspirations,
patients may develop tracheobronchitis with bronchospasm,
bloody or frothy sputum, and respiratory distress. The chest
radiograph usually shows unilateral focal or patchy
consolidations in the dependent lung segments.
Question: What is aspiration pneumonia? - ANSWER-An
alveolar space
infection resulting from the inhalation of pathogenic
material from the
oropharynx.
Aspiration Pneumonitis
Inflammatory chemical injury
Inhalation of gastric contents
Can lead to aspiration pneumonia
Depressed level of consciousness
Unilateral focal/patchy consolidations in dependent lung
segments
Prophylactic antibiotics NOT recommended
When diagnosing pneumonia in children, which of the following
findings has the
highest odds
ratio?
Crackles
Oxygen saturation < 92%
