Pulmonary ROSH Review Exam fully solved &
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Terms in this set (189)
A 25-year-old man presents for Correct Answer ( D )
evaluation of fever and cough. He Explanation:
reports last week that he was The patient had a recent influenza infection and
diagnosed with influenza. In the last now presents with a lobar infiltrate. Staphylococcus
2 days he developed a worsening aureus pneumonia is classically associated with
cough productive of large amounts causing post-influenza bacterial pneumonia. On
of sputum. Vital signs are T 101°F, HR Gram stain this is seen as Gram positive cocci in
98, BP 120/60, RR 18, and 95% clusters
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
,Question: In which population is COPD, Alcoholics and the elderly.
Klebsiella pneumonia most
commonly seen in?
Bacterial Pneumonia Overview Bacterial Pneumonia
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 Correct Answer ( B )
for shortness of breath and note on Explanation:
exam decreased breath sounds at Classic physical signs of a pleural effusion include
the left lung base. You are suspicious diminished breath sounds, dullness to percussion,
of a small pleural effusion. In which decreased tactile fremitus, and occasionally a
of the following views on the chest localized pleural friction rub. Chest radiograph
radiograph is the small pleural confirms the suspicion of pleural effusion. The
effusion most likely to be detected? classic radiographic appearance of a pleural
effusion is blunting of the costophrenic angle on
Lateral the upright chest radiograph
Lateral decubitus left side down
Lateral decubitus right side down
Posterior-anterior (PA) 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 Supine.
difficult to detect in which
radiographic position?
, Which of the following complications Correct Answer ( C )
can be prevented by simultaneously Explanation:
administering pyridoxine and Isoniazid (INH) inhibits the enzyme responsible for
isoniazid in a patient with the conversion of pyridoxine (vitamin B6) to one of
tuberculosis exposure? its active metabolites, pyridoxal phosphate (PLP).
This depletion of vitamin B6 may lead to
Color blindness complications such as peripheral neuropathy and
Hepatitis seizures. Therefore, vitamin B6 should be
Peripheral neuropathy administered concomitantly to patients taking
Renal failure isoniazid. PLP is also a coenzyme required for the
synthesis of gamma-aminobutyric acid (GABA), an
inhibitory neurotransmitter. Decreased GABA
formation in the setting of vitamin B6 deficiency
may also contribute to seizures.
Color blindness (A) is not a complication of INH.
However, another commonly used drug in TB,
ethambutol, is associated with retrobulbar neuritis
and red-green color blindness. INH is metabolized
by the liver and gets converted to an ammonium
molecule that can lead to hepatotoxicity (B).
However, this is not affected by vitamin B6
supplementation. Renal failure (D) is a complication
of pyridoxine overdose.
updated 2026 (latest version verified for
accuracy) | 2025\2026 Latest!!
Save
Terms in this set (189)
A 25-year-old man presents for Correct Answer ( D )
evaluation of fever and cough. He Explanation:
reports last week that he was The patient had a recent influenza infection and
diagnosed with influenza. In the last now presents with a lobar infiltrate. Staphylococcus
2 days he developed a worsening aureus pneumonia is classically associated with
cough productive of large amounts causing post-influenza bacterial pneumonia. On
of sputum. Vital signs are T 101°F, HR Gram stain this is seen as Gram positive cocci in
98, BP 120/60, RR 18, and 95% clusters
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
,Question: In which population is COPD, Alcoholics and the elderly.
Klebsiella pneumonia most
commonly seen in?
Bacterial Pneumonia Overview Bacterial Pneumonia
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 Correct Answer ( B )
for shortness of breath and note on Explanation:
exam decreased breath sounds at Classic physical signs of a pleural effusion include
the left lung base. You are suspicious diminished breath sounds, dullness to percussion,
of a small pleural effusion. In which decreased tactile fremitus, and occasionally a
of the following views on the chest localized pleural friction rub. Chest radiograph
radiograph is the small pleural confirms the suspicion of pleural effusion. The
effusion most likely to be detected? classic radiographic appearance of a pleural
effusion is blunting of the costophrenic angle on
Lateral the upright chest radiograph
Lateral decubitus left side down
Lateral decubitus right side down
Posterior-anterior (PA) 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 Supine.
difficult to detect in which
radiographic position?
, Which of the following complications Correct Answer ( C )
can be prevented by simultaneously Explanation:
administering pyridoxine and Isoniazid (INH) inhibits the enzyme responsible for
isoniazid in a patient with the conversion of pyridoxine (vitamin B6) to one of
tuberculosis exposure? its active metabolites, pyridoxal phosphate (PLP).
This depletion of vitamin B6 may lead to
Color blindness complications such as peripheral neuropathy and
Hepatitis seizures. Therefore, vitamin B6 should be
Peripheral neuropathy administered concomitantly to patients taking
Renal failure isoniazid. PLP is also a coenzyme required for the
synthesis of gamma-aminobutyric acid (GABA), an
inhibitory neurotransmitter. Decreased GABA
formation in the setting of vitamin B6 deficiency
may also contribute to seizures.
Color blindness (A) is not a complication of INH.
However, another commonly used drug in TB,
ethambutol, is associated with retrobulbar neuritis
and red-green color blindness. INH is metabolized
by the liver and gets converted to an ammonium
molecule that can lead to hepatotoxicity (B).
However, this is not affected by vitamin B6
supplementation. Renal failure (D) is a complication
of pyridoxine overdose.
