PULMONARY ROSH REVIEW EXAM WITH
PRACTICE QUESTIONS AND VERIFIED SOLUTIONS
GRADED A+ TESTED AND APPROVED 2026 NEW
MODIFIED
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to your office
for her annual exam. She has had her hepatitis B vaccination, but wants to know if she needs
any additional vaccinations because of her new diagnosis. Which of the following is the most
appropriate next step in her management?
Administer annual influenza vaccine only
Administer pneumococcus and annual influenza vaccines
Administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole
The patient does not need any additional vaccines since she is up to date --CORRECT
ANSWER--Correct Answer ( B )
Explanation:
Patients with diabetes mellitus require regular monitoring and health maintenance to prevent
diabetes-related complications. Health maintenance for these patients includes three
vaccinations: annual influenza, pneumococcus (repeated at age 65 if given prior to that age)
and the hepatitis B three dose series. Patients with diabetes mellitus require annual foot,
dental and dilated eye examinations, blood pressure monitoring, and smoking cessation
counseling. Upon diagnosis, a serum creatinine should be drawn. Annual fasting serum lipids
and urinary albumin-to-creatinine ratios should be monitored. Hemoglobin A1C should be
obtained every 3-6 months with a goal of <7%.
Question: What is the blood pressure goal for patients with diabetes mellitus type 2? --
CORRECT ANSWER--< 140/90.
Page 1 of 125
,A 36-year-old veterinarian presents with myalgias, dry cough, and severe headache. His vital
signs include blood pressure 138/74 mm Hg, heart rate 82 beats/minute, temperature 39°C,
and oxygen saturation 94% on room air. He has hepatosplenomegaly on abdominal exam. His
chest X-ray shows patchy perihilar infiltrates. What of the following is the most appropriate
antibiotic for this patient?
Amoxicillin-clavulanate
Doxycycline
Levofloxacin
Trimethoprim-sulfamethoxazole --CORRECT ANSWER--Correct Answer ( B )
Explanation:
Psittacosis is caused by Chlamydia psittaci, an obligate intracellular gram-negative organism.
It is harbored in avian species making bird owners, veterinarians, and pet-shop employees
particularly susceptible to infection. Patients present with high fevers, severe headache,
myalgias, nonproductive cough, and hepatosplenomegaly. Chest X-rays show patchy
perihilar or lower lobe infiltrates. Patients may have proteinuria and elevated liver
transaminases. Diagnosis should be considered in patients with community acquired
pneumonia and exposure to birds. The treatment of choice is a 14-21 day course of
doxycycline. Complications are uncommon in patients treated with appropriate antibiotics.
Question: What is the antibiotic of choice for psittacosis in children and pregnant women? --
CORRECT ANSWER--Erythromycin.
Psittacosis
Patient with a history of exposure to birds
Complaining of high fevers, severe headache, myalgias, nonproductive cough
Page 2 of 125
,PE will show hepatosplenomegaly
CXR will show patchy perihilar or lower lobe infiltrates
Most commonly caused by Chlamydia psittaci
Treatment is doxycycline
Which of the following physiologic responses would occur after application of noninvasive
positive pressure ventilation in a patient presenting with an acute exacerbation of chronic
obstructive pulmonary disease?
Increased afterload
Increased alveolar dead space
Increased tidal volumes
Increased venous return --CORRECT ANSWER--Correct Answer ( C )
Explanation:
Noninvasive positive pressure ventilation applies a consistently positive airway pressure to
increase laminar flow. This leads to airway stenting, elimination of dead space through
alveolar recruitment, and an increase in tidal volumes and minute ventilation. The beneficial
effects of positive pressure ventilation are not only realized in the pulmonary system but also
in the cardiovascular system. Patients with pulmonary edema from decompensated heart
failure benefit from the increased intrathoracic pressure which decreases venous return and
increases left heart output and thus decreases afterload.
Increased afterload (A) is incorrect because the increased intrathoracic pressure increases left
heart output which decreases afterload. Increased alveolar dead space (B) is incorrect because
airway stenting recruits alveoli and decreases the alveolar dead space. Increased venous
return (D) is incorrect because the increased intrathoracic pressure actually decreases the
venous return.
Page 3 of 125
, Question: What is a physiologic complication of noninvasive positive pressure ventilation? --
CORRECT ANSWER--Barotrauma including pneumothorax.
What lab abnormality is commonly seen in sarcoidosis?
Hypercalcemia
Hypocalcemia
Hypophosphatemia
Neutropenia --CORRECT ANSWER--Correct Answer ( A )
Explanation:
Sarcoidosis has a number of lab abnormalities associated with it including hypercalcemia.
Sarcoidosis is a multisystem inflammatory disease that involves non-caeseating granulomas
composed of collections of T-helper cells and other inflammatory cells. It predominantly
affects the lungs and intrathoracic lymph nodes but can involve a number of systems
including cardiac, skin and neurologic. Chest radiography often reveals hilar adenopathy in
early stages and progresses to pulmonary fibrosis. Patients may present with a host of non-
specific symptoms including fever, fatigue, weight loss and polyarthritis. Other symptoms
depend on end organ involvement. The granulomas secrete 1,25 vitamin D leading to
hypercalcemia and hypercalciuria.
Question: What is the most useful test to confirm a diagnosis of sarcoidosis? --CORRECT
ANSWER--Biopsy of the affected organ.
Sarcoidosis
African-Americans, females
Primary target organ: lungs
Page 4 of 125
PRACTICE QUESTIONS AND VERIFIED SOLUTIONS
GRADED A+ TESTED AND APPROVED 2026 NEW
MODIFIED
A 45-year-old patient with newly diagnosed diabetes mellitus type 2 presents to your office
for her annual exam. She has had her hepatitis B vaccination, but wants to know if she needs
any additional vaccinations because of her new diagnosis. Which of the following is the most
appropriate next step in her management?
Administer annual influenza vaccine only
Administer pneumococcus and annual influenza vaccines
Administer pneumonia prophylaxis with trimethoprim-sulfamethoxazole
The patient does not need any additional vaccines since she is up to date --CORRECT
ANSWER--Correct Answer ( B )
Explanation:
Patients with diabetes mellitus require regular monitoring and health maintenance to prevent
diabetes-related complications. Health maintenance for these patients includes three
vaccinations: annual influenza, pneumococcus (repeated at age 65 if given prior to that age)
and the hepatitis B three dose series. Patients with diabetes mellitus require annual foot,
dental and dilated eye examinations, blood pressure monitoring, and smoking cessation
counseling. Upon diagnosis, a serum creatinine should be drawn. Annual fasting serum lipids
and urinary albumin-to-creatinine ratios should be monitored. Hemoglobin A1C should be
obtained every 3-6 months with a goal of <7%.
Question: What is the blood pressure goal for patients with diabetes mellitus type 2? --
CORRECT ANSWER--< 140/90.
Page 1 of 125
,A 36-year-old veterinarian presents with myalgias, dry cough, and severe headache. His vital
signs include blood pressure 138/74 mm Hg, heart rate 82 beats/minute, temperature 39°C,
and oxygen saturation 94% on room air. He has hepatosplenomegaly on abdominal exam. His
chest X-ray shows patchy perihilar infiltrates. What of the following is the most appropriate
antibiotic for this patient?
Amoxicillin-clavulanate
Doxycycline
Levofloxacin
Trimethoprim-sulfamethoxazole --CORRECT ANSWER--Correct Answer ( B )
Explanation:
Psittacosis is caused by Chlamydia psittaci, an obligate intracellular gram-negative organism.
It is harbored in avian species making bird owners, veterinarians, and pet-shop employees
particularly susceptible to infection. Patients present with high fevers, severe headache,
myalgias, nonproductive cough, and hepatosplenomegaly. Chest X-rays show patchy
perihilar or lower lobe infiltrates. Patients may have proteinuria and elevated liver
transaminases. Diagnosis should be considered in patients with community acquired
pneumonia and exposure to birds. The treatment of choice is a 14-21 day course of
doxycycline. Complications are uncommon in patients treated with appropriate antibiotics.
Question: What is the antibiotic of choice for psittacosis in children and pregnant women? --
CORRECT ANSWER--Erythromycin.
Psittacosis
Patient with a history of exposure to birds
Complaining of high fevers, severe headache, myalgias, nonproductive cough
Page 2 of 125
,PE will show hepatosplenomegaly
CXR will show patchy perihilar or lower lobe infiltrates
Most commonly caused by Chlamydia psittaci
Treatment is doxycycline
Which of the following physiologic responses would occur after application of noninvasive
positive pressure ventilation in a patient presenting with an acute exacerbation of chronic
obstructive pulmonary disease?
Increased afterload
Increased alveolar dead space
Increased tidal volumes
Increased venous return --CORRECT ANSWER--Correct Answer ( C )
Explanation:
Noninvasive positive pressure ventilation applies a consistently positive airway pressure to
increase laminar flow. This leads to airway stenting, elimination of dead space through
alveolar recruitment, and an increase in tidal volumes and minute ventilation. The beneficial
effects of positive pressure ventilation are not only realized in the pulmonary system but also
in the cardiovascular system. Patients with pulmonary edema from decompensated heart
failure benefit from the increased intrathoracic pressure which decreases venous return and
increases left heart output and thus decreases afterload.
Increased afterload (A) is incorrect because the increased intrathoracic pressure increases left
heart output which decreases afterload. Increased alveolar dead space (B) is incorrect because
airway stenting recruits alveoli and decreases the alveolar dead space. Increased venous
return (D) is incorrect because the increased intrathoracic pressure actually decreases the
venous return.
Page 3 of 125
, Question: What is a physiologic complication of noninvasive positive pressure ventilation? --
CORRECT ANSWER--Barotrauma including pneumothorax.
What lab abnormality is commonly seen in sarcoidosis?
Hypercalcemia
Hypocalcemia
Hypophosphatemia
Neutropenia --CORRECT ANSWER--Correct Answer ( A )
Explanation:
Sarcoidosis has a number of lab abnormalities associated with it including hypercalcemia.
Sarcoidosis is a multisystem inflammatory disease that involves non-caeseating granulomas
composed of collections of T-helper cells and other inflammatory cells. It predominantly
affects the lungs and intrathoracic lymph nodes but can involve a number of systems
including cardiac, skin and neurologic. Chest radiography often reveals hilar adenopathy in
early stages and progresses to pulmonary fibrosis. Patients may present with a host of non-
specific symptoms including fever, fatigue, weight loss and polyarthritis. Other symptoms
depend on end organ involvement. The granulomas secrete 1,25 vitamin D leading to
hypercalcemia and hypercalciuria.
Question: What is the most useful test to confirm a diagnosis of sarcoidosis? --CORRECT
ANSWER--Biopsy of the affected organ.
Sarcoidosis
African-Americans, females
Primary target organ: lungs
Page 4 of 125
