PULMONARY ROSH REVIEW EXAM LATEST 2024-
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2025 WITH 189 ACTUAL QUESTIONS AND CORRECT
p p p p p p p p
VERIFIED ANSWERS ALREADY GRADED A+ 100% G
p p p p p p
UARANTEED PASS! p
Ap25-year-
oldpmanppresentspforpevaluationpofpfeverpandpcough.pHepreportsplastpweekpthatphepwaspdiagnosedpw
ithpinfluenza.pInptheplastp2pdaysphepdevelopedpapworseningpcoughpproductivepofplargepamountspofpsp
utum.pVitalpsignsparepTp101°F,pHRp98,pBPp120/60,pRRp18,pandp95%poxygen
saturationponproompair.pHispchestpX-
raypdemonstratespaplobarpinfiltratepinpthepleftplowerplobe.pWhichpofpthepfollowingpwouldpyoupm
ostplikelypexpectptopseeponptheppatient'spGrampstain?
GrampnegativepbacillipGra
mpnegativepdiplococcipGra
mppositivepbacilli
Gramppositivepcoccipinpclustersp-
(ANSWER)CorrectpAnswerp(pDp)pExplanation:
p
Theppatientphadpaprecentpinfluenzapinfectionpandpnowppresentspwithpaplobarpinfiltrate.
Staphylococcuspaureusppneumoniapispclassicallypassociatedpwithpcausingppost-
influenzapbacterialppneumonia.pOnpGrampstainpthispispseenpaspGramppositivepcoccipinpclusters
Question:pInpwhichppopulationpispKlebsiellappneumoniapmostpcommonlypseenpin?p-
p(ANSWER)COPD,pAlcoholicspandpthepelderly.
BacterialpPneumoniapOverviewp-p(ANSWER)BacterialpPneumonia
S.ppneumonia:pmostpcommon,prustypcoloredpsputum,prigors,pgram+ppairedplancetsp
Klebsiella:palcoholics,pcurrantpjellypsputum,pbulgingpfissures,
S.paureus:pIVDA,ppostinfluenza,pelderly,pgram+pcoccipinpclusters
H.pinfluenzae:pCOPD,pgrampnegativeppleomorphicprodspPseudomo
nas:pcysticpfibrosis,pnursingphomepresidentpandpcyanosis
,Healthpcarepassociatedppneumonia:ppseudomonas,pMRSAp
Outpatient,phealthy:pmacrolideporpdoxycycline
Outpatient,pcomorbidity:prespiratoryptractpfluoroquinolonep(RTF)p
Inpatient:pRTF
ICU:pantipneumococcalpß-lactamp(ceftriaxoneporpcefotaxime)p+peitherpazithromycinporpanpRTF
Youpevaluatepap65-year-
oldppatientpforpshortnesspofpbreathpandpnoteponpexampdecreasedpbreathpsoundspatpthepleftplungpbase.
pYouparepsuspiciouspofpapsmallppleuralpeffusion.pInpwhichpofpthepfollowingpviewsponpthepchestpradi
ographpispthepsmallppleuralpeffusionpmostplikelyptopbepdetected?
Lateral
Lateralpdecubituspleftpsidepdownp
Lateralpdecubitusprightpsidepdown
Posterior-anteriorp(PA)p-
p (ANSWER)CorrectpAnswerp(pBp)pExplanation:
Classicpphysicalpsignspofpappleuralpeffusionpincludepdiminishedpbreathpsounds,pdullnessptoppercus
sion,pdecreasedptactilepfremitus,pandpoccasionallypaplocalizedppleuralpfrictionprub.pChestpradiogra
phpconfirmspthepsuspicionpofppleuralpeffusion.pThepclassicpradiographicpappearancepofpappleuralpef
fusionpispbluntingpofpthepcostophrenicpangleponpthepuprightpchestpradiograph
PleuralpEffusion
Transudate:pCHFp(mostpcommon)
Exudate:pinfectionp>pmalignancy,pPE
↓pBreathpsoundsp+pdullppercussionp+p↓ptactilepfremitusp
CXR:pbluntingpofpthepcostophrenicpangle
Question:pAppleuralpeffusionpispmostpdifficultptopdetectpinpwhichpradiographicpposition?p-
p(ANSWER)Supine.
,Whichpofpthepfollowingpcomplicationspcanpbeppreventedpbypsimultaneouslypadministeringpp
yridoxinepandpisoniazidpinpappatientpwithptuberculosispexposure?
Colorpblindnessp
Hepatitis
Peripheralpneuropathy
Renalpfailurep-
(ANSWER)CorrectpAnswerp(pCp)pExplanation:
p
Isoniazidp(INH)pinhibitspthepenzymepresponsiblepforpthepconversionpofppyridoxinep(vitaminpB6)ptopo
nepofpitspactivepmetabolites,ppyridoxalpphosphatep(PLP).pThispdepletionpofpvitaminpB6pmaypleadptop
complicationspsuchpaspperipheralpneuropathypandpseizures.pTherefore,pvitaminpB6pshouldpbepadmin
isteredpconcomitantlyptoppatientsptakingpisoniazid.pPLPpispalsopapcoenzymeprequiredpforpthepsynthes
ispofpgamma-
aminobutyricpacidp(GABA),panpinhibitorypneurotransmitter.pDecreasedpGABApformationpinpthepset
tingpofpvitaminpB6pdeficiencypmaypalsopcontributeptopseizures.
Colorpblindnessp(A)pispnotpapcomplicationpofpINH.pHowever,panotherpcommonlypusedpdrugpinpTB,pe
thambutol,pispassociatedpwithpretrobulbarpneuritispandpred-greenpcolorpblindness.pINHpis
metabolizedpbypthepliverpandpgetspconvertedptopanpammoniumpmoleculepthatpcanpleadpto
hepatotoxicityp(B).pHowever,pthispispnotpaffectedpbypvitaminpB6psupplementation.pRenalpfailure
(D)pispapcomplicationpofppyridoxinepoverdose.
Question:pWhatpispthepmostpcommonplocationpofpextrapulmonarypTB?p-p(ANSWER)Lymphpnodes.
PulmonarypTuberculosisp(TB)
RFs:pimmunodeficiency,pimmigrant,pclosepcontactp
Latent/primarypTB:pasymptomatic
Active/reactivationpTB:pfever,pnightpsweats,pweightploss,pproductivepcough,phemoptysisp
Erythemapnodosum
PrimarypTBpCXR:pGhonpfocus
Active/reactivationpTB:pupperplobes,pcavitaryplesions
, Dx:psputumpsmearspforpacid-
fastpbacillip(AFB),psputum/tissuepculturepforpAFBp(goldpstandard)pPPD:pgoldpstandardpforplatentpT
Bpdx
LatentpTBprx:p9pmonthspofpINH
PrimarypTBprx:prifampin,pINH,ppyraziniamide,pethambutolp(RIPE)
Ap45-year-
oldppatientpwithpnewlypdiagnosedpdiabetespmellitusptypep2ppresentsptopyourpofficepforpherpannualpex
am.pShephasphadpherphepatitispBpvaccination,pbutpwantsptopknowpifpshepneedspanypadditionalpvaccin
ationspbecausepofpherpnewpdiagnosis.pWhichpofpthepfollowingpispthepmostpappropriatepnextpsteppinph
erpmanagement?
Administerpannualpinfluenzapvaccineponly
Administerppneumococcuspandpannualpinfluenzapvaccines
Administerppneumoniapprophylaxispwithptrimethoprim-sulfamethoxazole
Theppatientpdoespnotpneedpanypadditionalpvaccinespsincepshepispupptopdatep-
p(ANSWER)Correctp Answerp(pBp)
Explanation:
Patientspwithpdiabetespmellitusprequirepregularpmonitoringpandphealthpmaintenanceptoppreventpd
iabetes-relatedpcomplications.pHealthpmaintenancepforptheseppatientspincludespthree
vaccinations:pannualpinfluenza,ppneumococcusp(repeatedpatpagep65pifpgivenppriorptopthatpage)pandpt
hephepatitispBpthreepdosepseries.pPatientspwithpdiabetespmellitusprequirepannualpfoot,pdentalpandpdila
tedpeyepexaminations,pbloodppressurepmonitoring,pandpsmokingpcessationpcounseling.pUponpdiagn
osis,papserumpcreatininepshouldpbepdrawn.pAnnualpfastingpserumplipidspandpurinarypalbumin-pto-
creatininepratiospshouldpbepmonitored.pHemoglobinpA1Cpshouldpbepobtainedpeveryp3-
6pmonthspwithpapgoalpofp<7%.
Question:pWhatpispthepbloodppressurepgoalpforppatientspwithpdiabetespmellitusptypep2?p-
p(ANSWER)<p140/90.
Ap36-year-
oldpveterinarianppresentspwithpmyalgias,pdrypcough,pandpseverepheadache.pHispvitalpsignspincludep
bloodppressurep138/74pmmpHg,pheartpratep82pbeats/minute,ptemperaturep39°C,pandpoxygenpsaturati
onp94%ponproompair.pHephasphepatosplenomegalyponpabdominalpexam.pHispchestpX-
raypshowsppatchypperihilarpinfiltrates.pWhatpofpthepfollowingpispthepmostpappropriatepantibioticpforpt
hisppatient?
p p p p p
2025 WITH 189 ACTUAL QUESTIONS AND CORRECT
p p p p p p p p
VERIFIED ANSWERS ALREADY GRADED A+ 100% G
p p p p p p
UARANTEED PASS! p
Ap25-year-
oldpmanppresentspforpevaluationpofpfeverpandpcough.pHepreportsplastpweekpthatphepwaspdiagnosedpw
ithpinfluenza.pInptheplastp2pdaysphepdevelopedpapworseningpcoughpproductivepofplargepamountspofpsp
utum.pVitalpsignsparepTp101°F,pHRp98,pBPp120/60,pRRp18,pandp95%poxygen
saturationponproompair.pHispchestpX-
raypdemonstratespaplobarpinfiltratepinpthepleftplowerplobe.pWhichpofpthepfollowingpwouldpyoupm
ostplikelypexpectptopseeponptheppatient'spGrampstain?
GrampnegativepbacillipGra
mpnegativepdiplococcipGra
mppositivepbacilli
Gramppositivepcoccipinpclustersp-
(ANSWER)CorrectpAnswerp(pDp)pExplanation:
p
Theppatientphadpaprecentpinfluenzapinfectionpandpnowppresentspwithpaplobarpinfiltrate.
Staphylococcuspaureusppneumoniapispclassicallypassociatedpwithpcausingppost-
influenzapbacterialppneumonia.pOnpGrampstainpthispispseenpaspGramppositivepcoccipinpclusters
Question:pInpwhichppopulationpispKlebsiellappneumoniapmostpcommonlypseenpin?p-
p(ANSWER)COPD,pAlcoholicspandpthepelderly.
BacterialpPneumoniapOverviewp-p(ANSWER)BacterialpPneumonia
S.ppneumonia:pmostpcommon,prustypcoloredpsputum,prigors,pgram+ppairedplancetsp
Klebsiella:palcoholics,pcurrantpjellypsputum,pbulgingpfissures,
S.paureus:pIVDA,ppostinfluenza,pelderly,pgram+pcoccipinpclusters
H.pinfluenzae:pCOPD,pgrampnegativeppleomorphicprodspPseudomo
nas:pcysticpfibrosis,pnursingphomepresidentpandpcyanosis
,Healthpcarepassociatedppneumonia:ppseudomonas,pMRSAp
Outpatient,phealthy:pmacrolideporpdoxycycline
Outpatient,pcomorbidity:prespiratoryptractpfluoroquinolonep(RTF)p
Inpatient:pRTF
ICU:pantipneumococcalpß-lactamp(ceftriaxoneporpcefotaxime)p+peitherpazithromycinporpanpRTF
Youpevaluatepap65-year-
oldppatientpforpshortnesspofpbreathpandpnoteponpexampdecreasedpbreathpsoundspatpthepleftplungpbase.
pYouparepsuspiciouspofpapsmallppleuralpeffusion.pInpwhichpofpthepfollowingpviewsponpthepchestpradi
ographpispthepsmallppleuralpeffusionpmostplikelyptopbepdetected?
Lateral
Lateralpdecubituspleftpsidepdownp
Lateralpdecubitusprightpsidepdown
Posterior-anteriorp(PA)p-
p (ANSWER)CorrectpAnswerp(pBp)pExplanation:
Classicpphysicalpsignspofpappleuralpeffusionpincludepdiminishedpbreathpsounds,pdullnessptoppercus
sion,pdecreasedptactilepfremitus,pandpoccasionallypaplocalizedppleuralpfrictionprub.pChestpradiogra
phpconfirmspthepsuspicionpofppleuralpeffusion.pThepclassicpradiographicpappearancepofpappleuralpef
fusionpispbluntingpofpthepcostophrenicpangleponpthepuprightpchestpradiograph
PleuralpEffusion
Transudate:pCHFp(mostpcommon)
Exudate:pinfectionp>pmalignancy,pPE
↓pBreathpsoundsp+pdullppercussionp+p↓ptactilepfremitusp
CXR:pbluntingpofpthepcostophrenicpangle
Question:pAppleuralpeffusionpispmostpdifficultptopdetectpinpwhichpradiographicpposition?p-
p(ANSWER)Supine.
,Whichpofpthepfollowingpcomplicationspcanpbeppreventedpbypsimultaneouslypadministeringpp
yridoxinepandpisoniazidpinpappatientpwithptuberculosispexposure?
Colorpblindnessp
Hepatitis
Peripheralpneuropathy
Renalpfailurep-
(ANSWER)CorrectpAnswerp(pCp)pExplanation:
p
Isoniazidp(INH)pinhibitspthepenzymepresponsiblepforpthepconversionpofppyridoxinep(vitaminpB6)ptopo
nepofpitspactivepmetabolites,ppyridoxalpphosphatep(PLP).pThispdepletionpofpvitaminpB6pmaypleadptop
complicationspsuchpaspperipheralpneuropathypandpseizures.pTherefore,pvitaminpB6pshouldpbepadmin
isteredpconcomitantlyptoppatientsptakingpisoniazid.pPLPpispalsopapcoenzymeprequiredpforpthepsynthes
ispofpgamma-
aminobutyricpacidp(GABA),panpinhibitorypneurotransmitter.pDecreasedpGABApformationpinpthepset
tingpofpvitaminpB6pdeficiencypmaypalsopcontributeptopseizures.
Colorpblindnessp(A)pispnotpapcomplicationpofpINH.pHowever,panotherpcommonlypusedpdrugpinpTB,pe
thambutol,pispassociatedpwithpretrobulbarpneuritispandpred-greenpcolorpblindness.pINHpis
metabolizedpbypthepliverpandpgetspconvertedptopanpammoniumpmoleculepthatpcanpleadpto
hepatotoxicityp(B).pHowever,pthispispnotpaffectedpbypvitaminpB6psupplementation.pRenalpfailure
(D)pispapcomplicationpofppyridoxinepoverdose.
Question:pWhatpispthepmostpcommonplocationpofpextrapulmonarypTB?p-p(ANSWER)Lymphpnodes.
PulmonarypTuberculosisp(TB)
RFs:pimmunodeficiency,pimmigrant,pclosepcontactp
Latent/primarypTB:pasymptomatic
Active/reactivationpTB:pfever,pnightpsweats,pweightploss,pproductivepcough,phemoptysisp
Erythemapnodosum
PrimarypTBpCXR:pGhonpfocus
Active/reactivationpTB:pupperplobes,pcavitaryplesions
, Dx:psputumpsmearspforpacid-
fastpbacillip(AFB),psputum/tissuepculturepforpAFBp(goldpstandard)pPPD:pgoldpstandardpforplatentpT
Bpdx
LatentpTBprx:p9pmonthspofpINH
PrimarypTBprx:prifampin,pINH,ppyraziniamide,pethambutolp(RIPE)
Ap45-year-
oldppatientpwithpnewlypdiagnosedpdiabetespmellitusptypep2ppresentsptopyourpofficepforpherpannualpex
am.pShephasphadpherphepatitispBpvaccination,pbutpwantsptopknowpifpshepneedspanypadditionalpvaccin
ationspbecausepofpherpnewpdiagnosis.pWhichpofpthepfollowingpispthepmostpappropriatepnextpsteppinph
erpmanagement?
Administerpannualpinfluenzapvaccineponly
Administerppneumococcuspandpannualpinfluenzapvaccines
Administerppneumoniapprophylaxispwithptrimethoprim-sulfamethoxazole
Theppatientpdoespnotpneedpanypadditionalpvaccinespsincepshepispupptopdatep-
p(ANSWER)Correctp Answerp(pBp)
Explanation:
Patientspwithpdiabetespmellitusprequirepregularpmonitoringpandphealthpmaintenanceptoppreventpd
iabetes-relatedpcomplications.pHealthpmaintenancepforptheseppatientspincludespthree
vaccinations:pannualpinfluenza,ppneumococcusp(repeatedpatpagep65pifpgivenppriorptopthatpage)pandpt
hephepatitispBpthreepdosepseries.pPatientspwithpdiabetespmellitusprequirepannualpfoot,pdentalpandpdila
tedpeyepexaminations,pbloodppressurepmonitoring,pandpsmokingpcessationpcounseling.pUponpdiagn
osis,papserumpcreatininepshouldpbepdrawn.pAnnualpfastingpserumplipidspandpurinarypalbumin-pto-
creatininepratiospshouldpbepmonitored.pHemoglobinpA1Cpshouldpbepobtainedpeveryp3-
6pmonthspwithpapgoalpofp<7%.
Question:pWhatpispthepbloodppressurepgoalpforppatientspwithpdiabetespmellitusptypep2?p-
p(ANSWER)<p140/90.
Ap36-year-
oldpveterinarianppresentspwithpmyalgias,pdrypcough,pandpseverepheadache.pHispvitalpsignspincludep
bloodppressurep138/74pmmpHg,pheartpratep82pbeats/minute,ptemperaturep39°C,pandpoxygenpsaturati
onp94%ponproompair.pHephasphepatosplenomegalyponpabdominalpexam.pHispchestpX-
raypshowsppatchypperihilarpinfiltrates.pWhatpofpthepfollowingpispthepmostpappropriatepantibioticpforpt
hisppatient?
