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Question 1 of 13
1. Question
Physiologists are studying the mechanisms of pleural fluid formation and absorption in the normal state. They obtain healthy experimental animals whose pleuropulmonary anatomy and physiology closely resembles that of humans. Intravenous radioisotope tracers are injected into these animals and are monitored closely to track fluid movement into and out of the pleural space. Which of the following pathways of pleural fluid turnover is most likely to be observed?
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Question 2 of 13
2. Question
A 70-year-old woman has been enrolled in a longitudinal research study on aging for the last 30 years. Medical history is significant for osteoporosis; she has developed moderate kyphosis due to gradual loss of vertebral body height. She is otherwise active and healthy with no additional medical issues. She has never smoked. Compared to her physiology testing done years ago, which of the following changes is most consistent with normal aging?
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Question 3 of 13
3. Question
A 64-year-old man comes to the office due to worsening dyspnea on exertion for the past 3 months. The patient has had a nonproductive cough but no chest pain, fever, or chills. He was diagnosed with hypertension several years ago but takes no medications. Blood pressure is 160/96 mm Hg, pulse is 92/min, and respirations are 18/min. Physical examination shows bilateral inspiratory crackles as well as dullness to percussion and decreased breath sounds at the right lung base. Chest x-ray reveals a right-sided pleural effusion. Which of the following pleuropulmonary changes are most likely present in this patient?
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Question 4 of 13
4. Question
A 33-year-old man comes to the office due to trouble swallowing and a chronic sore throat. He has no chronic medical conditions and does not use tobacco or alcohol. Physical examination shows an enlarged, ulcerated right tonsil. Biopsy of the ulcerated lesion reveals infiltrating nests of moderately differentiated squamous cells. Immunohistochemistry is positive for p16, suggesting that the tumor is likely due to human papilloma virus. Further imaging studies for cancer staging are planned. This patient’s tumor is most likely to spread first to which of the following locations?
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Question 5 of 13
5. Question
A 50-year-old man comes to the office due to a lump in his neck that has been present for 4 months and is enlarging. On examination, there is a firm, nontender, nonmobile mass in the right anterior neck. Otoscopic examination shows a clear right middle ear effusion. Needle biopsy of the neck mass is consistent with regional nodal spread of squamous cell carcinoma. Which of the following is the most likely site of the primary tumor?
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Question 6 of 13
6. Question
A 68-year-old man is evaluated in the hospital due to a pleural effusion. He has a history of base of tongue squamous cell carcinoma with involvement of multiple left anterior cervical lymph nodes. Two days ago, the patient underwent surgery to remove the tumor and the anterior cervical lymph nodes. Today, he has increasing shortness of breath, and chest x-ray reveals a large left pleural effusion. Which of the following was most likely injured during this patient’s surgical procedure?
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Question 7 of 13
7. Question
A 13-year-old girl is admitted for fever, cough, and malaise for the past two days. She has no history of sick contacts and all her immunizations are up to date. Her leukocyte count is 21,000/mm3 with 7% band forms. Upright chest x-ray findings are shown in the image below:
Which of the following is the most likely location of the pathologic process in this patient?
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Question 8 of 13
8. Question
A 20-month old girl is brought to the emergency department for difficulty breathing. The patient has had rhinorrhea and nasal congestion for the past 2 days. She developed a cough and noisy breathing this evening. Medical history is otherwise negative. She is growing well, meeting milestones, and up-to-date on immunizations. On examination, the patient has suprasternal and intercostal retractions, inspiratory stridor, and a barking cough. Inflammation and edema of which of the following sites is most likely causing this patient’s stridor?
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Question 9 of 13
9. Question
An 83-year-old man comes to the emergency department due to a 1-week history of fever, malaise, cough, right-sided chest pain, and worsening dyspnea. Temperature is 38.4 C (101.1 F), blood pressure is 116/70 mm Hg, and pulse is 98/min. On physical examination, the patient is frail appearing. Breath sounds are decreased on the right side. Heart sounds are normal. The abdomen is soft and nontender. Chest x-ray shows a moderate-sized right pleural effusion. Thoracentesis yields purulent fluid. Pleural fluid analysis reveals a large number of leukocytes with 80% neutrophils. Which of the following is the most likely underlying mechanism for this patient’s pleural effusion?
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Question 10 of 13
10. Question
A 22-year-old woman comes to the office due to worsening cough. The patient has been coughing every day for the past several months, but over the last 4 weeks, the cough has worsened, with increased amounts of thick sputum and shortness of breath. Streaks of blood have been present in the sputum on several occasions. The patient also has a history of chronic sinusitis and repeated hospitalizations for airway infections. She takes pancreatic enzyme supplements for chronic diarrhea. She does not use tobacco, alcohol, or illicit drugs. Physical examination reveals nasal polyps, a barrel-shaped chest, bilateral coarse lung crackles, and digital clubbing. Chest x-ray shows hyperinflated lungs and dilated, thickened airways. Sputum culture from this patient is most likely to yield which of the following organisms?
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Question 11 of 13
11. Question
A 13-year-old boy with cystic fibrosis comes to the clinic with a persistent cough over the past 2 weeks despite treatment with several oral antibiotics. Temperature is 36.7 C (98.1 F). Pulmonary examination reveals diffuse wheezing. Pulmonary function testing is consistent with an exacerbation of the underlying disease, and the patient is admitted for broad-spectrum intravenous antibiotics and aggressive respiratory therapy. Induced sputum is collected for cultures. In addition to blood, chocolate, and MacConkey agar, this patient’s sputum should also be cultured on which of the following media?
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Question 12 of 13
12. Question
A 10-year-old boy is brought to the emergency department due to respiratory distress. Over the past 6 hours, rapid, noisy breathing has progressively developed. Temperature is 40.1 C (104.2 F), blood pressure is 105/75 mm Hg, pulse is 120/min, and respirations are 32/min. Examination shows inspiratory stridor and supraclavicular retractions. Lateral neck x-ray is shown in the exhibit. The patient is admitted to the hospital, and blood cultures are obtained. If blood cultures are positive, which of the following would most likely be seen on Gram stain?
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Question 13 of 13
13. Question
A 54-year-old woman comes to the office due to worsening nonproductive cough and dyspnea for the past several months. She also reports anorexia and an unintentional weight loss of 7 kg (15.4 lb). The patient has no prior medical conditions, takes no medications, and is a lifelong nonsmoker. Physical examination shows decreased breath sounds on the left side. Chest x-ray reveals a large left-sided pleural effusion. Thoracentesis yields fluid with a large number of red blood cells and numerous atypical cells staining positive for mucin. Which of the following is the most likely primary mechanism of this patient’s pleural effusion?
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