WS SbebeeeuuNaaveeesercnar ‘A Styoarld womans brought to he enexgoncy deparment duo to an aggessve ‘ough wth copious amounts of thick foamy yellow groen putin Sho says she has hod this cough or bout years win exacerbation sim to her presaeation today. So aso opas tat her cough is wosoin the morning. Sho was evaustod mute timosin the ast several yorsbecovze of recurent bouts of bronchitis thet have requited testment wth rtbivcs She sa nonoker On phyla exam te Boag pressures 25/78 mm Hg, pulse rates 3D Im resprctey ate min and 36:7C (BED). Chor aureutaton reves tackles and ‘over te right mile lobe andthe esto her physical examinations are nea. The ‘chest ay shows ieguor pactiesin te ight middle bbe and dtse way Uhckering: Based on ths Nitony and physical exam, which ofthe llwingis the most ly agnosis? © A Tuberetosts (© 8.Alpnastantypsin donconcy © C Bronchiotss © E-cronicbeonetes‘A Styoarold womans brought to he enexgoncy deparment duo to an aggessve ‘cough wth copious amounts of tek Foam yellow-gron sputum. Sho says she osha tis ough er about years win exacerbaton snl to her prsentaten ‘today. She as epors ator coughs wots in ho maming. Sho was evaluated mip times nthe pst several years because of rearort bouts of ones that have rege emer wt antibies, She ra non-smoke On physica exam, ‘the blood pressures 125/78 mm Ho, ps aes Bm, espa rates in nd tempratre = 367°C (98.0F} Chest ausadtaon vent aces and wheezing ver tonight mile lobe andthe rest fhe pysical exarinations ae hormal The chest ay sows regula cpactles ne ight middelobe acd (Ste sey ching, Gascon is Hato and phys eam which ofthe following the mos! Waly agnor? A Tubercuode © 8.Alpna:tantypsndotconcy € Bronchiot Beasae £ cvonicbroncite Result: WS SbebeeeuuNaaveeesercnar avaExplanation: Related Videos: Consct ansvr€ Bs on th cn Mags nd chat ay i pont Inst ty ster om bonhicas, Te conan mot commer ets econo aninecous pes a teen th orerna rd peratent dsrtn ofone or more ft conducng bono arway Bee nage The conc: scion and Cnc Signs ‘heels nce any cbstucton(og,foeenboayepraton rte © ‘roe CA, Yana eon, inst ot cy enon, lee {ronchopimonay sper APA ened Cee snc. © Series Doan tet © Bere ae First Aid References: Fst Afr the USMLE Step 12018, 2h oa 651 Fst A forthe USMLE Step 12018, 2h oa 657 Frat Ad forthe USMLE Stop 12017, 27H 699 WS See BeeeUuNaaveseserssarecarevsaasus| eae}[Prenchopumonary aspergloss ABPA, a caret smolang, © First Aid References: N Ft A fer UE a 1 mh \ | sen | | Fttther tn wate 108,200 557 é BF A | | nseenermarnertconzmea en \a Cael cineal mantetaton of bronchitis elude a protictue cough eh copious amounts oft smoting.ucpuruet spun, wich usualy ‘preset for yours, Patients on hve a past istry repeated aggressive ‘esprotory vat infections however. single apace ot scr! preumon emus tuberculosis r mycoplasma inecton can resut nbronchecass. Physical examination Frings of ackles and wheeting are cerimon who ‘gal boing occurs neiy about 2% of patios wt agnosod ‘The Kay ining include dated and tickaned akways ad iegular ‘pects that apresent cous plugs Disted broncls and mucous pugs are also evident, istlogcally CT scan isthe gol standard agnosis for . " ” = »VAUBH Ec as¥uuspabsasaecessacacec hea. o-8 ‘opacies that represent mucous plugs Dilated bronchioles a MUCOUS DUDS steals evident, Mstlogcally CT scans he gol standard agnostic test or ‘teen, and ets are seen en high esolon CT scan. After the agnosis |S conmed, evaluation for underivng causes, Sach es cyst ross, ‘rmunestobun ceicencios, nd myeabactrl dase, sould be poroimed based onthe cinealcreumstanees oft patient ‘Option A: though patients wth tuberculosis often present wih a productive cough, they ales have some oer typical symptoms of tubercles Le. ever, ‘igh swoats. and walght oss), hich ao absontin his patent Movover the racdogaphe tudes of uber wll domonstatocavty formation atte {pac of he ngs and grartoms formation athe hu ‘Option: Alpha taniuypin deficiency (ATO resus n hepatic ane espiatory spt. The ast common symptom of ATD s dyspnea which show ence of emphysanstous bude at the base of oth lungs. ‘Option: Atough COPD and roncHects have may symptors in common, the chatacters featires of bronchiectasis clude tronic dally ough wie macopurulnt sputum production. Aso, the above pati aks ise aco indeatng COPD feg. smoke. and the rodogroph« ngs sunDest ‘broncvectats. ‘Optom The diagnos of chon bronchi requires a even productus| cough or at ast’ 3 months over 2 yeas Ou patents counting and also producing copious amounts of sputum, which uggess bronchiectasis. ‘estonaly, he imaging stds of ron bone wl domonetate ae aVAUBH Ec as¥uuspabsasaecessacacec hea. o-8 ‘Opkon A though pation: wth bors often prosent waa productive ough, they als have some oer yal symptoms of tubercles eve eight sweats. and welt ss). hich ae absent inthis patent Moreover, the ‘ecyapte cis of becca wl domonetats cout rman at ne apex of he ngs and grarfoms formation a he hu ‘Option Alpha-tantypsn deficiency (AATD ests in hepatic ae espratory symptoms. Tha mast common symptom of AATD dyspnea which ‘= abeont inthe above patio. Moreover tho veologc studios in ATO woud show evidence of emphysematous blo atthe base of both lungs ‘Option: Athioush COPD and broneiecass hove many symptorsin ‘commen, the caactet fairer of bronclectass nck tron aly ough wieymucopurlnt sputum production. Also, the above pal aks isk {actor inating COPD fog sek), and the radiographic ndings suaoeot ‘roncvesae ‘Option: The diagnos of conc bronchi requires a erere productve ‘ough for ot ast 2 months over2 year. Our patents coughing and also rodung copious amounts of sputum which suggests bronchiectasis. ‘sionally, he imaging stds of conc bronchi wl demonstrate Incressed bronchovesuor marge. Leaming objective: Bronchistass 2 ynctome cf chronic cough with copious feulsmeting sputum production assecated wit permanent kway Xay thangs nude ta radoluent ung darklungs wih few makings) cause thay aehypet ested and a et dlapryagms ako iypcal. A crest CT . " ” = » geesWS See Be eeeu Seay eves esses acacenwoas Patonts wth COPD rogue chest Xray to ode terrae elagoces. The >eray ndings neice ta racoluert ange ar linge wth ew mags) because hey aehyper- fated and a at danagin sao rca Achest CT ‘leo recommended Pulmonary ncn teat [Pe ae so pat tho ‘workup n patents vith suspected COPD ad show an FEVUFV rat of ess ‘han G7 The ng volume measurements often show an wncrease ntl ang capoaty, funciona residual pact, andrea wotame ‘Option A: Asbestosis a fvm o preumnaconieis. hough the history of ‘blag constuction worker sa hk ctor or aabestos ypc cones 3 ‘esbicive pater on punonay function teen nike this patent whe has 2n ‘bstuctve pata, ‘Option 8: Onesty nypoventaionsyotame i charactorizd by favgue and 30 ka’ Tho pation lofts pulmonary sear le ofen restrictive, unlike the above paint who has fan obebuctve pat, ‘Option: llopanic pulmonary fibrosis more typkay causes aresicove pater on sromety wih pore decreases in ath the FEV! and FC; tik ths patent who hasan obstructive pate Acton, pulmonary bros ‘mot ely to esl in decreased lung volumes in convastto the Ineased ‘ung volumes san nti patent. ‘option D: Atnough bronchicss shares many fares wah COPD een proce cough the patients wth bronchiectasis produce copious emes ‘ofsputum tate do not eee nthe above ptr. Aceon, he mah tology of broctctsiss acon or ecant espratny Vat inocton ‘Our pation does nt seem to have preuroni or istry of respiratory Pesctc to etWS See Be eeeu Seay eves esses acacenwoas atactorforasbestor, typical caures@ resticwe pater on pumonary function festng nike his patent who has an ‘bstuctve pat, ‘Option B:Ovesty hypoventilation synatome is charactorized by faigue and cyte somnetencoin pains who are obese (IM > 30 kg Tho parm ofthis pulmoary seas son resicve,unlke the above ptt who has an obsructve pata, ‘Option Conte puna rose mote tpn cnses aresicwe ‘tenon sromety wh parol docressos nah th FEV! ahd FC. ut ths patent who hasan obsractive pate Adktonally, pulmonary boss ‘mor ily to est n decreased ling volumes convastto the inceased ‘ng volumes sen nis patent. Option: though bronchictss shares many features wih COPD (chee rose cough, the patents wth brnchietae produce copious wlumos ‘of sputum tate do not seen he above pair. Aceon he mah ‘tology of bronchiectasis acvonc or ecuent esplatory vat nection. (Ou patient dos not Soom wo have pocurania of ant orespatoy Infection, br esa sory of smoking, amar tk eto for develo c0°0. {Leaming objective: The carcinal poms of COPD incudeayepnea, hrc ough, and sputum production. The mest common eat symptom & xoronel ‘epnee, The pumonaryfuncbon testing shows an FEVUFVC rato of es than (7 and hing volume measurements hat cen demenetste an Wereaeed TLC, FRC ond RV Hct‘8 50,yoarot4 man prosnts wih a 2.aay Noy of creasing ety in bron witha productive cough He reports having shortness of breath over the ast Ihonths, the ha fet woes snes he sonractes mead tat na Bee raveng ‘sounds fc. Tey, Deepa bey achos, Neadecho an Tower long wth HS ‘rons cough. Hi past moda hctory i signfcant or preabees, wich he ‘contol wth xc and let He has 3 30 pack year smoking sory. Hs blood pressure 2078 mn, pulse ate fe SO/min, temperate 369°C 8S) and respratory rat Simin Physical examination evel: diminished breath sounds bilateral a bate shaped chest. and meseied resting tough peed ps. chest ay eves afatenee dlepvagm and no ss ef consliation. Pumonary function texting reves FEVVFVE ais of 60% Arter blood gnee (ARG) ot thi patent are most kyo rveal which afte lloming? zs : " : x = © A Noranion gap metabolic actos (© 8 Primary ospratry acidosis © C Primary respiratory alkalosis (© E Ann gap metabolic acidosis with espratxy akalosis eae}‘8 50,yoarot4 man prosnts wih a 2.aay Noy of creasing ety in bron witha productive cough He reports having shortness of breath over the ast Ihonths, the ha fet woes snes he sonractes mead tat na Bee raveng ‘sounds fc. Tey, Deepa bey achos, Neadecho an Tower long wth HS ‘rons cough. Hi past moda hctory i signfcant or preabees, wich he ‘contol wth xc and let He has 3 30 pack year smoking sory. Hs blood pressure 2078 mn, pulse ate fe SO/min, temperate 369°C 8S) and respratory rat Simin Physical examination evel: diminished breath sounds bata baetstaped chest and measured breathing trough pursed Ips. A chest Xa eveas a Matened daphragm and no signs consoldaton. Pulmonary Function testing reves FEVUFVC rai cf 60% Arter blood gnee (ARG) of this patent are most kyo rveal which afte lloming? zs : " : x = cat ‘A.Non-anion gap metabolic acidosis ~~ 3 18. imary respiratory acdess om . © Primary respratery alkalosis om a £ Ann gop meteboc acidosis wth respteyakaloss x Result: er. " ” = » gees Explanation: ‘Correct answer B:Gion th ptlont’s History of shortness of breath and 930 eckyear smoking Neto, ths patient most kay has een bstuctve ‘pulmonar disease (COPD) wich i curonty exacrbatod duo to a econt ‘upper respatery infection Radiographic featrcesuagestve of COPD incu Increased radeticency ofthe ing anda at aptragm, ‘Anal blood gece (ABs) ae perormed during acute exacerbations of (COPD o measure the seventy of he episode. Mido moserate hypoxema wth nypercapei is common in his pepultion, The primary acid bao disorder In COPD i respator acidosis oe o chronic carbon donde retetion Chon resprtory actos leads to compensatory metabolic halos the absence of blood ges measurements, Soran Diabonato vols ao set To {ooning disease prosession ‘Option A: The causes of non-arion gap metabo actoss nce ares, ‘eal tubular ctdose, and some chugs e. spronoactone, acetazolamie, ‘Option c: Pinay respiratory akaloas cous est due to ypervertaion ‘ich causes excessive removal of ctbon xe kom our body. Peers wih (COPD retan carbon doce nd hectare have pana tesa ack Related Videos © ine ra Dee: San osm © hate lsc Pan Ove COPD Cease First Aid Reterences: Fst Ad forthe USMLE Step 1 2018, 20th: 60 Fst Ad forthe USMLE Step 1 2018, 2th oh: 56 Fst A forthe USMLE Step 12017, 27th 538WS Seb eeeUuN aay Beesercnaracasewoas! ‘COPD to measure the saver ofthe epsode Milo moderate hyporems ‘th pesca is common in his pepulton, The primar ackbse dsxcer | COPD respiratory acidoris dv to ceric carbon ote retention ‘Chron resprtory actoss leads to compensatory metabolaaloss. the absence of blood gas measurements, seam Dabonsto evel ae set for ‘option A: Te causes of on anion gap metabolic acidosis nude ar, ‘eral ubuar cos, and some chugs ea. sprendacone, etal, ‘te, COPD doesnot case metabo eksoes ‘Option: Primary reepratoyakales cous rest due to hyperveraton ‘anicn causes excessive rroval of carbon oxide om out body. Parts wh ‘COPD ret carbon done nd threore have primary respiratory ecko rotalsione ‘Option D: Compensatory reepratory acidosis eon response to prinay matali aa Cases of primary metabolic anos include vomiing and ‘erosemio use whichis cmpensated by retaining carbon oxi, hereby resulting nrespatory aise. n pater wth COPD, metabocakalos| ‘compensates fo pinaty spar aids ‘Option: Arion gop metabo acids wih respatry alesis so mixed _sci.base dlsordor which sean in pation wih saat etoxeaton. Th patent has no evidence of salelte use, Learing objective: ators wth COPD may develop espa acidosis ue ts.trons carom doce retnton, Chron eepaary sit lenaet compensatory metbote aos First Aid References: Fst Ad forthe USMLE Step 12018, 29h 860 Fst A forthe USMLE Step 1 2018, 28th: 056 Fst A forthe USMLE Sop 12017, 27h ch 638ScbeeeuuNaeruvesenssaracacexsoal £75 year-old man is evauted a to emergency depart fr ncseasing shores of breath forthe lst mont He aco comiaine of dry coh or the Inst mort. Italy his shores of breath ocurs wth exert, eutnow hafeeks itat estas wel. H ha no ater complains. He has asodontany Mose ahaa 2 hip replacement surgery recon, The past medial history is sitar hypertension for whch he staking lsnepi The patria time non-smoker. ‘The Blood presi s 35/85 mm He, pulse ae 6 BS/min, nd the tempera ts {386°C (97977, Physical examination roves ie nepntry crackles and gts ‘Subba. chest ay reveals pargheraletcuar opacities associated wth acton broncnicctass predominant athe ung bases. The pumonary uncon test ress resolution CT scan ofthe chests shown, Which ofthe flowing he most ksh agnosis? 8 Pulmonary omen DB. Kopathic pulmonary resis {C-Chrone obctuctve pulmonary asease 1. Druginduced pumenary resis £ chonyeia proumanioeEerer as - £75 year-old man is evauted a to emergency depart fr ncseasing shores of breath forthe lst mont He aco comiaine of dry coh or the Inst mort. Italy his shores of breath ocurs wth exert, eutnow hafeeks itat estas wel. H ha no ater complains. He has asodontany Mose ahaa 2 hip replacement surgery recon, The past medial history is sitar hypertension for whch he staking lsnepi The patria time non-smoker. ‘The Blood presi s 35/85 mm He, pulse ae 6 BS/min, nd the tempera ts 386°C (97977, Physical examination roves ie nepntry crackles and gts ‘ubbing, chest ray reveals pergheraletiuaropactes associated wh tract bronchiectasis predeminaray atthe ng bass. The pulmonary function rao. High erlion CT scan fhe chest shown, Wich he following isthe eos mee sear eam OBES ‘8 Pulmonary mot 8. optic pumonary bres C Crvone obetrictve pumonayaesaes 2. Druginduced pumenay foes £ chonyeia proumanioe ScbeeeuuNasrusesenssaracacenvoalWS See beaeUuNaaveeesersnarecaceese Explanation: ‘Corect answer This ptiont hos iopatic pulmonary fibrosis (FF. wich ‘Sa fom of dtuse parenchymal lung dsaasa tends to be more common in ‘men wi mest cases presenting ao over the age o 50 year. The athogonest involves exposure t an nating agent ag smoke, “ronmental olin, endronmna sof valet) na sisceptble est eaing tote inal aveclarepsnelal damage e-ctablsing an intact epthtan allowing hein ea key componont of atmal wound naaing The mechanism considered Dein IPF sho aetuatcn of aveolreptaialces after an nur hich provokes the migraten. lleration, and activation of mesenchymal cls. These changos outa the ‘maton of feats foo eodng tothe excess accumulation ot ‘etraceldor mate wt the reversible destin of he ing rence. ‘The patents typically recent wih progrestive dyspnea on averion and conic ay cough ger cubing chest pan fatigue, malaise and woight Joss. The pulmonary function test eats may be noma nk sseae6 oF show aresiewe patem = recent eapaey ad ea king epacty bit ‘ear nema sida! value} The DLCO teasing capacty of ho hang or 2° a £8 35 youl man prsonis oho omorgoncy room duo to shorines of boat hat tated an hour ago whe plying focal wth some tends, He hashod senior {episodes the past when he aco had tbe rshed tothe osptal Physica ‘xanination shows body tenets 272°C (8.7), pul aos YON respratey rat is 28min an blood pressure 60 mm Ha. Als. & shows ‘decreased beat sounds en bot sides, the peak expan fo rato 6200 Un {and 550; 5 89% on com ai. The man fs ven an ial etme wth ebutzaton Using anal shor acting fiagont An ateral blood os anal shows the folowing WS SbebeeeuuNaaveeesercnar pH 788 P20, 59mmHo Paco, 26 mmHg HOO; 26meait ‘Aner aanerng oxygen by mask, te mare PaO, mereass 075mm Hg, Which ofthe atoning the most het cause otis patents conan? '8. carbon menor (CO} plsoning oleae ato respiratory detrosssyndome YARDS) eal}Seer Beas BuSadyeseverssaracaceuss| Explanation: Comet new Atma isn ceanee that ses hyper dis to a9 ‘ncroas m the veatavonporison (V0) rao with an increased aver tril 49 rodent amount ofbiood reaching the aveol per minut. The Aa gracent isthe “ference belween the avecar concentration of cxygen (andthe ati eoncenuaten of exygen (9 ina dsoasod ng, votlaondecroses but ptusion remains the same. The net eflectsporemia. 2 cecrease nthe ‘amount of angen nthe Heed tata PaO, offs than 80mm Ho ‘supplemental cnyaen sin ths patents case), Common causes of hypoxenia ue o VQ mismatch wih increased ba gadentincude obsvuctve lung ‘asoases asthma, COPD) punt vascular dsoases(pumenay embaten), nd rst dees, ‘tho startofn atin attack. normal P20; (100 mn Ha) als de toa ‘mnshod vertaton surface oronchocansrcts level below 60 mm Hg Indicates a sever attack asi this pat’ case PaCO2 als deceases rm {2 nomal evel a 40 ie Hg ue othe mereased roepratry ae whic, tur, produces an elevation in pH, Since HCO. 5 the noma range, Related Videos: ‘Asthma: Sutypes and Diagn First Aid References: Fst Ad fr the USMLE Step 12018, 29th e650 Pst ad for the USMLE Sep 1 (2018, 280 e@: 5 Fat Ad forthe USMLE Step 1 2017, 270 ec 628WS Sex beeeUuNaaveeesersnarecaceese ‘vio startfan asta stack normal PaO, (100 mn Hg) as de wa ‘mnshed versa surface broncheconsrtei a evel bow 60 mm Ha Indicates a severe attack. as this pant’ case PaCO2 als decease rm {normal evel a 40 me Hg 6 ote creased espratty ae we, ‘ur, produces an elevation in pH, Since HCO nthe nol range, rmetable aslo can be ned out 63 aghast inthe patient. ‘Option B: CO peering a conn, potently tn a ely Ldexclagnosed cause of ypasemie because isnanspeciic nical ‘breseniation.CO has profound ec on oxygen tanspet (ths 240 mes ‘mote afrity for hemesictn than oxygen) an, alesse degree peripheral ‘gen ltt. CO sometines indices the appetance of non cardogenic pulmonary edema, eflectvely causing shunt The tostment for CO potions ‘nck promt removal om the sree of CO adn of 10% aoe Dy nometveating facemask or endovacheal ube. Ts patent rece lowdose anygen and weuld nat expend fhe hed CO poisoning Option: kcictass oss oung volume due tothe colapse tung ‘issue This causes shunt veo oteperfied but not vertate. The a ‘rade decreases and PaO, would netnciase withthe us of exygen, ‘Option D: Respiratory muscle wesknesscaurelby the newomncua esoee ‘can causo ypavcmi due tonsa vontaten. In those cases, PCO, tends to, the Ra gradient romaine unaired, od the pation respons 10 ‘veatment wth oxygen. Ahough this patent responds to cxyge, Ne eal 2cO, ot elevated ts actualy below the normal ange) ng out erence dense os 0 Gagnoss, ‘Option Paints wah ARDS ype presor win vespiatonyastess chritenzedby ayspnae, ypeminbbeal eco ititates, aed ne bectucioWS Sex beeeUuNaaveeesersnarecaceese low:dose anygon and would nat eepond be hod CO poisons. Option: Acictass toss oung volume due tthe clase of ung ‘issue. This couses a shunt eo ofe perfused but not vertated. The a ‘fader decreases and PaO, would notnclase withthe use of exygen, ‘Option D: Reston muscle wesknesscaurelhy he nevomcula esoee ‘can causo ypavcmi due to insure vera. n those casos, PCO, tends tors, he a gadint remains unaored, oe he patlont expand to ‘veatment wth oxigen Ahough this patent respond to cxyge, Ne eal 2cO, ' ot lovato ts actualy below the normal ange) ng out peromuscuor diease 36a diagnos Option: Paints wh ARDS typically recor with recpttoy tess chhractezedby dyspnea, hypoxemia bata aeoarifittes, ae use crackles, These thangs usualy begin witin 48-72 hous of thelneing event ana hen pi won. aria blood gas0s evo hypoxemia whichis en companied by acute respratoryakaloss and an elevated a gradient. High ‘oncenuatons of supplemental erygen ave generally requted to maintain equ ygonaion, Tough ts plot has expla ass, be dos notre high conceneations of angen to improve, making this dagesis cathe Leaming objective: Actin ea ezente hat causes hypoomindustoan ‘ncraasa the Vi rato wit an creased A. gracent ithe dseased un, ‘ia mismatch nreases because the heterogenety of both vention ae persion weson. The nt effect hypoxemia, Hypoxemie duoto V1 ‘naman can be crtected win iow to moderate Row supplemental oxygen, HctWS SbebeeeuuNaaveeesercnar ‘oad boys brought othe otc by his mtn th compl of loa nasal ‘decharge ane cough for tho past 2 wooks, The metho ays that her zon has pal ‘rng swing Alo the boy often complains t headaches wth» ml ever ‘Atmough Ns mor gave rin somo orto counter madison, are wes only 8 tlghtimorovement Five days ag, his nasal ichorge became puruent with an Increase nthe quency fs cough He has no relvant medal istry His as Inctse: near ate 95 bp respkatory ate ran er temperatute 373°C 1002"F (On physical era, he ashore phan wth purr cere cn the postr wail hats, ard nostri wth copious arunt of pus. Vic athe Tollowing themes ely cause? A Dpnnera 8. Rese shuts C Non.aterge vasometor hints © D.SueprococeatphaynonsWS Sse be aeUuNaaveseseessarecacess| ‘A oad boys brought othe feo by his meter wth complains of loa esl echorgo and cough forthe past 2 wooks The mother says that her sn bs pam ung swalowng Alo, he bey often complain of headeches wh mld over atheugh ns mother gave hi Some overho counter modieaton, thee Was on sght improvement Five days ago, his rasa dicharge became purulent wih aninerease nthe quency fis cough, He ha no relevant medial ery Hs als nce: near rate 95 Op, espa tate ini, and tempeiue 379° 1000277. physical exploration he hs hyperemic phary i puro ‘ascharge on he poster wal, altos. and nostis wth copious amounts of pus (Whi of ne toning the mesticy couse? A Dpnnera 8. cso shuts © CNon-aterge vasomotor ints 2. Sueprococcalphayngas aGada Resul Bch tt" ” = » gees Explanation: Comet newer Sinus o thneenuate the nfamimation ofthe ‘mucosal ining o ono mea of ho paanasa suse. Such infanmation common during val upper respatoryinfetons URH but ual resales spomaneouny cite acta nos) acu when here Secondary Sacealntoction of tha sinuses ‘ABR hasbeen clastic accorcng fo the dation and recarence as lows: Ate ‘symptoms Compe resaive n< 30 days ‘subzcutoCompltety escve i230 and < SO cays ‘Atleast 3 opsodes of <20 dys duration separated by intwals ‘of 10 cays without symptoms ma 6-month pete or at east four such epsedes no 12 month pated ‘chvonie minosinusts is dain by apodes of ammation ofthe paranasa ‘sinuses thot ast > 90 days, during which paints hove persistent symptoms ye minesnieie may be Related Videos: © Kazsrni Oven sn Poeny © Hess srs dead Eneoeay First Aid References: Prat ad forthe USMLE Step 12019, 290 09 57 Fst Ad forthe USMLE Step 12018, 28 of): 653, Fst Afr the USMLE Stop 1 (2017 270 eo) 535WS Sse be aeUuNaaveseseessarecacess| ‘Chronic hinasmusts is dod by epsodes of ilammation ofthe paranasa ‘sinuses that ast» 90 days ding which paints have pesistnt symptoms {e, cough, minorhen, nasal obatrucon, Cae minosnuie may bo ‘elated to nenfetouscontions suchas aera. es boss, cary ‘yskinesa gosteecophegel er of exposure to eevionmental polars. ‘The cna fates of ABRS ete a cough mal symplons, ov, halts eadaee facil pain ae sweling. and sre trot ‘Via URI and aloo hints ae the most frequent predkposing factors or /ABRS in chdten Lees conmen predisposing acters include anstomic ‘bstucton mucosal trans and suddon changes nerosphorc pees ‘The dlognoss of uncompliated ABRS con bo made clnically i chleren wth symptoms an ge of sro inflammation ye cough, nae ‘symptoms or bth and oe of ho folowing presentations: ‘Symptoms | reser wiheut improvement for> 19 ad < 30 ays, ‘Severe appearance, trperature= 29°C 1022, ane purulent symptoms nasal charg or 23 consocuive days Worsening nease nespietory symptoms, new onset ot severe mplom_heedache or fever or ecurence a fever a ital ‘The fdrgsin a patient wth ARBS incu a cough asl symptoms eve, altos, needache fal pan and naling, sre oat. Tho paint in his incl vet fits the ceri for ARBS (ess thon 30 dos} of he {ecompleated type fo full te tee ceria} and has many ofthe cial Anns pal of Bch ttWS Sse be aeUuNaaveseseessarecacess| ‘The fnargein patent wih ARBS Incase 3 cough aes eympoms eee haltoss, neadachofacal pan and satin, sto tveat. Tho patent in is ical veto lis the ceri for ARBS (ess than 30 dos} of ho Lucompleated ype fo fits te tree ceri and has many of te cal Anaings pica of ‘Option A: Respctoryaipthetais pial caused by toxin-podcng stains ‘tC apterice rail, eased by tgenie rane ct oer ‘Conmebacterum species eros, Cfemotcum. of pseudotubercls)- Symptoms play begin 2-5 days after necten. The ‘most commen prseatng thangs at a sre myoat, malaise, cervical ymphadenopoty, anc arage fever at ast net of cases oc ‘lboration of toxin induces the formation of coalescing peeudomembrane (composad atnecrotc te oukoeyes,enthvcyes ptt olan ‘raises. This membrane can extend © any porn ofthe respiatory rac ‘tem te rasa passages othe wacheobronchl Woo. Upto two-three of aeee have tansitophayngoa vehement: nolemont fhe laryngeal, nasal and trachecbroetil ef comon. Opton: Nonateric vasomotor tis vasomotor his, itepathe hints, ‘tnt ied anf rece ante ae cine Ue a ‘Synonyaes used ree to exon nena als NAR) asynaromein vihicn some combination ef snoceing, inohos, esl congestion, and postnaalranage present ovr tne the absence o 9 spece many NAR canbe best dctnguised lem other fms of uns wi a detated lineal istry. Compared with allergic hati NAR as ater age of onset {usunty ater age 20}and mre prominent nasal congestion and poses ‘tanage. Patios ofen Kenly weather centions or nanspcte respiatory ttt eg, lgatato smoke) as xacoratng ocr.WS Sse be aeUuNaaveseseessarecacess| tants eg, gate smoke) 95 exacorbatng acters ‘Option: Group A stoptacoccus (GAS) ho most common cause etbacova ‘haryngisin chen and adolescents, accounts for 630% of al cases of [haryngts in chren between the ages of 55 years. ntemperat cates, ‘Moincldence ef GAs phaymgts peaks ding the wir and ety sping GAS _horynats yl as an abrupt ons. Fever, headeche. abdominal ah ‘nausea, and voting may accompany 3 sore test Acton features may ‘nce exudate phar, craig tender ator contcal ron node, ‘alt petechib, famed uns and scaratifom ash, Symptoms aly ‘resolve spontaneous in 3-5 dys. ‘Option E: The common cots usa 3 mil and enn va ness lnvotang, to varie degrees, sneezing. nase congestion and dscharge, sore (trot cough lovgree fee, beadecho, and mula. infart d yourg tier. the eyptoms usualy peak en cay 2-8 ofthe and hen gradual Improve over 0-14 days, in older children andadclescets, symptoms usaly ‘solve 5-7 days. Re-vahton may be warranted fh symptoms worsen or exceed the expected duration Leeming objective: Acie bactetlhnosinuns ABRS) hos been chsied sezorang wn aura andrecurence 5 IEW: + cate Symptoms completely resolve < 30 dys. + Subacute Symptoms compltayesovein2 30 and< 90 days. + Rocuront acute: Atlas tres cpeodos of <3 days cation sper bpnteras of 10 days without symptoms in 2 6-nont peo, or at lest our such episodes na 2-month ped ‘Chore thnosiusts ic dened by episodes of flammation ofthe parnasa ‘Sruses tat aet> 90 dys, arg vnich patents have porstnt symptom (e.9, 90 dys, dung which patents have persitnt symptoms (9.cough hiner, nasal obstucion.WSSbebeeeeuNearuveseessarecaces| ‘4 30 yoa-ol8 patent comes tho omorgoncy room wi aot complaint a ot ‘hestpain anda productive cough wih purlnt stu forthe past weok He also omptine ot hones of basin He sah na Been prewousy diagnosed eth respratey rat of 2iin,tomperatre 327 {LT} bood peesre of 20160 rng, $0, 80% Hemogram 3 olows Hemoglobin mai Hematoot 45% Lucey count 2,000"? ‘Newvoptis 82% lymphocytes 15% Monocyes 3% Pratletcourt 270000inmn* (Chest Kray avsolr inten tele base wth a bronchoarame 8. Poser .Hitoplesmoss ‘ung esneor E Tuboretots ens‘4 30 yoa-ol8 patent comes tho omorgoncy room wi aot complaint a ot ‘hestpain anda productive cough wih purlnt stu forthe past weok He also omptine ot hones of basin He sah na Been prewousy diagnosed eth respratey rat of 2iin,tomperatre 327 {LT} bood peesre of 20160 rng, $0, 80% Hemogram 3 olows Hemoglobin mai Hematoot 45% Lucey count 2,000"? ‘Newvoptis 82% lymphocytes 15% Monocyes 3% Pratletcourt 270000inmn* (Chest Kray avsolr inten tele base wth a bronchoarame : " : x = nats Be most ety agnosis? 8. Pomerania C Histoplesmoss ‘ung esneor E Tuboretots eal}Explanation: Related Videos: comet newer There are 2 man types of ate bacterin pneumens ‘broncopnumenia (th ober topography) and lobar pacman aber topography), Bronchopneumonia fbulr prouroni is an acute oxuatve Pruner suppurative ilommation of the gs chareterzed by fol of consolation Preumons Osesteoton : Surrounded by normal prencyna, See mage Deb fr he voualzaton of © ossomn bets ypoe First Aid References: Fst Ad forthe USMLE Step 12018, 20h 04) 5 Fst Ad forthe USMLE Stop 12018, 28 oh: 654 Fst Afr the USMLE Step 12017270 dh 645 WS SbebeeeuuNaaveeesercnar eae‘suppurative ifanmaton ofthe ngs characterized by fol of consoldation Sureured by normal parenchyna, Soo mage dalow othe voualzation ot e% ScbeeeuuSaeruvesenssaracaces| © Manos cutee First Aid References: Fst Ad forth USMLE Sop 1 2018, 29th 0: 58 Frat Aid forthe USMLE Stop 12018, 28 od 654 Fst Ad forthe USMLE Stop 12017270 e545HOY Bees Be ERR ENeeeessarecasen ‘Common elogesincdudebactvis Such as Stapylococcus Sueprcoccus, Hoomoptsusintuentoe, Proteu,Eschovche ct Lover pneumonia kan aeuo nude ilammatin fan entra pulmonary lobe, pocuced in 95% of cases by Sreptococcus preumonie. The ssc resentation of obarpeumenia with abrupt ont feve. chills, cous, end so pai, occu mora common in th younger pation. Physica! ‘amination yp reveals sors of consotdaton, lk factr for acai pneumonia nude hn infection, ltl abe, ‘smoking, COPD an asta, hyposplenism or plenetony, srmunecompyomso, and thers gomalsshoss. natctaion pregnancy. ‘rack cocaine we, wong. Fox degre, the sputum Gram an can be used Inti tt shouldbe conte by bio care onary ang ‘Atheugh iar consoldation supgestwo of acta peurnona, radogaphs ‘cannot olay diferente bacarilfom non octal poumons. ‘Option A: Sarcoidosis pial aft young adit. appeal on hall cof eaes te detected n asmptomate nuk de odontal ‘adapt abpemaltes e, lateral har adenopathy, etl opactes, ‘Common presenting symptoms incl a caugh, depres chest pn ye suspected satcldes Dest the advances n ou mrowledge ef the Immunopatogenans ot sarcoidosis the elogysllramaine © myst, ‘Option c:stoplasmesiscausoa by Hsoplsma capstan which proliferates best nso contaminated wth bd Bot croppings, lich ae Delve ae the rol earatereies fren sporti fhe organi ‘Stes commeniy assocetod wi expasute to H capsulatum nude cckon 20pe of farm bulsng wt ge accumulations a chicken cropping Abandoned buting,brdoo% tes, caves, and wood. ActesHOY Bees Be ERR ENeeeessarecasen ‘snpecid sarcoidosis. Despite the advances i ur knowledge ofthe ‘rmunopetogences of srcldets, tn elegy ellremsine = mysten ‘Opton: Hstepasmeosis causes by Hteplema capsulatum which feats ost scl contamina with bit cbt croppinge, wih aro ‘loves to ater th sol characteris favoring sprain of ho organism. ‘Stes commonly associated wih exposure to H capsuetun nude chien o0ps arm bung with ge accumulations of chicken eppings, associated wth exposure nie excavation, constuction demotion, ‘emodeng, woodeuting ana gathering and expan caves. Symptomate pulmonary Histoplasmosis pial presents a subacute pulmenayinfaction weeks to mont lowes exposure. Symptons are wsualy mi, andthe ‘vents causing the expose ae fat oder Racootap typcal show {focal iftetes and medaetnal or sar ymphdonopaty ‘option: Thaugh ican preson tha cough chest pai and dyspnce, ether the radography nor the History ofthis patent suggests ng cancer 8 chest redograph CT fs much bette emonseatng anew or enlarging focal ‘esion pout fio, plow nocdarty, nlxged iar or pararacsl [lect wuld euggest long cane The ik near for ong canes nce ‘smoking ain ik rcton aaaton therapy, enwonmontl facts, pumanery ‘tro HIV infection, geno actos aleohol ort ecto, A tagnot ‘denoted upon he pathologie esitonctextsogi eg, Pewra te) ‘stopathloge eg, teu ope spacers, ‘Option: The lagna of pulmonary tubecuoss(T) shoud be suspected in atonts wi lovan crcl mantestaions (a cough fer mote than 2103, weeks duration, phedencpaty fevers. right sweats. weit and ‘elevart eodemislog tatre Misty o ie TB nen o deacona 1. = a ‘focal tes and mecastnal or lar ymphadenopathy. ‘Option: Thouch can presen wlth a cough chest an and dpe, ether the radecraphy ner te Histor of ts potent suggests ng cancer A chest adogrph CTs much bot cemansvating a now of elgg foal reson, pour fusion, low nockany nlxged hor or paatracl ‘ede, endcbronci lesion, potebstucve pnaumena, or segmantallobar ‘oloctsi would suggesting cancr The isk actors for ung cancer cud “smoking ain ek fer adlaton therapy, envronment factors, pxdmonsry ‘Soros HV infection, genni facos,sleoholorietay actor tagnot ‘made based upon he pathologic evaluation eying, plowal ho stopathlooic le. issue bore specimens, pon: The diagnos f pulmonary ibercuose (TH) should be suspected in atts with relevant cirscal manestaons (a cough for more than 2103, ‘weeks dation, phederopaty fevers. ight sweats, weightloss and ‘llevan epemvologi Tacs story o pie TBivection o soa, known ‘or porsble TB exposure, andor past or present renenceln or raveltoan area where T's endemic The most common chest adograph abnormally ‘ir adenopathy, Otter manesttons inca plow fusions and puenary HOY Bees Be ERR ENeeeessarecasen Looming objective: There are 2 man pes of ext bate paeumonia ‘brenchopneumenia ath obs topography) and lebarpneumonis feber ‘epog.apny, onchopreumana duly phoumoni) an acu axudatve suppurative flormation of te es characeried by fel of corsoltation Soreunced by normal parenchyma Lebar pnaumnis san ate etecarer a ‘4 40yoa.olt man prsonts ote ofc complain of cis, ver, and pede ‘cough forthe pst 24 hours Ho has a history of voking ince he was 18 yors 1 He vale areata of Sinn respon rate of 20min, emperre 39°C (102277, tod pressure 10/70 mm Hg, On syst examination, theres dullness ‘on prcusion onto upper rit lobe, aswel as Bron beat sures ond tsgophony The pin aclograph revels an create deny wth a avectat pate mt upper ight abe Which cn she most comnon tlogc agent of he surpocted cose? SOY Bees URGE EN esersnaracace | sueptococcus preumarioe 8. Chlomyata poeunonioe Legionet pounapnia .Hoomophis inure E MycoplosmepreumenoeEarer as 1. = a ‘4 40yoa.olt man prsonts ote ofc complain of cis, ver, and pede ‘cough forthe pst 24 hours Ho has a istory of oking ince he was 18 yors 1 He vale ar: ears of Sinn respon rate of 20min, empertee 380°C (02-77. lod pressure NOY7O mm H,On physical examination, theto S| {dulness on porcssin on ho upper ight bs. as wol as bronchial reat sounds and egephony The plain radiograph reveals an increase in density with an alvelor pate mine upper ight lobe Which ae she most comen etlogc aget of tho sapecte deca? © Kaipara om 2. Chaya preumenioe a» Legenate poounopria a © Hoerophusinkeneve % Myceptsma pues i ea Result @ conec sOrecgcusayrgcacwessacecas Bh oese.-Explanation: Related Videos: ‘Comect answer A: strepococcus pneumoniae has wadtionaly been the most, commen cause of communty-acqured peumenia (CAP. The esc ‘rerenaton of pneumococea pers, th Supt onet of feve cis, ‘ough, and side prin occurs more common nthe younger pant Phys ‘amination ypicaly reveal Sgro cansotastion(auoss on poresion, ‘roncil breath sounds, eocpry, and whispered peconlogy Whe sputun Gram stan can suggest peumacocalinfecton, the agnosis of ‘phoumocaccal pnoumaria should be cortiemed by blood culture at utinary First Aid References: frtigen though lobar corsoldations sggetve of Dace reuonn, ‘cpap cannot olay diferente baci tem nenbacttl peumoni Fst Ad forthe USMLE Step 12018, 26 od 136 © eee Peumere Fst Ad forthe USMLE Stp 12019, 2h of 135 ‘Option B:C:prcumanice Is a common Chlanyaa spacis to cause human Fst Afr the USMLE Stop 12017 270 e152 Infection, Studs that wed molecule techniques hve ented [Preomonie nies than of esos of CAP Dna ds oC prsumeniae asa higher Inccence nok ashi in cotrast wh Mycoplasma “Transmssion of the organs fot tobe person to person and has been nplcated in outbreaks of uring heme aequtepeumonia. Preumaria and #@¥ Bees Be eRe rev esenssarecasSOY Bees URGE EN esersnaracace ‘Option B:C.preumonioe sa cmon Chlamydia spaces cate human foe higher nesence nee ait: sn cotrt wh Mops fpncumonie tec, which acurs ost comment n younger age groups mplcated in outreaks of parsing heme seq poumonia Preumona and ‘bronchitis re the most commen respatry infections assoited with C ‘pneumoniae. Se common eto hoover, cudo grail ens ot ‘ymptoms, essocted phaynatis, and hoarseness Sn ecuerty accompanies or develops asa compilation ofCgreumanize preumenis, Injection wth Mjeopiosma preumanioe, Lgioneda Sp, and respi ‘ruses con present in sia ttn ‘Opton: Leglonnlas sose ithe more common syrxkome of pneumonia “oust by Lagionalo species, Respiratory symptoms arent prominent ‘nay The cough a fs, rd and cn Sipay axoducve. Te sputum may ‘be bloc streaked, but gross hemp ar, Chest pain can occur some patos an, seconpnsa by hemapfyin may ad to an sronscie ‘agnosis of pulmonary embolim. Gasvortastnal symptoms ae ocr ‘brominont wth thos nauies, veri nd! abdorinal pan Patents re Common ltrs uth a headache an drcasonal spot Py ‘amination vets les wi subsequent signs of consedaton Fevers ‘itty aye prose and orl temperature grate than 80% (0227) should suggest he possi of Legernatres' tease Laboratory becomes ae common but nonspede icing real and hepatic ‘ystuncton, tembocyopeni,laxoeyes, nd hypaphoephatomi, yponatemiosrum sodium 20 mEq occur signin more equerty Jonna’ dicase than in preunonia of othe ctcloies, Hematuia ahd Fst Ad forthe USMLE Step 1 (2018, 28th ea 3S Frat Ad forth USMLE Stop 12017, 27 oo 22SOY Bees URGE EN esersnaracace ‘Option C: Lalani soso fh mare common syncrom of pneumonia caused by Legionella species, Respratory sptoms arent prominent Intl The cough a fs, ld ander sighaly productive. The spturn may be loca streaked, but ross nomopysi ar, Chos psn can occur n some patents ae faccompanied by hemoptysis may lad to an erroneous ‘agnosis of pulmonary emboli. Gastotestinal ymptoms ae oft ptominont wh hoa raises, Yering and abdominal pa Patent ro Common lthsic with headache ad occasional stpor Physica ‘examination revels les wth subsequent sgn of conseleaten Fevers wresaty aeys present and oft tompertuo greater than 80% (027F) should suggest tho possibly of Legernakes' dears. Laborato Spsenmlties ae common bitnonepectsnckcng rena and hepatic ‘ystuncion,embacyopeia, leukocytes, nd hypopesphatom, Hyponavomio serum sodium: 120 mEq/l occur sini more oquerty In legionnater' lease than n preumona fhe eologes eats ona toon aro also common. Vitualyalpaonis wn Lgionnaes’ disease ‘vo roiogrpte abnomaies by tothe day afin. Th most common ater a patchy unicoarinirate that progresses consolation; howeNe, alypes of nivates have been reported, ning use, ners ‘Option D: Haomepusintuenzas fe common considered a cause ot ‘neumonn especaly In olde adn cgoetie smokers, and patent wth onic obstuctve lung disease. However several lage seis flowing the wacspread use a conjugate vacins agaist infiuerzo0 type Bin con hve shown 9 decreasing edenceofinfecton ae sto nonypete trans compared win the mete invasive type b fection. Based onthe ‘roponsy forthe organism to tact tho munacompromsed an ldar ‘cs, th reslitonts oft slow with many pavers having prelongod orptlaatonEarer a 1. = a Inte, Plewralefsons are a0 commonplace ‘Option: Hamas tenses commony considered a cause of ‘Bneumons especaly nol aduts,.in cgaete smokers, and puters wth Chronic obstuctvo ung asoase. However, several go Serie ftw the widespread ws of coniugatevocines agaist nfiuorcoe type bin ken [ive sown eeeotng inedenceotinfacon ana seit nonypesbe stra comparod win tho moto vase ype befocton. Based on ho bropersty forthe organist fet he munacompromised alder ‘204, the ecluonis ohn sow, wth may patents hawng pelonged ‘Option E: Mycontsma poeumanie fa coriman cause of CAP. econ can ‘cas st any age uate ate highest among schock aged cen mitary ‘ecrits,anecollage rants. atone may have» cough hanna ‘hisrtea, and ea pan, cry 10 percent of patents develop preumonia. No ‘incl or raiograpne fates dsnguish mycoplasma pasisnana tom neuron of anyother etology. xtapuknenay manifestations may nvate melas fat cnicaly Seicant, skin ach including Stevens-Johnson synarome, clas, encepats, and eho coma nowous tam SOY Bees URGE EN esersnaracace Loaring objective: Streptococcus preumorie hos aonay boon the most ‘common care of CAP The sneepretennton of preumscocen preven, eh au onset of ova, cs, cough and sido pain, occurs moro commonly ‘nth younger pation Pryicalexsmnaton ypc reveals signs of ‘consol Sumer on perieslo, bronco resth round. phony, an vwispere pecontoguy.£8 20,yoar-ot4 mao mitay cnt comes othe ofc wih complain ofa over ‘and ano productive cough that stared dys ogo, He a states having pain ‘hrng swing He hae mild hebache and pain ne laa He doesnot havo any flevant past medical istry. HS was nde the olewing beod rose of 2078 rm Hg, dso of Onin tempeatire 376°C NOD, resiatory Fate inn. Physical exam reveals a congosted if ynpanc membrane and ‘mone on auscutaon ofthe gh ung base. The iood test ests ae glen #@¥ Bees BeeRerENesenssaracas . Homogiobl 1S mga Hemmiort 50% a Lewooye count 7500! a Newtophis: 67% = Bones: 5% Eoonophie: Besopniss Of . Lumohoowtes: 20% Monoeyes: 5% Low tors of eld sagan ore delete His ches reiogrph shows pot ‘etned nocd apace inthe gM ner ung Zone Which of he lowing the most ely organism responiie es patent’s condtion? 1 Sopnyococeus aweus 8 Mycoposma preumonts srapincoceus posumonioeHomogiobi 1 mala Hemet 50% Lewooye count 7500! Nowtophis: 67% : Benes: 2% Eosinophi: Besophiss Ot Lumohocwtes: 28% a Monocyes: 5% Low tors of cold pagans re detected His chest relogrph shows potty ‘etinednosdor apace nthe ght wer lung Zone Which of he lowing the most ly ergantsn responsi or spats conation? #@¥ Bees BeeRerENesenssaracas 1 Stophylcoccus oweus 8 Mycontsma preumonto Sueptococcus peumonioe ©.Hoomopntusinnvonzo0 E chlomce pstaca Monegome nga. a Hemmoce 508 . Lacey count 7500Hem* — Nowopnis re : ome oe Econephis Seon - Lymphocytes: 28% : Nonospes Sk Low tors of cold pagans re detected His chest relogrph shows potty ‘etinednosdor apace nthe ght wer lung Zone Which of he lowing the most ly ergantsn responsi or spats conation? #@¥ Bees BeeRerENesenssaracas 1 Stophylcoccus oweus © 8.Myconlesma preumanio .sueptococcus preumonioe ©.Hoomopntusinnvonzo0 E chlomce pstacsGreegcisayrgcacwessacacasBeseesee- Explanation: CCorect answer B: Poets wih respatory inflection caused by Mt. peuonioe ‘mayhavea cough, phan, mnorhea, and earache and onl 10% of atontsdoveop pieumeia. M proumnonie sane ofthe most commen ‘ounce of typi reunoria, Mycoplasma fection can acer at any age, Bt Iniecton aes ae highest sang eehoa a9 chien mitre, cotege studens ‘Atypical preumonla (due to Mpreuenive,Chanydapreumonice,e Logionelle spp nas boon that acount for7-20% of emmy sequced ‘neurons (CAP) fo whic 3 oxthocen ca be ened However. the ‘maine may be igherin patents wit mdr dscase at can be managed ‘epot on he ncidence of Mpreumanice a 3 cause of CAP Mos tutes, ‘even hase that use serologic ane lecular tecrniques fat identy any panagon in neary BOX ot as05 ‘No ctncal or radographic tates astingush mycaplasina pooumont tor ‘neuron of ny ater stolgy, but chest Kaye most often sho one be ‘pacts wth Mf pneumonioe Exrapimonary mantoetatons may hvohe emebss alt cncaly Serica skin ash Indu Stevenson Related Videos: © MespsonePonon non © teatro First Aid References: Fst Ad forthe USMLE Step 1 2019, 29th ed: 150 Fst Ad forthe USMLE Step 12018, 28h e150 Fst A forthe USMLE Step 12017, 27K 46#@¥ Bees BeeRerENesenssaracas pahogon in ary 50% ot cases. No ctncal radiographic totes dsingush mycoplasma pneumonia tor ‘opacies wih M neumeniae. Exrapuimonary manfesttions may woe hemolysis fal nical rican, skin ash indi Stevenson syne, ad card nenecon, mentestaon mele encopals and ‘otter cental nervous system complications. Colt agli regulary occur ‘uring Mycopisma pneumoniae rection, ‘though ow tts o meso arthodies ae quently eneourtered in pss ‘rth thew orders fic! marfestiton of cold aggitinn symdrome occur ‘only those unusual coves n which te ertibody Were great elevated, ‘Option A: Pansy ntction ie to Staphylococcus anes can osc among comment rn hospealseting (part inthe contort of rtubation or ‘tne reprtay ret ietimertation),. aus preuania can ales ote ‘towing wal pneumonia ofthe Sting of ght sided endocatcts wah pulmony ero. Option: Steptocaccu proumenie has tionally been the most canon ‘cause of commuriy- acquired preumena the pean, S ‘ncumonie wae response for> 75% of cares of pneumonia, However, mote fecontstuses nave slated the gars ony 518% of casas te Ute ‘States but na ghee proportion of seein some other counties. The ssc presentation of preumococcal pneumeri, wth abrupt onset of fv cis, ‘ough, and side pon cceurs more common ato younger patent ysis ‘amination yplalyraveais sors of corsakdaton ‘ptonD: Hoemoplitismfuenzoescommeny considered a caus of [heumonn expec nae adits who smoke dn patente th conc Prat Ad forthe USMLE Stop 12018, 28h od 50 Fst A forthe USMLE Step 1 (2017, 27 ed 46,#@¥ Bees BeeRerENesenssaracas ‘Option: Hoemopiis mfuenzoe fs commeny considered venus of [Bheumons eepecaly nae adits who make nn patente th econ ‘bstuctve hing ceotse However, svorallge sates eowing tho wicerpread us of corugatevocines agaist H influenzae type bin ken ‘ive sown eeeotnginecenceotinfacon ana seh nonypesbe toencoe infin hs nt been wl tut, thee are no ure festereeragoreng te reeokitn, Boon onthe property forthe organi ‘eh many patients having prolong hoepatztons, Only 50% paint ‘tum to the prevous ve of funtion By 8 weoks ‘Option: Patacons the main sase caused by Oc stot an has been recognized twoughut the word eluding the United States, the Utes Kingdom, Eutope, te Mao East, an Asan Bra ro ho pamaty reser for Chama plot bul anamiasion mother arash ao ‘been reported Pstacosisuculy occurs sporadcaly but outbveaks caused by contact wit an fected by arene uncomera. Oueaks felted 10 et ‘hops, avares, veterinary hestals, oul flocks, ane key an duck processing have been cesribee.Chlemyee pata can alsa cause ‘Loaming objective: Patios wth ospratry fection cased by Me ‘ppeumoni may eve a cough phar hinores, nd pan ony 1% ‘of patents devecp preumena. M_peuneniges ono ofthe most common causes atypia pneumonia, Mycoplasma fection can occur at any age, ut Infection aos ae highest ameng school-age chien mila tera, nt Colnge trons. No nico alographefstios sbnguch mycoplasma ‘pneumonia fom preunonia of any the tle. Eerapuimonary ‘mantostaions may vate nametsis (aly cca signs sn ash1 mvonzo0 ection as nt boon wl studod, nd hero are no urque {eatres rearing is resokitn, Basa onthe property forthe organi Infect he mrunccompromced and older aduts, to reson is ften sow, ‘wan many patents having pretend hosptatzars. Only 50% patos ‘eturt the prevus lve function by 6 weoks ‘Opton:Paitacocs is the main isco caused by Ole stot and hs been recognized thoughout the wor, ling the United States, the Unted Kingdom, Europe, he Male East, nd Aaa, Bc are the pay ‘resencir fot Chae pate bul anamision or ter ana ha la ‘been reported Patacose uly occur sporaccaly Ex tracks ated! ‘by contact wit an fected bud te not uncomeren Outbreaks lated 1 pet hops, ares, velernary hail, pul locke, al eka an dk ‘roceccing have been cesrbed. Cony pec can also casa ‘neumonis but oa ese extent than Chamy dia pneumoniae ‘Leaming objective: Patients wth espator lection couse by Me ‘neumonio may eve a cough pharyngts, inormoa, nd arpa ony 1% ‘of patients devel pneumenn. Mpsumonige sone ofthe most common causes of atypia pneumonia Mycoplasma fection can occur at any age, ut Intecon rates ae highest emeng school-aged chron tay tear nt ‘ologe stron No cna or eogrph fotos dsbngush myeoplems _Bneemnia ram praumoni of anyother logy Berapiimonary ‘mantostatons may inate namely cncaly signee sn ash ‘nung Steven Johnson syndrome, ad cards neon encephals and oer ental nervous sytem complicatens ae commen, Cold agivtins ‘egury occur dung Mycoptsma pneumoniae infection. #@¥ Bees BeeRerENesenssaracasPerr [a a” G ‘25 yous woman presents to ho ctx, complaining orecurent shornoss of breath and ecughing Up blood forth pat 3 wees. She also notes that sho has fet rosressvely weaker dung ths ered Previous is, the woman hes Boon hoa an has no relevant past medical sty Her po rates BO, cod prossure is 20785 mm Ha, reepiaory rato 2Bfnin, and temperate is 77S [G86 There arene sgneantndngs on the physical exam Urnnys shows he fotowing: . Color yellow " ‘epearanco leat CGicose egatve o ‘bin negative a Ketone gate , Specie gawty 1010, aloes wrece pH 6 : Urstiinogen —— Oamga. Leukocyte esterase negative Reghiccs cae HPF Epihelalcets —— 2squamoustPr HOC Bees Ue eRe Eves eessarecs| ME Blood tet shows: Hemoglobin Saft Hematoort 8Perr [a a” G Nt Blood tet shows: Hemoglobin maja Hematocrt we Leskooye count 00am? Lymphocytes 20k : Monocytes x : Mean corpuscular volume 85 1 Pele count 200,000%men* 8 resting 32mgid a ues ssmgiat . Anieniearantbodies negate Anttopoanic antbodies , cANcA peste 620) ‘plan adograph otha cost ovens @homagonecus lesion nthe mide tot tho lfthemihorax Which of to flowing he most holy aognosi ne patent? HOC Bees Ue eRe Eves eessarecs| Granuomatoas wth potangts GPA) © Pulmonary andrenal bere E Systemic upuseryomatosus (SLE): Henatoat os R Louroeya court 000mm? ‘evtoonts om : Lmpbocies 30 > noses x — eon comscuervlome 854 Prt cout 3000001 Grosunne 22mg a ure matt : Anacerardbodes_negare Anos nibodies ance postvo e20), A plalnatooraph ofthe chest evens © homageneous lesion nthe mid tard of ‘thelehemtnrme Which afm follonng the mort Wy agnosie = SO 8 Bees ee eRe EL es eessarecs| 8 Pumonny asperailoss .Gransomatose wih pelangits GPA) Pulmonary andrenal bors Sptemic lupus ermatosus (SLE)sOreeacuisaurecusercsgs esa -B-8-8-8 Explanation: Ccomect answar C: Hemoptyssis usualy caused by away dsoases Such as ‘bronchi, brencecacs, peoples, foreign bodies, rune ean 0 be ‘nud by pimionary parsnhymal dears or ulmonay vase ase oF ‘may be sepa. GPA fomerly Wegene’splandomatesi fo example. 2 ‘pulmensy parenchymal dase tht causes hemor emp i ato caused by aveoar hamerthage andlor Racheabionchil ‘lseaze wich, nu caueed by necrose oft vessel walls ie 0 Intron ef the blocd vassals wth itananatory cel which is ssocated wth ‘fonsdenstous itamation nthe surounang tase, Common manifestations of GR incude the aa na, oat. sways oF ‘pulmonary parenchyma, eral ctaneous. and pha or ert! symptoms ‘This patent has onal ictoscopc homo wth ed Bood call casts and ise In cresening) sry nl pulmonary (omen and 9 monary noel chest Xray thangs Anemia nater thang ns patont has common in ‘GPA nomooytanomia Sots ost for CANCA, which isthe recommended int tet to administer when GPAs urpactec however, 9 ‘lpsy ofthe kidney, sor ung shoul also be peered to cont the ‘ysophoanhamide or ma, Related Videos: ‘A noubean was dotvored by emoigency cesarean section at 32 wooks gosto. Because of oa dsoes, tho grunting newborns adneted tothe NCU. The ps of ‘the tngers cone aes on aan, hhh some to nove th ‘onygon supplementation A chest Xray scbtancd, which shows aground ass appearance A hagnesis of peer respiratory dstoss syndrome was made and wh surfactant supplementation, te patents conctonimeroved Which ofthe Tollowing sets oF muauternenormand! eels in the mth could Mave caused ths — ‘cont orn: {tet a a © 8.Catot tyrone st: oa. . catty ws * cote tone is 7m =) Result: = a a @ core 3 Explanation First Aid References:” = » = Explanation: CComec answer This paso as neonatal respiratory sts syndrome, ‘hice dio to an raion evel of waotot Tholecthin, (prospnaveyenoine}i-sphingomyeln ato cused to seen for lng many ‘totic too, Rik factor for neonatal estat dso yncome ‘nce prematurity cesarean socton, and maternal abotes. Coro! and ‘tyrone promot the production of suctantsin utero along wth sun Resistance ormatemal dates decieases the production of surfactant ‘Option B has decreased level of cortisol and thyroxine and increased the lovot of nein, wach wt great decreas ho syrnese of suactort [AGPAP and surfactant supplementation for neonates with factona spied (tev of 0.40 a higher Tey a at he kor pumonay a aks and ‘brenchopumonay dsl, ‘Optom A: The hormonal owls owned here may so oad to neon respratery ities synerome, Howove thle much es key cause NROS, {han thehormanal combination of decreased eral and yoo wth ‘nerosed nui Option C: The hormonal eel utined here may solos to neonatal First Aid References: Fst Ad forthe USMLE Step 12018, 2h oa 654 Fst Afr the USMLE Step 12018, 28th: 860 Fst Ad forthe USMLE Step 12017 27th ch 642WS see be aeuuyzaveseserss (phosphaveycnoine}3o-sphingomyeln ato Is used to seren for lng matny lt fetuces mtoo, Rik actor for neonatal estat dtens yncrome ‘nel prematuny cesarean section, and maternal cabsten Coral nd ‘throane promot the production of surtantsin tera along wth sun ‘Option B has decrensed level of corti and thyroxine and increased the level of insta, wich wt gest decrease ho Symes of sacar ‘Neonates wth neonatal respratry csresssydreme are best treated with "nCPAP and surfactant supplementation for neonates with factonal sped O, tevel af 0.40 er higher They a a ho vk or puny a aks and bronchopulmonary dsl ‘Option A: The hormonal eels ound hore may ako eas to neonatal respratery stress eyncrome, Howove this much es key cause NROS. {han thehormanal combination of decroasod eral and yoko wth ‘nerosed ini ptonC: The hormonal evel lined here may slo load to neonatal ‘espatory ates eyncome: however the patent ha an creased cons eve ich can compensate fr the lck of tyrone ‘Option: Asal the values are normal nts ase san al physiologic ‘ondton wich wi eed to the normal producton of sutactae. ‘Loaming objective: The oath o-sphingonyean ato rear than 26 ‘omietont wth on adequate sifctnt love Perak, ceseran section ‘Slory, ond in resetance ar he ek toe tor the ceveloment ot eet espratry dsiesssyndiome Fst Ad forthe USMLE Stop 12017, 27th ch 6425 . . Sesceeesuuazayvesesess| ‘A 3. yoar-od man prosents oa medal clnicor ovation of nctaal cough and Mogen actvated protein (MAP) kinase phosphatase expessons peepee einer'8.20-yoa-ot man prosents ois prima cae prod wih aris of ecuront cough, wheezing, ad broatleseness since erly ckood He provost ‘aagnosed wth bronchial asthe He was preecbed raranasalfvtasane fer daly ‘mediation fer daly use Which ofthe followng medications, with its comesponding mechani, she not best stp mn terapy? [A B2agontsts leverse bronchoconstcton but donot contal the 48% ‘serv ntiarasion. £8. arteukotienes such 9 montelukast oe zafetukost exert he 18% ‘bent fects in brencia asthma by blocking Cyl T2ecepes. Beebe beeeuu Naar uses eel (C-omatnaman ets by blocing bth ceuatiog and mast collbound 13% we .Theophyline actvatoshetne acetranstease ~ £E Mrogenactvatea protein MAP} Kinase phosphatase exxession 20% epegrte yn erento Result: Lesva” = » gees AGS Explanation: ‘comet answer E Inhaled conicosterois (ICS) are the most effective ant Inammatory agents used inthe management of bronchial atime ho an Inflamatry fects are caused by modding te varsrpon of utile ‘genes. Inthe cl, CS upregusios he wanscrpten of mtopen acted totem AP) Kinase presphataso! which has a stong a iarinatry ect ‘ine domreguotng NFB. These 2 score dec the rleare of cytokines ‘homokines, adhesion molecules and eifarmtory enzymes nan ant lnlsnmatary arecton. Paicatono and ater inated coricoserkis act taaly ‘an have minimal yates de oto ow biowaiabily Option A: agonists reverse bronchoconiction by aetvtngBiZ-dronere receptors, stratng aden cytse thcugh G preter and increasing Inacetua’ cyte adenosine monophosphate (CAM? and ebxng away ‘smoot muscles. Toy aso mlay reduc underiingitaimation by bing ost cel mecators, ection in plarn exudion. cnhbition of eraory ‘nerve activation, ‘Option B: The current FOA apprved antleukctenes block Cy Hecepters, Dutt CsLT2 eCopt. Cjstanyticukoenes bind to ysLTEecpens and ‘GsL 2 receptor to couse bronchocortcon,neeosed vasclor permestiy, an neeneeeesnaphicinfanmaten. The aiesetrene (such a5 morttkast and ztkas act as antagarits athe Cys Related Videos: etna: Teter First Aid References: Fst Ad forthe USMLE Stop 12019, 20h oa: 672 Fst Ad fr the USMLE Step 12018, 25h: 655 Pst ad forthe USMLE Step 12017 27h ch 49Beebe beeeuu Naar uses eel 3nmation by init mast ell mediators, eduction plasma eatin, ae nbn of sensory ‘Option B: The curent FDA appreved anticukotienes block GystTreceptes, Dutt Cyst T2 ocoptos. Cstanylicukosenes bind to CysL Tectia and ‘CL T2-eceptors to case brnchocorscton, incensed ascot Permesby, an nceace eosinophil inammaten. The antlewetrenes (such a5 morotast and za) act as antagonists athe CysLTacepter on. ‘Option ¢: Oman Ange a Hocking antibody hat neues _reudatngIgé and membrane bund gE bound onthe surface of ymphocfes ‘nd donde cas butt des not bn to the mast basophil cel und IE. ‘Option: Theophyline causes bonchodlaten by inhibits ‘Phesphodestorases and increas nacallarcycc AMP maw moat ‘muscles Theophylne aso has anantrtammatry eect, which s mediated by atnation of histone deacotyase-2 HDAC, Leaming objective: Ant-ilanmatry lcs oF1CS are contibuted by bath \progutting the transcription of mioger-actvat poten HAE) nase ‘Shesphotare-t and nhbion of NF binding, 62-agone ar anchors ‘hat elbesmoeth muscle by inereasinginraalular cAMP. They ae heve non ronchoalatretocs and may nit intammation.Theapline activates HOAC® to produce antfarmatory effects Anteukotones produce Denefesl eects on bronchi era by blocking Oye ceptors ‘Omalzumad does nt ind to cel bound ge.safes: We seebeeeeuysayeees ‘A Btyoa-old man presnts wi raduayIncroasing shortness of ros. Fer ho Tast2 yous ho has had a producto cough on mos ays Past model Neto signscant er hypeension and a ecent admission othe hosp or pneumonia FHeusoea tiamcnaone alr and uses an ebol alr os 8 e8cu0 hha. He ao takes einopsi and aml diy. He has soko a pack ay fr tho Tas 32 years and has interior to ust om Today, Hood pressure i 2/57 rum Hg neat ae 7 respuatoy ats 22 and temperatures 374°C (9937) On physi exam, hess achypnoa ainda sme dle fishing is Sentonces. Hs heart has regular ot and hyn Auscutation fis ngs reve wheezing end onc at inproves ae a deep cough Fremaus ie abaert. Pumanary uncon fst hom FEVUFUC of SSR wth nochange in FEV ae ‘abutero eament. Wc ofthe foloning Is the mos kay pathogy associated wih his patents sease? £8, Chron graromstous fommaton wth ltr ior Iymphedenopaty © C.Aiway nypersonsty © D.itamed bronchus with pertophy and hyperplasia of mucous lands (© E Consolidation and ted hepatzationsafes: We seebeeeeuysayeees Lesva ‘A Btyoa-old man presnts wi raduayIncroasing shortness of ros. Fer ho Tast2 yous ho has had a producto cough on mos ays Past model Neto signscant er hypeension and a ecent admission othe hosp or pneumonia FHeusoea tiamcnaone alr and uses an ebol alr os 8 e8cu0 hha. He ao takes einopsi and aml diy. He has soko a pack ay fr tho Tas 32 years and has interior to ust om Today, Hood pressure i 2/57 rum Hg neat ae 7 respuatoy ats 22 and temperatures 374°C (9937) On physi exam, hess achypnoa ainda sme dle fishing is Sentonces. Hs heart has regular ot and hyn Auscutation fis ngs reve wheezing end onc at inproves ae a deep cough Fremaus ie abaert. Pumanary uncon fst hom FEVUFUC of SSR wth nochange in FEV ae ‘abutero eament. Wc ofthe foloning Is the mos kay pathogy associated wih his patents sease? £8, Chron graromstous fommaton wth ltr ior Ey Iymphedenopaty © Away nypersorsty * ‘Ina bronchus wth hypertrophy andyporplai of mucous 62% ind Consolidation and ed hepatzaion 168‘W ” = » = Explanation: ‘comet answer 0: This patient has conc bronchi. 3 chronic cbstuctve pumenaty dsease, lagnesed clinical bya preductve cough fo ‘stlast 3 eonscutve mane or at ast 2 canscitve yer. On pysial ‘am, wheezing nc honehcan be henrdthat often improves ale couch Pulmonary function test so show te ebsvuctve pata wih a educed FFEVYEVC tla. Tho noneversbty wih abut halon detngushes tis ‘lseose fom asta. The pthophysilogy of chron benchts consists of tonic intanmaton of he conch wth hypervophyand hyperplasia of ‘mucous glands (Gable! glands) Eis stongly essocatod wih smoking. ‘Option A: Peomanart bench aon|s seen in bronchiectasis TSS ‘ssocated ah asovere Gone Inecton. (OpbonB: Chan nn casesting granulomatous inarmaton and bist ‘ar phadenopaty are characters of sacotods Option C: Aeway hypersensy s fete of sta, ‘ptonE: Corsalaton and heptzaton are stages of pneumonia, On ‘hye exam, conenon is posive for rei. Leaming objective: Chronic bonis 3 neal diagnose charactented by 2 ea nc ONO sso Related Videos: © Lane Berets toate First Aid References: Fst Ad forthe USMLE Step 1 2018, 290: 50 Fst Aa for me USMLE Step 12018, 250 0a: 56 Fst A forthe USMLE Step 12017, 27th 538