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A 67 yo man is referred to the Pulmonary Clinic for acute shortness of breath. He is a recently retired accountant and has never smoked. PFT produces the following clinical measures for someone of his age, gender, and height; Measurement                   Value (L)              % of Predicted ValueFVC                                        3.9                          70%FEV1                                      2.4                          61%FEV1/FVC                            62%                       64% After administration of albuterol, the same values are attained. Which of the following condition would best describe these clinical data?

A 45 year old hypertensive man presents complaining of increasing shortness of breath over the past six months. His lower extremities are swollen. For the past week, he cannot sleep flat and is using 2 pillows to sleep. He wakes two or three times during the night to urinate. His vital signs are unremarkable. Lung auscultation reveals mild bilateral crackles. His lower extremities show +2 edema. An echocardiogram shows a left ventricular ejection fraction of 35% (normal 55%-60%) and a pulmonary pressure of 55 mm Hg (normal less than 20 mm Hg). What is the most likely reason for patient’s increase pulmonary pressure?

A 2 yo baby presents with fever of 38oC and pain in her left ear. The otoscopic exam is shown in the image, with the patient’s finding to the right and normal to the left. What is the MOST LIKELY outcome to this patient if no antibiotic treatment is administered? 

A 54-year-old woman with severe emphysema due to alpha-1 antitrypsin deficiency presents to emergency room with worsening dyspnea over the last two days. She also describes associated cough, chills, and fatigue. On exam, her respiratory rate is 32 breaths/minute, dyspneic on conversation, and in a tripod position using intercostal muscle. She requires supplemental oxygen via a 100% non-rebreather to maintain a SpO2 >90%. Labs are notable for leukocytosis, lymphopenia, thrombocytosis, and abnormal liver tests. An arterial blood gas revealed a PaO2 of 72 mmHg. Chest x-ray is below.     Which of the following would be the most appropriate medical therapy?

A 68 yo man presents to the UF Health ED with acute dyspnea. He has a 7 year history of left heart failure and subsequent pulmonary hypertension. A chest X-ray indicates increased interstitial markings. Respiratory rate is 34 breaths per minute and shallow. SpO2 = 83% on room air. The FIO2 is then increased to 50% and 5 minutes later, SpO2 = 100% and respirations have dropped to 17 breathes per minute. Which of the following most accurately describes this clinical situation?

Asthma is characterized by which of the following?

A 40 year old male who recently returned from a trip to Saudi Arabia presents with a fever of 39˚C, chills, headache, rigors and has difficulty breathing. Given his travel history (there has recently been an outbreak of MERS in the Middle East), you take sputum and feces samples and send them off to the lab for testing. Your differential diagnosis includes influenza and MERS. For which of the following viruses that can cause respiratory illness could you expect to find infectious virus excreted in feces?

A 45 year old hypertensive man presents complaining of increasing shortness of breath over the past six months. His lower extremities are swollen. For the past week, he cannot sleep flat and is using 2 pillows to sleep. He wakes two or three times during the night to urinate. His vital signs are unremarkable. Lung auscultation reveals mild bilateral crackles. His lower extremities show +2 edema. An echocardiogram shows a left ventricular ejection fraction of 35% (normal 55%-60%) and a pulmonary pressure of 55 mm Hg (normal less than 20 mm Hg). What is the most likely reason for patient’s increase pulmonary pressure?

Which of the following is a secondary muscle of expiration?

A 16 yo boy was involved in an automobile accident and was directly transported to the UF Health ED. He suffered multiple trauma including long bone fractures. He is hypotensive and requires transfusion of 10 units of blood and 24 liters of normal saline. Twenty four hours later, he becomes acutely short of breath. On FIO2 = 100%, arterial blood gas data are pH = 7.48, PaCO2 = 30 mm Hg, and PaO2 = 45 mm Hg, and HCO3- = 21 mEq/L. A chest X-ray shows bilateral infiltrates. Which of the following conditions would best describe these clinical observations?