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2224 Radiology

A 26-year-old woman with a past history of seizure disorder is admitted to the medical ICU with status epilepticus. Due to continued seizures, she is placed in a barbiturate coma. As pa of suppoive measures, she is intubated, placed on a mechanical ventilator, and given IV fluids through a central line. She remains stable overnight. In the morning, however, the respiratory therapist repos that she has had excessive mucopurulent secretions throughout the night and that her peak and plateau airway pressures have risen 20 cm. She is febrile with a temperature of 100.2degF the next morning. CXR is shown.An impoant step in management of this patient would be

AChest tube placement
BThoracotomy
CFiberoptic bronchoscopy, antibiotic therapy, and chest physiotherapy
DAbrupt cessation of barbiturates
Radiology
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2229 Radiology

A 53-year-old male smoker, unemployed with no occupational exposure, is admitted with progressive shoness of breath. He has been unwell for some time and has received multiple courses of antibiotics for “bronchitis.” During the prior 4 mo, he has not had any medical follow-up. On exam, he is afebrile but looks ill. Lung exams reveal diffuse rhonchi and crackles with no localizing signs. ABGs on room air show PaO2 of 68 mm Hg with mild compensated respiratory alkalosis. Sputum for AFB is negative. CXR is shown.Associated with this diagnosis is

AClubbing
BIncreased IgE
CHypocalcemia
DEosinophilia
Radiology
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2232 Radiology

A 32-year-old female nonsmoker is admitted with a 5-wk history of intermittent hemoptysis. She denies any sputum production, fever, or repeated infections. There is no history of contact with TB. On physical examination, the patient is afebrile; she has dullness on percussion and decreased breath sounds in the LLL zone posteriorly. CV exam is normal. PPD is 4-mm induration. Bronchoscopy shows a polypoid lesion paially obstructing the left lower lobe orifice. This lesion bled easily during the procedure. Bronchial washings are negative for malignancy and the biopsy is pending. Chest x-ray is shown below.What is the radiological diagnosis?

ALLL pneumonia
BLLL atelectasis
CPneumothorax
DPleural effusion
Radiology
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