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A 72 yo man arrives the UF Family Medicine Clinic for his quarterly checkup. He is over weight (BMI = 31) and his diet largely consists of processed foods. He takes Captopril for hypertension (BP= 180/140, without meds) and Metformin for diabetes (A1C = 9.3% without meds). He tells you that since his last visit three months prior, he has quit smoking. He states that the urge to return to smoking is strong, as he smoked 1-2 packs of cigarettes per day, for 23 years. Respiratory rate is 29 bpm. Breathing room air, his lab data are as follows; pH = 7.47, PaCO2 = 24 mm Hg, PaO2 = 58 mm Hg, HCO3- = 17 mEq/L, and SpO2 = 88%. The most likely cause of the patient’s hypoxemia is

A 58 yo male is admitted to the hospital with pancreatitis. Initially his chest X-ray was clear, but 24 hours after admission his X-ray reveals bilateral interstitial infiltrates. He is being treated with IV fluids, pain control medication, and supportive care, but he is developing increasing respiratory distress; RR =42 (increased), O2 saturation = 90% with FiO2 = 100% given by mask. He is then intubated and placed on 100% oxygen. His arterial blood gas reveal a PaO2 of 70 mm Hg. At this point, what can you do to improve his chances of survival?

M protein is an important virulence factor of Streptococcus pyogenes group A. It contributes to virulence by:

A 37 yo male, with no prior medical illness, presented with a 6-month history of episodes of coughing, shortness of breath, and intermittent fever. He suffered from dyspnea on minor exertion. The patient worked in a cattle feed factory and noticed that he had more complaints after his working hours. Bilateral basal lung crackles were noted on physical examination. Pulmonary function tests showed a restrictive pattern. Radiographic imaging showed a diffuse distribution of ill–defined nodules. Photomicrographs of a lung biopsy are shown below:   These findings are most consistent with the diagnosis of

A 35 yo woman develops progressive shortness of breath with cough, over a 3 month period. She works in a library. On physical examination she is noted to have lymphadenopathy of her axilla and neck, bilaterally. A radiographic imaging shows multiple interstitial nodules in all lung fields. A lung biopsy is performed and a high power microscopic image of one of the nodules is shown.  Which of the following is the most likely diagnosis?

A 50 year old alcoholic patient with poor dentition presents 4 days following a severe inebriation and vomiting episode, with fever and productive cough. His chest x-ray shows a cavity with an air-fluid level and the Gram stain from his sputum shows multiple different species of organism. The sputum culture grows mostly anaerobes and some Streptococcus species. Where did these bacteria most likely come from?

A 19 yo man was involved in an automobile accident and was transported directly to the UF Health ED. He has suffered multiple trauma, including contusions to the head and chest. With FIO2 = 50%, arterial blood gas data are pH = 7.17, PaCO2 = 65 mm Hg, PaO2 = 65 mm Hg, and HCO3- = 23 mEq/L. Which of the following would best describe these clinical observations?

A 2-month-old boy presented with a 10-day history of sore throat, fever, and profuse respiratory secretions. During the last 3 days, he developed a cough that progressively increased in frequency and forcefulness. His chest radiography was clear. His white blood cell was 17,700 cells/mm3 with 80% lymphocytes. Gram-negative coccobacilli were cultured on charcoal blood agar from a nasopharyngeal swab. The MOST LIKELY etiological agent is:

Mrs. G is an 80 yo woman nursing home resident who was brought to the Emergency Room for a chief complaint of severe shortness of breath and fever. Two months prior to admission (PTA), she suffered a right cortical stroke and has left sided weakness. Three days PTA she was noted to be coughing heavily and was intermittently bringing up yellow, foul smelling sputum. She was also noted to have a fever = 39 degrees C.Two days PTA, she began complaining of chest pain on inspiration. The day of admission she complained of severe shortness of breath and was noted to have an increased respiratory rate. PE: BP 85/60, P125, RR 35, Temp 40 degrees C. Oxygen saturation on room air is 90% Gen: Very ill appearing elderly female in acute respiratory distress. HENT: Teeth in poor repair, poor dental hygiene with multiple carries and severe gingivitis. Lungs: Decreased breath sound right posterior lung field 1/3rd up the lung field. Dullness to percussion lower 1/3rd of the right posterior lung field. Neuro exam: Alert oriented, dense left hemiparesis, poor gag response LAB: WBC 14,000 (65% PMN 10% bands, 25% Lymphs) Comment: elevated WBC CXR: Infiltrate noted in the RLL, as well as an area of higher radio-density in the lower 1/3rd of the same lung field suggestive of pleural fluid. What is the likely cause of her pneumonia?

Common pulmonary function abnormalities in individuals with moderate to severe restrictive lung disease include which one of the following sets of findings?                 FEV1                                      Expiratory flow rates                      RV/TLC ratioA             normal                                  normal                                                  normal B             increased                            increased                                            increased C             decreased                           decreased                                           increasedD             decreased                           decreased                                           decreasedE              decreased                           increased                                            increased