A 55 year old female who lives in Gainesville, Florida was diagnosed with breast cancer. After her first round of chemotherapy, she went spelunking in a cave in central Florida, against advice from her physician. She developed severe shortness of breath, cough, and chest pain. She was intubated and a bronchoalveolar lavage (BAL) was performed. A culture of the BAL fluid grew a white fuzzy colony after 4 days of incubation in the laboratory. What did a wet preparation of this colony show?

A 65 year old male presents to your office complaining of cough for the last year. He is a 50 pack year smoker and continues to smoke. He also complains of significant weight loss. His vital signs are stable. His physical exam is only positive for clubbing and a prolonged expiratory phase. You suspect he has COPD and order lung function testing. You also order a chest X-ray, and the result is shown.   Based on these clinical data, which is the best finding?

A 22 yo male presents complaining of shortness of breath, cough, and wheezing. He has no past medical history. He thinks he caught a cold because all his friends have the same symptoms. He takes no medications. You listen to his lungs and he has wheezing. His vital signs are normal. His chest X-ray is normal. You order spirometry and the results are as follow: FVC: 5 L (98% predicted), FEV1: 4L (80 % of predicted), and FEV1/FVC ratio 65%. After administering a short acting bronchodilator to the patient, spirometry is repeated and the results are as follows: FVC: 5.1 L (99% of predicted) and FEV1 4.1 L (81% of predicted). What is the most likely diagnosis?

A 70 yo male has just suffered a stroke. On the second day of his hospitalization, he spikes a fever to 39°C and his respiratory rate increases to 30 per minute. He complains of some chest pain on deep inspiration, and has a cough productive of yellow, foul smelling sputum. His physical examination indicates rales in the right lower lobe of his lung, and his CXR reveals a dense right lower lobe infiltrate. What is the most likely organism or organisms that are responsible for his pneumonia?

A 42 year old businessman presents with a 5 day history of sneezing, clear rhinorrhea, and dry sore throat. Over the last 10 days he has also had headache, facial pain, and his nasal discharge is now green and has a fetid smell. He has been using topical decongestant nasal spray and acetaminophen for the past two days with partial symptom relief. Other than the symptoms noted above, examination is unremarkable except for bilateral maxillary facial tenderness. What do the three most common etiologic agents for this man’s disease have in common?

A 55 year old female with no past medical history presents with acute onset of a productive cough and pleuritic chest pain. On physical exam, you hear rales in the left lower lobe. There is dullness to percussion and egophony in that area as well. A sputum Gram stain and culture on a blood agar plate with an optochin antibiotic disk are shown.     What is the organism?

A patient has come into the clinic claiming to have had a chronic cough for 2-3 weeks. When performing your auscultation, you note rapid, shallow breathing and a wheezing sound upon exhale. The patient describes coughing up mucus, and being tired, but there has not been a fever. The patient’s history shows a pattern of clinical visits during this time each year. You conclude this patient is having a seasonal allergic reaction. What is a likely physiological mechanism for the patient’s cough?

A 25 yo female presents to the ED complaining of acute shortness of breath. She takes oral contraceptives and just landed after a 10 hour flight. She has edema in the right leg. You suspect a vascular defect (ie, pulmonary embolism). What is the most likely finding on the Ventilation/Perfusion scan?

The perfusion of blood through the alveolar blood vessels is lowest at

Which of the following will cause a rightward shift of the Oxyhemoglobin Dissociation curve?