QuestionWeek 3 quizQuestion 1. Susan P., a 60-year-old woman with a 30 pack year history, presents to your primary care practice for evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices would you consider strongly in your critical thinking process?Seasonal allergiesAcute bronchitisBronchial asthmaChronic bronchitisQuestion 2. A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal. Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be?Observation and reassuranceTreatment with an antibiotic such as amoxicillinTreatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanateCombination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler.Question 3.Emphysematous changes in the lungs produce the following characteristic in COPD patients?Asymmetric chest expansionIncreased lateral diameterIncreased anterior-posterior diameterPectus excavatumQuestion 4. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary fibrosis. In the instance of an extensive bronchial obstruction:No palpable vibration is feltDecreased fremitus is feltIncreased fremitus is feltVibration is referred to the non-obstructed lobeQuestion 5. Your patient presents with complaint of persistent cough. After you have finished obtaining the History of Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The most common cause of cough with wheezing is asthma. What of the following physical exam findings will support your tentative diagnosis of asthma?Clear, watery nasal drainage with nasal turbinate swellingPharyngeal exudate and lymphadenopathyClubbing, cyanosis and edema.Diminished lung sounds with rales in both basesQuestion 6.Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?Computed tomography (CT) scanChest X-ray with PA, lateral, and lordotic viewsUltrasoundPositron emission tomography (PET) scanQuestion 7. A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to:Exercise-induced coughBronchiectasisAlpha-1 deficiencyPericarditisQuestion 8. Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:PneumothoraxPleural effusionPneumoniaPulmonary embolismQuestion 9. A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving, they stop for dinner.Midway through the meal, the woman becomes very short of breath, with chest pain and a feeling of panic. Which of the following problems is most likely?Pulmonary edemaHeart failurePulmonary embolismPneumoniaQuestion 10. A cough is described as chronic if it has been present for:2 weeks or more8 weeks or more3 months or more6 months or moreQuestion 11. Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to evaluate upper respiratory symptoms with new onset wheeze?Chest X-rayMethacholine challenge testSpirometry, both with and without bronchodilationVentilation/perfusion scanQuestion 12. In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3 weeks. The findings that support moderate persistent symptoms include:Symptoms daily with nighttime awakening more than 1 time a week. FEV1 >60%, but predicted <80%. FEV1/FVC reduced 5%Symptoms less than twice a week and less than twice a week nighttime awakening. FEV1 >80% predicted. FEV1/FVC normalSymptoms more than 2 days a week, but not daily. Nighttime awakenings 3-4 times a month. FEV1 >80% predicted. FEV1/FVC normalSymptoms throughout the day with nighttime awakenings every night. FEV1< 60% predicted. FEV1/FVC reduced >5%Question 13. The following criterion is considered a positive finding when determining whether a patient with asthma can be safely monitored and treated at home:Age over 40Fever greater than 101Tachypnea greater than 30 breaths/minuteProductive coughQuestion 14. Medications are chosen based on the severity of asthma. Considering the patient that is diagnosed with moderate persistent asthma, the preferred option for maintenance medication is:High-dose inhaled corticosteroid and leukotriene receptor antagonistOral corticosteroid—high and low dose as appropriateShort acting beta2 agonist inhaler and theophyllineLow dose inhaled corticosteroid and long acting beta2 agonist inhalerQuestion 15. A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:Can be treated as an outpatientRequires hospitalization for treatmentRequires a high dose of parenteral antibioticCan be treated with oral antibioticsQuestion 16. Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?Fever of 102Infiltrates on chest X-rayPleural effusion on chest X-rayElevated white blood cell countQuestion 17. A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:Barrel-shaped chestClubbingPectus excavatumProlonged capillary refillQuestion 18. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:Legionnaires’ diseaseMalariaTuberculosisPneumoniaQuestion 19. A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:Lung cancerTuberculosisPneumoniaCOPDQuestion 20. A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident.Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:Pulmonary embolismPleural effusionPneumothoraxFracture of ribs
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