Question

Week 3 quiz

Question 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 allergies

Acute bronchitis

Bronchial asthma

Chronic bronchitis

Question 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 reassurance

Treatment with an antibiotic such as amoxicillin

Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate

Combination 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 expansion

Increased lateral diameter

Increased anterior-posterior diameter

Pectus excavatum

Question 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 felt

Decreased fremitus is felt

Increased fremitus is felt

Vibration is referred to the non-obstructed lobe

Question 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 swelling

Pharyngeal exudate and lymphadenopathy

Clubbing, cyanosis and edema .

Diminished lung sounds with rales in both bases

Question 6 . Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?

Computed tomography (CT) scan

Chest X-ray with PA, lateral, and lordotic views

Ultrasound

Positron emission tomography (PET) scan

Question 7 .  A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion .  This could be due to:

Exercise-induced cough

Bronchiectasis

Alpha-1 deficiency

Pericarditis

Question 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:

Pneumothorax

Pleural effusion

Pneumonia

Pulmonary embolism

Question 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 edema

Heart failure

Pulmonary embolism

Pneumonia

Question 10 .  A cough is described as chronic if it has been present for:

2 weeks or more

8 weeks or more

3 months or more

6 months or more

Question 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-ray

Methacholine challenge test

Spirometry, both with and without bronchodilation

Ventilation/perfusion scan

Question 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 normal

Symptoms more than 2 days a week, but not daily .  Nighttime awakenings 3-4 times a month .  FEV1 >80% predicted .  FEV1/FVC normal

Symptoms 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 40

Fever greater than 101

Tachypnea greater than 30 breaths/minute

Productive cough

Question 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 antagonist

Oral corticosteroid—high and low dose as appropriate

Short acting beta2 agonist inhaler and theophylline

Low dose inhaled corticosteroid and long acting beta2 agonist inhaler

Question 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 outpatient

Requires hospitalization for treatment

Requires a high dose of parenteral antibiotic

Can be treated with oral antibiotics

Question 16 .  Which of the following is considered a “red flag” when diagnosing a patient with pneumonia?

Fever of 102

Infiltrates on chest X-ray

Pleural effusion on chest X-ray

Elevated white blood cell count

Question 17 .  A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following:

Barrel-shaped chest

Clubbing

Pectus excavatum

Prolonged capillary refill

Question 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’ disease

Malaria

Tuberculosis

Pneumonia

Question 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 cancer

Tuberculosis

Pneumonia

COPD

Question 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 embolism

Pleural effusion

Pneumothorax

Fracture of ribs