Diana Flores
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Diana Flores
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Pulm remedition practice quizzes

Question 1 of 61

1

Which of the following disorders is not associated with clubbing of the fingers/toes?

Select one of the following:

  • Cystic fibrosis

  • Lung cancer

  • COPD

  • Bronchietasis

  • Idiopathic pulmonary fibrosis

Explanation

Question 2 of 61

1

A 64 year old male with a 30 pack year smoking history presents to your clinic with low energy, weight loss, and hemoptysis. After a complete work-up his diagnosis is squamous cell cancer of the right lower lobe with effusion. All of the following physical exam findings could be consistent with his diagnosis except:

Select one of the following:

  • Firm R supraclavicular lymph node

  • Generalized wasting

  • Clubbing of the fingers

  • Increased tactile fremitus in RLL

  • Decreased to absent breath sounds in right lower posterior chest

Explanation

Question 3 of 61

1

A 32 year old male with cystic fibrosis is hospitalized with severe pneumonia. The most likely causative organism in the patient is:

Select one of the following:

  • E. Coli

  • Enterrococci

  • RSV

  • Strep pneumonia

  • Pseudomas

Explanation

Question 4 of 61

1

Which of the following is a complication of cystic fibrosis?

Select one of the following:

  • Pleural effusion requiring frequent thoracentesis

  • Bullae formation

  • Bronchiectasis

  • Granuloma formation

Explanation

Question 5 of 61

1

A community has an outbreak of Legionnaire's disease. The most likely souce for the outbreak is:

Select one of the following:

  • Contaminated local produce

  • Animal to human transmission

  • Close contact of ill individuals, droplet transmission

  • Hotel showers

  • Back up of local sewer into the streets

Explanation

Question 6 of 61

1

Which of the following is/are the most important tests to follow in a patient receiving both isoniazid and rifampin for tuberculosis?

Select one of the following:

  • Renal function tests

  • Liver function tests

  • Monthly eye examinations

  • Amylase and lipase

Explanation

Question 7 of 61

1

Which of the following therapies is most likely to provide benefit to a patient with chronic stable emphysema with a resting oxygen saturation of 86%?

Select one of the following:

  • Inhaled tiotropium daily

  • Inhaled albuterol as needed

  • Oral Prednisone daily

  • Supplemental oxygen at night only

  • Continuous supplemental oxygen

Explanation

Question 8 of 61

1

A 56 year old patient with a 40 pack year history of smoking, comes to your clinic complaining of fatigue, dyspnea on exertion worsening for almost a year, and daily productive cough without hemoptysis or weight loss. Your work-up is most likely to reveal:

Select one of the following:

  • Normal diffusing capacity of lung for carbon monoxide

  • Decreased residual volume

  • Normal to slightly increased FEV1

  • Decreased FEV1/FVC

Explanation

Question 9 of 61

1

A 35 year old post-surgical patient complains of calf tenderness and acute dyspnea. You strongly suspect PE.Your first step would be to:

Select one of the following:

  • Give 5mg of Coumadin (warfarin) stat

  • Order a D-dimer

  • Order lower extremity dopplers

  • Order a VQ scan or spiral CT with PE protocol

Explanation

Question 10 of 61

1

The most common physical exam finding of a PE is:

Select one of the following:

  • Wheezing

  • Calf swelling

  • Tachypnea

  • Pulmonary rhonchi

Explanation

Question 11 of 61

1

A chest radiograph in a patient with COPD is likely to show

Select one of the following:

  • Hyperinflation of the lungs and flattened diaphragm

  • Small opacities in the upper lung fields

  • Mediastinal shift with pleural air

  • Blunting of costophrenic angles

Explanation

Question 12 of 61

1

A 30 year old female presents to the ED via EMS. Her family reports she has been feeling ill with URI/flu-like symptoms for several days. This morning they found her in bed with vomitus on her face and clothing. In the ED she continues to deteriorate with hypoxemia refractory to oxygen. What is her most likely diagnosis?

Select one of the following:

  • Pneumonia

  • ARDS

  • Pulmonary embolus

  • Status asthmaticus exacerbated by influenza

Explanation

Question 13 of 61

1

In the 30 y/o patient that was feeling ill with URI/flu-like sxs for several days and was found in her bed with vomitus on her face and clothing and was deteriorating in the ED with hypoxemia refractory to oxygen, you would also expect to find:

Select one of the following:

  • Purulent, foul smelling sputum with hemoptysis

  • Myalgia, fatigue, nonproductive cough

  • Tachypnea, frothy pink or reddish sputum, rales

  • Fever, night sweats, weight loss

Explanation

Question 14 of 61

1

A 26 year old male comes to the ED with acute onset ipsilateral chest pain and dyspnea. PE reveals unilateral chest expansion, decreased tactile fremitus, hyperresonance, and diminished breath sounds. This is most likely diganosis of

Select one of the following:

  • Pleural effusion

  • Foreign body aspiration

  • Pneumothorax

  • Pneumonia

Explanation

Question 15 of 61

1

A chest radiograph in a patient with interstitial lung disease would most likely show:

Select one of the following:

  • Diffuse ground glass appearance

  • Patchy diffuse infiltrates

  • Unilaterally elevated diaphragm

  • Blurring of the posterior diaphragm

Explanation

Question 16 of 61

1

If you are suspicious that a patient might have a small pleural effusion, you might want to order:

Select one of the following:

  • Thoracentesis

  • PA and lateral CXR

  • Lateral and decubitus CXR

  • MRI

  • Ultrasound

Explanation

Question 17 of 61

1

What is the mainstay of treatment for interstitial lung disease?

Select one of the following:

  • Corticosteroids

  • Chronic antibiotic prophylaxis

  • CPAP machine at night

  • Diuretics for pulmonary edema

  • Oral bronchodilator

Explanation

Question 18 of 61

1

Which of the following would be least effective in managing your emphysema patients?

Select one of the following:

  • Corticosteroids

  • Smoking cessation

  • Diuretics if cor pulmonale is present

  • Oxygen supplementation

  • Pulmonary rehabilitation

Explanation

Question 19 of 61

1

A patient presents with presumed CAP. She has flu-like symptoms, dry cough, fever, abdominal pain and diarrhea. Upon PE you find relative bradycardia, no obvious consolidations on lung exam. X-ray shows unilateral, patchy lobar alveolar infiltrates. This picture is suggestive of what etiology for her pneumonia?

Select one of the following:

  • Staph Aureus

  • Chlamydial

  • Legionella

  • Viral pneumonia

Explanation

Question 20 of 61

1

What type of lung cancer can be most accurately described as: occurring in roughly 20-25% of cases, prone to hematogenous spread, unsuitable for resection, widespread metastases common.

Select one of the following:

  • Squamous cell

  • Adenocarcinoma

  • Large cell

  • Small cell

Explanation

Question 21 of 61

1

Which of the following is NOT a common lab abnormality found in chronic bronchitis?

Select one of the following:

  • Elevated hemoglobin

  • Decrease n PaCO2

  • PaO2 slightly normal

  • Normal DLco

Explanation

Question 22 of 61

1

Which of the following is the only treatment known to extend quality of life in patients with COPD?

Select one of the following:

  • O2

  • Prednisone

  • Ipratropium bromide

  • Long-acting beta agonists

Explanation

Question 23 of 61

1

Patient with history of stable COPD currently on home O2 and Atrovent presents to your office stating he has been having trouble sleeping because he wakes up short of breath. He states he has used his Atrovent during these episodes with very minimal improvement. Which of the following medications would you next recommend to help his night sxs?

Select one of the following:

  • Theophylline

  • Corticosteroids

  • Long acting beta agonist

  • Tell him to just continue using his atrovent and his symptoms should improve over time

Explanation

Question 24 of 61

1

Patient with h/o chronic bronchitis presents to your office c/o worsening dyspnea and coughing with increased amount of purulent sputum. Which of the following medications would the pt most benefit from for his current condition?

Select one of the following:

  • Levoquin

  • Inhaled ipratropium bromide

  • Beta 2 agonist

  • Penicillin G

Explanation

Question 25 of 61

1

Which of the following is the most common pathogen for cause of infection at early age in patients with cystic fibrosis?

Select one of the following:

  • Pseudomonas

  • Staph aureus

  • Strep pneumo

  • H. influenza

Explanation

Question 26 of 61

1

A young patient is brought into your office by his mother after he has developed productive cough and dyspnea, which has affected his physical performance during gym at school. Mother denies any other illness but states he occasionally has abdominal pain that does not seem to be related to flu or URI sxs. She denies patient having any other symptoms. During your exam you notice patient has pururlent nasal discharge and nasal polyps and his lung exam reveals hyperresonance to percussion and apical crackles. Which of the following conditions is going to be at the top of your differential?

Select one of the following:

  • Mycoplasm pneumonia

  • Cystic fibrosis

  • Granulomatosis with polyangiitis

  • Asthma

Explanation

Question 27 of 61

1

55 year old patient with 50 pack year history presents to your office c/o worsening dyspnea. He also admits to unintentional recent weight loss. He denies any fever, chills, or productive cough. When you exam your patient, he appears thin and to be in respiratory distress, using his accessory muscles to get air into his lungs. You do not notice any cyanosis. Pt has hyperresonance to percussion and when you listen to his lungs, there is not much air movement throughout. Pt does not have any peripheral edema. Which of the following diseases are at the top of your differential?

Select one of the following:

  • Chronic bronchitis

  • Emphysema

  • COPD

  • Rb-ILD

Explanation

Question 28 of 61

1

You obtain a paracentesis fluid and find it to have 100 white blood cells and a pH of 7.45. Pleural LDH is 0.5, and pleural fluid total cholesterol is 50. Pleural total protein-to-serum protein is 0.1 Which of the following best describes the fluid?

Select one of the following:

  • Transudative

  • Exudative

  • Chylous

  • Hemothorax

Explanation

Question 29 of 61

1

You obtain a parecentesis analysis and the results state that the total protein-to-serum ratio is 0.4 with pleural fluid LDH 0.5. Triglycerides are 30 mg/dL and RBC is 100,000. Which of the following is the correct interpretation of the fluid?

Select one of the following:

  • Hemorrhagic pleural effusion

  • Chylous pleural effusion

  • Transudative effusion

  • Exudative

Explanation

Question 30 of 61

1

You obtain a pleural effusion analysis and the report states that WBC count is 50,000 cells/mcL, RBC count is 50,000 cells/mcL and glucose is equal to serum levels. Which of the following is the correct interpretation of the fluid sample?

Select one of the following:

  • Chylous

  • Malignancy

  • Exudative

  • Tuberculosos

Explanation

Question 31 of 61

1

Patient presents to the ED with difficulty in breathing with pleuritic chest pain status post fall x30 minutes ago. Pt states he was skateboarding when he fell off his skateboard and onto the curb with his left side. On physical exam you notice slightly diminished breath sounds and decreased tactile fremitus on the left. When you do a chest x-ray you notice a visceral pleural line on expiratory film about 25% from the parietal pleura on the left and radiolucent costophrenic sulcus on supine film. Which of the following will be you next step in order to treat this patient?

Select one of the following:

  • Patient only needs observation

  • Simple aspiration with 16 gauge small-bore catheter

  • Antibiotics

  • Open thoracotomy

Explanation

Question 32 of 61

1

Patient presents c/o pleuritic chest pain, dyspnea, and cough. On your physical exam you notice patient is tachycardic and tachypneic, with a respiratory rate of 20 bpm. You hear crackles on auscultation with a pleuritic friction rub. Patient does admit to returning from the Philippines 2 weeks ago but otherwise denies h/o oral contraceptives or recent surgeries. Pt is not a smoker. Which of the following tests is most useful in obtaining a diagnosis for this patient?

Select one of the following:

  • ELISA D-dimer

  • ABGs

  • Helical CT

  • Chest x-ray

Explanation

Question 33 of 61

1

Patient presents c/o pleuritic chest pain, dyspnea, and cough. On your physical exam you notice patient is tachycardic and tachypneic, with a respiratory rate of 20 bpm. You hear crackles on auscultation with a pleuritic friction rub. Patient denies h/o oral contraceptives or recent surgeries or traveling or recent h/o PE. Pt is not a smoker. Which of the following tests should be ordered first in order to help diagnose the patient?

Select one of the following:

  • ELISA d-dimer

  • Helical CT

  • Chest x-ray

  • Pulmonary angiography

Explanation

Question 34 of 61

1

Which of the following is NOT a possible cause of primary pneumothorax?

Select one of the following:

  • Marfan's

  • Trauma

  • Cystic fibrosis

  • Cigarette smoking

Explanation

Question 35 of 61

1

Which of the following is NOT a risk factor for recurrence of spontaneous pneumothorax?

Select one of the following:

  • Previous PTX

  • Smoking

  • Family history

  • There is 30% chance after observation alone

  • All of the above

Explanation

Question 36 of 61

1

Your patient with h/o sarcoidosis presents with increasing dyspnea, nonproductive cough, and increasing malaise and fatigue. She denies any recent fever, chills, rhinorrhea, or sore throat. On physical exam you notice she has an S3 heart sound as well as JVD, hepatomegaly, and LE edema. Lab results are consistent with her h/o sarcoidosis and you only notice that she has a slight decrease in her PaCO2. You obtain a chest x-ray report which states there is enlargement of the main pulmonary arteries. Which of the following is on the top of your differential?

Select one of the following:

  • Pulmonary edema

  • Pulmonary hypertension

  • Pulmonary embolism

  • Left-sided heart failure

Explanation

Question 37 of 61

1

Someone presents to your office c/o persistent cough for the past week with associated rhinorrhea and headache. Pt decided to come to your office today because he noticed some blood in his sputum and became concerned. Vital signs reveal pt is afebrile with a normal BP and respiratory rate and O2 sat 96%. Pt does not appear in any acute distress. The rest of the physical exam is unremarkable. Which of the following is the best treatment for this patient?

Select one of the following:

  • High resolution CT

  • Chest x-ray

  • Emperic antibiotics

  • Send them home with short course of short-acting B2 agonist for symptomatic relief

Explanation

Question 38 of 61

1

Which of the following is incorrect regarding hemoptysis?

Select one of the following:

  • It is defined as the expectoration of blood that originates below the vocal cords

  • A large blood volume loss is indicated by bradycardia, hypotension, and hypoxia

  • Most cases presenting in the outpatient setting are due to infection such as acute or chronic bronchitis, pneumonia, and TB

  • All of the above are true

Explanation

Question 39 of 61

1

Which of the following is NOT true regarding respiratory failure?

Select one of the following:

  • No improvement with O2

  • Metabolic alkalosis

  • Respiratory alkalosis

  • High PaCO2

Explanation

Question 40 of 61

1

Patient presents to your office c/o significant dyspnea at rest with associated pink, frothy sputum. On your physical exam you notice she is diaphoretic and cyanotic, and showing signs of respiratory distress. She is tachycardic and has JVD with peripheral edema. Which of the following conditions is at the top of your differential?

Select one of the following:

  • Pulmonary edema

  • Acute bronchitis

  • Pneumonia

  • Pneumothorax

Explanation

Question 41 of 61

1

In which of the following conditions do you NOT expect to find clubbing of the fingers?

Select one of the following:

  • Cor pulmonale

  • Cyanotic heart disease

  • Bronchiectasis

  • Emphysema

  • None of the above

Explanation

Question 42 of 61

1

Which of the following is true regarding distinguishing between asthma and other obstructive lung diseases?

Select one of the following:

  • After inhaling short-acting bronchodilator in asthma, you have ≥ 12% increase in FEV1

  • After inhaling short-acting bronchodilator in asthma, you have ≥12% in FVC

  • Positive methacholine test is ≥20% fall in FEV1 after inhalation of methacholine or histamine, therefore indicating COPD

  • You have decrease in FVC in asthma, whereas you have increase in FVC in COPD

Explanation

Question 43 of 61

1

Which of the following conditions will you NOT have a decrease in CO gas diffusing across the alveolocapillary membrane?

Select one of the following:

  • Chronic bronchitis

  • Emphysema

  • RB-ILD

  • Sarcoidosis

Explanation

Question 44 of 61

1

Which of the following best describes how we are able to measure DLco?

Select one of the following:

  • CO binds to hemoglobin instead of O2

  • CO binds to 02 instead of carbon dioxide

  • Anything that damages the bronchial epithelium will cause decrease in DLco

  • None of the above

Explanation

Question 45 of 61

1

Pt presents to your office c/o persistent cough, fever, night sweats, malaise, and unintentional weight loss. On physical exam, you notice that the pt appears chronically ill and malnourished with lymphadenopathy. You obtain a chest x-ray, which reveals upper lobe lesions and caseating granulomas. Which of the following should be your next step?

Select one of the following:

  • Obtain CT scan

  • Obtain a skin test

  • Obtain an acid-fast bacilli stain

  • Prescribe the patient with prednisone and have them follow-up in a week.

Explanation

Question 46 of 61

1

16 y/o Patient, whose uncle currently with TB has come to visit from Africa, presents after having a TB test done 2 days ago. You notice an area of induration and so you pull out a ruler to measure the induration. How many mm should the induration be in order for you to be concerned about patient having TB?

Select one of the following:

  • ≥5mm

  • ≥10mm

  • ≥15mm

  • ≥1mm

Explanation

Question 47 of 61

1

Which of the following is NOT true regarding a TB skin test?

Select one of the following:

  • Test includes injection of 0.1mm of PPD containing 5tU intradermally

  • Test is positive when area is erythematous

  • HIV-patients are high risk and therefore are considered to have a positive TB test if area of induration is ≥5mm.

  • Patients with previous TB are at high risk and therefore are considered to have a positive TB test if area of induration is ≥5mm.

Explanation

Question 48 of 61

1

Which condition is described as inflammatory cells attacking tissue and causing goblet cell hyperplasia and hypertrophy of bronchial smooth muscle?

Select one of the following:

  • Pleural effusion

  • Asthma

  • ARDS

  • Emphysema

Explanation

Question 49 of 61

1

A 19 year old male college student presents with a 4-day h/o fever, headache, sore throat, myalgia, malaise, and a nonproductive cough. On HEENT exam, you note an erythematous pharynx without exudate and bullous lesion. The lung examination reveals diffuse crackles. A chest x-ray reveals a right-sided lower lobe patchy infiltrate. Which of the following is the most likely cause?

Select one of the following:

  • Mycoplasma pneumoniae

  • Klebsiella

  • Strep pneumo

  • Staph aureus

Explanation

Question 50 of 61

1

Which condition is best described as having beginning symptoms of URI (cough, sore throat, rhinitis) which develops into headache, malaise, anorexia, fever and chills, ocular symptoms, erythematous conjunctiva and cervical lymph nodes? Physical exam negative for crackles and rales.

Select one of the following:

  • Influenza

  • Mycoplasma pneumonia

  • TB

  • Acute bronchitis

Explanation

Question 51 of 61

1

Chronic sinusitis, arthralgias, fever, skin rash, weight loss, and nodular pulmonary infiltrates with cavitation as late finding are usually associated with

Select one of the following:

  • Sarcoidosis

  • TB

  • Granulomatosis with polyangiitis

  • COPD

Explanation

Question 52 of 61

1

Carcinoma that begins centrally and spreads locally and may show "pearls" on imaging best describes

Select one of the following:

  • Squamous cell carcinoma

  • Adenocarcinoma

  • Large cell carcinoma

  • Small cell carcinoma

Explanation

Question 53 of 61

1

Carcinoma that begins centrally and has extensive spread that may appear like coin lesions best describes

Select one of the following:

  • Small cell carcinoma

  • Squamous cell carcinoma

  • Adenocarcinoma

  • Large cell carcinoma

Explanation

Question 54 of 61

1

Carcinoma that may present as peripheral nodules or masses and usually metastasizes to the liver, adrenal, bone, or CNS best describes

Select one of the following:

  • Squamous cell

  • Large cell

  • Adeno

  • Small cell

Explanation

Question 55 of 61

1

Carcinoma that begins centrally or peripherally and identified when is it not squamous or adenocarcinoma best describes

Select one of the following:

  • Squamous cell

  • Adenocarcinoma

  • Large cell

  • Small cell

Explanation

Question 56 of 61

1

Which of the following characteristics BEST describes stridor?

Select one of the following:

  • It is typically seen in pertussis

  • It is caused by turbulent airflow from narrowed upper airway at or above the vocal cords during inspiration

  • It is caused by turbulent airflow from narrowed upper airway at or below the vocal cords during inspiration

  • Never caused by paralysis of the airways

Explanation

Question 57 of 61

1

Chronic productive cough, exertional dyspnea, RUQ pain, cyanosis, clubbing, hepatomegaly, and LE edema best describes

Select one of the following:

  • Cor pulmonale

  • Pulmonary hypertension

  • Pulmonary edema

  • Pulmonary embolism

Explanation

Question 58 of 61

1

57 y/o male presents presents for regular check up. He has had a dry cough and dyspnea for the past 2 years. On lung exam, you notice he has ground glass and honeycombing with multiple, thick-walled cystic spaces int he periphery. Which of the following conditions are you going to work him up for?

Select one of the following:

  • UIP

  • COP

  • RB-ILD

  • NSIP

Explanation

Question 59 of 61

1

43 y/o male with 60 pack year smoking history and chronic insidious dry cough and dyspnea presents to your office for routine check-up. You pull a chest x-ray on this patient and notice there is a ground glass appearance and, what appears to be, an upper lobe emphysema. For which of the following conditions will you work him up for?

Select one of the following:

  • UIP

  • Sarcoidosis

  • NSIP

  • RB-ILD

Explanation

Question 60 of 61

1

A young male presents to the ER due to acute onset of severe dyspnea. Family reports pt had a cold a week ago, but denies any other current symptoms. Pt's O2 sats are 76% and continue to decrease, so you attempt to place him on O2, hoping this will improve his symptoms. You obtain a quick x-ray which shows ground glass bilaterally with fibrosis. Which of the following conditions will this patient be worked up for?

Select one of the following:

  • RB-ILD

  • ARDS

  • AIP

  • NSIP

Explanation

Question 61 of 61

1

Patient is a 47 year old female who presents to your clinic stating she has had this persistent cough and dyspnea for the past 2 months that has not gone away. She states she presents because she wants to make the cough go away and she is tired of coughing all the time. Your physical exam reveals diffuse fine late inspiratory crackles. You obtain a chest x-ray which only shows ground glass, but no honeycombing. Which of the following is at the top of your differential?

Select one of the following:

  • UIP

  • RB-ILD

  • AIP

  • NSIP

Explanation

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