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Clinical Medicine - Approach to the Patient

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Approach to the Patient with Pulmonary Disease Lecture 11/17/15
campbellpa2017
Quiz by campbellpa2017, updated more than 1 year ago
campbellpa2017
Created by campbellpa2017 about 9 years ago
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Question 1

Question
Which of the following is characteristic of OBSTRUCTIVE pulmonary diseases (select all that apply)
Answer
  • Reduction in airflow due to increased resistance in airways (e.g. narrowing of airway lumen)
  • Dyspnea resulting from net reduction in lung volume
  • Decreased elastic recoil of pulmonary parenchyma surrounding the airways, effectively reducing lumen caliber
  • Reduction in lung compliance, requiring greater pressure to inflate lungs

Question 2

Question
Which of the following are considered OBSTRUCTIVE pulmonary diseases? (select all that apply)
Answer
  • chest wall tumors
  • cystic fibrosis
  • ARDS
  • bronchiolitis
  • asthma

Question 3

Question
Which of the following may be related to RESTRICTIVE pulmonary diseases? (select all that apply)
Answer
  • Asthma
  • Silicosis
  • Cystic fibrosis
  • Severe Scoliosis
  • ARDS

Question 4

Question
Restrictive lung diseases are often complicated with pulmonary hypertension and cor pulmonale (i.e. right ventricular dilation to lung disease)
Answer
  • True
  • False

Question 5

Question
Which of the following are characteristic of bronchiectasis? (select all that apply)
Answer
  • Px: wheezing, crackles, clubbing, hypoxemia
  • Px: productive cough, hemoptysis, chest pain
  • acquired or congenital disorder of large bronchi, causing abnormal dilation and loss of bronchiole wall tone
  • usually the result of a disorder such as cystic fibrosis
  • reversible with treatment

Question 6

Question
A purulent pleural effusion caused by the spread on infection to the pleural space is termed:
Answer
  • Hemothorax
  • Chylothorax
  • Pneumothorax
  • Hyrdothorax
  • Empyema

Question 7

Question
Which of the following may be the cause of a pleural effusion?
Answer
  • Collagen vascular disorder
  • Metastatic cancer
  • Systemic infection
  • A & B Only
  • All of the above

Question 8

Question
Lymph fluid in the pleural space (due to thoracic duct trauma or obstruction) is termed:
Answer
  • Pneumothorax
  • Empyema
  • Hydrothorax
  • Chylothorax
  • Lymphothorax

Question 9

Question
Which of the following is most typically found in the setting of congestive heart failure?
Answer
  • Hydrothorax
  • Pneumothorax
  • Empyema
  • Hemothorax
  • Chylothorax

Question 10

Question
A tension pneumothorax refers to a pneumothorax in which the defect acts as a valve, causing air to enter the pleural space on inspiration but preventing air from leaving on expiration.
Answer
  • True
  • False

Question 11

Question
A pneumothorax (air in the pleural space) can be secondary to:
Answer
  • COPD
  • asthma
  • lung abscess (communicating w/ pleural space)
  • A & C only
  • All of the above

Question 12

Question
Which of the following may be classified as a pulmonary hemorrhage syndrome?
Answer
  • Goodpasture's syndrome
  • Wegener's granulomatosis
  • Churg-Strauss syndrome
  • Both A & B
  • All of the above

Question 13

Question
Which of the following are items used on the COPD population screener (COPD-PS) questionnaire? (check all that apply)
Answer
  • During the past 4 weeks, how much of the time did you feel short of breath?
  • Do you ever cough up any "stuff", such as mucus or phlegm?
  • In the past 12 months, I do less than I used to because of my breathing problems.
  • Have you smoked at least 100 cigarettes in your entire life?
  • How old are you?

Question 14

Question
Hypoxia refers to decreased levels of oxygen in the arterial blood.
Answer
  • True
  • False

Question 15

Question
Which of the following terms/definitions are NOT correctly paired? (select all that apply)
Answer
  • Orthopnea - SOB that begins or increases when lying down
  • Paroxysmal nocturnal dyspnea - sudden onset of SOB after a period of sleep
  • Platypnea - dyspnea that decreases when in upright position
  • Hypercapnea - dyspnea related to increased CO2 in blood
  • Tachypnea - rapid rate of breathing

Question 16

Question
Increased tactile fremitus on physical exam may indicate the presence of consolidation of pneumonia.
Answer
  • True
  • False

Question 17

Question
Decreased tactile fremitus on physical exam may indicate (check all that apply)
Answer
  • ipsilateral pneumothorax
  • pleural effusion
  • pneumonia
  • pleural scarring
  • hyperinflation of lungs

Question 18

Question
Chest X-Ray Findings [blank_start]Air-space diseases[blank_end] may show poorly defined opacities that obliterate normal shadows. [blank_start]Interstitial diseases[blank_end] may show linear, reticular, septal lines, bronchovascular thickening, multiple small opacities. [blank_start]Lymphasdenopathy[blank_end] may show an abnormal mediastinal contour
Answer
  • Air-space diseases
  • Interstitial diseases
  • Lymphadenopathy
  • Air space diseases
  • Interstitial diseases
  • Lymphadenopathy
  • Interstitial diseases
  • Lymphasdenopathy
  • Air-space diseases

Question 19

Question
What clinical finding is apparent on this x-ray?
Image:
25997312-3e89-44b2-9b0b-757a0072e993 (image/png)
Answer
  • Pneumonia
  • Pneumothorax
  • Interstitial lung disease
  • Multiple nodules/masses
  • Pleural effusion

Question 20

Question
Clinical finding on this chest x-ray
Image:
cd1ab746-5e99-41fc-b703-e7706ad4e548 (image/png)
Answer
  • pneumonia
  • pneumothorax
  • interstitial lung disease
  • lung mass/nodule
  • pleural effusion

Question 21

Question
Clinical finding on this chest x-ray
Image:
67573bc3-f1c9-40bc-87f0-7ab18e563011 (image/png)
Answer
  • pneumonia
  • pneumothorax
  • pleural effusion
  • mass/nodule
  • interstitial lung disease

Question 22

Question
Clinical finding on this chest x-ray
Image:
5bced25e-9749-4446-91c0-d9ee7776c7f0 (image/png)
Answer
  • pneumonia
  • pleural effusion
  • interstitial lung disease
  • mass/nodule
  • pneumothorax

Question 23

Question
Clinical finding on chest x-ray
Image:
948f0336-5038-48bb-a7e5-db47bb158586 (image/png)
Answer
  • pneumonia
  • pneumothorax
  • interstitial lung disease
  • pleural effusion
  • lung mass/nodule

Question 24

Question
Which of the following is the primary imaging method used for detecting a pulmonary embolism?
Answer
  • AP & Lateral Chest x-ray
  • CT angiography
  • PET scan
  • MRI
  • Ultrasound

Question 25

Question
A chest CT increases contrast by a factor of 200 but also increases radiation exposure by nearly 60x.
Answer
  • True
  • False

Question 26

Question
This imaging method may be preferred when evaluating mediastinal masses (w/ vascular involvement) and pulmonary hypertension.
Answer
  • Chest x-ray
  • Ultrasound
  • CT
  • MRI
  • PET scan

Question 27

Question
Which of the following statements are accurate regarding pulmonary function testing (PFT) (check all that apply)
Answer
  • measures external lung function
  • useful for evaluation of pts w/ dyspnea and wheezing
  • quantifies the degree and reversibility of a disease
  • used to measure disease progression
  • may assess thoracic structural abnormalities

Question 28

Question
Forced Vital Capacity (FVC) is the volume of air expired after a full inspiration and may be... (check all that apply)
Answer
  • normal in obstructive lung disease
  • slightly decreased in obstructive lung disease
  • slightly increased in restrictive lung disease
  • normal in restrictive lung disease
  • decreased in restrictive lung disease

Question 29

Question
Forced Expiratory Volume in 1 second (FEV1) is reduced in both obstructive and restrictive lung diseases.
Answer
  • True
  • False

Question 30

Question
FEV1/FVC in normal patients is usually around 70-80% (0.7 - 0.8)
Answer
  • True
  • False

Question 31

Question
Check all of the following statements which are true regarding expected FEV1/FVC percents.
Answer
  • FEV1/FVC is expected to be decreased in patients with obstructive lung diseases
  • FEV1/FVC is expected to be increased in patients with obstructive lung diseases
  • FEV1/FVC may be normal in patients with restrictive lung diseases
  • FEV1/FVC may be increased in patients with restrictive lung diseases

Question 32

Question
Forced mid-expiratory flow (FEF, 25-75%) is expected to be decreased in both obstructive and restrictive lung diseases.
Answer
  • True
  • False

Question 33

Question
Diffusing capacity of the lung for carbon monoxide (DLCO) is decreased in parenchymal lung disease and COPD (especially emphysema) but is expected to be normal in asthmatic patients.
Answer
  • True
  • False

Question 34

Question
When would a peak flow meter be used?
Answer
  • evaluating the effectiveness (pre & post) treatment
  • at home by an asthmatic pt. to track lung function
  • measuring FEV1 or FVC when other PFTs are unavailable
  • Both A & B
  • All of the above

Question 35

Question
Capnography is a noninvasive measurement of exhaled CO2 and cardiopulmonary function.
Answer
  • True
  • False

Question 36

Question
Acute bronchitis is more often associated with respiratory viruses than a bacterial infections.
Answer
  • True
  • False

Question 37

Question
Signs & Sxs associated with Acute Bronchitis (check all that apply)
Answer
  • Cough (initially nonproductive but later mucoid sputum may be present)
  • Tracheitis (burning substernal pain associated w/ respiration)
  • Signs of consolidation and/or opacity on chest x-ray (after 7-10 days)
  • Rhonchi and coarse crackles
  • Hemoptysis

Question 38

Question
Which of the following medications is NOT generally recommended in the treatment of bronchitis: (check all that apply)
Answer
  • Analgesics
  • Antihistamines
  • Beta-2 Agonists
  • Anti-tussives
  • Expectorants
  • Mucolytics
  • Antibiotics

Question 39

Question
Influenza vaccines vary in effectiveness from 20% - 90%
Answer
  • True
  • False

Question 40

Question
Complications of influenza may include which of the following (check all that apply)
Answer
  • pneumonia
  • myocarditis or pericarditis
  • Toxic shock syndrome
  • transverse myelitis
  • Guillian-Barre

Question 41

Question
Which of the following are used in the treatment of influenza?
Answer
  • Neurominidase inhibitors (e.g. zanamivir, oseltamivir)
  • Adamantane agents (e.g. amantadine, rimantadine)
  • Supportive care/treatments
  • Broad-Spectrum Antibiotics
  • Leukotriene Receptor Antagonist
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