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Pulm remedition practice quizzes

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pulm remediation quiz
Diana Flores
Quiz by Diana Flores, updated more than 1 year ago
Diana Flores
Created by Diana Flores almost 9 years ago
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Resource summary

Question 1

Question
Which of the following disorders is not associated with clubbing of the fingers/toes?
Answer
  • Cystic fibrosis
  • Lung cancer
  • COPD
  • Bronchietasis
  • Idiopathic pulmonary fibrosis

Question 2

Question
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:
Answer
  • 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

Question 3

Question
A 32 year old male with cystic fibrosis is hospitalized with severe pneumonia. The most likely causative organism in the patient is:
Answer
  • E. Coli
  • Enterrococci
  • RSV
  • Strep pneumonia
  • Pseudomas

Question 4

Question
Which of the following is a complication of cystic fibrosis?
Answer
  • Pleural effusion requiring frequent thoracentesis
  • Bullae formation
  • Bronchiectasis
  • Granuloma formation

Question 5

Question
A community has an outbreak of Legionnaire's disease. The most likely souce for the outbreak is:
Answer
  • Contaminated local produce
  • Animal to human transmission
  • Close contact of ill individuals, droplet transmission
  • Hotel showers
  • Back up of local sewer into the streets

Question 6

Question
Which of the following is/are the most important tests to follow in a patient receiving both isoniazid and rifampin for tuberculosis?
Answer
  • Renal function tests
  • Liver function tests
  • Monthly eye examinations
  • Amylase and lipase

Question 7

Question
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%?
Answer
  • Inhaled tiotropium daily
  • Inhaled albuterol as needed
  • Oral Prednisone daily
  • Supplemental oxygen at night only
  • Continuous supplemental oxygen

Question 8

Question
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:
Answer
  • Normal diffusing capacity of lung for carbon monoxide
  • Decreased residual volume
  • Normal to slightly increased FEV1
  • Decreased FEV1/FVC

Question 9

Question
A 35 year old post-surgical patient complains of calf tenderness and acute dyspnea. You strongly suspect PE.Your first step would be to:
Answer
  • Give 5mg of Coumadin (warfarin) stat
  • Order a D-dimer
  • Order lower extremity dopplers
  • Order a VQ scan or spiral CT with PE protocol

Question 10

Question
The most common physical exam finding of a PE is:
Answer
  • Wheezing
  • Calf swelling
  • Tachypnea
  • Pulmonary rhonchi

Question 11

Question
A chest radiograph in a patient with COPD is likely to show
Answer
  • Hyperinflation of the lungs and flattened diaphragm
  • Small opacities in the upper lung fields
  • Mediastinal shift with pleural air
  • Blunting of costophrenic angles

Question 12

Question
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?
Answer
  • Pneumonia
  • ARDS
  • Pulmonary embolus
  • Status asthmaticus exacerbated by influenza

Question 13

Question
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:
Answer
  • Purulent, foul smelling sputum with hemoptysis
  • Myalgia, fatigue, nonproductive cough
  • Tachypnea, frothy pink or reddish sputum, rales
  • Fever, night sweats, weight loss

Question 14

Question
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
Answer
  • Pleural effusion
  • Foreign body aspiration
  • Pneumothorax
  • Pneumonia

Question 15

Question
A chest radiograph in a patient with interstitial lung disease would most likely show:
Answer
  • Diffuse ground glass appearance
  • Patchy diffuse infiltrates
  • Unilaterally elevated diaphragm
  • Blurring of the posterior diaphragm

Question 16

Question
If you are suspicious that a patient might have a small pleural effusion, you might want to order:
Answer
  • Thoracentesis
  • PA and lateral CXR
  • Lateral and decubitus CXR
  • MRI
  • Ultrasound

Question 17

Question
What is the mainstay of treatment for interstitial lung disease?
Answer
  • Corticosteroids
  • Chronic antibiotic prophylaxis
  • CPAP machine at night
  • Diuretics for pulmonary edema
  • Oral bronchodilator

Question 18

Question
Which of the following would be least effective in managing your emphysema patients?
Answer
  • Corticosteroids
  • Smoking cessation
  • Diuretics if cor pulmonale is present
  • Oxygen supplementation
  • Pulmonary rehabilitation

Question 19

Question
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?
Answer
  • Staph Aureus
  • Chlamydial
  • Legionella
  • Viral pneumonia

Question 20

Question
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.
Answer
  • Squamous cell
  • Adenocarcinoma
  • Large cell
  • Small cell

Question 21

Question
Which of the following is NOT a common lab abnormality found in chronic bronchitis?
Answer
  • Elevated hemoglobin
  • Decrease n PaCO2
  • PaO2 slightly normal
  • Normal DLco

Question 22

Question
Which of the following is the only treatment known to extend quality of life in patients with COPD?
Answer
  • O2
  • Prednisone
  • Ipratropium bromide
  • Long-acting beta agonists

Question 23

Question
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?
Answer
  • Theophylline
  • Corticosteroids
  • Long acting beta agonist
  • Tell him to just continue using his atrovent and his symptoms should improve over time

Question 24

Question
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?
Answer
  • Levoquin
  • Inhaled ipratropium bromide
  • Beta 2 agonist
  • Penicillin G

Question 25

Question
Which of the following is the most common pathogen for cause of infection at early age in patients with cystic fibrosis?
Answer
  • Pseudomonas
  • Staph aureus
  • Strep pneumo
  • H. influenza

Question 26

Question
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?
Answer
  • Mycoplasm pneumonia
  • Cystic fibrosis
  • Granulomatosis with polyangiitis
  • Asthma

Question 27

Question
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?
Answer
  • Chronic bronchitis
  • Emphysema
  • COPD
  • Rb-ILD

Question 28

Question
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?
Answer
  • Transudative
  • Exudative
  • Chylous
  • Hemothorax

Question 29

Question
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?
Answer
  • Hemorrhagic pleural effusion
  • Chylous pleural effusion
  • Transudative effusion
  • Exudative

Question 30

Question
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?
Answer
  • Chylous
  • Malignancy
  • Exudative
  • Tuberculosos

Question 31

Question
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?
Answer
  • Patient only needs observation
  • Simple aspiration with 16 gauge small-bore catheter
  • Antibiotics
  • Open thoracotomy

Question 32

Question
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?
Answer
  • ELISA D-dimer
  • ABGs
  • Helical CT
  • Chest x-ray

Question 33

Question
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?
Answer
  • ELISA d-dimer
  • Helical CT
  • Chest x-ray
  • Pulmonary angiography

Question 34

Question
Which of the following is NOT a possible cause of primary pneumothorax?
Answer
  • Marfan's
  • Trauma
  • Cystic fibrosis
  • Cigarette smoking

Question 35

Question
Which of the following is NOT a risk factor for recurrence of spontaneous pneumothorax?
Answer
  • Previous PTX
  • Smoking
  • Family history
  • There is 30% chance after observation alone
  • All of the above

Question 36

Question
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?
Answer
  • Pulmonary edema
  • Pulmonary hypertension
  • Pulmonary embolism
  • Left-sided heart failure

Question 37

Question
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?
Answer
  • High resolution CT
  • Chest x-ray
  • Emperic antibiotics
  • Send them home with short course of short-acting B2 agonist for symptomatic relief

Question 38

Question
Which of the following is incorrect regarding hemoptysis?
Answer
  • 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

Question 39

Question
Which of the following is NOT true regarding respiratory failure?
Answer
  • No improvement with O2
  • Metabolic alkalosis
  • Respiratory alkalosis
  • High PaCO2

Question 40

Question
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?
Answer
  • Pulmonary edema
  • Acute bronchitis
  • Pneumonia
  • Pneumothorax

Question 41

Question
In which of the following conditions do you NOT expect to find clubbing of the fingers?
Answer
  • Cor pulmonale
  • Cyanotic heart disease
  • Bronchiectasis
  • Emphysema
  • None of the above

Question 42

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

Question 43

Question
Which of the following conditions will you NOT have a decrease in CO gas diffusing across the alveolocapillary membrane?
Answer
  • Chronic bronchitis
  • Emphysema
  • RB-ILD
  • Sarcoidosis

Question 44

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

Question 45

Question
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?
Answer
  • 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.

Question 46

Question
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?
Answer
  • ≥5mm
  • ≥10mm
  • ≥15mm
  • ≥1mm

Question 47

Question
Which of the following is NOT true regarding a TB skin test?
Answer
  • 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.

Question 48

Question
Which condition is described as inflammatory cells attacking tissue and causing goblet cell hyperplasia and hypertrophy of bronchial smooth muscle?
Answer
  • Pleural effusion
  • Asthma
  • ARDS
  • Emphysema

Question 49

Question
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?
Answer
  • Mycoplasma pneumoniae
  • Klebsiella
  • Strep pneumo
  • Staph aureus

Question 50

Question
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.
Answer
  • Influenza
  • Mycoplasma pneumonia
  • TB
  • Acute bronchitis

Question 51

Question
Chronic sinusitis, arthralgias, fever, skin rash, weight loss, and nodular pulmonary infiltrates with cavitation as late finding are usually associated with
Answer
  • Sarcoidosis
  • TB
  • Granulomatosis with polyangiitis
  • COPD

Question 52

Question
Carcinoma that begins centrally and spreads locally and may show "pearls" on imaging best describes
Answer
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Large cell carcinoma
  • Small cell carcinoma

Question 53

Question
Carcinoma that begins centrally and has extensive spread that may appear like coin lesions best describes
Answer
  • Small cell carcinoma
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Large cell carcinoma

Question 54

Question
Carcinoma that may present as peripheral nodules or masses and usually metastasizes to the liver, adrenal, bone, or CNS best describes
Answer
  • Squamous cell
  • Large cell
  • Adeno
  • Small cell

Question 55

Question
Carcinoma that begins centrally or peripherally and identified when is it not squamous or adenocarcinoma best describes
Answer
  • Squamous cell
  • Adenocarcinoma
  • Large cell
  • Small cell

Question 56

Question
Which of the following characteristics BEST describes stridor?
Answer
  • 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

Question 57

Question
Chronic productive cough, exertional dyspnea, RUQ pain, cyanosis, clubbing, hepatomegaly, and LE edema best describes
Answer
  • Cor pulmonale
  • Pulmonary hypertension
  • Pulmonary edema
  • Pulmonary embolism

Question 58

Question
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?
Answer
  • UIP
  • COP
  • RB-ILD
  • NSIP

Question 59

Question
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?
Answer
  • UIP
  • Sarcoidosis
  • NSIP
  • RB-ILD

Question 60

Question
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?
Answer
  • RB-ILD
  • ARDS
  • AIP
  • NSIP

Question 61

Question
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?
Answer
  • UIP
  • RB-ILD
  • AIP
  • NSIP
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