JAAPA/CME Midterm 2

Question 1

what is the defining spirometric feature of COPD
A. decreased FEV1
B. FEV1/FVC less than 70%
C. decreased total lung capacity
D. Decreased residual volume

Answer 1

B

Question 2

what is the most common symptom of COPD exacerbation
A. increase in cough
B. increase in sputum production
C. increase in wheezing
D. increase in dyspnea

Answer 2

D

Question 3

what is the most common cause of COPD exacerbations?
A. exposure to pollutants
B. viral infection
C. Bacterial infection
D. Medication nonadherance

Answer 3

C

Question 4

which patient is most likely to require hospital admission?
A. 25 year old woman responding to initial outpatient treatment
B. 50 year old man with inadequate home support
C. 52 year old woman with mild underlying COPD
D. 60 year old man with no comorbidities

Answer 4

B

Question 5

Which treatment is recommended for all hospitalized patients with COPD?
A. long acting inhaled bronchodilator
B. high dose IV or oral corticosteroid
C. IV antibiotics 
D. Low dose IV or oral corticosteroids

Answer 5

D

Question 6

What is the name given to a pulmonary lesion measuring 3.5 cm?
A. pulmonary nodule
B. pulmonary mass
C. bronchial nodule
D. subcentimeter nodule

Answer 6

B

Question 7

a 35 year old woman undergoes an abdominal CT scan and an incidental 4 mm pulmonary lesion is found. What is the most likely cause?
A. granuloma
B. hamartoma
C. malignancy
D. postinfectious scarring

Answer 7

D

Question 8

What should a 35 year old woman (who undergoes an abdominal CT scan and an incidental 4 mm pulmonary lesion is found) be told about the risk of lung cancer?
A. risk is less than 1%
B. risk is 6% to 28%
C. risk is greater than 20%
D. risk is greater than 50%

Answer 8

A

Question 9

what is the leading risk factor for lung cancer?
A. asbestos exposure
B. cigar smoking
C. cigarette smoking
D. a first degree relative with lung cancer

Answer 9

C

Question 10

A 28 yo man presents to the family practice clinic for follow up on a pulmonary nodule. An incidental pulmonary nodule was first seen on CT 3 years ago. A recent chest CT shows an unchanged 8 mm dense, centrally located pulmonary nodule with a uniform calcification pattern. He has never smoked and has no family hx of cancer and no hx of exposure to airborne occupational hazards. What is the appropriate follow-up recommendation?
A. no follow up indicated
B. annual chest CT screening
C. referral to pulmonology
D. annual chest radiograph screening

Answer 10

A

Question 11

A 28 yo woman presents to the family practice clinic for follow up on a pulmonary nodule. An incidental pulmonary nodule was first seen on CT 3 months ago. A recent chest CT shows an unchanged 1 cm mixed density lesion with ground class appearance that is unchanged from previous CT. She has never smoked and has no family hx of cancer and no hx of exposure to airborne occupational hazards. What is the appropriate follow-up recommendation?
A. no follow up indicated
B. annual chest CT screening
C. referral to pulmonology
D. annual chest radiograph screening

Answer 11

C

Question 12

Which statement is correct about worldwide statistics on TB?

a. More than half of patients infected with TB will progress to the active form.
b. One-third of the world’s population is infected with TB.
c. In the United States, cases of TB rose from 2012 to 2013.
d. Immigrants to the United States are relatively protected from TB due to their immunity from exposure in foreign countries.

Answer 12

B

Question 13

Which of the following is a known step in the pathogenesis of TB infection?

a. Anaerobic bacteria from body fuids and open skin structures are the source of TB contagions.
b. Once alveolar macrophages take up the bacteria, a host is contagious.
c. A necrotic granuloma is the immediate result of the action of goblet cells.
d. CD4 T lymphocytes release interferon gamma, which leads to the release of tumor necrosis factor alpha.

Answer 13

D

Question 14

Which statement is correct about the diagnosis of TB?

a. A negative PPD test defnitively rules out TB infection.
b. Close contacts such as family members are more than 80% likely to become infected with active TB.
c. A patient with pneumonia, lung cancer, or sarcoidosis may have a delayed diagnosis of TB.
d. Cough, fever, night sweats, and weight loss are present in every patient with active TB.

Answer 14

C

Question 15

Which statement is correct about latent TB?

a. Latent TB is asymptomatic and non-transmittable.
b. Infection with latent TB is almost never recognized with a positive delayed hypersensitivity response test.
c. Latent TB is not necessary to identify since it does not require treatment unless it becomes active.
d. A PPD skin test is the gold standard for diagnosing latent TB

Answer 15

A

Question 16

Which statement is correct about treatment of TB?

a. There is no role for preventive therapy for patients with latent TB.
b. In children under age 12 years, the recommended regimen is 12 doses of once-weekly isoniazid and rifapentine.
c. For patients on antiretroviral therapy, rifampin is contraindicated due to hepatotoxicity.
d. For active TB, monotherapy is suffcient to eradicate the infection.

Answer 16

C

Question 17

Despite the availability of the pertussis vaccine, how often do pertussis epidemics occur in the uS?

a. annually
b. every 1-3 years
c. every 3-5 years
d. every 5-7 years

Answer 17

C

Question 18

which age group has the highest incidence of pertussis?

a. infants
b. adolescents
c. adults
d. older adults (over 65 yo)

Answer 18

b

Question 19

which age group has the greatest risk of pertussis related complications?

a. infants
b. adolescents
c. adults
d. older adults (over 65 yo)

Answer 19

A

Question 20

which symptoms characterize the catarrhal stage of pertussis infection?

a. runny nose, low grade fever and mild occasional cough
b. persistent cough, sweats, and facial swelling
c. rare, intermittent coughing bouts for several weeks to months
d. hypoxia, resulting in seizures and encephalopathy

Answer 20

A

Question 21

A 32 yo woman comes to your primary care clinic complaining of severe coughing paroxysms with post tussive vomiting for 10 days. tehse symptoms were preceded by viral respiratory symptoms. Which diagnostic tests should you order?
A. PCR for B. pertussis
B. PCR and culture for B. pertussis
C. ELISA testing for pertussis toxin IgG and IgA
D. None, pertussis in this patient is a clinical diagnosis

Answer 21

B

Question 22

A 3 weeks old boy is diagnosed with pertussis and has NKDA and no known family hx of G6PD deficiency. What is the antibacterial drug of choice?
A. azithromycin
B. Clarithromycin
C. erythromycin
D. TMP-SMX

Answer 22

A

Question 23

Which statement is correct about the various assessment tools for respiratory disorders?
A. The Epworth sleepiness scale is highly objective in confirming OSA
B. The GOLD classification is used to determine the severity of OSA
C. The modified medical research council Dyspnea scale assesses lung volumes and flow rates.
D. Nocturnal polysomnography is the gold standard for diagnosing OSA

Answer 23

D

Question 24

Which statement is correct about the epidemiology of respiratory diseases involved in overlap syndrome?
A. According to the NIH, sleeping-disordered breathing affects more than 15% of the worldwide population.
B. The WHO determined that more than 3 million people died of COPD in the United States in 2012.
C. COPD is estimated to become the fifth leading cause of death worldwide by 2030
D. Studies show that OSA is unrelated to other respiratory diseases

Answer 24

A

Question 25

Which of the following is a characteristic of the pathophysiology of OSA?
A. In OSA, upper airway muscles contract and block airflow.
B. Episodes of hypopnea or apnea with residual effort last at least 10 seconds
C. OSA occurs only in patients with a BMI in the overweight or obese categories.
D. The diagnosis of OSA requires the presence of at least one of these: retrognathia, tonsillar hypertrophy, or macroglossia.

Answer 25

B

Question 26

What is the characteristic of overlap syndrome?
A. It is defined by the coexistence of OSA and asthma.
B. According to the Wang study, patients who had an Sp02 below 90% also had decreased TNF-alfa levels.
C. OSA contributes to airway inflammation in patients with COPD.
D. Overlap syndrome causes less severe oxygen disturbances than OSA or COPD alone

Answer 26

C

Question 27

Which statement is correct about treatment of overlap syndrome?
A. Supplemental oxygen should not be added to CPAP for patients with severe COPD.
B. Using CPAP to treat patients with overlap syndrome reduces mortality.
C. Weight loss is shown to improve OSA, but not COPD outcomes.
D. Patients with overlap syndrome, even when treated with CPAP, have more exacerbations than patients with COPD alone.

Answer 27

B