Pulmonary System

Question 1

A 26-year-old female smoker developed chest pain several hours ago. Her past history is unremarkable, and she takes no medications regularly. She reports the abrupt onset of nonexer1ional chest pain, associated with shortness of breath and cough. It seems to be worse when she is lying down. It was not
brought on by trauma. Which of the following is the most likely origin of her pain?
A. Costochondritis
B. Asthma
C. Pulmonary embolus (PE)
D. Myocardial ischemia
E. Bronchitis

Answer 1

1. C

Question 2

A 20-year-old man has the abrupt onset of chest pain. He has an unremarkable past medical history, but his father had his first myocardial infarction in his late 30’s. On examination, the patient is thin and anxious-appearing. Other than tachycardia, his cardiac exam is normal. His lung examination reveals decreased breath sounds on ??? with hyper-resonance to percussion. What is the best treatment for his condition?
A. Insertion of a chest tube
B. Antibiotic therapy (like amoxicillin or azithromycin)
C. Bronchodilator therapy (beta-agonists, like albuterol)
D. Long-term anticoagulation
E. Immediately give 325 mg of aspirin, and transfer to an emergency room

Answer 2

2. A

Question 3

A 22-year-old woman was treated by her doctor for acute bronchitis 4 weeks ago. Although she feels much better, the cough has persisted. She has used bronchodilators, antihistamines, and antitussives (cough suppressants). Which of the following is the best course of treatment at this time?
A. A 1 0-day course of amoxicillin
B. A 5-day course of azithromycin
C. A steroid nasal spray
D. An NSAID
E. An oral steroid taper

Answer 3

3. E

Question 4

A 7 year-old girl presents to the clinic with a recent history of coughing. As the symptoms progressed, the cough comes in paroxysms and there is occasional blood mixed in the sputum. What disease is most likely in this patient?
A. TB
B. Bronchitis
C. Pertussis
D. Asthma

Answer 4

4. C

Question 5

A 54 year old woman has COPD. Which of the following interventions could best improve her symptoms?
A. Taking corticosteroids
B. Using a beta-agonist, like albuterol
C. Quitting smoking
D. Drinking red wine

Answer 5

5. C

Question 6

A patient has chronic bronchitis. He has difficulty breathing and appears swollen and bloated. Which other symptom is most consistent with chronic bronchitis?
A. Shallow, rapid breathing
B. Having a pinkish appearance.
C. Deep, rapid breathing
D. Having a bluish appearance

Answer 6

6. D

Question 7

A 32 year old man comes to the doctor's office on an April afternoon with symptoms of itchy, watery eyes, sneeze, post-nasal drip, and sneezing. The doctor determines the man likely has seasonal allergy. The patient was prescribed an antihistamine. Which of the following is a common side-effect?
A. Bradycardia
B. Headache
C. Sedation
D. Hypertension

Answer 7

7. C

Question 8

school is screening its students with the tuberculin skin test because a student tested positive for tuberculosis. Which of the following is correct about tuberculosis?
A. Cause is a virus, with symptoms of weight loss, night sweats, and coughing blood.
B. Cause is a bacterium, with symptoms of weight loss, night sweats, and coughing blood.
C. Cause is a fungus, with symptoms of weight gain, night sweats, and coughing blood.
D. Cause is a parasite, with symptoms of weight loss, night sweats, and coughing blood.

Answer 8

8. B

Question 9

A patient has asthma and is taking asthma medication. Which of the following statements is most correct?
A. Beta-agonists work by causing bronchodilation and activating the sympathetic nervous system.
B. Muscarinic antagonists work by causing bronchodilation and inhibiting the parasympathetic nervous system.
C. Both A and B
D. None of the Above

Answer 9

9. C

Question 10

A 2 year-old child exhibits wheezing, drooling, raspy cough worse today than yesterday, and appears red. Her temperature is 103.1 F. Which of the following is the most appropriate intervention?
A. Refer the case to a doctor
B. Treat the child with Chinese herbs
C. Do acupressure or acupuncture on REN 22, REN 23, and GV 26
D. Refer the case to the emergency room

Answer 10

10. D

Question 11

Which lifestyle change would be MOST beneficial for a hypet1ensive person?
A. Cessation of smoking
B. Take advantage of more leisure activities
C. Balance exercise with appropriate rest
D. Take in more fibrous foods

Answer 11

11.A

Question 12

Bronchospasm, swelling, and plugging of bronchi by thick mucous secretions are all signs of:
A. Impending myocardial infarction
B. Ingestion of a poison
C. HTN
D. Acute asthma attack

Answer 12

12. D

Question 13

Patient has a history of upper respiratory infections. He now presents with chills and fever, chest pain, labored breathing, cough, and bloody sputum. What condition does this patient likely have?
A. Pneumothorax
B. Pneumonia
C. Bronchitis
D. Infectious bronchitis

Answer 13

13. B

Question 14

A patient presents with fever, a rapid heartbeat, chronic cough with bloody sputum, weakness, weight loss, swollen lymph nodes in the neck. What is your assessment?
A. Bronchitis
B. Tuberculosis
C. Pulmonary embolism
D. Pneumonia

Answer 14

14. B

Question 15

Antihistamines may cause a person to
A. Become unusually elated
B. Become constipated
C. Refrain from eating meals
D. Become drowsy and fall asleep easily

Answer 15

15. D

Question 16

Ramon is a 10 year-old with difficulty breathing at night. He reports that his chest becomes tight and that he has difficulty breathing out. His mother reports mild cases of hay fever for the past three years. He also has heat rashes in the summer. He avoids strawberries as they make him break out in rashes. They live in a historic 100 year old home which still has old carpets. The exam shows a normal chest and spine, with no kyphosis or scoliosis. ENT exam is normal. The diaphragms move equally with deep inspiration. Auscultation reveals normal breath sounds with no broncophony or rales. Cardiac exam is normal.
What is the presumptive diagnosis?
A. Pneumonia
B. Asthma
C. Bronchitis
D.COPD

Answer 16

16. B

Question 17

An X-ray showing consolidation of the right lower lobe of the lung would most likely indicate
A. Protozoa pneumonia
B. Viral pneumonia
C. Fungal pneumonia
D. Bacterial pneumonia

Answer 17

17.D

Question 18

Emilio is ‘a 38 year-old with a 2-3 pack per day smoking habit. He has breathing problems, chronic cough, excess mucous production, and shortness of
breath. He has a hacking cough and his chest sounds as if it is full of rales. Examination reveals a barrel chest with his chest muscles helping him to breathe. There is very little movement from the diaphragm. He has dorsal
kyphosis. His fingers are clubbed. Listening to his chest reveals rales, rhonchi, and decreased breath sounds throughout both sides of his chest. All of the following are a possible diagnosis except?
A. Emphysema
B. COPD, blue bloater type
C. Chronic bronchitis
D. COPD, pink puffer type

Answer 18

18. B

Question 19

19. Marjorie is a 37 year old bank teller. During the past 20 years, she has smoked 2 packs of cigarettes per day. She has had a chronic cough for the past five years which has recently been getting worse. In the past couple of weeks she has coughed up blood on two different occasions. She has lost 15 pounds in
    the past three months without changes in diet or exercise. What is the diagnosis that must be ruled out?
    A. Asthma
    B. Lung cancer
    C. COPD
    D. Chronic bronchitis

Answer 19

19. B

Question 20

A 29 year-old African American patient calls your office in severe distress. She reports that her breathing condition is acting up and thinks she may be dying. You have treated her for asthma in the past and it always has been a mild condition. She can be heard wheezing and gasping for air. She has used her nebulizer but it is not helping. She then says that she got stung by a bee and then hangs up. She arrives at the office with her mother. Her face is swollen an she has hives on her neck and chest. Her face is gray and she is sweaty. She is gasping for air. You administer oxygen. What would you do first?
A. Have assistant call 91 1
B. Elevate her legs
C. Keep her on oxygen
D. Give adrenalin Epi-pen injection

Answer 20

20. A

Question 21

Ben is a 43 year-old tax accountant. He lives with his male partner in Venice, California. Ben complains of pain during swallowing. He has a past history of sore throats and has been treated for allergies which became worse when he moved to California saying that everything smells moldy and damp to him. Last
week he coughed a few spots of blood. He enjoys smoking a pipe while working as it relaxes him. When he played baseball for about 10 years as a shortstop he chewed tobacco. He reports that he has unintentionally lost 10 pounds over the past three months and attributes it to his regular workouts. What is the presumptive diagnosis?
A. Lung cancer
B. Chronic bronchitis secondary to chronic mold exposure
C. Pneumonia, viral type
D. Throat cancer

Answer 21

21. D

Question 22

A 29 year-old African American patient calls your office in severe distress. She reports that her breathing condition is acting up and thinks she may be dying. You have treated her for asthma in the past and it always has been a mild condition. She can be heard wheezing and gasping for air. She has used her nebulizer but it is not helping. She then says that she got stung by a bee and then hangs up. She arrives at the office with her mother. Her face is swollen and she has hives on her neck and chest. Her face is gray and she is sweaty. She is gasping for air. You administer oxygen. What is the presumptive diagnosis?
A. Bee allergy
B. COPD
C. Anaphylactic shock and asthma
D. Acute asthmatic exacerbations

Answer 22

22. C
    Anaphylactic shock: an extreme, often life-threatening allergic reaction to an antigen to which the body has become hypersensitive.

Question 23

A 32 year old female complains of recurring fever with a history of 15 days. The fever comes and goes and lasts between 30-60 minutes. She has self-medicated
with Tylenol which improves the fever but then returns. She reports that her temperature was 101.5 degrees Fat its highest and 100.4 degrees F at its lowest. Her appetite is poor and has lost 1 0 pounds. She has a cough, ear pain, sore throat, nasal congestion, and nasal drainage. All her muscles are sore with pain in the wrists, shoulders, hips and ankles. PHYSICAL EXAM: BP is 85/55; HR. 110 bpm and regular; respiratory rate 14 breaths/min; temperature 100.9 degrees F. She has no rashes. Nose patent with edematous erythematous turbinates. The face is tender to palpation in the maxillary sinuses. Oropharynx is moist with erythema in the posterior pharyngeal wall with no exudates. Neck is tender with enlarged ( 1-2 cm) anterior cervical lymph nodes. Lungs show no
wheezing, rales, or rhonchi. Based on the preceding history and limited physical examination prior to lab tests what is the most likely disease state?
A. Meningitis
B. Viral upper respiratory infection
C. Sinusitis
D.Bronchitis

Answer 23

23. C

Question 24

Beta-agonists are chemical agents that
A. relax smooth muscles in the bronchioles
B. act on the adrenal cortex
C. block alpha receptors
D. suppress the cough reflex

Answer 24

24. A

Question 25

A 42 year-old male developed Pneumothorax after acupuncture. How is the diagnosis confirmed?
A. upright expiratory chest x-ray
B. upright inspiratory chest x-ray
C. upright CT of the chest
D. supine expiratory chest x-ray

Answer 25

25. B

Question 26

A 69 year-old male has Emphysema. What are the symptoms and signs?
A. Productive cough for at least 3 months per year for 2+ years, cyanosis, dyspnea, wheezing
B. Hemoptysis, chest pain, Dyspnea, cough, weight loss, hoarseness
C. Pursed lip breathing, prolonged expiratory period with grunting, dyspnea, barrel-shaped chest
D. Loud snoring, snorting during sleep, restless sleep, day-time sleepiness, impaired concentration

Answer 26

26. C

Question 27

A 42 year-old male developed Pneumothorax after acupuncture. What are the symptoms and signs?
A. Chest pain, Dyspnea, anxiety, diminished breath sounds, lung hyper-resonance on affected side
B. Malaise, fever, exertional dyspnea, productive cough, rales, dullness to percussion over lung areas
C. Pursed lip breathing, prolonged expiratory period with grunting, dyspnea, barrel-shaped chest
D. Productive cough for at least 3 months per year for 2+ years, cyanosis, dyspnea, wheezing

Answer 27

27. A