Respiratory Flashcards
A patient recovering from a viral infection has a persistent cough 6 weeks after the infection.
What will the provider do?
a. Perform chest radiography to assess for secondary infection
b. Perform pulmonary function and asthma challenge testing
c. Prescribe a second round of azithromycin to treat the persistent infection
d. Reassure the patient that this is common after such an infection
ANS: D
Postinfection cough is common after a viral infection and may persist up to 8 weeks after the
infection; this type of cough generally needs no intervention. It is not necessary to perform
chest radiography unless secondary infection is suspected. Antibiotics are not indicated.
Unless the cough persists after 8 weeks, asthma testing is not indicated.
A nonsmoking adult with a history of cardiovascular disease reports having a chronic cough
without fever or upper airway symptoms. A chest radiograph is normal. What will the
provider consider initially as the cause of this patient’s cough?
a. ACE inhibitor medication use
b. Chronic obstructive pulmonary disease
c. Gastroesophageal reflux disease
d. Psychogenic cough
ANS: A
About 10% of patients taking ACE inhibitors will develop chronic cough. COPD, GERD, and psychogenic causes are possible, but given this patient’s cardiovascular history, the possibility
of ACE inhibitor-induced cough should be investigated initially.
A young adult patient develops a cough persisting longer than 2 months. The provider prescribes pulmonary function tests and a chest radiograph, which are normal. The patient denies abdominal complaints. There are no signs of rhinitis or sinusitis and the patient does not take any medications. What will the provider evaluate next to help determine the cause of this cough? a. 24-hour esophageal pH monitoring b. Methacholine challenge test c. Sputum culture d. Tuberculosis testing
ANS: B
Chronic cough without other symptoms may indicate asthma. If PFTs are normal, a
methacholine challenge test may be performed. 24-hour esophageal pH monitoring is
sometimes performed to evaluate for GERD, but this patient does not have abdominal
symptoms and this test is usually not performed because it is inconvenient. Sputum culture is
not indicated. TB is less likely.
Which is characteristic of obstructive bronchitis and not emphysema?
a. Damage to the alveolar wall
b. Destruction of alveolar architecture
c. Mild alteration in lung tissue compliance
d. Mismatch of ventilation and perfusion
ANS: C
Obstructive bronchitis causes much less parenchymal damage than emphysema does, so there
is milder alteration in lung tissue compliance. The other symptoms are characteristic of
emphysema.
Which test is the most diagnostic for chronic obstructive pulmonary disease (COPD)?
a. COPD Assessment Test
b. Forced expiratory time maneuver
c. Lung radiograph
d. Spirometry for FVC and FEV1
ANS: D
Spirometry testing is the gold standard for diagnosing and assessing COPD because it is
reproducible and objective. The forced expiratory time maneuver is easy to perform in a clinic setting and is a good screening to indicate a need for confirmatory spirometry. Lung radiographs are non-specific but may indicate hyper expansion of the lungs. The COPD assessment test helps measure health status impairment in persons already diagnosed with
COPD.
A patient diagnosed with chronic obstructive pulmonary disease reports daily symptoms of
dyspnea and cough. Which medication will the primary health care provider prescribe?
a. Ipratropium bromide
b. Pirbuterol acetate
c. Salmeterol xinafoate
d. Theophylline
ANS: A
Ipratropium bromide is an anticholinergic medication and is used as first-line therapy in
patients with daily symptoms. Pirbuterol acetate and salmeterol xinafoate are both
beta2-adrenergics and are used to relieve bronchospasm; pirbuterol is a short-term medication
used for symptomatic relief and salmeterol is a long-term medication useful for reducing
nocturnal symptoms. Theophylline is a third-line agent.
A young adult patient without a previous history of lung disease has an increased respiratory
rate and reports a feeling of “not getting enough air.” The provider auscultates clear breath
sounds and notes no signs of increased respiratory effort. Which diagnostic test will the
provider perform initially?
a. Chest radiograph
b. Complete blood count
c. Computerized tomography
d. Spirometry
ANS: B
This patient has no signs indicating lung disease but does exhibit signs of hypoxia. A CBC
would evaluate for anemia, which is a more common cause of hypoxia in otherwise healthy
adults. Chest radiography is used to evaluate infectious causes. CT is used if interstitial lung
disease is suspected. Spirometry is useful to diagnose asthma and COPD.
A patient reports shortness of breath with activity and exhibits increased work of breathing
with prolonged expirations. Which diagnostic test will the provider order to confirm a
diagnosis in this patient?
a. Arterial blood gases
b. Blood cultures
c. Spirometry
d. Ventilation/perfusion scan
ANS: C
The patient has signs of either asthma or COPD. Spirometry is essential to both the diagnosis
and management of these diseases. ABGs are useful when evaluating severity of
exacerbations but are not specific to these diseases. Blood cultures are drawn if pneumonia is
suspected. A ventilation/perfusion scan is performed to evaluate for pulmonary
thromboembolic disease.
An older adult patient diagnosed with chronic obstructive lung disease (COPD) is
experiencing dyspnea and has an oxygen saturation of 89% on room air. The patient has no
history of pulmonary hypertension or congestive heart failure. What will the provider order to
help manage this patient’s dyspnea?
a. Anxiolytic drugs
b. Breathing exercises
c. Opioid medications
d. Supplemental oxygen
ANS: B
Formal pulmonary rehabilitation programs, including breathing exercises, are used to manage
long-term disease such as COPD. Anxiolytics and opioids must be used cautiously because of
respiratory depression side effects. Medicare does not approve oxygen supplementation unless
saturations are less than 88% on room air or for patients who have pulmonary hypertension or
CHF who have saturations <89%.
A patient with a smoking history of 35 pack years reports having a chronic cough with recent
symptoms of pink, frothy blood on a tissue. The chest radiograph shows a possible nodule in
the right upper lobe. Which diagnostic test is indicated?
a. Coagulation studies
b. Computed tomography (CT)
c. Fiberoptic bronchoscopy
d. Needle biopsy
ANS: B
CT is suggested for initial evaluation of patients at high risk of malignancy, such as a smoker with >30 pack years, who have suspicious findings on chest radiography. Coagulation studies are performed for patients taking anticoagulants or a history of coagulopathy. Fiberoptic bronchoscopy is used with CT but is not the initial test. Needle biopsy is performed if other tests indicate a tumor.
A patient reports coughing up a small amount of blood after a week of cough and fever. The
patient has been previously healthy and does not smoke or work around pollutants or irritants.
What will the provider suspect as the most likely cause of this patient’s symptoms?
a. Infection
b. Lung abscess
c. Malignancy
d. Thromboembolism
ANS: A
In a healthy patient without risk factors who has a cough and fever, infection is the most likely
cause. Lung abscess may occur but is less likely. Malignancy is also less likely.
Thromboembolism is more likely after surgery or with trauma.
A patient with hemoptysis and no other symptoms has a normal chest radiograph (CXR),
computed tomography (CT), and fiberoptic bronchoscopy studies. What is the next action in
managing this patient?
a. Observation
b. Prophylactic antibiotics
c. Specialist consultation
d. Surgical intervention
ANS: A
Patients with negative findings on CXR, CT, and bronchoscopy, with no risk factors may be
observed for 3 years. Antibiotics are not indicated, since signs of infection are not present.
Specialty consultation and surgery are not indicated.
A patient with a cough has a suspicious lung lesion, a mediastinal lymph mass, and several
bone lesions. What test is indicated to determine histology and staging of this cancer?
a. Biopsy of a bone lesion
b. Bone marrow aspiration and biopsy
c. Bronchoscopy with lung biopsy
d. Thoracentesis and pleural fluid cytology
ANS: A
The diagnosis and stage should be determined in the least invasive manner possible. A single
biopsy of the bone lesion can determine histology and staging. The other procedures are more
invasive and not necessary
A patient with limited stage small cell lung cancer (SCLC) has undergone chemotherapy with a good initial response to therapy. What will the provider tell this patient about the prognosis
for treating this disease?
a. Surgical resection will improve survival chances dramatically.
b. That relapse is likely with a 2-year overall survival of 50%.
c. There is an 80% chance of 5-year survival.
d. Treatment will proceed with curative intent.
ANS: B
Although SCLC often responds very well initially to chemotherapy, the majority of patients
will relapse and the 2-year survival rates are approximately 50%. Surgical resection does not
play a significant role in the management of SCLC because the majority of patients have
metastatic disease at diagnosis. Treatment is generally palliative.
When screening for metastatic cancer in a patient with lung cancer, what will the provider
assess for? (Select all that apply.)
a. Reports of headache
b. Increased presence of a cough
c. Diagnostically confirmed low hematocrit
d. Existence of lymph nodes greater than 1 cm
e. Presence of unexplained weight gain greater than 10 pounds
ANS: A, C, D
Headaches may indicate brain metastases. Low hematocrit and lymphadenopathy with nodes greater than 1 cm also indicate metastasis. Increased cough is a sign of lung cancer itself, not metastasis. Patients with metastatic cancer have unexplained weight loss of more than 10
pounds.
