Unit 3, Part 3

Question 1

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

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

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

Answer 3

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.

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

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%.