Pulmonology Multiple Choice Questions :-
1. What two diseases are included in COPD?
A. chronic bronchitis and asthma
B. chronic bronchitis and emphysema (Correct Answer)
2. COPD is characterized by the presence of ____________ _______________ as a result of either of these two disease states. It is very similar to asthma.
A. airflow restriction
B. airflow obstruction (Correct Answer)
3. What two pulmonary diseases together represent the fourth leading cause of death in the US, with over 100,000 deaths reported annually.
A. emphysema and asthma
B. COPD and Asthma (Correct Answer)
C. chronic bronchitis and asthma
4. T/F Most patients with COPD have features of BOTH chronic bronchitis and emphysema
A. True (Correct Answer)
B. False
5. T/F Cigarette smoking has nothing to do with COPD
A. True
B. False (Correct Answer)
6. Which disease is anatomically defined as an abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of the bonchiolar walls and the alveolar septa?
A. Chronic bronchitis
B. emphysema (Correct Answer)
7. T/F Patients with emphysema have increased lung compliance
A. True (Correct Answer)
B. False
Incorrect
8. Patients with which disease are known as “pink puffers”
A. Emphysema (Correct Answer)
B. Chronic bronchitis
C. Asthma
D. Bronchiectasis
9. You are presented an x ray with an increased blackness, increased retro-sternal space, a small heart, and a depressed, flattened diaphragm, and the presence of blebs. The patient is complaining of dyspnea that is severe and occurs early. Physical exam appears normal. What diagnosis is suspected?
A. Chronic bronchitis
B. Emphysema (Correct Answer)
10. What is the earliest symptom of COPD?
A. yellow or green sputum
B. daily morning cough with no sputum
C. daily morning cough with clear sputum (Correct Answer)
11. When do you order an ABG on a COPD patient? (click all that apply)
A. when hypoxemia or hypercapnia is suspected (Missed)
B. FEV1 < 40% (Missed)
C. FEV1 < 50%
D. If there are clinical signs of right heart failure (Missed)
E. FEV1 < 30%
12. What lab test do you order on the sputum sample of a COPD patient?
A. culture and sensitivity
B. culture and gram stain (Correct Answer)
C. acid fast bacteria
D. culture only
13. What are the common pathogens present in the sputum of a COPD patient
A. Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis (Correct Answer)
B. Staphylococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis
C. Streptococcus pneumonia, acid fast bacillus, Haemophilus influenzae
14. A CBC on a COPD patient with show polycythemia. What is polycythemia?
A. an excess of white blood cells
B. an excess of red blood cells (Correct Answer)
C. an excess of lymphocytes
D. an excess of erythrocytes
Explanation
due to an increased red blood cell count to compensate for hypoxemia
15. What are the common EKG abnormalities seen in a COPD patient?
A. multifocal atrial tachycardia (Missed)
B. atrial flutter (Missed)
C. atrial fibrillaitons (Missed)
D. low voltage and right axis deviation, poor R wave progression (Missed)
16) What are possbile complicatons of COPD?
A. Pulmonary hypertension, cor pulmonale, and chronic respiratory failure, and pulmonary embolism (Correct Answer)
B. Cor pulmonale, and chronic respiratory failure, and pulmonary embolism
C. Pulmonary hypotension, cor pulmonale, and chronic respiratory failure, and pulmonary embolism
17) What vaccines should you recommend to a patient with COPD?
A. yearly pneumococcal vaccine and yearly influenza
B. pneumococcal vaccine and yearly influenza vaccine (Correct Answer)
18) What is the worst stage of COPD?
A. Stage I- FEV1 < 20%
B. Stage II- FEV1 < 30%
C. Stage III- FEV1 < 30% (Correct Answer)
Explanation
Range is from 0-III (with a moderate= IIA and IIB)
19) The cornerstone of treatment of asthma is inhaled corticosteroids, what is the treatment for patients with COPD after smoking cessation has been discussed?
A. supplemental oxygen (home) on a rate of 1-3 meters to achieve a PaO2 > 55 mm Hg (Correct Answer)
B. supplemental oxygen (home) on a rate of 1-3 meters to achieve a PaO2 > 45 mm Hg
C. supplemental oxygen (home) on a rate of 5-10 meters to achieve a PaO2 > 55 mm Hg
20) T/F Bupropion (Wellbutrin) is a treatment option for smoking cessation in motivated patients
A. True (Correct Answer)
B. False
21) What two bronchodilators are most often prescribed for patients with COPD?
A. Atrovent (anti-cholinergic ipratropium bromide) and albuterol (short-acting beta agonists) (Correct Answer)
B. Cromolyn sodium (Intal) and nedocromil (Tilade)
C. Salmeterol (Serevent) and fomoterol (Foradil Aerolizer)
22) T/F Albuterol is the primary drug for asthma and atrovent is for COPD, but both are used in both conditions
A. True (Correct Answer)
B. False
23) T/F MDIs are contraindicated in patients with a peanut or soy allergy?
A. True (Correct Answer)
B. False
24) T/F Corticosteroids are useful for patients with COPD
A. True
B. False (Correct Answer)
25) What two symptoms of a COPD flare suggest that you should put them on an antibiotic?
A. tachypnea and change in quantity or character of sputum
B. dyspnea and change in quantitiy or character of sputum (Correct Answer)
C. orthopnea and low SaO2 (low oxygen saturation)
D. dyspnea and high SaO2 (oxygen saturation)
26) What antibiotic do you prescribe for patients with a flare of COPD
A. Cipro
B. Augmentin
C. Bactrim (Correct Answer)
27) T/F You have to consider withholding oxygen therapy to avoid worsening respiratory acidemia
A. True
B. False (Correct Answer)
28) Which of the following should you consider regarding intubating a patient with COPD?
A. Intubate as soon as possible and try NPPV noninvasive positive-pressure ventilation delivered by face mask only when the patients family wishes not to intubate
B. Hold of intubating and try NPPV noninvasive positive-pressure ventilation delivered by face mask to reduce the need for intubating (Correct Answer)
29) T/F Cystic fibrosis is an autosomal dominant disorder?
A. True
B. False (Correct Answer)
30) Which disease is caused by abnormalities in a membrane chloride channel that results in altered chloride transport and water flux across the apical surface of epithelial cells
A. COPD
B. Cystic fibrosis (Correct Answer)
C. Bronchietasis
D. Asthma
31) At what age do symptoms of cystic fibrosis occur?
A. 1 year (Correct Answer)
B. 2 years
C. 5 years
D. 7 years
32) A 7 month old female presents with wheezing, dyspnea, chronic cough, nasal polyps, greasy stools and poor growth. What diagnosis are these symptoms consistent with?
A. COPD
B. Emphysema
C. Chronic Bronchitis
D. Cystic fibrosis (Correct Answer)
E. Bronchiectasis
33) T/F Cystic fibrosis is a restricting and obstructive disease?
A. True (Correct Answer)
B. False
34) What test is the gold standard for diagnosis cystic fibrosis?
A. lick the patient to see if they taste sweet
B. Quantitative pilocarpine iontophoresis sweet test (sweet test)
C. Quantitative pilocarpine iontophoresis sweat test (sweat test) (Correct Answer)
D. lick the patient to see if they taste salty
35) Which of the following result from a sweat test is considered to be diagnostic of cystic fibrosis?
A. >30mEq/L
B. >40mEq/L
C. >50mEq/L
D. > 60mEq/L (Correct Answer)
36) How do you clear lower airway secretions for cystic fibrosis patients?
A. directed cough (Missed)
B. postural drainage (Missed)
C. Chest palpation
D. Chest percussion (Missed)
E. vibration techniques (Missed)
37) What infectious agents are common in cystic fibrosis patients that have active airway infections?
A. strephococcus aureus
B. staphylococcus aureus (Missed)
C. pseudomonas aeruginosa (Missed)
D. haemophilus ingluenzae (Missed)
E. stenotrohomanas maltophilia and burkholderia cepacia are occasionally isolated (Missed)
38) What diet recommendations are suggested for cystic fibrosis patients?
A. low salting of foods
B. liberal salting of foods (Missed)
C. low protein and low calorie diets (.5 times the recommended normal intake)
D. high protein and high calorie diets (1.5 times the recommended normal intake) (Missed)
E. double vitamin supplements (Missed)
39) What drugs do you prescribe to patients with cystic fibrosis?
A. atrovent and albuterol
B. pulmozyme and mucomyst (Correct Answer)
40. Cystic fibrosis causes frequent respiratory infections by ____.
A. decreasing surfactant production
B. limiting macrophage efficacy
C. limiting humidification of inhaled air
D. thickening of secreted mucus (Correct Answer)
E. limiting warming of inhaled air
41. Surfactant _____.
A. increased in people with ARDS
B. increased in babies with IRDS
C. increases surface tension
D. contributes to a normal lung compliance (Correct Answer)
E. increases the work of breathing
42. Stimulating the sympathetics will decrease airflow through the conducting zone.
A. True
B. False (Correct Answer)
43. Which of the following would increase in obstructive but not restrictive lung disease?
A. ratio of FEV1/FVC
B. FEV1
C. FVC
D. residual volume (Correct Answer)
44. Which of the following does not contribute to alveoli remain inflated?
A. surface tension (Correct Answer)
B. surfactant
C. negative pleural pressure
D. residual volume
Explanation
Surface tension contributes to alveoli deflating.
45. The quantity of oxygen carried in the blood _____.
A. increases with increased altitude
B. increases by increasing the number of circulating RBCs (Correct Answer)
C. increases by decreasing the concentration of hemoglobin in the blood
D. increases by breathing lower pressure of oxygen
46. Which one of the below is not a function of the respiratory system?
A. allows gas exchange of oxygen and carbon dioxide
B. can alter the pH by changing oxygen levels (Correct Answer)
C. provides protection against some microorganisms by preventing their entry into the body and by removing them from respiratory surfaces
D. allows for speech and sound generation
Explanation
Changing the carbon dioxide levels
47 Air is filtered as it moves through narrow curved channels in the nasal cavity called _________ and the debris is trapped and moved towards the pharynx by _______ epithelium.
A. meati, pseudostratified ciliated columnar (Correct Answer)
B. conchae, pseudostratified ciliated columnar
C. meati, stratified squamous
D. conchiae, stratified squamous
48. Which one of the cavities or ducts does not drain into or out of the nasal cavity?
A. vestibule
B. paranasal sinus
C. choanae
D. auditory tube (Correct Answer)
Explanation
Auditory tube trains into the nasopharynx
49. Which is not a function of the nasal cavity?
A. filters the air
B. provides exchange site for gases (Correct Answer)
C. warms the air
D. moistens the air
50. The posterior surface of the nasopharynx contains what tonsils?
A. palatine
B. oral
C. lingual
D. pharyngeal (Correct Answer)
Explanation
Also called the adenoid tonsils
12) The soft palate including the uvula closes off the ______________ when swallowing.
A. oropharynx
B. nasopharynx (Correct Answer)
C. glottis
D. laryngopharynx
13) Coughing will cause the trachealis muscle to:
A. contract, which will narrow the diameter of the trachea (Correct Answer)
B. relax, which will increase the diameter of the trachea
C. contract, which will close the vocal cords
D. relax, which will open the vocal cords
14) In an asthma attack the _________________ muscle in the ______________ contract.
A. smooth, trachea
B. skeletal, bronchi
C. skeletal, terminal bronchioles
D. smooth, terminal bronchioles (Correct Answer)
15) 95 percent of the epithelium of the alveoli is?
A. simple squamous (Correct Answer)
B. simple columnar
C. pseudostratified columnar
D. stratified squamous
16) If the elastic fibers were removed from around the alveolar sacs, the lungs in normal breathing would lose most of their ability to:
A. expand so inhalation would be impeded
B. expand so exhalation would be impeded
C. recoil so exhalation would be impeded (Correct Answer)
D. recoil so inhalation would be impeded
Explanation
This is an increase in compliance of the lungs thus decrease in the elastic recoil and airflow is obstructed i.e. air gets trapped in the lungs
17) Surfactant is a mixture of lipoprotein molecules produced by special cells in the alveoli called?
A. macrophages
B. Type I pneumocytes
C. Type II pneumocytes (Correct Answer)
D. red blood cells
18) The pathway of oxygen from the alveoli across the respiratory membrane to the capillaries is:
A. simple squamous → basement membrance of alveolus → interstitial space → endothelium → basement membrane of endothelium → simple squamous (Correct Answer)
B. simple cuboidal → basement membrane of alveolus → endothelium → basement membrane of capillary → simple squamous
C. simple squamous → basement membrane of capillary → interstitial space → basement membrane of alveolus → simple squamous
D. simple squamous → interstitial space → simple squamous
19) The right lung contains _________ lobes while the left lung contains ________ lobes because?
A. 2, 3; the heart takes up space on the right side
B. 2, 3; the trachea, blood vessels and esophagus travel on the right side
C. 3, 2; the heart takes up space on the left side (Correct Answer)
D. 3, 2; the trachea, blood vessels and esophagus travel on the left side
20) Two-thirds of the increase in thoracic cavity volume during inspiration is caused by?
A. contraction of the external intercostals
B. contraction of the diaphragm (Correct Answer)
C. relaxation of the diaphragm
D. relaxation of the pectoralis minor and scalenes
21) The muscles that are most active in expiration are?
A. diaphragm
B. scalenes
C. external intercostals
D. internal intercostals (Correct Answer)
Explanation
Internal intercostals depress the ribcage for expiration.. External intercostals elevate the ribcage for inspiration
22) What is the membrane that lines the inner thoracic cavity wall, the superior surface of the diaphragm, and the mediastinum?
A. parietal pericardium
B. parietal pleura (Correct Answer)
C. visceral pericardium
D. visceral pleura
23) The space between the two lungs that houses the heart, trachea, esophagus and associated structures is called?
A. parietal cavity
B. thoracic cavity
C. pleural cavity
D. mediastinum (Correct Answer)
24) Your vestibular and vocal cords close tightly, your abdominal muscles contract, and the muscles of expiration contract forcefully. You have just experienced the preparation for?
A. cough reflex (Correct Answer)
B. sneeze reflex
C. hiccup
D. shouting reflex
25) According to Dalton’s Law, the partial pressure of oxygen in your alveoli is approximately?
A. 760 mmHg
B. 40 mmHg
C. 104 mmHg (Correct Answer)
D. 0 mmHg
26) In premature infants with respiratory distress syndrome or hyaline membrane disease, surfactant is not produced in adequate quantities and a respirator may be required. This is because surfactant…
A. increases the compliance of the lungs
B. decreases the surface tension of the fluid that lines the alveoli (Correct Answer)
C. decreases the elasticity of the elastic fibers in the alveolar walls
D. increases the ability of hemoglobin to bind to oxygen
27) Pneumothorax is the introduction of air into the pleural cavity through an opening resulting from penetration trauma, such as that caused by a knife. As a result of air in the pleural cavity the lungs tend to?
A. be less elastic and you cannot exhale
B. collapse (Correct Answer)
C. over inflate
D. increase the surface tension in the fluid lining the alveoli
28) During a normal inspiration, the pleural pressure is ____ and the alveolar pressure is ____ than atmospheric pressure.
A. positive, less
B. negative, greater
C. positive, greater
D. negative, less (Correct Answer)
29) Emphysema causes destruction of elastic lung tissue, as a result the elastic recoil of the lungs would _______ and the compliance of the lungs would ________.
A. decrease, decrease
B. decrease, increase (Correct Answer)
C. increase, decrease
D. increase, increase
Explanation
Compliance and elastance are indirectly proportional
30) The amount of air inspired or expired in a normal inhalation or exhalation is called _____ and has a volume of about ___ mL.
A. tidal volume, 4600
B. vital capacity, 4600
C. residual volume, 1200
D. tidal volume, 500 (Correct Answer)
31) You are exercising doing aerobics at the Griff. As you increase to a high intensity of exercise, you would expect the tidal volume to ______ and the frequency of respiration to _______.
A. decrease, increase
B. increase, increase (Correct Answer)
C. stay the same, increase
D. increase, decrease
32) In a normal inspiration, the amount of air that is actually available for exchange of oxygen and carbon dioxide is about ______mL.
A. 500
B. 150
C. 350 (Correct Answer)
D. 650
33) What best explains why Individuals with tuberculosis or pneumonia have difficulty breathing?
A. solubility coefficients for oxygen and carbon dioxide are increased and the surface area of the respiratory membrane is decreased
B. the thickness of the respiratory membrane is increased while the surface area is decreased (Correct Answer)
C. the thickness of the respiratory membrane is increased and the partial pressure difference across the respiratory membrane for oxygen and carbon dioxide is increased
D. the partial pressure differences across the respiratory membrane for oxygen and carbon dioxide are increased while the surface area is decreased
Explanation
Tuberculosis and pneumonia increase the thickness of the respiratory membrane by causing inflammation and fluid accumulation in the alveoli. These two pathologies also cause degeneration of the walls of the alveoli, which decreases the surface area of the respiratory membrane. So tuberculosis and pneumonia would cause both an increase in the thickness of the respiratory membrane and a decrease in its surface area. Ventilation of the lungs and therefore breathing would be severely affected.
34) Blood entering the lungs has a PO2 of 40 mm Hg while blood immediately leaving the lung capillaries has a PO2 of _____ mm Hg because it has reached equilibrium with the PO2 in the _________.
A. 45, interstitial fluid
B. 45, alveoli
C. 104, interstitial fluid
D. 104, alveoli (Correct Answer)
35) The dorsal and ventral respiratory groups make up the respiratory center and are located where?
A. pons
B. medulla (Correct Answer)
C. hypothalamus
D. cortex
36) What group in the respiratory center is most active during inspiration?
A. dorsal (Correct Answer)
B. pneumotaxic center
C. ventral
D. apneustic
37) Which of the following would be a collection of neurons in the pons which switches between inspiration and expiration?
A. apneustic
B. dorsal
C. ventral
D. pneumotaxic (Correct Answer)
38) Which muscle(s) is stimulated by the dorsal respiratory group?
A. external intercostals
B. internal intercostals
C. diaphragm (Correct Answer)
D. rectus abdominus
39) Which muscles is (are) stimulated by the ventral respiratory group?
A. diaphragm
B. rectus abdominis
C. intercostals (Correct Answer)
40) A Type I diabetic whose insulin levels drop too low will produce metabolic acids that will lower the pH of the blood. You would expect the diabetic to?
A. have brief periods of apnea
B. have no change in respiratory rate
C. decrease the respiratory rate
D. increase the respiratory rate (Correct Answer)
41) Chemoreceptors are located where?
A. walls of the carotid and aortic arteries and in the medulla oblongata (Correct Answer)
B. walls of the carotid and aortic arteries only
C. medulla oblongata and in the walls of the superior and inferior vena cavas
D. walls of the carotid and aortic arteries and in the walls of the superior and inferior vena cavas
42) Strong emotions can sometimes stimulate hyperventilation. The best treatment for hyperventilation is to?
A. just let the person relax and normal breathing will resume
B. give the person oxygen
C. have the person increase his or her rate of breathing
D. have the person breath into a bag (Correct Answer)
43) A drop in PO2 has little effect on the respiratory centers until the arterial PO2 drops by about 40%. However, a 10% rise in arterial PCO2 will cause the respiratory rate to double. This is because…
A. hemoglobin carries great reserves of oxygen while PCO2 changes also cause changes in pH (Correct Answer)
B. oxygen is not as important to the cells as is carbon dioxide
C. chemoreceptors are not sensitive to PO2 but are sensitive to PCO2 and pH
D. oxygen cannot diffuse from the blood into the cerebrospinal fluid while carbon dioxide can, and the chemoreceptors in the medulla oblongata are much more important in regulating respiration
Explanation
5 mm Hg increase in PCO2 will double the respiratory rate. Therefore blood PCO2 levels are much more important regulators of respiration than blood PO2 levels. Increase blood PCO2 levels also increases the production of carbon acid, which lowers the pH. Central (medulla oblongata) and peripheral (carotid and aortic arteries) chemoreceptors are sensitive to changes in PO2 but are much more sensitive to changes in PCO2 and pH.
44) A decrease in oxygen in the tissues below normal levels is called?
A. apnea
B. hypocapnia
C. hypoxia (Correct Answer)
D. hypercapnia
45) Which is not a paranasal sinus?
A. frontal
B. ethmoid
C. mastoid (Correct Answer)
D. maxillary
E. sphenoid
46) What structure separates the nasopharynx from the oropharynx?
A. hard palatae
B. vestibule
C. uvula (Correct Answer)
D. fauces
47) What is the opening between the vocal cords called?
A. epiglottis
B. glottis (Correct Answer)
C. larynx
D. fauces
48) If alveolar volume increases, alveolar pressure…
A. increases
B. decreases (Correct Answer)
C. stays the same
49) During expiration, the volume of the thorax ____ as the diaphragm ______.
A. decreases, contracts
B. decreases, relaxes (Correct Answer)
C. increases, contracts
D. increases, relaxes
50) Oxygen and carbon dioxide move through the respiratory membrane and into and out of cells by the process of?
A. active transport
B. exocytosis
C. diffusion (Correct Answer)
D. facilitated diffusion
1) T/F The normal peak flow is what the patient’s peak flow is when he is at his best
A. True (Correct Answer)
B. False
2) The peak flow system is broken down into zones; the green zone implies _______ control: the PEF > ____. The patient has no asthma symptoms and medications should be taken as usual.
A. caution, 50 to 80%
B. bad, 80%
C. good, 80% (Correct Answer)
D. medical alert, 50%
3) The peak flow system is broken down into zones; the red zone implies _______ control: the PEF ____. The patient should use a short-acting inhaled beta-agonist, and call the provider or go to the emergency room.
A. caution, 50-80%
B. a medical alert, < 50% (Correct Answer)
C. good control, >80%
4) The peak flow system is broken down into zones; the yellow zone implies _______ control: the PEF ____. The patient should use a short-acting inhaled beta-agonist
A. medical alert, <50%
B. caution, 50-80% (Correct Answer)
C. good control, >80%
D. caution, 60-80%
E. caution, 30-70%
5) T/F A routine chest x ray on an asthmatic does not show hyperinflation and peri-bronchial “cuffing”(bilateral, peri-hilar opacificaiton)
A. True
B. False (Correct Answer)
Explanation
remember- hyperinflation and peri-bronchial cuffing are signs of asthma on chest x ray
6) Which of the following are indications for ordering an arterial blood gas (ABG)?
A. mental status changes, signs of severe asthma, lack of improvement after 15 minutes of aggressive therapy
B. coughing, signs of severe asthma, lack of improvement after 20 minutes of aggressive therapy
C. mental status changes, signs of severe asthma, lack of improvement after 30 to 60 minutes of aggressive therapy (Correct Answer)
7) What are the complications of asthma?
A. exercise induced asthma, dehydration, airway infection, cor pulmonale, tussive syncope, headaches
B. Exhaustion, dehydration, airway infection, cor pulmonale, tussive syncope (Correct Answer)
C. chronic cough, dehydration, airway infection, cor pulmonale, hemoptosis, CVA
8) The term ____________ is used to describe a prolonged, severe asthma attack that does not respond to treatment, and involves bronchospasm so sever that the patient is at risk for respiratory failure.
A. cor pulmonale
B. status asthmaticus (Correct Answer)
C. dyspnea
D. apnea
E. status bronchospasmus
9) What are the age groups for treatment recommendations accoring to EPR-3?
A. 0-4, 5-11, 12 and older (Correct Answer)
B. 0-2, 2-11, 12 and older
C. 0-10, 10-15, 16 and older
10) What are the three classifications of severity of asthma?
A. mild persistent, moderate persistent, severe persistent
B. intermittent, mild persistent, moderate persistent, severe persistent (Correct Answer)
C. exertion persistent, mild persistent, moderate persistent, severe persistent
11)
“The likelihood of either asthma exacerbations, progressive decline in lung function, or risk of adverse effects from medicine” is defined by what term
A. impairment
B. risk (Correct Answer)
C. functional limitations
D. intensity of symptoms
12) ___________ is defined as “the frequency and intensity of symptoms and functional limitations the patient is experiencing, or has recently experienced.
A. risk
B. intensity (Correct Answer)
C. hypoxia
D. agitation
E. impairment
13) What is the treatment for persistent asthma?
A. short- acting bronchoconstrictors
B. daily anti-inflammatory therapy with inhaled corticosteroids (Correct Answer)
C. short-acting bonchodilators
D. long-acting bronchodilators only
14) Asthma medications can be broken down into 2 types: _____________ medications which are taken daily to achieve and maintain control of persistent asthma and _______ medications which are taken to promote prompt reversal of acute airflow obstruction and relief of accompaning sumptoms by direct relaxation of bronchial smooth muscle
A. quick relief, long-term control
B. long-term control, quick-relief (rescue) (Correct Answer)
15) T/F Maintenance, control, and preventive medications act to attenuate airway inflammation
A. True (Correct Answer)
B. False
16) What therapy is reserved for acutely ill patients and those that have trouble coordinating other therapies?
A. Metered-dose inhalers
B. helium-oxygen
C. small volume nebulizers (Correct Answer)
17) Corticosteroids, long acting bronchodilators and leukotriene antagonists are what type of pharmacologic agents for asthma
A. Long-term control medications (Correct Answer)
B. short acting medications
C. Quick-relief medications
Incorrect
18) ________ is/are the most potent and consistently effetive anti-inflammatory agents currently available.
A. B blockers
B. corticosteriods (Correct Answer)
C. bronchodilators
D. leukotreine antagonists
19) Why do you need to advise your patient to rinse their mouth out after using inhaled corticosteroids?
A. systemic side effects of cough, dysphonia, oropharyngeal candidiasis and systemic absorption
B. local side effects of cough, dysphonia, oropharyngeal candidiasis and systemic absorption (Correct Answer)
C. local side effects of cough, dysphagia, oropharyngeal candidiasis and systemic absorption
20) What medication do you use for preventing exercise induced bronchospasm and to treat nocturnal symptoms?
A. anti-intflammatory medications will treat the patient promptly in both cases
B. beta- adrenergic agents- long acting bronchodilators- these should not replace anti-inflammatory therapy (Correct Answer)
C. beta- adrenergic agents- long acting bronchodilators- these are safe to replace anti-inflammatory therapy
21) T/F Theohylline is a beta adrenergic agent
A. True
B. False (Correct Answer)
22) T/F Theophylline needs to be monitored closely due to the drugs narrow toxic-to- therapeutic range (5-15micrograms/mL), individuals metabolize it differently, and the effects of many factors on the drug absorption and metabolism.
A. True (Correct Answer)
B. False
23) Why does a nebulizer work better for asthmatics than the metered dose inhaler
A. Metered Dose Inhalers are difficult to use correctly therefore the patient doesn’t get an adequate dose
B. The dose delivered by nebulizer is 35-30 times greater than that of an inhaler (Correct Answer)
C. Nebulizers prevent asthma symptoms from recurring
D. The dose delivered by a nebulizer is 10-25 times greater than that of an inhaler
24) Why would an asthmatic be irritable?
A. Thay may be hypoxic
B. They may be hypoxic or hypocapnic
C. They may be hypoxic or hypercapnic (Correct Answer)
25) What is the most effective bronchodilator during asthma exacerbations?
A. leukotrienes
B. short-acting inhaled beta-adrenergic agonists- albuterol (Correct Answer)
C. corticosteroids
D. anticholinergic agents- ipratoropium MDI
26) What drug has a potential to cause long-term suppression of the hypothalamic-pituitary- adrenal axis after administration for 2 weeks or more?
A. anticholinergic agents
B. systemic corticosteroids (Correct Answer)
C. beta-adrenergic agents
D. phosphodiesterase inhibitors
27) Osteoporosis, cataracts,redistribution of fat, edema, thinning of skin, increased blood glucose in diabetics, decreased immune function, and stunted growth in children are all a result of what medication?
A. short acting beta agonists
B. systemic corticosteroids (Correct Answer)
C. phosphodiesterase inhibitors
28) What are the 3 goals of treating asthma exacerbations?
A. reduction of the likelihood of recurrence of obstruction (Missed)
B. correction of hypocalcemia
C. correction of hypoxemia (Missed)
D. reversal of airflow obstruction (Missed)
E. supplemental oxygen to maintain SaO2 greater than 89%
29) What is the written action you should provide to your patients that is based on signs and symptoms of expiratory flow rates?
A. Asthma action plan with green-go, yellow-caution, red-stop zones- (Correct Answer)
B. Asthma go plan with green-go, orange- caution, red-stop zones
C. Asthma plan with green- stop, yellow-caution, red-go zones
30) What is a congenital or acquired disorder of the bronchi that is a pathologic, irreversible, chronic dilation of the large and medium sized bronchi and brochioles, characterized by permanent, abnormal dilation and destruction of the bronchial walls- may be caused by recurrent inflammation or infection of the airways?
A. asthma
B. bronchiectasis (Correct Answer)
C. COPD
D. cystic fibrosis
31) A patient presents with a chronic cough, production of copious amounts of purulent sputum, hemoptysis, pleuritic pain, and recurrent pneumonia. What diagnosis would you consider?
A. COPD
B. bronchiectasis (Correct Answer)
C. asthma
D. cystic fibrosis
32) Upon physical exam you notice the patient has copious, foul-smelling, purulent sputum, persisent crackles at the lung bases, digital clubbing, weight loss, anemia, leukocytosis with a left shift. What three tests should you order on a sputum sample?
A. culture and sensitivity (Missed)
B. Gram stain (Missed)
C. test for acid fast bacteria (Missed)
D. culture without sensitivity
E. Giemesa stain
33) __________ bronchiectasis results from a global disorder which predisposes and individual to chronic inflammation whereas ______________ bronchiectasis results from a focal injury such as pneumonia/
A. localized, diffuse
B. diffuse, localized (Correct Answer)
C. primary, secondary
D. focal, diffuse
34) What disease causes half of all cases of bronchiectasis?
A. COPD
B. cystic fibrosis (Correct Answer)
C. Asthma
D. Pleuritis
35) Foul smelling sputum is often due to a/an ____________ infection.
A. aerobic
B. anaerobic (Correct Answer)
C. enteric
D. viral
E. mycobacterial
36) What disorder of the airway is characterized by crowded bronchial markings related to fibrosis, and small cystic spaces at the base of the lungs?
A. cystic fibrosis
B. bronchiectasis (Correct Answer)
C. Asthma
D. COPD
37) T/F X ray of the chest is the diagnostic study of choice for bronchiectasis and will reveal dilated, tortuous airways, and bronchial wall thickening due to peri-bronchial wall thickening due to peri-bronchial fibrosis.
A. True
B. False (Correct Answer)
Explanation
CT scan is the best dx test for bronchiectasis
38) What is the treatment of acute exacerbations of bronchiectasis?
A. oxygen, hydration, antibiotics, chest physiotherapy, inhaled bronchodilators (Correct Answer)
B. corticosteroids, hydration, antibiotics, chest physiotherapy, inhaled bronchodilators
C. oxygen, hydration, antibiotics, inhaled bronchodilators
D. oxygen, antibiotics, chest physiotherapy, inhaled bronchodilators
39) What are the complications of bronchiectasis?
A. dyspnea, cor pulmonale, secondary parietal abscesses
B. hemoptysis, cor pulmonale, amyloidosis, secondary visceral abscesses at distant sites (Correct Answer)
C. hemoptysis, cor pulmonale, amyloidosis, hypoxemia
40) Empirical oral antibiotic therapy is reasonable in acute exacerbation of a specific bacterial pathogen cannot be isolated. What are the two reasonable choices?
A. trimethoprim-sulfamethoxazole and a cephalosporin
B. amoxicillin and metronidazole
C. amoxicillin/ amoxicillin-clavulanate and trimethoprim-sulfamethoxazole (Correct Answer)
41) What three components characterize asthma?
A. inflammation of the airways, overflow of airflow, bronchial hyper-reactivity
B. inflammation of the airways, obstruction to airflow, bronchial hyper-reactivity (Correct Answer)
C. obstruction to airflow, bronchial hyper-reactivity, mucus production
D. chronic dilation of large and medium sized bronchi and bronchioles, destruction of the bronchial walls, recurrent inflammation or infection of the airways
42) T/F There is a genetic predisposition to asthma?
A. True (Correct Answer)
B. False
43) A patient presents with episodic wheezing, difficulty breathing, chest tightness, and cough- what is a likely diagnosis based on these symptoms? hint: in some cases airflow may be too limited to produce wheezing and the only diagnostic clue on auscultation may be globally reduced breath sounds with prolonged expiration.
A. COPD
B. bronchiectasis
C. cystic fibrosis
D. asthma (Correct Answer)
E. chronic cough
44) T/F The evaluation for asthma should include spirometry before and after the administration of a short-acting bronchodilator
A. true (Correct Answer)
B. false
45) Airflow obstruction is indicated by a reduced FEV1/FVC ratio (below ________ %)
A. 70% (Correct Answer)
B. 80%
C. 90%
D. 100%
46) Peak expiratory flow (PEF) meters are hand held devices designed as home monitoring tools. What is considered normal peak flow?
A. it is what the standard of care is across all aspects of asthma patients
B. it is what the patient’s peak flow is when he/she is at their best (Correct Answer)
C. it ranges between green zones and yellow zones according to PEF monitoring guidelines
D. a range to determine peak flow variability
47) Give three functions of the peak expiratory flow meter (select the three that apply)
A. provide the patient and provider with subjective measurements on which to base treatment
B. provide the patient and provider with objective measurements on which to base treatment (Missed)
C. establish peak flow maximums
D. quantify asthma severity (Missed)
E. establish peak flow variability (Missed)
48) ____________ is defined as hypertrophy of the right ventricles resulting from disease of the lungs.
A. tussive syncope
B. Cor pulmonale (Correct Answer)
C. status asthmaticus
D. atopy
49) (T/F) Atopy is the genetic predisposition to respond to allergens
A. True (Correct Answer)
B. False
50) T/F Routine chest x rays should be ordered on patients who have asthma
A. true
B. false (Correct Answer)
Explanation
x rays are only indicated when pneumonia, other mimicking dz, and complications of asthma (pneumothorax) is suspected
51) T/F The ERP-3 (Expert Panel Report-3) defines asthma severity as the “extrinsic intensity of the disease process”
A. True
B. False (Correct Answer)
Explanation
intrinsic intensity of the disease process
52) In what ways does asthma control reduce impairment? (click all that apply)
A. minimize the need for emergency department visits
B. preventing troublesome and chronic symptoms (Missed)
C. require the use of an inhaled short-acting beta-agonist less than 2 days/week (Missed)
D. prevent recurrent asthma exacerbations
E. meet family and patient expectations and satisfaction of asthma care (Missed)
53) In what ways does asthma control reduce risk? (click all that apply)
A. prevents recurrent asthma exacerbations and minimizes the need to go to the ER (Missed)
B. prevents progressive loss of lung function (Missed)
C. requires infrequent use of medications for quick relief of symptoms
D. meets patients expectations and satisfaction with asthma care
E. provides optimal pharmacotherapy with minimal or no adverse effects (Missed)
54) Long term asthma control medications are taken to reduce ___________ ;whereas quick relief medications are taken to reduce ________ and directly reduce____________.
A. inflammation, airflow obstruction and bronchospasm (Correct Answer)
B. airflow obstruction, inflammation and bronchospasm
C. bronchospasm, inflammation and airflow obstruction
55) Which asthma medications are considered safe during pregnancy? (click all that apply)
A. phosphodiesterase inhibitors
B. aerosolized beta-agonists (Missed)
C. aerosolized steroids (Missed)
D. oral steroids (Missed)
E. oral theophylline
56) What are the three classes of long-term control medications for asthma?
A. anticholinergic agents
B. Long-acting bronchodilators (Missed)
C. supplemental oxygen
D. corticosteroids (Missed)
E. leukotreine antagonists (Missed)
57) What medication is preferred for long-term control of asthma and are considered first-line agents for patients with persistent asthma?
A. systemic corticosteroids
B. inhaled corticosteroids (Correct Answer)
C. long-acting bronchodilators
D. leukotriene antagonists
58) T/F Systemic corticosteroids are used for prompt control of asthma during exacerbations, or when initiating long-term asthma therapy
A. True (Correct Answer)
B. False
59) What medication acts to modulate mast cell mediator release and eosinophil recruitment and takes weeks to see any beneficial effects?
A. mediator inhibitors such as cromolyn sodium (intal) and nedocromil (Tilade) (Correct Answer)
B. mediator inhibitors such as salmeterol (serevent) and formoterol (foradil aerolizer)
C. beta-adrenergic agents such as salmeterol (serevent) and formoterol (foradil aerolizer)
D. beta-adrenergic agents such as cromolyn sodium (intal) and nedocromil (Tilade)
60) ____________ are first line agents for patients with persistent asthma and ____________ are agents used for patients with mild persistent asthma or exercise-induced asthma
A. mediator inhibitors, inhaled corticosteroids
B. beta-adrenergic agents, inhaled corticosteroids
C. systemic corticosteroids, mediator inhibitors
D. inhaled corticosteroids, mediator inhibitors (Correct Answer)
61) T/F Beta-Adrenergic agents should not be used during acute broncho-constriction because they have a delayed onset of action, however, they are good for long-term control because they provide bronchodilation for up to 12 hours.
A. True (Correct Answer)
B. False
62) Which long term control medication should be used for nocturnal symptoms and for the PREVENTION of exercise-induced bronchospasm?
A. mediator inhibitors
B. beta-adrenergic agents (Correct Answer)
C. phosphodiesterase inhibitors
D. leukotriene antagonists
63) Which of the long term bronchodilators provides mild bronchodilation, anti-inflammation, mucociliary clearance, enhanced diaphragmatic contractility? Hint: the specific drug in this class has a narrow toxic-to-theraputic range
A. beta-adrenergic agents
B. mediator inhibitors
C. phosphodiesterase inhibitors (Correct Answer)
D. leukotriene antagonists
64) _____________ are biochimical mediators that contribute to airway obstruction and astjma symptoms by contracting airway smoooth muscle, increasing vascular permeability and mucus secretion, and attracting and activating airway inflammatory cells.
A. Leukotriene antagonists
B. Leukotrienes (Correct Answer)
C. Leunotrienes
D. Lipostreines
65) T/F Leukotriene antagonists are considered alternatives to low-dose inhaled corticosteroids in patients with mild persistent asthma
A. true (Correct Answer)
B. false
66) Which of the following are considered quick relief medications for asthma?
A. short acting beta adrenergic agents (Missed)
B. anticholinergic agents (Missed)
C. systemic corticosteroids (Missed)
D. leukotriene antagonists
E. long-acting bronchodilators
67) T/F Short-acting beta-adrenergic agonists should be used in all patients to treat acute symptoms
A. True (Correct Answer)
B. False
68) T/F Albuterol is the most common short acting inhaled beta-adrendergic agonist
A. True (Correct Answer)
B. False
69) Which medication is the R isomer of albuterol that is given in lower doses and has less beta-agonist associaed adverse effects such as tremors, hyperactivity, and tachycardia
A. Albuterol (Ventolin, Proventil)
B. Levalbuterol (Xopenex) (Correct Answer)
C. Ipratropium bromide (Atrovent)
70) Which quick relief asthma medication reverses vagally mediated bronchospasm, but not allergen or exercise-induced bronchospasms?
A. beta adrenergic agents
B. anticholinergic agents (Correct Answer)
C. antimuscarinic agents
D. cholinergic agonist agents
71) What is the most common anticholinergic agent used for quick relief for asthma exacerbations?
A. levalbuterol (Xopenex)
B. Ipratropium bromide (Atrovent) (Correct Answer)
C. pednisone
D. salmeterol (Serevent)
72) Which drug can you prescribe for a patient that have an intolerance to beta agonists?
A. anticholinergic agent- Atrovent (Correct Answer)
B. systemic corticosteroids- prednisone
C. leukotriene antagonists
73) Which drugs are effective primary treatment for patients with moderate to severe asthma exacerbations or who fail to respond promptly to beta agonist therapy?
A. leukotriene antagonists
B. anticholinergic agents
C. systemic corticosteroids (Correct Answer)
D. phosphodiesterase inhibitors
74) Which type of medication for asthma works by speeding the resolution of airflow obstruction and reduces the rate of relapse, should be prescribed for early administration at home as burst therapy?
A. systemic corticosteroids (Correct Answer)
B. anticholinergic agents
C. beta adrenergic agents
75) Which one of these statements is false?
A. supplemental oxygen should be given to maintain an SaO2 of > 90% to correct hypoxemia during an exacerbation
B. Short acting beta agonists are indicated and usually well tolerated during an acute asthma exacerbation in addition to early administration of systemic corticosteroids are indicated for moederate to severe exacerbations
C. a patient can be discharged home if the PEF or FEV1 has returned to greater than or equal to 60% of predicted or personal best and sx are minimal or absent (Correct Answer)
D. Serial measurement of airflow in the emergency department is important in regards to disposition and may reduce the rate of asthmatics admitted to the hospital
E. Response to initial treatment is a better indicator if the patient needs hosptialization than the severity of an exacerbation on presentation
1) A 40-year-old nurse presents with a 1-year history of rhinitis, and a more recent onset of episodic wheezing and dyspnea. Her symptoms seem to improve when she is on vacation. She does not smoke, although she says that her husband does. Her FEV1 improves 20% with inhaled B-agonists. Which one of the following is the most likely diagnosis?
A. Occupational asthma (Correct Answer)
B. Sarcoidosis
C. COPD
D. Anxiety
E. Vocal cord dysfunction
2) You see a 9-year-old female for evaluation of her asthma. She and her mother report that she has shortness of breath and wheezing 3–4 times per week, which improves with use of her albuterol inhaler. She does not awaken at night due to symptoms, and as long as she has her albuterol inhaler with her she does not feel her activities are limited by her symptoms. About once per year she requires prednisone for an exacerbation, often triggered by a viral infection. Based on this information you classify her asthma severity as
A. intermittent (Correct Answer)
B. mild persistent
C. moderate persistent
D. severe persistent
3) A 14-year-old female with a history of asthma is having daytime symptoms about once a week and symptoms that awaken her at night about once a month. Her asthma does not interfere with 1 normal activity, and her FEV is >80% of predicted. Which one of the following is the most appropriate treatment plan for this patient?
A. A short-acting inhaled beta-agonist as needed (Correct Answer)
B. Low-dose inhaled corticosteroids daily
C. A leukotriene receptor antagonist daily
D. Medium-dose inhaled corticosteroids daily
E. Low-dose inhaled corticosteroids plus a long-acting inhaled beta-agonist daily
4) Which one of the following is most consistent with a diagnosis of asthma?
A. Reduced FEV and reduced FEV1 /FVC ratio (Correct Answer)
B. Reduced FEV and normal FEV1 /FVC ratio
C. Reduced FEV and increased FEV1 /FVC ratio
D. Reduced FVC and normal FEV1 /FVC ratio
E. Reduced FVC and increased FEV1 /FVC ratio
5) Which one of the following is true concerning the use of short-acting inhaled B-agonists for asthma?
A. They should be given before any inhaled corticosteroid to facilitate lung delivery
B. They are ineffective in patients taking beta-blockers
C. They are less effective than oral B-agonists
D. They are less effective than anticholinergic bronchodilators when given with inhaled corticosteroids
E. Their effects begin within 5 minutes and last 4–6 hours (Correct Answer)
6) A 67-year-old smoker with a history of pulmonary tuberculosis at 22 years of age presents with a 6-month history of increasing shortness of breath. On office spirometry his FVC is 60% of predicted, his FEV1 is 80% of predicted, and his FEV1 /FVC ratio is 0.8. Which one of the following would be the most appropriate next step in his evaluation?
A. Refer to a pulmonary laboratory for static lung volume measurement and diffusion studies
B. Perform a bronchodilator challenge test (Correct Answer)
C. Investigate for nonpulmonary causes for the patient’s symptoms
D. Order a PPD skin test
1) Which disorder is charaacterized by a distincively brassy cough combined with hoarseness, inspiratory stridor, and signs of respiratory distress?
A. Influenza
B. Croup (Correct Answer)
C. Acute Bronchitis
D. Bronchiolitis
E. Pertussis
2) T/F Viral croup has a gradual onset and course
A. True (Correct Answer)
B. False
3) What are the signs and symptoms of croup?
A. respiratory distress (Missed)
B. inspiratory stridor (Missed)
C. barking cough (Missed)
D. low or high grade fever (more often high)
E. low or high grade fever (more often low) (Missed)
4) How do you diagnose croup?
A. Chest X ray showing bilateral infiltrates
B. CT scan showing calcifications in the lungs and spleen
C. soft tissue neck x ray showing the classic narrowing of the trachea in the AP view showing steeple sign or wine bottle sign (Correct Answer)
D. soft tissue neck CT showing narrowing of the epiglottis
5) T/F Croup in children is more serious than croup in an adult
A. True (Correct Answer)
B. False
6) What is the non drug treatment for croup?
A. analgesics and a cough preparation
B. rest in bed
C. humidified air from a hot shower or bath or hot or cold steam from a vaporizer or nebulizer- continue until the cough subsides (Correct Answer)
D. cough supressants, fluids to prevent drying of secretions, smoking cessation, and antihistamines
E. hydration, humidification, and oxygen supplementation
7) What are the signs a croup patient exhibits when they are in need of hospitalization?
A. cyanosis, decreased LOC, progressive stridor, or toxic appearing (Correct Answer)
B. necrosis of epithelium
C. acute sinusitis, otitis media, and purulent bronchitis, and pneumonia
D. rhabdomyolysis
E. Reye’s syndrome
8) T/F Inspiratory stridor at rest in a child is very worry-some
A. true (Correct Answer)
B. false
9) What medication should be used for hospitalized croup patients or moderately ill patients to try to eliminate the need for intubation during the first 24-48 hours when the illness is most severe?
Keep the child in the ER for at least 4 hours to avoid a rebound with worse symptoms
A. Albuterol
B. Racemic epinephrine (Vaponefrin) (Correct Answer)
C. Oseltamivir (Tamiflu)
D. Aznamivir (Relenza)
10) George recommends giving a steroid to treat croup. What is the recommended steroid?
A. budesonide
B. glucocorticoids
C. prednisone
D. dexamethasone (Correct Answer)
11) A child presents with a fever of 38.9, a runny nose, cough, and noisy breathing on inspiration. After further evaluation, the child’s mother describes the symptoms as getting worse at night. What is the most likely diagnosis?
A. influenza
B. acute bronchitis
C. acute laryngotracheitis (viral croup) (Correct Answer)
D. pertussis
12) T/F Croup involves the larynx, trachea, and bronchi
A. true (Correct Answer)
B. false
13) T/F People who die from the flu usually die from secondary bacteria pneumonia
A. True (Correct Answer)
B. False
14) T/F Influenza is transmitted by the respiratory route?
A. True (Correct Answer)
B. False
15) T/F You as a clinician can distinguish influenza A and B from each other based on the patients presentation
A. True
B. False (Correct Answer)
16) When is flu season? (Click all that apply)
A. winter (Missed)
B. summer
C. spring
D. fall (Missed)
17) T/F Pandemics are associated with type A influenza infections
A. True (Correct Answer)
B. False
18) A patient presents with a fever for the last 6 days, chills, malaise, myalgias, substernal soreness, headache, nasal congestion, and nausea. The patient denies a productive cough, but does have symptoms of a head cold (coryza) and a sore throat. What is the probable diagnosis based on this description?
A. Croup
B. Avian Flu
C. Influenza (Correct Answer)
D. Bronchiolitis
19) How do you diagnose influenza?
A. Rapid lab testing from bronchial or throat swabs (usually available during the epidemic season)
B. Rapid lab testing from nasal or throat swabs (usually available during the epidemic season) (Correct Answer)
C. over-night lab testing from bronchial or throat swabs
D. over-night lab testing from nasal or throat swabs
20) What is the treatment window for influenza?
A. 24 hours
B. 24-48 hours (Correct Answer)
C. 48-72 hours
D. 72 hours
21) What predisposes a patient with influenza to secondary bacterial infections?
A. necrosis of the nasal mucosa only
B. necrosis of the oral mucosa only
C. necrosis of the primary bronchioles only
D. necrosis of the respiratory epithelium (Correct Answer)
22) What are the complications of influenza? (click all that apply)
A. coccidiomycosis pneumonia
B. pneumococcal pneumonia (Correct Answer)
C. streptococcal pneumonia
D. staphylococcal pneumonia
23) What groups of people are at high risk for influenza complicaitons?
A. young and old
B. middle aged men
C. middle aged women
D. elderly and chronically ill (Correct Answer)
E. chronically ill patients only
24) What is also known as fatty liver with encephalopathy that is associated with aspirin in children during a viral infection? Hint: it is characterized by progressive hepatic failure and encephalopathy
A. ARDS
B. SARS
C. Crutzfield-jacob syndrome
D. Reye’s syndrome (Correct Answer)
25) How do you treat Reye’s syndrome?
A. cephalosporins
B. bronchodilators
C. intubate patient and wait 24 hours
D. supportive treatment and directed toward the management of cerebral edema (Correct Answer)
26) What is the name of the influenza vaccine?
A. Sanofi influenza virus vaccine
B. Trivalent influenza virus vaccine (Correct Answer)
C. Tetravalent influenza virus vaccine
D. Infanrix influenza virus vaccine
27) How long does the influenza vaccine provide immunity for?
A. it provides full immunity for the rest of the patient’s life
B. it provides full immunity for a few months to one year
C. It provides partial immunity for a few months to one year (Correct Answer)
D. it provieds partial immunity for the rest of the patient’s life
28) How long does it take the body to acquire immunity after the vaccination?
A. 1 week
B. 2 weeks (Correct Answer)
C. 3 weeks
D. 4 weeks
29) What months should you recommend your patients to get vaccinated?
A. August of September
B. September or October
C. October or November (Correct Answer)
D. November or December
30) What is/are the treatment(s) for influenza that must be administered within 48 hours of onset of symptoms and is effective against influenza type A and type B?
A. Zanamivir (Relenza) (Missed)
B. Oseltamivir (Tamiflu) (Missed)
C. Amantadine (Symmeterel)
D. Rimantadine (Flumadine)
31) Which two drugs are rarely used because they have limited viral coverage? (they only cover influenza A) Hint: both agents are most effective when given withing 48 hours after symptoms onset and are effective primarily in patients over the age of 12.
A. Amantadine (Symmetrel) (Missed)
B. Zanamivir (Relenza)
C. Rimantadine (Flumadine) (Missed)
32) Prognosis of the influenza virus that is uncomplicated is good and the illness should last between 1-7 days. When a patient has a persistent fever, white cell count over 10,000 what should be suspected?
A. Respiratory distress caused by increased airway resistance
B. Respiratory distress casued by decreased airway resistance
C. Bacterial pneumonia- most often pneumococcal pneumonia, but staphylococcal pneumonia is the most serious (Correct Answer)
D. Bacterial pneumonia- most often staphylococcal pneumonia, but pneumococcal pneumonia is the most serious
33) What is considered an acute inflammatory condition of the tracheobronchial tree associated with generalized respiratory symptoms?
A. croup
B. influenza
C. bronchiolitis
D. acute bronchitis (Correct Answer)
34) What are the infectious agents that lead to acute bronchitis? (Remember that infectious causes are primarily viral)Click all that apply
A. influenza A and B (Missed)
B. influenza A only (not B)
C. parainfluenza (Missed)
D. rhinovirus (Missed)
E. coronavirus and respiratory syncytial virus (RSV) (Missed)
35) What time of year is acute bronchitis most common?
A. summer months
B. fall months
C. winter months (Correct Answer)
D. spring months
36) T/F Cough is a predominant symptom of acute bronchitis and can persist for up to 2-3 weeks
A. True (Correct Answer)
B. Fasle
37) If you want to treat a viral illness in a pushy patient who wants antibiotics with? (Canitini jokes that this is no longer effective due to overuse)
A. Doxycycline
B. Zithromax (Correct Answer)
C. Cipro
D. Metronidazole
38) What illness is characterized by the nonspecific inflammation of the terminal and respiratory bronchioles?
A. Croup
B. Influenza
C. acute bronchitis
D. bronchiolitis (Correct Answer)
39) T/F Bronchiolitis is often a severe respiratory illness and is usually caused by RSV (respiratory syncytial virus) and sometimes caused by parainfluenza, adenovirus, and rhinovirus
A. True (Correct Answer)
B. False
40) What type of bronchiolitis is characterized by chronic inflammation, concentric scarring, and smooth muscle hypertrophy causing luminal obstruction? Hint: these patients have airflow obstruction spirometry, minimal radiographic abnormalities, and progressive clinical course that is unresponsive to corticosteroids.
A. Restrictive bronchiolitis
B. Proliferative bronchiolitis
C. Constrictive Bronchiolitis (Correct Answer)
41) Which type of bronchiolitis occurs when intraluminal polyps consisting of fibroblasts, foamy macrophages, and lymphocytes partially or completely obstruct the bronchioles. Hint: these patients may have obstruction or restriction on spirometry. Radiologic infiltrates are common, and the disease is frequently responsive to corticosteroids.
A. Restrictive bronchiolitis
B. Proliferative bronchiolitis (Correct Answer)
C. Constrictive bronchiolitis
D. Obstructive bronchiolitis
42) What months are most common for an RSV outbreak?
A. summer and fall
B. winter and spring (Correct Answer)
C. spring and summer
43) T/F Inoculation of bronchiolitis (which is most common in children) occurs through the nose and eyes
A. True (Correct Answer)
B. False
44) A child presents with a low-grade fever, tachyonea, wheezes,and hyperinflated lungs. His TMs are bulging and you suspect a concurrent streptococcus pneumonia infection. What illness is associatied with a concurrent streptococcus pneumonia infection?
A. Croup
B. Influenza
C. Acute Bronchitis
D. Bronchiolitis (Correct Answer)
45) T/F Cultures of naspoharyngeal secretions remains the gold standard of the diagnosis of bronchiolitis. Rapid diagnosis may be made by viral antigen identification of nasal washings for RSV using ELISA or immunofluorescent assay
A. True (Correct Answer)
B. False
46) You are presented with an x ray that shows air trapping and peribonchial thickening. You recall that this patient has a normal CBC, but has a low grade fever, tachypnea, wheezes, rhinorrhea, sneezing, and increased work of breathing. What is the likely diagnosis based on the x ray and presentation of the patient/
A. Croup
B. Influenza
C. Acute Bronchitis
D. Bronchiolitis (Correct Answer)
E. Pertussis
47) What is the treatment for bronchiolitis?
A. hydration, humidification of inspired air, ventilatory support prn, albuterol, ribavirin, and corticosteroids (Correct Answer)
B. albuterol, ribavirin, and corticosteroids and not non medical treatment
C. hydration, humidification of inspired air, albuterol, ribavirin, and
48) What is another name for pertussis?
A. croup
B. influenza
C. Whooping cough (Correct Answer)
D. ARDS
E. SARS
49) How is pertussis transmitted?
A. feces
B. airborne
C. respiratory droplets (Correct Answer)
D. contact
50) Does immunization or disease confer lasting immunity to pertussis?
A. No (Correct Answer)
B. Yes
51) What are the three stages of pertussis?
A. recurrent, paroxysmal, convalescent stages
B. domant, prominant, and life-threatening
C. obstructive, hyperinflative, restrictive stages
D. catarrhal, paroxysmal, convalescent stages (Correct Answer)
52) Which stage is characterized by its insidious onset with lacrimation, sneezind, head cold, malaise, and anorexia in addition to a hacking night cough that becomes a daily cough (diurnal)?
A. catarrhal stage (Correct Answer)
B. paroxysmal stage
C. convalescent stage
53) Which stage of pertussis is characterized by bursts of rapid consecutive coughs followed by a deep, high-pitched inspiration (Whoop)
A. catarrhal stage
B. paroxysmal stage (Correct Answer)
C. soncalescent stage
54) What stage of pertussis begins 4 weeks after the onset of the illness with a decrease in the frequency and severity of the sudden onset (paroxysms)of cough
A. catarrhal stage
B. paroxysmal stage
C. convalescent stage (Correct Answer)
55) T/F Symptoms of a cough for more than two weeks in an adult is suggestive of pertusis
A. True (Correct Answer)
B. False
56) Laboratory findings of a white blood cell count of __________ to ________ and a nasopharyngeal culture that is positive for _____________ are diagnostic of pertusis
A. 5,00 to 15,000, nasopharyngeal culture
B. 15,000 to 20,000, nasopharyngeal culture (Correct Answer)
C. 25,000 to 30,000, bronchial culture
D. 15,000 to 20,000, bronchial culture
57) What agar do you use to grow a culture of bordetella pertussis to diagnose pertussis?
A. Thayer Martin agar
B. Chocolate agar
C. Bordet-Gengon agar (Correct Answer)
D. Berdet-Gillan agar
58) What is the treatment for pertussis? (3)
A. Erythromycin (Missed)
B. Doxycycline
C. Azithromycin (Missed)
D. Clarithromycin (Missed)
E. Amoxicillin
59) Wet-lung, white-out, stiff lung, and shock lung are all alternative names of which disease?
A. Avian Flu
B. Acute Respiratory Distress Syndrome (Correct Answer)
C. RSV
D. Pertussis
60) What disease is a hyaline membrane disease of adults resulting form either direct or indirect injury to the alveolar-capillary membrane which ultimately leads to profound hypoxemia with no gas exchange?
A. Croup
B. Influenza
C. Acute Bronchitis
D. ARDS (Correct Answer)
61) T/F ARDS is the most sever form of acute lung injury
A. True (Correct Answer)
B. False
62) What pulmonary disorder is characterized by bilateral, widespread radiographic pulmonary infiltrates?
A. Avian Flu
B. ARDS (Correct Answer)
C. Pertussis
63) What are the risk factors for ARDS?
A. sepsis, severe multiple trauma, and aspiration of gastric contents (Correct Answer)
B. Asthma and emphysema
C. TB and AIDS
64) T/F Damage to the endothelial cells of capillaries and epithelial cells increase vascular permeability and decrease production and activity of surfactant
A. True (Correct Answer)
B. False
65) T/F Damage to the capillary and alveolar epithelium lead to protein rich pulmonary edema, alveolar collapse, and hypoxemia
A. True (Correct Answer)
B. False
66) What strain of influenza is the “bird flu”
A. H1N4
B. H5N1 (Correct Answer)
C. H1N5
67) What is the third step that must happen for the avian flu to become a pandemic?
A. It must infect humans whose immune system are naive to the virus
B. It must be virulent
C. It must be spread easily from person to person (Correct Answer)
68) Where is the most widespread distribution of H5N1 with human involvement?
A. Europe
B. South America
C. Asia (Correct Answer)
D. Africa
69) What questions should you ask all patients with influenza symptoms to rule out the Avian Flu?
A. Have you had a fever and respiratoy symptoms? (Missed)
B. Have you traveled to any of the affected countries in Asia and Europe?
(Missed)
C. If so, did you have any contact with poultry or with severely ill people (Missed)
70) Which of the following is consistent with the presentation of a patient with avian flu?
A. Rapid onset of severe illness; fever of 99.9, respiratory sx, distress
B. Rapid onset of severe illness and weakness
C. Rapid onset of severe illness; fever of 101F, respiratory sx, weakness, and possible vomiting and diarrhea (Correct Answer)
71) What drug(s) will you use to treat a case of avian flu? Select all that apply
A. Amantadine (Symmetrel)
B. Ramantadine (Flumadine)
C. Oseltamivir (Tamiflu) (Missed)
D. Acyclovir
E. Zanamivir (Relenza) (Missed)