Pulmonology SmartyPANCE

A 3 year-old girl is diagnosed with atopic dermatitis. Which of the following disorders is this child at risk for in the future? A. Asthma B. Tinea pedis C. Squamous carcinoma D. Systemic lupus erythematosus (SLE)

A. Asthma 50% of pts will get asthma/allergic rhinitis in future

The treatment of choice for cryptococcal meningeal infection is A. Amphotericin B and flucytosine B. Metronidazole C. Acyclovir D. Amantadine E. Penicillin G

A. Amphotericin B and flucytosine

A 55 year-old man with a history of chronic bronchitis presents with two days of increased dyspnea and cough with worsening purulent sputum production. He is currently using inhaled albuterol as needed. In addition to systemic corticosteroids, what pharmacologic agent is warranted at this time for treatment of this patient? A. Antibiotic B. Inhaled corticosteroid C. Long acting beta-agonist D. Theophylline

A. Antibiotic Empiric abx tx treats acute exacerbations of COPD - sputum changes = bacterial

Which of the following is the major pathogenetic mechanism that causes asthma? A. Airway inflammation B. Increased pulmonary secretions C. Presence of Ghon complexes D. Irreversible fibrosis

A. Airway inflammation Airway inflammation is major pathogenetic mechanism that leads to development of asthma

A patient presents with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is 85% of predicted. Which of the following is the most appropriate initial treatment? A. Albuterol (Proventil) inhaler B. Montelukast (Singulair) C. Salmeterol (Serevent) inhaler D. Sustained release theophylline

A. Albuterol (Proventil) inhaler Mild intermittent asthma - inhaled beta-2-agonists PRN - no long term

A 17 year-old male who is trying out for the track team notes excessive coughing with chest tightness when running. Which of the following is the most appropriate preventive agent for this patient? A. Albuterol inhaler (Proventil) B. Inhaled corticosteroids C. Aminophylline (Theo-Dur) D. Ipratropium (Atrovent)

A. Albuterol inhaler (Proventil) Beta 2 agonist - dilation aids in exercise-induced asthma when used prior to exercise

A 60 year-old patient with COPD characteristic of emphysema presents with a cough and increased sputum production. The following information is noted: Temperature 100°F (37.8°C); Respiratory rate 20/min; Heart rate 88 beats/min; pH 7.44; PaO2 75 mmHg; PaCO2 40 mmHg; O2 saturation 92%. Physical examination is remarkable for increased AP diameter, diminished breath sounds without wheezes, rhonchi, or other signs of respiratory distress. Which of the following would be an appropriate treatment for this patient? A. Broad-spectrum antibiotic B. Admission to the hospital C. Oxygen at 6 L/min by nasal cannula D. Brief course of oral theophylline

A. Broad-spectrum antibiotic Sputum = variable from pt to pt - but increase in sputum w/ hx of COPD reported by pt must = potentially infections

Patients with COPD have the symptoms of chronic bronchitis and emphysema. Which of the following morphologic patterns of emphysema is typically most severe in the upper lobes? A. Centriacinar emphysema B. Panacinar emphysema C. Distal acinar emphysema D. Paraseptal emphysema

A. Centriacinar emphysema Focal destruction limited to bronchioles + central portions of acini - smoking cigs!!!! worse in upper lobes

A 24 year-old male presents complaining of a 9 month history of increasing shortness of breath, dyspnea on exertion, and a cough productive of white sputum, mostly in the mornings. He denies orthopnea, PND, peripheral edema, fever, chills, night sweats, recent changes in weight, palpitations, chest pain, food intolerances, or other complaints. Patient has a history of recurrent lung infections. He states that his father had chronic pulmonary problems and died at age 42 from unknown lung disease. The patient denies smoking, alcohol or illicit drug use. On physical examination, the respiratory rate is 22 per minute, pulse of 98 bpm, temperature of 98.7 degrees. Pulmonary exam reveals end-expiratory wheezes bilaterally and hyperresonance to percussion. His cardiac exam is normal. Chest x- ray shows decreased lung markings. ECG is normal. Pulmonary function tests show an FEV1 63% of expected and residual capacity is 123% of expected. Which of the following is the most likely diagnosis? A. Emphysema B. Pulmonary fibrosis C. Ventricular septal defect D. Congestive heart failure

A. Emphysema obstructive lung disease based on PFTs - alpha-1 antitrypsin deficiency based on FHx and lack of smoking hx/young age

A 24 year-old male presents in respiratory distress and appears quite ill. A Gram stain and culture of the sputum reveals gram-positive cocci in clumps and a chest x-ray reveals multiple patchy infiltrates with some cavitations. Which of the following is most likely to also be found in his medical history? A. IV drug abuse B. Alcohol abuse C. Poor dental hygiene D. HIV positive patient

A. IV drug abuse PNA S aureus = IV drugs

Which of the following causes of pneumonia is most likely to be complicated by diarrhea? A. Legionella B. Chlamydophila C. Mycoplasma D. Pneumococcal

A. Legionella

You advise your patient from question one to take antipyretic drugs and get some rest. He returns to your office 5 days later feeling worse and now has a fever with a cough productive of purulent sputum. What is the most appropriate next step in the management of this patient? A. Treat with a macrolide antibiotic B. Administer penicillin intramuscularly C. Influenza titers D. Pulmonary function tests

A. Treat with a macrolide antibiotic productive cough = bacterial when added to >12 days + fever

A 14 year-old male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscles to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60 mmHg, P 160 bpm, RR 52. An arterial blood gas (ABG) is ordered. Normal ABG values at your institution are pH 7.35-7.45, CO2 35-45, pO2 80-95. Which of the following ABG findings suggests the poorest prognosis? A. pH = 7.27 pCO2 = 46 pO2 = 56 B. pH = 7.60, pCO2 = 18 pO2 = 80 C. pH = 7.44, pCO2 = 38 pO2 = 90 D. pH = 7.52, pCO2 = 28, pO2 = 80

A. pH = 7.27 pCO2 = 46 pO2 = 56 clinical presentation of asthma is a respiratory alkalosis with high RR, low pCO2, and decreased pO2.

A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1 day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday. Which of the following findings will most likely be seen on physical examination of this patient? A. spoken "ee" heard as "ay" B. hyperresonant percussion note C. wheezes over the involved area D. vesicular breath sounds over involved area

A. spoken "ee" heard as "ay" Bacterial PNA w/ consolidation

A 47 year-old HIV positive female presents with a complaint of a nonproductive cough. She is febrile, tachypneic and tachycardic. Lung exam reveals bilateral rales. Chest x-ray shows diffuse interstitial infiltrates. What is the recommended treatment in this patient? A. trimethoprim-Sulfamethoxazole (Bactrim) B. tetracycline (Sumycin) C. amantadine (Symmetrel) D. ticarcillin (Ticar)

A. trimethoprim-Sulfamethoxazole (Bactrim) DOC for all types of pneumocystis pt has HIV related PNA

You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility? A. Decrease In FEV1 B. Increase in FEV1 C. Decrease in FVC D. Increase in FVC

B. Increase in FEV1 Obstruction partially relieved by short-acting dilator - Increased forced expiratory volume in one second FEV1

A 40 year-old alcoholic male presents with sudden onset of severe chills, fever, dyspnea and cough productive of red mucoid sticky sputum. He appears ill looking with cyanosis. Examination reveals vital signs: Temp - 102 degrees F; Pulse - 120 /minute and regular; 89 RR - 28/min; BP 90/62 mm Hg. Lungs reveal minimal rales and dullness in the right upper lobe with decreased breath sounds. Chest x-ray reveals right upper lobe consolidation with a bulging fissure. Gram stain reveals many white blood cells and many gram- negative rods. Which of the following is the most appropriate drug of choice? A. Ticarcillin B. Cefotaxime C. Doxycycline D. Clindamycin

B. Cefotaxime PNA caused by Klebsiella - 3rd gen cephalosporin needed

Which of the following can be considered an effective prophylaxis for acute bronchitis? A. Oseltamivir 75 mg on day two of symptoms B. Influenza vaccine C. Inhaled corticosteroids D. Nystatin

B. Influenza vaccine

A 56 year-old female with a 35 pack year smoking history presents to the clinic with shortness of breath and cough. On examination, she is thin with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sounds. Pulmonary function tests show a marked increase in total lung capacity (TLC) and a decreased FEV1. What is the most likely diagnosis for this patient? A. Persistent asthma B. Chronic obstructive pulmonary disease C. Idiopathic fibrosing interstitial pneumonia D. Sarcoidosis

B. Chronic obstructive pulmonary disease increase in lung volume indicative of air trapping.

An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient? A. Administer nebulized corticosteroids B. Admit to the hospital C. Oral antimicrobial therapy D. Endotracheal intubation

B. Admit to the hospital Community acquired PNA = most deadly infectious disease in US

Which of the following best describes the pathophysiology of emphysema? A. Interstitial inflammation and fibrosis B. Alveolar enlargement and loss of septa C. Mucosal edema and inflammatory response D. Excessive mucus secretion and chronic cough

B. Alveolar enlargement and loss of septa Alveolar enlargement w/ loss of septal wall integrity w/out any evidence of fibrosis

Which of the following is an independent risk factor for development of a mesothelioma? A. Cigarette smoking B. Asbestos exposure C. Radon gas exposure D. Chronic obstructive lung disease

B. Asbestos exposure

Which of the following is independently associated with an increased risk for all-cause mortality in patients with COPD? A. Asthma B. Bronchiectasis C. Underweight status D. Depression

B. Bronchiectasis

A 27 year-old woman presents with one week of worsening productive cough, dyspnea, fever and malaise. Which of the following physical examination findings would support the diagnosis of lobar pneumonia? A. Decreased tactile fremitus B. Egophony C. Hyperresonance to percussion D. Wheeze

B. Egophony

Which of the following is a physical examination finding that is consistent with a diagnosis of lobar pneumonia? A. Resonant to percussion B. Late inspiratory crackles C. Decreased tactile fremitus D. Tracheal shift toward uninvolved side

B. Late inspiratory crackles PE findin consistent w/ lobar PNA

Which of the following pathophysiological processes is associated with chronic bronchitis A. Destruction of the lung parenchyma B. Mucous gland enlargement and goblet cell hyperplasia C. Smooth muscle hypertrophy in the large airways D. Increased mucus adhesion secondary to reduction in the salt and water content of the mucus

B. Mucous gland enlargement and goblet cell hyperplasia - enlargement of mucous glands + goblet cell hypertrophy in LARGE ariways

An 85-year-old nursing home resident presents with abrupt onset of cough, sore throat, headache, myalgias, and malaise. On examination the patient's temperature is 102 degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Which of the following is the treatment of choice in this patient? A. Amantadine (Symmetrel) B. Oseltamivir (Tamiflu) C. Acyclovir (Zovirax) D. Nevirapine (Viramune)

B. Oseltamivir (Tamiflu) Used to treat the flu

Which of the following is a common presenting clinical manifestation of a patient with interstitial lung disease? A. Early inspiratory crackles B. Progressive dyspnea on exertion C. Productive cough with copious sputum D. Decreased breath sounds with hyperresonant percussion

B. Progressive dyspnea on exertion interstitial lung disease commonly present with progressive dyspnea on exertion and a cough with minimal sputum production.

An elderly nursing home resident is admitted with methicillin-resistant Staphylococcus aureus pneumonia. Which of the following is the most appropriate treatment to initiate? A. Nafcillin B. Vancomycin C. Clindamycin D. Doxycycline

B. Vancomycin

What is the most common cause of acute bronchitis? A. H. influenzae B. Viral infection C. Fungal infection D. Allergic reaction

B. Viral infection

A 62 year-old female is admitted to a nursing home during an outbreak of influenza. In review of her records, you note that she did not receive the flu vaccine this year. Which of the following is the most appropriate drug of choice for influenza prophylaxis in this patient? A. Ciprofloxacin B. Zanamivir C. Clarithromycin D. Alpha-2b interferon

B. Zanamivir Zanamivir or oseltamivir are indicated for ppx use against influenza A or B

A 56 year-old male with a 40 pack-year smoking history presents complaining of progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted), an FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most consistent with A. sarcoidosis. B. chronic bronchitis. C. interstitial lung disease. D. congestive heart failure.

B. chronic bronchitis. Reduced FEV1 and FEV1/FVC = obstructive pattern in COPD

A 73-year-old obese female with a 20 pack year smoking history presents complaining of chronic productive cough. She states that it has been occurring over the past 3 years more frequently November through February. Which of the following pulmonary function test values would you expect to find decreased? A. Tidal volume B. forced expiratory volume in 1 second/forced vital capacity C. residual volume D. total lung capacity

B. forced expiratory volume in 1 second/forced vital capacity FEV1 decreased in obstructive lung disease - Ratio >0.7

Which of the following infectious agents is most likely to be found in a rural Kentucky farmer or in someone who is responsible for clearing bats out of the local caverns before the tourist season begins? A. cryptococcosis B. histoplasmosis C. psittacosis D. Candidal species

B. histoplasmosis

A patient presents with a history of progressive worsening of dyspnea over the past several years. He gives a history of having worked as a ship builder for over 50 years. He denies any alcohol or tobacco use. On examination you note clubbing and inspiratory crackles. Which of the following chest x-ray findings support your suspected diagnosis? A. hyperinflation and flat diaphragms B. interstitial fibrosis and pleural thickening C. cavitary lesions involving the upper lobes D. "eggshell" calcification of hilar lymph nodes

B. interstitial fibrosis and pleural thickening pt has asbestosis - occupational - CXR also have calcified pleural plaques on diaphragm or lateral chest wall

A 15 year-old male was seen last week with complaints of sore throat, headache, and mild cough. A diagnosis of URI was made and supportive treatment was initiated. He returns today with complaints of worsening cough and increasing fatigue. At this time, chest x-ray reveals bilateral hilar infiltrates. A WBC count is normal and a cold hemagglutinin titer is elevated. The most likely diagnosis is A. tuberculosis. B. mycoplasma pneumonia. C. pneumococcal pneumonia. D. staphylococcal pneumonia

B. mycoplasma pneumonia. insidious onset, interstitial infiltrate, elevated cold hemagglutinin titer

A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis? A. acute bronchitis B. viral pneumonia C. mycoplasma pneumonia D. pneumococcal pneumonia

B. viral pneumonia

A 65-year-old with COPD having received their first PPSV23 vaccination at age 63 should be revaccinated with PPSV23 in A. 1 year B. 3 years C. 5 years D. 10 years

C. 5 years

Which of the following studies provides the best clues to the acuteness and severity of disease exacerbation? A. Serum chemistry evaluation B. Alpha1-antitrypsin measurement C. Arterial blood gas (ABG) analysis D. Sputum evaluation

C. Arterial blood gas (ABG) analysis

A 45 year-old male presents with complaints of a chronic cough productive of mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it to a "smoker's cough". He has been coughing up a lot of sputum lasting all winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination reveals a moderately obese male in no acute respiratory distress. Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. Which of the following is the most likely diagnosis? A. Lung cancer B. Bronchiectasis C. Chronic bronchitis D. Interstitial lung disease

C. Chronic bronchitis

Which of the following physical exam findings is consistent with moderate emphysema? A. Increased tactile fremitus B. Dullness to percussion C. Distant heart sounds D. Deviated trachea

C. Distant heart sounds Common in emphysema pts cause hyperinflation

A 67 year-old man presents complaining of gradually worsening fatigue and shortness of breath. He is a previous smoker with an 80 pack-year smoking history. He denies chest pain, night sweats, or hemoptysis. On physical examination, you note a very thin male who appears older than his stated age. Lung and heart sounds are barely audible to auscultation. Which of the following interventions is likely to alter the disease course? A. Inhaled bronchodilator therapy B. Inhaled steroid therapy C. Home oxygen D. Theophylline

C. Home oxygen Prolongs life in COPD pts

A 63-year-old male, heavy smoker, presents to your office with a low-grade fever and sudden onset of dry cough for the past 6 days. You diagnose him with acute bronchitis. What is the most appropriate management at this time? A. Amoxicillin/clavulanic acid 875 mg two times per day for 10 days B. Doxycycline 100 mg PO two times per day for 14 days C. Increased fluids and ibuprofen D. Give the patient an albuterol inhaler

C. Increased fluids and ibuprofen Supportive therapy because MC cause is viral

A 30 year-old male presents with sudden onset of chills, fever, chest pain and a cough productive of greenish-brown sputum. On examination his temperature is 102 degrees F. He appears acutely ill and his respirations are shallow. Chest x-ray demonstrates left lower lobe consolidation. Which of the following findings would most likely be present on examination of his left lower lung? A. Hyperresonance B. Vesicular breath sounds C. Increased tactile fremitus D. Wheezing

C. Increased tactile fremitus

A patient with severe COPD presents to the Emergency Department with a 3 day history of increasing shortness of breath with exertion and cough productive of purulent sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of 50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of 7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most appropriate next step in his treatment? A. Decrease the oxygen flow rate. B. Administer oral corticosteroids. C. Intubate the patient. D. Administer salmeterol (Serevent)

C. Intubate the patient. Declining respiratory acidosis - respiratory failure due to increasing CO2 levels INTUBATE HIM NOW

Which of the following is accurate regarding the treatment of patients with COPD? A. Pneumococcal vaccines are contraindicated in patients with COPD B. Intravenous alpha1-antitrypsin levels should be kept at 8-10 mmol/L C. Long-term oxygen therapy is recommended for patients with a partial pressure of oxygen in arterial blood <55 mm Hg or oxygen saturation <90% D. Because cardiovascular disease is common in patients with COPD, beta-blockers are indicated in all patients

C. Long-term oxygen therapy is recommended for patients with a partial pressure of oxygen in arterial blood <55 mm Hg or oxygen saturation <90%

A 20 year-old male presents with 3 weeks of constitutional and upper respiratory symptoms, including malaise, sore throat, dry cough, and fever. Lung auscultation demonstrates diffuse crackles bilaterally. What is the most likely infectious agent involved? A. Respiratory syncytial virus B. Influenza virus C. Mycoplasma pneumoniae D. Streptococcus pneumoniae

C. Mycoplasma pneumoniae indolent course

A 57-year-old man is being evaluated for shortness of breath. The following spirometric data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L (predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed) 128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted These findings are consistent with which of the following? A. No demonstrable abnormality B. Restrictive lung disease C. Obstructive lung disease D. A ventilation/perfusion mismatch

C. Obstructive lung disease

Patients with long-term exposure to silica, coal dust, and asbestos may develop which of the following as complications? A. Airway Hyperreactivity B.Epithelial hyperplasia C. Pulmonary fibrosis D. Upper airway obstruction

C. Pulmonary fibrosis Pathogenesis = inflammation and subsequent fibrosis

What is the mechanism of action of salmeterol (Serevent) in the treatment of asthma? A. Anti-inflammatory B. Immunotherapy for specific allergens C. Relaxing of bronchial smooth muscle D. Reduction of leukotriene production

C. Relaxing of bronchial smooth muscle MOA for salmeterol is relaxation of bronchial smooth muscle

A 75 year-old man with a long history of COPD presents with acute onset of worsening dyspnea, increased productive cough, and marked agitation. While in the emergency department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg, PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate management at this point? A. oxygen supplementation with a 100% non-rebreather mask B. noninvasive positive pressure ventilation (NIPPV) C. endotracheal intubation and mechanical ventilation D. emergency tracheostomy

C. endotracheal intubation and mechanical ventilation Respiratory arrest - Respiratory acidosis

Which of the following is the most effective way for patients with persistent asthma to monitor the severity of their symptoms? A. call the health care provider regularly B. keep a diary of symptoms C. monitor peak flow D. ask a family member to monitor symptoms

C. monitor peak flow Effective way for pts + providers to manage symptoms + guide treatment

A 23 year-old female with history of asthma for the past 5 years presents with complaints of increasing shortness of breath for 2 days. Her asthma has been well controlled until 2 days ago and since yesterday she has been using her albuterol inhaler every 4-6 hours. She is normally very active, however yesterday she did not complete her 30 minutes exercise routine due to increasing dyspnea. She denies any cough, fever, recent surgeries or use of oral contraceptives. On examination, you note the presence of prolonged expiration and diffuse wheezing. The remainder of the exam is unremarkable. Which of the following is the most appropriate initial diagnostic evaluation prior to initiation of treatment? A. chest x-ray B. sputum gram stain C. peak flow D. ventilation - perfusion scan

C. peak flow Reading helps gauge current extent of obstruction + monitoring treatment

A patient presents with respiratory complaints. Chest x-ray reveals calcification of the hilar nodes with an eggshell pattern. Which of the following occupations is most consistent with these chest x-ray findings? A. building demolitioners B. coal miners C. sandblasters D. farmers

C. sandblasters CXR appearance of calcification of hilar nodes w/ eggshel pattern w/ long term exposure

A 69 year-old male presents with complaint of increasing dyspnea over the past 6-8 months. The patient denies cough, chest pain or smoking history. Physical examination reveals inspiratory crackles at the bases and clubbing of the nails. Chest x-ray reveals interstitial fibrosis of the lower lungs, thickened pleura and calcified pleural plaques of the lateral chest wall. Pulmonary function testing shows a restrictive pattern with a decreased diffusing capacity. What information is most likely noted in this patient's history? A. Coal mining B. Silica exposure C. Textile work D. Asbestos exposure

D. Asbestos exposure presents years later - increasing dyspnea and interstitial fibrosis of lower lungs, thickened pleura, calcified pleura - Restrictive pattern on PFT

A 42 year-old male with unremarkable past medical history is admitted to the general medical ward with community-acquired pneumonia. He has a 20 pack-year history of cigarette smoking. He is empirically started on ceftriaxone (Rocephin). Which of the following antibiotics would be most appropriate to add to his empiric treatment regimen? A. Piperacillin B. Vancomycin C. Clindamycin D. Azithromycin

D. Azithromycin Community-acquired PNA who need hospitalization get extended spectrum beta-lactam

A 22 year-old female with a history of asthma presents with complaints of increasing "asthma" attacks. The patient states she has been well controlled on albuterol inhaler until one month ago. Since that time she notices that she has had to use her inhaler 3-4 times a week and also has had increasing nighttime use averaging about three episodes in the past month. Spirometry reveals > 85% predicted value. Which of the following is the most appropriate intervention at this time? A. Oral prednisone B. Oral theophylline C. Salmeterol inhaler D. Beclomethasone inhaler

D. Beclomethasone inhaler Cromolyn OR Nedocromil also work Mild persistent asthma needs anti-inflammatory agent

Which of the following is generally recognized as the most significant symptom of COPD? A. Productive cough B. Pulmonary hypertension C. Cor pulmonale D. Breathlessness

D. Breathlessness Most significant symptoms - Dose not occur until 6th decade of life

Which of the following is an indication for a pediatric patient to receive the 23-valent polysaccharide vaccine (Pneumovax)? A. Children at any age with a history of asthma B. All children at 2,4,6 and 12-18 months of age C. All children at 12-23 months of age in a two dose series D. Children age 24-59 months at high risk for invasive pneumococcal disease

D. Children age 24-59 months at high risk for invasive pneumococcal disease

Which of the following chest x-ray abnormalities would most likely be seen in a patient with hypersensitivity pneumonitis? A. Lobar consolidation B. Apical infiltration C. Granulomatous inflammation D. Diffuse nodular densities

D. Diffuse nodular densities

A 2 month-old infant has been diagnosed with pneumonia due to Chlamydia trachomatis. Which of the following is the treatment of choice? A. Ceftriaxone (Rocephin B. Doxycycline C. Levofloxacin (Levaquin) D. Erythromycin

D. Erythromycin TOC for infant with Chlamydial PNA

Which of the following findings confirm the adequacy of a sputum specimen for Gram stain and culture? A. Decreased red blood cells B. Decreased bronchial epithelial cells C. Increased Gram positive cocci D. Increased polymorphonuclear leukocytes

D. Increased polymorphonuclear leukocytes

A 25 year-old male with a history of asthma presents complaining of increasing episodes of evening and daytime symptoms. He is on a short acting inhaled beta agonist prn. He is presently using his short acting beta agonist on a daily basis. Which of the following is the most appropriate addition to this patient's regimen? A. methylxanthine oxidase inhibitor B. long acting beta agonist inhaler C. leukotriene inhibitor D. Inhaled corticosteroid

D. Inhaled corticosteroid Mild-moderate persistent asthma

A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. Which of the following would be the most appropriate treatment for this patient? A. Mast cell stabilizer B. Long acting beta agonist C. Leukotriene receptor antagonist D. Low dose inhaled corticosteroid

D. Low dose inhaled corticosteroid TOC for mild persistent asthma

A 62 year-old male presents with a history of dyspnea on exertion and chronic cough worse with arising in the mornings. He has a 40-year-pack history of cigarette use. On examination there is increased AP diameter and decreased breath sounds with a prolonged expiratory phase. Pulse oximetry reveals an oxygen saturation of 93% on room air. In addition to smoking cessation, which of the following is an appropriate intervention at this time? A. Home oxygen therapy B. Maintenance oral steroids C. Prophylactic antibiotic therapy D. Recommend influenza and pneumococcal vaccines

D. Recommend influenza and pneumococcal vaccines - also stop smoking!

The most common pathogen identified in community acquired pneumonia (CAP) is A. Mycoplasma pneumoniae. B. Staphylococcus aureus. C. Legionella pneumophila. D. Streptococcus pneumoniae.

D. Streptococcus pneumoniae. majority of cases

In patients with COPD, which of the following has been shown to decrease rate of malignancy and cardiovascular disease and improve survival? A. bronchodilator therapy B. pulmonary rehabilitation C. oral glucocorticosteroids D. smoking cessation

D. smoking cessation

Which of the following is the most appropriate therapeutic agent for acute influenza? A. azithromycin (Zithromax) B. acyclovir (Zovirax) C. tetracycline (Sumycin) D. zanamivir (Relenza)

D. zanamivir (Relenza) Anti-viral agent - TOC for uncomplicated in patients >7

The drug of choice for treatment of severe coccidioidomycosis (" valley fever") is A. Ceftriaxone B. Tetracyline C. Ciprofloxacin D. Mefloquin E. Fluconazole

E. Fluconazole