Deck 8: Respiratory System

Question 1

While assessing auscultated spoken sounds, the auscultated sound is heard as "a-a-a" when the patient is asked to repeat "e-e-e." This is indicative of:

A) Asthma
B) Tumor
C) Pneumonia
D) Pleural effusion

Answer 1

Pneumonia

Question 2

A 75-year-old patient with community-acquired pneumonia presents with a temperature of 102.1°F, chills, productive cough, blood pressure 90/62, respiratory rate 28, white blood count 12,000, and blood urea nitrogen 20 mg/dl. He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:

A) Can be treated as an outpatient
B) Requires hospitalization for treatment
C) Requires a high dose of parenteral antibiotic
D) Can be treated with oral antibiotics

Answer 2

Can be treated as an outpatient

Question 3

The most common etiological organism for community-acquired pneumonia is:

A) Streptococcus pneumoniae
B) Beta hemolytic streptococcus
C) Mycoplasma
D) Methicillin resistant staphylococcus

Answer 3

Streptococcus pneumoniae

Question 4

On assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands greater than the other. This could be due to:

A) Pneumothorax
B) Pleural effusion
C) Pneumonia
D) Pulmonary embolism

Question 5

During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent with:

A) Chronic obstructive pulmonary disease
B) Pneumothorax
C) A normal finding
D) Pleural effusion

Question 6

A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking history of two packs of cigarettes per day since age 16. This would be recorded in the chart as:

A) 50 x 2-pack years
B) 100-pack years
C) 50-year, 2-pack history
D) 100 pack history

Question 7

When asthma is suspected, which of the following is not useful in making a diagnosis?

A) Decreased FEV1/FVC ratio
B) Decreased FEV1
C) Some reversibility with administration of bronchodilator
D) Peak flow meter reading

Question 8

When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be indicative of:

A) Pneumonia
B) Emphysema
C) Pneumothorax
D) Asthma

Question 9

A cough is described as chronic if it has been present for:

A) 2 weeks or more
B) 8 weeks or more
C) 3 months or more
D) 6 months or more

Question 10

The following criterion is considered a positive finding when determining whether a patient with pneumonia can be safely monitored and treated at home:

A) Age over 40
B) Fever greater than 101°F
C) Tachypnea greater than 30 breaths per minute
D) Productive cough

Question 11

If on physical examination the clinician auscultates rhonchi, the clinician should ask the patient to take a deep breath and cough in order to:

A) Mobilize secretions
B) Diagnose pleural effusion
C) Accurately distinguish lung sounds
D) A and C

Question 12

Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for:

A) Immediate endotracheal intubation
B) Broad spectrum IV antibiotics
C) Thoracentesis to rule out empyema
D) Gram stain and culture of sputum

Question 13

During auscultation of the chest, your examination reveals a loud grating sound at the lower anterolateral lung fields, at full inspiration and early expiration. This finding is consistent with:

A) Pneumonia
B) Pleuritis
C) Pneumothorax
D) A and B

Question 14

Which of the following medications are commonly associated with the side effect of cough?

A) Beta blocker
B) Diuretic
C) ACE inhibitor
D) Calcium antagonist

Question 15

Which of the following is considered a red flag when diagnosing a patient with pneumonia?

A) Fever of 102°F
B) Infiltrates on chest x-ray
C) Pleural effusion on chest x-ray
D) Elevated white blood cell count

Question 16

A 23-year-old patient who has had bronchiectasis since childhood is likely to have which of the following?

A) Barrel-shaped chest
B) Clubbing
C) Pectus excavatum
D) Prolonged capillary refill

Question 17

Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?

A) Computed tomography (CT) scan
B) Chest x-ray with posteroanterior, lateral, and lordotic views
C) Ultrasound
D) Positron emission tomography (PET) scan

Question 18

Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with:

A) Exercise-induced cough
B) Bronchiectasis
C) Chronic obstructive pulmonary disease
D) Pericarditis

Question 19

Which of the following details are not considered while staging asthma?

A) Nighttime awakenings
B) Long-acting beta agonist usage
C) Frequency of symptoms
D) Spirometry findings

Question 20

Which of the following is characteristic of chronic obstructive pulmonary disease (COPD)?

A) Asymmetric chest expansion
B) Increased lateral diameter
C) Increased anterior-posterior diameter
D) Pectus excavatum

Question 21

A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough, dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical examination reveals decreased breath sounds and dullness to percussion over the left lower lung field. The chest x-ray demonstrates shift of the mediastinum and trachea to the left. These are classic signs of:

A) Lung cancer
B) Tuberculosis
C) Pneumonia
D) Chronic obstructive pulmonary disease

Question 22

Patients with pulmonary fibrosis show decreased lung tissue compliance and diminished forced vital capacity. Pulmonary fibrosis is a type of:

A) Obstructive disease
B) Restrictive disease
C) Hyperreactive airway disease
D) None of the above

Question 23

Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should prompt the clinician to suspect:

A) Legionnaires' disease
B) Malaria
C) Tuberculosis
D) Pneumonia

Question 24

Causes of pleural effusions include all of the following except:

A) Malignancy
B) Pneumonia
C) Cardiomegaly
D) Chronic obstructive pulmonary disease

Question 25

A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a motorcycle accident. On examination you note tachypnea, use of intercostal muscles to breathe, asymmetric chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:

A) Pulmonary embolism
B) Pleural effusion
C) Pneumothorax
D) Fracture of ribs