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RESPIRATORY
RESPIRATORY PRACTICE EXAM QUESTIONS
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Sharon is a 29-year-old woman with moderate persistent asthma. She is not using prescribed inhaled corticosteroids, but is using albuterol PRN to relieve her cough and wheeze with reported satisfactory clinical effect. Currently she uses about two albuterol metered-dose inhalers per month and is requesting a prescription refill. You consider that: A. her asthma is well controlled and albuterol use can continue. B. excessive albuterol use is a risk factor for asthma death. C. her asthma is not well controlled and salmeterol (Serevent) should be added to relieve bronchospasm and reduce her albuterol use. D. her asthma has better control with albuterol than inhaled corticosteroids. - ANS ✓B In the treatment of asthma, leukotriene receptor antagonists should be used as: A. controllers to prevent bronchospasm. B. controllers to inhibit inflammatory responses. C. relievers to treat acute bronchospasm. D. relievers to treat bronchospasm and inflammation. - ANS ✓B According to the National Asthma Education and Prevention Program Expert Panel Report-3 (NAEPP EPR-3) guidelines, which of the following is not a risk for asthma death?
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A. hospitalization or an emergency department visit for asthma in the past month B. current use of systemic corticosteroids or recent withdrawal from systemic corticosteroids C. difficulty perceiving airflow obstruction or its severity D. rural residence - ANS ✓D An 18-year-old high school senior presents, asking for a letter stating that he should not participate in gym class because he has asthma. The most appropriate action is to: A. write the note because gym class participation could trigger asthma symptoms. B. excuse him from outdoor activities only to avoid pollen exposure. C. assess his level of asthma control and make changes in his treatment plan if needed so he can participate. D. write a note excusing him from gym until his follow-up exam in 2 months. - ANS ✓C You see a 34-year-old man with moderate persistent asthma who has a severe asthma flare and a regimen of oral prednisone is being considered. Which of the following is true? A. A taper is needed for prednisone therapy lasting longer than 4 days. B. A taper is not needed if the prednisone regimen is for 7 days or less. C. A taper is not needed regardless of duration of prednisone therapy. D. A taper is needed if the patient is taking concomitant inhaled corticosteroids. - ANS ✓B After inhaled corticosteroid is initiated, improvement in control is usually seen:
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.Clinical findings characteristic of asthma include all of the following except: A. a recurrent spasmodic cough that is worse at night. B. recurrent shortness of breath and chest tightness with exercise. C. a congested cough that is worse during the day. D. wheezing with and without associated respiratory infections. - ANS ✓C Which of the following best describes the mechanism of action of short- acting beta2-agonists? A. reducer of inflammation B. inhibition of secretions C. modification of leukotrienes D. smooth muscle relaxation - ANS ✓D Regarding the use of long-acting beta2-agonists (LABAs), which of the following is not true? A. LABAs enhance the antiinflammatory action of corticosteroids. B. Use of LABAs is associated with a small increase in risk of asthma death. C. LABA use reduces the risk of asthma exacerbations. D. LABAs can be used as monotherapy to relieve bronchospasms in asthma.
- ANS ✓B Which of the following is the therapeutic objective of using inhaled ipratropium bromide? A. as an antiinflammatory.
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B. an increase in vagal tone in the airway C. inhibition of muscarinic cholinergic receptors D. an increase in salivary and mucous secretions - ANS ✓C Which of the following is true regarding the use of systemic corticosteroids in the treatment of asthma? A. Frequent short bursts are preferred over daily inhaled corticosteroids. B. The oral corticosteroid should be started at day 3-4 of the asthma flare for optimal effect. C. The oral route is preferred over parenteral therapy. D. The adult dose to treat an asthma flare should not exceed the equivalent of prednisone - ANS ✓C Compared with short-acting beta2-agonists, long-acting beta2-agonists: A. are recommended as a first-line therapy in mild intermittent asthma. B. have a significantly different pharmacodynamic profile. C. have a rapid onset of action across the drug class. D. should be added to therapy only when ICS use does not provide adequate asthma - ANS ✓D Which of the following statements is false regarding the use of omalizumab (Xolair)? A. Its use is recommended for patients with mild persistent asthma to prevent asthma flares. B. The medication selectively binds to IgE to reduce exacerbations. C. Labeled indication is for patients with poorly controlled asthma with frequent exacerbations.
RESPIRATORY
When discussing immunizations with a 67-year-old woman with chronic obstructive pulmonary disease (COPD), you advise that she: A. receive live attenuated influenza virus vaccine. B. avoid immunization against influenza because of the risk associated with the vaccine. C. receive inactivated influenza virus vaccine. D. take an antiviral for the duration of the influenza season. - ANS ✓C True or False? Seasonal influenza vaccination is generally recommended for all persons over 6 months of age. - ANS ✓TRUE True or False? A 66 yo woman is an acceptable candidate for the high dose inactivated influenza vaccine. - ANS ✓TRUE True or False? Cigarette smokers should not receive the pneumococcal vaccine until 65 yo.
- ANS ✓FALSE True or False? A 52 yo immunocompetent patient with COPD who receives the pneumococcal vaccine should get revaccinated in 5 years. - ANS ✓FALSE When used in treating COPD, ipratropium bromide (Atrovent) is prescribed to achieve which of the following therapeutic effects? A. increase mucociliary clearance
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B. reduce alveolar volume C. bronchodilation D. mucolytic action - ANS ✓C What is the desired therapeutic action of inhaled corticosteroids when used to treat COPD? A. reversal of fixed airway obstruction B. improvement of central respiratory drive C. reduction of airway inflammation D. mucolytic activity - ANS ✓C Which is most consistent with the diagnosis of COPD? A. FEV1/FVC ratio equal to or less than 0. 70 after properly timed SABA use B. dyspnea on exhalation C. elevated diaphragms noted on x-ray D. polycythemia noted on complete blood cell count - ANS ✓A The most effective nonpharmacologic method to prevent exacerbations in patients with COPD is: A. weight loss for those with a BMI greater than 25 kg/m2. B. avoid exposure to children or day-care centers. C. brisk walking for at least 5 minutes 3-5 times a day as tolerated. D. avoid exposure to pulmonary irritants, such as cigarette smoke. - ANS ✓D When managing patients with COPD who continue to smoke cigarettes, a discussion on the importance of smoking cessation should occur:
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Which of the following pathogens is often implicated in a COPD exacerbation caused by respiratory tract infection? A. Legionella species B. Streptococcus pyogenes C. Respiratory tract viruses D. Staphylococcus aureus - ANS ✓C Which is the most appropriate choice of therapy in the treatment of a mild acute COPD exacerbation in a 42-year-old man? A. A 5-day course of levofloxacin B. A 7-day course of amoxicillin C. A 10-day course of doxycycline D. Antimicrobial therapy is usually not indicated. - ANS ✓D Which is the most appropriate statement about therapy for a severe COPD exacerbation in a 52-year-old man? A. A 5-day course azithromycin should be prescribed. B. A 10-day course of amoxicillin/clavulanate is advisable, C. A 7-day course of trimethoprim-sulfamethoxazole is recommended. D. The role of antimicrobial therapy is debated, even for severe disease. - ANS ✓D You see a 67-year-old man with stage IV (very severe) COPD who asks, "When should I use my home oxygen?" You respond: A. as needed when short of breath.
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B. primarily during sleep hours. C. preferably during waking hours. D. for at least 15 hours a day. - ANS ✓D With a COPD exacerbation, a chest x-ray should be obtained: A. routinely in all patients B. when attempting to rule out a concomitant pneumonia. C. if sputum volume is increased. D. when work of breathing is increased. - ANS ✓B Which of the following best describes the role of theophylline in COPD treatment? A. indicated in moderate to very severe COPD B. use limited by narrow therapeutic profile and drug-drug interaction potential C. a potent bronchodilator D. available only in parenteral form - ANS ✓B All of the following are consistent with the GOLD COPD recommendation for pulmonary rehabilitation except: A. reserved for very severe COPD. B. goals include improvement in overall well-being. C. an underused therapeutic option. D. components aimed at reducing the deconditioning common in COPD. - ANS ✓A
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D. provides a prediction as to who is at greatest risk for active disease development. - ANS ✓D Does this patient have a reactive TST? A 45 yo woman with T2DM and chest radiograph finding consistent with previous TB and a 7 mm induration. - ANS ✓YES Does this patient have a reactive TST? A 21 yo man with no identifiable TB risk factors and a 10 mm induration. - ANS ✓NO Does this patient have a reactive TST? A 31 yo man with HIV and a 6 mm induration. - ANS ✓YES Does this patient have a reactive TST? A 45 yo woman from a country in which TB is endemic who has a 11 mm induration. - ANS ✓YES Does this patient have a reactive TST? A 42 yo woman with RA who is taking etanercept who has a 7 mm induration. - ANS ✓YES Risk factors for development of infection reactivation in patients with latent TB infection include all of the following except: A. diabetes mellitus. B. immunocompromise. C. long-term oral corticosteroid therapy. D. male gender. - ANS ✓D
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Clinical presentation of progressive primary TB most commonly includes all of the following except: A. malaise. B. fever. C. dry cough. D. frank hemoptysis. - ANS ✓D According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for treatment of community-acquired pneumonia (CAP):A 42-year-old man with no comorbidity, no reported drug allergy, and no recent antimicrobial use? A. azithromycin B. cefpodoxime C. trimethoprim-sulfamethoxazole D. ciprofloxacin - ANS ✓A Which of the following best describes asthma? A. intermittent airway inflammation with occasional bronchospasm B. a disease of bronchospasm that leads to airway inflammation C. chronic airway inflammation with superimposed bronchospasm D. relatively fixed airway constriction - ANS ✓C
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(PEF) is 55% of personal best. In the office, her FEV1 is 65% of predicted. Her medication regimen should be adjusted to include: A. theophylline. B. salmeterol (Serevent). C. prednisone. D. montelukast (Singulair). - ANS ✓C For Jane in the above question, you also prescribe: A. amoxicillin. B. azithromycin. C. levofloxacin. D. no antimicrobial therapy. - ANS ✓D Peak expiratory flow meters: A. should only be used in the presence of a medical professional. B. provide a convenient method to check lung function at home. C. are as accurate as spirometry. D. should not be used more than once daily. - ANS ✓B Which of the following is most likely to appear on a chest radiograph of a person during an acute severe asthma attack? A. hyperinflation B. atelectasis C. consolidation D. Kerley B signs - ANS ✓A
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36 - year-old man with asthma also needs antihypertensive therapy. Which of the following products should you avoid prescribing? A. hydrochlorothiazide B. propranolol C. amlodipine D. enalapril - ANS ✓B Which of the following is inconsistent with the presentation of asthma that is not well controlled? A. a troublesome nocturnal cough at least 2 nights per week B. need for albuterol to relieve shortness of breath at least twice a week C. morning sputum production D. two or more exacerbations/year requiring oral corticosteroids - ANS ✓C The cornerstone of moderate persistent asthma drug therapy is the use of: A. oral theophylline. B. mast cell stabilizers. C. short-acting beta2-agonists. D. inhaled corticosteroids. - ANS ✓D According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for treatment of community-acquired
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According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for treatment of community-acquired pneumonia (CAP): A 28-year-old woman with a severe beta-lactam allergy who has a dry cough, headache, malaise, no recent antimicrobial use, and no comorbidity who takes no medication? A. clarithromycin B. amoxicillin C. levofloxacin D. ceftriaxone - ANS ✓A According to the American Thoracic Society/Infectious Disease Society of American (ATS/IDSA) Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults, which of the following is the most appropriate antimicrobial for treatment of community-acquired pneumonia (CAP): A 47-year-old woman who was recently treated within the past two months with a beta-lactam for acute bacterial sinusitis? A. amoxicillin-clavulanate B. high-dose amoxicillin C. clarithromycin D. moxifloxacin - ANS ✓D Criteria to distinguish if pneumonia is community-acquired include all of the following except: A. lives in the community. B. not a resident of a long-term care facility. C. no prior antimicrobial use in the previous 3 months.
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D. no recent hospitalization. - ANS ✓C Common symptoms of community-acquired pneumonia in otherwise well adults include all of the following except: A. cough. B. altered mental status. C. dyspnea. D. pleuritic chest pain. - ANS ✓B A diagnosis of pneumonia is confirmed by: A. sputum culture. B. sputum Gram stain C. bronchoalveolar lavage. D. chest radiograph. - ANS ✓D Which of the following is a quality of respiratory fluoroquinolones? A. activity against drug-resistant S. pneumoniae (DRSP) B. poor activity against atypical pathogens C. predominantly hepatic route of elimination D. poor activity against beta-lactamase producing organisms. - ANS ✓A The mechanism of resistance of DRSP is through the cell's: A. beta-lactamase production. B. hypertrophy of cell membrane.
