Clin Med Practice Exam 1: Pulmonary
Pulmonary - URI-interstitial, including IMHM
Questions and Answers
- 1.
After quitting smoking, how much time does it take to reduce the risk of lung cancer to half that of a smoker?
- A.
1 year
- B.
5 years
- C.
10 years
- D.
15 years
Correct Answer
C. 10 yearsExplanation
After quitting smoking, it takes approximately 10 years for the risk of lung cancer to be reduced to half that of a smoker. This is because the harmful effects of smoking gradually decrease over time as the body repairs itself. It is important to note that quitting smoking is the most effective way to reduce the risk of lung cancer and other smoking-related diseases.Rate this question:
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- 2.
A patient comes to the office in November with a headache, sore throat, earache and urticaria. Upon examination, he's found to have rhonchi, rales and lymphadenopathy, but the chest x-ray doesn't show any consolidation of the lower lung zones. Which is suspect?
- A.
Upper respiratory infection
- B.
Lung abscess
- C.
Mycoplasma (primary atypical) pnemonia
- D.
Pulmonary embolism
Correct Answer
C. Mycoplasma (primary atypical) pnemoniaExplanation
The patient presenting with symptoms such as headache, sore throat, earache, urticaria, rhonchi, rales, and lymphadenopathy suggests an atypical presentation of pneumonia. Mycoplasma pneumonia, also known as primary atypical pneumonia, is a common cause of respiratory infection characterized by these symptoms. The absence of consolidation in the lower lung zones on the chest x-ray further supports this suspicion. Upper respiratory infection, lung abscess, and pulmonary embolism are less likely to present with this combination of symptoms and findings.Rate this question:
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- 3.
Which the following is not associated with acute bronchitis?
- A.
Mycoplasma pneumoniae
- B.
Strep. pneumoniae
- C.
Chlamydia pneumoniae
- D.
Bordetella pertussis
Correct Answer
B. Strep. pneumoniaeExplanation
Strep. pneumoniae is not associated with acute bronchitis. Acute bronchitis is typically caused by viral infections, such as mycoplasma pneumoniae, chlamydia pneumoniae, or bordetella pertussis. Strep. pneumoniae is more commonly associated with pneumonia rather than bronchitis.Rate this question:
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- 4.
A 36 year old woman has been in the hospital for 30 hours. Unrelated to her original diagnosis, you find she has a low-grade fever, bronchial breath sounds, lungs dull to percussion and rales. Her chest X-ray shows consolidation. Pending results of cultures, which would be an appropriate treatment?
- A.
If there are other patients in the hospital who have been successfully treated for pneumonia, use the same antibiotic
- B.
Direct treatment at virulent organisms, especially pseudomonas and enterobacter species
- C.
Suspect she is a candidate for bronchial lavage
- D.
Immediately give her a nasal CPAP
Correct Answer
A. If there are other patients in the hospital who have been successfully treated for pneumonia, use the same antibioticExplanation
The appropriate treatment would be to use the same antibiotic that has successfully treated other patients in the hospital with pneumonia. This is because the patient's symptoms, such as low-grade fever, bronchial breath sounds, and consolidation on chest X-ray, are consistent with pneumonia. Using the same antibiotic that has worked for other patients would be a reasonable approach until the results of cultures are available to confirm the specific causative organism.Rate this question:
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- 5.
Which of the following appears on a chest X ray as a thick walled solitary cavity surrounded by consolidation?
- A.
Lung cancer
- B.
Epyema
- C.
Lung abscess
- D.
Epyema
Correct Answer
C. Lung abscessExplanation
A lung abscess appears on a chest X-ray as a thick-walled solitary cavity surrounded by consolidation. This means that there is a thick wall surrounding a cavity in the lung, and the area around it appears consolidated, which indicates inflammation and infection. This is a characteristic finding of a lung abscess, which is a localized collection of pus in the lung tissue.Rate this question:
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- 6.
A pre-op patient is a smoker. How long before the operation should he be told to stop smoking in order to decrease the risk of myocardial infarction?
- A.
20 minutes
- B.
8 hours
- C.
24 hours
- D.
48 hours
Correct Answer
C. 24 hoursExplanation
Smoking increases the risk of myocardial infarction (heart attack) due to its harmful effects on the cardiovascular system. When a patient smokes, their blood vessels constrict, their heart rate increases, and their blood pressure rises, all of which can lead to a heart attack. Therefore, to decrease the risk of myocardial infarction, a pre-op patient should be told to stop smoking at least 24 hours before the operation. This timeframe allows some time for the body to recover from the immediate effects of smoking and for the blood vessels to start returning to a healthier state.Rate this question:
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- 7.
Which of the following conditions is not responsive to corticosteroids?
- A.
Asthma
- B.
Constrictive bronchiolitis
- C.
Proliferative bronchiolitis
- D.
Bronchiolitis obliterans with organizing pneumonia (BOOP)
Correct Answer
B. Constrictive bronchiolitisExplanation
Constrictive bronchiolitis is a condition that is not responsive to corticosteroids. Corticosteroids are commonly used to reduce inflammation in the airways, which is effective in treating conditions such as asthma, proliferative bronchiolitis, and bronchiolitis obliterans with organizing pneumonia (BOOP). However, constrictive bronchiolitis is characterized by the narrowing and scarring of the small airways, which is not primarily driven by inflammation. Therefore, corticosteroids are not effective in treating this condition.Rate this question:
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- 8.
In which dyspnea patient would diffuse panbronchiolitis be on the differential diagnosis?
- A.
65 year old Caucasian woman with rheumatoid arthritis
- B.
35 year old African American man with type 2 diabetes
- C.
22 year old Korean man who is 6'4" and 140 pounds
- D.
A 40 year old Japanese man with a history of pansinusitis
Correct Answer
D. A 40 year old Japanese man with a history of pansinusitisExplanation
Diffuse panbronchiolitis is a chronic inflammatory disease that primarily affects the respiratory bronchioles. It is more commonly found in East Asian populations, particularly in Japan. The condition is characterized by persistent cough, sputum production, and dyspnea. The given answer of a 40-year-old Japanese man with a history of pansinusitis suggests that he may be at risk for diffuse panbronchiolitis due to his Japanese ethnicity and history of chronic sinusitis. The other options do not provide any specific risk factors for this condition.Rate this question:
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- 9.
Which of the following could produce 200 cc hemoptysis at a time or over 600 cc over 24 hours?
- A.
Bronchiectasis
- B.
Pulmonary embolism
- C.
Cystic fibrosis
- D.
Atelectasis
Correct Answer
A. BronchiectasisExplanation
Bronchiectasis is a condition characterized by the permanent enlargement of the airways in the lungs, leading to the accumulation of mucus and frequent infections. This can result in hemoptysis, the coughing up of blood, which can occur in large amounts. Therefore, bronchiectasis is the most likely condition to produce 200 cc of hemoptysis at a time or over 600 cc over 24 hours, compared to the other options of pulmonary embolism, cystic fibrosis, and atelectasis.Rate this question:
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- 10.
A thin, barrel-chested 32 year old male of European descent complains of dyspnea and wet cough. PFTs reveal an obstructive pattern that is unaffected by a bronchodilator. Chest X ray shows hyperinflation of the lungs and a flattened diaphragm with arterial depletion at the lung bases. Which is a logical step?
- A.
Order a pilocarpine sweat test
- B.
Test the serum level of alpha-1-antitrypsin
- C.
Recommend postural drainage
- D.
Order an ECG
Correct Answer
B. Test the serum level of alpha-1-antitrypsinExplanation
The given scenario suggests that the patient is experiencing symptoms of dyspnea and wet cough, along with an obstructive pattern in PFTs. The hyperinflation of the lungs and flattened diaphragm seen in the chest X-ray, along with arterial depletion at the lung bases, are indicative of a condition called alpha-1 antitrypsin deficiency. This is a genetic disorder that affects the production of a protein called alpha-1 antitrypsin, which helps protect the lungs from damage. Testing the serum level of alpha-1 antitrypsin is a logical step to confirm the diagnosis.Rate this question:
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- 11.
The same patient comes back a year later and admits noncompliance to treatment for his alpha-1-antitrypsin deficiency. This time his chest X-ray shows scattered irregular opacities and honeycombing. You then order a helical CT, which shows an area with a signet ring appearance. Which would probably not be a detail of the treatment?
- A.
Daily inhaled corticosteroids for maintenance
- B.
Antibiotics for acute exacerbations
- C.
Use of a flutter-valve device
- D.
Beta blockers
Correct Answer
D. Beta blockersExplanation
Beta blockers are not typically used in the treatment of alpha-1-antitrypsin deficiency. This condition primarily affects the lungs and liver, and treatment focuses on managing symptoms and preventing further damage. Daily inhaled corticosteroids for maintenance help reduce inflammation in the airways, antibiotics are used to treat acute exacerbations of respiratory infections, and a flutter-valve device is used to help clear mucus from the airways. Beta blockers are commonly used to treat conditions such as high blood pressure and heart disease, but they are not directly related to the treatment of alpha-1-antitrypsin deficiency.Rate this question:
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- 12.
A patient presents with anorexia, weight loss, fatigue, bone pain, hoarseness and anemia. Upon examination, you also find ptosis and a constricted pupil in her left eye and diaphoresis only on the right side of her face. What is suspect?
- A.
Superior vena cava syndrome
- B.
Small cell carcinoma
- C.
Pancoast tumor
- D.
Atelectasis
Correct Answer
C. Pancoast tumorExplanation
The patient's symptoms of anorexia, weight loss, fatigue, bone pain, hoarseness, and anemia are consistent with the presentation of a Pancoast tumor. The additional findings of ptosis and a constricted pupil in the left eye, as well as diaphoresis only on the right side of her face, suggest Horner syndrome, which is commonly associated with Pancoast tumors. Superior vena cava syndrome, small cell carcinoma, and atelectasis do not explain the full range of symptoms and findings seen in this patient.Rate this question:
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- 13.
In which cancer stage of non-small cell lung cancer is there involvement of lung tissue and lymph nodes in the lung?
- A.
I
- B.
II
- C.
III
- D.
IV
Correct Answer
B. IIExplanation
Stage II of non-small cell lung cancer is characterized by the involvement of lung tissue and nearby lymph nodes. In this stage, the cancer has spread to the lymph nodes within the lung but has not yet spread to distant parts of the body. This indicates a more advanced stage compared to Stage I, where the cancer is limited to the lung tissue only.Rate this question:
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- 14.
What does the Karnofski scale measure?
- A.
Risk for development of paraneoplastic syndrome
- B.
Quality of life
- C.
Risk for development of cor pulmonale
- D.
Apneic index
Correct Answer
B. Quality of lifeExplanation
The Karnofsky scale is a tool used to measure the quality of life of patients. It assesses their ability to perform daily activities and their overall well-being. It is commonly used in healthcare settings, particularly in oncology, to evaluate the impact of diseases and treatments on patients' functioning and overall quality of life.Rate this question:
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- 15.
Where in the lungs is surfactant produced?
- A.
Type I cells
- B.
Cuboidal cells
- C.
Type II cells
- D.
Both B and C
Correct Answer
D. Both B and CExplanation
Surfactant is produced in both cuboidal cells and type II cells in the lungs. Type II cells are responsible for the majority of surfactant production, while cuboidal cells also contribute to its production. Surfactant is a substance that reduces surface tension in the alveoli, preventing them from collapsing and allowing for efficient gas exchange in the lungs.Rate this question:
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- 16.
Equalization between the pressure of the pleura and the lungs would cause which of the following?
- A.
Pleural effusion
- B.
Pulmonary edema
- C.
Pneumothorax
- D.
Atelectasis
Correct Answer
C. PneumothoraxExplanation
Equalization between the pressure of the pleura and the lungs would cause pneumothorax. Pneumothorax occurs when air enters the pleural space, causing the lung to collapse. Equalization of pressure between the pleura and the lungs would disrupt the normal pressure gradient, leading to air entering the pleural space and causing pneumothorax. Pleural effusion, pulmonary edema, and atelectasis are not directly related to equalization of pressure between the pleura and the lungs.Rate this question:
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- 17.
Which of the following could cause pulmonary hypertension by increasing pulmonary venous pressure?
- A.
Acidosis
- B.
Congenital left to right intracardia shunts
- C.
Polycythemia
- D.
Mitral stenosis
Correct Answer
D. Mitral stenosisExplanation
Mitral stenosis refers to the narrowing of the mitral valve, which is responsible for regulating blood flow from the left atrium to the left ventricle. When the mitral valve is stenosed, it obstructs the flow of blood, causing increased pressure in the left atrium and subsequently in the pulmonary veins. This increased pressure is transmitted to the pulmonary circulation, leading to pulmonary hypertension. Therefore, mitral stenosis can cause pulmonary hypertension by increasing pulmonary venous pressure.Rate this question:
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- 18.
Which of the following is not a cause of an exudative pleural effusion?
- A.
Congestive heart failure
- B.
Epyema
- C.
SLE
- D.
TB
Correct Answer
A. Congestive heart failureExplanation
Congestive heart failure is not a cause of an exudative pleural effusion because exudative pleural effusions are typically caused by inflammation or infection, whereas congestive heart failure leads to a transudative pleural effusion. In congestive heart failure, increased pressure in the heart causes fluid to leak into the pleural space, resulting in a transudative effusion. Exudative pleural effusions, on the other hand, are caused by conditions such as infection (epyema), autoimmune diseases (SLE), and tuberculosis (TB), which lead to an increased permeability of blood vessels and the accumulation of inflammatory fluid in the pleural space.Rate this question:
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- 19.
An otherwise healthy 32 year old woman has a positive routine Matoux, and her chest X-ray shows a caseous granuloma. She freaks out. You reassure her by telling her:
- A.
The infection is self-limiting and has little chance of reactivation
- B.
Prophylaxis in patients her age will decrease the risk of cirrhosis and lower her chance of reactivation to less than 5%
- C.
The treatment for primary tuberculosis is an easy-to-follow regimen with few side effects
- D.
Most solitary lung nodules in patients her age and health status are benign
Correct Answer
B. Prophylaxis in patients her age will decrease the risk of cirrhosis and lower her chance of reactivation to less than 5%Explanation
The correct answer suggests that prophylaxis in patients her age will decrease the risk of cirrhosis and lower her chance of reactivation to less than 5%. This reassures the woman that there are measures she can take to reduce the risk of complications and reactivation of the infection. It implies that the infection is treatable and manageable, providing her with some peace of mind.Rate this question:
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- 20.
Which is false of tuberculosis treatment?
- A.
It lasts 6-9 months
- B.
It includes ethambutol and pyrazinamide for the entire course of treatment
- C.
Ethambutol has a side affect of optic neuritis
- D.
DOT should be used in HIV+ patients due to possible interactions with their existing treatment regimen
Correct Answer
B. It includes ethambutol and pyrazinamide for the entire course of treatmentExplanation
The statement "it includes ethambutol and pyrazinamide for the entire course of treatment" is false. While ethambutol and pyrazinamide are commonly used in the initial phase of tuberculosis treatment, they are usually discontinued after a few months. The continuation phase of treatment typically involves the use of isoniazid and rifampin for a total duration of 6-9 months. Therefore, it is incorrect to say that ethambutol and pyrazinamide are used for the entire course of treatment.Rate this question:
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Mar 22, 2023Quiz Edited by
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Jan 30, 2010Quiz Created by
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