Clin Med Practice Exam 1: Pulmonary

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  • 1/20 Questions

    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?

    • Order a pilocarpine sweat test
    • Test the serum level of alpha-1-antitrypsin
    • Recommend postural drainage
    • Order an ECG
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About This Quiz

This clinical medicine practice exam focuses on pulmonary conditions, assessing knowledge on lung cancer risk, pneumonia, bronchitis, and pre-operative care for smokers. It is designed for medical students preparing for board exams, enhancing diagnostic and treatment skills.

Clin Med Practice Exam 1: Pulmonary - Quiz

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  • 2. 

    Which of the following appears on a chest X ray as a thick walled solitary cavity surrounded by consolidation?

    • Lung cancer

    • Epyema

    • Lung abscess

    • Epyema

    Correct Answer
    A. Lung abscess
    Explanation
    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.

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  • 3. 

    Which of the following is not a cause of an exudative pleural effusion?

    • Congestive heart failure

    • Epyema

    • SLE

    • TB

    Correct Answer
    A. Congestive heart failure
    Explanation
    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.

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  • 4. 

    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?

    • Superior vena cava syndrome

    • Small cell carcinoma

    • Pancoast tumor

    • Atelectasis

    Correct Answer
    A. Pancoast tumor
    Explanation
    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.

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  • 5. 

    Which is false of tuberculosis treatment?

    • It lasts 6-9 months

    • It includes ethambutol and pyrazinamide for the entire course of treatment

    • Ethambutol has a side affect of optic neuritis

    • DOT should be used in HIV+ patients due to possible interactions with their existing treatment regimen

    Correct Answer
    A. It includes ethambutol and pyrazinamide for the entire course of treatment
    Explanation
    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.

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  • 6. 

    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?

    • If there are other patients in the hospital who have been successfully treated for pneumonia, use the same antibiotic

    • Direct treatment at virulent organisms, especially pseudomonas and enterobacter species

    • Suspect she is a candidate for bronchial lavage

    • 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 antibiotic
    Explanation
    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.

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  • 7. 

    In which cancer stage of non-small cell lung cancer is there involvement of lung tissue and lymph nodes in the lung?

    • I

    • II

    • III

    • IV

    Correct Answer
    A. II
    Explanation
    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.

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  • 8. 

    Equalization between the pressure of the pleura and the lungs would cause which of the following?

    • Pleural effusion

    • Pulmonary edema

    • Pneumothorax

    • Atelectasis

    Correct Answer
    A. Pneumothorax
    Explanation
    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.

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  • 9. 

    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?

    • Upper respiratory infection

    • Lung abscess

    • Mycoplasma (primary atypical) pnemonia

    • Pulmonary embolism

    Correct Answer
    A. Mycoplasma (primary atypical) pnemonia
    Explanation
    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.

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  • 10. 

    Which  of the following could produce 200 cc hemoptysis at a time or over 600 cc over 24 hours?

    • Bronchiectasis

    • Pulmonary embolism

    • Cystic fibrosis

    • Atelectasis

    Correct Answer
    A. Bronchiectasis
    Explanation
    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.

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  • 11. 

    Which of the following could cause pulmonary hypertension by increasing pulmonary venous pressure?

    • Acidosis

    • Congenital left to right intracardia shunts

    • Polycythemia

    • Mitral stenosis

    Correct Answer
    A. Mitral stenosis
    Explanation
    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.

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  • 12. 

    After quitting smoking, how much time does it take to reduce the risk of lung cancer to half that of a smoker?

    • 1 year

    • 5 years

    • 10 years

    • 15 years

    Correct Answer
    A. 10 years
    Explanation
    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.

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  • 13. 

    In which dyspnea patient would diffuse panbronchiolitis be on the differential diagnosis?

    • 65 year old Caucasian woman with rheumatoid arthritis

    • 35 year old African American man with type 2 diabetes

    • 22 year old Korean man who is 6'4" and 140 pounds

    • A 40 year old Japanese man with a history of pansinusitis

    Correct Answer
    A. A 40 year old Japanese man with a history of pansinusitis
    Explanation
    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.

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  • 14. 

    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?

    • Daily inhaled corticosteroids for maintenance

    • Antibiotics for acute exacerbations

    • Use of a flutter-valve device

    • Beta blockers

    Correct Answer
    A. Beta blockers
    Explanation
    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.

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  • 15. 

    What does the Karnofski scale measure?

    • Risk for development of paraneoplastic syndrome

    • Quality of life

    • Risk for development of cor pulmonale

    • Apneic index

    Correct Answer
    A. Quality of life
    Explanation
    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.

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  • 16. 

    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?

    • 20 minutes

    • 8 hours

    • 24 hours

    • 48 hours

    Correct Answer
    A. 24 hours
    Explanation
    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.

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  • 17. 

    Which of the following conditions is not responsive to corticosteroids?

    • Asthma

    • Constrictive bronchiolitis

    • Proliferative bronchiolitis

    • Bronchiolitis obliterans with organizing pneumonia (BOOP)

    Correct Answer
    A. Constrictive bronchiolitis
    Explanation
    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.

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  • 18. 

    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:

    • The infection is self-limiting and has little chance of reactivation

    • Prophylaxis in patients her age will decrease the risk of cirrhosis and lower her chance of reactivation to less than 5%

    • The treatment for primary tuberculosis is an easy-to-follow regimen with few side effects

    • Most solitary lung nodules in patients her age and health status are benign

    Correct Answer
    A. 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.

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  • 19. 

    Which the following is not associated with acute bronchitis?

    • Mycoplasma pneumoniae

    • Strep. pneumoniae

    • Chlamydia pneumoniae

    • Bordetella pertussis

    Correct Answer
    A. Strep. pneumoniae
    Explanation
    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.

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  • 20. 

    Where in the lungs is surfactant produced?

    • Type I cells

    • Cuboidal cells

    • Type II cells

    • Both B and C

    Correct Answer
    A. Both B and C
    Explanation
    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.

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  • Current Version
  • Mar 22, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jan 30, 2010
    Quiz Created by
    Day4517

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