FITZGERALD QUESTIONS WITH COMPLETE
SOLUTIONS
Michelle returns for an urgent care visit three weeks later
with a 2-day history of URI symptoms. She has a dry cough
and reports, “The rescue medication is not working as well
as usual. I was up all night coughing. When I cough, a little
bit of white phlegm sometimes comes up.” She denies fever,
nausea, or vomiting. Which of the following is the most
important clinical parameter in assessing Michelle’s asthma
flare?
SaO2=97%
Peak expiratory flow=55% of personal best
Presence of bilateral expiratory wheezes
Patient report of reduced response to beta2-agonist use
Michelle’s physical examination is consistent with an asthma
flare triggered by viral RTI. Her medication regimen should
be adjusted to include which of the following? (Yes or No?)
1. A short course of an oral corticosteroid YES
2. An oral macrolide antimicrobial NO
3. A single dose of injectable corticosteroid NO
4. Addition of a LTM for URI duration NO
Phil is a 22-year-old with a 7-year history of asthma who is
new to your practice. His last visit with his prior provider
,was around three months ago, and he states that during that
visit, he received a “refill on my albuterol inhaler.” He uses
albuterol 2 puffs around 2-3 times a day, stating, “My
asthma is pretty well-controlled with this inhaler. I hardly
ever cough and wheeze unless I exercise.” He is not using
any other medications and has no other health issues. Which
of the following is the most appropriate approach to Phil’s
asthma care?
Maintain his current regimen as he reports his asthma is “pretty
well-controlled.”
Advise on the use of high-dose ICS each time he requires a
SABA dose.
Prescribe ICS/LABA therapy, with instructions on using this
product as a controller and rescue therapy.
Add a LAMA to his treatment regimen to enhance exercise
tolerance.
Which of the following is consistent with the diagnosis of all
stages of chronic obstructive pulmonary disease?
FEV1:FVC ratio <0.70 post-bronchodilator
Dyspnea on exertion
Hypoxemia
Orthopnea
A 78-year-old man with COPD, who uses an inhaled LAMA
daily on a set schedule and SABA via MDI as needed for
symptom relief, presents with a COPD exacerbation. Which
,of the following describes the role of imaging in the
evaluation of COPD exacerbation?
A chest X-ray is a routine part of the evaluation of a person with
COPD exacerbation.
In COPD exacerbation, chest X-ray should not be obtained due
to radiation risk.
A chest X-ray should be ordered in COPD exacerbation in
the patient with fever and/or low SaO2 to help rule out
concomitant pneumonia.
A thoracic CT is the preferred imaging study to order in a COPD
exacerbation.
Ms. Matthews is a 78-year-old man with severe COPD, who
is currently using a LABA/LAMA DPI and who presents for
an acute care visit. Her current medications include an
ACEI, thiazide diuretic, statin, and a calcium channel
blocker. She reports increasing dyspnea and worsening
cough with small amounts of yellow-green sputum for the
past 24 hours. She states, “I hardly slept at all last night. I
kept waking up coughing.” She denies nausea, vomiting, or
fever. Physical examination reveals bilateral expiratory
wheezes and rhonchi with hyperresonance to percussion
without increased tactile fremitus or dullness to percussion.
SaO2=98%, T=97.6°F (36.4°C), BP=136/84 mm Hg, P=92
bpm (regular), RR=20 bpm. When considering
pharmacologic therapy to treat Ms. Matthews, the NP
prescribes which of the following? (Yes or No?)
, 1. A single dose of an injectable, sustained-release
corticosteroid NO
2. Oral clarithromycin NO
3. Opioid-containing cough suppressant NO
4. A short course of an oral corticosteroid YES
A 35-year-old man presents with a 1-year history of T2DM,
current A1C=7.9% (0.079 proportion). He is taking an
optimized dose of metformin with adherence and works
rotating shifts in a warehouse where he “grabs something to
eat when time permits.” His health insurance recently
changed, and he states, “I have a really big copay.” The next
step in his T2DM pharmacologic therapy should include:
A sulfonylurea.
A GLP-1 agonist.
A TZD.
No medication adjustment as he is tolerating his current
medications.
The NP sees a 56-year-old woman with a 3-year history of
T2DM and obesity (BMI=36 kg/m2). She states, “I really feel
like I am ready to work on my weight.” She has a history of
recurrent genital candidiasis and UTI. Her current A1C is
8.2% (0.082 proportion). What is the next best step in her
T2DM treatment?
Glipizide (SU)
Canagliflozin (SGLT2-I)
SOLUTIONS
Michelle returns for an urgent care visit three weeks later
with a 2-day history of URI symptoms. She has a dry cough
and reports, “The rescue medication is not working as well
as usual. I was up all night coughing. When I cough, a little
bit of white phlegm sometimes comes up.” She denies fever,
nausea, or vomiting. Which of the following is the most
important clinical parameter in assessing Michelle’s asthma
flare?
SaO2=97%
Peak expiratory flow=55% of personal best
Presence of bilateral expiratory wheezes
Patient report of reduced response to beta2-agonist use
Michelle’s physical examination is consistent with an asthma
flare triggered by viral RTI. Her medication regimen should
be adjusted to include which of the following? (Yes or No?)
1. A short course of an oral corticosteroid YES
2. An oral macrolide antimicrobial NO
3. A single dose of injectable corticosteroid NO
4. Addition of a LTM for URI duration NO
Phil is a 22-year-old with a 7-year history of asthma who is
new to your practice. His last visit with his prior provider
,was around three months ago, and he states that during that
visit, he received a “refill on my albuterol inhaler.” He uses
albuterol 2 puffs around 2-3 times a day, stating, “My
asthma is pretty well-controlled with this inhaler. I hardly
ever cough and wheeze unless I exercise.” He is not using
any other medications and has no other health issues. Which
of the following is the most appropriate approach to Phil’s
asthma care?
Maintain his current regimen as he reports his asthma is “pretty
well-controlled.”
Advise on the use of high-dose ICS each time he requires a
SABA dose.
Prescribe ICS/LABA therapy, with instructions on using this
product as a controller and rescue therapy.
Add a LAMA to his treatment regimen to enhance exercise
tolerance.
Which of the following is consistent with the diagnosis of all
stages of chronic obstructive pulmonary disease?
FEV1:FVC ratio <0.70 post-bronchodilator
Dyspnea on exertion
Hypoxemia
Orthopnea
A 78-year-old man with COPD, who uses an inhaled LAMA
daily on a set schedule and SABA via MDI as needed for
symptom relief, presents with a COPD exacerbation. Which
,of the following describes the role of imaging in the
evaluation of COPD exacerbation?
A chest X-ray is a routine part of the evaluation of a person with
COPD exacerbation.
In COPD exacerbation, chest X-ray should not be obtained due
to radiation risk.
A chest X-ray should be ordered in COPD exacerbation in
the patient with fever and/or low SaO2 to help rule out
concomitant pneumonia.
A thoracic CT is the preferred imaging study to order in a COPD
exacerbation.
Ms. Matthews is a 78-year-old man with severe COPD, who
is currently using a LABA/LAMA DPI and who presents for
an acute care visit. Her current medications include an
ACEI, thiazide diuretic, statin, and a calcium channel
blocker. She reports increasing dyspnea and worsening
cough with small amounts of yellow-green sputum for the
past 24 hours. She states, “I hardly slept at all last night. I
kept waking up coughing.” She denies nausea, vomiting, or
fever. Physical examination reveals bilateral expiratory
wheezes and rhonchi with hyperresonance to percussion
without increased tactile fremitus or dullness to percussion.
SaO2=98%, T=97.6°F (36.4°C), BP=136/84 mm Hg, P=92
bpm (regular), RR=20 bpm. When considering
pharmacologic therapy to treat Ms. Matthews, the NP
prescribes which of the following? (Yes or No?)
, 1. A single dose of an injectable, sustained-release
corticosteroid NO
2. Oral clarithromycin NO
3. Opioid-containing cough suppressant NO
4. A short course of an oral corticosteroid YES
A 35-year-old man presents with a 1-year history of T2DM,
current A1C=7.9% (0.079 proportion). He is taking an
optimized dose of metformin with adherence and works
rotating shifts in a warehouse where he “grabs something to
eat when time permits.” His health insurance recently
changed, and he states, “I have a really big copay.” The next
step in his T2DM pharmacologic therapy should include:
A sulfonylurea.
A GLP-1 agonist.
A TZD.
No medication adjustment as he is tolerating his current
medications.
The NP sees a 56-year-old woman with a 3-year history of
T2DM and obesity (BMI=36 kg/m2). She states, “I really feel
like I am ready to work on my weight.” She has a history of
recurrent genital candidiasis and UTI. Her current A1C is
8.2% (0.082 proportion). What is the next best step in her
T2DM treatment?
Glipizide (SU)
Canagliflozin (SGLT2-I)
