Module 3 Rosh Review Prep
1. A 3-week-old female infant presents to the clinic with a history of fever, runny nose, nasal
congestion, and cough for the past two days. Her fever has been 101°F at home rectally. On
exam, the infant has a heart rate of 168 bpm, respiratory rate of 72 with mild expiratory
wheezing, and pulse oximetry of 94% on room air. She is currently afebrile in the clinic. She has
no cyanosis. She does exhibit mild nasal flaring but has no retractions or grunting. What is the
most likely diagnosis for this infant?
a. Bacterial pneumonia
b. Influenza
c. Pneumonitis
d. Respiratory syncytial virus
2. A 34-year-old man presents to the clinic with insomnia for 6 months. He states that it takes him
several hours to fall asleep, and he wakes up every 2–3 hours. He reports eating before going to
bed. He has no significant past medical history. Which of the following is the most appropriate
initial step in management?
a. Avoid large meals before sleep
b. Begin cognitive behavioral therapy
c. Start zolpidem 5 mg daily
d. Take an afternoon nap daily
3. Community-acquired pneumonia in a patient with comorbidities such as chronic renal, heart, or
lung disease requires special attention to treatment. What is the best treatment for this
population of patients?
a. Amoxicillin-clavulanate 875-125 mg by mouth twice daily for seven days
b. Azithromycin 500 mg by mouth on day one and then 250 mg by mouth daily for four
days
c. Doxycycline 100 mg by mouth twice daily for seven days
d. Levofloxacin 750 mg by mouth daily for five days
,4. A 15-year-old boy who recently migrated from Pakistan presents with severe coughing spells. One
week ago, he experienced malaise, rhinorrhea, and fever. During the exam, the boy experiences
prolonged coughing spells followed by vigorous inspirations. Between the spells, the boy appears
well and has few symptoms. Which of the following is the most likely diagnosis?
a. Bordetella pertussis
b. Corynebacterium diphtheriae
c. Influenza virus
d. Mycoplasma pneumoniae
5. What is the most common presenting concern in patients with lung cancer?
a. Chest pain
b. Cough
c. Dyspnea
d. Hemoptysis
6. Which of the following statements is true regarding emphysema?
a. Associated with mucopurulent sputum and chronic cough
b. Characterized by submucosal and peribronchiolar fibrosis
c. Structural changes occur distal to the terminal bronchioles
d. There is airflow obstruction that is reversible with treatment
7. A 64-year-old woman presents with a 4-day history of a productive cough with shortness of
breath and wheezing. She is coughing up copious green mucus. She has no other known health
issues. She is diagnosed with an exacerbation of her chronic bronchitis. Which of the following is
the best treatment for this patient?
a. Amoxicillin 875 mg twice daily for 7 days
b. Amoxicillin-clavulanate 875/125 mg twice daily for 7 days
c. Clarithromycin 500 mg twice daily for 7 days
d. Prednisone 40 mg daily for 5 days
, 8. A 57-year-old man presents with daytime sleepiness. He is having difficulty completing his
afternoon work duties without a nap. He wakes feeling unrested and frequently has a headache
in the morning. You suspect obstructive sleep apnea to be the cause. Which objective finding
would most likely be associated with this diagnosis?
a. Absence of tonsils
b. Blood pressure 116/68
c. Body mass index 40
d. Neck circumference 15 inches
9. Which of the following would be the most appropriate intervention for a healthy 1-year-old girl
who is hospitalized with her first episode of bronchiolitis?
a. Administering an inhaled bronchodilator
b. Administering nebulized hypertonic saline
c. Nasal suctioning
d. Prescribing oral glucocorticoids
10. A 70-year-old man with congestive heart failure was seen in the clinic 1 week ago with shortness
of breath. The patient’s chest X-ray was normal, so the provider prescribed furosemide 40 mg PO
twice daily. The patient returned to the clinic today with worsening dyspnea, pleuritic pain, and a
nonproductive cough. The provider notes diminished breath sounds and jugular vein distention.
Which of the following diagnostic tests is most likely to confirm the suspected diagnosis?
a. Bronchoscopy
b. Chest CT
c. Pleural biopsy
d. Repeat chest X-ray
11. A 67-year-old man presents to the clinic for a routine follow-up visit. He was diagnosed with
GOLD category B chronic obstructive pulmonary disease three years ago. He has had one mild
exacerbation in the past year but no hospitalizations. His initial presenting symptoms of dyspnea
and productive cough have improved significantly with daily use of inhaled tiotropium. SpO2 with
ambulation is 94%. The patient stopped smoking five years ago and carries a 35-year pack history.
He received pneumococcal conjugate vaccine one year ago. Which of the following is the most
appropriate additional step in management?
a. Advise that pulmonary rehabilitation is ineffective
b. Order pneumococcal polysaccharide vaccine
c. Prescribe oxygen 2L/NC for use with ambulation
d. Repeat dose of pneumococcal conjugate vaccine
1. A 3-week-old female infant presents to the clinic with a history of fever, runny nose, nasal
congestion, and cough for the past two days. Her fever has been 101°F at home rectally. On
exam, the infant has a heart rate of 168 bpm, respiratory rate of 72 with mild expiratory
wheezing, and pulse oximetry of 94% on room air. She is currently afebrile in the clinic. She has
no cyanosis. She does exhibit mild nasal flaring but has no retractions or grunting. What is the
most likely diagnosis for this infant?
a. Bacterial pneumonia
b. Influenza
c. Pneumonitis
d. Respiratory syncytial virus
2. A 34-year-old man presents to the clinic with insomnia for 6 months. He states that it takes him
several hours to fall asleep, and he wakes up every 2–3 hours. He reports eating before going to
bed. He has no significant past medical history. Which of the following is the most appropriate
initial step in management?
a. Avoid large meals before sleep
b. Begin cognitive behavioral therapy
c. Start zolpidem 5 mg daily
d. Take an afternoon nap daily
3. Community-acquired pneumonia in a patient with comorbidities such as chronic renal, heart, or
lung disease requires special attention to treatment. What is the best treatment for this
population of patients?
a. Amoxicillin-clavulanate 875-125 mg by mouth twice daily for seven days
b. Azithromycin 500 mg by mouth on day one and then 250 mg by mouth daily for four
days
c. Doxycycline 100 mg by mouth twice daily for seven days
d. Levofloxacin 750 mg by mouth daily for five days
,4. A 15-year-old boy who recently migrated from Pakistan presents with severe coughing spells. One
week ago, he experienced malaise, rhinorrhea, and fever. During the exam, the boy experiences
prolonged coughing spells followed by vigorous inspirations. Between the spells, the boy appears
well and has few symptoms. Which of the following is the most likely diagnosis?
a. Bordetella pertussis
b. Corynebacterium diphtheriae
c. Influenza virus
d. Mycoplasma pneumoniae
5. What is the most common presenting concern in patients with lung cancer?
a. Chest pain
b. Cough
c. Dyspnea
d. Hemoptysis
6. Which of the following statements is true regarding emphysema?
a. Associated with mucopurulent sputum and chronic cough
b. Characterized by submucosal and peribronchiolar fibrosis
c. Structural changes occur distal to the terminal bronchioles
d. There is airflow obstruction that is reversible with treatment
7. A 64-year-old woman presents with a 4-day history of a productive cough with shortness of
breath and wheezing. She is coughing up copious green mucus. She has no other known health
issues. She is diagnosed with an exacerbation of her chronic bronchitis. Which of the following is
the best treatment for this patient?
a. Amoxicillin 875 mg twice daily for 7 days
b. Amoxicillin-clavulanate 875/125 mg twice daily for 7 days
c. Clarithromycin 500 mg twice daily for 7 days
d. Prednisone 40 mg daily for 5 days
, 8. A 57-year-old man presents with daytime sleepiness. He is having difficulty completing his
afternoon work duties without a nap. He wakes feeling unrested and frequently has a headache
in the morning. You suspect obstructive sleep apnea to be the cause. Which objective finding
would most likely be associated with this diagnosis?
a. Absence of tonsils
b. Blood pressure 116/68
c. Body mass index 40
d. Neck circumference 15 inches
9. Which of the following would be the most appropriate intervention for a healthy 1-year-old girl
who is hospitalized with her first episode of bronchiolitis?
a. Administering an inhaled bronchodilator
b. Administering nebulized hypertonic saline
c. Nasal suctioning
d. Prescribing oral glucocorticoids
10. A 70-year-old man with congestive heart failure was seen in the clinic 1 week ago with shortness
of breath. The patient’s chest X-ray was normal, so the provider prescribed furosemide 40 mg PO
twice daily. The patient returned to the clinic today with worsening dyspnea, pleuritic pain, and a
nonproductive cough. The provider notes diminished breath sounds and jugular vein distention.
Which of the following diagnostic tests is most likely to confirm the suspected diagnosis?
a. Bronchoscopy
b. Chest CT
c. Pleural biopsy
d. Repeat chest X-ray
11. A 67-year-old man presents to the clinic for a routine follow-up visit. He was diagnosed with
GOLD category B chronic obstructive pulmonary disease three years ago. He has had one mild
exacerbation in the past year but no hospitalizations. His initial presenting symptoms of dyspnea
and productive cough have improved significantly with daily use of inhaled tiotropium. SpO2 with
ambulation is 94%. The patient stopped smoking five years ago and carries a 35-year pack history.
He received pneumococcal conjugate vaccine one year ago. Which of the following is the most
appropriate additional step in management?
a. Advise that pulmonary rehabilitation is ineffective
b. Order pneumococcal polysaccharide vaccine
c. Prescribe oxygen 2L/NC for use with ambulation
d. Repeat dose of pneumococcal conjugate vaccine
