SMARTY PANCE QUESTIONS AND ANSWERS
Which of the following pathophysiological processes is associated with chronic
bronchitis
A. Destruction of the lung parenchyma
B. Mucous gland enlargement and goblet cell hyperplasia
C. Smooth muscle hypertrophy in the large airways
D. Increased mucus adhesion secondary to reduction in the salt and water content of
the mucus - Answers - B. Mucous gland enlargement and goblet cell hyperplasia
A 65-year-old with COPD having received their first PPSV23 vaccination at age 63
should be revaccinated with PPSV23 in
A. 1 year
B. 3 years
C. 5 years
D. 10 years - Answers - C. 5 years
A patient with severe COPD presents to the Emergency Department with a 3 day
history of increasing shortness of breath with exertion and cough productive of purulent
sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of
50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and
an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of
7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most
appropriate next step in his treatment?
A. Decrease the oxygen flow rate.
B. Administer oral corticosteroids.
C. Intubate the patient.
D. Administer salmeterol (Serevent) - Answers - C. Intubate the patient
A 56 year-old male with a 40 pack-year smoking history presents complaining of
progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted),
an FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most
consistent with
A. sarcoidosis.
B. chronic bronchitis.
C. interstitial lung disease.
D. congestive heart failure - Answers - B. chronic bronchitis
A 55 year-old man with a history of chronic bronchitis presents with two days of
increased dyspnea and cough with worsening purulent sputum production. He is
currently using inhaled albuterol as needed. In addition to systemic corticosteroids, what
pharmacologic agent is warranted at this time for treatment of this patient?
A. Antibiotic
B. Inhaled corticosteroid
,C. Long acting beta-agonist
D. Theophylline - Answers - A. Antibiotic
A 67 year-old man presents complaining of gradually worsening fatigue and shortness
of breath. He is a previous smoker with an 80 pack-year smoking history. He denies
chest pain, night sweats, or hemoptysis. On physical examination, you note a very thin
male who appears older than his stated age. Lung and heart sounds are barely audible
to auscultation. Which of the following interventions is likely to alter the disease course?
A. Inhaled bronchodilator therapy
B. Inhaled steroid therapy
C. Home oxygen
D. Theophylline - Answers - C. Home oxygen
Patients with COPD have the symptoms of chronic bronchitis and emphysema. Which
of the following morphologic patterns of emphysema is typically most severe in the
upper lobes?
A. Centriacinar emphysema
B. Panacinar emphysema
C. Distal acinar emphysema
D. Paraseptal emphysema - Answers - A. Centriacinar emphysema
Which of the following is independently associated with an increased risk for all-cause
mortality in patients with COPD?
A. Asthma
B. Bronchiectasis
C. Underweight status
D. Depression - Answers - B. Bronchiectasis
Which of the following is generally recognized as the most significant symptom of
COPD?
A. Productive cough
B. Pulmonary hypertension
C. Cor pulmonale
D. Breathlessness - Answers - D. Breathlessness
Which of the following studies provides the best clues to the acuteness and severity of
disease exacerbation?
A. Serum chemistry evaluation
B. Alpha1-antitrypsin measurement
C. Arterial blood gas (ABG) analysis
D. Sputum evaluation - Answers - C. Arterial blood gas (ABG) analysis
Which of the following is accurate regarding the treatment of patients with COPD?
A. Pneumococcal vaccines are contraindicated in patients with COPD
B. Intravenous alpha1-antitrypsin levels should be kept at 8-10 mmol/L
,C. Long-term oxygen therapy is recommended for patients with a partial pressure of
oxygen in arterial blood <55 mm Hg or oxygen saturation <90%
D. Because cardiovascular disease is common in patients with COPD, beta-blockers
are indicated in all patients - Answers - C. Long-term oxygen therapy is recommended
for patients with a partial pressure of oxygen in arterial blood <55 mm Hg or oxygen
saturation <90%
A 73-year-old obese female with a 20 pack year smoking history presents complaining
of chronic productive cough. She states that it has been occurring over the past 3 years
more frequently November through February. Which of the following pulmonary function
test values would you expect to find decreased?
A. tidal volume
B. forced expiratory volume in 1 second/forced vital capacity
C. residual volume
D. total lung capacity - Answers - B. forced expiratory volume in 1 second/forced vital
capacity (Obstructive lung disease)
A 75 year-old man with a long history of COPD presents with acute onset of worsening
dyspnea, increased productive cough, and marked agitation. While in the emergency
department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg,
PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate
management at this point?
A. oxygen supplementation with a 100% non-rebreather mask
B. noninvasive positive pressure ventilation (NIPPV)
C. endotracheal intubation and mechanical ventilation
D. emergency tracheostomy - Answers - C. endotracheal intubation and mechanical
ventilation
In patients with COPD, which of the following has been shown to decrease rate of
malignancy and cardiovascular disease and improve survival?
A.bronchodilator therapy
B. pulmonary rehabilitation
C. oral glucocorticosteroids
D. smoking cessation - Answers - D. smoking cessation
A 45 year-old male presents with complaints of a chronic cough productive of
mucopurulent sputum. The cough has been present for the past 3 years, but he
attributed it to a "smoker's cough". He has been coughing up a lot of sputum lasting all
winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain.
Physical examination reveals a moderately obese male in no acute respiratory distress.
Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral
edema. Which of the following is the most likely diagnosis?
A. Lung cancer
B. Bronchiectasis
C. Chronic bronchitis
D. Interstitial lung disease - Answers - C. Chronic bronchitis
, A 57-year-old man is being evaluated for shortness of breath. The following spirometric
data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L
(predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed)
128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted These
findings are consistent with which of the following?
A. No demonstrable abnormality
B. Restrictive lung disease
C. Obstructive lung disease
D. A ventilation/perfusion mismatch - Answers - C. Obstructive lung disease
A 62 year-old male presents with a history of dyspnea on exertion and chronic cough
worse with arising in the mornings. He has a 40-year-pack history of cigarette use. On
examination there is increased AP diameter and decreased breath sounds with a
prolonged expiratory phase. Pulse oximetry reveals an oxygen saturation of 93% on
room air. In addition to smoking cessation, which of the following is an appropriate
intervention at this time?
A. Home oxygen therapy
B. Maintenance oral steroids
C. Prophylactic antibiotic therapy
D. Recommend influenza and pneumococcal vaccines - Answers - D. Recommend
influenza and pneumococcal vaccines
Which of the following best describes the pathophysiology of emphysema?
A. Interstitial inflammation and fibrosis
B. Alveolar enlargement and loss of septa
C. Mucosal edema and inflammatory response
D. Excessive mucus secretion and chronic cough - Answers - B. Alveolar enlargement
and loss of septa
Which of the following physical exam findings is consistent with moderate emphysema?
A. Increased tactile fremitus
B. Dullness to percussion
C. Distant heart sounds
D. Deviated trachea - Answers - C. Distant heart sounds
A 60 year-old patient with COPD characteristic of emphysema presents with a cough
and increased sputum production. The following information is noted: Temperature
100°F (37.8°C); Respiratory rate 20/min; Heart rate 88 beats/min; pH 7.44; PaO2 75
mmHg; PaCO2 40 mmHg; O2 saturation 92%. Physical examination is remarkable for
increased AP diameter, diminished breath sounds without wheezes, rhonchi, or other
signs of respiratory distress. Which of the following would be an appropriate treatment
for this patient?
A. Broad-spectrum antibiotic
B. Admission to the hospital
C. Oxygen at 6 L/min by nasal cannula
Which of the following pathophysiological processes is associated with chronic
bronchitis
A. Destruction of the lung parenchyma
B. Mucous gland enlargement and goblet cell hyperplasia
C. Smooth muscle hypertrophy in the large airways
D. Increased mucus adhesion secondary to reduction in the salt and water content of
the mucus - Answers - B. Mucous gland enlargement and goblet cell hyperplasia
A 65-year-old with COPD having received their first PPSV23 vaccination at age 63
should be revaccinated with PPSV23 in
A. 1 year
B. 3 years
C. 5 years
D. 10 years - Answers - C. 5 years
A patient with severe COPD presents to the Emergency Department with a 3 day
history of increasing shortness of breath with exertion and cough productive of purulent
sputum. An arterial blood gas reveals a pH of 7.25, PaCO2 of 70 mmHg and PaO2 of
50 mmHg. He is started on albuterol nebulizer, nasal oxygen at 2 liters per minute, and
an IV is started. After one hour of treatment, his arterial blood gas now reveals a pH of
7.15, PaCO2 100 mmHg and PaO2 of 70 mmHg. Which of the following is the most
appropriate next step in his treatment?
A. Decrease the oxygen flow rate.
B. Administer oral corticosteroids.
C. Intubate the patient.
D. Administer salmeterol (Serevent) - Answers - C. Intubate the patient
A 56 year-old male with a 40 pack-year smoking history presents complaining of
progressive shortness of breath. Spirometry reveals an FEV1 of 2 L (40% of predicted),
an FVC of 4 L (80% of predicted) and an FEV1/FVC of 50%. These findings are most
consistent with
A. sarcoidosis.
B. chronic bronchitis.
C. interstitial lung disease.
D. congestive heart failure - Answers - B. chronic bronchitis
A 55 year-old man with a history of chronic bronchitis presents with two days of
increased dyspnea and cough with worsening purulent sputum production. He is
currently using inhaled albuterol as needed. In addition to systemic corticosteroids, what
pharmacologic agent is warranted at this time for treatment of this patient?
A. Antibiotic
B. Inhaled corticosteroid
,C. Long acting beta-agonist
D. Theophylline - Answers - A. Antibiotic
A 67 year-old man presents complaining of gradually worsening fatigue and shortness
of breath. He is a previous smoker with an 80 pack-year smoking history. He denies
chest pain, night sweats, or hemoptysis. On physical examination, you note a very thin
male who appears older than his stated age. Lung and heart sounds are barely audible
to auscultation. Which of the following interventions is likely to alter the disease course?
A. Inhaled bronchodilator therapy
B. Inhaled steroid therapy
C. Home oxygen
D. Theophylline - Answers - C. Home oxygen
Patients with COPD have the symptoms of chronic bronchitis and emphysema. Which
of the following morphologic patterns of emphysema is typically most severe in the
upper lobes?
A. Centriacinar emphysema
B. Panacinar emphysema
C. Distal acinar emphysema
D. Paraseptal emphysema - Answers - A. Centriacinar emphysema
Which of the following is independently associated with an increased risk for all-cause
mortality in patients with COPD?
A. Asthma
B. Bronchiectasis
C. Underweight status
D. Depression - Answers - B. Bronchiectasis
Which of the following is generally recognized as the most significant symptom of
COPD?
A. Productive cough
B. Pulmonary hypertension
C. Cor pulmonale
D. Breathlessness - Answers - D. Breathlessness
Which of the following studies provides the best clues to the acuteness and severity of
disease exacerbation?
A. Serum chemistry evaluation
B. Alpha1-antitrypsin measurement
C. Arterial blood gas (ABG) analysis
D. Sputum evaluation - Answers - C. Arterial blood gas (ABG) analysis
Which of the following is accurate regarding the treatment of patients with COPD?
A. Pneumococcal vaccines are contraindicated in patients with COPD
B. Intravenous alpha1-antitrypsin levels should be kept at 8-10 mmol/L
,C. Long-term oxygen therapy is recommended for patients with a partial pressure of
oxygen in arterial blood <55 mm Hg or oxygen saturation <90%
D. Because cardiovascular disease is common in patients with COPD, beta-blockers
are indicated in all patients - Answers - C. Long-term oxygen therapy is recommended
for patients with a partial pressure of oxygen in arterial blood <55 mm Hg or oxygen
saturation <90%
A 73-year-old obese female with a 20 pack year smoking history presents complaining
of chronic productive cough. She states that it has been occurring over the past 3 years
more frequently November through February. Which of the following pulmonary function
test values would you expect to find decreased?
A. tidal volume
B. forced expiratory volume in 1 second/forced vital capacity
C. residual volume
D. total lung capacity - Answers - B. forced expiratory volume in 1 second/forced vital
capacity (Obstructive lung disease)
A 75 year-old man with a long history of COPD presents with acute onset of worsening
dyspnea, increased productive cough, and marked agitation. While in the emergency
department he becomes lethargic and obtunded. His ABG's reveal a PaO2 40 mmHg,
PaCO2 65 mmHg, and arterial pH 7.25. Which of the following is the most appropriate
management at this point?
A. oxygen supplementation with a 100% non-rebreather mask
B. noninvasive positive pressure ventilation (NIPPV)
C. endotracheal intubation and mechanical ventilation
D. emergency tracheostomy - Answers - C. endotracheal intubation and mechanical
ventilation
In patients with COPD, which of the following has been shown to decrease rate of
malignancy and cardiovascular disease and improve survival?
A.bronchodilator therapy
B. pulmonary rehabilitation
C. oral glucocorticosteroids
D. smoking cessation - Answers - D. smoking cessation
A 45 year-old male presents with complaints of a chronic cough productive of
mucopurulent sputum. The cough has been present for the past 3 years, but he
attributed it to a "smoker's cough". He has been coughing up a lot of sputum lasting all
winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain.
Physical examination reveals a moderately obese male in no acute respiratory distress.
Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral
edema. Which of the following is the most likely diagnosis?
A. Lung cancer
B. Bronchiectasis
C. Chronic bronchitis
D. Interstitial lung disease - Answers - C. Chronic bronchitis
, A 57-year-old man is being evaluated for shortness of breath. The following spirometric
data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L
(predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed)
128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted These
findings are consistent with which of the following?
A. No demonstrable abnormality
B. Restrictive lung disease
C. Obstructive lung disease
D. A ventilation/perfusion mismatch - Answers - C. Obstructive lung disease
A 62 year-old male presents with a history of dyspnea on exertion and chronic cough
worse with arising in the mornings. He has a 40-year-pack history of cigarette use. On
examination there is increased AP diameter and decreased breath sounds with a
prolonged expiratory phase. Pulse oximetry reveals an oxygen saturation of 93% on
room air. In addition to smoking cessation, which of the following is an appropriate
intervention at this time?
A. Home oxygen therapy
B. Maintenance oral steroids
C. Prophylactic antibiotic therapy
D. Recommend influenza and pneumococcal vaccines - Answers - D. Recommend
influenza and pneumococcal vaccines
Which of the following best describes the pathophysiology of emphysema?
A. Interstitial inflammation and fibrosis
B. Alveolar enlargement and loss of septa
C. Mucosal edema and inflammatory response
D. Excessive mucus secretion and chronic cough - Answers - B. Alveolar enlargement
and loss of septa
Which of the following physical exam findings is consistent with moderate emphysema?
A. Increased tactile fremitus
B. Dullness to percussion
C. Distant heart sounds
D. Deviated trachea - Answers - C. Distant heart sounds
A 60 year-old patient with COPD characteristic of emphysema presents with a cough
and increased sputum production. The following information is noted: Temperature
100°F (37.8°C); Respiratory rate 20/min; Heart rate 88 beats/min; pH 7.44; PaO2 75
mmHg; PaCO2 40 mmHg; O2 saturation 92%. Physical examination is remarkable for
increased AP diameter, diminished breath sounds without wheezes, rhonchi, or other
signs of respiratory distress. Which of the following would be an appropriate treatment
for this patient?
A. Broad-spectrum antibiotic
B. Admission to the hospital
C. Oxygen at 6 L/min by nasal cannula
