MSN 621 final with complete solutions
latest version
A .decrease .in .the .forced .expiratory .volume .in .one .second .(FEV1) .to .forced .vital
.capacity .(FVC) .ratio .is .most .likely .to .be .seen .in .a .patient .with .which .of .the
.following? .- .CORRECT .ANSWER-Asthma
A .middle-aged .male .presents .to .the .emergency .department .with .an
.exacerbation .of .his .chronic .obstructive .pulmonary .disease .(COPD). .He .has
.been .coughing .and .been .moderately .short .of .breath .for .the .past .2 .days. .He
.says .that .his .inhalers .do .work, .but .he .ran .out .of .supplies. .He .complains .of
.general .malaise. .After .examining .him, .you .decide .to .start .him .on .antibiotics.
.However, .you .first .decide .to .send .the .sputum .for .gram .stain .and .culture.
.According .to .the .2015 .Global .Initiative .for .Chronic .Obstructive .Lung .Disease
.report, .which .of .the .following .organisms .is .most .likely .to .be .involved .in .COPD
.exacerbation? .- .CORRECT .ANSWER-Moraxella .catarrhalis
A .65-year-old .male .is .evaluated .for .worsening .shortness .of .breath .and .a
.productive .cough .for .6 .months. .He .is .a .current .smoker .with .a .30-pack-year
.smoking .history. .His .other .medical .history .includes .hypertension .and .chronic
.kidney .disease. .On .examination, .his .blood .pressure .is .145/95 .mmHg, .pulse
.88/min, .and .oxygen .saturation .of .92% .on .room .air. .He .does .not .have
.accessory .muscle .use. .On .lung .auscultation, .there .is .decreased .air .movement
.and .prolonged .expiration. .There .are .no .wheezes .detected. .No .S3 .or .S4
.auscultated. .There .is .no .jugular .vein .distention. .He .has .no .lower .extremity
.edema .and .denies .chest .pain .or .calf .tenderness. .Chest .x-ray .reveals .bilateral
.hyperinflated .lung .fields. .Which .of .the .following .is .the .next .best .step .in .the
.diagnosis .of .this .patient's .condition? .- .CORRECT .ANSWER-Spirometry
A .65-year-old .male .patient .presents .to .the .hospital .with .the .complaint .of
.increasing .shortness .of .breath. .His .condition .has .been .progressively
.worsening .over .the .past .six .months. .He .is .a .smoker .and .a .bird .keeper. .He .has
.one .son .and .one .daughter .with .asthma. .On .examination, .there .is .a .wheeze .and
.coarse .end-inspiratory .crackles .in .the .chest. .A .chest .radiograph .reveals .diffuse
.non-specific .changes .consistent .with .lung .disease. .What .investigation .is .most
.likely .to .yield .the .diagnosis .in .this .case? .- .CORRECT .ANSWER-Spirometry .with
.reversibility
,A .65-year-old .male .patient .presents .to .the .clinic .with .complaints .of .a .dry .cough
.and .wheezing, .particularly .at .night. .He .has .had .asthma. .Six .months .ago, .his
.symptoms .were .well-controlled .on .inhaled .fomoterol .and .low .dose .budesonide
.twice .a .day .and .occasional .use .of .an .albuterol .inhaler .as .required. .However,
.now .he .is .more .short .of .breath .with .morning .dipping .of .his .peak .flow
.readings. .On .examination, .he .is .mildly .dyspneic .but .able .to .complete
.sentences. .On .auscultation, .there .are .wheezes .scattered .in .his .chest. .His .peak
.expiratory .flow .rate .is .70% .of .predicted. .What .is .the .most .appropriate .next
.step .in .the .management .of .this .patient? .- .CORRECT .ANSWER-Inhaled
.budesonide .dose
A .patient .with .mild, .persistent .asthma .has .been .well .controlled .with .low-dose
.inhaled .corticosteroids. .He .presents .for .follow .up .complaining .of .some
.limitation .with .normal .activities .and .needing .albuterol .for .symptom .relief .3 .to .4
.days .per .week .over .the .past .month. .Which .of .the .following .is .the .preferred
.next .step? .- .CORRECT .ANSWER-Medium .dose .inhaled .corticosteroid
A .37-year-old .woman .presents .with .complaints .of .intermittent .dry .cough .and
.chest .tightness .since .she .started .a .new .job .as .a .chambermaid .at .a .hotel .5-
weeks .ago. .Her .symptoms .are .worst .at .night. .She .does .not .have .any .rhinitis,
.postnasal .drip, .or .history .of .allergic .rhinitis. .She .has .never .smoked .and .doe
.not .take .any .medicine. .On .physical .examination, .the .patient .appears
.comfortable .and .speaks .full .sentences .without .any .problem. .Oral .and .nasal
.mucosa .appears .normal. .On .auscultation .of .lungs, .wheeze .is .reported .in .the
.left .lung. .The .chest .x-ray .report .comes .out .normal. .Which .of .the .following .is
.the .next .best .step .in .identifying .the .cause .of .the .patient's .current .symptoms? .-
.CORRECT .ANSWER-Spirometry .with .pre .and .post .bronchodilator .testing
A .40-year-old .male .patient .comes .in .with .a .chief .complaint .of .difficulty
.breathing. .His .cardiac .function .test .results .are .normal. .He .shows .airway
.hyperresponsiveness .to .the .methacholine .challenge .test. .His .lung .spirometry
.test .reveals .a .lower-than-predicted .level .of .forced .expiratory .volume .in .the .first
.second .(FEV1). .Based .on .the .most .likely .diagnosis, .what .is .the .most
.appropriate .first-line .therapy .for .a .patient .with .infrequent .episodes .of .mild
.symptoms? .- .CORRECT .ANSWER-Albuterol .alone
A .78-year-old .male .presents .to .the .clinic .with .complaints .of .a .cough .that
.started .three .days .ago. .The .cough .is .associated .with .sputum, .which .is .scanty
.in .volume .and .yellow .in .color. .He .also .complains .of .mild .headaches .and .a
.stuffy .nose .for .the .last .two .days. .On .further .questioning, .he .reveals .that .he
.has .had .two .similar .episodes .previously, .which .subsided .within .a .week. .A
.detailed .medical .history .reveals .that .he .was .diagnosed .with .diabetes .mellitus
.twenty .years .ago .and .is .on .metformin. .His .vital .signs .show .a .blood .pressure
.of .100/80 .mmHg, .a .respiratory .rate .of .14/min, .a .heart .rate .of .88/min, .and .a
.temperature .of .99 .F .(37.1 .C). .Auscultation .of .the .chest .was .performed, .which
.reveals .bilateral .coarse .rhonchi, .whereas .a .chest .x-ray .is .normal. .What .is .the
.most .appropriate .next .step .in .the .management .of .his .condition? .- .CORRECT
.ANSWER-Abx .and .antitussives
,A .17-year-old .male .presents .with .a .two-day .history .of .fever, .runny .nose, .and
.cough .productive .of .clear .sputum. .His .past .medical .history .is .unremarkable,
.and .he .takes .no .medication. .His .blood .pressure .is .110/70 .mmHg, .respiratory
.rate .16 .breaths .per .minute, .heart .rate .102 .beats .per .minute, .temperature .101.8
.F .(38.8 .C), .and .oxygen .saturation .98% .on .room .air. .The .lung .examination
.demonstrates .clear .breath .sounds .bilaterally. .In .addition .to .an .antipyretic, .what
.is .the .most .appropriate .treatment .for .this .patient? .- .CORRECT .ANSWER-
Guaifensen
A .28-year-old .male .patient .with .a .past .medical .history .significant .for .asthma
.presents .to .the .primary .care .office .for .complaints .of .cough, .shortness .of
.breath .for .24 .hours .duration. .His .symptoms .started .abruptly .and .are
.progressively .worsening. .He .denies .fevers .or .chills .and .has .had .no .known
.exposure .to .sick .contacts. .Vital .signs .are .within .normal .limits. .Physical
.examination .is .significant .for .mild .expiratory .wheezing. .His .asthma .is .well
.controlled, .and .he .has .not .used .any .inhalers .for .a .few .years. .What .is .the .next
.best .step .in .the .management .of .this .patient? .- .CORRECT .ANSWER-Prescribe
.albuterol
A .35-year-old .female .presents .to .the .out-patient .department .with .complaints .of
.cough .with .whitish .sputum .production .for .the .past .three .months. .She
.mentions .that .the .cough .worsens .at .night. .She .has .no .other .complaints. .The
.patient .mentions .that .she .has .tried .chlorpheniramine .for .a .week, .and .no
.improvement .was .noted. .She .has .a .history .of .gastroesophageal .reflux .disease,
.for .which .she .takes .famotidine. .She .has .been .smoking .a .pack .of .cigarettes .a
.day .for .the .past .seven .years .and .drinks .alcohol .socially. .Vitals .show .a .blood
.pressure .of .133/85 .mm .Hg, .pulse .of .79/min, .respiratory .rate .of .14/min, .and
.temperature .of .98.6 .F .(37 .C). .Pulmonary .examination .reveals .normal .breath
.sounds .bilaterally. .A .chest .x-ray .is .normal. .Which .of .the .following .is .the .best
.next .step .in .the .management .of .the .patient's .condition? .- .CORRECT .ANSWER-
Pulm .fxn .tests
A .20-year-old .man .presents .to .the .clinic .with .two .months .history .of .cough .and
.right-sided .chest .pain. .On .examination, .his .chest .movement .on .the .right .side
.is .diminished, .the .trachea .is .shifted .to .the .left, .and .a .stony .dull .percussion
.note .is .present .on .the .right .side. .His .breath .sounds .are .impaired, .and .vocal
.fremitus .is .present. .Which .of .the .following .is .the .most .likely .diagnosis? .-
.CORRECT .ANSWER-Right .pleural .effusion
A .62-year-old .man .presents .with .general .malaise, .occasional .cough, .and .weight
.loss .of .10 .lbs .(4.5 .kg) .over .the .last .two .months. .History .is .significant .for
.prediabetes .managed .with .diet .and .cigarette .smoking. .Physical .examination
.findings .include .mild .edema .in .the .extremities .and .clubbing .bilaterally. .Blood
.work .shows .mild .anemia .and .sodium .of .122 .mg/dL. .What .test .should .be .done
.next? .- .CORRECT .ANSWER-Chest .radiograph
A .patient .with .chronic .obstructive .pulmonary .disease .(COPD) .and .chronic
.carbon .dioxide .retention .in .a .nursing .home .is .wheezing. .The .oxygen .saturation
, .drops .from .93 .to .90. .Which .of .the .following .would .be .most .appropriate? .-
.CORRECT .ANSWER-Albuterol .by .neb
A .70-year-old .man .with .severe .chronic .obstructive .pulmonary .disease .(COPD)
.has .had .multiple .hospital .admission .for .exacerbations. .He .is .an .ex-smoker .of
.40 .pack .years. .He .takes .budesonide/formoterol .combination .and .tiotropium
.inhalers. .He .is .up-to-date .with .his .Influenza .and .pneumococcal .vaccine. .What
.should .be .advised .to .decrease .his .COPD .exacerbations? .- .CORRECT
.ANSWER-Start .on .roflumilast
A .65-year-old .female .is .evaluated .for .shortness .of .breath .with .exertion .and .a
.chronic .cough. .She .is .often .unable .to .walk .farther .than .200 .feet .without
.stopping .to .catch .her .breath. .She .is .a .current .smoker .with .a .33-pack-year
.smoking .history. .She .has .no .prior .hospitalizations. .On .physical .examination,
.her .vital .signs .are .within .normal .limits .at .rest. .Auscultation .of .her .lungs
.reveals .bilateral .expiratory .wheezes. .The .remainder .of .her .physical .examination
.is .normal. .Spirometry .is .performed .and .shows .an .FEV1 .of .72% .of .predicted.
.Her .post-bronchodilator .FEV1/FVC .ratio .is .60%. .Her .modified .medical .research
.council .(mMRC) .dyspnea .score .is .3. .She .is .counseled .on .smoking .cessation.
.Which .of .the .following .is .the .most .appropriate .pharmacological .treatment .for
.this .patient? .- .CORRECT .ANSWER-Short .acting .bronchodilator .as .needed .and
.a .long .acting .bronchodilator
A .56-year-old .man .with .a .past .medical .history .of .uncontrolled .hypertension,
.poorly .controlled .diabetes .mellitus .and .hyperlipidemia .presents .with .a .1-hour
.history .of .sudden .onset, .sharp .left .shoulder .pain. .He .states .that .the .pain .is
.exacerbated .by .deep .breathing, .and .coughing. .The .patient .is .diaphoretic. .He
.does .not .take .any .medication .except .aspirin .which .he .took .today .when .the
.chest .pain .began. .On .examination, .his .oxygen .saturation .is .99% .on .room .air,
.respiratory .rate .20/minute, .heart .rate .88/min, .and .blood .pressure .110/50 .mmHg.
.A .chest .x-ray .is .unremarkable. .Which .of .the .following .is .the .next .best .step .in
.the .management .of .this .patient? .- .CORRECT .ANSWER-EKG
A .26-year-old .woman .G1P0000 .at .24 .weeks .gestation .presents .to .the .clinic .in
.October .for .evaluation .of .cough, .rhinorrhea, .and .subjective .fever .for .24 .hours.
.The .patient .has .no .significant .past .medical .history .and .takes .only .a .prenatal
.vitamin .daily. .Vital .signs .show .oral .temperature .38 .C .(100.4 .F), .blood .pressure
.120/80 .mmHg, .pulse .90/minute, .respirations .18/minute, .and .oxygen .saturation
.96% .on .room .air. .Physical .exam .reveals .a .mildly .ill-appearing .gravid .female .in
.no .acute .distress .with .lung .fields .that .are .clear .to .auscultation .bilaterally.
.Continuous .fetal .monitoring .is .normal. .Nasal .swab .ELISA .is .positive .for
.influenza .A. .Which .of .the .following .is .the .most .appropriate .treatment .for .this
.patient .to .decrease .the .likelihood .of .progression .to .viral .pneumonia? .-
.CORRECT .ANSWER-Oseltamivir
A .17-year-old .male .patient .presents .to .the .hospital .with .severe .shortness .of
.breath, .audible .wheeze, .and .fatigue. .He .has .had .asthma .for .ten .years,
.controlled .on .beclomethasone .500 .mcg .inhaled .twice .a .day. .On .examination,
.he .looks .tired .and .has .decreased .air .entry .on .auscultation. .His .arterial .blood
latest version
A .decrease .in .the .forced .expiratory .volume .in .one .second .(FEV1) .to .forced .vital
.capacity .(FVC) .ratio .is .most .likely .to .be .seen .in .a .patient .with .which .of .the
.following? .- .CORRECT .ANSWER-Asthma
A .middle-aged .male .presents .to .the .emergency .department .with .an
.exacerbation .of .his .chronic .obstructive .pulmonary .disease .(COPD). .He .has
.been .coughing .and .been .moderately .short .of .breath .for .the .past .2 .days. .He
.says .that .his .inhalers .do .work, .but .he .ran .out .of .supplies. .He .complains .of
.general .malaise. .After .examining .him, .you .decide .to .start .him .on .antibiotics.
.However, .you .first .decide .to .send .the .sputum .for .gram .stain .and .culture.
.According .to .the .2015 .Global .Initiative .for .Chronic .Obstructive .Lung .Disease
.report, .which .of .the .following .organisms .is .most .likely .to .be .involved .in .COPD
.exacerbation? .- .CORRECT .ANSWER-Moraxella .catarrhalis
A .65-year-old .male .is .evaluated .for .worsening .shortness .of .breath .and .a
.productive .cough .for .6 .months. .He .is .a .current .smoker .with .a .30-pack-year
.smoking .history. .His .other .medical .history .includes .hypertension .and .chronic
.kidney .disease. .On .examination, .his .blood .pressure .is .145/95 .mmHg, .pulse
.88/min, .and .oxygen .saturation .of .92% .on .room .air. .He .does .not .have
.accessory .muscle .use. .On .lung .auscultation, .there .is .decreased .air .movement
.and .prolonged .expiration. .There .are .no .wheezes .detected. .No .S3 .or .S4
.auscultated. .There .is .no .jugular .vein .distention. .He .has .no .lower .extremity
.edema .and .denies .chest .pain .or .calf .tenderness. .Chest .x-ray .reveals .bilateral
.hyperinflated .lung .fields. .Which .of .the .following .is .the .next .best .step .in .the
.diagnosis .of .this .patient's .condition? .- .CORRECT .ANSWER-Spirometry
A .65-year-old .male .patient .presents .to .the .hospital .with .the .complaint .of
.increasing .shortness .of .breath. .His .condition .has .been .progressively
.worsening .over .the .past .six .months. .He .is .a .smoker .and .a .bird .keeper. .He .has
.one .son .and .one .daughter .with .asthma. .On .examination, .there .is .a .wheeze .and
.coarse .end-inspiratory .crackles .in .the .chest. .A .chest .radiograph .reveals .diffuse
.non-specific .changes .consistent .with .lung .disease. .What .investigation .is .most
.likely .to .yield .the .diagnosis .in .this .case? .- .CORRECT .ANSWER-Spirometry .with
.reversibility
,A .65-year-old .male .patient .presents .to .the .clinic .with .complaints .of .a .dry .cough
.and .wheezing, .particularly .at .night. .He .has .had .asthma. .Six .months .ago, .his
.symptoms .were .well-controlled .on .inhaled .fomoterol .and .low .dose .budesonide
.twice .a .day .and .occasional .use .of .an .albuterol .inhaler .as .required. .However,
.now .he .is .more .short .of .breath .with .morning .dipping .of .his .peak .flow
.readings. .On .examination, .he .is .mildly .dyspneic .but .able .to .complete
.sentences. .On .auscultation, .there .are .wheezes .scattered .in .his .chest. .His .peak
.expiratory .flow .rate .is .70% .of .predicted. .What .is .the .most .appropriate .next
.step .in .the .management .of .this .patient? .- .CORRECT .ANSWER-Inhaled
.budesonide .dose
A .patient .with .mild, .persistent .asthma .has .been .well .controlled .with .low-dose
.inhaled .corticosteroids. .He .presents .for .follow .up .complaining .of .some
.limitation .with .normal .activities .and .needing .albuterol .for .symptom .relief .3 .to .4
.days .per .week .over .the .past .month. .Which .of .the .following .is .the .preferred
.next .step? .- .CORRECT .ANSWER-Medium .dose .inhaled .corticosteroid
A .37-year-old .woman .presents .with .complaints .of .intermittent .dry .cough .and
.chest .tightness .since .she .started .a .new .job .as .a .chambermaid .at .a .hotel .5-
weeks .ago. .Her .symptoms .are .worst .at .night. .She .does .not .have .any .rhinitis,
.postnasal .drip, .or .history .of .allergic .rhinitis. .She .has .never .smoked .and .doe
.not .take .any .medicine. .On .physical .examination, .the .patient .appears
.comfortable .and .speaks .full .sentences .without .any .problem. .Oral .and .nasal
.mucosa .appears .normal. .On .auscultation .of .lungs, .wheeze .is .reported .in .the
.left .lung. .The .chest .x-ray .report .comes .out .normal. .Which .of .the .following .is
.the .next .best .step .in .identifying .the .cause .of .the .patient's .current .symptoms? .-
.CORRECT .ANSWER-Spirometry .with .pre .and .post .bronchodilator .testing
A .40-year-old .male .patient .comes .in .with .a .chief .complaint .of .difficulty
.breathing. .His .cardiac .function .test .results .are .normal. .He .shows .airway
.hyperresponsiveness .to .the .methacholine .challenge .test. .His .lung .spirometry
.test .reveals .a .lower-than-predicted .level .of .forced .expiratory .volume .in .the .first
.second .(FEV1). .Based .on .the .most .likely .diagnosis, .what .is .the .most
.appropriate .first-line .therapy .for .a .patient .with .infrequent .episodes .of .mild
.symptoms? .- .CORRECT .ANSWER-Albuterol .alone
A .78-year-old .male .presents .to .the .clinic .with .complaints .of .a .cough .that
.started .three .days .ago. .The .cough .is .associated .with .sputum, .which .is .scanty
.in .volume .and .yellow .in .color. .He .also .complains .of .mild .headaches .and .a
.stuffy .nose .for .the .last .two .days. .On .further .questioning, .he .reveals .that .he
.has .had .two .similar .episodes .previously, .which .subsided .within .a .week. .A
.detailed .medical .history .reveals .that .he .was .diagnosed .with .diabetes .mellitus
.twenty .years .ago .and .is .on .metformin. .His .vital .signs .show .a .blood .pressure
.of .100/80 .mmHg, .a .respiratory .rate .of .14/min, .a .heart .rate .of .88/min, .and .a
.temperature .of .99 .F .(37.1 .C). .Auscultation .of .the .chest .was .performed, .which
.reveals .bilateral .coarse .rhonchi, .whereas .a .chest .x-ray .is .normal. .What .is .the
.most .appropriate .next .step .in .the .management .of .his .condition? .- .CORRECT
.ANSWER-Abx .and .antitussives
,A .17-year-old .male .presents .with .a .two-day .history .of .fever, .runny .nose, .and
.cough .productive .of .clear .sputum. .His .past .medical .history .is .unremarkable,
.and .he .takes .no .medication. .His .blood .pressure .is .110/70 .mmHg, .respiratory
.rate .16 .breaths .per .minute, .heart .rate .102 .beats .per .minute, .temperature .101.8
.F .(38.8 .C), .and .oxygen .saturation .98% .on .room .air. .The .lung .examination
.demonstrates .clear .breath .sounds .bilaterally. .In .addition .to .an .antipyretic, .what
.is .the .most .appropriate .treatment .for .this .patient? .- .CORRECT .ANSWER-
Guaifensen
A .28-year-old .male .patient .with .a .past .medical .history .significant .for .asthma
.presents .to .the .primary .care .office .for .complaints .of .cough, .shortness .of
.breath .for .24 .hours .duration. .His .symptoms .started .abruptly .and .are
.progressively .worsening. .He .denies .fevers .or .chills .and .has .had .no .known
.exposure .to .sick .contacts. .Vital .signs .are .within .normal .limits. .Physical
.examination .is .significant .for .mild .expiratory .wheezing. .His .asthma .is .well
.controlled, .and .he .has .not .used .any .inhalers .for .a .few .years. .What .is .the .next
.best .step .in .the .management .of .this .patient? .- .CORRECT .ANSWER-Prescribe
.albuterol
A .35-year-old .female .presents .to .the .out-patient .department .with .complaints .of
.cough .with .whitish .sputum .production .for .the .past .three .months. .She
.mentions .that .the .cough .worsens .at .night. .She .has .no .other .complaints. .The
.patient .mentions .that .she .has .tried .chlorpheniramine .for .a .week, .and .no
.improvement .was .noted. .She .has .a .history .of .gastroesophageal .reflux .disease,
.for .which .she .takes .famotidine. .She .has .been .smoking .a .pack .of .cigarettes .a
.day .for .the .past .seven .years .and .drinks .alcohol .socially. .Vitals .show .a .blood
.pressure .of .133/85 .mm .Hg, .pulse .of .79/min, .respiratory .rate .of .14/min, .and
.temperature .of .98.6 .F .(37 .C). .Pulmonary .examination .reveals .normal .breath
.sounds .bilaterally. .A .chest .x-ray .is .normal. .Which .of .the .following .is .the .best
.next .step .in .the .management .of .the .patient's .condition? .- .CORRECT .ANSWER-
Pulm .fxn .tests
A .20-year-old .man .presents .to .the .clinic .with .two .months .history .of .cough .and
.right-sided .chest .pain. .On .examination, .his .chest .movement .on .the .right .side
.is .diminished, .the .trachea .is .shifted .to .the .left, .and .a .stony .dull .percussion
.note .is .present .on .the .right .side. .His .breath .sounds .are .impaired, .and .vocal
.fremitus .is .present. .Which .of .the .following .is .the .most .likely .diagnosis? .-
.CORRECT .ANSWER-Right .pleural .effusion
A .62-year-old .man .presents .with .general .malaise, .occasional .cough, .and .weight
.loss .of .10 .lbs .(4.5 .kg) .over .the .last .two .months. .History .is .significant .for
.prediabetes .managed .with .diet .and .cigarette .smoking. .Physical .examination
.findings .include .mild .edema .in .the .extremities .and .clubbing .bilaterally. .Blood
.work .shows .mild .anemia .and .sodium .of .122 .mg/dL. .What .test .should .be .done
.next? .- .CORRECT .ANSWER-Chest .radiograph
A .patient .with .chronic .obstructive .pulmonary .disease .(COPD) .and .chronic
.carbon .dioxide .retention .in .a .nursing .home .is .wheezing. .The .oxygen .saturation
, .drops .from .93 .to .90. .Which .of .the .following .would .be .most .appropriate? .-
.CORRECT .ANSWER-Albuterol .by .neb
A .70-year-old .man .with .severe .chronic .obstructive .pulmonary .disease .(COPD)
.has .had .multiple .hospital .admission .for .exacerbations. .He .is .an .ex-smoker .of
.40 .pack .years. .He .takes .budesonide/formoterol .combination .and .tiotropium
.inhalers. .He .is .up-to-date .with .his .Influenza .and .pneumococcal .vaccine. .What
.should .be .advised .to .decrease .his .COPD .exacerbations? .- .CORRECT
.ANSWER-Start .on .roflumilast
A .65-year-old .female .is .evaluated .for .shortness .of .breath .with .exertion .and .a
.chronic .cough. .She .is .often .unable .to .walk .farther .than .200 .feet .without
.stopping .to .catch .her .breath. .She .is .a .current .smoker .with .a .33-pack-year
.smoking .history. .She .has .no .prior .hospitalizations. .On .physical .examination,
.her .vital .signs .are .within .normal .limits .at .rest. .Auscultation .of .her .lungs
.reveals .bilateral .expiratory .wheezes. .The .remainder .of .her .physical .examination
.is .normal. .Spirometry .is .performed .and .shows .an .FEV1 .of .72% .of .predicted.
.Her .post-bronchodilator .FEV1/FVC .ratio .is .60%. .Her .modified .medical .research
.council .(mMRC) .dyspnea .score .is .3. .She .is .counseled .on .smoking .cessation.
.Which .of .the .following .is .the .most .appropriate .pharmacological .treatment .for
.this .patient? .- .CORRECT .ANSWER-Short .acting .bronchodilator .as .needed .and
.a .long .acting .bronchodilator
A .56-year-old .man .with .a .past .medical .history .of .uncontrolled .hypertension,
.poorly .controlled .diabetes .mellitus .and .hyperlipidemia .presents .with .a .1-hour
.history .of .sudden .onset, .sharp .left .shoulder .pain. .He .states .that .the .pain .is
.exacerbated .by .deep .breathing, .and .coughing. .The .patient .is .diaphoretic. .He
.does .not .take .any .medication .except .aspirin .which .he .took .today .when .the
.chest .pain .began. .On .examination, .his .oxygen .saturation .is .99% .on .room .air,
.respiratory .rate .20/minute, .heart .rate .88/min, .and .blood .pressure .110/50 .mmHg.
.A .chest .x-ray .is .unremarkable. .Which .of .the .following .is .the .next .best .step .in
.the .management .of .this .patient? .- .CORRECT .ANSWER-EKG
A .26-year-old .woman .G1P0000 .at .24 .weeks .gestation .presents .to .the .clinic .in
.October .for .evaluation .of .cough, .rhinorrhea, .and .subjective .fever .for .24 .hours.
.The .patient .has .no .significant .past .medical .history .and .takes .only .a .prenatal
.vitamin .daily. .Vital .signs .show .oral .temperature .38 .C .(100.4 .F), .blood .pressure
.120/80 .mmHg, .pulse .90/minute, .respirations .18/minute, .and .oxygen .saturation
.96% .on .room .air. .Physical .exam .reveals .a .mildly .ill-appearing .gravid .female .in
.no .acute .distress .with .lung .fields .that .are .clear .to .auscultation .bilaterally.
.Continuous .fetal .monitoring .is .normal. .Nasal .swab .ELISA .is .positive .for
.influenza .A. .Which .of .the .following .is .the .most .appropriate .treatment .for .this
.patient .to .decrease .the .likelihood .of .progression .to .viral .pneumonia? .-
.CORRECT .ANSWER-Oseltamivir
A .17-year-old .male .patient .presents .to .the .hospital .with .severe .shortness .of
.breath, .audible .wheeze, .and .fatigue. .He .has .had .asthma .for .ten .years,
.controlled .on .beclomethasone .500 .mcg .inhaled .twice .a .day. .On .examination,
.he .looks .tired .and .has .decreased .air .entry .on .auscultation. .His .arterial .blood
