PULM Test Questions And Answers Verified 100% Correct
A 25-year-old white woman who is in training for a competitive marathon
complains of " hitting a wall" and "getting short of breath quicker than she
should:' She complains of coughing at the end of her training runs, and states
that she may be expecting too much of herself. She does not smoke, has no
significant family history, and no history of occupational or environmental
exposures. Her physical findings including lung examination are
unremarkable.
Spirometry reveals normal values both pre- and post-albuterol treatment.
What would be the most reasonable first step in treatment of this patient?
A. Trial of albuterol MDI before exercise
B. Chest radiograph
C. Chest CT
D. Counseling for athletic burnout or stress
E. An echocardiogram (ECG) to rule out pulmonary hypertension or
cardiac disorder - ANSWER A (Exercise-induced asthma or bronchoconstriction is a
common, underdiagnosed condition in athletes. Many of the athletes are unaware of
the problem. It is defined as a 10% lowering of forced expiratory volume in 1 second
(FEV1) when challenged with exercise. It is much more common in highventilation
sports and in cold, dry air. The incidence among cross-country skiers is as high as
50%. A physical examination and spirometry at rest will be normal unless there is
underlying asthma. Methacholine challenge testing can be ordered, but if it is not
available, a trial with an albuterol inhaler is reasonable. Pulmonary or cardiac
dysfunction not found during the physical examination is much less likely and,
therefore, an ECG and chest x-ray would not be indicated until common etiologies
have been ruled out. Psychological causes are also a less likely etiology.)
A 34-year-old man with a past history of asthma presents to an acute care clinic
with an asthma exacerbation. Treatment with nebulized albuterol and
ipratropium does not offer significant improvement, and he is then admitted to
the hospital. He is afebrile, has a respiratory rate of 24 breaths/ min, pulse rate
is 96 beats/min, and oxygen saturation is 93% on room air. On examination, he
has diffuse bilateral inspiratory and expiratory wheezes, mild intercostal
retractions, and a clear productive cough. Which one of the following
should be the next step in the management of this patient?
A. Chest physical therapy
B. Inhaled corticosteroids
C. Azithromycin orally
D. Theophylline orally
, E. Oral corticosteroids - ANSWER E (Hospital management of acute
exacerbations of asthma should include inhaled short-acting
bronchodilators and systemic corticosteroids. The efficacy of oral versus
intravenous corticosteroids has been shown to be equivalent. Antibiotics
are not needed in the treatment of asthma exacerbations unless there are
signs of infection. Inhaled ipratropium is recommended for treatment in the
emergency department, but not in the hospital. Chest physical therapy and
theophylline are not recommended for acute asthma exacerbations.)
A 13-year-old adolescent boy has a nonproductive cough and mild shortness
of breath on a daily basis. He is awakened by the cough at least five nights
per month. Which one of the following would be the most appropriate
treatment for this patient?
A. A long-acting beta-agonist daily
B. A short-acting beta-agonist daily
C. Oral prednisone daily
D. An oral leukotriene inhibitor as needed
E. Inhaled corticosteroids daily - ANSWER E (This patient has moderate
persistent asthma. The most effective treatment is daily inhaled
corticosteroids. A leukotriene inhibitor would be less effective and as a
controller should be used daily. Oral prednisone daily is problematic due to
the risk of adrenal insufficiency. Short- and long-acting -agonists are not
recommended as daily therapy because they are considered rescue
medications rather than asthma controllers.)
A 30-year-old woman with no past medical history presents with a productive
cough of 2-week duration. She states she also has a runny nose, body aches,
congestion, and fevers for the past week. In office she is normotensive, with a
normal pulse, and temperature of 101.2°F. Her physical examination is
significant for sinus tenderness, boggy nasal turbinates, and crackles in the
left lower lobe lung fields. Which one of the following is the best initial step in
management?
A. Reassure the patient that she likely has a viral infection and it will resolve
on its own.
B. Order a rapid strep test and treat if positive
C. Prescribe amoxicillin for a likely bacterial infection
D. Order chest x-ray to rule out possible pneumonia - ANSWER D (Acute bronchitis is
a diagnosis of exclusion in the absence of clinical or radiographic findings concerning
for pneumonia. In this patient with fevers, productive cough, and rales on lung
examination, it is important to rule out pneumonia. If there is a strong clinical suspicion
of community-acquired pneumonia, a chest x-ray is not necessary, and outpatient
treatment with antibiotics can be initiated. The diagnosis of streptococcal pharyngitis is
A 25-year-old white woman who is in training for a competitive marathon
complains of " hitting a wall" and "getting short of breath quicker than she
should:' She complains of coughing at the end of her training runs, and states
that she may be expecting too much of herself. She does not smoke, has no
significant family history, and no history of occupational or environmental
exposures. Her physical findings including lung examination are
unremarkable.
Spirometry reveals normal values both pre- and post-albuterol treatment.
What would be the most reasonable first step in treatment of this patient?
A. Trial of albuterol MDI before exercise
B. Chest radiograph
C. Chest CT
D. Counseling for athletic burnout or stress
E. An echocardiogram (ECG) to rule out pulmonary hypertension or
cardiac disorder - ANSWER A (Exercise-induced asthma or bronchoconstriction is a
common, underdiagnosed condition in athletes. Many of the athletes are unaware of
the problem. It is defined as a 10% lowering of forced expiratory volume in 1 second
(FEV1) when challenged with exercise. It is much more common in highventilation
sports and in cold, dry air. The incidence among cross-country skiers is as high as
50%. A physical examination and spirometry at rest will be normal unless there is
underlying asthma. Methacholine challenge testing can be ordered, but if it is not
available, a trial with an albuterol inhaler is reasonable. Pulmonary or cardiac
dysfunction not found during the physical examination is much less likely and,
therefore, an ECG and chest x-ray would not be indicated until common etiologies
have been ruled out. Psychological causes are also a less likely etiology.)
A 34-year-old man with a past history of asthma presents to an acute care clinic
with an asthma exacerbation. Treatment with nebulized albuterol and
ipratropium does not offer significant improvement, and he is then admitted to
the hospital. He is afebrile, has a respiratory rate of 24 breaths/ min, pulse rate
is 96 beats/min, and oxygen saturation is 93% on room air. On examination, he
has diffuse bilateral inspiratory and expiratory wheezes, mild intercostal
retractions, and a clear productive cough. Which one of the following
should be the next step in the management of this patient?
A. Chest physical therapy
B. Inhaled corticosteroids
C. Azithromycin orally
D. Theophylline orally
, E. Oral corticosteroids - ANSWER E (Hospital management of acute
exacerbations of asthma should include inhaled short-acting
bronchodilators and systemic corticosteroids. The efficacy of oral versus
intravenous corticosteroids has been shown to be equivalent. Antibiotics
are not needed in the treatment of asthma exacerbations unless there are
signs of infection. Inhaled ipratropium is recommended for treatment in the
emergency department, but not in the hospital. Chest physical therapy and
theophylline are not recommended for acute asthma exacerbations.)
A 13-year-old adolescent boy has a nonproductive cough and mild shortness
of breath on a daily basis. He is awakened by the cough at least five nights
per month. Which one of the following would be the most appropriate
treatment for this patient?
A. A long-acting beta-agonist daily
B. A short-acting beta-agonist daily
C. Oral prednisone daily
D. An oral leukotriene inhibitor as needed
E. Inhaled corticosteroids daily - ANSWER E (This patient has moderate
persistent asthma. The most effective treatment is daily inhaled
corticosteroids. A leukotriene inhibitor would be less effective and as a
controller should be used daily. Oral prednisone daily is problematic due to
the risk of adrenal insufficiency. Short- and long-acting -agonists are not
recommended as daily therapy because they are considered rescue
medications rather than asthma controllers.)
A 30-year-old woman with no past medical history presents with a productive
cough of 2-week duration. She states she also has a runny nose, body aches,
congestion, and fevers for the past week. In office she is normotensive, with a
normal pulse, and temperature of 101.2°F. Her physical examination is
significant for sinus tenderness, boggy nasal turbinates, and crackles in the
left lower lobe lung fields. Which one of the following is the best initial step in
management?
A. Reassure the patient that she likely has a viral infection and it will resolve
on its own.
B. Order a rapid strep test and treat if positive
C. Prescribe amoxicillin for a likely bacterial infection
D. Order chest x-ray to rule out possible pneumonia - ANSWER D (Acute bronchitis is
a diagnosis of exclusion in the absence of clinical or radiographic findings concerning
for pneumonia. In this patient with fevers, productive cough, and rales on lung
examination, it is important to rule out pneumonia. If there is a strong clinical suspicion
of community-acquired pneumonia, a chest x-ray is not necessary, and outpatient
treatment with antibiotics can be initiated. The diagnosis of streptococcal pharyngitis is
