NR511 MIDTERM Q BANK QUESTIONS AND ANSWERS
WELL RATED AND GRADED DOWNLOAD TO SCORE
A+(2023/2024)
A patient received the pneumonia immunization at age 60 years. He is 65 years old and
presents to your clinic today. What recommendation should be made about the
pneumococcal immunization? (Heshould receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years
has elapsedsince his last one. The CDC does not recommend immunizing this patient every 5
years. Two immunizations are available, PCV13 and PPSV23. He needs both, but PCV13
should be administered today. PPSV23 should be administered at least 1 year later.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to
diagnose because symptoms can be varied and involve multiple body systems
(extrapulmonary manifestations).Infection with Mycoplasma may present with a normal
white blood cell count, maculopapular rash, GI symptoms, tender joints and aches, and,
though rare, cardiac rhythm disturbances. Respiratory symptoms may not be pronounced. On
chest X-ray there are some unique findings (peribronchial pattern) with Mycoplasma. These
include thickened bronchial shadow, streaks of interstitial infiltration,and atelectasis. These
are more likely to occur in the lower lobes.
An adult has upper respiratory symptoms and cough for the past 14 days. What should be
considered?(Pertussis)
Pertussis should always be considered in adults who present with acute cough of greater than
5 days’ duration. The incubation period for pertussis is about 7-10 days. Patients present with
URI symptoms for 1-2 weeks. The classic paroxysmal cough usually begins in the second
,week of the illness. The duration ofsymptoms and cough are about 3 months even when
treated with antibiotics. This is highly infectious and is a reportable disease.
Which medication below is contraindicated in an asthma patient because it may increase
risk ofsudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with
an inhaledsteroid. Otherwise, using a long-acting bronchodilator like salmeterol is
contraindicated. There is an increased risk of sudden death with asthma exacerbations when
this class is used solo to treat asthma. The other choices can be used to treat asthma. Choices
vary depending on the patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many
yearsshould: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has
used inhaledsteroids and smokes, has multiple risk factors for osteoporosis. Additionally,
she probably has emphysema because she smoked (or still smokes). If she is Asian or
Caucasian, she has still another riskfactor. Screening for osteoporosis should be considered
when managing patients with multiple risk factors.
Which of the following medications should be used cautiously in a patient who has asthma?
(Timololophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in
patients who have asthma. Even though timolol is being administered in the eye, it is
absorbed through mucous membranes and can exert systemic effects. Beta blockers should be
avoided in patients with asthma andused cautiously in patients with COPD. The other
medications listed have no specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the
most common symptom associated with acute bronchitis. Purulent sputum is identified in
more than 50% of patients with acute bronchitis. The color imparted to the sputum is usually
,due to sloughing of epithelialcells, not bacterial infection. Concurrent upper respiratory
symptoms are typical of acute bronchitis.
Pharyngitis is common.
Mild persistent asthma is characterized by: (symptoms occurring more than twice weekly)
Symptoms of mild persistent asthma include three to four nocturnal awakenings per month
or symptoms that worsen more than twice a week but not every day. A daily inhaled steroid
and a bronchodilator used as needed for exacerbations are the methods of treatment. Therapy
needs to be intensified if symptoms appear more frequently than twice a week. When
medication is intensified, a long-acting bronchodilator is typically added to the steroid.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is assessed if there
is concern about the circumference of either the head or the chest. An exception to this
observation can occur in premature infants where the head grows very rapidly. Normally, the
head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24
months the head and chest circumference should be about equal and by 2 years of age the
chest should be larger than the head. Thechest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely
diagnosis?(Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and
cough, should direct the examiner to consider pneumonia as the diagnosis. Other common
clinical findings with pneumonia include chest pain, dyspnea, and sputum production.
Though not common, some patientswith pneumonia exhibit gastrointestinal symptoms like
nausea, vomiting, and diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature > 101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most common
symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of
patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing
, of epithelial cells, not bacterial infection. Concurrent upper respiratory symptoms are typical
of acute bronchitis. Pharyngitis is commonwithin the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
One of the most common causes of cough in adults is asthma. Cough due to asthma is
often accompanied by episodic wheezing or dyspnea, though some patients who have
asthma only cough. Thisis termed “cough-variant asthma.” The clinical presentation of
asthma varies but hyper-responsiveness ofthe airways is a typical finding.
The most common cause of atypical pneumonia in adults is: (Mycoplasma pneumonia)
In patients who have atypical pneumonia, Mycoplasma is the most common pathogen. M.
pneumoniaeis so named because of its atypical appearance on chest X-ray. This organism is
responsible for “walking pneumonia” that is prevalent in a young adult population. This
accounts for about 15% of pneumonia and is transmitted via respiratory droplet.
Which patient might be expected to have the worst FEV1? (A 65-year-old with emphysema)
FEV 1 stands for “forced expiratory volume in 1 second.” This is the volume of air that is
forcefully exhaled in the first second of exhalation after a deep breath. Patients with
emphysema are not able todo this efficiently because their alveoli are stretched, and mostly
contain trapped air. FEV 1 is used toassess airway obstruction. An asthma patient in the
green zone would be expected to have a normal (compared to himself) FEV1. An FEV1
measurement or pulmonary function tests would not be performed on a patient with
pneumonia or bronchiectasis because he would have diminished respiratory capacity
related to his infection.
A patient who has asthma presents with chest tightness, wheezing, coughing, and fever.
He has wheezing and diminished breath sounds in the upper right lobe. His cough is
nonproductive, and he denies nasal symptoms. Which symptom is not likely related to
his asthma? (Fever)
WELL RATED AND GRADED DOWNLOAD TO SCORE
A+(2023/2024)
A patient received the pneumonia immunization at age 60 years. He is 65 years old and
presents to your clinic today. What recommendation should be made about the
pneumococcal immunization? (Heshould receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years
has elapsedsince his last one. The CDC does not recommend immunizing this patient every 5
years. Two immunizations are available, PCV13 and PPSV23. He needs both, but PCV13
should be administered today. PPSV23 should be administered at least 1 year later.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to
diagnose because symptoms can be varied and involve multiple body systems
(extrapulmonary manifestations).Infection with Mycoplasma may present with a normal
white blood cell count, maculopapular rash, GI symptoms, tender joints and aches, and,
though rare, cardiac rhythm disturbances. Respiratory symptoms may not be pronounced. On
chest X-ray there are some unique findings (peribronchial pattern) with Mycoplasma. These
include thickened bronchial shadow, streaks of interstitial infiltration,and atelectasis. These
are more likely to occur in the lower lobes.
An adult has upper respiratory symptoms and cough for the past 14 days. What should be
considered?(Pertussis)
Pertussis should always be considered in adults who present with acute cough of greater than
5 days’ duration. The incubation period for pertussis is about 7-10 days. Patients present with
URI symptoms for 1-2 weeks. The classic paroxysmal cough usually begins in the second
,week of the illness. The duration ofsymptoms and cough are about 3 months even when
treated with antibiotics. This is highly infectious and is a reportable disease.
Which medication below is contraindicated in an asthma patient because it may increase
risk ofsudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with
an inhaledsteroid. Otherwise, using a long-acting bronchodilator like salmeterol is
contraindicated. There is an increased risk of sudden death with asthma exacerbations when
this class is used solo to treat asthma. The other choices can be used to treat asthma. Choices
vary depending on the patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many
yearsshould: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has
used inhaledsteroids and smokes, has multiple risk factors for osteoporosis. Additionally,
she probably has emphysema because she smoked (or still smokes). If she is Asian or
Caucasian, she has still another riskfactor. Screening for osteoporosis should be considered
when managing patients with multiple risk factors.
Which of the following medications should be used cautiously in a patient who has asthma?
(Timololophthalmic drops)
Timolol is a beta blocker. This class of medications can precipitate bronchoconstriction in
patients who have asthma. Even though timolol is being administered in the eye, it is
absorbed through mucous membranes and can exert systemic effects. Beta blockers should be
avoided in patients with asthma andused cautiously in patients with COPD. The other
medications listed have no specific contraindications for patients with asthma.
The most common symptom associated with acute bronchitis is: (Cough)
Fever (temp > 101°F) is an unusual symptom associated with acute bronchitis. Cough is the
most common symptom associated with acute bronchitis. Purulent sputum is identified in
more than 50% of patients with acute bronchitis. The color imparted to the sputum is usually
,due to sloughing of epithelialcells, not bacterial infection. Concurrent upper respiratory
symptoms are typical of acute bronchitis.
Pharyngitis is common.
Mild persistent asthma is characterized by: (symptoms occurring more than twice weekly)
Symptoms of mild persistent asthma include three to four nocturnal awakenings per month
or symptoms that worsen more than twice a week but not every day. A daily inhaled steroid
and a bronchodilator used as needed for exacerbations are the methods of treatment. Therapy
needs to be intensified if symptoms appear more frequently than twice a week. When
medication is intensified, a long-acting bronchodilator is typically added to the steroid.
The chest circumference of a 12 month-old is: (equal to head circumference)
The chest circumference is not routinely measured at well-child visits, but is assessed if there
is concern about the circumference of either the head or the chest. An exception to this
observation can occur in premature infants where the head grows very rapidly. Normally, the
head exceeds the chest circumference by 1-2 cm from birth until 6 months. Between 6 and 24
months the head and chest circumference should be about equal and by 2 years of age the
chest should be larger than the head. Thechest circumference is measured at the nipple line.
A patient with cough and fever is found to have infiltrates on chest x-ray. What is his likely
diagnosis?(Pneumonia)
The finding of infiltrates on chest x-ray, in conjunction with clinical findings of fever and
cough, should direct the examiner to consider pneumonia as the diagnosis. Other common
clinical findings with pneumonia include chest pain, dyspnea, and sputum production.
Though not common, some patientswith pneumonia exhibit gastrointestinal symptoms like
nausea, vomiting, and diarrhea.
An uncommon symptom associated with acute bronchitis is: (temperature > 101°F)
Fever is an unusual symptom associated with acute bronchitis. Cough is the most common
symptom associated with acute bronchitis. Purulent sputum is identified in more than 50% of
patients with acute bronchitis. The color imparted to the sputum is usually due to sloughing
, of epithelial cells, not bacterial infection. Concurrent upper respiratory symptoms are typical
of acute bronchitis. Pharyngitis is commonwithin the first 3 days of the illness.
Patients who have cough-variant asthma: (all exhibit cough)
One of the most common causes of cough in adults is asthma. Cough due to asthma is
often accompanied by episodic wheezing or dyspnea, though some patients who have
asthma only cough. Thisis termed “cough-variant asthma.” The clinical presentation of
asthma varies but hyper-responsiveness ofthe airways is a typical finding.
The most common cause of atypical pneumonia in adults is: (Mycoplasma pneumonia)
In patients who have atypical pneumonia, Mycoplasma is the most common pathogen. M.
pneumoniaeis so named because of its atypical appearance on chest X-ray. This organism is
responsible for “walking pneumonia” that is prevalent in a young adult population. This
accounts for about 15% of pneumonia and is transmitted via respiratory droplet.
Which patient might be expected to have the worst FEV1? (A 65-year-old with emphysema)
FEV 1 stands for “forced expiratory volume in 1 second.” This is the volume of air that is
forcefully exhaled in the first second of exhalation after a deep breath. Patients with
emphysema are not able todo this efficiently because their alveoli are stretched, and mostly
contain trapped air. FEV 1 is used toassess airway obstruction. An asthma patient in the
green zone would be expected to have a normal (compared to himself) FEV1. An FEV1
measurement or pulmonary function tests would not be performed on a patient with
pneumonia or bronchiectasis because he would have diminished respiratory capacity
related to his infection.
A patient who has asthma presents with chest tightness, wheezing, coughing, and fever.
He has wheezing and diminished breath sounds in the upper right lobe. His cough is
nonproductive, and he denies nasal symptoms. Which symptom is not likely related to
his asthma? (Fever)
