COPD and Asthma Diagnosis and Management

Which of the following is NOT typically found in a patient with COPD?

A) airway inflammation
B) progressive airway obstruction
C) at least partially reversible airway obstruction
D) excessive sputum production

According to the GOLD report, which of the following is the greatest worldwide risk factor for COPD?

A) Exposure to fungal spores in the soil
B) Genetic predisposition
C) Exposure to influenza viruses
D) Cigarette smoking

Which of the following statements accurately describes the anatomic alterations of the lungs associated with emphysema?

I. It is the weakening and permanent enlargement of the air spaces distal to the terminal bronchioles.
II. It is most closely associated with cystic fibrosis.
III. The distal airways tend to collapse during expiration in response to increased intrapleural pressure.
IV. It is characterized by thick secretions and mucus plugging.

A) II, IV
B) III, IV
C) I, III
D) I, II, IV

The genetic reference to a person with a normal level of alpha1-antitrypsin is phenotype:

A) MM
B) MZ
C) ZZ
D) AZ

Which of the following are pathologic alterations found with emphysema?

I. Air trapping and hyperinflation
II. Mucus plugs
III. Decreased surface area for gas exchange
IV. Weakened respiratory bronchioles

A) I, II
B) II, IV
C) I, III, IV
D) II, III, IV

What is the critical alpha 1-antitrypsin level below which lung elastin is attacked and broken down?

A) 57 mg/dl
B) 84 mg/dl
C) 100 mg/dl
D) 150 mg/dl

Which complaint is most closely associated with the diagnosis of chronic bronchitis?

A) airway enlargement
B) chronic productive cough
C) dyspnea on exertion
D) hemoptysis

Which of the following clinical manifestations are associated with late-stage chronic bronchitis?

I. Rhonchi
II. Cor pulmonale
III. Digital clubbing
IV. Severe weight loss and thin build

A) I, II
B) II, IV
C) I, III, IV
D) I, II, III

Which of the following is not used to confirm the diagnosis of COPD?

A) Presence of a chronic cough
B) Chronic exposure to environmental smoke
C) FEV1/FVC ratio greater than 0.70
D) FEV1 <80%

What treatment for COPD patients has been shown to improve long-term survival?

A) Bronchodilators
B) Corticosteroids
C) Mechanical ventilation
D) Oxygen therapy

Which airways are most susceptible to airway obstruction in patients with COPD?

A) Large
B) Medium
C) Small
D) Cannot say

Which of the following signs and symptoms is most closely associated with respiratory failure in a COPD patient?

A) bilateral wheezing
B) changes in mental status
C) dyspnea on exertion
D) daily phlegm production

It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma?

A) hyperactivity of the airways secondary to inflammation of the airways
B) diminished vascularity on the chest radiograph
C) hyperinflation of the lung parenchyma
D) normalization of the FEV1 after use of a bronchodilator

Which of the following factors is not associated with extrinsic asthma?

A) Pet danders
B) Cold air
C) GERD
D) Dust mites

What pathophysiologic characteristic of asthma has been most recently emphasized in the description and subsequent treatment of this disease?

A) hyperactivity of the airways secondary to inflammation of the airways
B) hyperinflation of the lung parenchyma
C) inflammation of the airways
D) mucus plugging of the airways

How much improvement is needed in the FEV1 after bronchodilator therapy before reversibility can be considered present in the patient with obstructive lung disease?

A) 50 ml
B) 200 ml
C) 350 ml
D) 500 ml

A patient is admitted to the emergency department with an acute asthma exacerbation. Based on the following blood gas results, how severe is the asthma attack?

pH 7.35, PaO2 58 mm Hg, PaCO2 46 mm Hg, HCO3 18 mEq/L, SaO2 89%

A) Mild
B) Moderate
C) Severe
D) Very Severe

Which of the following recurrent symptoms is not commonly associated with asthma?

A) Cough
B) Chest tightness
C) Fever
D) Wheeze

A fractional concentration of exhaled nitric oxide level greater than ___ ppb is an indication of airway inflammation requiring controller medication increase.

A) 20
B) 30
C) 40
D) 50

An asthmatic patient's best effort produces a PEFR of 55% of personal best. What is indicated at this time?

A) Patient should lie down and try to relax.
B) Patient should probably seek medical attention now.
C) Patient should retry the PEFR maneuver.
D) Patient should take his or her controller medications.

What medication is currently the most effective for the treatment of asthma?

A) Corticosteroids
B) Beta 2-agonists bronchodilators
C) Cromolyn
D) Leukotriene inhibitors

All of the following are major pathologic or structural changes associated with cystic fibrosis, except:

A) Partial airway obstruction leading to hyperinflation
B) Bronchospasm
C) Thick, tenacious mucus
D) Total airway obstruction leading to atelectasis.

Which of the following cannot be used in the diagnosis of cystic fibrosis?

A) An elevated potassium level in the sweat
B) An elevated chloride level in the sweat
C) Genetic testing of the parents
D) An elevated blood level of immunoreactive trypsin

Men with cystic fibrosis have difficulty reproducing because:

A) The seminal vesicle is overproducing semen, dampening the motility of sperm cells
B) The vas deferens is missing or underdeveloped causing semen ejaculation containing sperm cells impossible
C) The spermatozoa head is engorged that causes distortion of its almond-shape, making it difficult to penetrate into the ovum
D) The male reproductive system is unable to produce mature sperm cells due to the genetic defect of the CFTR gene

A patient has a lung infection with Pseudomonas aeruginosa. What antibiotic should be used against it?

A) Tobramycin
B) Dornase alpha
C) Sulfamethoxazole-trimethoprim
D) Pentamidine

Rigid and dilated bronchi are the key anatomic alterations found in which type of bronchiectasis?

A) Varicose
B) Cystic
C) Fusiform
D) Cylindrical

Which of the following are clinical findings observed in bronchiectasis?

I. Jugular venous distention
II. Decreased FEF 25%-75%
III. Leukocytosis
IV. Anemia
V. Decreased RV/TLC ratio

A) I, III, IV
B) I, V
C) II, III, IV, V
D) I, II, III, IV

Which of the following is the hallmark of bronchiectasis?

A) Chronic cough with production of large quantities of foul-smelling sputum
B) Hemoptysis
C) Decreased DLCO with normal to decreased expiratory flow rates on pulmonary function
D) Dyspnea on exertion

Which of the following is the usual characteristic of the sputum of a patient with bronchiectasis?

A) It is usually sweet or musky
B) When examined microscopically there are Curschmann's spirals
C) It contains eosinophils
D) It is usually voluminous and tends to settle into several different layers

Which of the following is the usual imaging finding seen in patients with cylindrical bronchiectasis?

A) Tram-lines
B) Patchy Infiltrates
C) Kerley A lines
D) Increased vascular markings

Which of the following can cause pneumonia?

I. Bacteria
II. Viruses
III. Prions
IV. Fungi

A) I, II
B) I, II, III
C) I, II, IV
D) I, II, III, IV

Overall, most cases of bacterial pneumonia are caused by:

A) Gram-negative bacteria
B) Gram-positive bacteria
C) Viruses
D) Prions

Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops:

A) between 24 and 48 hours after endotracheal intubation.
B) more than 48 to 72 hours after endotracheal intubation.
C) less than 24 hours after mechanical ventilation is started.
D) more than 72 hours after mechanical ventilation is started.

The physical assessment findings on a patient with pneumonia would include all of the following, except:

A) Whispered pectoriloquy
B) Dull percussion note
C) Increased vocal fremitus
D) Decreased tactile fremitus

Which of the following types of pneumonia suggests that the patient acquired it through inhalation of infectious particles?

A) Cytomegalovirus
B) Haemophilus influenzae
C) Staphylococcus
D) Blastomycosis

Which group of patients is most likely to develop pneumonia subsequent to large volume aspiration?

A) Patients with ARDS in the intensive care unit
B) Middle age men with alcohol toxicity
C) Pregnant women with diabetes mellitus
D) Obese patients with obstructive sleep apnea

What mechanism has been found to be useful in minimizing the development of pneumonia associated with intubated patients?

A) elevation of the head of the bed
B) frequent suctioning through the endotracheal tube
C) maintaining the patient on severe fluid restriction
D) use of tracheal gas insufflation

Which of the following types of pneumonia suggests that the patient acquired it because of the reactivation of a latent infection, often in the setting of immunosuppression?

A) Cytomegalovirus
B) Haemophilus influenzae
C) Legionella pneumophila
D) Staphylococcus

The following are common causative agents of atypical community-acquired pneumonia, except:

A) Legionella species
B) Klebsiella species
C) Chlamydophilia pneumoniae
D) Mycoplasma pneumoniae

What term is used to describe objects capable of transmitting infection through physical contact with them?

A) consolidates
B) contaminants
C) fomites
D) nanospees

A patient with pneumococcal pneumonia commonly presents with the following clinical manifestations, except:

A) high fever
B) dark green sputum
C) pleuritic chest pain
D) teeth-chattering chills

Your patient has community-acquired bacterial pneumonia. Which of the following symptoms are common with this type of pneumonia?

I. cough with purulent sputum
II. diarrhea
III. high fever
IV. shaking chills

A) 1, 2, and 3
B) 2 and 4
C) 1, 3, and 4
D) 1, 2, 3, and 4

What finding on the chest radiograph is typical for viral pneumonia?

A) interstitial infiltrates
B) lobar consolidation
C) patchy infiltrate surrounding one bronchus or several bronchi
D) pleural effusion

In the patient suspected of having tuberculosis, what finding on Gram stain would result in the initiation of antituberculosis medications?

A) acid-fast bacilli
B) gram-negative rods
C) pleomorphic cocci
D) presence of gram-negative cocci

A patient has been found to have tuberculosis (TB) in several organs of the body. What term is used to describe this situation?

A) Primary TB
B) Postprimary TB
C) Disseminated TB
D) Multiorgan TB

Mycobacterium tuberculosis is particularly damaging to the lungs because of the:

A) healing of a tubercle
B) formation of micropulmonary emboli
C) increased mucus production
D) irreversible bronchospasm that it causes

All of the following are the clinical manifestations typically seen in patients with uncontrolled tuberculosis, except:

A) weight loss
B) high fever
C) bloody sputum
D) night sweats

After a tuberculin skin test, an induration of what size is suggestive of TB, requiring further retesting?

A) 2 mm
B) 5 mm
C) 8 mm
D) 11 mm

The preferred stain that is used to identify the TB organism is called:

A) Gram stain
B) fluorescent acid-fast stain
C) Ziehl-Neelsen
D) gentian violet

What medication is used to treat a person who has converted to a positive TB skin test but does not have active disease?

A) Virazole
B) Isoniazid
C) Rifampin
D) Tetracycline

As pulmonary edema progresses, the fluid moves in which of the following sequences?

A) Peribronchial interstitial spaces, bronchi, trachea
B) Alveoli, bronchioles, bronchi
C) Bronchioles, bronchi, trachea
D) Pulmonary capillaries, alveoli, bronchioles

The following are major pathologic or structural changes seen in the lungs with pulmonary edema, except:

A) atelectasis
B) bronchospasm
C) alveolar flooding
D) Interstitial edema

What is the normal hydrostatic pressure in the pulmonary capillaries?

A) 0 to 5 mm Hg
B) 5 to 10 mm Hg
C) 10 to 15 mm Hg
D) 25 to 30 mm Hg

All of the following are clinical manifestations typically seen in patients with pulmonary edema, except:

A) Wheezing
B) Cheyne-stokes respiration
C) hypochloremia
D) hypertension in late stages

Kerley A and B lines are seen radiographically in what stage of the disease progression of pulmonary edema?

A) Mild
B) Moderate
C) Severe
D) Late

Noncardiogenic pulmonary edema may present all of the following radiologic findings, except:

A) Abnormal cardiac silhouette
B) Fluffy densities near the hilum
C) Absence of pleural effusion
D) All of the above is present

Which is not included in the management of cardiogenic pulmonary edema?

A) Reduction of systemic vascular resistance
B) Positive inotropic medication
C) Preload reducing medication
D) Positive chronotropic medication

A patient has a decreased oncotic pressure. What can be done to increase it?

A) Implement a high-salt diet
B) Administer albumin
C) Administer milrinone
D) Administer morphine sulfate

Pulmonary edema produces:

A) a restrictive pulmonary disorder
B) an obstructive pulmonary disorder
C) both restrictive and obstructive disorders
D) obstructive cardiac disease

The death of lung tissue that may result from an obstruction of the pulmonary artery is called a:

A) pulmonary embolism
B) pleural effusion
C) pulmonary infarction
D) pulmonary empyema

Which of the following are primary factors associated with the formation of a deep vein thrombosis (DVT)?

I. Blood vessel injury
II. Age greater than 40 years
III. Hypercoagulability
IV. Venous stasis

A) 1
B) 2, 3
C) 2, 3, 4
D) 1, 3, 4

Which of the following risk factors is NOT associated with an increase in the incidence of pulmonary embolism?

A) advanced age
B) immobilization
C) multiple injuries from trauma
D) positive smoking history

Which of the following pathophysiologic changes in the lung is not typically associated with pulmonary embolism?

A) bronchoconstriction
B) decreased ciliary mobility
C) increased dead space ventilation
D) reduced surfactant production

The best test for diagnosing a suspected pulmonary embolism is a:

A) CT-pulmonary angiogram
B) ultrasonography
C) D-dimer blood test
D) chest radiograph

Which of the following physical examination findings is consistent with the diagnosis of pulmonary embolism?

A) congestive heart failure
B) inspiratory crackles on auscultation
C) loud P2
D) tachypnea

What are the two most common findings on the electrocardiogram (ECG) in the patient with pulmonary embolism?

A) bradycardia and elevated ST segment
B) inverted T waves and depressed ST segment
C) large P waves and inverted T waves
D) tachycardia and depressed ST segment

A patient's D-dimer blood test results show a value of >500 µg/ml. How should these results be interpreted?

A) The patient does not have a pulmonary embolism
B) The patient's anticoagulant level is acceptable
C) The patient has an increased level of fibrinogen
D) The patient is having a heart attack

Which of the following are included in the management of pulmonary embolism?

I. Oxygen
II. Vitamin K
III. Heparin
IV. Streptokinase

A) 1, 4
B) 2, 3
C) 1, 3, 4
D) 1, 2, 3

What radiologic sign is usually seen in patients with pulmonary embolism?

A) Silhouette sign
B) Westermark sign
C) Meniscus sign
D) Deep sulcus sign

Which of the following are anatomic alterations that occur when a person has a pneumothorax?

I. The lung on the affected side collapses
II. The visceral and parietal pleura separate
III. The visceral pleura adheres to the parietal pleura
IV. The chest wall moves outward

A) 1, 3
B) 3, 4
C) 2, 4
D) 1, 2, 4

A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition?

A) Spontaneous pneumothorax
B) Tension pneumothorax
C) Iatrogenic pneumothorax
D) Benign pneumothorax

A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called:

A) Valsalva maneuver
B) paradoxical breathing
C) pendelluft
D) chest retractions

In patients with tension pneumothorax, which radiologic findings is less likely seen?

A) elevated diaphragm
B) mediastinal shift to the unaffected side
C) increased translucency on the side of the pneumothorax
D) atelectasis

A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath after her yoga session. The physician has determined that she has a 15% pneumothorax. Which of the following is the appropriate treatment?

A) needle aspiration using the largest needle available
B) limit activity and encourage bed rest
C) perform chest tube thoracostomy
D) perform emergency pleurodesis

After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended pleurodesis to reduce the occurrence of future pneumothoraces. Which of these chemical solutions is less likely to be used in this procedure?

A) talc
B) tetracycline
C) bleomycin sulfate
D) alteplase

Which of the following are associated with a transudative pleural effusion?

I. Thin and watery fluid
II. Fluid has a lot of cellular debris
III. Fluid has high protein count
IV. Few blood cells

A) 2, 3
B) 1, 4
C) 2, 4
D) 1, 3, 4

During a chest assessment on a patient with a large pleural effusion, which of the following would be expected?

I. Increased tactile and vocal fremitus
II. Hyperresonant percussion note
III. Diminished breath sounds
IV. Tracheal shift

A) 1, 4
B) 1, 2
C) 3, 4
D) 1, 3, 4

Which of the following chest radiograph findings is not associated with a large pleural effusion?

A) Blunting of the costophrenic angle
B) Fluid level on the affected side
C) Mediastinal shift toward the unaffected side
D) Elevated hemidiaphragm on the affected side

Which of the following conditions is most closely associated with exudative pleural effusion?

A) liver cirrhosis
B) congestive heart failure
C) nephrotic syndrome
D) mesothelioma

An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement?

I. The tube is placed in the second to third intercostal space.
II. The tube is placed in the fourth to fifth intercostal space.
III. The tube is placed in the midclavicular line.
IV. The tube is placed in the midaxillary line.

A) 1, 4
B) 2, 3
C) 1, 3
D) 2, 4

The most common cause of lung cancer is:

A) cigarette smoking
B) air pollution
C) asbestos exposure
D) exposure to radon gas

Which of the following are non-small cell lung cancers?

I. Large cell carcinoma
II. Squamous carcinoma
III. Adenocarcinoma
IV. Oat cell carcinoma

A) 1, 3
B) 2, 4
C) 1, 2, 3
D) 2, 3, 4

What is the preferred surgical treatment for a large, single tumor located in the right lower lobe?

A) Lobectomy
B) Wedge resection
C) Segmentectomy
D) Pneumonectomy

A patient with lung cancer has learned the cancer has metastasized to three other locations. What is the recommended treatment option?

A) Radiation therapy to all known tumors
B) Surgical removal of all known tumors
C) Chemotherapy
D) Needle aspiration of the tumors

Which of the following is NOT associated with local tumor growth in the central airways?

A) large airway obstruction
B) hemoptysis
C) cough
D) fine crackles

The peripheral nervous system problems found with Guillain-Barré syndrome (GBS) include:

I. loss of reflexes.
II. increased reflex reactions.
III. flaccid paralysis of skeletal muscles.
IV. tetany of skeletal muscles.

A) 2, 3
B) 1, 4
C) 1, 3
D) 2, 4

The major pathologic or structural changes of the lungs associated with ventilator failure accompanying Guillain-Barré syndrome include:

I. alveolar consolidation
II. airway distortion and dilation
III. mucosal edema
IV. atelectasis

A) 1, 4
B) 2, 3
C) 1, 2, 3
D) 2, 3, 4

Clinical indications that a patient has impending acute ventilatory failure include:

I. pH < 7.35
II. FVC < 20 mL/kg
III. PaCO2 > 45 mm Hg
IV. MEP > 40 cm H2O

A) 1, 3
B) 1, 2, 3
C) 2, 4
D) 2, 3, 4

What clinical change would be expected following a rest period for a patient with myasthenia gravis?

A) There is no clinical change
B) Strength decreases
C) Muscle strength improves
D) Ascending paralysis descends

All are major pathologic or structural changes of the lungs associated with myasthenic crisis, except:

A) alveolar consolidation
B) airway obstruction
C) mucus accumulation
D) hyperinflation

A patient has a prolonged case of ARDS. What changes would be expected in the patient's alveolar cells?

A) Multiplication of the type I cells
B) Influx of macrophages
C) Hyperplasia and swelling of the type II cells
D) Development of emphysema

Which of the following pulmonary changes are associated with ARDS?

I. Abnormal surfactant
II. Interstitial edema
III. Decreased shunt
IV. Narrowing of the alveolar-capillary membrane

A) 1, 2
B) 3, 4
C) 1, 3
D) 1, 2, 3

Which of the following are recommended to treat alveolar consolidation and atelectasis associated with ARDS?

I. Aerosolized bronchodilator medications
II. Continuous positive airway pressure (CPAP)
III. Chest percussion and postural drainage
IV. Positive end-expiratory pressure (PEEP)

A) 1, 3
B) 2, 4
C) 1, 2, 3
D) 2, 3, 4

Breath sounds associated with ARDS include:

I. vesicular
II. bronchovesicular
III. Crackles
IV. bronchial

A) 3
B) 1, 2
C) 3, 4
D) 2, 3, 4

The chest radiograph finding indicative of severe ARDS is:

A) Ground-glass appearance
B) Crazy paving pattern
C) Perihilar streaking
D) Honey-combing

According to the Berlin definition of ARDS, what does a PaO2/FIO2 ratio of 150 mm Hg indicate for a patient on mechanical ventilation with a PEEP of 10 cm H2O?

A) Normal lungs
B) Mild ARDS
C) Moderate ARDS
D) Severe ARDS

The clinical manifestations associated with ARDS usually appear:

A) 2 to 4 hours following the inciting event
B) 4 to 12 hours following the inciting event
C) 6 to 72 hours following the inciting event
D) 72 to 96 hours following the inciting event

What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS?

A) prolonged expiratory time
B) permissive hypercapnia
C) inverse-ratio ventilation
D) intermittent mandatory ventilation

Which of the following are current ventilatory strategies in the treatment of ARDS?

I. Large tidal volume
II. Small tidal volume
III. Rapid respiratory rates
IV. Slow respiratory rates

A) 2
B) 3
C) 1, 4
D) 2, 3

Which of the following statements is true about prone-positioning of patients with ARDS?

A) It produces a transient improvement in gas exchange
B) It dramatically reduces the mortality of patients with ARDS
C) It does not require experienced staff
D) It does not improve gas exchange at all

In which of the pulmonary disorders would you expect to see faster respiratory rate and decreased tidal volume?

A) Pulmonary fibrosis
B) Emphysema
C) Asthma
D) Chronic bronchitis

During an assessment of a patient, the RCP places her hand on a patient's right lower lobe and asks the patient to repeat "99". Findings include decreased tactile fremitus in the RLL as compared to the left. This finding is consistent with:

A) Pleural effusion of the RLL
B) Pneumothorax of the LLL
C) Pneumonia of the RLL
D) Atelectasis of the RLL

Hepatomegaly, jugular venous distension, and a right ventricular heave are consistent with what clinical condition?

A) Congestive heart failure
B) Right-sided heart failure
C) Tension pneumothorax
D) Severe asthma

This is the inward movement of the lower lateral chest wall during each inspiration that indicates severe hyperinflation.

A) Hoover sign
B) Schamroth sign
C) Homan's sign
D) Rovsing sign

A 16-year-old patient has been admitted and shows signs of poor body development. Upon assessment, you also noted digital clubbing, hyperresonance to percussion, and a productive cough. It has also been reported that the patient has foul-smelling stools. Which of the following conditions are these findings consistent with?

A) Acute respiratory distress syndrome
B) Heart failure
C) Acute bronchitis
D) Cystic fibrosis

You were called by the physician to perform a Tensilon test on a new patient. This test is commonly used to confirm the diagnosis for which of the following conditions?

A) Myasthenia gravis
B) Guillain-Barré syndrome
C) Multiple sclerosis
D) Poliomyelitis

A 56-year-old male patient has been admitted and diagnosed with Guillain-Barré syndrome. In order to determine the patient's need for ventilatory support, which of the following values is the most critical to monitor?

A) Residual volume
B) Inspiratory capacity
C) Peak inspiratory flow
D) Expiratory reserve volume

Which of the following procedures would be most beneficial in preventing atelectasis in a 59-year-old female patient that is less than 24 hours post-surgery?

A) Albuterol via SVN four times daily
B) Pursed-lip breathing as needed
C) Inspiratory resistance exercises three times daily
D) Incentive spirometry maneuver 10 times per hour

At rest, what level does the mean pulmonary artery pressure need to reach before it is considered pulmonary hypertension?

A) >10 mm Hg
B) >15 mm Hg
C) >20 mm Hg
D) >25 mm Hg

Which of the following are major mechanisms that contribute to the pulmonary hypertension commonly seen in a patient with a pulmonary embolism?

I. Decreased cross-sectional area of the pulmonary vascular system
II. Vasodilation induced by alveolar hypoxia
III. Reflexes from the aortic and carotid sinus baroreceptors
IV. Vasoconstriction induced by humoral agents

A) I, IV
B) II, III
C) I, III, IV
D) II, III, IV

Which among the following are two of the most common symptoms associated with primary pulmonary hypertension?

I. Dry cough
II. Dyspnea
III. Syncope
IV. Angina
V. Hemoptysis

A) I, II
B) II, III
C) III, V
D) I, IV

Which of the following radiographic findings is typical for patients with primary pulmonary hypertension?

I. Pruning of the main pulmonary artery
II. Right atrial hypertrophy
III. Enlargement of the peripheral arteries
IV. Enlargement of hilar pulmonary arteries
V. Normal right ventricular muscle mass

A) I, III, IV
B) II, III, IV
C) I, III
D) II, IV

All of the following are general findings of pulmonary hypertension, except:

A) Productive cough
B) Ortner syndrome
C) Hemoptysis
D) Raynaud's phenomenon

An oral calcium channel blocker may be used to help manage some patients who have which of the following classifications of pulmonary hypertension?

A) Group 1 Pulmonary Arterial Hypertension
B) Group 3 Pulmonary Hypertension
C) Group 4 Pulmonary Hypertension
D) Group 5 Pulmonary Hypertension

A diagnosis of respiratory failure can be made if which of the following are present?

A) PaCO2 49 mm Hg, PaO2 65 mm Hg, FiO2 0.21, PB 760 mm Hg
B) PaCO2 57 mm Hg, PaO2 75 mm Hg, FiO2 0.21, PB 760 mm Hg
C) P(A-a)O2 23 mm Hg, FiO2 0.21, PB 760 mm Hg
D) PaO2/FiO2 400, PB 750 mm Hg

Which of the following indicate severely impaired oxygenation requiring high FiO2s and positive end expiratory pressure?

A) PaO2-FiO2 greater than 350 mm Hg on 100% O2
B) VC less than 10 ml/kg
C) PaO2/FiO2 more than 300
D) PaCO2 greater than 45 mm Hg

You determine that an acutely ill patient can generate an MIP of -18 cm H2O. Based on this information, what might you conclude?

A) The patient has adequate respiratory muscle strength
B) The patient has insufficient alveolar ventilation
C) The patient has decreased negative inspiratory force
D) The patient has an unstable or irregular ventilatory drive

When is respiratory muscle fatigue likely to occur?

A) When VE exceeds 20% of the MVV
B) When VE exceeds 40% of the MVV
C) When VE exceeds 60% of the MVV
D) When VE exceeds 80% of the MVV

Which of the following modes of ventilatory support would you recommend for a hypoxemic patient with congestive heart failure?

A) Continuous positive airway pressure (CPAP)
B) Intermittent mandatory ventilation (IMV)
C) Inverse-ratio pressure-control ventilation (PCV)
D) High-level pressure support ventilation (PSV)

A patient who just suffered severe closed-head injury and has a high intracranial pressure (ICP) is about to be placed on ventilatory support. Which of the following is the most appropriate ventilatory strategy?

A) Maintain a PaCO2 from 25 to 30 mm Hg
B) Allow permissive hypercapnia
C) Maintain a high mean pressure using PEEP levels of 10 to 15 cm H2O
D) Adjust minute ventilation to maintain a pH of 7.35 to 7.45

Which pulmonary injury is unique in a patient who has been brought to the emergency department after inhaling superheated steam?

A) Atelectasis
B) Tracheomalacia
C) Thick secretions
D) Pharyngeal edema

A 10-year-old patient has inhaled hot gases, and an inspection of her mouth shows edema and blisters. What should the respiratory therapist recommend?

A) Perform a bronchoscopy to evaluate the trachea
B) Perform endotracheal intubation
C) Monitor her SpO2 once per shift
D) Administer an aerosol treatment with racemic epinephrine

Clinical signs associated with acute upper airway obstruction due to thermal injury include:

I. pleural friction rub
II. inspiratory stridor
III. pulmonary edema
IV. painful swallowing

A) 1, 3
B) 2, 4
C) 2, 3, 4
D) 1, 2, 3

A chest radiograph of a patient who sustained smoke inhalation and thermal injuries in a house fire reveals dense, fluffy opacities and patchy infiltrates. During which phase of the clinical course of smoke inhalation injury is the patient most likely presenting?

A) Early stage
B) 2-5 days after inhalation
C) Intermediate stage
D) Late stage

A 10-year-old girl was rescued from a school swimming pool, where she was found unconscious, and transported to a nearby hospital, where her lungs were discovered to be dry. What could cause dry lungs in this near drowning?

A) Her glottis spasmed and prevented pool water from entering her lungs
B) Chlorinated pool water is quickly absorbed across the alveolar-capillary membrane
C) Her young age and the cool pool water prevented serious pulmonary injury
D) She swallowed the water

The following are effects of a near-drowning victim inhaling water into the lungs, except:

A) alveolar consolidation
B) bronchospasm
C) production of frothy, white secretions
D) pleural effusion

A near-drowning victim in cardiac arrest has been placed in an ambulance. During transport, the paramedics should perform all of the following, except:

A) contact the victim's insurance carrier
B) perform high-quality CPR
C) conserve the victim's body heat
D) administer FiO2 1.0

What is the upper time limit that a cold-water near-drowning victim can be submerged and survive?

A) 10 minutes
B) 20 minutes
C) 40 minutes
D) 60 minutes

All of the following are clinical manifestations typically seen in wet-drowning patients, except:

A) Normal lung fields seen on chest radiograph
B) Decreased vital capacity measured on spirometry
C) Widespread wheezing heard on auscultation
D) Fluffy infiltrates seen on chest radiograph

In the general sequence of events that occurs in drowning or near drowning, what occurs during the 4th event?

A) Panic and violent struggle to return to the surface
B) Gasping inspirations and aspiration
C) Period of calmness and apnea
D) Swallowing of large amounts of fluid, followed by vomiting

Charcot-Leyden crystals are microscopic structures formed during allergic asthma that originate from:

A) Breakdown of eosinophils
B) Degranulation of mast cells
C) Cellular debris of the causative bacterial agent
D) Proteinolysis of IgE

What pulse characteristic is typically seen during asthma attack?

A) Pulsus alternans
B) Bounding pulses
C) Pulsus paradoxus
D) Thready pulses

Which of the following strategies is useful in the mechanical ventilation of a patient in status asthmaticus?

I. allow peak inspiratory pressures to go as high as required
II. permissive hypercapnia
III. prolonged inspiratory time
IV. small tidal volumes

A) I, II, III
B) II, IV
C) I, III
D) II, III, IV

During an asthmatic episode, the smooth muscles of the bronchi may hypertrophize as much as:

A) Two times normal thickness
B) Three times normal thickness
C) Four times normal thickness
D) Five times normal thickness

A patient's clinical history presents the following: three daytime symptoms in a week, no limitation of activities, no nocturnal symptoms, normal PEFR and FEV1. Which of the following would best classify the level of the patient's asthma control?

A) Controlled
B) Partially Controlled
C) Uncontrolled
D) Cannot say

Based on the Management Approach Based on Control for Children Older than 5 Years, Adolescents and Adults modified by GINA (2014), patients who do not reach an acceptable level of control at what step in are considered to have "difficult-to-treat asthma."

A) Step 3
B) Step 4
C) Step 5
D) Step 6

A symptomatic asthmatic patient was initially prescribed with as needed rapid-acting B2-agonist and a low-dose inhaled corticosteroid (ICS). With this treatment regimen, the patient still has poor asthma control that prompts clinician to consider stepping up treatment to gain asthma control. Which of the following is the appropriate treatment action to take?

A) as needed rapid-acting B2-agonist and a leukotriene modifier
B) as needed rapid-acting B2-agonist, medium-dose ICS, plus long-acting B2-agonist
C) as needed rapid-acting B2-agonist, low-dose ICS, plus long-acting B2 agonist
D) as needed rapid-acting B2-agonist, medium-dose ICS, plus leukotriene modifier

Antibiotics should be administered to patients with exacerbations of COPD who demonstrate any of the following signs, except:

A) increased dyspnea
B) increased body temperature
C) increased sputum volume
D) increased sputum purulence

When two carriers of cystic fibrosis gene mutation produce an offspring, which of the following statement/s is/are true?

I. 50% chance that the baby will be a carrier
II. 25% chance that the baby will have cystic fibrosis
III. 50% chance that the baby will have cystic fibrosis
IV. 75% chance that the baby will not express CF traits

A) I, II
B) II, IV
C) I, II, IV
D) I, II, III

Which of the following pathophysiologic mechanism's is/are associated with bronchospasm?

I. Increased airway resistance
II. Increased lung compliance
III. Decreased V/Q ratio
IV. Irritant reflex
V. Air-trapping

A) I, II, III, IV, V
B) I, III, V
C) I, III, IV, V
D) I, II, III, IV

A patient presents the following: increased FRC, decreased PEFR, increased RV, and decreased FVC. The patient most likely has what condition?

A) Pneumonia
B) Kyphoscoliosis
C) Pleural effusion
D) Emphysema

When a patient has a restrictive pulmonary impairment, the patient would demonstrate which of the following clinical manifestations?

I. Increased tactile and vocal fremitus
II. Booming percussion note
III. Wheezing and crackles
IV. Prominent voice transmission
V. Thud-like percussion note

A) I, III, IV, V
B) II, III, IV
C) I, IV, V
D) I, II, IV, V

Dry cough may be seen in all of the following conditions, except:

A) Asthma
B) Viral infections
C) Lung tumor
D) ILDs

A patient has a voluminous and foul-smelling sputum that separates into multiple layers. Which of the following conditions is least likely to be associated with this finding?

A) Bronchiectasis
B) Lung abscess
C) Cystic Fibrosis
D) Tuberculosis

A patient presents with unilateral chest expansion, tracheal deviation to the contralateral side, dullness to percussion, and absent breath sounds on the affected side. Which of the following conditions is the patient most likely experiencing?

A) Pneumothorax
B) Pleural effusion
C) Pulmonary embolism
D) Foreign body aspiration

All of the following conditions reveal increased radiopacity in chest radiograph, except:

A) Atelectasis
B) Pulmonary edema
C) Pulmonary interstitial emphysema
D) Pulmonary calcification and fibrosis

What breath sound is associated with atelectasis?

A) Early inspiratory crackles
B) Late inspiratory crackles
C) Early expiratory crackles
D) Late expiratory crackles

Heart sound intensity is increased in which condition?

A) Pneumothorax
B) COPD
C) Pulmonary edema
D) Pulmonary hypertension

A patient returns for a follow-up consultation one week after being discharged from the hospital for pneumonia. During auscultation, prominent bronchial breath sounds are heard over the trachea. This finding is best described as:

A) Inflammatory pneumonitis in the upper lobes
B) Mild obstruction in the central airways
C) Normal lungs
D) Consolidation in the upper lobes

Weak and thready pulses are commonly associated in which of the following conditions:

A) Aortic stenosis
B) Aortic insufficiency
C) Congestive heart failure
D) Status asthmaticus