MSN 622 FINAL ACTUAL EXAM QUESTIONS
AND VERIFIED DETAILED ANSWERS
FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS GRADED A+
⩥ 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?
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?
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?
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?
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?
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?
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?
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?
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?
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,
AND VERIFIED DETAILED ANSWERS
FREQUENTLY TESTED QUESTIONS AND
SOLUTIONS GRADED A+
⩥ 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?
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?
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?
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?
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?
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?
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?
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?
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?
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,
