APEA 6440 Respiratory Exam Review
2025/2026 Latest Edition by Amelie
Hollier and Mimi Secor - Pass First
Attempt and Avoid Resits
APEA 6440 Respiratory System Practice Block
1. Chronic Obstructive Pulmonary Disease (COPD) Management
Question: A 66-year-old male with a 40 pack-year smoking history presents with a worsening
chronic cough and progressive dyspnea on exertion. A post-bronchodilator spirometry confirms
COPD with an $FEV_1/FVC < 0.70$ and an $FEV_1$ of $62\%$ predicted. He reports having
had one exacerbation requiring oral antibiotics in the past year, and his COPD Assessment Test
(CAT) score is 14. According to the current GOLD guidelines, which medication class is the
most appropriate initial long-term maintenance therapy?
A) Short-Acting Beta-2 Agonist (SABA) as needed only
B) Long-Acting Muscarinic Antagonist (LAMA) or Long-Acting Beta-2 Agonist (LABA)
C) Inhaled Corticosteroid (ICS) combined with a LABA
, D) Oral Theophylline daily
Answer: B) Long-Acting Muscarinic Antagonist (LAMA) or Long-Acting Beta-2 Agonist
(LABA)
Rationale: This patient falls into GOLD Group A or B (specifically Group B based on a CAT
score $\ge 10$ and $\le 1$ exacerbation not leading to hospital admission). For Group B patients,
initial therapy consists of a long-acting bronchodilator—either a LAMA (e.g., tiotropium) or a
LABA (e.g., salmeterol). LAMAs are often preferred for their superior reduction in exacerbation
rates. ICS therapy should not be used as monotherapy and is typically reserved for patients with
a high blood eosinophil count or frequent, severe exacerbations (Group E).
2. Community-Acquired Pneumonia (CAP) Differentiators
Question: A 38-year-old female presents with a 4-day history of a dry, hacking cough, low-
grade fever ($100.1^\circ\text{F}$), malaise, and a mild headache. On physical examination, her
lungs are clear to auscultation bilaterally without consolidation, but a chest X-ray reveals diffuse,
patchy infiltrates in the lower lobes. She has no significant past medical history, no recent
antibiotic exposure, and no drug allergies. Which pathogen and empirical treatment are most
likely?
A) Streptococcus pneumoniae; High-dose Amoxicillin
B) Mycoplasma pneumoniae; Azithromycin or Doxycycline
C) Haemophilus influenzae; Ceftriaxone
D) Legionella pneumophila; Levofloxacin
Answer: B) Mycoplasma pneumoniae; Azithromycin or Doxycycline*
Rationale: This scenario describes "atypical pneumonia" (often called "walking pneumonia"),
characteristically caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae. It
typically affects younger adults and presents with a discrepancy between mild physical exam
findings ("clear lungs") and more pronounced radiologic findings ("patchy infiltrates"). Atypical
pathogens lack a peptidoglycan cell wall, rendering beta-lactams like Amoxicillin completely
ineffective. Macrolides (Azithromycin) or Tetracyclines (Doxycycline) are the first-line
treatment choices.
3. Acute Bronchitis Clinical Decision-Making
Question: A 28-year-old male presents with a productive cough of 12 days' duration. The
sputum is thick and yellowish-green. He is afebrile, and his vital signs are stable: HR 76 bpm,
RR 14 bpm, and $\text{SpO}_2\ 99\%$ on room air. Auscultation reveals diffuse wheezing that
clears with coughing. He has no history of asthma or lung disease. The patient is demanding an
antibiotic for his "chest infection." What is the most appropriate action by the nurse practitioner?
2025/2026 Latest Edition by Amelie
Hollier and Mimi Secor - Pass First
Attempt and Avoid Resits
APEA 6440 Respiratory System Practice Block
1. Chronic Obstructive Pulmonary Disease (COPD) Management
Question: A 66-year-old male with a 40 pack-year smoking history presents with a worsening
chronic cough and progressive dyspnea on exertion. A post-bronchodilator spirometry confirms
COPD with an $FEV_1/FVC < 0.70$ and an $FEV_1$ of $62\%$ predicted. He reports having
had one exacerbation requiring oral antibiotics in the past year, and his COPD Assessment Test
(CAT) score is 14. According to the current GOLD guidelines, which medication class is the
most appropriate initial long-term maintenance therapy?
A) Short-Acting Beta-2 Agonist (SABA) as needed only
B) Long-Acting Muscarinic Antagonist (LAMA) or Long-Acting Beta-2 Agonist (LABA)
C) Inhaled Corticosteroid (ICS) combined with a LABA
, D) Oral Theophylline daily
Answer: B) Long-Acting Muscarinic Antagonist (LAMA) or Long-Acting Beta-2 Agonist
(LABA)
Rationale: This patient falls into GOLD Group A or B (specifically Group B based on a CAT
score $\ge 10$ and $\le 1$ exacerbation not leading to hospital admission). For Group B patients,
initial therapy consists of a long-acting bronchodilator—either a LAMA (e.g., tiotropium) or a
LABA (e.g., salmeterol). LAMAs are often preferred for their superior reduction in exacerbation
rates. ICS therapy should not be used as monotherapy and is typically reserved for patients with
a high blood eosinophil count or frequent, severe exacerbations (Group E).
2. Community-Acquired Pneumonia (CAP) Differentiators
Question: A 38-year-old female presents with a 4-day history of a dry, hacking cough, low-
grade fever ($100.1^\circ\text{F}$), malaise, and a mild headache. On physical examination, her
lungs are clear to auscultation bilaterally without consolidation, but a chest X-ray reveals diffuse,
patchy infiltrates in the lower lobes. She has no significant past medical history, no recent
antibiotic exposure, and no drug allergies. Which pathogen and empirical treatment are most
likely?
A) Streptococcus pneumoniae; High-dose Amoxicillin
B) Mycoplasma pneumoniae; Azithromycin or Doxycycline
C) Haemophilus influenzae; Ceftriaxone
D) Legionella pneumophila; Levofloxacin
Answer: B) Mycoplasma pneumoniae; Azithromycin or Doxycycline*
Rationale: This scenario describes "atypical pneumonia" (often called "walking pneumonia"),
characteristically caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae. It
typically affects younger adults and presents with a discrepancy between mild physical exam
findings ("clear lungs") and more pronounced radiologic findings ("patchy infiltrates"). Atypical
pathogens lack a peptidoglycan cell wall, rendering beta-lactams like Amoxicillin completely
ineffective. Macrolides (Azithromycin) or Tetracyclines (Doxycycline) are the first-line
treatment choices.
3. Acute Bronchitis Clinical Decision-Making
Question: A 28-year-old male presents with a productive cough of 12 days' duration. The
sputum is thick and yellowish-green. He is afebrile, and his vital signs are stable: HR 76 bpm,
RR 14 bpm, and $\text{SpO}_2\ 99\%$ on room air. Auscultation reveals diffuse wheezing that
clears with coughing. He has no history of asthma or lung disease. The patient is demanding an
antibiotic for his "chest infection." What is the most appropriate action by the nurse practitioner?
