EOR BOOST EXAM QUESTIONS AND
CORRECT ANSWERS
Which of the following treatments for chronic obstructive pulmonary disease-related chronic bronchitis
is associated with decreased mortality?
A. Inhaled glucocorticoids
B. Oxygen Therapy
C. Pneumococcal Vaccine
D. Short acting Bronchodilators - Answer-B. Oxygen Therapy
However, oxygen therapy and smoking cessation are the only two interventions associated with
decreased mortality in patients with chronic obstructive pulmonary disease-related chronic bronchitis.
Inhaled glucocorticoids (A) are used in the treatment of COPD to target airway inflammation. They
appear to decrease exacerbations and potentially slow the progression of symptoms but do not improve
lung function or mortality. They are only used in the treatment of COPD as part of a combined regimen.
The pneumococcal vaccine (C) should be offered to patients with COPD but does not directly decrease
mortality. Short-acting bronchodilators (D) are a mainstay of therapy for COPD and have been proven to
,improve lung function and reported symptoms. They have not been proven to decrease mortality
associated with COPD.
What class of drugs may be used for palliative care of dyspnea associated with sever COPD? - Answer-
Opioids
A 58-year-old man with a 20 pack-year smoking history complains of a chronic, productive cough.
Diffuse wheezing is noted on physical exam. Which of the following additional physical exam findings
would be expected?
A. Decreased AP chest diameter
B. Decreased heart sound
C. Prolonged inspiratory phase of breathing
D. SPlitting of the first heart sound - Answer-B. Decreased heart sound
Physical exam findings in patients with COPD may include increased anteroposterior chest diameter,
prolonged expiratory phase of breathing, splitting of the second heart sound, wheezes, pursed-lip
breathing, and decreased heart and lung sounds due to lung hyperinflation.
Decreased anteroposterior chest diameter (A) would not be expected in patients with COPD. On the
contrary, an increase in anteroposterior chest diameter may be seen as a result of lung hyperinflation
and increased residual lung volume. Prolonged inspiratory phase of breathing (C) would also not be
expected in a patient with COPD. Patients with COPD do not tend to have trouble with inhalation, but
rather with exhalation. The exhalatory phase of breathing is prolonged in these patients due to airway
inflammation, mucosal edema, and destruction of small airways. When alveolar septa are destroyed, the
attachments of the lung parenchyma to the airways are disrupted, leading to airway closure during
expiration. Splitting of the first heart sound (D) is physiologic, although an increase in this splitting can
occur in the setting of right bundle branch block or ventricular tachycardia. Splitting of the second heart
sound with an accentuation of the pulmonic component can be seen in patients with COPD who also are
suffering from cor pulmonale. In cor pulmonale, pulmonary disease leads to pulmonary hypertension
and right-sided heart failure.
,What is the most common trigger for anaphylaxis? - Answer-Food allergy
A 24-year-old man presents with complaints of increasing drainage from both eyes associated with mild
discomfort for the past day. He denies severe eye pain or blurring of his vision. He also complains of
dysuria and urethral discharge. He is sexually active and does not regularly use protection. On
examination, his visual acuity is 20/20 in both eyes. There is profuse purulent discharge as well as
marked chemosis, lid swelling, and tender preauricular adenopathy. Which of the following is the most
appropriate diagnostic evaluation?
A. Direct Fluorescent antibody testing
B. Fluorescent treponemal antibody absorption test
C. Gram Stain
D. Tzanck Smear - Answer-C. Gram Stain
Neisseria gonorrhoeae may be transmitted to the eyes from the hands after contact with infected
genitalia resulting in a hyperacute bacterial conjunctivitis. The ophthalmologic infection presents as
copious purulent discharge, marked chemosis, erythema, lid swelling and tenderness, and tender
preauricular adenopathy. Gram stain is the most appropriate diagnostic evaluation in this patient with
signs and symptoms concerning for hyperacute bacterial conjunctivitis caused by Neisseria gonorrhoeae.
Gram stain of the discharge will reveal Gram-negative diplococci. When suspected, immediate
ophthalmologic referral should be obtained as patients require hospitalization for systemic and topical
therapy and close monitoring. If left untreated, hyperacute bacterial conjunctivitis can lead to
permanent blindness.
(A) Direct fluorescent antibody testing=for Varicella Zoster
(B) Fluorescent treponemal antibody absorption test=Syphilis
(D) Tzanck Smear: Herpes Simplex, varicella, zoster
What are two potential complications of hyper acute bacterial conjunctivitis? - Answer-Keratitis and
Perforation
, A 64-year-old man with a history of diabetes mellitus presents with pain in his right calf while walking.
The pain is relieved with rest. He has smoked one pack of cigarettes per day for the past 35 years. Exam
reveals a cool extremity with diminished pulses. What is the gold-standard diagnostic study for your
suspected diagnosis?
A. Bedside ABI
B. Contrast Arteriography
C. Duplex US
D. X ray - Answer-B. Contrast Arteriography
GOLD STANDARD FOR PERIPHERAL ARTERY DISEASE
Contrast arteriography remains the gold standard for the evaluation of the threatened limb in peripheral
artery disease. Peripheral artery disease may be silent or present with signs and symptoms indicative of
extremity ischemia. The majority of patients with peripheral artery disease have atherosclerotic disease
of the lower extremity. Risk factors for peripheral artery disease include advanced age, smoking, male
gender, diabetes, and black ethnicity. Patients may present asymptomatically or with pain in affected
extremity related to activity, known as intermittent claudication. They may also present with non-
healing wounds, ulceration, or gangrene. Exam may reveal a cool extremity with absent or diminished
pulses, though findings depend on the severity of the disease. Management is aimed at relieving
symptoms and lowering the risk of cardiovascular disease progression. Exercise programs and possibly
pharmacologic therapy with antithrombotics such as aspirin are recommended. Revascularization may
be necessary.
What are the indications used to determine which asymptomatic adults need to be screened for
diabetes?
-BP >_______/______
-Age >___________
-Overweight + an additional risk factor such as family with DM or HLD. - Answer-BP>135/80
Age>45
CORRECT ANSWERS
Which of the following treatments for chronic obstructive pulmonary disease-related chronic bronchitis
is associated with decreased mortality?
A. Inhaled glucocorticoids
B. Oxygen Therapy
C. Pneumococcal Vaccine
D. Short acting Bronchodilators - Answer-B. Oxygen Therapy
However, oxygen therapy and smoking cessation are the only two interventions associated with
decreased mortality in patients with chronic obstructive pulmonary disease-related chronic bronchitis.
Inhaled glucocorticoids (A) are used in the treatment of COPD to target airway inflammation. They
appear to decrease exacerbations and potentially slow the progression of symptoms but do not improve
lung function or mortality. They are only used in the treatment of COPD as part of a combined regimen.
The pneumococcal vaccine (C) should be offered to patients with COPD but does not directly decrease
mortality. Short-acting bronchodilators (D) are a mainstay of therapy for COPD and have been proven to
,improve lung function and reported symptoms. They have not been proven to decrease mortality
associated with COPD.
What class of drugs may be used for palliative care of dyspnea associated with sever COPD? - Answer-
Opioids
A 58-year-old man with a 20 pack-year smoking history complains of a chronic, productive cough.
Diffuse wheezing is noted on physical exam. Which of the following additional physical exam findings
would be expected?
A. Decreased AP chest diameter
B. Decreased heart sound
C. Prolonged inspiratory phase of breathing
D. SPlitting of the first heart sound - Answer-B. Decreased heart sound
Physical exam findings in patients with COPD may include increased anteroposterior chest diameter,
prolonged expiratory phase of breathing, splitting of the second heart sound, wheezes, pursed-lip
breathing, and decreased heart and lung sounds due to lung hyperinflation.
Decreased anteroposterior chest diameter (A) would not be expected in patients with COPD. On the
contrary, an increase in anteroposterior chest diameter may be seen as a result of lung hyperinflation
and increased residual lung volume. Prolonged inspiratory phase of breathing (C) would also not be
expected in a patient with COPD. Patients with COPD do not tend to have trouble with inhalation, but
rather with exhalation. The exhalatory phase of breathing is prolonged in these patients due to airway
inflammation, mucosal edema, and destruction of small airways. When alveolar septa are destroyed, the
attachments of the lung parenchyma to the airways are disrupted, leading to airway closure during
expiration. Splitting of the first heart sound (D) is physiologic, although an increase in this splitting can
occur in the setting of right bundle branch block or ventricular tachycardia. Splitting of the second heart
sound with an accentuation of the pulmonic component can be seen in patients with COPD who also are
suffering from cor pulmonale. In cor pulmonale, pulmonary disease leads to pulmonary hypertension
and right-sided heart failure.
,What is the most common trigger for anaphylaxis? - Answer-Food allergy
A 24-year-old man presents with complaints of increasing drainage from both eyes associated with mild
discomfort for the past day. He denies severe eye pain or blurring of his vision. He also complains of
dysuria and urethral discharge. He is sexually active and does not regularly use protection. On
examination, his visual acuity is 20/20 in both eyes. There is profuse purulent discharge as well as
marked chemosis, lid swelling, and tender preauricular adenopathy. Which of the following is the most
appropriate diagnostic evaluation?
A. Direct Fluorescent antibody testing
B. Fluorescent treponemal antibody absorption test
C. Gram Stain
D. Tzanck Smear - Answer-C. Gram Stain
Neisseria gonorrhoeae may be transmitted to the eyes from the hands after contact with infected
genitalia resulting in a hyperacute bacterial conjunctivitis. The ophthalmologic infection presents as
copious purulent discharge, marked chemosis, erythema, lid swelling and tenderness, and tender
preauricular adenopathy. Gram stain is the most appropriate diagnostic evaluation in this patient with
signs and symptoms concerning for hyperacute bacterial conjunctivitis caused by Neisseria gonorrhoeae.
Gram stain of the discharge will reveal Gram-negative diplococci. When suspected, immediate
ophthalmologic referral should be obtained as patients require hospitalization for systemic and topical
therapy and close monitoring. If left untreated, hyperacute bacterial conjunctivitis can lead to
permanent blindness.
(A) Direct fluorescent antibody testing=for Varicella Zoster
(B) Fluorescent treponemal antibody absorption test=Syphilis
(D) Tzanck Smear: Herpes Simplex, varicella, zoster
What are two potential complications of hyper acute bacterial conjunctivitis? - Answer-Keratitis and
Perforation
, A 64-year-old man with a history of diabetes mellitus presents with pain in his right calf while walking.
The pain is relieved with rest. He has smoked one pack of cigarettes per day for the past 35 years. Exam
reveals a cool extremity with diminished pulses. What is the gold-standard diagnostic study for your
suspected diagnosis?
A. Bedside ABI
B. Contrast Arteriography
C. Duplex US
D. X ray - Answer-B. Contrast Arteriography
GOLD STANDARD FOR PERIPHERAL ARTERY DISEASE
Contrast arteriography remains the gold standard for the evaluation of the threatened limb in peripheral
artery disease. Peripheral artery disease may be silent or present with signs and symptoms indicative of
extremity ischemia. The majority of patients with peripheral artery disease have atherosclerotic disease
of the lower extremity. Risk factors for peripheral artery disease include advanced age, smoking, male
gender, diabetes, and black ethnicity. Patients may present asymptomatically or with pain in affected
extremity related to activity, known as intermittent claudication. They may also present with non-
healing wounds, ulceration, or gangrene. Exam may reveal a cool extremity with absent or diminished
pulses, though findings depend on the severity of the disease. Management is aimed at relieving
symptoms and lowering the risk of cardiovascular disease progression. Exercise programs and possibly
pharmacologic therapy with antithrombotics such as aspirin are recommended. Revascularization may
be necessary.
What are the indications used to determine which asymptomatic adults need to be screened for
diabetes?
-BP >_______/______
-Age >___________
-Overweight + an additional risk factor such as family with DM or HLD. - Answer-BP>135/80
Age>45
