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Question 1
A 32-year-old man has acute bronchitis. He is a non-smoker and is otherwise healthy. How
should he be managed?
Options:
A. Treat symptoms only
B. Prescribe a macrolide antibiotic
C. Prescribe an antitussive
D. Prescribe an antibiotic and antitussive
Answer: A. Treat symptoms only
Explanation: Acute bronchitis is typically viral in healthy individuals, so antibiotics are
unnecessary. Symptomatic management (e.g., hydration, NSAIDs, rest) is recommended.
Question 2
An 84-year-old male has acute bronchitis. Which of the following tests would you perform as the
Nurse Practitioner?
Options:
A. Sputum culture
B. Chest X-ray
C. Chest CT
D. Chest MRI
Answer: B. Chest X-ray
Explanation: In elderly patients, a chest X-ray is warranted to rule out pneumonia or other
serious conditions like lung cancer.
Question 3
A 58-year-old male has acute bronchitis. He is a heavy smoker but is otherwise healthy. What is
the most likely etiology?
,Options:
A. Viral infection
B. S. pneumoniae
C. B. pertussis
D. Haemophilus influenzae
Answer: D. Haemophilus influenzae
Explanation: Smokers are at higher risk for bacterial bronchitis, with H. influenzae being a
common pathogen.
Question 4
A 76-year-old man has an acute productive cough, fever (100–101°F) for 3–4 days. He is a non-
smoker and otherwise healthy. Which diagnosis should be included in your differential?
Options:
A. Acute bronchitis
B. Pneumonitis
C. Pneumonia
D. COPD
E. Bronchiectasis
F. Pertussis
Answer: C. Pneumonia
Explanation: Fever + productive cough in an elderly patient raises concern for pneumonia, even
in non-smokers.
Question 5
Which of the following warrant a chest X-ray when an acute cough is present?
Options:
A. Temp >100.4°F
B. HR 86
C. Rales/consolidation
D. Age >65 years
E. RR >26
Answer: A, C, E
Explanation: Abnormal vitals (fever, tachypnea), rales, or consolidation suggest pneumonia and
require imaging. Age >75 is also a red flag (though not listed here).
Question 6
,A 76-year-old male has a chest X-ray showing infiltrates. Which medication is first-line
treatment?
Options:
A. Amoxicillin 1 g TID
B. Doxycycline 100 mg BID
C. Azithromycin 500 mg day 1, then 250 mg daily
D. Clarithromycin 500 mg BID
Answer: A. Amoxicillin 1 g TID
Explanation: For uncomplicated pneumonia in outpatients, amoxicillin covers S. pneumoniae,
the most common pathogen.
Question 7
A 76-year-old male with COPD, DM, and alcoholism has a chest X-ray showing infiltrates.
Which medication is first-line?
Options:
A. Amoxicillin
B. Levofloxacin
C. Azithromycin
D. Doxycycline
Answer: B. Levofloxacin
Explanation: Patients with comorbidities (COPD, DM) need broader coverage (e.g., respiratory
fluoroquinolone) for H. influenzae and atypical pathogens.
Question 8
The same patient (COPD, DM, alcoholism) is most likely infected with:
Options:
A. H. influenzae
B. S. pneumoniae
C. B. pertussis
D. Viral infection
Answer: A. H. influenzae
Explanation: H. influenzae is common in smokers and patients with COPD.
Question 9
A 56-year-old male has suspected COPD. Which symptoms are indicative?
Options:
A. Progressive dyspnea
, B. Acute cough
C. Sputum production for >2 months
D. FEV1/FVC >0.70
E. Alpha-1 antitrypsin deficiency
Answer: A, C, E
Explanation: COPD is characterized by chronic symptoms (dyspnea, cough, sputum) and
FEV1/FVC <0.70. Alpha-1 deficiency is a risk factor.
Question 10
A 56-year-old male with COPD. Which medication is first-line?
Options:
A. SABA (albuterol)
B. LABA (salmeterol)
C. Inhaled anticholinergic (ipratropium)
D. LAAC (aclidinium)
Answer: A. SABA (albuterol)
Explanation: Short-acting bronchodilators (SABAs) are first-line for acute symptom relief in
COPD.
Question 11
Which of the following diagnoses decrease hemoglobin (Hgb) over time?
Options:
A. COPD Stage 3
B. DM with A1C 13.8
C. Testosterone use
D. Resident of Denver, CO
E. Age 84 years
Answer: A, B, E
Explanation:
COPD: Chronic hypoxia stimulates polycythemia (increased Hgb), but advanced disease
may lead to anemia of chronic disease.
DM (A1C 13.8): Poorly controlled diabetes causes anemia due to chronic kidney disease
or inflammation.
Age >80: Increased risk of anemia from chronic disease, malnutrition, or myelodysplasia.
(Testosterone increases Hgb; high altitude [Denver] increases Hgb due to hypoxia.)