MN568 Midterm Exam 2025| 180 Questions
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Q: During cerumen extraction, touching the external meatus causes a patient to wince
and cough. What reflex is this?
A. Babinski reflex
B. Gag reflex
C. Arnold reflex
D. Moro reflex
Answer: C. Arnold reflex
Explanation: The Arnold reflex (auriculovagal reflex) is triggered by
stimulation of the ear canal, leading to coughing or vagal responses like
bradycardia.
Q: Sam (78) has PFTs showing normal TLC, decreased PaO₂, increased PaCO₂, coarse
crackles, and wheezes. What is the diagnosis?
A. Emphysema
B. Chronic Bronchitis
C. Asthma
D. Pulmonary fibrosis
Answer: B. Chronic Bronchitis
Explanation: Chronic bronchitis presents with hypoxemia, hypercapnia,
crackles (due to secretions), and wheezes. PFTs show obstructive patterns
without reduced TLC.
Q: George has COPD with FEV₁ 80%. How severe is his COPD?
A. Stage 4 (very severe)
B. Stage 3 (severe)
C. Stage 1 (mild)
D. Stage 2 (moderate)
Answer: C. Stage 1 mild COPD
, Explanation: GOLD guidelines classify FEV₁ ≥80% predicted as mild
COPD (Stage 1).
Q: African American patients may have adverse reactions to which asthma medication?
A. Inhaled corticosteroids
B. Long-acting beta-agonists (LABAs)
C. Leukotriene modifiers
D. Anticholinergics
Answer: B. Long-acting beta-agonist bronchodilators
Explanation: LABAs (e.g., salmeterol) may have reduced efficacy or increased
risk in African Americans due to genetic polymorphisms in β-adrenergic
receptors.
Q: Mabel has a CURB-65 score of 3 for CAP. What should you do?
A. Treat at home with oral antibiotics
B. Monitor outpatient with follow-up
C. Hospitalize and consider ICU admission
D. Administer IV fluids in clinic
Answer: C. Hospitalize and consider admitting her to the ICU
Explanation: CURB-65 scores ≥3 indicate severe pneumonia requiring
hospitalization. ICU admission is considered for high-risk features.
Q: Why might a patient have a decreased TB test response?
A. Recent influenza vaccination
B. Long-term corticosteroid therapy
C. High-protein diet
D. Exercise regimen
Answer: B. She has been on long-term corticosteroid therapy
Explanation: Corticosteroids suppress cell-mediated immunity, reducing
reactivity to tuberculin skin tests (TST).
Q: To prevent peripheral neuropathy from isoniazid (INH), which drug is given
prophylactically?
, A. Thiamine
B. Pyridoxine (vitamin B₆)
C. Niacin
D. Folic acid
Answer: B. Pyridoxine
Explanation: INH disrupts vitamin B₆ metabolism. Pyridoxine (25–50
mg/day) prevents neuropathy.
Q: Jolene’s breast cancer is staged T1, N0, M0. What does this mean?
A. Tumor size unclear; no lymph node spread; metastasis unclear
B. Cancer in situ; spreading to lymph nodes; metastasis unclear
C. Tumor <3 cm; no lymph node spread; no distant metastasis
D. Tumor ~5 cm; lymph nodes unclear; no metastasis
Answer: C. The cancer is less than 3 cm in size and has not spread to the lymph
nodes or other parts of the body.
Explanation: T1: tumor ≤2 cm; N0: no regional nodes; M0: no distant
metastasis.
Q: Nathan (32, smoker) gets irate when advised to quit. What should you do?
A. Avoid discussing smoking
B. Refer to psychiatry
C. Prescribe nicotine patches
D. Continue asking at every visit
Answer: D. Continue to ask him at every visit if he is ready to quit
Explanation: The "5 A's" (Ask, Advise, Assess, Assist, Arrange) recommend
persistent, nonjudgmental inquiry to motivate change.
Q: If starting Chantix tomorrow, when should the patient quit smoking?
A. Immediately
B. After 3 days
C. In 1 week
, D. After 2 weeks
Answer: C. His quit date should be in 1 week
Explanation: Chantix (varenicline) requires 1 week of titration before quitting
to achieve steady-state levels.
Q: What is critical when teaching about nicotine gum?
A. Chew continuously for 30 minutes
B. Use with coffee to enhance absorption
C. Chew until soft, then park in buccal mucosa
D. Swallow after chewing
Answer: C. The gum must be correctly chewed to a softened state and then
placed in the buccal mucosa
Explanation: "Parking" the gum allows nicotine absorption through oral
mucosa, avoiding GI irritation.
Q: Cydney has asthma with daily symptoms (>1 week), nighttime awakenings, uses
rescue inhaler, FEV1 60-80% predicted. How would you classify her asthma?
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: C. Moderate persistent
Explanation: Daily symptoms, nighttime awakenings >1x/week, FEV1 60-80%
predicted, and rescue inhaler use align with moderate persistent asthma per
NHLBI guidelines.
Q: Joyce takes a long-acting beta agonist (LABA) for asthma. What additional
medication should she take?
A. Short-acting beta agonist (SABA)
B. Inhaled corticosteroid
C. Leukotriene modifier
D. Theophylline
Answer: B. Inhaled corticosteroid
Complete with Verified Answers for
Guaranteed Pass
Q: During cerumen extraction, touching the external meatus causes a patient to wince
and cough. What reflex is this?
A. Babinski reflex
B. Gag reflex
C. Arnold reflex
D. Moro reflex
Answer: C. Arnold reflex
Explanation: The Arnold reflex (auriculovagal reflex) is triggered by
stimulation of the ear canal, leading to coughing or vagal responses like
bradycardia.
Q: Sam (78) has PFTs showing normal TLC, decreased PaO₂, increased PaCO₂, coarse
crackles, and wheezes. What is the diagnosis?
A. Emphysema
B. Chronic Bronchitis
C. Asthma
D. Pulmonary fibrosis
Answer: B. Chronic Bronchitis
Explanation: Chronic bronchitis presents with hypoxemia, hypercapnia,
crackles (due to secretions), and wheezes. PFTs show obstructive patterns
without reduced TLC.
Q: George has COPD with FEV₁ 80%. How severe is his COPD?
A. Stage 4 (very severe)
B. Stage 3 (severe)
C. Stage 1 (mild)
D. Stage 2 (moderate)
Answer: C. Stage 1 mild COPD
, Explanation: GOLD guidelines classify FEV₁ ≥80% predicted as mild
COPD (Stage 1).
Q: African American patients may have adverse reactions to which asthma medication?
A. Inhaled corticosteroids
B. Long-acting beta-agonists (LABAs)
C. Leukotriene modifiers
D. Anticholinergics
Answer: B. Long-acting beta-agonist bronchodilators
Explanation: LABAs (e.g., salmeterol) may have reduced efficacy or increased
risk in African Americans due to genetic polymorphisms in β-adrenergic
receptors.
Q: Mabel has a CURB-65 score of 3 for CAP. What should you do?
A. Treat at home with oral antibiotics
B. Monitor outpatient with follow-up
C. Hospitalize and consider ICU admission
D. Administer IV fluids in clinic
Answer: C. Hospitalize and consider admitting her to the ICU
Explanation: CURB-65 scores ≥3 indicate severe pneumonia requiring
hospitalization. ICU admission is considered for high-risk features.
Q: Why might a patient have a decreased TB test response?
A. Recent influenza vaccination
B. Long-term corticosteroid therapy
C. High-protein diet
D. Exercise regimen
Answer: B. She has been on long-term corticosteroid therapy
Explanation: Corticosteroids suppress cell-mediated immunity, reducing
reactivity to tuberculin skin tests (TST).
Q: To prevent peripheral neuropathy from isoniazid (INH), which drug is given
prophylactically?
, A. Thiamine
B. Pyridoxine (vitamin B₆)
C. Niacin
D. Folic acid
Answer: B. Pyridoxine
Explanation: INH disrupts vitamin B₆ metabolism. Pyridoxine (25–50
mg/day) prevents neuropathy.
Q: Jolene’s breast cancer is staged T1, N0, M0. What does this mean?
A. Tumor size unclear; no lymph node spread; metastasis unclear
B. Cancer in situ; spreading to lymph nodes; metastasis unclear
C. Tumor <3 cm; no lymph node spread; no distant metastasis
D. Tumor ~5 cm; lymph nodes unclear; no metastasis
Answer: C. The cancer is less than 3 cm in size and has not spread to the lymph
nodes or other parts of the body.
Explanation: T1: tumor ≤2 cm; N0: no regional nodes; M0: no distant
metastasis.
Q: Nathan (32, smoker) gets irate when advised to quit. What should you do?
A. Avoid discussing smoking
B. Refer to psychiatry
C. Prescribe nicotine patches
D. Continue asking at every visit
Answer: D. Continue to ask him at every visit if he is ready to quit
Explanation: The "5 A's" (Ask, Advise, Assess, Assist, Arrange) recommend
persistent, nonjudgmental inquiry to motivate change.
Q: If starting Chantix tomorrow, when should the patient quit smoking?
A. Immediately
B. After 3 days
C. In 1 week
, D. After 2 weeks
Answer: C. His quit date should be in 1 week
Explanation: Chantix (varenicline) requires 1 week of titration before quitting
to achieve steady-state levels.
Q: What is critical when teaching about nicotine gum?
A. Chew continuously for 30 minutes
B. Use with coffee to enhance absorption
C. Chew until soft, then park in buccal mucosa
D. Swallow after chewing
Answer: C. The gum must be correctly chewed to a softened state and then
placed in the buccal mucosa
Explanation: "Parking" the gum allows nicotine absorption through oral
mucosa, avoiding GI irritation.
Q: Cydney has asthma with daily symptoms (>1 week), nighttime awakenings, uses
rescue inhaler, FEV1 60-80% predicted. How would you classify her asthma?
A. Mild intermittent
B. Mild persistent
C. Moderate persistent
D. Severe persistent
Answer: C. Moderate persistent
Explanation: Daily symptoms, nighttime awakenings >1x/week, FEV1 60-80%
predicted, and rescue inhaler use align with moderate persistent asthma per
NHLBI guidelines.
Q: Joyce takes a long-acting beta agonist (LABA) for asthma. What additional
medication should she take?
A. Short-acting beta agonist (SABA)
B. Inhaled corticosteroid
C. Leukotriene modifier
D. Theophylline
Answer: B. Inhaled corticosteroid
