Chapter 15. Dyspnea
Multiple Choice
Identify the choice that best completes the statement or answers the question.
A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking
1.
history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
A. 50 x 2-pack years
B. 100-pack years
C. 50-year, 2-pack history
D. 100 pack history
Which of the following is characteristic of COPD?
2.
A. Asymmetric chest expansion
B. Increased lateral diameter
C. Increased anterior-posterior diameter
D. Pectus excavatum
When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be
3.
indicative of:
A. Pneumonia
B. Emphysema
C. Pneumothorax
D. Asthma
4. with: During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent
A. COPD
B. Pneumothorax
C. A normal finding
D. Pleural effusion
Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?
5.
A. Computed tomography (CT) scan
B. Chest xray with PA, lateral, and lordotic views
C. Ultrasound
D. Positron emission tomography (PET) scan
Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with:
6.
A. Exercise-induced cough
B. Bronciectasis
C. COPD
D. Pericarditis
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands
7.
greater than the other. This could be due to:
A. Pneumothorax
B. Pleural effusion
C. Pneumonia
D. Pulmonary embolism
During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full
8.
inspiration and early expiration. This finding is consistent with:
A. Pneumonia
B. Pleuritis
C. Pneumothorax
D. A and B
While assessing auscultated spoken sounds, the ausculated sound is heard as “a-a-a” when he is asked to repeat “e-e-
9.
e. ” This is indicative of:
A. Asthma
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, B. Tumor
C. Pneumonia
D. Pleural effusion
A cough is described as chronic if it has been present for:
10.
A. 2 weeks or more
B. 8 weeks or more
C. 3 months or more
D. 6 months or more
Which of the following medications are commonly associated with the side effect of cough?
11.
A. Beta blocker
B. Diuretic
C. ACE inhibitor
D. Calcium antagonist
Which of the following details are NOT considered while staging asthma?
12.
A. Nighttime awakenings
B. Long-acting beta agonist usage
C. Frequency of symptoms
D. Spirometry findings
When asthma is suspected, which of the following is NOT useful in making a diagnosis?
13.
A. Decreased FEV1/FVC ratio
B. Decreased FEV1
C. Some reversibility with administration of bronchodilator
D. Peak flow meter reading
The following criterion is considered a positive finding when determining whether a patient with asthma can be safely
14.
monitored and treated at home:
A. Age over 40
B. Fever greater than 101
C. Tachypnea greater than 30 breaths/minute
D. Productive cough
The most common etiologic organism for community-acquired pneumonia is:
15.
A. Streptococcus pneumoniae
B. Beta hemolytic streptococcus
C. Mycoplasma
D. Methicillin resistant staphylococcus
A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive
16.
cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl. He has a history of mild dementia and his mental status is
unchanged from his last visit. These findings indicate that the patient:
A. Can be treated as an outpatient
B. Requires hospitalization for treatment
C. Requires a high dose of parenteral antibiotic
D. Can be treated with oral antibiotics
Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for:
17.
A. Immediate endotracheal intubation
B. Broad spectrum intravenous antibiotics
C. Thoracentesis to rule out empyema
D. Gram stain and culture of sputum
18.
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Multiple Choice
Identify the choice that best completes the statement or answers the question.
A 66-year-old patient presents to the clinic complaining of dyspnea and wheezing. The patient reports a smoking
1.
history of 2 packs of cigarettes per day since age 16. This would be recorded in the chart as:
A. 50 x 2-pack years
B. 100-pack years
C. 50-year, 2-pack history
D. 100 pack history
Which of the following is characteristic of COPD?
2.
A. Asymmetric chest expansion
B. Increased lateral diameter
C. Increased anterior-posterior diameter
D. Pectus excavatum
When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This can be
3.
indicative of:
A. Pneumonia
B. Emphysema
C. Pneumothorax
D. Asthma
4. with: During physical examination of a patient, you note resonance on percussion in the upper lung fields. This is consistent
A. COPD
B. Pneumothorax
C. A normal finding
D. Pleural effusion
Which of the following imaging studies should be considered if a pulmonary malignancy is suspected?
5.
A. Computed tomography (CT) scan
B. Chest xray with PA, lateral, and lordotic views
C. Ultrasound
D. Positron emission tomography (PET) scan
Alpha-1 antitrypsin deficiency should be considered in patients diagnosed with:
6.
A. Exercise-induced cough
B. Bronciectasis
C. COPD
D. Pericarditis
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side expands
7.
greater than the other. This could be due to:
A. Pneumothorax
B. Pleural effusion
C. Pneumonia
D. Pulmonary embolism
During auscultation of the chest, your exam reveals a loud grating sound at the lower anterolateral lung fields, at full
8.
inspiration and early expiration. This finding is consistent with:
A. Pneumonia
B. Pleuritis
C. Pneumothorax
D. A and B
While assessing auscultated spoken sounds, the ausculated sound is heard as “a-a-a” when he is asked to repeat “e-e-
9.
e. ” This is indicative of:
A. Asthma
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, B. Tumor
C. Pneumonia
D. Pleural effusion
A cough is described as chronic if it has been present for:
10.
A. 2 weeks or more
B. 8 weeks or more
C. 3 months or more
D. 6 months or more
Which of the following medications are commonly associated with the side effect of cough?
11.
A. Beta blocker
B. Diuretic
C. ACE inhibitor
D. Calcium antagonist
Which of the following details are NOT considered while staging asthma?
12.
A. Nighttime awakenings
B. Long-acting beta agonist usage
C. Frequency of symptoms
D. Spirometry findings
When asthma is suspected, which of the following is NOT useful in making a diagnosis?
13.
A. Decreased FEV1/FVC ratio
B. Decreased FEV1
C. Some reversibility with administration of bronchodilator
D. Peak flow meter reading
The following criterion is considered a positive finding when determining whether a patient with asthma can be safely
14.
monitored and treated at home:
A. Age over 40
B. Fever greater than 101
C. Tachypnea greater than 30 breaths/minute
D. Productive cough
The most common etiologic organism for community-acquired pneumonia is:
15.
A. Streptococcus pneumoniae
B. Beta hemolytic streptococcus
C. Mycoplasma
D. Methicillin resistant staphylococcus
A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive
16.
cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl. He has a history of mild dementia and his mental status is
unchanged from his last visit. These findings indicate that the patient:
A. Can be treated as an outpatient
B. Requires hospitalization for treatment
C. Requires a high dose of parenteral antibiotic
D. Can be treated with oral antibiotics
Your patient with community-acquired pneumonia shows a pleural effusion on chest x-ray, indicating the need for:
17.
A. Immediate endotracheal intubation
B. Broad spectrum intravenous antibiotics
C. Thoracentesis to rule out empyema
D. Gram stain and culture of sputum
18.
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