A 56-year-old, overweight man presents for bronchitis. He tells you that every winter he
gets bronchitis that makes him short of breath and productive of "tons" of mucus for two
to three months. Further questioning reveals that he has smoked heavily for 35 years
but is trying to cut back. A physical exam is normal except for a BMI of 31, and a lung
exam that shows rhonchi bilaterally. Which of the following tests would be most useful in
initially guiding diagnosis and management of his condition?
AArterial blood gas analysis
BChest CT scan
CChest radiographYour Answer
DPulmonary function testing - D
What is the most common presenting complaint in patients with lung cancer?
AChest pain
BCoughCorrect Answer
CDyspnea
DHemoptysis - B
A 34-year-old man presents to the clinic with insomnia for 6 months. He states that it
takes him several hours to fall asleep, and he wakes up every 2-3 hours. He reports
eating before going to bed. He has no significant past medical history. Which of the
following is the most appropriate initial step in management?
AAvoid large meals before sleepCorrect Answer
BBegin cognitive behavioral therapyYour Answer
CStart zolpidem 5 mg daily
DTake an afternoon nap daily - A
A 65-year-old man is evaluated for a 2-year history of dyspnea on exertion. He reports
dyspnea and occasional wheezing mainly with increased exertion like climbing stairs or
walking briskly up an incline. He reports no chest pain. He has a 15-year history of well-
controlled hypertension and hyperlipidemia treated with amlodipine and atorvastatin. He
has a 30 pack-year history of smoking. On physical examination, his vital signs are
normal. His lungs are clear to auscultation. His laboratory work reveals a normal
complete blood count and chemistry panel. Spirometry shows a postbronchodilator
FEV1 of 80% and FEV1/FVC ratio of 0.65. A chest radiograph and electrocardiogram
are both normal. What is the most appropriate initial treatment for this patient?
AInhaled corticosteroid and long-acting beta-agonistYour Answer
BLong-acting beta-agonist
CLong-acting muscarinic antagonist
DShort-acting beta-agonist - D
Which of the following is associated with improved survival in a patient with COPD?
, ADaily inhaled corticosteroids for patients with a history of frequent exacerbationsYour
Answer
BDaily inhaled long-acting beta-agonists for patients with FEV1 < 60% predicted
CLow-flow supplemental oxygen via nasal cannula for patients with hypoxemiaCorrect
Answer
DRegular inhaled short-acting beta-agonists for patients with FEV1 < 50% predicted - C
A 21-year-old woman presents with two weeks of a "wet" cough following an upper
respiratory infection. She is worried because she is coughing up green phlegm. She has
no significant pulmonary disease history and is only mildly short of breath during "cough
fits." On exam, she is afebrile with normal vital signs. She does have rhonchi in bilateral
lung fields that clears with coughing. Which of the following is this patient's most likely
diagnosis?
AAcute bronchitisCorrect Answer
BBacterial pneumonia
CCroup
DInfluenza - A
Which of the following measurements performed during spirometry helps to make a
definitive diagnosis of emphysema?
ADiffusion capacity for carbon monoxide
BForced expiratory volume in 1 second/forced vital capacityCorrect Answer
CPeak expiratory flow
DResidual volume - B
A 14-month-old girl presents to the office with a three-day history of rhinorrhea and low-
grade temperature. Today the patient has developed a cough and parents note some
changes in her breathing. She has no history of asthma or any other pulmonary
problems. On examination, there is diffuse wheezing, mild substernal retractions, and
mild tachypnea. Which of the following is the most likely diagnosis?
AAcute bronchiolitisCorrect Answer
BAsthma exacerbation
CBacterial pneumonia
DCroup - A
A 61-year-old man presents with symptoms of a nonproductive cough and dyspnea. He
states that the symptoms have been present for approximately 1 year and have been
gradually worsening. The patient reports no hemoptysis or night sweats, and the review
of systems is otherwise normal. Physical exam reveals inspiratory crackles at the lung
bases and digital clubbing. Chest X-ray shows reduced lung volumes and
reticulonodular opacities. The patient's CT scan shows honeycombed cystic lesions in
the subpleural spaces. Which of the following is the most likely diagnosis?
AChronic bronchitis
BGranulomatosis with polyangitis
CIdiopathic pulmonary fibrosisCorrect Answer
DSarcoidosis
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