FAMILY MED PAEA PULMONOLOGY
EXAM ACTUAL EXAM PRACTICE
QUESTIONS AND DETAILED CORRECT
ANSWERS WITH RATIONALE | 2024-2025
A 69 year-old male presents with complaint f increasing
dyspnea over the past 6-8 months. The patient denies
cough, chest pain or smoking history. Physical exam
reveals inspiratory crackles at the bases and clubbing of
the nails. Chest x-ray reveals interstitial fibrosis of the
lower lungs, thickened pleura and calcified pleural plaques
of the lateral chest wall. Pulmonary function testing shows
a restrictive pattern with a decreased diffusing capacity.
What is most likely noted in this patient's history?
A. coal mining
B. silica exposure
C. textile work
D. asbestos Correct Answer D. asbestos
(Asbestosis exposure often presents years later with
increasing dyspnea and interstitial fibrosis of the
lower lungs, thickened pleura and calcified pleura
plaques. They will have a restrictive pattern on PFT)
A 9 year-old male presents with difficulty breathing for one
hour. The patient states his chest feels tight and he can't
catch his breath. On PE you note the patient to be short of
breath with speaking. He is tachypneic and tachycardic.
Lung exam reveals retraction of intercostal muscles and
,loud expiratory wheezes throughout all lung fields. What is
the most likely spirometry finding in this patient?
A. decreased FEV1 and decreased FVC
B. increased FEV1 and decreased TLC
C. decreased FEV1 and increased FVC
D. Increased FVC and increased TLC Correct Answer
Decreased FEV1 Decreased FVC
(Patients with asthma will have a decreased Forced
Expiratory Volume in 1 second (FEV1), a normal or
decreased Forced Vital Capacity (FVC) and a normal
or increased Total Lung Capacity (TLC))
A 20 year-old male presents with complaint of difficulty
breathing, chest tightness and wheeze during gym class.
He denies symptoms at any other times. He denies
nighttime cough or shortness of breath. Which of the
following is the first line therapy for this patient?
A. short acting beta agonist before exercise
B. immunotherapy
C. leukotriene modifers
D. inhaled corticosteroids Correct Answer SABA before
exercise
Which of the following patients has a contraindication for
the use of live attenuated intranasal influenza vaccination?
A. asthma
B. DM
C. Chronic Liver Failure
,D. Chronic Renal Failure Correct Answer Asthma
(Asthma patients are at risk for acute bronchospasm
when they are subjected to the live intranasal
influenza vaccine. This risk is not present with the
inactivated vaccine given parenterally)
• A 23 year-old female with history of asthma for the past 5
years presents with complaints of increasing shortness of
breath for 2 days. Her asthma has been well-controlled
until 2 days ago. Since yesterday, she has been using her
albuterol inhaler every 4 to 6 hours. She is normally very
active, however yesterday she did not complete her 30
minute exercise routine due to increasing dyspnea. She
denies any cough, fever, recent surgeries, or use of oral
contraceptives. On examination, you note the presence of
prolonged expiration and diffuse wheezing. The remainder
of the exam is unremarkable. Which of the following is the
most appropriate initial diagnostic evaluation prior to
initiation of treatment?
o A. Chest x-ray
o B. Sputum gram stain
o C. Peak flow
o D. Ventilation-perfusion scan Correct Answer o C. Peak
flow
(A peak flow reading will help you to gauge her
current extent of airflow obstruction and is helpful in
monitoring the effectiveness of any treatment
interventions)
• A 34 year-old female with a history of asthma presents
with complaints of increasing asthma attacks. The patient
, states she has been well-controlled on albuterol inhaler
until one month ago. Since that time she notices that she
has had to use her inhaler 3-4 times a week and also has
had increasing nighttime use averaging about three
episodes in the past month. Spirometry reveals greater
than 85% predicted value. Which of the following is the
most appropriate intervention at this time?
A. oral prednisone
B. oral theophylline
C. salmeterol
D. beclomethasone Correct Answer Beclomethasone
(Qvar)inhaler
(This patient has progressed to mild persistent
asthma. In addition to her inhaled beta2-agonist
(albuterol), she should be started on an anti-
inflammatory agent. Inhaled corticosteroids, such as
beclomethasone, are preferred for long-term control)
• A 3 year-old girl is diagnosed with atopic dermatitis.
Which of the following disorders is this child at risk for in
the future?
A. asthma
B. tinea pedia
C. squamous carcinoma
D. SLE Correct Answer asthma
• Which of the following pathophysiological processes is
associated with chronic bronchitis?
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