Pulmonary Practice Questions

Question 1

A 71-year-old man is admitted to the ICU with a history of severe pancreatitis and new onset difficulty breathing. His vital signs are a blood pressure of 100/60 mm Hg, heart rate of 100/min, respirations of 27/min, temperature of 36.7°C (98.1°F), and oxygen saturation of 85% on room air. Physical examination shows a cachectic male in severe respiratory distress. Rales are heard at the base of each lung. The patient is intubated and a Swan-Ganz catheter is inserted. Pulmonary capillary wedge pressure is 8 mm Hg. An arterial blood gas study reveals a PaO2: FiO2 ratio of 180. The patient is diagnosed with acute respiratory distress syndrome. In which of the following segments of the respiratory tract are the cells responsible for the symptoms observed in this patient found?

Accepted Answer

Alveolar sacs

Answer

Terminal bronchioles

Answer

Bronchi

Answer

Respiratory bronchioles

Answer

Bronchioles

Question 2

A 63-year-old man presents to the emergency department because of progressive difficulty with breathing. He has a history of diabetes, hypertension, and chronic bronchitis. He has been receiving medications to moderate his conditions and reports being compliant with his schedule. He reports a recent difficulty with tackling simple chores in the house. He has not been able to walk for more than 1 block over the past few days. His persistent cough has also been worsening with more formation of sputum. During his diagnosis of bronchitis, about a year ago, he had a 40-pack-year smoking history. The patient is in evident distress and uses his accessory muscles to breathe. The vital signs include: temperature 38.6°C (101.5°F), blood pressure 120/85 mm Hg, pulse 100/min, respiratory rate 26/min, and oxygen (O2) saturation 87%. A decrease in breathing sounds with expiratory wheezes is heard on auscultation of the lungs. The arterial blood gas (ABG) analysis shows:
PCO2 60 mm Hg
PO2 45 mm Hg
pH 7.3
HCO3– 25 mEq/L
Which of the following is the most appropriate next step in the treatment?

Accepted Answer

O2 supplementation

Answer

Aminophylline

Answer

Methylprednisolone

Answer

Albuterol

Answer

Levofloxacin

Question 3

A 67-year-old man is brought to the emergency department because of increasing shortness of breath that began while playing outdoors with his grandson. He has a history of asthma but does not take any medications for it. On arrival, he is alert and oriented. He is out of breath and unable to finish his sentences. His pulse is 130/min, respirations are 23/min and labored, and blood pressure is 110/70 mm Hg. Physical examination shows nasal flaring and sternocleidomastoid muscle use. Pulmonary exam shows poor air movement bilaterally but no wheezing. Cardiac examination shows no abnormalities. Oxygen is administered via non-rebreather mask. He is given three albuterol nebulizer treatments, inhaled ipratropium, and intravenous methylprednisolone. The patient is confused and disoriented. Arterial blood gas analysis shows:
pH 7.34
Pco2 44 mm Hg
Po2 54 mm Hg
O2 saturation 87%
Which of the following is the most appropriate next step in management?

Accepted Answer

Endotracheal intubation

Answer

Flexible bronchoscopy

Answer

Intravenous magnesium sulfate therapy

Answer

Continuous albuterol nebulizer therapy

Answer

Intravenous theophylline therapy

Question 4

A previously healthy 64-year-old woman comes to the physician because of a dry cough and progressively worsening shortness of breath for the past 2 months. She has not had fever, chills, or night sweats. She has smoked one pack of cigarettes daily for the past 45 years. She appears thin. Examination of the lung shows a prolonged expiratory phase and end-expiratory wheezing. Spirometry shows decreased FEV1:FVC ratio (< 70% predicted), decreased FEV1, and a total lung capacity of 125% of predicted. The diffusion capacity of the lung (DLCO) is decreased. Which of the following is the most likely diagnosis?

Accepted Answer

Chronic obstructive pulmonary disease

Answer

Bronchiectasis

Answer

Interstitial lung disease

Answer

Hypersensitivity pneumonitis

Answer

Bronchial asthma

Question 5

A 57-year-old man presents to the clinic for a chronic cough over the past 4 months. The patient reports a productive yellow/green cough that is worse at night. He denies any significant precipitating event prior to his symptoms. He denies fever, chest pain, palpitations, weight changes, or abdominal pain, but endorses some difficulty breathing that waxes and wanes. He denies alcohol usage but endorses a 35 pack-year smoking history. A physical examination demonstrates mild wheezes, bibasilar crackles, and mild clubbing of his fingertips. A pulmonary function test is subsequently ordered, and partial results are shown below:

Tidal volume: 500 mL
Residual volume: 1700 mL
Expiratory reserve volume: 1500 mL
Inspiratory reserve volume: 3000 mL

What is the functional residual capacity of this patient?

Accepted Answer

3200 mL

Answer

4500 mL

Answer

2000 mL

Answer

2200 mL

Answer

3500 mL

Question 6

A 65-year-old man presents to the emergency department with shortness of breath. He was at home cleaning his yard when his symptoms began. The patient is a farmer and does not have regular medical care. He has smoked two packs of cigarettes every day for the past 40 years. The patient lives alone and admits to feeling lonely at times. His temperature is 99.5°F (37.5°C), blood pressure is 159/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 86% on room air. On physical exam, you note a man in distress. Pulmonary exam reveals poor air movement, wheezing, and bibasilar crackles. Cardiac exam is notable for an S4 heart sound. The patient is started on appropriate therapy and his symptoms improve. Prior to discharge he is no longer distressed when breathing and his oxygen saturation is 90% on room air. Which of the following interventions could improve mortality the most in this patient?

Accepted Answer

Varenicline

Answer

Albuterol

Answer

Ipratropium

Answer

Home oxygen

Answer

Magnesium

Question 7

A 72-year-old man being treated for benign prostatic hyperplasia (BPH) is admitted to the emergency department for 1 week of dysuria, nocturia, urge incontinence, and difficulty initiating micturition. His medical history is relevant for hypertension, active tobacco use, chronic obstructive pulmonary disease, and BPH with multiple urinary tract infections. Upon admission, he is found with a heart rate of 130/min, respiratory rate of 19/min, body temperature of 39.0°C (102.2°F), and blood pressure of 80/50 mm Hg. Additional findings during the physical examination include decreased breath sounds, wheezes, crackles at the lung bases, and intense right flank pain. A complete blood count shows leukocytosis and neutrophilia with a left shift. A sample for arterial blood gas analysis (ABG) was taken, which is shown below.
Laboratory test
Serum Na+ 140 mEq/L
Serum Cl- 102 mEq/L
Serum K+ 4.8 mEq/L
Serum creatinine (SCr)  2.3 mg/dL
    Arterial blood gas  
pH 7.12
Po2 82 mm Hg
Pco2 60 mm Hg
SO2% 92%
HCO3- 12.0 mEq/L
Which of the following best explains the patient’s condition?

Accepted Answer

Metabolic acidosis complicated by respiratory acidosis

Answer

Metabolic acidosis complicated by respiratory alkalosis

Answer

Non-anion gap metabolic acidosis

Answer

Respiratory alkalosis complicated by metabolic acidosis

Answer

Respiratory acidosis complicated by metabolic alkalosis

Question 8

A 72-year-old obese man presents as a new patient to his primary care physician because he has been feeling tired and short of breath after recently moving to Denver. He is a former 50 pack-year smoker and has previously had deep venous thrombosis. Furthermore, he previously had a lobe of the lung removed due to lung cancer. Finally, he has a family history of a progressive restrictive lung disease. Laboratory values are obtained as follows:

Oxygen tension in inspired air = 130 mmHg
Alveolar carbon dioxide tension = 48 mmHg
Arterial oxygen tension = 58 mmHg
Respiratory exchange ratio = 0.80
Respiratory rate = 20/min
Tidal volume = 500 mL

Which of the following mechanisms is consistent with these values?

Accepted Answer

Hypoventilation

Answer

Shunt physiology

Answer

High altitude

Answer

V/Q mismatch

Answer

Pulmonary fibrosis

Question 9

A 72-year-old man is brought to the emergency department after an episode of hemoptysis. He has a chronic cough that is productive of copious sputum. Six years ago, he had a stroke that left him with difficulty swallowing. He smoked one pack of cigarettes daily for 40 years, but quit 2 years ago. His respirations are 25/min and labored. Physical examination shows digital clubbing. An x-ray of the chest shows tram track opacities in the lower lung fields. Which of the following is the most likely diagnosis?

Accepted Answer

Bronchiectasis

Answer

Aspiration pneumonia

Answer

Emphysema

Answer

Lung cancer

Answer

Chronic bronchitis

Question 10

A 22-year-old woman presents to the emergency department with a chief concern of shortness of breath. She was hiking when she suddenly felt unable to breathe and had to take slow deep breaths to improve her symptoms. The patient is a Swedish foreign exchange student and does not speak any English. Her past medical history and current medications are unknown. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 90% on room air. Physical exam is notable for poor air movement bilaterally and tachycardia. The patient is started on treatment. Which of the following best describes this patient's underlying pathology?

FEV1 = Forced expiratory volume in 1 second
FVC = Forced vital capacity
DLCO = Diffusing capacity of carbon monoxide

Accepted Answer

Normal DLCO

Answer

Increased FVC

Answer

Increased FEV1

Answer

Increased FEV1/FVC

Answer

Decreased airway tone

Pulmonary

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Atelectasis

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Pulmonary vascular disorders

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Pleural diseases

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