NSG 6420 WEEK 3 QUIZ / NSG6420 WEEK 3 QUIZ: GRADED A | 100% CORRECT |SOUTH UNIVERSITY
1.
Susan P., a 60-year-old woman with a 30 pack year history,
... [Show More] presents to your primary care practice for
evaluation of a persistent, daily cough with increased sputum production, worse in the morning, occurring over
the past three months. She tells you, “I have the same thing, year after year.” Which of the following choices
would you consider strongly in your critical thinking process?
Seasonal allergies
Acute bronchitis
Bronchial asthma
Chronic bronchitis
2.
The pulmonary component includes an abnormal inflammatory response to noxious stimuli, principally
tobacco, but also occupational and environmental pollutants. The hallmark of chronic bronchitis is a
daily chronic cough with increased sputum production lasting for at least 3 consecutive months in at
least 2 consecutive years, usually worse on awakening; this may or may not be
associated with COPD (GOLD, 2011
3.
A patient presents complaining of a 5 day history of upper respiratory symptoms including nasal congestion
and drainage. On the day the symptoms began he had a low-grade fever that has now resolved. His nasal
congestion persisted and he has had yellow nasal drainage for three days associated with mild headaches. On
exam he is afebrile and in no distress. Examination of his tympanic membranes and throat are normal.
Examination of his nose is unremarkable although a slight yellowish-clear drainage is noted. There is
tenderness when you lightly percuss his maxillary sinus. What would your treatment plan for this patient be?
Observation and reassurance
Treatment with an antibiotic such as amoxicillin
Treatment with an antibiotic such as a fluoroquinoline or amoxicillin-clavulanate
Combination of a low dose inhaled corticosteroid and a long acting beta2 agonist inhaler.
4.
A previously healthy 24 year old man presents at a clinic in Southern New England ten days after a weekend
camping trip. He reports the appearance of a painless skin lesion on his right thigh five days previously. He
now notes malaise, low-grade fever, and migrating joint pain of 48 hours duration. Careful questioning fails to
elicit any recent history of an insect bite. The lesion on the thigh had begun to fade, but you recognize an area
of central clearing with an erythematous margin. Further examination reveals a second, similar lesion near the
right axilla. Question: The patient referred to in the scenario returns three days later complaining of worsening
weakness and lightheadedness. His pulse is 42 and his pressure in the supine position is 90/40. You quickly
obtain an EKG, which reveals third degree heart block. The best management at this point would include: A)
Add oral cefuroxime 500mg po bid to his antibiotic regimen. B) Stop all antibiotics immediately and
administer Benadryl 50mg intramuscularly stat. C) Administer atropine 1mg intravenously, observe the patient
for 4 hours and discharge if he remains stable. D) Admit the patient for cardiac monitoring and begin
intravenous ceftriaxone 2g per day. E) Stop all antibiotics immediately and admit the patient for
electrophysiological studies.
5.
. When palpating the posterior chest, the clinician notes increased tactile fremitus over the left lower lobe. This
can be indicative of pneumonia. Areas of increased fremitus should raise the suspicion of conditions resulting
in increased solidity or consolidation in the underlying lung tissue, such as in pneumonia, tumor, or pulmonary
fibrosis. In the instance of an extensive bronchial obstruction:
6.
Your patient presents with complaint of persistent cough. After you have finished obtaining the History of
Present Illness, you realize that the patient may be having episodes of wheezing, in addition to his cough. The
most common cause of cough with wheezing is asthma. What of the following physical exam findings will
support your tentative diagnosis of asthma?
Clear, watery nasal drainage with nasal turbinate swelling
Pharyngeal exudate and lymphadenopathy
Clubbing, cyanosis and edema.
Diminished lung sounds with rales in both bases
7.
Which of the following imaging studies should be considered if a pulmonary malignancy is suspected
Computed tomography (CT) scan
Chest X-ray with PA, lateral, and lordotic views
Ultrasound
Positron emission tomography (PET) scan
8.
A 26-year-old, non-smoker, male presented to your clinic with SOB with exertion. This could be due to
Exercise-induced cough
Bronchiectasis
Alpha-1 deficiency
Pericarditis
9.
Upon assessment of respiratory excursion, the clinician notes asymmetric expansion of the chest. One side
expands greater than the other. This could be due to
Pneumothorax
Pleural effusion
Pneumonia
Pulmonary embolismefinition
10.
A 72-year-old woman and her husband are on a cross-country driving vacation. After a long day of driving,
they stop for dinner. Midway through the meal, the woman becomes very short of breath, with chest pain and a
feeling of panic. Which of the following problems is most likely?
Pulmonary edema
Heart failure
Pulmonary embolism
Pneumonia
11.
A cough is described as chronic if it has been present for
12.
Testing is necessary for the diagnosis of asthma because history and physical are not reliable means of
excluding other diagnoses or determining the extent of lung impairment. What is the study that is used to
evaluate upper respiratory symptoms with new onset wheeze?
Chest X-ray
Methacholine challenge test
Spirometry, both with and without bronchodilation
Ventilation/perfusion scan
13.
. Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting
cough, hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should
prompt the clinician to suspect:
Legionnaires' disease
Malaria
Tuberculosis
Pneumonia
14.
Your patient has just returned from a 6-month missionary trip to Southeast Asia. He reports unremitting cough,
hemoptysis, and an unintentional weight loss of 10 pounds over the last month. These symptoms should
prompt the clinician to suspect:
Legionnaires' disease
Malaria
Tuberculosis
Pneumonia
15.
A 76-year-old patient with a 200-pack year smoking history presents with complaints of chronic cough,
dyspnea, fatigue, hemoptysis, and weight loss over the past 2 months. The physical exam reveals decreased
breath sounds and dullness to percussion over the left lower lung field. The chest X-ray demonstrates shift of
the mediastinum and trachea to the left. These are classic signs of:
Lung cancer
Tuberculosis
Pneumonia
COPD
16.
A 24-year-old patient presents to the emergency department after sustaining multiple traumatic injuries after a
motorcycle accident. Upon examination, you note tachypnea, use of intercostal muscles to breathe, asymmetric
chest expansion, and no breath sounds over the left lower lobe. It is most important to suspect:
Pulmonary embolism
Pleural effusion
Pneumothorax
Fracture of ribs
17.
A 23-year-old patient who has had bronchiectasis since childhood is likely to have which ofthe following:
Barrel-shaped chest
Clubbing
Pectus excavatum
Prolonged capillary refill
18.
Which of the following is considered a “red flag” when diagnosing a patient with pneumonia
Fever of 102
Infiltrates on chest X-ray
Pleural effusion on chest X-ray
Elevated white blood cell count
19.
A 75-year-old patient with community-acquired pneumonia presents with chills, productive cough, temperature
of 102.1, pulse 100, respiration 18, BP 90/52, WBC 12,000, and blood urea nitrogen (BUN) 22 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:
Can be treated as an outpatient
Requires hospitalization for treatment
Requires a high dose of parenteral antibiotic
Can be treated with oral antibiotics
20.
The following criterion is considered a positive finding when determining whether a patient with asthma can
be safely monitored and treated at home:
Age over 40
Fever greater than 101
Tachypnea greater than 30 breaths/minute
Productive cough
21.
In classifying the severity of your patient presenting with an acute exacerbation of asthma. You determine that
they have moderate persistent symptoms based on the report of symptoms and spirometry readings of the last 3
weeks. The findings that support moderate persistent symptoms include [Show Less]