Pulmonology 1 The Audio PANCE and PANRE Podcast Topic Specific Review Episode 29

Welcome to episode 29of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast. Over the next few episodes, I will be covering topic specific PANCE and PANRE review from the Academy course content following the NCCPA content blueprint. This week we will be covering 10 topic specific Pulmonology board review questions. Below you will find an interactive exam to complement the podcast. I hope you enjoy this free audio component to the examination portion of this site. The full pulmonology review includes over 142 pulmonology specific questions andis available to all members of the PANCE and PANRE Academy. You can download and listen to past FREE episodes here,oniTunesor StitcherRadio. You can listen to the latest episode, take an interactive quizand download your results below. Listen Carefully Then Take The Quiz If you can't see the audio player click here to listen to the full episode. Pulmonology PANCE and PANREPodcast Quiz The Audio PANCE and PANRE Pulmonology Quiz 1 Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed The Audio PANCE and PANRE Pulmonology Quiz 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%% Your answers are highlighted below. Question 1A 45 year-old male presents with sudden onset of pleuritic chest pain, productive cough and fever for 1 day. He relates having symptoms of a "cold" for the past week that suddenly became worse yesterday. Which of the following findings will most likely be seen on physical examination of this patient?Aspoken "ee" heard as "ay"Bhyperresonant percussion noteHint: Consolidation from bacterial pneumonia causes findings of dullness to percussion, late inspiratory crackles and bronchial breath sounds over the involved area.Cwheezes over the involved areaHint: See answer for explanation.Dvesicular breath sounds over involved areaHint: Consolidation from bacterial pneumonia causes bronchial breath sounds over the involved area.Question 1 Explanation: This patient most likely has a bacterial pneumonia with consolidation, which would produce egophony, where a spoken "ee" is heard as "ay."Question 2A foreign body lodged in the trachea that is causing partial obstruction will most likel y produce what physical examination finding?A stridorBaphoniaHint: Aphonia, inability to cough and progressive cyanosis are seen with complete obstruction of the trachea, not partial obstruction.Cinability to coughHint: Aphonia, inability to cough and progressive cyanosis are seen with complete obstruction of the trachea, not partial obstruction.Dprogressive cyanosis Hint: Aphonia, inability to cough and progressive cyanosis are seen with complete obstruction of the trachea, not partial obstruction.Question 2 Explanation: An inspiratory wheeze is called stridor, which indicates a partial obstruction of the trachea or larynx.Question 3On physical examination you note diminished breath sounds over the right lower lobe with decreased tactile fremitus and dullness to percussion. Which of the following is the most likely cause?AasthmaHint: Asthma is characterized by decreased tactile fremitus, but would have resonant to hyperresonant percussion, not dullness.BconsolidationHint: Consolida tion from pneumonia is characterized by dullness to percussion, but would have an increased, not decreased, tactile fremitus.CpneumothoraxHint: pneumothorax is characterized by decreased to absent tactile fremitus, but would have a hyperresonant percussion note, not dullness.Dpleural effusionQuestion 3 Explanation: A decreased tactile fremitus and dullness to percussion would be found in a pleural effusion. No answers yet Question 4Which of the following is essential to make a diagnosis of cystic fibrosis?APositive family historyHint: Cystic fibrosis is a genetic disease, but a positive family history in and of itself is not enough to diagnose the condition.BElevated sweat chlorideCRecurrent respiratory infectionsHint: While recurrent respiratory infections are a classic presentation of cystic fibrosis, the diagnosis relies on confirmation.DElevated trypsinogen levels Hint: Trypsinogen levels are used as a neonatal screening test and if elevated should be followed by more definitive testing to confirm the diagnosis.Question 4 Explanation: The diagnosis of cystic fibrosis is made only after an elevated sweat chloride test or demonstration of a genotype consistent with cystic fibrosis.Question 5An adult patient who is HIV positive receives a PPD. He develops an area of induration that measures 8 mm after 48 hours. Which of the following is the most appropriate interpretation of this test result?Apositiv eBnegativeHint: See answer for explanationCactive infectionHint: A positive PPD identifies patients that have been infected with Mycobacterium tuberculosis, but does not indicate whether the disease is currently active or inactive.Dfalsely negative Hint: See answer for explanationQuestion 5 Explanation: A reaction size of greater than or equal to 5 mm in a HIV positive patient is considered a positive tuberculin skin test reaction. CDC PPD Interpretation GuidelinesQuestion 6A 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 and since yesterday she has been using her albuterol inhaler every 4-6 hours. She is normally very active, however yesterday she did not complete her 30 minutes 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?Achest x-rayHint: A chest x-ray should be ordered in an asthmatic patient only if you are concerned about the presence of pneumonia or pneumothorax, neither of which is supported by the H A peak flow reading will help you to gauge her current exte nt of airflow obstruction and is helpful in monitoring the effectiveness of any treatment interventions. Question 7A patient presents with a history of progressive worsening of dyspnea over the past several years. He gives a history of having worked as a ship builder for over 50 years. He denies any alcohol or tobacco use. On examination you note clubbing and inspiratory crackles. Which of the following chest x-ray findings support your suspected diagnosis?Ahyperinflation and flat diaphragmsHint: Chest x-ray findings of hyperinflation and flat diaphragms suggest long-standing chronic obstructive lung disease.Binterstitial fibrosis and pleural thickeningCcavitary lesions involving the upper lobesHint: Chest x-ray findings of cavitary lesions involving the upper lobes suggest pulmonary tuberculosis.D"eggshell" calcification of hilar lymph nodes Hint: Chest x-ray findings of "eggshell" calcification of hilar lymph nodes strongly supports the diagnosis of silicosis. It occurs in workers from mines, foundries, sandblasting, and glass manufacturing.Question 7 Explanation: This patient most li kely has asbestosis, which is supported by his occupation as a ship builder and clinical presentation as noted above. Some occupations are associated with an elevated risk of asbestos exposure. Historically, naval shipyard workers are among the most frequently exposed. It is likely that workers who served between World War II and the Korean War came in contact with dangerous levels of asbestos, increasing their chances of developing diseases like asbestos-related lung cancer and mesothelioma. Chest x-ray findings include interstitial fibrosis, pleural thickening and calcified pleural plaques on the diaphragm or lateral chest wall. Question 8You are called to the nursery to see a male infant, born by uncomplicated vaginal delivery. He weighs 2,600 grams and has one deep crease on the anterior third of each foot. Respirations are 88 breaths/minute with expiratory grunting and intercostals retractions. He is cyanotic on room air and becomes pink when placed in 60% oxygen. Chest x-ray shows atelectasis with air bronchograms. Which of the following is the most likely diagnosis?Aneonatal pneumoniaHint: While tachypnea, grunting, retractions and cyanosis may be signs of neonatal pneumonia, they are primarily late findings of progressive respiratory distress and would not be seen immediately at the time of delivery. A chest x-ray in pneumonia would also most commonly reveal an infiltrate or effusion.Bcongenital heart diseaseHint: While congenital heart disease may present with cyanosis, the chest x-ray will reveal a cardiac abnormality, such as cardiomegaly.Chyaline membrane diseaseDchronic lung disease of prematurity Hint: Chronic lung disease of prematurity is a complication in about 20% of infants with hyaline membrane disease. It is defined as respiratory symptoms, oxygen requirement and chest x-ray abnormalities at 1 month of age so it cannot be diagnosed at this time in this newborn.Question 8 Explanation: Hyaline membrane disease is the most common cause of respiratory distress in the premature infant. The infant typically presents with tachypnea, cyanosis and expiratory grunting. A chest x-ray reveals hypoexpansion and air bronchograms.Question 9A 15 year-old male presents with a 1 week history of hacking non-productive cough, low grade fever, malaise and myalgias. Examination is unremarkable except for a few scattered rhonchi and rales upon auscultation of the chest. The chest x-ray reveals interstitial infiltrates and a cold agglutinin titer was negative. Which of the following is the most likely diagnosis?Aacute bronchitisHint: While the patient's clinical symptoms of dry cough and rh onchi support this diagnosis, the chest x-ray would be normal or only show a mild increase in bronchovascular markings, not infiltrates.Bviral pneumoniaCmycoplasma pneumoniaHint: While the gradual onset of symptoms suggest mycoplasma, the negative cold agglutinin titer makes this less likely.Dpneumococcal pneumonia Hint: In older children the signs and symptoms of pneumococcal pneumonia are similar to an adult and consist of an abrupt onset of cough, fever and chills. The chest x-ray would reveal a lobar consolidation, not interstitial, picture.Question 9 Explanation: The patient's clinical symptoms as well as chest x-ray findings and negative cold agglutinin titer are most consistent with viral pneumonia. Cold agglutinin would likely be positive in a patient with mycoplasma pneumonia. Question 10A 53 year-old female status post abdominal hysterectomy 3 days ago suddenly develops pleuritic chest pain and dyspnea. On exam she is tachycardic and tachypneic with rales in the left lower lobe. A chest x-ray is unremarkable and an EKG reveals tachycardia. Which of the following is the most likely diagnosis?AatelectasisHint: Small atelectasis is commonly asymptomatic, while large atelectasis may produce signs of dyspnea and cough. Exam reveals absence of breath sounds in the area involved and dullness to percussion. A chest x-ray would reveal various findings dependent on the location of the atelectasis, but would not be normal.BpneumothoraxHint: While a pneumothorax commonly presents with pleuritic chest pain and dyspnea, exam would reveal the presence of diminished breath sounds and hyperresonance on the involved side. A chest x-ray would reveal presence of a pleural line on the expiratory chest x-ray.Cpulmonary embolismDmyocardial infarctionHint: While a myocardial infarction usually presents with dyspnea, the chest pain is not usually pleuritic in nature. An EKG would commonly reveal ST segment changes, which would be consistent with ischemia or infarct.Question 10 Explanation: Risk factors for pulmonary embolism include advanced age, surgery and prolonged bedrest. While the diagnosis of pulmonary embolism is difficult due to nonspecific clinical findings, the most common symptoms include pleuritic chest pain and dyspnea associated with tachypnea. Chest x-ray and EKG are usually normal. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 10 questions to complete. List Return Shaded items are complete. 12345678910End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! Looking for all the podcast episodes? This FREE series is limited to every other episode, you can download and enjoy the complete audio series by joiningThe PANCE and PANRE Exam Academy. I will bereleasing new episodes every few weeks. The Academy is currently discounted, so sign up now. Resources and Show Notes: My list of recommended PANCE and PANRE review books This Podcast is also available on iTunes and Stitcher Radio for Android iTunes:The Audio PANCE AND PANRE Podcast iTunes Stitcher Radio:The Audio PANCE and PANRE Podcast Stitcher document.createElement('audio'); http://traffic.libsyn.com/pasquini/Pulmonology_1_The_Audio_PANCE_and_PANRE_Podcast_Topic_Specific_Review_Episode_29.mp3Podcast: Download () | EmbedSubscribe: Apple Podcasts | Android | Email | Google Podcasts | Stitcher | RSS | PANCE and PANRE Podcast PlayerView all posts in this seriesThe Audio PANCE and PANRE Board Review Podcast Episode 1The Audio PANCE and PANRE Board Review Podcast Episode 3The Audio PANCE and PANRE Board Review Podcast Episode 5The Audio PANCE and PANRE Board Review Podcast Episode 7The Audio PANCE and PANRE Board Review Podcast Episode 9The Audio PANCE and PANRE Board Review Podcast Episode 11The Audio PANCE and PANRE Board Review Podcast Episode 13The Audio PANCE and PANRE Board Review Podcast Episode 15The Audio PANCE and PANRE Board Review Podcast Episode 17The Audio PANCE and PANRE Board Review Podcast Episode 19The Audio PANCE and PANRE Board Review Podcast Episode 21The Audio PANCE and PANRE Board Review Podcast Episode 23The Audio PANCE and PANRE Board Review Podcast Episode 25Cardiology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 27Pulmonology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 29Gastroenterology 1: The Audio PANCE and PANRE Podcast Topic Specific Review Episode 31EENT 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 33Genitourinary 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 35Musculoskeletal 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 37Reproductive System 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 39Episode 41: The Audio PANCE and PANRE Board Review PodcastEpisode 43: The Audio PANCE and PANRE Board Review PodcastMurmur Madness: The Audio PANCE and PANRE Episode 45Episode 47: The Audio PANCE and PANRE Board Review Podcast Comprehensive Audio QuizEpisode 49: The Audio PANCE and PANRE Board Review Podcast Comprehensive Audio QuizEpisod e 51: The Audio PANCE and PANRE Board Review Podcast Comprehensive Audio QuizEpisode 53: General Surgery End of Rotation Exam The Audio PANCE and PANRE PodcastEpisode 55: The Audio PANCE and PANRE Board Review PodcastEpisode 57: The Audio PANCE and PANRE Board Review PodcastEpisode 59: Emergency Medicine EOR The Audio PANCE and PANRE Board Review PodcastEpisode 61: The Audio PANCE and PANRE Board Review PodcastEpisode 63: The Audio PANCE and PANRE PA Board Review PodcastPodcast Episode 65: Hepatitis B Breakdown With Joe Gilboy PA-CPodcast Episode 67: Ten PANCE and PANRE Board Review Audio QuestionsPodcast Episode 69: Ten PANCE and PANRE Board Review Audio QuestionsPodcast Episode 71: Ten PANCE and PANRE Board Review Audio QuestionsPodcast Episode 73: Ten FREE PANCE and PANRE Audio Board Review QuestionsPodcast Episode 75: Ten FREE PANCE and PANRE Audio Board Review QuestionsPodcast Episode 77: The Audio PANCE and PANRE Board Review Podcast You may also like -Genitourinary 1: The Audio PANCE and PANRE Board Review Podcast Topic Specific Review Episode 35Welcome to episode 35of the FREE Audio PANCE and PANRE Physician Assistant Board Review Podcast. 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