Question Year Male Question & Answer Guide (With Explanation)

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QUESTION 1 1. A 68 year old male with history of COPD presents to the office with a hx of 2 hospitalizations (for COPD). He notes that he is feeling okay but he reports that he has to stop walking after a few minutes to catch his breath. He denies symptoms at rest. What medication would you place him on? Tiotroprium Albuterol Formoterol Salmeterol QUESTION 2 1. A 72 year old female with history of COPD comes to the office. She is currently taking Salmeterol twice a day along with levalbuterol prn. However, she has increasing symptoms of dyspnea. What should be added to her therapy to help reduce and relieve her symptoms? LAMA ICS SAMA Theophyline QUESTION 3 1. A 21 year old male present to the office for fever, chills, fatigue and cough for the past 5 days. He reports that he had an upper respiratory infection about 3 weeks ago and got better for a few days and now is sick again. His exam shows a fever of 103.7 and the remainder of his vitals are normal. His lung exam shows rales bilaterally without wheezing. He has no known allergies. What is your treatment recommendation? Azithromycin Ventolin inhaler Budesonide Ciprofloxin QUESTION 4 1. A 63yo male is in the office with shortness of breath and wheezing for the past 3 weeks. His chest xray shows flattened diaphrams. On exam he has audible wheezing and appears to be in slight distress with a respiratory rate of 28. He has no fever or chills. You suspect he has emphysema, what medications would you send him home on while performing the rest of your work up? Ventolin and Ipratropium Budesonide/formoterol Fluticasone and Ventolin Prednisone and Levabuterol QUESTION 5 1. A 27 year old patient with a history of asthma appears in your office for a follow-up visit. He reports that he has been free of wheezing for the last several weeks; however, he feels that he is not able to play soccer like he used to as he gets winded very quickly. He is only using an albuterol inhaler at this time before he exercises. You feel that his asthma should be under better control. Which additional medications would you prescribe for him today? 1. Ipatropium Bromide and Albuterol (Combivent 20mcg/100mcg) 2. Fluticasone HFA 88 mcg 3. beclomethasone 480 mcg 4. Budesonide + formoterol 80/4.5 mg QUESTION 6 1. A 28 year old male comes to your clinic with 7 day history of cough. He denies fever, night sweats, SOB, wheezing. He is a non-smoker with no significant past medical history. He is concerned about cough because it is productive with thick yellow-tinged sputum. His vital signs are normal and exam is unremarkable. Your best plan of action is to recommend and/or prescribe the following? Dextromethorphan+guaifenesin Flovent Ipratroprium Azithromyacin QUESTION 7 1. A patients comes to see you for a routine physical. He mentions that he has noticed slowly increasing shortness of breath during exertion. He is a 67 years old and a retired coal miner who has smoked 2-3 packs of cigarettes a day for many years. He also complains of a cough productive of large amounts of whitish sputum, especially in the mornings. He had been attributing his shortness of breath to his weight ( he is quite obese), and admits that he really doesn’t exert himself very much. However, he now has to stop and rest while going up the single flight of stairs leading to his apartment. You note a chest x-ray report on his chart from two years ago that shows lung field hyperinflation. What tests would you order to help you make a diagnosis of COPD in this patient? Peak Flow, Pulse Ox, ABGs CXR, Pulse Ox, Pulmonary Function Tests VQ scan, Pulse Ox, Pulmonary Function Tests CXR, Pulse Ox, ABGs QUESTION 8 1. A 76yo female with PMH of COPD presents with increasing dypsnea a cough with copious amounts of thick yellow green sputum. She denies a fever. Her physical exam is positive for bilateral inspiratory wheezes, rhonchi and hyperresonance with percussion. Her current medications are ipratropium bromide/albuterol MDI and medium dose fluticasone via MDI as well as lisinopril, hydrochlorothiazide, atorvastatin and a baby aspirin daily. What additional treatment would be the best for her today? Cefpodoxime and an injectable, sustained released corticosteroid Clarithromycin and increase in her inhaled corticosteroid via MDI by 2 puffs each day Augmentin and oral theophylline Doxycycline with a short course of an oral corticosteroid QUESTION 9 1. A 24 year old female presents to the office for a routine physical. She has a history of asthma and eczema. She indicates that everything is going well for her. She reports that she takes Symbicort 80/.4.5mcg 2 puffs twice a day and albuterol once a day for wheezing. What would you recommend for her? Continue with current management Increase the Symbicort to 160/4.5mcg Change to Beclomethasone 80mcg Start Advair 100/50mcg 2 puffs twice a day QUESTION 10 1. A 52 year old asthmatic comes to your office with an asthma exacerbation. He reports wheezing and shortness of breath. His RR is 23 and his O2 sat is 91%. What medications would you consider to treat the immediate exacerbation in the office? SABA, montelukast and IV steroids SABA, supplemental O2 and IV Steroids LABA, supplemental O2 and IV steroids LABA, IV Steroids, montelukast

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