Pulmonary System Practice Problems with Answers

1) A 12-year-old female presents to her PCP with her mother who states that the child has had frequent bouts of “bronchitis” this winter. She also notes that she has occasionally had trouble with wheezing when running laps with her soccer team. She states that this happens 2 to 3 times/week. She states that it does not really affect her activity too much. Examination reveals normal breath sounds. Pulmonary function testing shows decreased FEV1, which reverses after a bronchodilator. What is the most likely diagnosis?

2) A 45-year-old nonsmoker has progressive shortness of breath and a chronic, nonproductive cough over 6 months. Chest X-ray shows a reticular “honeycombing” pattern. Pulmonary function tests reveal a restrictive pattern. Which of the following best describes this condition?

3) A patient will be receiving oxygen for a prolonged period of time. Which of the following modalities should be put into place for this patient?

4) A 56-year-old male with a 40 pack-year smoking history presents with progressive dyspnea and a chronic cough. On physical exam, he has an increased anteroposterior (AP) chest diameter and distant breath sounds with prolonged expiration. Which of the following is the most likely diagnosis?

5) A 12-year-old female presents to her PCP with the complaint of wheezing and coughing when running during soccer. Examination reveals scattered wheezes throughout all lung fields. Which of the following is NOT an appropriate diagnostic tool?

6) A 65-year-old male with a 60 packs/year history of smoking and hypertension presents with complaints of non-productive cough. Physical examination reveals BP 130/80. Pharynx is pink, moist, and without exudate. Cardiac and pulmonary exams are normal. What is the most appropriate FIRST step?

7) A 45-year-old male presents to the ER after experiencing chest pain and dyspnea. EKG shows a prominent S wave in lead 1 and a Q wave and inverted T wave in lead 3. What is the most important NEXT test?

8) Dextromethorphan is commonly used in the treatment which of the following?

9) A 30-year-old male presents to the ER with acute onset of pleuritic chest pain and dyspnea. He is tall, thin, and otherwise healthy. Physical exam reveals hyperresonance to percussion on the right side and diminished breath sounds. Which of the following is the most likely diagnosis?

10) Which of the following is typically prescribed for maintenance treatment of chronic obstructive pulmonary disorder (COPD)?

11) An 18-month-old female presents with her mother, who states that the child has had a persistent cough since she was very young. … She has also been hospitalized recently for some sort of “stomach problem.” Examination reveals a poorly developed child. Examination of the chest reveals coarse wheezes throughout. Sweat test is positive. What is the most likely diagnosis?

12) A 25-year-old female complains of episodic wheezing, chest tightness, and coughing, primarily at night. She notes it often occurs after she exercises. Spirometry reveals a reversible obstructive pattern after bronchodilator administration. Which of the following is the most likely diagnosis?

13) A 65-year-old male with known COPD presents with increased cough, sputum production, and shortness of breath. He has a low-grade fever. He denies hemoptysis. Which of the following is the most appropriate immediate management?

14) A 68-year-old hospitalized patient develops a sudden onset of pleuritic chest pain, tachypnea, and hypoxia. He has been on prolonged bed rest. Which of the following diagnostic tests is most appropriate to confirm the suspected diagnosis?

15) Pleural mesothelioma is a pulmonary disorder most commonly caused by exposure to which of the following?

16) A 54-year-old farmer complains of progressive exertional dyspnea, dry cough, and fatigue. He has worked with hay and moldy crops for 20 years. Chest imaging shows diffuse nodular opacities, and biopsy reveals noncaseating granulomas. Which of the following diagnoses best fits these findings?

17) Albuterol is commonly prescribed to treat which of the following?

18) A 57-year-old male with a 50 packs/year history of smoking presents to his PCP with a six-month history of chronic cough. He reports that the cough is productive in nature and frequently associated with wheezing. Examination of the chest reveals scattered rhonchi and wheezes. Heart sounds are diminished. Pulmonary function testing reveals a reduction in FEV1/FVC ratio that does not respond to bronchodilators. What is the most likely diagnosis?

19) A 55-year-old obese male presents to his PCP with complaints of persistent fatigue. Recently, he has started falling asleep at traffic lights. He states that he never can get enough rest and that he is tired even upon awakening. He often has a headache in the morning. His wife has moved to another bedroom because of his loud snoring. What is the most likely diagnosis?

20) A 42-year-old obese male presents to his PCP with the complaint of excessive fatigue and headache. He states that he even feels tired upon waking and can fall asleep while waiting at traffic lights. Examination reveals an obese male with a neck circumference of 19 inches. Visualization of the tonsilar pillars and uvula is not possible without using a tongue depressor. What is the most important diagnostic tool in evaluating this patient?