Q bank questions
Respiratory
An adult has upper respiratory symptoms and cough for the past 14 days. What should be considered?
(Pertussis)
Pertussis should always be considered in adults who present with acute cough of greater than 5 days’
duration. The incubation period for pertussis is about 7-10 days. Patients present with URI symptoms for
1-2 weeks. The classic paroxysmal cough usually begins in the second week of the illness. The duration of
symptoms and cough are about 3 months even when treated with antibiotics. This is highly infectious
and is a reportable disease.
Mycoplasma pneumoniae is: (a disease with extrapulmonary manifestations)
Mycoplasma is an atypical pathogen and produces atypical pneumonia. It can be difficult to diagnose
because symptoms can be varied and involve multiple body systems (extrapulmonary manifestations).
Infection with Mycoplasma may present with a normal white blood cell count, maculopapular rash, GI
symptoms, tender joints and aches, and, though rare, cardiac rhythm disturbances. Respiratory
symptoms may not be pronounced. On chest X-ray there are some unique findings (peribronchial
pattern) with Mycoplasma. These include thickened bronchial shadow, streaks of interstitial infiltration,
and atelectasis. These are more likely to occur in the lower lobes.
Which medication below is contraindicated in an asthma patient because it may increase risk of
sudden death if used alone? (Long-acting bronchodilator)
A long-acting bronchodilator can be used to treat asthma when it is used in combination with an inhaled
steroid. Otherwise, using a long-acting bronchodilator like salmeterol is contraindicated. There is an
increased risk of sudden death with asthma exacerbations when this class is used solo to treat asthma.
The other choices can be used to treat asthma. Choices vary depending on the patient.
A 75-year-old female with emphysema who has been treated with inhaled steroids for many years
should: (should be screened for osteoporosis)
Older females are at higher risk than others for osteoporosis. This female patient, who has used inhaled
steroids and smokes, has multiple risk factors for osteoporosis. Additionally, she probably has
emphysema because she smoked (or still smokes). If she is Asian or Caucasian, she has still another risk
factor. Screening for osteoporosis should be considered when managing patients with multiple risk
factors.
A patient received the pneumonia immunization at age 60 years. He is 65 years old and presents to
your clinic today. What recommendation should be made about the pneumococcal immunization? (He
should receive another one today)
This patient should receive another one today because he is 65 years old and at least 5 years has elapsed
since his last one. The CDC does not recommend immunizing this patient every 5 years. Two
immunizations are available, PCV13 and PPSV23. He needs both, but PCV13 should be administered
today. PPSV23 should be administered at least 1 year later.
