Patho Exam 4

Patients with bronchiectasis can have which of the following anatomic alterations?

1. Hyperinflation

2. Pulmonary embolism

3. Consolidation

4. Pneumothorax

a. 1, 3

b. 1, 4

c. 2, 3, 4

d. 1, 2, 3

a. 1, 3

Rigid and dilated bronchi are the key anatomic alterations found in which type of bronchiectasis?

a. Varicose

b. Cystic

c. Emphysematous

d. Cylindrical

d. Cylindrical

Irregularly dilated and constricted bronchi are the key anatomic alterations found in which type of bronchiectasis?

a. Cystic

b. Varicose

c. Cylindrical

d. Saccular

b. Varicose

Which form of bronchiectasis causes the greatest amount of damage to the tracheobronchial tree?

a. Triphasic

b. Varicose

c. Cystic

d. Fusiform

c. Cystic

Congenital causes of bronchiectasis include:

a. influenza.

b. cystic fibrosis.

c. COPD.

d. rheumatic disease.

b. cystic fibrosis

A mother brought her 2-year-old son to the physician. He has been coughing up secretions and having wheezy breathing ever since choking on food 6 months ago. The physician diagnosed the boy with bronchiectasis. What could be the cause?

a. Cystic fibrosis

b. Measles

c. Asthma

d. Aspiration

d. Aspiration

For religious reasons, a young couple has not given their 4-year-old daughter the usual childhood immunizations. She has been repeatedly hospitalized with pulmonary infections. What should the respiratory therapist caring for the child tell the parents that the child is at risk for developing?

a. Chronic bronchitis

b. Asthma

c. Bronchiectasis

d. Left ventricular hypertrophy

c. Bronchiectasis

Management of the patient with bronchiectasis may include:

1. expectorants.

2. early childhood immunizations.

3. lung resection.

4. lung transplant.

a. 1, 3

b. 3, 4

c. 1, 2, 3

d. 2, 3, 4

c. 1, 2, 3

Which of the following should a patient with bronchiectasis do to reduce the risk for the condition worsening?

1. Avoid air pollution.

2. Get an influenza vaccination.

3. Take an antibiotic every day.

4. Avoid smoking.

a. 3, 4

b. 1, 2, 4

c. 2, 3, 4

d. 1, 2, 3

b. 1, 2, 4

Severe bronchiectasis is associated with:

1. vesicular breath sounds.

2. cor pulmonale.

3. distended neck veins.

4. polycythemia.

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

c. 2, 3, 4

Which of the following pulmonary function testing values would be found in a patient with severe, obstructive bronchiectasis?

1. Decreased RV/TLC ratio

2. Increased PEFR

3. Increased FEF25%-75%

4. Decreased FEF25%-75%

a. 4

b. 2, 3

c. 1, 4

d. 1, 2, 3

a. 4

A patient with long-standing bronchiectasis also has pneumonia. Which of the following hematology test results would be expected?

1. Decreased red blood cell (RBC) count

2. Decreased white blood cell (WBC) count

3. Elevated WBC count

4. Increased hemoglobin and hematocrit

a. 1, 2

b. 3, 4

c. 2, 4

d. 1, 3, 4

b. 3, 4

The preferred imaging method to diagnose a patient's with noncystic fibrosis bronchiectasis is:

a. posterior-anterior radiograph (x-ray).

b. anterior-posterior radiograph (x-ray).

c. high-resolution computed tomography (HR-CT).

d. bronchogram

c. high-resolution computed tomography (HR-CT).

One of the main challenges in caring for a patient with bronchiectasis is:

a. contending with bronchospasm.

b. removing excessive bronchopulmonary secretions.

c. returning the FRC to within normal limits.

d. maximizing gas exchange across the alveolar-capillary membrane.

e. rehydrating dried secretions.

b. removing excessive bronchopulmonary secretions.

In developed countries, the most common cause of acquired bronchiectasis is:

a. emphysema.

b. lung abscess.

c. cystic fibrosis.

d. pulmonary fibrosis.

c. cystic fibrosis.

Which of the following is the hallmark of bronchiectasis?

a. Chronic cough with production of large quantities of foul-smelling sputum

b. Bronchospasm

c. Decreased DL CO with normal to decreased expiratory flowrates on pulmonary function

d. Dyspnea on exertion

a. Chronic cough with production of large quantities of foul-smelling sputum

Which of the following is the usual characteristic of the sputum of a patient with bronchiectasis?

a. It is usually sweet or musky smelling.

b. When examined microscopically there are Kirshman's spirals.

c. It contains eosinophils.

d. It is usually voluminous and tends to settle into several different layers

d. It is usually voluminous and tends to settle into several different layers

A patient with severe bronchiectasis may show:

1. distended neck veins.

2. pitting edema.

3. enlarged and tender liver.

4. S 3 heart sound.

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

d. 1, 2, 3

Hemodynamic findings in a patient with severe bronchiectasis may show:

1. decreased CVP.

2. increased RAP.

3. normal cardiac output.

4. increased PVR.

a. 1

b. 2, 3

c. 2, 3, 4

d. 1, 2, 3

c. 2, 3, 4

Which of the following is the term used to describe the parallel or curved opacity lines of varying length caused by branchial wall thickening that are seen in patients with cylindrical bronchiectasis?

a. Tram-lines

b. Infiltrates

c. Reid lines

d. Tubular lines

Infiltrates

You patient has a bacterial pneumonia. What kills the invading bacteria?
a. macrophages
b. red blood cells
c. polymorphonuclear leukocytes
d. serum fluid

c. polymorphonuclear leukocytes

Which of the following can cause pneumonia?
1. bacteria
2. viruses
3. prions
4. fungi

a. 1, 2
b. 2, 3
c. 1, 2, 4
d. 1, 2, 3, 4

c. 1, 2, 4

The following pulmonary infection is most commonly seen in patients with AIDS:
a. anaerobic
b. pneumocystis carinii
c. streptococcus pneumoniae
d. legionella pneumophila

b. pneumocystis carinii

Ventilator-acquired pneumonia (VAP) is defined as pneumonia that develops:
a. between 24 - 48 hours after endotracheal intubation
b. more than 48 - 72 hours after endotracheal intubation
c. less than 24 hours after mechanical ventilation is started
d. more than 48 - 72 hours after mechanical ventilation is started

d. more than 48 - 72 hours after mechanical ventilation is started

A patient has a pleural effusion related to her pneumonia. What can be used to help treat it?
a. hyperinflation therapy
b. supplemental oxygen
c. thoracentesis
d. percussion and postural drainage

c. thoracentesis

The most commonly prescribed class of antibiotic used against gram-positive bacterial organism is:
a. penicillin (amoxicillin)
b. isoniazid (INH)
c. cephalosporins (cefotaxime)
d. ketoconazole (nizoral)

a. penicillin (amoxicillin)

The most commonly prescribed aerosolized antibiotic used against pneumocystis carinii is:
a. penicillin (penicillin G)
b. tobramycin (TOBI)
c. tetracycline (achromycin)
d. pentamidine isethionate (NebuPent)

d. pentamidine isethionate (NebuPent)

Your patient has bilateral pneumonia. What findings can be expected on the CT scan?
1. depressed diaphragms
2. elongated heart
3. air bronchograms
4. consolidation

a. 3, 4
b. 1, 2
c. 2, 3, 4
d. 1, 2, 3, 4

a. 3, 4

During the early stages of a lung abscess, the pathological process is the same as that of:
a. pulmonary edema
b. bronchopulmonary dysplasia
c. pneumonia
d. pulmonary fibrosis

c. pneumonia

In response to the patient having a lung infection, how does the body respond?
a. polymorphonuclear leukocytes go to the area
b. erythrocytes go to the area
c. surface goblet cells increase mucus production
d. metabolism is decreased

a. polymorphonuclear leukocytes go to the area

In severe cases of tissue necrosis related to an abscess, what can occur?
1. fluid ruptures into a bronchus
2. broncholithiasis occurs
3. bronchospasm will close off the affected bronchi
4. fluid ruptures into the intrapleural space

a. 1, 2
b. 1, 4
c. 3, 4
d. 1, 2, 3

b. 1, 4

Your patient has aspirated. This can result in all of the following EXCEPT:
a. fungal pneumonia
b. anaerobic bacterial pneumoia
c. chemical pneumonitis
d. both B and C

a. fungal pneumonia

Your intubated, unconscious patient has accidentally had the cuff deflated. This has resulted in the aspiration of oral secretions. What microorganisms are likely to be found in her tracheal secretions now?
1. legionalla pneumophila
2. pseudomonas aeruginosa
3. peptococci
4. bacteroides fragilis

a. 1, 3
b. 3, 4
c. 1, 2
d. 1, 2, 4

b. 3, 4

Predisposing factors that frequently lead to the aspiration of gastrointestinal fluids (and anaerobes) are usually related to which of the following?
1. general anesthesia
2. head trauma
3. seizure disorder
4. alcoholic abuse

a. 1, 2
b. 2, 3, 4
c. 1, 2, 3
d. 1, 2, 3, 4

d. 1, 2, 3, 4

A lung abscess may be caused by which of the following?
1. penetrating chest wound
2. septic embolism
3. aspirated foreign body
4. bronchogenic cyst

a. 1, 2
b. 3, 4
c. 1, 2, 4
d. 1, 2, 3, 4

d. 1, 2, 3, 4

What antibiotic agent would be appropriate for treating an anaerobic lung abscess infection?
a. metronidazole (flagyl)
b. pentamidine (NebuPent)
c. fluoroquinolones (levofloxacin)
d. monobactam (aztreonam)

a. metronidazole (flagyl)

A patient with an abscess has coughed out a large volume of brown-colored, putrid sputum. What is the most likely class of microorganism that would cause this?
a. fungi
b. viruses
c. aerobic bacteria
d. anaerobic bacteria

d. anaerobic bacteria

When a lung abscess is seen on a chest radiograph, a distinguising factor is the:
a. solid mass
b. air bronchograms
c. consolidation of the affected segment or lobe
d. air-fluid level in the cavity

d. air-fluid level in the cavity

Which of the following is also known as Friedlander's bacillus?
a. haemophilus influenzae
b. pseudomonas aeruginosa
c. legionella pneumophila
d. klebsiella

d. klebsiella

Ribavirin aerosol has been shown to be effective in treating children with which of the following?
a. klebsiella
b. haemophilus influenzae type B
c. respiratory syncytial virus
d. pseudomonas aeruginosa

c. respiratory syncytial virus

In the absence of a secondary bacterial infection, lung inflammation caused by the aspiration of gastric fluids usually becomes insignificant in approximately how many days?
a. 2
b. 3
c. 5
d. 7

b. 3

Which of the following is or are associated with pneumonia?
1. decreased tactile and vocal fremitus
2. increased C(a-v)O2
3. decreased PEFR
4. increased VC

a. 1 only
b. 3 only
c. 2 and 4
d. 1 and 3

b. 3 only

Which of the following is or are associated with the formation of a lung abscess?
1. bullae or cysts that become infected
2. interstitial lung disease with cavity formation
3. bronchial obstruction with secondary cavitating infection
4. penetrating chest wounds that lead to an infection

a. 1 only
b. 3 only
c. 2 and 4
d. 1, 2, 3, 4

d. 1, 2, 3, 4

Anatomically, a lung abscess most commonly forms in which part(s) of the lung?
1. posterior segment of the upper lobe
2. lateral basal segment of the lower lobe
3. anterior segment of the upper lobe
4. superior segment of the lower lobe

a. 1 only
b. 3 only
c. 1 and 4
d. 2 and 3

c. 1 and 4

Which of the following pulmonay function findings may be associated with a severe and extensive lung abscess?
1. decreased FVC
2. increased PEFR
3. decreased RV
4. increased FRC

a. 3 only
b. 2 and 4
c. 3 and 4
d. 1 and 3

d. 1 and 3

Aspiration pneumonia results in all of the following anatomic alterations EXCEPT:
a. alveolar consolidation
b. destruction of the alveolar-capillary membrane
c. atelectasis
d. inflammation of the alveoli

b. destruction of the alveolar-capillary membrane

What term applies to the filling of alveolar spaces as a result of pneumonia?
a. Antigen-antibody reaction
b. Concretion
c. Effusion
d. Consolidation

c. Effusion

The expression "walking pneumonia" is generally applied to patient with what typed of pneumonia?
a. Klebsiella pneumoniae
b. Pneumocystis carinii
c. Mycoplasma pneumoniae
d. Streptococcus pneumoniae

c. Mycoplasma pneumoniae

The most commonly found bacterial cause for pneumonia is:
a. Pseudomonas aeruginosa
b. Streptococcus pneumoniae
c. Mycoplasma pneumoniae
d. Klebsiella pneumoniae

b. Streptococcus pneumoniae

A patient with severe pneumonia can be expected to have the following:
1. chest pain
2. tachycardia
3. hemoptysis
4. cyanosis

a. 4
b. 2, 3
c. 1, 2, 4
d. 1, 2, 3, 4

d. 1, 2, 3, 4

Which of the following anatomic alterations of the lungs is/are associated with lung abscess?
1. Bronchospasm
2. Alveolar consolidation
3. Atelectasis
4. Excessive airway secretions

a. 3, 4
b. 1, 2
c. 1, 2, 4
d. 2, 3, 4

d. 2, 3, 4

A patient with an abscess had the fluid from it rupture into the intrapleural space. What can this result in?
a. Bronchiectasis
b. Empyema
c. Emphysema
d. Pulmonary embolism

b. Empyema

What is the usual underlying cause of a patient developing a lung abscess?
a. Weakened immune system
b. AIDS
c. Cystic fibrosis
d. Aspiration of gastric and oral fluids

d. Aspiration of gastric and oral fluids

Which of the following groups of microorganisms are usually found to cause a lung abscess?
1. Anaerobic gram negative bacilli
2. Viruses
3. Anaerobic gram positive cocci
4. Fungi

a. 3
b. 1, 3
c. 2, 3, 4
d. 1, 2, 3, 4

b. 1, 3

If a patient is lying supine and vomits and aspirates, the most likely place for a lung abscess to be found is:
a. superior segment of the right lower lobe
b. right middle lobe
c. left upper lobe
d. lingular segments

a. superior segment of the right lower lobe

The chest assessment findings commonly found directly over an abscess include:
1. whispered pectoriloquy
2. dull percussion note
3. bronchial breath sounds
4. diminished breath sounds

a. 2, 3
b. 1, 4
c. 2, 3, 4
d. 1, 2, 3, 4

d. 1, 2, 3, 4

What is the term for the fibrinous membrane that surrounds a lung abscess?

Pyogenic membrane

What is the standard treatment for a lung abscess caused by an anaerobic pathogen?

Clindamycin

when a patient has pneumonia, which of the following would be found in the alveolar effusion fluids?
1. mucus
2. serum fluid
3. saliva
4. red blood cells
a. 1 3
b. 2 4
c. 2 3
d. 1 2 3 4

B. 2 4

A 28-year-old patient who has dogs, parakeets, and cats as pets has been admitted with pneumonia. It is suspected that she acquired the infection from one of her pets. What organism is likely to be found in her sputum?
a. bacteroides melaninogenicus
b. staphylococcus aureus
c. chlamydia psittaci
d. haemophilus influenzae

chlamydia psittaci

overall, most cases of pneumonia are caused by:
a. viruses
b. gram-negative bacteria
c. protozoa
d. fungi

viruses

a patient has a bacterial pneumonia. What kills the invading bacteria?
a. macrophages
b. red blood cells
c. polymorphonuclear leukocytes
d. serum fluid

polymorphonuclear leukocytes

A mother brought her 2 year old son to the physician. He has been coughing up secretions and having wheezy breathing ever since choking on food six months ago. The physician diagnosed the boy with bronchiectasis. What could be the cause?
a.Cystic fibrosis
b.Measles
c.Asthma
d.Aspiration

d.Aspiration

Following a cerebrovascular accident, a patient lying in the supine position aspirated gastric contents. In what areas of the lungs would a lung abscess be most likely to develop?
1. Posterior segment of the upper lobes
2. Apical segments of the upper lobes
3. Superior segments of the lower lobes
4. Anterior segments of both lower lobes

1 and 3

Hemodynamic findings in a patient with severe bronchiectasis may show:
1. decreased CVP.
2. increased RAP.
3. normal cardiac output.
4. increased PVR.
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3

c. 2, 3, 4

Your patient has aspirated. This can result in all of the following, except

1. Anaerobic, bacterial pneumonia.
2. Chemical pneumonitis

Which of the following respiratory care protocols will most help patients with bronchiectasis that is experiencing increased airway resistance with coarse crackles and to prevent or reduce reoccurring infections?

a. airway clearance protocol
b. aerosolized medication therapy c. protocol
d. lung expansion protocol
oxygen therapy protocol

a. airway clearance protocol

All of the following medications are commonly used in the treatment of bronchiectasis Except:

a. Antibiotics
b. Corticosteroids
c. Expectorants
d. Beta 2 Agonist

b. corticosteroids

What is Bronchiectasis?

An acquired disorder of the major bronchi and bronchioles that is characterized by the chronic dilation and distortion of one or more bronchi.

What is the recommended treatment for a lung abscess caused by methicillin-resistant Staphylococcus aureus (MRSA)?
a. Neomycin
b. Linezolid
c. Penicillin
d. Clindamycin

b. Linezolid

Fungal diseases can cause which type of pulmonary disorder?
a. An acute restrictive disorder
b. A chronic restrictive disorder
c. An acute obstructive disorder
d. A chronic obstructive disorder

b. A chronic restrictive disorder

What is considered to be the gold standard for the diagnosis of histoplasmosis?
a. Fungal culture test
b. Blood serum antigen levels
c. Chest x-ray
d. Fungal culture

d. Fungal culture

Anatomic alterations found in the lungs of patients with a fungal infection include:
1. fibrosis of lung parenchyma.
2. alveolar-capillary destruction.
3. hyperinflation.
4. mucosal edema.
a. 1, 2
b. 2, 3
c. 3, 4
d. 1, 2, 4

a. 1, 2

Which of the following is a disadvantage of the fungal culture test?
a. A large amount of blood is needed.
b. It has a high false-positive and is not very accurate.
c. It takes 4 weeks or longer for the fungus to grow.
d. A large amount of lymph node tissue is needed.

c. It takes 4 weeks or longer for the fungus to grow.

Which parts of the lungs are most commonly affected by a fungal infection?
a. Mainstem bronchi
b. Lingula
c. Lower lobes
d. Upper lobes

d. Upper lobes

Fungal lung infections are usually spread by:
a. inhaling spores.
b. blood.
c. contact with infected sputum.
d. inhaling infected droplets.

a. inhaling spores.

A patient lives in Cleveland and has HIV and a weakened immune system. What fungal infection is the patient at risk for developing?
a. Mycoplasma infection
b. Blastomycosis
c. Streptococcal infection
d. Disseminated histoplasmosis

d. Disseminated histoplasmosis

Which type of fungal lung infection frequently results in productive cough with purulent sputum?
a. Staphylococcal infection
b. Blastomycosis
c. Klebsiella infection
d. Histoplasmosis

b. Blastomycosis

A skin test is available to confirm which of the following fungal infections?
a. Coccidioidomycosis
b. Blastomycosis
c. Tuberculosis
d. Pseudomonal infection

a. Coccidioidomycosis

After cleaning out his chicken coop, a farmer has developed a fungal lung infection. What type of infection is it most likely to be?
a. Coccidioidomycosis
b. Blastomycosis
c. Histoplasmosis
d. Cryptococcal infection

c. Histoplasmosis

Which of the following are identified as opportunistic yeast pathogens?
1. Candida albicans
2. Cryptococcus neoformans
3. Aspergillus
4. Mycoplasma
a. 1
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3

d. 1, 2, 3

In the Midwestern part of the United States, what is the most common fungal infection of the lungs?
a. Cryptococcosis
b. Histoplasmosis
c. Blastomycosis
d. Coccidioidomycosis

b. Histoplasmosis

Severe acute respiratory syndrome is believed to be caused by:
a. an arthropod.
b. HIV infection.
c. a coronavirus.
d. H5N1.

c. a coronavirus.

Pulmonary function testing results on a patient with advanced fungal pneumonia will display which of the following?
1. Increased ERV
2. Decreased IRV
3. Decreased IC
4. Increased TLC
a. 1, 4
b. 2, 3
c. 2, 3, 4
d. 1, 2, 3

b. 2, 3

During the advanced stages of a fungal lung infection, which of the following is commonly seen on the chest radiograph?
a. Hyperinflation
b. Spherical nodules
c. Right shift of the heart
d. Cavities

d. Cavities