1. Most patients with COPD have a history of:
- Cigarette smoking
- Excessive alcohol consumption
- Seasonal allergies
- Injection drug use
2. Untreated obstructive sleep apnea may result in all of the following except:
- Excessive daytime sleepiness
- Sexual dysfunction
- Increased risk for cardiovascular disease
3. Low birth weight is linked to increased risk of developing:
- Seasonal allergies
- Childhood asthma
4. A history of smoking, abnormal permanent enlargement of the alveoli, cough, and dyspnea suggest:
- Chronic bronchitis
- Obstructive sleep apnea
5. All of the following are increase risk of developing lung cancer except:
- Exposure to radon or asbestos
- Exposure to coal products or radioactive substances such as uranium
- History of seasonal allergies
6. Which of the following statement about lymphangioleiomyomatosisis not true?
- It is a rare lung disease that affects many more women than men
- It involves the growth of smooth muscle cells in the lungs, pulmonary blood vessels, lymphatics, and pleurae
- It is of unknown etiology
- It is considered a neoplastic disease
7. Treatment for influenza generally includes all of the following except:
- Ampicillin and tetracycline
- Rest and ample fluids
- Oseltamivir and zanamivir
- Over-the-counter medications to relive fever, myalgias, and headache
8. Pneumonia may be caused by any of the following except:
- Bee sting
9. The most common causes of pneumonia in children under age 5 are:
10. Concern about the possibility of pandemic tuberculosis has been fueled by a rise in all of the following except:
- The number of reported cases in the U.S.
- MDR TB and XDR TB
11. Occupational exposure to asbestos is associated with increased risk of developing:
- Cystic fibrosis
- Aspiration pneumonia
12. Actions to prevent acute bronchitis may include all of the following except:
- Frequent hand washing
- Annual flu shot
- Wearing a protective mask while using paint or solvents
- Taking high doses of vitamin C
13. All of the following are true about histoplasmosis except:
- Symptoms appear suddenly and are moderate to severe
- It is caused by inhaling the spores of a fungus that arise from soil
- Many cases are asymptomatic
- Symptoms arise within 24 hours of exposure
14. Workers who handle unprocessed cotton are at risk of developing:
15. All of the following statements about pulmonary sarcoidosis are true except:
- It causes dyspnea, dry cough, and chest pain
- African Americans and Scandinavians are disproportionately affected
- It is treated with antiviral agents
- Many cases resolve without intervention
16. Cystic fibrosis patients suffer pulmonary infections of all of the following pathogens except:
- Pseudomonas aeruginosa
- Haemophilus influenzae
- Staphylococcus aureus
- Candida albicans
17. All of the following are true about acute respiratory distress syndrome (ARDS) except:
- It generally arises in persons with serious comorbidities
- It may be life threatening
- It is a common complication of anesthesia
- Some ARDS patients suffer permanent lung damage
18. Hantavirus pulmonary syndrome arises from contact with any of the following except:
- Infected rodents
- Infected rodent urine or droppings
- Infected rodent saliva
- Infected people
19. Symptoms of pertussis include all of the following except:
- Runny nose and mild fever
- Severe coughing
- Choking in infants
20. Silicosis is a disorder characterized by all of the following except:
- Severe cough, tachypnea and weakness
- Fever, night sweats and chest pain
- Paralysis of the lower extremities
Answers and Explanations
Approximately 80% to 90% of COPD diagnoses are attributable to cigarette smoking. About 15% of smokers display the declining pulmonary function that leads to COPD and its associated disability. Although stopping smoking slows the progression of the disease, persons with COP do not recover lost pulmonary function.
Although obstructive sleep apnea may exacerbate symptoms of asthma or COPD, it does not cause these disorders. Obesity is a risk factor for sleep apnea and is related to its severity. Most people with sleep apnea have a BMI greater than 30. Men with a neck circumference of 17 inches or greater and women with a neck circumference of 16 inches or greater are at higher risk for sleep apnea.
Infants with birth weights of 5.5 pounds or less are at a greater risk of respiratory disorders such as asthma than infants with normal birth weights. Risk of developing asthma also appears to be heritable; if both parents have asthma, the risk is 50%. Maternal factors associated with increased risk for asthma include poor maternal nutrition, smoking, and failure to breastfeed.
Emphysema is a chronic obstructive pulmonary disease (COPD). It is the fourth leading cause of death in the United States. Symptoms of emphysema include shortness of breath, wheezing, chronic cough, fatigue, loss of appetite, and weight loss. Smoking, exposure to secondhand smoke, occupational exposure to fumes or dust from chemicals, grain, cotton, wood or mining products, and HIV infection increase risk for emphysema.
In addition to the above-mentioned risk factors, environmental exposure to chemicals such as arsenic, vinyl chloride, and mustard gas increase risk of developing lung cancer. Chronic lung inflammation and scarring resulting from conditions such as silicosis, berylliosis, tuberculosis, and pneumonia also may increase risk.
Lymphangioleiomyomatosis is nonmalignant proliferation of smooth muscle cells. Symptoms include cough, dyspnea, chest pain, and hemoptysis. Because these symptoms are often present in COPD, some cases of lymphangioleiomyomatosis are misdiagnosed. The disease is generally diagnosed using chest x-ray and high-resolution CT; in instances where these are inconclusive, lung biopsy may be performed.
Influenza is a viral respiratory infection that also produces body-wide symptoms, including muscle and joint pain, headache, sore throat, nasal congestion, and fever. Most people with mild influenza recover without drug treatment; however, those with more severe illnesses and persons at increased risk of complications – children less than 2 years of age, pregnant women, older adults and persons with chronic respiratory or immune disorders – may be treated with antiviral drugs.
Pneumonia is an infection of one or both lungs. Along with the above-mentioned causes, pneumonia may result from fungal infection, such as Pneumocystis, and in response to various chemicals. About one-third of pneumonia cases in the United States result from respiratory viruses. Because influenza viruses are the most common viral etiology, preventing influenza via immunization helps to prevent pneumonia.
Children at increased risk of developing pneumonia include those born prematurely, children who breathe secondhand smoke, children with asthma or sickle-cell disease, and children with congenital heart defects or compromised immune systems. Children who are malnourished or in crowded daycare settings also are at increased risk.
Multidrug-resistant tuberculosis (MDR TB) is resistant to isoniazid and rifampin. Extensively-drug resistant tuberculosis (XDR TB) is resistant to at least isoniazid and rifampin and to any fluoroquinolone and at least one of the three second-line injectable drugs: capreomycin, kanamycin, or amikan. An estimated one third of the increase in TB cases worldwide can be attributed to HIV infection, which increases susceptibility to new infection and allows activation of latent TB.
Mesothelioma is a cancer of the lining that protects the internal organs. The pleura, which cover the lungs and line the chest wall, are most commonly affected. Symptoms of mesothelioma include dyspnea resulting from pleural effusion as well as chest wall pain, anemia, hemoptysis, wheezing, hoarseness, cough, weight loss, and fatigue.
The hallmark of acute bronchitis is a persistent couch, which may be dry or productive. Other symptoms include fever, chest pain, sore throat, wheezing, and mild dyspnea. Actions to prevent exposure to environmental irritants such smoke, paint, paint remover, and varnish help to prevent acute bronchitis. Persons age 60 and older may be advised to get vaccinated against pneumococcal pneumonia.
Histoplasmosis is caused by inhaling the spores of the fungus Histoplasma capsulatum, which is found in bird and bat excrement and in soil. Histoplasmosis is often asymptomatic; when it is symptomatic, it is comparable to mild influenza. Chronic histoplasmosis has been compared to tuberculosis. Although most cases resolve spontaneously, antifungal treatment is prescribed for severe infection.
Byssinosis, also known as brown lung disease, is caused by occupational exposure to dust arising from cotton, hemp, and flax processing. Symptoms are comparable to mild asthma and generally resolve when exposure to the irritant ends. Using a facemask to prevent exposure to irritants helps to prevent byssinosis.
Pulmonary sarcoidosis is an inflammatory condition that produces granulomas in the lungs. Granulomas that persist can produce scarring of fibrotic lung tissue, which in the most severe cases develops into pulmonary fibrosis. Chest x-ray, pulmonary function tests, blood tests, bronchoalveolar lavage, and biopsy may be used to diagnose sarcoidosis. When treatment is needed, it is usually a course of corticosteroids.
Bacteria grow in the mucus produced by patients with cystic fibrosis. Pseudomonas aeruginosa is the most common bacterial source of infection in the lungs of patients with cystic fibrosis. Azithromycin is prescribed to combat bacteria in the lungs and aerosolized antibiotics also may be used to treat lung infections.
Acute respiratory distress syndrome (ARDS) is the sudden failure of the lungs to move sufficient oxygen into the blood. Without adequate oxygen supply organ function may be seriously compromised. ARDS may be caused by sepsis, trauma, pulmonary infection, blood transfusions, smoke inhalation, narcotics, aspiration and shock. As many as 30% of cases are fatal.
Hantavirus pulmonary syndrome cannot be transmitted from person to person. The life threatening disease comes from contact with infected rats and mice. There is no treatment or cure for the disease, however timely oxygen therapy to assist with breathing is associated with better clinical outcomes. Nonetheless, of the 465 cases reported in the United States through March 2007, 35% resulted in death.
Symptoms of pertussis often appear similar to cold symptoms; however, they persist and severe coughing may result in transient loss of consciousness, vomiting, and difficulty breathing. Treatment may involve antibiotics and intravenous fluids. Pertussis may be prevented via immunization; the pertussis vaccine is administered in 5 doses from infancy to age 6 and adolescents are given a booster shot between the ages of 11 and 12.
Silicosis is a lung disease that results from the inhalation of particles of silica, a mineral in sand rock and ores. Workers in construction, mining, and sandblasting may be at risk for silicosis. Silica dust produces inflammation, scarring, and nodular lesions in the upper lobes of the lungs. Silicosis is irreversible. Treatment such as cough suppressants, oxygen, and bronchodilators aims to relieve symptoms.