Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Adult lungs on the family exam: telling asthma from COPD, matching inhalers to the current GINA and GOLD reports, deciding who with pneumonia can go home, and noticing the cough that needs imaging. Children's and newborns' breathing problems have pages of their own.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Tuberculosis: testing and latent infection treatment.
Sleep and upper airway: obstructive sleep apnea, chronic rhinosinusitis.
Red flags: hemoptysis, weight loss, a fixed wheeze, vasculitis clues.
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16 adult respiratory questions
0 / 16 answered16 questions
Tap an option: why each one is right or wrong appears under it.
Adult respiratory care
A 70-year-old man with a 50-pack-year smoking history has had a cough for 2 months with streaks of blood and a 7-kg weight loss. A fixed, monophonic wheeze is heard over the right upper lung field that does not clear with coughing. Which is the most appropriate next step?
Spirometry assesses airflow obstruction, but a fixed one-sided wheeze with hemoptysis and weight loss points to a localized airway lesion that spirometry will not show.
A fixed monophonic wheeze that does not clear with coughing, plus hemoptysis and weight loss in a heavy smoker, suggests an endobronchial tumor; chest CT is the next step, followed by bronchoscopy.
Antibiotics for presumed bronchitis delay the diagnosis of a likely obstructing tumor.
A bronchodilator trial treats diffuse bronchospasm, not a localized fixed obstruction.
A 34-year-old baker has had wheezing, chest tightness, and cough for 6 months. Her symptoms worsen over the workweek and improve during weekends and a recent 2-week vacation. She has no fever, weight loss, or crackles. Which is the most likely diagnosis?
Hypersensitivity pneumonitis causes dyspnea, cough, crackles, and sometimes fever and weight loss, not mainly wheeze.
Vocal cord dysfunction causes inspiratory stridor and throat tightness, often with sudden onset, not a workweek pattern.
Reflux cough is linked to meals and lying down, not to the workplace.
Wheeze, chest tightness, and cough that worsen through the workweek and improve on weekends and vacation in a baker (flour exposure) are occupational asthma; serial peak flow at and away from work supports it.
A 55-year-old woman with severe obstructive sleep apnea has used fixed-setting CPAP for 8 weeks. The download shows use on 95% of nights for 7 hours, minimal mask leak, and a residual AHI of 14 events per hour. She still has daytime sleepiness and her bed partner still hears apneas. What is the most appropriate next step?
Modafinil treats residual sleepiness only after the apnea is adequately treated; her apnea is not yet controlled.
Mask refitting addresses leak, but the download already shows minimal leak.
Hypoglossal nerve stimulation is for patients who cannot use CPAP; she uses it well but at the wrong pressure.
A residual AHI of 14 despite good adherence and little leak means the pressure is too low; auto-titration or a titration study sets an effective pressure.
A 50-year-old man with chronic rhinosinusitis without nasal polyps, confirmed by CT, has used fluticasone nasal spray daily for 8 weeks with correct technique. He still has nasal congestion, facial pressure, and thick postnasal drainage. He has not tried any other treatment. What is the most appropriate addition?
Daily topical decongestants cause rebound congestion (rhinitis medicamentosa).
Long antibiotic courses are not first-line for CRS without polyps and add resistance and adverse effects.
High-volume saline irrigation together with an intranasal steroid is first-line for chronic rhinosinusitis without polyps.
Surgery is considered after maximal medical therapy fails; saline irrigation has not been tried.
A 30-year-old woman with asthma started fluticasone by inhaler 8 weeks ago and now has no daytime or night symptoms. She reports a sore mouth and hoarse voice. Exam shows white plaques on the tongue and palate that scrape off. She does not use a spacer. What is the most appropriate management?
Oral candidiasis from an inhaled steroid is treated with a topical antifungal such as nystatin, rinsing and spitting after each dose, and a spacer to reduce oral deposition.
Montelukast is less effective than an inhaled steroid; switching gives up good asthma control for a treatable side effect.
Every-other-day dosing reduces control and does not address the technique that caused the thrush.
Stopping the inhaled steroid risks losing asthma control; thrush is treated while the controller continues.
A 46-year-old man with COPD (FEV1 48% predicted) remains symptomatic on ICS–LABA therapy. He smoked 10 pack-years and quit at 30, and CT shows panlobular emphysema predominantly at the lung bases. His brother has 'liver problems.' Which test is most appropriate?
Sweat chloride tests for cystic fibrosis, which causes bronchiectasis in younger patients rather than basal panlobular emphysema.
Early emphysema with light smoking, a basal panlobular pattern, and a relative with liver disease suggest alpha-1 antitrypsin deficiency; all adults with COPD should have a level checked once.
Serum ACE has been used in sarcoidosis and does not explain emphysema.
Total IgE is used for allergic asthma and allergic bronchopulmonary aspergillosis, not for early basal emphysema.
A 61-year-old former smoker (35 pack-years) has 1 year of gradually worsening exertional dyspnea and a morning productive cough. He has prolonged expiration, no leg edema, a normal JVP, and a resting SpO2 of 95%. Which test is most appropriate to establish the diagnosis?
Progressive exertional dyspnea and a chronic productive cough in a former heavy smoker suggest COPD, and spirometry showing a post-bronchodilator FEV1/FVC below 0.70 confirms it.
An arterial blood gas assesses severity in hypoxemic or hypercapnic patients; it does not diagnose COPD, and his SpO2 is 95%.
A methacholine challenge is used when asthma is suspected and spirometry is normal.
High-resolution CT is for interstitial lung disease or to assess emphysema extent, not the first diagnostic test for COPD.
A 34-year-old man started rifampin 3 weeks ago for latent tuberculosis and is worried because his urine has turned orange-red. He has no dysuria, flank pain, jaundice, or muscle pain. Urine dipstick is negative for blood and bilirubin, and microscopy shows 0–1 RBCs/hpf. Liver enzymes are normal. What is the most likely explanation?
Myoglobinuria gives a positive dipstick for blood without red cells, and he has no muscle pain.
Glomerular hematuria would give a positive dipstick for blood and red cells on microscopy.
Rifampin colors urine, tears, and sweat orange-red; with a negative dipstick for blood and normal liver tests this is a harmless drug effect.
Hepatitis would raise liver enzymes and give bilirubin on the dipstick; both are normal.
A 68-year-old woman with severe COPD (FEV1 32% predicted) and resting oxygen saturation of 86% has worsening leg edema and abdominal fullness. Examination shows JVD, hepatomegaly, a loud P2, and clear lung bases. Echocardiogram shows a dilated, hypokinetic right ventricle with an estimated pulmonary artery pressure of 58 mmHg and an LVEF of 60%. What is the most likely diagnosis?
An LVEF of 60% excludes heart failure with reduced ejection fraction.
Cirrhosis causes ascites and edema but not an elevated JVP, a loud P2, and a dilated right ventricle.
Constrictive pericarditis causes right-sided congestion with a normal-sized right ventricle and a pericardial knock, not pulmonary hypertension.
Right ventricular dilation and pulmonary hypertension from chronic hypoxemic lung disease, with a normal LVEF, is cor pulmonale.
A 55-year-old presents with chronic cough and dyspnea. Which history detail is pivotal when a pulmonary cause is suspected?
A recent infection explains a short postinfectious cough, not a chronic cough with dyspnea.
Cough after meals suggests reflux or aspiration, which are not pulmonary causes.
Smoking and occupational or environmental inhalation exposures are the main causes of chronic lung disease and shape the workup.
A family history of asthma raises the likelihood of asthma, but it is less important than tobacco and inhalation exposure for chronic cough with dyspnea.
A 54-year-old man has 2 months of persistent sinusitis with bloody nasal crusting, cough with hemoptysis, and dark urine. Examination shows nasal mucosal ulceration and a saddle-nose deformity beginning to form. He has no asthma history, and the eosinophil count is normal. Urinalysis shows red cell casts, and chest CT shows cavitating nodules. What is the most likely diagnosis?
EGPA occurs with asthma and eosinophilia, which he does not have.
IgA vasculitis causes palpable purpura, arthritis, and abdominal pain, mostly in children.
Destructive sinus and nasal disease, cavitating lung nodules, and glomerulonephritis with red cell casts form the triad of granulomatosis with polyangiitis, usually with c-ANCA (PR3).
Microscopic polyangiitis affects the kidneys and lungs but spares the upper airway and does not form granulomas or cavitating nodules.
A 45-year-old man has 3 days of fever, productive cough, and pleuritic pain. There are focal crackles over the right lower lung. He is alert with normal vital signs apart from a temperature of 38.7°C (101.7°F). Which test is needed to confirm the diagnosis of community-acquired pneumonia?
A chest radiograph showing an infiltrate is needed to diagnose community-acquired pneumonia; exam findings alone are not reliable enough.
A CBC supports infection but cannot confirm pneumonia.
Sputum culture is not routine for outpatients with community-acquired pneumonia and does not confirm the diagnosis.
Procalcitonin is not used to diagnose CAP or to decide whether to start antibiotics (ATS/IDSA 2019).
A 62-year-old man with community-acquired pneumonia is alert and oriented. His respiratory rate is 32/min, blood pressure 86/58 mmHg, and BUN 26 mg/dL. What is his CURB-65 score?
A score of 1 misses two of the three abnormal criteria.
A score of 4 would need confusion or age 65 or older, and he has neither.
A score of 2 usually counts either the BP or the BUN but not both; all three abnormal criteria score.
Three points: respiratory rate of 30 or more, systolic BP under 90, and BUN over 19 mg/dL each score 1; he is alert and younger than 65, so a score of 3 supports hospital admission.
A 70-year-old man with stable COPD has a resting oxygen saturation of 87% on room air on two clinic visits 3 weeks apart, without an exacerbation in between. An arterial blood gas shows a PaO2 of 54 mm Hg. He does not smoke. Which management is most appropriate?
Oxygen limited to exertion, with a 6-month recheck, leaves his resting hypoxemia untreated; the survival benefit comes from use for at least 15 hours a day.
Resting PaO2 of 55 mm Hg or less (or SpO2 of 88% or less) confirmed in a stable patient meets criteria for long-term oxygen, which improves survival when used at least 15 hours a day.
CPAP treats obstructive sleep apnea; it does not correct daytime resting hypoxemia from COPD.
Long-term oral steroids do not correct hypoxemia, have no role in stable COPD, and cause serious adverse effects.
A 19-year-old man with asthma comes to urgent care with a 2-day exacerbation. After three albuterol treatments, he is more drowsy and speaks in single words. Which finding best indicates impending respiratory failure?
A peak flow of 65% of personal best indicates a moderate exacerbation, not impending respiratory failure.
A quiet chest with faint breath sounds in a tiring, drowsy patient means so little air is moving that wheeze cannot be generated; it signals impending respiratory failure and the need for emergency transfer.
A respiratory rate of 24 is elevated but does not by itself signal respiratory failure, and a falling rate with drowsiness can be a late sign of fatigue.
Loud wheezes show that air is still moving; they are less ominous than a chest that has gone quiet.
A running total sits here; it fills in after your last pick.
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Inhaler and antibiotic traps
A short-acting beta-agonist alone for asthma. Since 2019 GINA has advised against treating adults and adolescents with a SABA alone. Its preferred track gives low-dose ICS-formoterol whenever symptoms occur, reliever and anti-inflammatory in one inhaler (GINA 2026).
Any ICS-LABA as a reliever. The as-needed approach depends on formoterol's fast onset; salmeterol combinations cannot be used that way.
Inhaled steroids in COPD by symptoms. GOLD 2026 starts most symptomatic patients on a LAMA plus LABA and adds an inhaled corticosteroid for exacerbations with raised blood eosinophils; an ICS without a long-acting bronchodilator is not COPD maintenance therapy.
Antibiotics for acute bronchitis. Otherwise healthy adults do not need them, and the cough can last up to three weeks (CDC).
Outpatient pneumonia without comorbidities. ATS/IDSA 2019 names amoxicillin or doxycycline; a macrolide alone only where pneumococcal macrolide resistance is below 25%. With comorbidities: amoxicillin-clavulanate or a cephalosporin plus a macrolide or doxycycline, or a respiratory fluoroquinolone alone.
Treating a positive TB test straight away. Active disease is excluded first, with a symptom review and a chest radiograph; an interferon-gamma release assay is preferred after BCG vaccination (CDC).
No. GOLD 2023 merged the two high-exacerbation groups into group E, giving A, B and E, and later reports kept that scheme. An item written to the older groups would be out of date.