Respiratory

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Chronic Rhinosinusitis

Which one of the following statements about the diagnosis and management of chronic rhinosinusitis (CRS) is false?

  • The rate of asthma among people with CRS is estimated to be 5 times higher than in the general population.
  • The standard imaging modality is a noncontrast CT scan of the sinuses.
  • Endoscopic sinus surgery is effective for patients who have failed standard medical therapy.
  • Monoclonal antibody therapy is not indicated in patients with severe CRS with nasal polyps.
Volume 40.6 - Question 10

COPD

Which one of the following statements comparing the triple inhalers budesonide-glycopyrrolate-formoterol (Breztri) and fluticasone-umeclidinium-vilanterol (Trelegy) in COPD is false?

  • Breztri is associated with a higher incidence of first moderate COPD exacerbations.
  • Breztri is associated with a higher incidence of first admission to hospital for pneumonia.
  • Breztri is a metered dose inhaler containing hydrofluoroalkanes.
  • Breztri is associated with a similar all cause mortality.
Volume 40.6 - Question 9

Asthma Prescribing and Carbon Emissions

Which one of the following statements regarding health professionals’ decision-making when choosing which inhaler to prescribe for asthma to reduce carbon emissions is false?

  • Clinicians assume that older patients would be less motivated by environmental concerns.
  • Familiarity is a key factor in inhaler device choice.
  • Clinicians do not consider stigma a barrier to open discussion of environmental considerations.
  • Pharmacy stock is identified as an external constraint that prevents change in practice.
Volume 40.6 - Question 8

Refractory Chronic Cough

Which one of the following statements about unexplained or refractory chronic cough is false?

  • The absence of cough during sleep is a nonspecific finding.
  • Ipsilateral vagotomy for unresectable lung cancer has alleviated cough
  • Centrally acting neuromodulators, when used alone, have had positive effects on cough-related outcomes.
  • Patients receiving gabapentinoids are at lower risk for severe acute exacerbations of COPD.
Volume 40.5 - Question 28

Varenicline & Vaping

Varenicline, combined with behavioral counseling, increases vaping abstinence in youth who vape nicotine and do not regularly smoke tobacco.

  • True
  • False
Volume 40.5 - Question 27

Inhaled Corticosteroid Use in Chronic Obstructive Pulmonary Disease

Long-term vs short term inhaled corticosteroid use for chronic obstructive pulmonary disease is associated with significantly greater rates of the composite outcome of type 2 diabetes, cataracts, pneumonia, osteoporosis, and nontraumatic fracture; recurrent pneumonia; and recurrent fracture.

  • True
  • False
Volume 40.5 - Question 22

Oxygen Therapy

Among patients with chronic severe hypoxemia at rest, long-term oxygen therapy used for 24 hours per day results in a lower risk of the composite outcome of hospitalization or death within 1 year than therapy for 15 hours per day.

  • True
  • False
Volume 40.4 - Question 33

Corticosteroids in Pneumonia

Corticosteroids are strongly recommended in adults hospitalized with severe bacterial community-acquired pneumonia.

  • True
  • False
Volume 40.3 - Question 21

Tirzepatide for Sleep Apnea

When tirzepatide is used to treat moderate-to-severe sleep apnea in adult obese patients, which one of the following is false?

  • In patients not already receiving treatment with positive airway pressure (PAP), it reduces the apnea-hypopnea index (AHI).
  • In patients receiving PAP, it reduces the AHI.
  • It significantly reduces systolic blood pressure.
  • It is associated with a significant increase in gallbladder-related adverse events.
Volume 40.3 - Question 30

Lung Cancer Among First Nations, Inuit & Métis

Which one of the following statements regarding lung cancer among First Nations, Inuit and Métis peoples is false?

  • Over 50% of Inuit with small-cell lung cancer are diagnosed with advanced stage disease.
  • First Nations individuals are less likely to be seen at specialized cancer centres in Ontario than non-Indigenous Canadians.
  • The age standardised incidence rate of lung cancer is statistically higher in Métis people than non-Indigenous Canadians.
  • Incidence amongst Inuit women is 2-3 times higher compared to non-Indigenous Canadian women.
Volume 40.3 - Question 8

Bisoprolol for the Reduction of COPD Exacerbations

Among people with COPD at high risk of exacerbation, treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both.

  • True
  • False
Volume 40.2 - Question 33

Prevention of Ventilator-Associated Pneumonia

In patients with acute brain injury, a single (2g) ceftriaxone dose decreased the risk of early ventilator-associated pneumonia.

  • True
  • False
Volume 40.2 - Question 4

Chronic Refractory Cough

Which one of the following statements about chronic refractory cough is false?

  • It is recommended to use inhaled corticosteroids as empiric treatment.
  • Multimodality speech pathology therapy can improve cough frequency.
  • Amitriptyline can be an effective treatment.
  • Gabapentin can be an effective treatment.
Volume 40.1 - Question 20

Chronic Cough

Which one of the following statements about chronic cough is false?

  • The prevalence of asthma in patients with chronic cough ranges from 24% to 32%.
  • Leukotriene inhibitors are recommended as first-line treatment in adults and adolescents with nonasthmatic eosinophilic bronchitis.
  • The presence of acid reflux in patients with chronic cough does not necessarily indicate that the cough is due to GERD.
  • ACE inhibitors should be replaced with an alternative, such as an angiotensin receptor blockers, if patients develop chronic cough.
Volume 40.1 - Question 19

Respiratory Syncytial Virus

Which one of the following statements about respiratory syncytial virus (RSV) infections in children is false?

  • There is no difference in time to improvement between patients with minimal handling versus frequent changes in body position and physical activity.
  • Compared to low flow, high flow nasal cannula oxygen reduces the need for pediatric ICU admission and mechanical ventilation.
  • A single injection of nirsevimab can provide infants protection over an entire RSV season.
  • Vaccinating pregnant people is an effective strategy for protecting infants against RSV.
Volume 40.1 - Question 11

Treatment of Pulmonary Embolism

Which one of the following statements about the treatment of pulmonary embolism (PE) is false? 

  • Embolectomy or catheter-directed treatments are recommended as the first line treatment of high risk PE.  
  • Patients with cancer-associated thrombosis without high risk of gastrointestinal or genitourinary bleeding can be treated with an oral Xa inhibitor (eg, apixaban and rivaroxaban). 
  • Younger patients with subsegmental PE and no evidence of deep venous thrombosis may not require anticoagulation. 
  • Selected patients with acute PE can be managed as outpatients.   
Volume 39.5 - Question 17

Diagnosis of Pulmonary Embolism

Which one of the following statements about the diagnosis of pulmonary embolism (PE) is false? 

  • The sensitivity of clinician gestalt is comparable to that of risk stratification tools. 
  • The fetal radiation exposure for computed tomography pulmonary angiography is dangerous. 
  • False positive results of subsegmental PEs are common.  
  • A normal D-dimer level in non–high-risk patients can safely exclude PE.  
Volume 39.5 - Question 16

Wheezy Toddlers

Which one of the following statements about wheezy toddlers is false?

  • Over half of children in the preschool years have at least one wheezy episode.
  • Most who wheeze repeatedly progress to persistent asthma.
  • There is a lack of demonstrated efficacy for oral corticosteroid use in an outpatient setting.
  • Favorable response to oral corticosteroid therapy in the in-hospital setting has been shown.
Volume 35.61 - Question 19

Cystic Fibrosis

Which one of the following statements about cystic fibrosis is false? 

  • Pancreatic insufficiency occurs in over 80% of patients.   
  • Diabetes affects approximately one quarter of patients older than 30 years of age.   
  • Noncirrhotic portal hypertension without synthetic liver dysfunction is common.   
  • Median age of survival remains <50 years in Canada. 
Volume 39.4 - Question 35

Outdoor Cold Air for Croup Symptoms

A 30-minute exposure to outdoor cold air (<10°C), as an adjunct to oral dexamethasone, is beneficial for reducing the intensity of clinical symptoms in children with croup. 

  • True
  • False
Volume 39.4 - Question 11

Climate Change

Dry powder inhalers produce a smaller carbon footprint than metered dose inhalers when used for asthma maintenance therapy without loss of asthma control.

  • True
  • False
Volume 39.3 - Question 24

Corticosteroid Therapy for CAP

Which one of the following statements about the use of adjunctive corticosteroids for the treatment of patients hospitalized with community acquired pneumonia is false?

  • All cause mortality at 30 days is reduced.
  • Incidence of acute respiratory distress syndrome is reduced.
  • Admissions to ICU are reduced.
  • Incidence of hyperglycaemia is increased.
Volume 39.3 - Question 20

PoCUS & Pleural Effusion Detection

Point of care ultrasound assessment is more accurate than comprehensive physical examination in the detection of pleural effusions.

  • True
  • False
Volume 37.3 - Question 18

Bronchiolitis

Which one of the following statements about diagnosis and treatment of bronchiolitis in infants is true?

  • Chest x-rays are indicated for diagnosis.
  • Salbutamol is beneficial.
  • Routine measurement of oxygen saturation is not recommended in well appearing infants.
  • Inhaled corticosteroids are beneficial.
Volume 39.3 - Question 12

Venous Thromboembolism Treatment

Patients with venous thromboembolism (VTE) who are initiated on apixaban have lower rates for recurrent VTE than those initiated on rivaroxaban.

  • True
  • False
Volume 37.6 - Question 34

Asthma Control

For patients with uncontrolled asthma on inhaled corticosteroid plus long-acting inhaled β2-agonists, adding a long-acting muscarinic antagonist results in each of the following except: 

  • Improvement in asthma control scores    
  • Reduction in severe exacerbation incidence rate   
  • Improvement in asthma-related quality of life   
  • Increased incidence of dysphonia 
Volume 36.5 - Question 31

Adult Pneumonia

Among patients admitted to hospital with community-acquired pneumonia who are clinically stable, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment.  

  • True
  • False
Volume 36.5 - Question 20

Lung Cancer

Low-dose computed tomography screening in high-risk patients is associated with a significant reduction in lung cancer-specific mortality.  

  • True
  • False
Volume 36.4 - Question 34

Sustained Release Morphine in Severe COPD

Regular, low-dose, oral sustained-release morphine for four weeks improves disease-specific health status in patients with COPD.  

  • True
  • False
Volume 36.4 - Question 33

Thunderstorm Asthma

Thunderstorm asthma epidemics result in extra demand on emergency department resources. 

  • True
  • False
Volume 36.4 - Question 32

Racial Bias in Pulse Oximetry Measurement

Reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia. 

  • True
  • False
Volume 36.4 - Question 17

Maintenance Treatment of Asthma

Which one of the following statements about asthma is false? 

  • An inhaled corticosteroid is the most effective maintenance treatment for asthma of any severity.     
  • For persistent asthma, budesonide/formoterol as a single maintenance and reliever therapy reduces the risk of asthma exacerbations.   
  • Neuropsychiatric events have been reported with montelukast.   
  • Anaphylaxis associated with omalizumab invariably occurs within 40 minutes. 
Volume 36.3 - Question 32

Beta Blocker Use in Patients with COPD

Which one of the following statements about the use of beta-blockers in patients with COPD is false? 

  • The use of systemic beta blockers increases the risk of COPD exacerbations.   
  • There is no difference in the rate of COPD exacerbations between patients receiving noncardioselective beta blockers and those not receiving beta blockers.     
  • The risk of in-hospital mortality in patients with COPD treated with beta blockers is lower than that in patients not treated with beta blockers.   
  • The risk of all-cause mortality in patients with COPD treated with beta blockers is lower than that in patients not treated with beta blockers. 
Volume 36.3 - Question 31

Tezepelumab for Severe Asthma

Add-on maintenance treatment with once-monthly injections of tezepelumab can reduce exacerbations in adolescents and adults with severe uncontrolled asthma, irrespective of blood eosinophil levels.

  • True
  • False
Volume 37.6 - Question 8

Active Air Cleaners and COPD

The use of an active air cleaner for 6 months is effective in decreasing the rates of moderate exacerbations in former smokers with moderate to severe COPD.

  • True
  • False
Volume 37.6 - Question 7

Lung Cancer Screening

Annual low-dose CT screening has been recommended in adults 50 to 80 years of age who have a 20 pack-year smoking history.

  • True
  • False
Volume 37.6 - Question 6

Challenges of Sarcoidosis and Its Management

Which one of the following statements about sarcoidosis is false?

  • Incidence peaks at a younger age in women than men.
  • Development requires a genetic predisposition.
  • Chronic disease develops in approximately one third of patients.
  • Most fatal cases are due to advanced lung disease, followed by cardiac complications.
Volume 37.2 - Question 24

Self-management of Asthma

Regularly supported self-management interventions improve quality of life among patients with asthma. 

  • True
  • False
Volume 36.1 - Question 31

Management of Traumatic Hemothorax

Concerning the management of traumatic hemothorax requiring drainage, a 14-Fr percutaneous catheter (pigtail) is as effective as a chest tube.

  • True
  • False
Volume 37.5 - Question 38

Pulmonary Embolism

In nonhypotensive patients with acute symptomatic pulmonary embolism (PE), a high heart rate portends an increased risk of all-cause and PE-related mortality.

  • True
  • False
Volume 38.2 - Question 9

Prone Positioning of Patients with COVID-19

For hospitalized ward patients with COVID-19 and moderate hypoxemia, encouraging prone positioning reduces the risk of worsening respiratory failure.

  • True
  • False
Volume 37.5 - Question 25

Virtual Pulmonary Rehab

For patients with COPD, virtual pulmonary rehabilitation compared to in-person pulmonary rehabilitation results in each one of the following except:

  • Similar improvement in 6 minute walking distance.
  • Similar reduction in symptoms of breathlessness.
  • Similar improvement in quality of life score.
  • Reduced program completion.
Volume 37.5 - Question 19

Influenza Antiviral Treatment and Length of Stay

In children with laboratory-confirmed influenza and high-risk medical conditions not admitted to the ICU, antiviral therapy was associated with significantly shorter hospitalizations if started In the first 2 days from symptom onset.

  • True
  • False
Volume 37.5 - Question 9

COPD and Drugs for Diabetes

In patients with COPD and type 2 diabetes, SGLT-2 inhibitors, compared to sulfonylureas, are associated with a reduced risk of severe COPD exacerbations.

  • True
  • False
Volume 38.4 - Question 30

Dyspnea in Long Covid  

In patients with COVID-19 who received mechanical ventilation and who have persistent dyspnea, dyspnea scores improve more with exercise training rehabilitation therapy than with standard physiotherapy. 

  • True
  • False
Volume 39.1 - Question 26

E-Cigarettes & MI Risk

Nicotine consumption using only e-cigarettes is associated with a lower risk of myocardial infarction compared with traditional cigarette smoking.

  • True
  • False
Volume 38.3 - Question 22

Prone Positioning in Hypoxemic Patients with COVID-19

In non-intubated adults with hypoxemic respiratory failure due to covid-19, awake prone positioning compared with usual care results in which one of the following significantly improved outcomes?

  • Mortality
  • Risk of endotracheal intubation
  • Hospital length of stay
  • Ventilator-free days
Volume 38.3 - Question 13

Dexamethasone and Treatment of Pediatric Asthma Exacerbations

In a pediatric patient with a mild to moderate exacerbation of asthma presenting to the emergency department, a single dose of dexamethasone is not inferior to two doses of dexamethasone.

  • True
  • False
Volume 38.3 - Question 3

Community Acquired Pneumonia

Which one of the following statements about community-acquired pneumonia is false?

  • Death at one year occurs in about 30% of all hospitalized patients.
  • In viral pneumonia, procalcitonin levels are typically high.
  • Testing for viruses should be considered for most patients.
  • Doxycycline is a recommended first-line therapy in healthy patients under 65 years old.
Volume 39.2 - Question 40

Sjogren's Syndrome

Interstitial lung disease is the most frequent pulmonary complication of Sjogren’s Syndrome.

  • True
  • False
Volume 39.2 - Question 39

Occupational Lung Disease

More than 10% of all lung diseases are attributed to occupational exposures. 

  • True
  • False
Volume 39.1 - Question 6

Varenicline and Vaping

Varenicline is effective for increasing the vaping cessation rate in adults who use electronic cigarettes.   

  • True
  • False
Volume 39.1 - Question 5

Right Ventricular Failure

Which one of the following statements about right heart failure is false?

  • Early satiety is a common symptom.
  • Cardiac MRI is the reference standard for assessment of right ventricular ejection fraction.
  • Cardiac sarcoidosis may manifest as predominant right ventricular dysfunction.
  • Direct pulmonary vasodilators are largely beneficial in patients with pulmonary hypertension due to left heart disease.
Volume 38.6 - Question 34

Latent Tuberculosis

Rifamycin-based regimens are preferred therapy for latent tuberculosis because of higher adherence rates than isoniazid regimens.

  • True
  • False
Volume 38.6 - Question 21

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