Respiratory

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Causes of Interstitial Lung Disease

Workplace inhalational exposure to metals is associated with an increased risk of interstitial lung disease in a similar magnitude to smoking and asbestos.  

  • True
  • False
Volume 41.2 - Question 17

Glucocorticoid-Induced Adrenal Insufficiency

Which one of the following statements concerning glucocorticoid-induced adrenal insufficiency is false?  

  • It is the most common form of adrenal insufficiency.  
  • It can be induced by the use of inhaled steroids.  
  • It can result in an adrenal crisis if steroid treatments are weaned too rapidly.  
  • These patients commonly develop mineralocorticoid deficiency.  
Volume 41.2 - Question 2

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

Asthma and COPD

A 73-year-old man presents with a history of progressive shortness of breath. You ask your nurse to perform a spirometry in the office before you see the patient. The prebronchodilator and postbronchodilator FEV1-FVC ratios are 47.8% and 50.3%, respectively. The prebronchodilator and postbronchodilator FEV1 results are 1.52 L and 1.88 L, respectively (increase of 360 mL and 24%).
Volume 37.3 - Question 42

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

Sleep Disorders

Mr. ZS, a 23-year-old patient, is at your office today because he has been having problems falling asleep for the past 3 months. He reports having difficulty initiating sleep within 60 minutes after he lies down to go to bed. He also experiences frequent awakenings once he falls asleep. Sometimes he wakes up earlier than he wants to and has daytime fatigue and irritability as a consequence. This occurs about at least 3 times per week.
Volume 37.6 - Question 40

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

Bronchiectasis

A 60-year-old female in your practice presents with a 9-month history of chronic cough and intermittent shortness of breath. She says the cough is sometimes wet and sometimes dry. She has a history of mild asthma. She has been using her puffers regularly but they don’t always work well. She hasn’t presented before this because she just assumed she was getting different viruses being around her grandchildren who are in daycare. She has not had any fever, chest pain or weight loss. Her only other known medical condition is well controlled rheumatoid arthritis. She is a non-smoker. You wonder if she could have bronchiectasis.
Volume 38.3 - Question 40

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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