Pneumonia and Respiratory Infections Practice Questions

30 multiple-choice questions on Pneumonia and respiratory infections for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. You arrive to find an 82-year-old nursing home resident with fever, productive cough, tachypnea, and crackles in the right lower lobe. What is the most likely cause?

   1. A. Hyperventilation syndrome
   2. B. Spontaneous pneumothorax
   3. C. Pneumonia
   4. D. Acute asthma exacerbation
   Show answer

   Answer: C. Pneumonia

   Fever, productive cough, and focal crackles in an older adult strongly suggest pneumonia, which is common in long-term care residents.

2. A 58-year-old has had shaking chills, high fever, and a cough producing rust-colored sputum since yesterday. Which organism is the classic cause of this picture?

   1. A. Mycobacterium tuberculosis
   2. B. Respiratory syncytial virus
   3. C. Bordetella pertussis
   4. D. Streptococcus pneumoniae
   Show answer

   Answer: D. Streptococcus pneumoniae

   Abrupt fever, rigors, pleuritic pain, and rusty sputum are the classic picture of pneumococcal pneumonia. Tuberculosis develops over weeks with night sweats and weight loss. RSV mainly causes bronchiolitis in infants and colds in adults. Pertussis causes coughing fits rather than rusty sputum.

3. Which patient is at highest risk of developing pneumonia?

   1. A. A 79-year-old with a recent stroke
   2. B. A 25-year-old runner with allergies
   3. C. A 45-year-old with treated hypertension
   4. D. A 50-year-old with controlled diabetes
   Show answer

   Answer: A. A 79-year-old with a recent stroke

   Older age, impaired swallowing, immobility, and chronic illness increase pneumonia risk. Stroke patients are particularly prone to aspiration. Controlled diabetes adds some risk and treated hypertension little, but neither approaches the risk of advanced age with stroke-related swallowing problems, and a young runner with allergies is low risk.

4. Aspiration pneumonia in a patient who was upright when aspirating most commonly affects which area?

   1. A. Right lower lobe
   2. B. Right upper lobe
   3. C. Left upper lobe
   4. D. Left lingula
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   Answer: A. Right lower lobe

   The right mainstem bronchus is wider and more vertical, so aspirated material typically settles in the right lower lobe in an upright patient.

5. A 70-year-old with pneumonia is confused, breathing 32 times a minute, with a BP of 104/58. Using the CRB-65 score (one point each for confusion, respiratory rate 30 or more, low BP, and age 65 or more), what is his score?

   1. A. 2
   2. B. 3
   3. C. 1
   4. D. 4
   Show answer

   Answer: D. 4

   He scores 1 for new confusion, 1 for a rate of 30 or more, 1 for BP (systolic under 90 or diastolic 60 or less; his diastolic is 58), and 1 for age 65 or more, for a total of 4, which signals high risk and the need for hospital care. A score of 2 or 3 misses one or two criteria. A score of 1 counts only his age.

6. A 58-year-old with alcohol use disorder has high fever, a severe cough, and thick, dark red sputum that looks like currant jelly. Which organism classically causes this picture?

   1. A. Respiratory syncytial virus
   2. B. Bordetella pertussis
   3. C. Influenza A virus
   4. D. Klebsiella pneumoniae
   Show answer

   Answer: D. Klebsiella pneumoniae

   Klebsiella pneumonia is classically seen in people with alcohol use disorder or diabetes and produces thick, bloody "currant jelly" sputum, often in an upper lobe. RSV causes bronchiolitis in infants and cold-like illness in adults. Pertussis causes coughing fits. Influenza causes fever and dry cough rather than currant jelly sputum.

7. Which sound might you hear over an area of consolidated lung in pneumonia?

   1. A. Normal vesicular sounds
   2. B. Inspiratory stridor
   3. C. Absent sounds bilaterally
   4. D. Bronchial breath sounds
   Show answer

   Answer: D. Bronchial breath sounds

   Consolidated lung transmits sound well, so bronchial (tubular) breath sounds may be heard over areas where normal vesicular sounds are expected.

8. A 47-year-old with pneumonia complains of sharp chest pain that worsens with deep breaths. This type of pain is called:

   1. A. Pleuritic
   2. B. Radiating
   3. C. Anginal
   4. D. Visceral
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   Answer: A. Pleuritic

   Inflammation of the pleura causes sharp, localized pain that worsens with inspiration or coughing.

9. A sheep farmer has had fever, severe headache, and a dry cough for a week. He helped with lambing 2 weeks ago. Which infection does this exposure suggest?

   1. A. Tuberculosis from the sheep's wool
   2. B. Q fever from livestock birth products
   3. C. Legionella from the barn water trough
   4. D. Psittacosis from the sheep's droppings
   Show answer

   Answer: B. Q fever from livestock birth products

   Q fever (Coxiella burnetii) is spread by inhaling dust contaminated by placentas and birth fluids of sheep, goats, and cattle, and causes fever, severe headache, and pneumonia. Wool does not carry tuberculosis. Legionella grows in water systems such as cooling towers, not a farm trough. Psittacosis comes from birds, not sheep.

10. Which patient with a 3-week cough is at highest risk of having active tuberculosis?

    1. A. A teacher with seasonal allergies and a dry cough
    2. B. A runner with exercise-induced bronchospasm
    3. C. A child with a recent cold, runny nose, and a mild cough
    4. D. A man with HIV who was recently released from prison
    Show answer

    Answer: D. A man with HIV who was recently released from prison

    TB risk is highest with HIV or other immune suppression, recent time in prisons or shelters, and birth or travel in high-incidence countries. A long cough in someone with these risks calls for airborne precautions. Allergies, exercise bronchospasm, and a recent cold are common, low-risk causes of cough.

11. Pertussis (whooping cough) is characterized by:

    1. A. Wheezing with hives and itching
    2. B. A barking cough and hoarseness
    3. C. Coughing fits with a 'whoop'
    4. D. Sudden stridor and a muffled voice
    Show answer

    Answer: C. Coughing fits with a 'whoop'

    Pertussis causes paroxysms of coughing followed by a high-pitched inspiratory 'whoop' and can be life-threatening in infants.

12. Respiratory syncytial virus (RSV) most commonly causes which condition in infants?

    1. A. Epiglottitis
    2. B. Pleural effusion
    3. C. Pneumothorax
    4. D. Bronchiolitis
    Show answer

    Answer: D. Bronchiolitis

    RSV is the most common cause of bronchiolitis, causing wheezing, nasal congestion, and respiratory distress in infants.

13. A 35-year-old has had a cough with yellow sputum for 5 days. His temperature is 37.4 °C (99.3 °F), heart rate 84, respiratory rate 16, SpO2 98%, and his lungs are clear. What is most likely?

    1. A. Lobar pneumonia
    2. B. Acute bronchitis
    3. C. Pulmonary embolism
    4. D. Heart failure
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    Answer: B. Acute bronchitis

    A productive cough with normal vital signs and a clear lung exam fits acute bronchitis, usually viral; sputum color alone does not mean bacterial infection. Pneumonia usually causes fever, tachycardia, tachypnea, or focal crackles. A PE causes sudden dyspnea and tachycardia. Heart failure causes orthopnea, edema, and crackles.

14. An hour after vomiting and aspirating while drunk, a man has wheezing, crackles, and an SpO2 of 89%. He has no fever. What best explains his findings?

    1. A. A bacterial pneumonia that has already set in
    2. B. Chemical injury to the lungs from stomach acid
    3. C. A new asthma attack from the alcohol
    4. D. A pulmonary embolism from lying still for hours
    Show answer

    Answer: B. Chemical injury to the lungs from stomach acid

    Inhaling acidic stomach contents causes chemical injury (aspiration pneumonitis) within minutes to hours, with wheezing, crackles, and hypoxemia; bacterial pneumonia may follow later. A bacterial pneumonia usually takes a day or more to develop. Alcohol does not cause a new asthma attack. A PE would not explain an hour-old aspiration with crackles and wheezing.

15. Why is a pulse oximetry reading important in a patient with suspected pneumonia?

    1. A. It rules out sepsis completely
    2. B. Hypoxemia guides oxygen therapy
    3. C. It shows how well he is ventilating
    4. D. A normal value rules out pneumonia
    Show answer

    Answer: B. Hypoxemia guides oxygen therapy

    Pneumonia impairs gas exchange. SpO2 helps identify hypoxemia and guides titration of oxygen. SpO2 reflects oxygenation, not ventilation or CO2, a normal reading does not exclude pneumonia, and it cannot rule out sepsis.

16. A 21-year-old who uses THC vaping cartridges has a week of cough, dyspnea, fever, vomiting, and diarrhea. His SpO2 is 88%. What should you suspect?

    1. A. Simple viral gastroenteritis with dehydration
    2. B. Exercise-induced bronchospasm
    3. C. Vaping-associated lung injury (EVALI)
    4. D. Spontaneous pneumothorax
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    Answer: C. Vaping-associated lung injury (EVALI)

    EVALI combines respiratory symptoms with fever and gastrointestinal complaints in people who vape, most often THC products containing vitamin E acetate, and can progress to respiratory failure. Gastroenteritis does not cause this hypoxemia. Exercise bronchospasm is brief and linked to exertion. A pneumothorax causes sudden pleuritic pain, not a week of fever and vomiting.

17. A 30-year-old has had fever, dry cough, and fatigue for 10 days after cleaning out an old chicken coop in Ohio. Which infection should this exposure raise?

    1. A. Tuberculosis caught from the chickens
    2. B. Histoplasmosis from fungal spores
    3. C. Pertussis from the dust
    4. D. Legionella from the coop
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    Answer: B. Histoplasmosis from fungal spores

    Histoplasma grows in soil enriched with bird or bat droppings, especially in the Ohio and Mississippi River valleys, and disturbing it (cleaning coops, caves, demolition) releases spores that cause a flu-like lung infection. Chickens do not spread tuberculosis. Pertussis spreads between people. Legionella comes from contaminated water systems, not coop dust.

18. Which finding suggests that blood a patient brought up came from the lungs rather than the stomach?

    1. A. Dark "coffee-ground" material after vomiting
    2. B. Blood mixed with partly digested food particles
    3. C. A history of stomach ulcers and nausea
    4. D. Bright red, frothy blood brought up by coughing
    Show answer

    Answer: D. Bright red, frothy blood brought up by coughing

    Blood from the airways is usually bright red and frothy, mixed with sputum, and comes up with coughing. Coffee-ground material, food particles, nausea, and ulcer history point to a gastrointestinal source (hematemesis).

19. A 50-year-old who recently bought a pet parrot has high fever, headache, and a dry cough. Which infection should you mention to the hospital?

    1. A. Rabies from the bird's bite
    2. B. Influenza B from the pet store
    3. C. Psittacosis carried by the bird
    4. D. Asthma from the bird's feathers
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    Answer: C. Psittacosis carried by the bird

    Psittacosis is caused by Chlamydia psittaci, spread in dried droppings and feather dust of pet birds, and causes fever, severe headache, and pneumonia; the exposure history guides antibiotic choice. Birds do not carry rabies. Influenza B spreads from person to person. Feather allergy can cause wheezing but not high fever.

20. Which vaccination helps prevent a common bacterial cause of pneumonia in older adults?

    1. A. Pneumococcal vaccine
    2. B. Hepatitis B vaccine
    3. C. Varicella vaccine
    4. D. Tetanus vaccine alone
    Show answer

    Answer: A. Pneumococcal vaccine

    Pneumococcal vaccines protect against Streptococcus pneumoniae, a common bacterial cause of community-acquired pneumonia.

21. A patient with a cold describes a runny nose, sore throat, and mild cough with normal vital signs. This is best classified as:

    1. A. A pulmonary embolism
    2. B. An acute asthma exacerbation
    3. C. An upper airway infection
    4. D. A lower respiratory infection
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    Answer: C. An upper airway infection

    Upper respiratory infections involve the nose, sinuses, and pharynx and are usually viral and self-limited.

22. A patient with COVID-19 pneumonia is talking comfortably, but his SpO2 is 84% on room air. How should you respond?

    1. A. Reassure him, since he looks comfortable
    2. B. Give oxygen and treat the hypoxemia
    3. C. Recheck it in 30 minutes before acting
    4. D. Have him walk to see if it improves
    Show answer

    Answer: B. Give oxygen and treat the hypoxemia

    Some COVID-19 patients have marked hypoxemia with little visible distress ("silent hypoxemia"), and the low saturation still needs oxygen and close monitoring. Looking comfortable does not make an SpO2 of 84% safe. Waiting delays treatment. Exertion lowers saturation further.

23. A 35-year-old with HIV and a low CD4 count has fever, dry cough, and dyspnea on exertion with an SpO2 that drops when walking. Which infection should be suspected?

    1. A. Pneumocystis pneumonia
    2. B. Viral croup
    3. C. Acute bronchiolitis
    4. D. Streptococcal pharyngitis
    Show answer

    Answer: A. Pneumocystis pneumonia

    Pneumocystis jirovecii pneumonia is an opportunistic infection in immunocompromised patients and classically causes exertional hypoxemia.

24. Which hand-off detail is most useful when transferring a patient with suspected pneumonia and sepsis?

    1. A. His full past surgical history
    2. B. The brand names of his inhalers
    3. C. Vital sign trends and fluids given
    4. D. His family history of lung disease
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    Answer: C. Vital sign trends and fluids given

    Trends in blood pressure, heart rate, mental status, and SpO2, plus the fluid volume and drugs given, let the receiving team continue sepsis care without delay. Surgical history, inhaler brands, and family history are part of the full record but do not drive the next minutes of care.

25. Why are patients with chronic lung disease at increased risk of pneumonia?

    1. A. Lower body temperature
    2. B. Impaired airway clearance
    3. C. Stronger cough reflex
    4. D. Increased white blood cells
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    Answer: B. Impaired airway clearance

    Damaged cilia, mucus pooling, and structural lung changes reduce clearance of pathogens and increase infection risk.

26. A 66-year-old has a fever and green sputum, with dullness to percussion over the right base. Dullness most likely reflects:

    1. A. Consolidation or fluid
    2. B. Trapped air in alveoli
    3. C. A large pneumothorax
    4. D. Diffuse bronchospasm
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    Answer: A. Consolidation or fluid

    Dull percussion suggests lung tissue filled with fluid or inflammatory material, or a pleural effusion. Hyperresonance suggests air.

27. An 82-year-old nursing home resident is short of breath with a temperature of 35.6 °C (96.1 °F), crackles at the right base, and new confusion. How should the low temperature affect your impression?

    1. A. It can occur with severe infection in older adults
    2. B. It rules out pneumonia as the cause
    3. C. It proves the confusion is from cold exposure alone
    4. D. It means sepsis is no longer possible
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    Answer: A. It can occur with severe infection in older adults

    Older adults with pneumonia or sepsis may have a normal or low temperature rather than fever, and hypothermia in sepsis signals a worse prognosis. A low temperature does not rule out infection. Without cold exposure, it does not explain the confusion. Sepsis remains likely given crackles, dyspnea, and new confusion.

28. Two patients with cystic fibrosis at the same clinic both need transport to the hospital. What infection-control advice applies?

    1. A. Keep them at least 6 feet apart, in separate units
    2. B. Transport them together to limit exposures
    3. C. Patients who have no fever need no separation
    4. D. Distance does not matter as long as they wear gloves
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    Answer: A. Keep them at least 6 feet apart, in separate units

    People with cystic fibrosis can pass resistant bacteria such as Pseudomonas and Burkholderia to one another, so the CF Foundation advises keeping them at least 6 feet apart and never transporting two together. Transporting them together increases cross-infection. Carriers can spread bacteria without fever. Gloves do not stop respiratory spread.

29. A 52-year-old with pneumonia is febrile, alert, and has an SpO2 of 90% on room air with mild distress. What is the most appropriate oxygen delivery to start?

    1. A. Nasal cannula, titrated to SpO2
    2. B. Nonrebreather at 15 L/min, left on
    3. C. CPAP at 10 cm H2O at once
    4. D. Immediate BVM ventilation
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    Answer: A. Nasal cannula, titrated to SpO2

    Start with the least invasive device that meets the target SpO2 and escalate as needed. BVM ventilation is for inadequate breathing. A nonrebreather left at 15 L/min overshoots the 94% to 98% target, and CPAP is not the starting device for an alert patient in mild distress whose SpO2 can be corrected with a cannula.

30. Legionnaires' disease is a type of pneumonia often linked to:

    1. A. Cat scratches
    2. B. Undercooked poultry
    3. C. Contaminated water
    4. D. Mosquito bites
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    Answer: C. Contaminated water

    Legionella bacteria grow in water systems such as cooling towers, hot tubs, and plumbing and are spread by inhaling contaminated water droplets.