FREE Internal Medicine Pulmonary Disease Essentials Questions and Answers

Question 1

A 68-year-old male with a 40-pack-year smoking history presents with chronic dyspnea and cough.
Spirometry reveals a post-bronchodilator FEV1/FVC ratio of 0.65 and an FEV1 of 45% predicted.
He has had three exacerbations in the past year, one requiring hospitalization.
His blood eosinophil count is 350 cells/µL.
According to the 2024 GOLD guidelines, what is the most appropriate initial pharmacologic management?

Accepted Answer

LAMA + LABA + Inhaled corticosteroid (ICS) combination therapy

Answer

Long-acting muscarinic antagonist (LAMA) monotherapy

Answer

Long-acting beta-agonist (LABA) + LAMA combination therapy

Answer

Short-acting beta-agonist (SABA) as needed only

Question 2

A 25-year-old woman presents with intermittent episodes of wheezing, shortness of breath, and chest tightness. These symptoms occur 3-4 days a week and awaken her from sleep about twice a month. She uses an albuterol inhaler for symptom relief, which she needs several times a week. According to the most recent GINA guidelines, which of the following is the preferred initial controller therapy?

Accepted Answer

As-needed low-dose inhaled corticosteroid (ICS)-formoterol

Answer

Short-acting beta-agonist (SABA) as needed

Answer

Daily low-dose inhaled corticosteroid (ICS) plus as-needed SABA

Answer

Daily leukotriene receptor antagonist (LTRA)

Question 3

A 55-year-old male presents to the emergency department with acute onset of pleuritic chest pain and dyspnea. His heart rate is 115 bpm, and he has a history of a deep vein thrombosis (DVT) 5 years ago. He is otherwise healthy and takes no medications. His Wells score for pulmonary embolism (PE) is calculated to be 4.5. What is the most appropriate next step in the diagnostic workup?

Accepted Answer

Proceed directly to CT pulmonary angiography (CTPA)

Answer

Order a D-dimer test and proceed based on the result

Answer

Discharge the patient as PE is unlikely

Answer

Start empiric anticoagulation without further imaging

Question 4

A 72-year-old male with a new diagnosis of idiopathic pulmonary fibrosis (IPF) presents for management. His FVC is 75% of predicted. He complains of a persistent dry cough and exertional dyspnea. Which of the following treatments has been shown to slow the rate of FVC decline in patients with IPF?

Accepted Answer

Pirfenidone

Answer

Prednisone

Answer

N-acetylcysteine

Answer

Azathioprine

Question 5

A 65-year-old female is admitted to the hospital from a nursing home with a 3-day history of fever, productive cough, and confusion. A chest x-ray confirms a right lower lobe infiltrate. She was hospitalized and treated with intravenous antibiotics for a urinary tract infection 60 days ago. According to the 2019 IDSA/ATS guidelines for community-acquired pneumonia (CAP), which of the following is an essential component of her initial empiric antibiotic regimen?

Accepted Answer

Coverage for methicillin-resistant Staphylococcus aureus (MRSA)

Answer

Coverage for atypical pathogens with a macrolide

Answer

Monotherapy with a respiratory fluoroquinolone

Answer

Routine use of corticosteroids

Question 6

Which of the following is the defining spirometric criterion for establishing a diagnosis of Chronic Obstructive Pulmonary Disease (COPD)?

Accepted Answer

A post-bronchodilator Forced Expiratory Volume in 1 second (FEV1) to Forced Vital Capacity (FVC) ratio of less than 0.70

Answer

Forced Expiratory Volume in 1 second (FEV1) less than 80% of predicted

Answer

A greater than 12% and 200 mL increase in FEV1 after bronchodilator administration

Answer

Total Lung Capacity (TLC) greater than 120% of predicted