FREE Internal Medicine Pulmonary Disease Questions and Answers

Question 1

A 67-year-old male with a known diagnosis of severe COPD presents with a 3-day history of increased dyspnea, increased sputum volume, and sputum that has changed from white to green.
He has not required hospitalization.
According to the GOLD 2024 guidelines, which of the following is the most appropriate management in addition to short-acting bronchodilators?

Accepted Answer

Systemic corticosteroids and antibiotics

Answer

Inhaled corticosteroids only

Answer

A long-acting muscarinic antagonist (LAMA) only

Answer

Theophylline and supportive care

Question 2

A 72-year-old former smoker presents with a 2-year history of progressive exertional dyspnea and a persistent dry cough. A high-resolution CT (HRCT) of the chest reveals bilateral, peripheral, and basilar predominant reticular abnormalities with definitive honeycombing. What is the most likely diagnosis based on this classic HRCT finding?

Accepted Answer

Usual Interstitial Pneumonia (UIP) pattern consistent with Idiopathic Pulmonary Fibrosis (IPF)

Answer

Nonspecific Interstitial Pneumonia (NSIP)

Answer

Sarcoidosis

Answer

Hypersensitivity Pneumonitis

Question 3

A 30-year-old patient with persistent asthma is using a low-dose inhaled corticosteroid (ICS) daily and a short-acting beta-agonist (SABA) for relief. She reports waking with cough 3 times per month and using her SABA reliever 4 days a week. According to the 2024 GINA guidelines' preferred pathway, what is the most appropriate next step in management?

Accepted Answer

Switch to a low-dose ICS-formoterol combination for both maintenance and reliever therapy (MART).

Answer

Increase the dose of her current ICS to medium-dose and continue SABA for relief.

Answer

Add a long-acting muscarinic antagonist (LAMA) to her current regimen.

Answer

Add montelukast and continue her current regimen.

Question 4

Which of the following patients meets the 2021 USPSTF criteria for annual screening for lung cancer with low-dose computed tomography (LDCT)?

Accepted Answer

A 65-year-old with a 22 pack-year smoking history who quit smoking 10 years ago.

Answer

A 48-year-old with a 25 pack-year smoking history who currently smokes.

Answer

A 70-year-old with a 15 pack-year smoking history who quit smoking 5 years ago.

Answer

A 55-year-old with a 30 pack-year smoking history who quit smoking 18 years ago.

Question 5

A 60-year-old male presents to the emergency department with sudden-onset, severe dyspnea and syncope. His blood pressure is 75/45 mmHg and heart rate is 140/min. A bedside echocardiogram shows severe right ventricular dilation and dysfunction. A CT angiogram confirms a saddle pulmonary embolism. In the absence of absolute contraindications, what is the most appropriate immediate intervention?

Accepted Answer

Systemic thrombolysis with tissue plasminogen activator (tPA)

Answer

Placement of an inferior vena cava (IVC) filter

Answer

Initiation of unfractionated heparin infusion alone

Answer

Catheter-directed thrombolysis

Question 6

A diagnostic thoracentesis is performed on a patient with a new pleural effusion. The results are: pleural fluid protein 2.5 g/dL and LDH 120 IU/L. The concurrent serum protein is 7.5 g/dL and serum LDH is 300 IU/L (upper limit of normal is 200 IU/L). According to Light's criteria, how should this effusion be classified?

Accepted Answer

Transudative

Answer

Exudative

Answer

Chylous

Answer

Hemorrhagic