Internal Medicine Exam Pulmonary Disease 2 — Questions and Answers
Question 1: A 55-year-old smoker presents with progressive dyspnea and a barrel chest. Spirometry shows FEV1/FVC ratio of 0.60 and FEV1 40% predicted. Which GOLD stage does this represent?
- GOLD 1 (Mild)
- GOLD 2 (Moderate)
- GOLD 3 (Severe) (Correct answer)
- GOLD 4 (Very Severe)
Correct answer: GOLD 3 (Severe)
GOLD stage 3 (Severe) corresponds to FEV1 30–49% predicted with FEV1/FVC <0.70.
Question 2: A patient with known asthma presents with severe bronchospasm unresponsive to multiple doses of inhaled beta-agonist. What is the most appropriate next step?
- Increase inhaled corticosteroid dose
- Administer IV magnesium sulfate (Correct answer)
- Perform emergency intubation
- Give oral montelukast
Correct answer: Administer IV magnesium sulfate
IV magnesium sulfate causes bronchial smooth muscle relaxation and is indicated in severe asthma refractory to initial beta-agonist and steroid therapy.
Question 3: A 35-year-old nonsmoker with recurrent spontaneous pneumothoraces is found to have lung cysts and renal angiomyolipomas on CT. What is the most likely diagnosis?
- Langerhans cell histiocytosis
- Lymphangioleiomyomatosis (LAM) (Correct answer)
- Birt-Hogg-Dubé syndrome
- Pulmonary sarcoidosis
Correct answer: Lymphangioleiomyomatosis (LAM)
LAM is characterized by diffuse pulmonary cysts, recurrent pneumothoraces, and renal angiomyolipomas, predominantly in women of childbearing age.
Question 4: Which finding on pulmonary function testing is most consistent with pulmonary fibrosis?
- Decreased FEV1/FVC ratio
- Increased total lung capacity
- Decreased DLCO with preserved FEV1/FVC ratio (Correct answer)
- Increased residual volume
Correct answer: Decreased DLCO with preserved FEV1/FVC ratio
Pulmonary fibrosis produces a restrictive pattern with decreased DLCO due to impaired gas exchange across fibrotic lung tissue, and the FEV1/FVC ratio is preserved or elevated.
Question 5: A 60-year-old man with a history of asbestos exposure presents with pleural plaques and mild dyspnea. Which malignancy is he at highest risk for?
- Squamous cell carcinoma of the lung
- Mesothelioma (Correct answer)
- Adenocarcinoma of the lung
- Small cell lung cancer
Correct answer: Mesothelioma
Asbestos exposure is the leading cause of malignant mesothelioma, a tumor arising from the pleural mesothelium.
Question 6: A patient with COPD exacerbation receives supplemental oxygen and develops worsening somnolence. ABG shows pH 7.28, PaCO2 72 mmHg, PaO2 68 mmHg. What is the best next intervention?
- Increase oxygen flow rate to achieve SpO2 >98%
- Start noninvasive positive pressure ventilation (NIPPV) (Correct answer)
- Administer IV sodium bicarbonate
- Perform immediate endotracheal intubation
Correct answer: Start noninvasive positive pressure ventilation (NIPPV)
NIPPV (BiPAP) is the first-line intervention for hypercapnic respiratory failure in COPD exacerbations, reducing the need for intubation and improving outcomes.
Question 7: Which of the following is a characteristic feature of Löfgren syndrome in the context of sarcoidosis?
- Unilateral hilar lymphadenopathy, uveitis, and facial palsy
- Bilateral hilar adenopathy, erythema nodosum, and polyarthritis (Correct answer)
- Pulmonary fibrosis, cor pulmonale, and hemoptysis
- Skin plaques, hypercalcemia, and renal failure
Correct answer: Bilateral hilar adenopathy, erythema nodosum, and polyarthritis
Löfgren syndrome is an acute form of sarcoidosis presenting with bilateral hilar adenopathy, erythema nodosum, and polyarthritis, and carries an excellent prognosis.
Internal Medicine Exam Pulmonary Disease 2
A 55-year-old smoker presents with progressive dyspnea and a barrel chest.
Spirometry shows FEV1/FVC ratio of 0.60 and FEV1 40% predicted.
Which GOLD stage does this represent?