Internal Medicine Exam Pulmonary Disease 3

Question 1

A 48-year-old obese man reports excessive daytime sleepiness, loud snoring, and witnessed apneas. Polysomnography shows an AHI of 32. What is the first-line treatment?

Accepted Answer

Continuous positive airway pressure (CPAP)

Answer

CPAP is the first-line treatment for moderate-to-severe obstructive sleep apnea (AHI ≥15), as it maintains airway patency during sleep.

Question 2

A 30-year-old African American woman presents with dyspnea, bilateral hilar lymphadenopathy on CXR, and elevated serum ACE. Transbronchial biopsy shows noncaseating granulomas. What is the diagnosis?

Accepted Answer

Sarcoidosis

Answer

Sarcoidosis classically presents with bilateral hilar adenopathy, elevated ACE, and noncaseating granulomas on biopsy, most commonly in young Black women.

Question 3

Which type of lung cancer is most strongly associated with hypercalcemia without bone metastases?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma secretes PTHrP, causing hypercalcemia of malignancy independent of bone metastases.

Question 4

A 25-year-old tall, thin male develops sudden onset right-sided chest pain and dyspnea. CXR shows a 25% right pneumothorax. He has no prior lung disease. What is the most appropriate management?

Accepted Answer

Tube thoracostomy with chest tube drainage

Answer

A primary spontaneous pneumothorax >20% in a symptomatic patient warrants tube thoracostomy for lung re-expansion.

Question 5

A patient on isoniazid for latent TB develops peripheral neuropathy. Which vitamin deficiency is responsible?

Accepted Answer

Vitamin B6 (pyridoxine)

Answer

Isoniazid inhibits pyridoxine (B6) metabolism, causing peripheral neuropathy; B6 supplementation is given prophylactically.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Pulmonary Disease 3