Internal Medicine Exam Pulmonary Disease Essentials 2

Question 1

A 65-year-old smoker presents with chronic productive cough and FEV1/FVC ratio of 0.62 post-bronchodilator. Which GOLD stage classification applies if FEV1 is 45% predicted?

Accepted Answer

GOLD 3 (Severe)

Answer

GOLD Stage 3 (Severe) is defined by FEV1 30-49% predicted with FEV1/FVC < 0.70 post-bronchodilator.

Question 2

Which finding on CT chest is most characteristic of hypersensitivity pneumonitis in the subacute phase?

Accepted Answer

Centrilobular nodules with ground-glass opacity and air trapping

Answer

Subacute hypersensitivity pneumonitis classically shows centrilobular nodules, ground-glass opacity, and mosaic attenuation with air trapping on expiratory CT.

Question 3

A patient with newly diagnosed pulmonary arterial hypertension has a mean PAP of 28 mmHg, PAWP of 10 mmHg, and PVR of 3.5 WU. What is the correct hemodynamic classification?

Accepted Answer

Pre-capillary pulmonary hypertension

Answer

Pre-capillary PH is defined by mean PAP ≥ 20 mmHg, PAWP ≤ 15 mmHg, and PVR ≥ 2 WU.

Question 4

A 35-year-old nonsmoker presents with spontaneous pneumothorax. Chest X-ray shows a 2.5 cm rim of air. What is the most appropriate next step?

Accepted Answer

Needle aspiration and discharge if successful

Answer

For a primary spontaneous pneumothorax > 2 cm in a stable patient, needle aspiration is first-line per BTS guidelines, with discharge if successful.

Question 5

Which medication used for COPD management acts by inhibiting phosphodiesterase-4 to reduce exacerbations?

Accepted Answer

Roflumilast

Answer

Roflumilast is a selective PDE-4 inhibitor that reduces inflammation and decreases exacerbation frequency in severe COPD with chronic bronchitis.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Pulmonary Disease Essentials 2