Internal Medicine Exam Pulmonary Disease Essentials 5

Question 1

A 40-year-old nonsmoking woman with hemoptysis and renal failure has a chest CT showing bilateral pulmonary infiltrates. Serum ANCA is positive (PR3 pattern). What is the most likely diagnosis?

Accepted Answer

Granulomatosis with polyangiitis (GPA)

Answer

GPA (formerly Wegener's) presents with the classic triad of upper airway, lower airway, and renal disease with positive c-ANCA (anti-PR3) in > 90% of cases.

Question 2

Which statement about the management of community-acquired pneumonia (CAP) requiring ICU admission is correct?

Accepted Answer

Beta-lactam plus macrolide or beta-lactam plus respiratory fluoroquinolone is recommended

Answer

IDSA/ATS guidelines recommend combination therapy with a beta-lactam plus either a macrolide or a respiratory fluoroquinolone for severe CAP requiring ICU admission.

Question 3

A 72-year-old with COPD has resting SpO2 of 87% on room air. Which statement about long-term oxygen therapy (LTOT) is correct?

Accepted Answer

LTOT at ≥ 15 hours/day improves survival in patients with PaO2 ≤ 55 mmHg

Answer

The MRC and NOTT trials showed LTOT used ≥ 15 hours/day improves survival in COPD patients with PaO2 ≤ 55 mmHg (or ≤ 59 mmHg with cor pulmonale or polycythemia).

Question 4

A 30-year-old woman presents with pleuritic chest pain, dyspnea, and a Wells score of 5. D-dimer is 1.8 μg/mL. What is the next best step?

Accepted Answer

Start anticoagulation and confirm diagnosis with CT pulmonary angiography

Answer

A Wells score > 4 indicates high pretest probability for PE; a positive D-dimer in this context mandates confirmatory CT-PA and concurrent anticoagulation if no contraindication.

Question 5

A patient with severe persistent asthma remains uncontrolled on high-dose ICS/LABA and tiotropium. Serum IgE is 850 IU/mL and blood eosinophils are 350 cells/μL. Which biologic therapy targets both IgE and is FDA-approved for this patient?

Accepted Answer

Omalizumab (anti-IgE)

Answer

Omalizumab binds free IgE and is indicated for moderate-to-severe allergic asthma with elevated serum IgE (30-700 IU/mL) in patients ≥ 6 years; at 850 IU/mL it exceeds the labeled range but dupilumab or mepolizumab would be alternatives.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Exam Pulmonary Disease Essentials 5