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Pulmonology Flashcards

7 cards from real ITE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 58-year-old male with COPD has a PaCO2 of 68 mmHg at baseline. He is started on supplemental oxygen and his PaCO2 rises to 82 mmHg with worsening somnolence. Which mechanism best explains this hypercapnia?

    Answer: Haldane effect releasing CO2 from hemoglobin

    The Haldane effect causes oxyhemoglobin to release CO2 more readily, and V/Q mismatch worsening also contributes, but the primary mechanism in COPD oxygen-induced hypercapnia is the Haldane effect displacing CO2 from hemoglobin.

  2. A 45-year-old woman presents with progressive dyspnea and PFTs showing FVC 62%, FEV1 68%, FEV1/FVC 88%, and DLCO 48%. CT chest shows bilateral ground-glass opacities with subpleural honeycombing. What is the most likely diagnosis?

    Answer: Idiopathic pulmonary fibrosis (IPF)

    Subpleural honeycombing on HRCT with a restrictive pattern and reduced DLCO in an older patient is the classic presentation of IPF with a UIP pattern.

  3. A patient with sarcoidosis has bilateral hilar lymphadenopathy on CXR but is asymptomatic. Spirometry is normal. What is the most appropriate management?

    Answer: Observation and monitoring

    Stage I sarcoidosis (bilateral hilar adenopathy without parenchymal infiltrates) in asymptomatic patients frequently remits spontaneously and does not require treatment.

  4. A 32-year-old nonsmoking female develops sudden onset pleuritic chest pain and dyspnea. CXR shows a 30% right-sided pneumothorax. She has no prior history. What is the most appropriate next step?

    Answer: Needle aspiration

    For a first episode of primary spontaneous pneumothorax >20%, needle aspiration is the recommended first-line intervention per BTS guidelines.

  5. A 65-year-old male with a 40 pack-year history presents with hemoptysis and a 3 cm spiculated right upper lobe mass on CT. PET scan shows uptake in the mass and ipsilateral mediastinal nodes. What TNM stage does mediastinal nodal involvement represent?

    Answer: N2

    Ipsilateral mediastinal or subcarinal lymph node involvement is classified as N2 disease in the TNM staging system for lung cancer.

  6. A 28-year-old with HIV (CD4 count 45 cells/µL) presents with fever, dry cough, and progressive dyspnea over 3 weeks. LDH is markedly elevated. CXR shows bilateral interstitial infiltrates. What is the first-line treatment?

    Answer: Trimethoprim-sulfamethoxazole + prednisone

    PCP pneumonia in HIV patients with moderate-to-severe disease (PaO2 35) is treated with TMP-SMX plus adjunctive corticosteroids.

  7. A 55-year-old male with obesity (BMI 38) reports excessive daytime sleepiness and witnessed apneas. Polysomnography shows AHI of 42 events/hour with oxygen desaturations to 78%. What is the most appropriate initial treatment?

    Answer: CPAP therapy

    CPAP is the first-line treatment for moderate-to-severe obstructive sleep apnea (AHI ≥15 events/hour) and is superior to other modalities for symptom relief.