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Pulmonology Flashcards

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  1. A 48-year-old male with scleroderma presents with hemoptysis and renal failure. Urinalysis shows RBC casts. ANCA is negative. Chest CT shows bilateral ground-glass opacities. Anti-GBM antibody is positive. What is the diagnosis?

    Answer: Goodpasture syndrome

    Anti-GBM antibody positivity with pulmonary hemorrhage and rapidly progressive glomerulonephritis (RBC casts) is diagnostic of Goodpasture syndrome.

  2. A 38-year-old male with no prior lung disease is found to have bilateral apical bullae. He is a tall, thin male. Which genetic condition should be considered?

    Answer: Marfan syndrome

    Marfan syndrome is associated with apical bullae and spontaneous pneumothorax in tall, thin individuals due to connective tissue abnormalities affecting the lung.

  3. A 55-year-old female ex-smoker with COPD (FEV1 45% predicted) has had 3 exacerbations in the past year requiring hospitalization. Her current regimen is LAMA + LABA. What additional therapy has shown mortality benefit in this patient?

    Answer: Inhaled corticosteroid (ICS)

    Adding ICS to LAMA+LABA (triple therapy) reduces exacerbations and has shown mortality benefit in COPD patients with frequent exacerbations, particularly those with elevated eosinophils.

  4. A 30-year-old woman with lymphangioleiomyomatosis (LAM) has progressive dyspnea and FEV1/FVC of 0.62. Which treatment has been shown to stabilize lung function in LAM?

    Answer: Sirolimus (rapamycin)

    Sirolimus, an mTOR inhibitor, has been shown in clinical trials to stabilize FEV1, improve quality of life, and reduce chylous effusions in LAM.

  5. A 67-year-old male with right lower lobe lung adenocarcinoma is found to have an EGFR exon 19 deletion. What is the preferred first-line systemic therapy?

    Answer: Osimertinib

    Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, is the preferred first-line treatment for EGFR-mutant metastatic NSCLC based on the FLAURA trial.

  6. A 50-year-old male presents with progressive dyspnea, hypoxemia, and bilateral infiltrates 5 days after starting amiodarone. HRCT shows bilateral ground-glass opacities with consolidation in a peripheral distribution. What is the pathological pattern most likely seen on lung biopsy?

    Answer: Organizing pneumonia (OP)

    Amiodarone pulmonary toxicity most commonly manifests as organizing pneumonia (OP) pattern, though it can also cause phospholipidosis and UIP; peripheral consolidation on CT is the OP hallmark.

  7. A 45-year-old female farmer presents with acute dyspnea, fever, and bilateral infiltrates 4-6 hours after entering a hay storage barn. Precipitating antibodies to Thermophilic actinomycetes are positive. What is the diagnosis?

    Answer: Acute hypersensitivity pneumonitis (Farmer's lung)

    Farmer's lung is a classic form of acute hypersensitivity pneumonitis caused by inhalation of thermophilic actinomycetes from moldy hay, occurring 4–8 hours after exposure.