ITE Pulmonary and Critical Care 2

Question 1

A 58-year-old man with COPD presents with acute hypercapnic respiratory failure.
ABG shows pH 7.28, PaCO2 72 mmHg, PaO2 58 mmHg on room air.
Which intervention is MOST appropriate as first-line therapy?

Accepted Answer

Non-invasive positive pressure ventilation (NIPPV)

Answer

Immediate endotracheal intubation

Answer

High-flow nasal cannula at 40 L/min

Answer

Heliox administration

Question 2

A 45-year-old woman develops acute respiratory distress syndrome (ARDS) after septic shock. P/F ratio is 95. Which ventilator strategy has the strongest mortality benefit?

Accepted Answer

Low tidal volume ventilation at 6 mL/kg IBW with plateau pressure <30 cmH2O

Answer

High tidal volume ventilation at 10 mL/kg IBW

Answer

Pressure-controlled ventilation targeting RR <12 breaths/min

Answer

High PEEP strategy with FiO2 titration only

Question 3

A 62-year-old woman with known pulmonary arterial hypertension presents with worsening dyspnea and right heart failure. Echocardiogram shows RV dilation and septal bowing. Which hemodynamic finding on right heart catheterization confirms WHO Group 1 PAH?

Accepted Answer

Mean PAP >20 mmHg with PCWP ≤15 mmHg and PVR ≥3 Wood units

Answer

Mean PAP >20 mmHg with PCWP >15 mmHg

Answer

Systolic PAP >50 mmHg with normal PVR

Answer

Mean PAP >25 mmHg with elevated cardiac output

Question 4

A 70-year-old man on mechanical ventilation develops sudden hemodynamic instability with decreased breath sounds on the left, tracheal deviation to the right, and rising peak airway pressures. What is the immediate management?

Accepted Answer

Needle decompression of the left hemithorax

Answer

Chest X-ray to confirm diagnosis

Answer

Increase PEEP to recruit atelectatic lung

Answer

Bronchoscopy to assess for mucus plugging

Question 5

A 55-year-old man with idiopathic pulmonary fibrosis (IPF) has FVC 65% predicted and DLCO 48% predicted. Honeycombing is present on HRCT. Which medication has been shown to slow FVC decline in IPF?

Accepted Answer

Nintedanib 150 mg twice daily

Answer

Prednisone 60 mg/day

Answer

N-acetylcysteine 600 mg three times daily

Answer

Azathioprine 150 mg/day

Question 6

A 48-year-old woman with obesity (BMI 38) presents with daytime somnolence, morning headaches, and an AHI of 42 events/hour with SpO2 nadir of 78% on polysomnography. What is the MOST appropriate first-line treatment?

Accepted Answer

Continuous positive airway pressure (CPAP)

Answer

Supplemental oxygen via nasal cannula at night

Answer

Bilevel positive airway pressure (BiPAP)

Answer

Uvulopalatopharyngoplasty (UPPP)

Question 7

A 35-year-old African American woman presents with bilateral hilar lymphadenopathy, erythema nodosum, and polyarthritis. Serum ACE is elevated. Bronchoscopy with BAL shows lymphocytosis with CD4:CD8 ratio of 5:1. What is the MOST likely diagnosis?

Accepted Answer

Sarcoidosis

Answer

Lymphoma with pulmonary involvement

Answer

Hypersensitivity pneumonitis

Answer

Berylliosis