ITE Pulmonology 2

Question 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?

Accepted Answer

Haldane effect releasing CO2 from hemoglobin

Answer

Increased dead space ventilation

Answer

Suppression of hypoxic drive reducing minute ventilation

Answer

Worsening V/Q mismatch from oxygen-induced pulmonary vasoconstriction

Question 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?

Accepted Answer

Idiopathic pulmonary fibrosis (IPF)

Answer

Nonspecific interstitial pneumonia (NSIP)

Answer

Cryptogenic organizing pneumonia (COP)

Answer

Hypersensitivity pneumonitis

Question 3

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

Accepted Answer

Observation and monitoring

Answer

Start prednisone 40 mg/day

Answer

Start methotrexate

Answer

Perform surgical lung biopsy

Question 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?

Accepted Answer

Needle aspiration

Answer

Small-bore chest tube placement

Answer

Observation with 100% oxygen

Answer

Video-assisted thoracoscopic surgery (VATS)

Question 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?

Accepted Answer

N2

Answer

N1

Answer

N3

Answer

M1a

Question 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?

Accepted Answer

Trimethoprim-sulfamethoxazole + prednisone

Answer

Azithromycin + ethambutol

Answer

Fluconazole

Answer

Ganciclovir

Question 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?

Accepted Answer

CPAP therapy

Answer

Mandibular advancement device

Answer

Positional therapy

Answer

Uvulopalatopharyngoplasty (UPPP)