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

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.

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

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.

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

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

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

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

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

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

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Pulmonology 2