ITE Pulmonology 3

Question 1

A 40-year-old woman with systemic sclerosis develops worsening dyspnea on exertion.
Echo shows RVSP of 52 mmHg.
Right heart catheterization reveals mPAP 38 mmHg, PCWP 8 mmHg, PVR 6 Wood units.
What is the diagnosis?

Accepted Answer

Pulmonary arterial hypertension (Group 1)

Answer

Heart failure with preserved ejection fraction

Answer

Pulmonary hypertension due to left heart disease (Group 2)

Answer

Chronic thromboembolic pulmonary hypertension (Group 4)

Question 2

A patient with IPF is being considered for antifibrotic therapy. Which of the following has been shown to slow decline in FVC in IPF?

Accepted Answer

Nintedanib

Answer

Prednisone

Answer

N-acetylcysteine

Answer

Azathioprine

Question 3

A 70-year-old male with known COPD presents with increased sputum production, change in sputum color, and worsening dyspnea. He is managed outpatient with a short-acting bronchodilator. Which antibiotic is most appropriate for an uncomplicated AECOPD without risk factors for Pseudomonas?

Accepted Answer

Azithromycin or doxycycline

Answer

Piperacillin-tazobactam

Answer

Ciprofloxacin

Answer

Cefepime

Question 4

A 35-year-old African American female presents with bilateral hilar adenopathy, uveitis, erythema nodosum, and polyarthritis. Serum ACE is elevated. Which finding on bronchoscopy with BAL would most support the diagnosis of sarcoidosis?

Accepted Answer

Lymphocytosis with CD4:CD8 ratio >3.5

Answer

Eosinophilia >25%

Answer

Neutrophilia >50%

Answer

Hemosiderin-laden macrophages

Question 5

A 50-year-old male with a right pleural effusion undergoes thoracentesis. Analysis shows: protein 4.2 g/dL (serum 7.0), LDH 280 U/L (serum 180), glucose 40 mg/dL, pH 7.15. What is the most likely etiology?

Accepted Answer

Parapneumonic effusion/empyema

Answer

Congestive heart failure

Answer

Hepatic hydrothorax

Answer

Pulmonary embolism

Question 6

A 62-year-old former smoker has a 1.2 cm solid pulmonary nodule discovered incidentally on CT. He had a similar CT 2 years ago showing no nodule. What is the most appropriate next step per Fleischner Society guidelines?

Accepted Answer

Short-interval CT follow-up in 3 months

Answer

PET scan

Answer

CT-guided biopsy

Answer

No follow-up needed

Question 7

A patient with moderate persistent asthma remains uncontrolled on medium-dose ICS alone. Per GINA step-up guidelines, what is the preferred add-on therapy?

Accepted Answer

Add long-acting beta-agonist (LABA)

Answer

Add oral corticosteroids

Answer

Double the ICS dose

Answer

Add theophylline