ITE Pulmonology 4

Question 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?

Accepted Answer

Goodpasture syndrome

Answer

Granulomatosis with polyangiitis

Answer

Microscopic polyangiitis

Answer

Diffuse alveolar hemorrhage from scleroderma

Question 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?

Accepted Answer

Marfan syndrome

Answer

Alpha-1 antitrypsin deficiency

Answer

Cystic fibrosis

Answer

Birt-Hogg-Dubé syndrome

Question 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?

Accepted Answer

Inhaled corticosteroid (ICS)

Answer

Roflumilast

Answer

Azithromycin prophylaxis

Answer

Pulmonary rehabilitation

Question 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?

Accepted Answer

Sirolimus (rapamycin)

Answer

Doxycycline

Answer

Progesterone therapy

Answer

Hydroxychloroquine

Question 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?

Accepted Answer

Osimertinib

Answer

Carboplatin + paclitaxel

Answer

Pembrolizumab

Answer

Crizotinib

Question 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?

Accepted Answer

Organizing pneumonia (OP)

Answer

Usual interstitial pneumonia (UIP)

Answer

Diffuse alveolar damage (DAD)

Answer

Lymphoid interstitial pneumonia (LIP)

Question 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?

Accepted Answer

Acute hypersensitivity pneumonitis (Farmer's lung)

Answer

Acute sarcoidosis

Answer

Organic dust toxic syndrome (ODTS)

Answer

Allergic bronchopulmonary aspergillosis (ABPA)