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

Anti-GBM antibody positivity with pulmonary hemorrhage and rapidly progressive glomerulonephritis (RBC casts) is diagnostic of Goodpasture syndrome.

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

Marfan syndrome is associated with apical bullae and spontaneous pneumothorax in tall, thin individuals due to connective tissue abnormalities affecting the lung.

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

Adding ICS to LAMA+LABA (triple therapy) reduces exacerbations and has shown mortality benefit in COPD patients with frequent exacerbations, particularly those with elevated eosinophils.

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

Sirolimus, an mTOR inhibitor, has been shown in clinical trials to stabilize FEV1, improve quality of life, and reduce chylous effusions in LAM.

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

Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, is the preferred first-line treatment for EGFR-mutant metastatic NSCLC based on the FLAURA trial.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Pulmonology 4