ITE Pulmonology 5

Question 1

A 52-year-old male with a history of deep vein thrombosis presents with exertional dyspnea 18 months after a PE.
V/Q scan shows multiple segmental mismatched defects. mPAP on RHC is 32 mmHg with PVR of 5 Wood units.
What is the best treatment option?

Accepted Answer

Pulmonary endarterectomy (PEA)

Answer

Lifelong anticoagulation alone

Answer

Balloon pulmonary angioplasty (BPA)

Answer

Bosentan

Question 2

A 60-year-old male with long-standing GERD and Barrett's esophagus develops a dry cough and progressive dyspnea. HRCT shows basal-predominant reticulation with traction bronchiectasis and honeycombing. The BAL shows 6% lymphocytes. What is the most likely diagnosis?

Accepted Answer

Idiopathic pulmonary fibrosis (IPF)

Answer

Hypersensitivity pneumonitis

Answer

NSIP associated with GERD

Answer

Cryptogenic organizing pneumonia

Question 3

A 25-year-old male with cystic fibrosis has FEV1 that has declined from 65% to 42% over 2 years despite optimal inhaled therapy. He has the F508del/F508del genotype. Which CFTR modulator regimen is most appropriate?

Accepted Answer

Elexacaftor-tezacaftor-ivacaftor (Trikafta)

Answer

Ivacaftor alone

Answer

Lumacaftor-ivacaftor

Answer

Ataluren

Question 4

A 72-year-old male with COPD and FEV1 30% predicted is evaluated for lung volume reduction surgery (LVRS). Which finding would make him an IDEAL candidate for LVRS?

Accepted Answer

Upper-lobe predominant emphysema with low exercise capacity

Answer

Homogeneous emphysema on CT with DLCO <20%

Answer

FEV1 <20% predicted with homogeneous disease

Answer

Alpha-1 antitrypsin deficiency with lower-lobe predominant emphysema

Question 5

A 44-year-old female never-smoker develops cough and hemoptysis. Bronchoscopy reveals a polypoid endobronchial lesion in the right lower lobe. Biopsy shows carcinoid features with 3 mitoses/10 HPF and focal necrosis. What is the diagnosis?

Accepted Answer

Atypical carcinoid tumor

Answer

Typical carcinoid tumor

Answer

Large cell neuroendocrine carcinoma

Answer

Small cell lung carcinoma

Question 6

A 38-year-old male returns from a camping trip in the Ohio River Valley with fever, night sweats, and a hilar mass on CXR. Serum LDH is mildly elevated. Urine Histoplasma antigen is positive. What is the most appropriate treatment?

Accepted Answer

Itraconazole for 12 weeks

Answer

Observation — self-limited illness

Answer

Amphotericin B liposomal formulation

Answer

Fluconazole

Question 7

A 55-year-old male with newly diagnosed small cell lung cancer has disease confined to the right hemithorax and ipsilateral mediastinal nodes that can be encompassed in a radiation field. What is the classification and treatment approach?

Accepted Answer

Limited-stage SCLC — concurrent chemoradiation

Answer

Extensive-stage SCLC — chemotherapy alone

Answer

Limited-stage SCLC — surgery followed by chemotherapy

Answer

Extensive-stage SCLC — chemo + immunotherapy