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

Chronic thromboembolic pulmonary hypertension (CTEPH) with surgically accessible proximal lesions is best treated with pulmonary endarterectomy, which is potentially curative.

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

The HRCT pattern of bibasilar honeycombing with traction bronchiectasis represents UIP pattern, most consistent with IPF, even in the context of GERD; low BAL lymphocytes also favor IPF over HP.

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

Elexacaftor-tezacaftor-ivacaftor (Trikafta) is approved for F508del homozygous patients age ≥2 and produces the greatest improvement in lung function of any available CFTR modulator combination.

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

The NETT trial showed survival benefit for LVRS in patients with upper-lobe predominant emphysema and low exercise capacity; homogeneous disease with FEV1/DLCO <20% showed excess mortality.

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

Atypical carcinoid is defined by 2–10 mitoses/10 HPF and/or foci of necrosis, distinguishing it from typical carcinoid (<2 mitoses/10 HPF, no necrosis); both differ from high-grade neuroendocrine tumors.

ITE - Internal Medicine In-Training Exam Practice Test

ITE - Internal Medicine In-Training Exam Practice Test

ITE Pulmonology 5