MD Pulmonary Disease Management 3

Question 1

A 62-year-old presents with sudden pleuritic chest pain and dyspnea. CT pulmonary angiography confirms bilateral pulmonary emboli. HR is 118, BP is 98/60, troponin is elevated. What is the most appropriate immediate management?

Accepted Answer

Systemic thrombolysis with alteplase

Answer

Massive PE with hemodynamic instability and no contraindications warrants systemic thrombolysis as it provides the fastest clot lysis.

Question 2

Which finding on high-resolution CT (HRCT) chest is most characteristic of usual interstitial pneumonia (UIP) pattern?

Accepted Answer

Bilateral subpleural honeycombing with traction bronchiectasis

Answer

UIP pattern on HRCT shows bilateral, subpleural, basal-predominant honeycombing with or without traction bronchiectasis, representing the radiologic correlate of IPF.

Question 3

A patient with moderate persistent asthma is well-controlled on medium-dose ICS/LABA. She is planning pregnancy. What is the most appropriate medication adjustment?

Accepted Answer

Continue current regimen

Answer

Well-controlled asthma during pregnancy should be maintained on current therapy, as uncontrolled asthma poses greater risk to mother and fetus than ICS/LABA.

Question 4

A 55-year-old with scleroderma develops progressive exertional dyspnea. Echocardiogram shows RVSP of 55 mmHg. Right heart catheterization confirms mPAP of 38 mmHg with normal PCWP. What is the most appropriate initial therapy?

Accepted Answer

Oral sildenafil

Answer

For WHO functional class II-III pulmonary arterial hypertension, oral PDE-5 inhibitors like sildenafil or ERA like ambrisentan/bosentan are recommended initial therapy.

Question 5

A patient develops fever, productive cough, and consolidation 5 days after intubation for trauma. BAL culture grows Pseudomonas aeruginosa. Which antibiotic regimen is most appropriate?

Accepted Answer

Cefepime plus tobramycin

Answer

Ventilator-associated pneumonia caused by Pseudomonas requires double-coverage with an antipseudomonal beta-lactam plus an aminoglycoside or fluoroquinolone to reduce resistance risk.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Pulmonary Disease Management 3