MD Pulmonary Disease Management 4

Question 1

A 28-year-old with cystic fibrosis has FEV1 of 40% predicted and is homozygous for F508del mutation. Which targeted therapy is most appropriate?

Accepted Answer

Elexacaftor/tezacaftor/ivacaftor (ETI)

Answer

Elexacaftor/tezacaftor/ivacaftor (Trikafta) is the most effective CFTR modulator for F508del homozygous patients, producing the greatest improvement in FEV1 and sweat chloride.

Question 2

A 67-year-old with a 50 pack-year smoking history undergoes low-dose CT screening. A 7 mm solid nodule is found. Per Lung-RADS, what is the recommended follow-up?

Accepted Answer

Repeat LDCT in 6 months

Answer

A 7 mm solid nodule in a high-risk screening patient is Lung-RADS 3 (probably benign), warranting a 6-month follow-up LDCT.

Question 3

A mechanically ventilated patient with ARDS has plateau pressure of 34 cmH2O despite tidal volume of 6 mL/kg IBW. Driving pressure is 18 cmH2O. What intervention has been shown to reduce mortality?

Accepted Answer

Prone positioning for ≥16 hours/day

Answer

Prone positioning for ≥16 hours/day reduces mortality in moderate-to-severe ARDS (PaO2/FiO2 <150) as demonstrated in the PROSEVA trial.

Question 4

A 50-year-old presents with hemoptysis and a chest X-ray showing left lower lobe atelectasis with a central mass. Bronchoscopy reveals a carcinoid tumor. Which histologic finding would classify this as typical rather than atypical carcinoid?

Accepted Answer

Fewer than 2 mitoses per 10 HPF with no necrosis

Answer

Typical carcinoid is defined by fewer than 2 mitoses per 10 HPF and absence of necrosis; atypical carcinoid has 2-10 mitoses per 10 HPF or necrosis.

Question 5

A patient with moderate persistent asthma continues to have frequent exacerbations despite maximum-dose ICS/LABA. IgE is 450 IU/mL and blood eosinophils are 380 cells/μL. Which add-on biologic therapy is most appropriate?

Accepted Answer

Omalizumab (anti-IgE)

Answer

Omalizumab is indicated for moderate-to-severe allergic asthma with elevated IgE and sensitivity to perennial allergens when uncontrolled on high-dose ICS/LABA.

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MD - Doctor of Medicine Practice Test

MD Pulmonary Disease Management 4