MD Pulmonary Disease Management 5

Question 1

A 38-year-old presents with recurrent spontaneous pneumothorax. CT shows bilateral cystic lung disease. She has a history of renal angiomyolipomas. What is the most likely diagnosis?

Accepted Answer

Lymphangioleiomyomatosis (LAM)

Answer

Lymphangioleiomyomatosis presents in women of childbearing age with bilateral thin-walled pulmonary cysts, spontaneous pneumothorax, and renal angiomyolipomas.

Question 2

A 55-year-old presents with progressive dyspnea and chest tightness. Spirometry shows FEV1 86% predicted, FVC 87% predicted, FEV1/FVC 0.79. Diffusing capacity (DLCO) is 48% predicted. What diagnosis is most consistent?

Accepted Answer

Pulmonary vascular disease

Answer

Isolated severe reduction in DLCO with normal spirometry and FEV1/FVC ratio suggests pulmonary vascular disease (e.g., pulmonary hypertension or pulmonary emboli).

Question 3

Which antibiotic regimen is recommended for outpatient treatment of community-acquired pneumonia in a 45-year-old with no comorbidities and no recent antibiotic use?

Accepted Answer

Amoxicillin monotherapy

Answer

IDSA/ATS guidelines recommend amoxicillin as first-line monotherapy for outpatient CAP in otherwise healthy patients without comorbidities or risk factors for drug-resistant organisms.

Question 4

A patient with a large left-sided pleural effusion undergoes thoracentesis. After removal of 1.2 L, the patient develops acute chest tightness and CT shows ipsilateral pulmonary infiltrates. What is the most likely complication?

Accepted Answer

Re-expansion pulmonary edema

Answer

Re-expansion pulmonary edema is a rare but serious complication of rapid large-volume thoracentesis, caused by rapid re-expansion of the collapsed lung.

Question 5

A 48-year-old with rheumatoid arthritis develops a new pleural effusion. Pleural fluid analysis shows glucose of 18 mg/dL, pH 7.00, LDH 2,100 U/L, and protein 4.8 g/dL. What is the most likely etiology?

Accepted Answer

Rheumatoid pleuritis

Answer

Rheumatoid pleural effusions characteristically show very low glucose (<30 mg/dL), very low pH, and very high LDH due to immune complex deposition and impaired glucose transport.

MD - Doctor of Medicine Practice Test

MD - Doctor of Medicine Practice Test

MD Pulmonary Disease Management 5