Internal Medicine Pulmonary Disease Questions and Answers

Question 1

A 67-year-old male with a known diagnosis of severe COPD presents with a 3-day history of increased dyspnea, increased sputum volume, and sputum that has changed from white to green. He has not required hospitalization. According to the GOLD 2024 guidelines, which of the following is the most appropriate management in addition to short-acting bronchodilators?

Accepted Answer

Systemic corticosteroids and antibiotics

Answer

According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, a COPD exacerbation characterized by all three cardinal symptoms (increased dyspnea, increased sputum volume, and increased sputum purulence) is classified as moderate and warrants treatment with systemic corticosteroids and antibiotics, in addition to short-acting bronchodilators. Systemic corticosteroids (e.g., prednisone for 5 days) shorten recovery time and improve lung function, while antibiotics are indicated when increased sputum purulence is present.

Question 2

A 72-year-old former smoker presents with a 2-year history of progressive exertional dyspnea and a persistent dry cough. A high-resolution CT (HRCT) of the chest reveals bilateral, peripheral, and basilar predominant reticular abnormalities with definitive honeycombing. What is the most likely diagnosis based on this classic HRCT finding?

Accepted Answer

Usual Interstitial Pneumonia (UIP) pattern consistent with Idiopathic Pulmonary Fibrosis (IPF)

Answer

The HRCT findings described—bilateral, peripheral, basilar predominant fibrosis with honeycombing—are the classic features of a Usual Interstitial Pneumonia (UIP) pattern. In the appropriate clinical context (an older adult with progressive dyspnea and exclusion of other causes), a definitive UIP pattern on HRCT is diagnostic for Idiopathic Pulmonary Fibrosis (IPF) without the need for a surgical lung biopsy.

Question 3

A 30-year-old patient with persistent asthma is using a low-dose inhaled corticosteroid (ICS) daily and a short-acting beta-agonist (SABA) for relief. She reports waking with cough 3 times per month and using her SABA reliever 4 days a week. According to the 2024 GINA guidelines' preferred pathway, what is the most appropriate next step in management?

Accepted Answer

Switch to a low-dose ICS-formoterol combination for both maintenance and reliever therapy (MART).

Answer

The patient's symptoms indicate her asthma is not well-controlled, requiring a step-up in therapy from GINA Step 2. The preferred GINA strategy (Track 1) for Step 3 is to switch the patient to a low-dose inhaled corticosteroid-formoterol combination to be used for both daily maintenance and as a reliever (MART strategy). This approach is favored over simply increasing the ICS dose or adding other agents while continuing with a SABA-only reliever, as it reduces the risk of severe exacerbations.

Question 4

Which of the following patients meets the 2021 USPSTF criteria for annual screening for lung cancer with low-dose computed tomography (LDCT)?

Accepted Answer

A 65-year-old with a 22 pack-year smoking history who quit smoking 10 years ago.

Answer

The 2021 USPSTF guidelines recommend annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year or greater smoking history and either currently smoke or have quit within the past 15 years. The patient in option B (age 65, 22 pack-years, quit 10 years ago) is the only one who meets all three criteria.

Question 5

A 60-year-old male presents to the emergency department with sudden-onset, severe dyspnea and syncope. His blood pressure is 75/45 mmHg and heart rate is 140/min. A bedside echocardiogram shows severe right ventricular dilation and dysfunction. A CT angiogram confirms a saddle pulmonary embolism. In the absence of absolute contraindications, what is the most appropriate immediate intervention?

Accepted Answer

Systemic thrombolysis with tissue plasminogen activator (tPA)

Answer

This patient presents with a massive (high-risk) pulmonary embolism, defined by the presence of persistent hypotension and shock. For patients with massive PE who do not have a high bleeding risk, guidelines recommend immediate reperfusion therapy. Systemic thrombolysis is the most readily available and recommended first-line advanced therapy to rapidly dissolve the clot and improve hemodynamics. While catheter-directed therapy and surgical embolectomy are options, systemic thrombolysis is the preferred initial choice if not contraindicated.

Internal Medicine Exam Practice Test

Internal Medicine Exam Practice Test

Internal Medicine Pulmonary Disease Questions and Answers