PANCE Pulmonary System 2

Question 1

A 55-year-old smoker presents with progressive dyspnea and a barrel chest. Spirometry shows FEV1/FVC ratio of 0.60. Which pathophysiologic mechanism best explains his air trapping?

Accepted Answer

Loss of elastic recoil causing dynamic airway collapse

Answer

In emphysema, destruction of alveolar walls reduces elastic recoil, causing dynamic small airway collapse during expiration and air trapping.

Question 2

A 30-year-old woman with known asthma presents to the ED with severe bronchospasm unresponsive to two doses of albuterol. Which medication is most appropriate next?

Accepted Answer

IV magnesium sulfate

Answer

IV magnesium sulfate relaxes bronchial smooth muscle and is indicated for severe acute asthma refractory to initial bronchodilator therapy.

Question 3

A patient with community-acquired pneumonia has a parapneumonic effusion. Thoracentesis reveals pH 7.15, glucose 45 mg/dL, and LDH 1,200 U/L. What is the next best step?

Accepted Answer

Chest tube drainage

Answer

A pH <7.20, glucose <60 mg/dL, and elevated LDH indicate a complicated parapneumonic effusion requiring chest tube drainage.

Question 4

Which finding on chest X-ray is most characteristic of a tension pneumothorax?

Accepted Answer

Contralateral tracheal deviation with ipsilateral lung collapse

Answer

Tension pneumothorax causes mediastinal shift away from the affected side due to positive pressure buildup, displacing the trachea contralaterally.

Question 5

A 45-year-old with silicosis develops a new cavitary upper lobe lesion. Which organism is most likely responsible?

Accepted Answer

Mycobacterium tuberculosis

Answer

Silicosis dramatically increases susceptibility to tuberculosis, which preferentially causes upper lobe cavitary lesions.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Pulmonary System 2