PANCE Pulmonary System 3

Question 1

A 70-year-old male presents with insidious onset dyspnea and a dry cough over 18 months. HRCT shows honeycombing with basal predominance. Pulmonary function tests reveal a restrictive pattern. Which diagnosis is most likely?

Accepted Answer

Idiopathic pulmonary fibrosis (IPF)

Answer

IPF classically presents in older males with progressive dyspnea, basal honeycombing on HRCT, and a restrictive PFT pattern with no identifiable cause.

Question 2

Which ventilator setting is most important in preventing ventilator-induced lung injury (VILI) in ARDS patients?

Accepted Answer

Tidal volume 6 mL/kg ideal body weight

Answer

Low tidal volume ventilation (6 mL/kg IBW) as established by the ARDSnet trial is the most evidence-based intervention to reduce VILI and mortality.

Question 3

A 35-year-old flight attendant develops sudden-onset pleuritic chest pain and dyspnea after a long flight. CT pulmonary angiography confirms a pulmonary embolism. She has no bleeding risk factors. What is the first-line treatment?

Accepted Answer

Rivaroxaban

Answer

Direct oral anticoagulants such as rivaroxaban are now first-line for hemodynamically stable PE due to ease of use and non-inferiority to heparin/warfarin.

Question 4

A patient with known primary pulmonary hypertension develops worsening dyspnea. Echocardiogram shows RV systolic pressure of 80 mmHg. Which medication class acts by increasing cyclic GMP to cause pulmonary vasodilation?

Accepted Answer

Phosphodiesterase-5 inhibitors (sildenafil)

Answer

PDE-5 inhibitors prevent breakdown of cGMP, sustaining NO-mediated pulmonary vasodilation and reducing pulmonary vascular resistance.

Question 5

Which of the following best differentiates central from obstructive sleep apnea on polysomnography?

Accepted Answer

Absence of respiratory effort during apneic episodes

Answer

Central sleep apnea is defined by cessation of both airflow and respiratory effort, whereas obstructive events have persistent thoracoabdominal effort.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Pulmonary System 3