PANCE Pulmonary System 5

Question 1

A 22-year-old presents with sudden onset unilateral chest pain and dyspnea. He is tall and thin with no prior medical history. CXR shows a 25% pneumothorax. What is the appropriate management?

Accepted Answer

Simple aspiration or small-bore chest tube

Answer

A primary spontaneous pneumothorax >20% in a symptomatic patient warrants simple aspiration or small-bore chest tube; observation is reserved for <20% with minimal symptoms.

Question 2

A patient with COPD exacerbation has a PaCO2 of 65 mmHg and pH of 7.28 despite controlled oxygen therapy. Which intervention has the strongest evidence for avoiding intubation?

Accepted Answer

Non-invasive positive pressure ventilation (NIPPV)

Answer

NIPPV (BiPAP) is first-line for hypercapnic respiratory failure in COPD exacerbation, reducing intubation rates and mortality.

Question 3

A patient with suspected TB has a positive QuantiFERON-Gold test but a negative tuberculin skin test. Which situation best explains this discordant result?

Accepted Answer

Prior BCG vaccination causing false-positive TST but not IGRA

Answer

BCG vaccination causes false-positive TST reactions but does not affect IGRA results, which are BCG-unaffected because they use ESAT-6 and CFP-10 antigens absent from BCG.

Question 4

Which pulmonary function test pattern is characteristic of a fixed upper airway obstruction such as tracheal stenosis?

Accepted Answer

Flattening of both inspiratory and expiratory loops on flow-volume curve

Answer

Fixed upper airway obstruction flattens both the inspiratory and expiratory limbs of the flow-volume loop due to fixed resistance regardless of effort.

Question 5

A 48-year-old on amiodarone for 3 years develops new bilateral pulmonary infiltrates and worsening PFTs. Which mechanism best explains amiodarone pulmonary toxicity?

Accepted Answer

Direct phospholipid accumulation and oxidative injury

Answer

Amiodarone and its metabolite desethylamiodarone accumulate in lysosomes, causing phospholipidosis and oxidative lung injury.

PANCE Test Practice Test

PANCE Test Practice Test

PANCE Pulmonary System 5