PANRE Pulmonology 2

Question 1

A 58-year-old male with a 40-pack-year smoking history presents with progressive dyspnea and FEV1/FVC ratio of 0.62 post-bronchodilator.
Which GOLD stage classification applies if his FEV1 is 45% predicted?

Accepted Answer

GOLD 3

Answer

GOLD 1

Answer

GOLD 2

Answer

GOLD 4

Question 2

A patient with known asthma presents with acute exacerbation. Peak flow is 45% of personal best and fails to improve after initial bronchodilator therapy. What is the most appropriate next step?

Accepted Answer

Admit for IV magnesium sulfate and systemic corticosteroids

Answer

Discharge with oral steroids

Answer

Prescribe a second course of inhaled albuterol and discharge

Answer

Initiate subcutaneous epinephrine only

Question 3

Which finding on high-resolution CT chest is most characteristic of idiopathic pulmonary fibrosis (IPF)?

Accepted Answer

Honeycombing with basal and subpleural predominance

Answer

Ground-glass opacities in a perihilar distribution

Answer

Centrilobular nodules with tree-in-bud pattern

Answer

Diffuse consolidation with air bronchograms

Question 4

A 35-year-old woman presents with progressive dyspnea, bilateral hilar lymphadenopathy on CXR, and non-caseating granulomas on bronchoscopic biopsy. Serum ACE is elevated. Which treatment is most appropriate for asymptomatic pulmonary sarcoidosis?

Accepted Answer

Observation without treatment

Answer

Immediate systemic corticosteroids

Answer

Methotrexate

Answer

Hydroxychloroquine

Question 5

A patient with suspected pulmonary embolism has a Wells score of 6. D-dimer is elevated. What is the best next diagnostic step?

Accepted Answer

Obtain CT pulmonary angiography (CTPA)

Answer

Start anticoagulation empirically without further workup

Answer

Perform V/Q scan as first-line imaging

Answer

Obtain lower extremity Doppler ultrasound only

Question 6

A 62-year-old male with COPD on home oxygen presents with worsening dyspnea and productive cough with purulent sputum. CXR shows hyperinflation without new infiltrate. Which organism most commonly causes acute COPD exacerbations?

Accepted Answer

Haemophilus influenzae

Answer

Pseudomonas aeruginosa

Answer

Streptococcus pneumoniae

Answer

Moraxella catarrhalis

Question 7

Which medication is indicated to reduce COPD exacerbation frequency in a patient with FEV1 <60% predicted, ≥2 exacerbations per year, and no active cardiac rhythm abnormalities?

Accepted Answer

Azithromycin prophylaxis

Answer

Theophylline

Answer

Roflumilast

Answer

Oral N-acetylcysteine