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 Stage 3 (severe) corresponds to FEV1 30-49% predicted with FEV1/FVC <0.70 post-bronchodilator.

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

A peak flow below 50% of personal best that fails to respond to initial bronchodilator therapy warrants hospitalization with systemic corticosteroids and IV magnesium sulfate.

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

IPF classically shows honeycombing with traction bronchiectasis in a basal, subpleural distribution on HRCT, consistent with usual interstitial pneumonia (UIP) pattern.

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

Asymptomatic pulmonary sarcoidosis (stage I or II without significant impairment) often remits spontaneously and warrants watchful waiting rather than immediate treatment.

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

A Wells score ≥5 indicates high pre-test probability for PE, and CTPA is the preferred confirmatory imaging modality.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Pulmonology 2