PANRE Pulmonology 3

Question 1

A 48-year-old woman presents with pleuritic chest pain, fever, and a unilateral pleural effusion. Thoracentesis reveals pH 7.1, glucose 45 mg/dL, and LDH >1000 U/L. What is the most appropriate management?

Accepted Answer

Chest tube drainage

Answer

A complicated parapneumonic effusion or empyema with pH <7.2, glucose <60, or elevated LDH requires drainage with chest tube placement.

Question 2

A 70-year-old with a 45-pack-year history has a 1.2 cm spiculated pulmonary nodule on CT chest. PET scan shows increased FDG uptake. Which is the next best step?

Accepted Answer

Surgical resection or tissue sampling

Answer

A spiculated nodule >1 cm with high FDG avidity on PET in a high-risk patient warrants tissue diagnosis or surgical resection.

Question 3

Which type of lung cancer is most commonly associated with paraneoplastic hypercalcemia?

Accepted Answer

Squamous cell carcinoma

Answer

Squamous cell carcinoma of the lung most commonly causes hypercalcemia via PTHrP secretion as a paraneoplastic syndrome.

Question 4

A patient with obstructive sleep apnea fails CPAP therapy due to intolerance. BMI is 28 kg/m². AHI is 22. Which is the most appropriate alternative treatment?

Accepted Answer

Mandibular advancement device

Answer

A mandibular advancement device is the recommended alternative for mild-to-moderate OSA patients who cannot tolerate CPAP.

Question 5

A 30-year-old presents with spontaneous pneumothorax on the right side with 25% lung collapse. He is hemodynamically stable. What is the most appropriate management?

Accepted Answer

Small-bore chest tube or aspiration

Answer

A primary spontaneous pneumothorax with >20% collapse in a stable patient is typically managed with small-bore chest tube or needle aspiration.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Pulmonology 3