PANRE Pulmonology 4

Question 1

A 65-year-old with a history of rheumatoid arthritis presents with progressive dyspnea.
PFTs show FVC 62% predicted, DLCO 55% predicted, FEV1/FVC 0.78.
HRCT shows ground-glass opacities and reticulation.
Which pattern is most likely?

Accepted Answer

Non-specific interstitial pneumonia (NSIP)

Answer

Usual interstitial pneumonia (UIP)

Answer

Cryptogenic organizing pneumonia (COP)

Answer

Respiratory bronchiolitis-ILD

Question 2

A 40-year-old non-smoker presents with hemoptysis and bilateral pulmonary infiltrates. Urinalysis shows hematuria and red cell casts. Anti-GBM antibodies are positive. Which diagnosis is most likely?

Accepted Answer

Goodpasture syndrome

Answer

Granulomatosis with polyangiitis (GPA)

Answer

Microscopic polyangiitis

Answer

Idiopathic pulmonary hemosiderosis

Question 3

Which statement about transudative pleural effusions is correct?

Accepted Answer

Pleural protein/serum protein ratio <0.5

Answer

Pleural protein >3.0 g/dL

Answer

Pleural LDH >200 U/L

Answer

Pleural LDH/serum LDH ratio >0.6

Question 4

A 55-year-old male presents with progressive exertional dyspnea, loud P2, and right heart failure. Echocardiogram shows RVSP of 58 mmHg. Right heart catheterization confirms mean PAP of 32 mmHg with PCWP of 10 mmHg. Which initial treatment is recommended for WHO Group 1 pulmonary arterial hypertension?

Accepted Answer

Endothelin receptor antagonist or PDE-5 inhibitor

Answer

Calcium channel blockers in all patients

Answer

Anticoagulation alone

Answer

Supplemental oxygen only

Question 5

A 28-year-old female non-smoker presents with recurrent pneumothoraces and dyspnea. HRCT shows bilateral diffuse thin-walled cysts. She is taking oral contraceptives. What is the most likely diagnosis?

Accepted Answer

Lymphangioleiomyomatosis (LAM)

Answer

Langerhans cell histiocytosis

Answer

Birt-Hogg-Dubé syndrome

Answer

Pulmonary Langerhans cell histiocytosis

Question 6

A patient with COPD and resting PaO2 of 54 mmHg is prescribed home oxygen. What is the minimum recommended daily duration of oxygen use to improve survival?

Accepted Answer

15 hours per day

Answer

8 hours per day

Answer

12 hours per day

Answer

24 hours per day

Question 7

Which medication is used as a first-line maintenance therapy for mild persistent asthma in adults?

Accepted Answer

Low-dose inhaled corticosteroid (ICS)

Answer

Long-acting beta-agonist (LABA) monotherapy

Answer

Leukotriene receptor antagonist (LTRA) as preferred

Answer

Oral corticosteroids