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

NSIP is the most common ILD pattern associated with connective tissue diseases like rheumatoid arthritis, presenting with ground-glass opacities and reticulation on HRCT.

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

Goodpasture syndrome presents with pulmonary-renal syndrome (hemoptysis + glomerulonephritis) and is confirmed by positive anti-GBM antibodies.

Question 3

Which statement about transudative pleural effusions is correct?

Accepted Answer

Pleural protein/serum protein ratio <0.5

Answer

By Light's criteria, a transudate has pleural/serum protein ratio <0.5, pleural/serum LDH ratio <0.6, and pleural LDH <2/3 upper limit of normal.

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

WHO Group 1 PAH is treated with PAH-specific therapy including endothelin receptor antagonists (ambrisentan, bosentan) or PDE-5 inhibitors (sildenafil, tadalafil).

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

Lymphangioleiomyomatosis presents in women of childbearing age with diffuse bilateral thin-walled cysts, recurrent pneumothoraces, and chylothorax.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Pulmonology 4