PANRE Pulmonology 5

Question 1

A 45-year-old male presents with chronic cough, wheezing, and nasal polyps. He develops severe bronchospasm after taking ibuprofen for knee pain. What syndrome does he have?

Accepted Answer

Aspirin-exacerbated respiratory disease (AERD)

Answer

Churg-Strauss syndrome

Answer

Reactive airways dysfunction syndrome

Answer

Exercise-induced bronchoconstriction

Question 2

A 52-year-old farmer presents with acute onset fever, myalgia, and bilateral pulmonary infiltrates 4-6 hours after working in a dusty barn. Symptoms resolve within 24 hours without treatment. What is the most likely diagnosis?

Accepted Answer

Organic dust toxic syndrome

Answer

Community-acquired pneumonia

Answer

Hypersensitivity pneumonitis (acute)

Answer

Acute eosinophilic pneumonia

Question 3

A 68-year-old with lung adenocarcinoma is found to have an EGFR exon 19 deletion mutation. Which first-line therapy is most appropriate?

Accepted Answer

Osimertinib (third-generation EGFR TKI)

Answer

Carboplatin + paclitaxel chemotherapy

Answer

Pembrolizumab immunotherapy

Answer

Erlotinib (first-generation EGFR TKI)

Question 4

A 62-year-old presents with progressive dyspnea and is found to have bilateral pleural effusions. Echocardiography shows EF of 35%. Thoracentesis reveals protein 2.1 g/dL and LDH 140 U/L. What is the most likely cause?

Accepted Answer

Congestive heart failure transudate

Answer

Malignant pleural effusion

Answer

Parapneumonic effusion

Answer

Hepatic hydrothorax

Question 5

A 33-year-old with cystic fibrosis has FEV1 38% predicted and recurrent Pseudomonas exacerbations. Which chronic suppressive antibiotic regimen is most appropriate?

Accepted Answer

Inhaled tobramycin alternating monthly

Answer

Daily oral ciprofloxacin

Answer

Inhaled colistin twice daily continuously

Answer

IV piperacillin-tazobactam every 3 months

Question 6

Which ventilator parameter should be prioritized when managing ARDS to prevent ventilator-induced lung injury (VILI)?

Accepted Answer

Tidal volume 4-6 mL/kg ideal body weight

Answer

PEEP <5 cm H2O to avoid barotrauma

Answer

FiO2 100% to maximize oxygenation

Answer

RR <12 breaths/min to minimize auto-PEEP

Question 7

A 44-year-old HIV-positive patient with CD4 count of 90 cells/µL presents with progressive dyspnea, non-productive cough, and fever. CXR shows bilateral interstitial infiltrates. LDH is elevated at 520 U/L. What is the most likely diagnosis?

Accepted Answer

Pneumocystis jirovecii pneumonia (PCP)

Answer

Mycobacterium avium complex (MAC) pulmonary infection

Answer

Cytomegalovirus pneumonitis

Answer

Cryptococcal pneumonia