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

Aspirin-exacerbated respiratory disease (Samter's triad) consists of asthma, nasal polyps, and NSAID-induced bronchospasm.

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

Organic dust toxic syndrome (ODTS) occurs after heavy organic dust exposure causing flu-like illness and bilateral infiltrates that resolve spontaneously within 24-48 hours without sensitization.

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

Osimertinib is the preferred first-line EGFR TKI for NSCLC with EGFR-sensitizing mutations based on superior outcomes in the FLAURA trial.

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

Bilateral effusions with low protein and LDH in the context of reduced EF are consistent with a transudative effusion from congestive heart failure.

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

Inhaled tobramycin in alternating monthly cycles is a guideline-recommended chronic suppressive therapy for CF patients with chronic Pseudomonas infection.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Pulmonology 5