Pulmonary System Disorders Flashcards
7 cards from real Physician Assistant practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Pulmonary System Disorders flashcards as text
A 50-year-old man with chronic hypersensitivity pneumonitis from ongoing exposure develops honeycombing on HRCT. FVC is 55% predicted. He continues working as a farmer. Which intervention has the strongest evidence for slowing progression?
Answer: Complete removal from the offending antigen
Antigen avoidance is the cornerstone of hypersensitivity pneumonitis management; continued exposure drives progressive fibrosis regardless of pharmacologic therapy.
A 33-year-old with HIV (CD4 count 45 cells/μL) presents with progressive dyspnea, dry cough, and bilateral perihilar ground-glass opacities on CXR. LDH is markedly elevated. What is the diagnosis?
Answer: Pneumocystis jirovecii pneumonia
PCP classically presents in severely immunocompromised HIV patients with bilateral perihilar ground-glass opacities, elevated LDH, and an indolent progressive course.
A 44-year-old woman presents with transient migratory pulmonary infiltrates, peripheral eosinophilia of 18%, and wheezing. IgE is markedly elevated. Sputum contains eosinophils and fungal hyphae. What is the diagnosis?
Answer: Allergic bronchopulmonary aspergillosis (ABPA)
ABPA presents with asthma, migratory infiltrates, peripheral eosinophilia, markedly elevated total IgE, and Aspergillus-specific IgE/IgG with central bronchiectasis.
A 58-year-old with rheumatoid arthritis develops bilateral lower lobe subpleural honeycombing and traction bronchiectasis on HRCT. Pulmonary biopsy shows usual interstitial pneumonia (UIP) pattern. What is the best pharmacologic treatment?
Answer: Nintedanib (antifibrotic agent)
RA-ILD with UIP pattern can be treated with nintedanib, which has demonstrated slowed FVC decline in progressive pulmonary fibrosis regardless of underlying cause.
A 63-year-old former asbestos worker presents with a right pleural effusion. Thoracentesis shows an exudate with predominantly lymphocytes and low glucose. CT shows pleural thickening. What is the most likely diagnosis to exclude urgently?
Answer: Malignant pleural mesothelioma
Asbestos-exposed patients with exudative lymphocytic pleural effusion and pleural thickening must have malignant mesothelioma excluded as a priority due to its poor prognosis and latency of 20-50 years.
An intubated patient's capnography waveform shows a gradually rising plateau phase (shark-fin pattern) instead of the normal flat plateau. What does this indicate?
Answer: Obstructive airway disease with uneven emptying
The shark-fin or sloped plateau (phase III) on capnography indicates uneven alveolar emptying due to airflow obstruction, as seen in asthma or COPD.
A 29-year-old pregnant woman at 32 weeks gestation presents with acute onset pleuritic chest pain and hemoptysis. D-dimer is elevated. CT pulmonary angiography confirms PE. Which anticoagulant is preferred?
Answer: Low molecular weight heparin (LMWH)
LMWH is the preferred anticoagulant for PE in pregnancy; warfarin is teratogenic, DOACs lack safety data in pregnancy, and LMWH does not cross the placenta.