Physician Assistant Pulmonary System Disorders 3

Question 1

A 52-year-old with obstructive sleep apnea refuses CPAP. Which consequence of untreated OSA poses the greatest cardiovascular risk?

Accepted Answer

Repetitive hypoxemia and sympathetic surges causing systemic hypertension

Answer

Repetitive hypoxic episodes and arousal-associated sympathetic activation cause sustained systemic hypertension, which is the primary cardiovascular complication of OSA.

Question 2

A 40-year-old woman presents with exertional dyspnea and a mean pulmonary artery pressure of 30 mmHg on right heart catheterization. She has no left heart disease or lung disease. Which treatment is first-line for Group 1 pulmonary arterial hypertension?

Accepted Answer

Phosphodiesterase-5 inhibitors or endothelin receptor antagonists

Answer

PDE-5 inhibitors (sildenafil) or endothelin receptor antagonists (bosentan, ambrisentan) are first-line for Group 1 PAH in patients without vasoreactivity on testing.

Question 3

A 35-year-old non-smoker presents with lower lobe-predominant emphysema and recurrent liver disease. Which deficiency should be suspected?

Accepted Answer

Alpha-1 antitrypsin deficiency

Answer

Alpha-1 antitrypsin deficiency causes panacinar emphysema predominantly in the lower lobes and can cause liver disease from misfolded protein accumulation in hepatocytes.

Question 4

A mechanically ventilated ARDS patient has plateau pressure of 32 cmH2O and PEEP of 10 cmH2O. Driving pressure is 22 cmH2O. Which ventilator adjustment best reduces ventilator-induced lung injury?

Accepted Answer

Reduce tidal volume to achieve driving pressure ≤15 cmH2O

Answer

Driving pressure (plateau - PEEP) >15 cmH2O is associated with increased ARDS mortality; reducing tidal volume to lower driving pressure reduces stress on remaining functional lung units.

Question 5

A 60-year-old with COPD and FEV1 of 35% predicted has multiple hospitalizations yearly. Which long-acting bronchodilator combination has the strongest evidence for reducing exacerbations?

Accepted Answer

Long-acting beta-agonist plus inhaled corticosteroid plus long-acting muscarinic antagonist (triple therapy)

Answer

Triple therapy (LABA + LAMA + ICS) reduces exacerbation rates more than dual therapy in severe COPD patients with frequent exacerbations, per the IMPACT trial.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Pulmonary System Disorders 3