Physician Assistant Pulmonary System Disorders 5

Question 1

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?

Accepted Answer

Complete removal from the offending antigen

Answer

Antigen avoidance is the cornerstone of hypersensitivity pneumonitis management; continued exposure drives progressive fibrosis regardless of pharmacologic therapy.

Question 2

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?

Accepted Answer

Pneumocystis jirovecii pneumonia

Answer

PCP classically presents in severely immunocompromised HIV patients with bilateral perihilar ground-glass opacities, elevated LDH, and an indolent progressive course.

Question 3

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?

Accepted Answer

Allergic bronchopulmonary aspergillosis (ABPA)

Answer

ABPA presents with asthma, migratory infiltrates, peripheral eosinophilia, markedly elevated total IgE, and Aspergillus-specific IgE/IgG with central bronchiectasis.

Question 4

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?

Accepted Answer

Nintedanib (antifibrotic agent)

Answer

RA-ILD with UIP pattern can be treated with nintedanib, which has demonstrated slowed FVC decline in progressive pulmonary fibrosis regardless of underlying cause.

Question 5

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?

Accepted Answer

Malignant pleural mesothelioma

Answer

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.

Physician Assistant Practice Test

Physician Assistant Practice Test

Physician Assistant Pulmonary System Disorders 5