ITE Pulmonology 4 — Questions and Answers
Question 1: A 48-year-old male with scleroderma presents with hemoptysis and renal failure. Urinalysis shows RBC casts. ANCA is negative. Chest CT shows bilateral ground-glass opacities. Anti-GBM antibody is positive. What is the diagnosis?
- Granulomatosis with polyangiitis
- Goodpasture syndrome (Correct answer)
- Microscopic polyangiitis
- Diffuse alveolar hemorrhage from scleroderma
Correct answer: Goodpasture syndrome
Anti-GBM antibody positivity with pulmonary hemorrhage and rapidly progressive glomerulonephritis (RBC casts) is diagnostic of Goodpasture syndrome.
Question 2: A 38-year-old male with no prior lung disease is found to have bilateral apical bullae. He is a tall, thin male. Which genetic condition should be considered?
- Alpha-1 antitrypsin deficiency
- Cystic fibrosis
- Marfan syndrome (Correct answer)
- Birt-Hogg-Dubé syndrome
Correct answer: Marfan syndrome
Marfan syndrome is associated with apical bullae and spontaneous pneumothorax in tall, thin individuals due to connective tissue abnormalities affecting the lung.
Question 3: A 55-year-old female ex-smoker with COPD (FEV1 45% predicted) has had 3 exacerbations in the past year requiring hospitalization. Her current regimen is LAMA + LABA. What additional therapy has shown mortality benefit in this patient?
- Roflumilast
- Azithromycin prophylaxis
- Inhaled corticosteroid (ICS) (Correct answer)
- Pulmonary rehabilitation
Correct answer: Inhaled corticosteroid (ICS)
Adding ICS to LAMA+LABA (triple therapy) reduces exacerbations and has shown mortality benefit in COPD patients with frequent exacerbations, particularly those with elevated eosinophils.
Question 4: A 30-year-old woman with lymphangioleiomyomatosis (LAM) has progressive dyspnea and FEV1/FVC of 0.62. Which treatment has been shown to stabilize lung function in LAM?
- Sirolimus (rapamycin) (Correct answer)
- Doxycycline
- Progesterone therapy
- Hydroxychloroquine
Correct answer: Sirolimus (rapamycin)
Sirolimus, an mTOR inhibitor, has been shown in clinical trials to stabilize FEV1, improve quality of life, and reduce chylous effusions in LAM.
Question 5: A 67-year-old male with right lower lobe lung adenocarcinoma is found to have an EGFR exon 19 deletion. What is the preferred first-line systemic therapy?
- Carboplatin + paclitaxel
- Pembrolizumab
- Osimertinib (Correct answer)
- Crizotinib
Correct answer: Osimertinib
Osimertinib, a third-generation EGFR tyrosine kinase inhibitor, is the preferred first-line treatment for EGFR-mutant metastatic NSCLC based on the FLAURA trial.
Question 6: A 50-year-old male presents with progressive dyspnea, hypoxemia, and bilateral infiltrates 5 days after starting amiodarone. HRCT shows bilateral ground-glass opacities with consolidation in a peripheral distribution. What is the pathological pattern most likely seen on lung biopsy?
- Usual interstitial pneumonia (UIP)
- Diffuse alveolar damage (DAD)
- Organizing pneumonia (OP) (Correct answer)
- Lymphoid interstitial pneumonia (LIP)
Correct answer: Organizing pneumonia (OP)
Amiodarone pulmonary toxicity most commonly manifests as organizing pneumonia (OP) pattern, though it can also cause phospholipidosis and UIP; peripheral consolidation on CT is the OP hallmark.
Question 7: A 45-year-old female farmer presents with acute dyspnea, fever, and bilateral infiltrates 4-6 hours after entering a hay storage barn. Precipitating antibodies to Thermophilic actinomycetes are positive. What is the diagnosis?
- Acute sarcoidosis
- Acute hypersensitivity pneumonitis (Farmer's lung) (Correct answer)
- Organic dust toxic syndrome (ODTS)
- Allergic bronchopulmonary aspergillosis (ABPA)
Correct answer: Acute hypersensitivity pneumonitis (Farmer's lung)
Farmer's lung is a classic form of acute hypersensitivity pneumonitis caused by inhalation of thermophilic actinomycetes from moldy hay, occurring 4–8 hours after exposure.
ITE Pulmonology 4
A 48-year-old male with scleroderma presents with hemoptysis and renal failure.
Urinalysis shows RBC casts.
ANCA is negative.
Chest CT shows bilateral ground-glass opacities.
Anti-GBM antibody is positive.
What is the diagnosis?