PANRE Pulmonology 3 — Questions and Answers
Question 1: A 48-year-old woman presents with pleuritic chest pain, fever, and a unilateral pleural effusion. Thoracentesis reveals pH 7.1, glucose 45 mg/dL, and LDH >1000 U/L. What is the most appropriate management?
- Repeat thoracentesis in 48 hours
- Chest tube drainage (Correct answer)
- Oral antibiotics and observation
- Video-assisted thoracoscopic surgery (VATS) immediately
Correct answer: Chest tube drainage
A complicated parapneumonic effusion or empyema with pH <7.2, glucose <60, or elevated LDH requires drainage with chest tube placement.
Question 2: A 70-year-old with a 45-pack-year history has a 1.2 cm spiculated pulmonary nodule on CT chest. PET scan shows increased FDG uptake. Which is the next best step?
- Follow-up CT in 3 months
- Surgical resection or tissue sampling (Correct answer)
- PET-CT alone is sufficient for diagnosis
- Observation for 2 years
Correct answer: Surgical resection or tissue sampling
A spiculated nodule >1 cm with high FDG avidity on PET in a high-risk patient warrants tissue diagnosis or surgical resection.
Question 3: Which type of lung cancer is most commonly associated with paraneoplastic hypercalcemia?
- Small cell lung cancer
- Adenocarcinoma
- Squamous cell carcinoma (Correct answer)
- Large cell carcinoma
Correct answer: Squamous cell carcinoma
Squamous cell carcinoma of the lung most commonly causes hypercalcemia via PTHrP secretion as a paraneoplastic syndrome.
Question 4: A patient with obstructive sleep apnea fails CPAP therapy due to intolerance. BMI is 28 kg/m². AHI is 22. Which is the most appropriate alternative treatment?
- Supplemental oxygen alone
- Mandibular advancement device (Correct answer)
- Surgical uvulopalatopharyngoplasty (UPPP)
- Weight loss alone
Correct answer: Mandibular advancement device
A mandibular advancement device is the recommended alternative for mild-to-moderate OSA patients who cannot tolerate CPAP.
Question 5: A 30-year-old presents with spontaneous pneumothorax on the right side with 25% lung collapse. He is hemodynamically stable. What is the most appropriate management?
- Immediate needle decompression
- Small-bore chest tube or aspiration (Correct answer)
- Observation with supplemental oxygen
- Large-bore chest tube
Correct answer: Small-bore chest tube or aspiration
A primary spontaneous pneumothorax with >20% collapse in a stable patient is typically managed with small-bore chest tube or needle aspiration.
Question 6: Which pulmonary function test pattern is consistent with a restrictive lung disease?
- FEV1/FVC <0.70, increased TLC
- FEV1/FVC >0.70, decreased TLC and FVC (Correct answer)
- FEV1/FVC <0.70, normal TLC
- FEV1/FVC >0.70, increased RV
Correct answer: FEV1/FVC >0.70, decreased TLC and FVC
Restrictive lung disease shows FEV1/FVC ratio ≥0.70 (preserved) with decreased TLC and FVC due to reduced lung volumes.
Question 7: A 55-year-old with chronic cough undergoes bronchoscopy revealing endobronchial lesion. Biopsy shows small cells with high nuclear-to-cytoplasm ratio and crush artifact. Which treatment is most appropriate?
- Surgical lobectomy
- Chemotherapy with etoposide and platinum (Correct answer)
- Targeted therapy with EGFR inhibitor
- Radiation therapy alone
Correct answer: Chemotherapy with etoposide and platinum
Small cell lung cancer is managed with platinum-based chemotherapy (etoposide + cisplatin/carboplatin) as it is highly sensitive to chemotherapy but rarely curable surgically.
PANRE Pulmonology 3
A 48-year-old woman presents with pleuritic chest pain, fever, and a unilateral pleural effusion.
Thoracentesis reveals pH 7.1, glucose 45 mg/dL, and LDH >1000 U/L.
What is the most appropriate management?