PANRE Pulmonology 4 — Questions and Answers
Question 1: A 65-year-old with a history of rheumatoid arthritis presents with progressive dyspnea. PFTs show FVC 62% predicted, DLCO 55% predicted, FEV1/FVC 0.78. HRCT shows ground-glass opacities and reticulation. Which pattern is most likely?
- Usual interstitial pneumonia (UIP)
- Non-specific interstitial pneumonia (NSIP) (Correct answer)
- Cryptogenic organizing pneumonia (COP)
- Respiratory bronchiolitis-ILD
Correct answer: Non-specific interstitial pneumonia (NSIP)
NSIP is the most common ILD pattern associated with connective tissue diseases like rheumatoid arthritis, presenting with ground-glass opacities and reticulation on HRCT.
Question 2: A 40-year-old non-smoker presents with hemoptysis and bilateral pulmonary infiltrates. Urinalysis shows hematuria and red cell casts. Anti-GBM antibodies are positive. Which diagnosis is most likely?
- Granulomatosis with polyangiitis (GPA)
- Goodpasture syndrome (Correct answer)
- Microscopic polyangiitis
- Idiopathic pulmonary hemosiderosis
Correct answer: Goodpasture syndrome
Goodpasture syndrome presents with pulmonary-renal syndrome (hemoptysis + glomerulonephritis) and is confirmed by positive anti-GBM antibodies.
Question 3: Which statement about transudative pleural effusions is correct?
- Pleural protein >3.0 g/dL
- Pleural LDH >200 U/L
- Pleural LDH/serum LDH ratio >0.6
- Pleural protein/serum protein ratio <0.5 (Correct answer)
Correct answer: Pleural protein/serum protein ratio <0.5
By Light's criteria, a transudate has pleural/serum protein ratio <0.5, pleural/serum LDH ratio <0.6, and pleural LDH <2/3 upper limit of normal.
Question 4: A 55-year-old male presents with progressive exertional dyspnea, loud P2, and right heart failure. Echocardiogram shows RVSP of 58 mmHg. Right heart catheterization confirms mean PAP of 32 mmHg with PCWP of 10 mmHg. Which initial treatment is recommended for WHO Group 1 pulmonary arterial hypertension?
- Calcium channel blockers in all patients
- Endothelin receptor antagonist or PDE-5 inhibitor (Correct answer)
- Anticoagulation alone
- Supplemental oxygen only
Correct answer: Endothelin receptor antagonist or PDE-5 inhibitor
WHO Group 1 PAH is treated with PAH-specific therapy including endothelin receptor antagonists (ambrisentan, bosentan) or PDE-5 inhibitors (sildenafil, tadalafil).
Question 5: A 28-year-old female non-smoker presents with recurrent pneumothoraces and dyspnea. HRCT shows bilateral diffuse thin-walled cysts. She is taking oral contraceptives. What is the most likely diagnosis?
- Langerhans cell histiocytosis
- Lymphangioleiomyomatosis (LAM) (Correct answer)
- Birt-Hogg-Dubé syndrome
- Pulmonary Langerhans cell histiocytosis
Correct answer: Lymphangioleiomyomatosis (LAM)
Lymphangioleiomyomatosis presents in women of childbearing age with diffuse bilateral thin-walled cysts, recurrent pneumothoraces, and chylothorax.
Question 6: A patient with COPD and resting PaO2 of 54 mmHg is prescribed home oxygen. What is the minimum recommended daily duration of oxygen use to improve survival?
- 8 hours per day
- 12 hours per day
- 15 hours per day (Correct answer)
- 24 hours per day
Correct answer: 15 hours per day
The NOTT trial demonstrated that continuous oxygen (≥18 hours) improved survival, but the minimum beneficial threshold shown was 15 hours per day.
Question 7: Which medication is used as a first-line maintenance therapy for mild persistent asthma in adults?
- Long-acting beta-agonist (LABA) monotherapy
- Low-dose inhaled corticosteroid (ICS) (Correct answer)
- Leukotriene receptor antagonist (LTRA) as preferred
- Oral corticosteroids
Correct answer: Low-dose inhaled corticosteroid (ICS)
Low-dose inhaled corticosteroids are the preferred first-line controller therapy for mild persistent asthma per GINA guidelines.
PANRE Pulmonology 4
A 65-year-old with a history of rheumatoid arthritis presents with progressive dyspnea.
PFTs show FVC 62% predicted, DLCO 55% predicted, FEV1/FVC 0.78.
HRCT shows ground-glass opacities and reticulation.
Which pattern is most likely?