PANRE Pulmonology 5 — Questions and Answers
Question 1: A 45-year-old male presents with chronic cough, wheezing, and nasal polyps. He develops severe bronchospasm after taking ibuprofen for knee pain. What syndrome does he have?
- Churg-Strauss syndrome
- Aspirin-exacerbated respiratory disease (AERD) (Correct answer)
- Reactive airways dysfunction syndrome
- Exercise-induced bronchoconstriction
Correct answer: Aspirin-exacerbated respiratory disease (AERD)
Aspirin-exacerbated respiratory disease (Samter's triad) consists of asthma, nasal polyps, and NSAID-induced bronchospasm.
Question 2: A 52-year-old farmer presents with acute onset fever, myalgia, and bilateral pulmonary infiltrates 4-6 hours after working in a dusty barn. Symptoms resolve within 24 hours without treatment. What is the most likely diagnosis?
- Community-acquired pneumonia
- Hypersensitivity pneumonitis (acute)
- Acute eosinophilic pneumonia
- Organic dust toxic syndrome (Correct answer)
Correct answer: Organic dust toxic syndrome
Organic dust toxic syndrome (ODTS) occurs after heavy organic dust exposure causing flu-like illness and bilateral infiltrates that resolve spontaneously within 24-48 hours without sensitization.
Question 3: A 68-year-old with lung adenocarcinoma is found to have an EGFR exon 19 deletion mutation. Which first-line therapy is most appropriate?
- Carboplatin + paclitaxel chemotherapy
- Osimertinib (third-generation EGFR TKI) (Correct answer)
- Pembrolizumab immunotherapy
- Erlotinib (first-generation EGFR TKI)
Correct answer: Osimertinib (third-generation EGFR TKI)
Osimertinib is the preferred first-line EGFR TKI for NSCLC with EGFR-sensitizing mutations based on superior outcomes in the FLAURA trial.
Question 4: A 62-year-old presents with progressive dyspnea and is found to have bilateral pleural effusions. Echocardiography shows EF of 35%. Thoracentesis reveals protein 2.1 g/dL and LDH 140 U/L. What is the most likely cause?
- Malignant pleural effusion
- Parapneumonic effusion
- Congestive heart failure transudate (Correct answer)
- Hepatic hydrothorax
Correct answer: Congestive heart failure transudate
Bilateral effusions with low protein and LDH in the context of reduced EF are consistent with a transudative effusion from congestive heart failure.
Question 5: A 33-year-old with cystic fibrosis has FEV1 38% predicted and recurrent Pseudomonas exacerbations. Which chronic suppressive antibiotic regimen is most appropriate?
- Daily oral ciprofloxacin
- Inhaled tobramycin alternating monthly (Correct answer)
- Inhaled colistin twice daily continuously
- IV piperacillin-tazobactam every 3 months
Correct answer: Inhaled tobramycin alternating monthly
Inhaled tobramycin in alternating monthly cycles is a guideline-recommended chronic suppressive therapy for CF patients with chronic Pseudomonas infection.
Question 6: Which ventilator parameter should be prioritized when managing ARDS to prevent ventilator-induced lung injury (VILI)?
- PEEP <5 cm H2O to avoid barotrauma
- Tidal volume 4-6 mL/kg ideal body weight (Correct answer)
- FiO2 100% to maximize oxygenation
- RR <12 breaths/min to minimize auto-PEEP
Correct answer: Tidal volume 4-6 mL/kg ideal body weight
The ARDSNet protocol demonstrated reduced mortality using lung-protective ventilation with low tidal volumes of 4-6 mL/kg IBW to minimize VILI.
Question 7: A 44-year-old HIV-positive patient with CD4 count of 90 cells/µL presents with progressive dyspnea, non-productive cough, and fever. CXR shows bilateral interstitial infiltrates. LDH is elevated at 520 U/L. What is the most likely diagnosis?
- Mycobacterium avium complex (MAC) pulmonary infection
- Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
- Cytomegalovirus pneumonitis
- Cryptococcal pneumonia
Correct answer: Pneumocystis jirovecii pneumonia (PCP)
PCP classically presents in HIV patients with CD4 <200 with bilateral interstitial infiltrates, elevated LDH, and non-productive cough, and is the leading AIDS-defining pulmonary opportunistic infection.
PANRE Pulmonology 5
A 45-year-old male presents with chronic cough, wheezing, and nasal polyps.
He develops severe bronchospasm after taking ibuprofen for knee pain.
What syndrome does he have?