Pulmonary Disease Essentials Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Pulmonary Disease Essentials flashcards as text
A 40-year-old nonsmoking woman with hemoptysis and renal failure has a chest CT showing bilateral pulmonary infiltrates. Serum ANCA is positive (PR3 pattern). What is the most likely diagnosis?
Answer: Granulomatosis with polyangiitis (GPA)
GPA (formerly Wegener's) presents with the classic triad of upper airway, lower airway, and renal disease with positive c-ANCA (anti-PR3) in > 90% of cases.
Which statement about the management of community-acquired pneumonia (CAP) requiring ICU admission is correct?
Answer: Beta-lactam plus macrolide or beta-lactam plus respiratory fluoroquinolone is recommended
IDSA/ATS guidelines recommend combination therapy with a beta-lactam plus either a macrolide or a respiratory fluoroquinolone for severe CAP requiring ICU admission.
A 72-year-old with COPD has resting SpO2 of 87% on room air. Which statement about long-term oxygen therapy (LTOT) is correct?
Answer: LTOT at ≥ 15 hours/day improves survival in patients with PaO2 ≤ 55 mmHg
The MRC and NOTT trials showed LTOT used ≥ 15 hours/day improves survival in COPD patients with PaO2 ≤ 55 mmHg (or ≤ 59 mmHg with cor pulmonale or polycythemia).
A 30-year-old woman presents with pleuritic chest pain, dyspnea, and a Wells score of 5. D-dimer is 1.8 μg/mL. What is the next best step?
Answer: Start anticoagulation and confirm diagnosis with CT pulmonary angiography
A Wells score > 4 indicates high pretest probability for PE; a positive D-dimer in this context mandates confirmatory CT-PA and concurrent anticoagulation if no contraindication.
A patient with severe persistent asthma remains uncontrolled on high-dose ICS/LABA and tiotropium. Serum IgE is 850 IU/mL and blood eosinophils are 350 cells/μL. Which biologic therapy targets both IgE and is FDA-approved for this patient?
Answer: Omalizumab (anti-IgE)
Omalizumab binds free IgE and is indicated for moderate-to-severe allergic asthma with elevated serum IgE (30-700 IU/mL) in patients ≥ 6 years; at 850 IU/mL it exceeds the labeled range but dupilumab or mepolizumab would be alternatives.
Which of the following best describes the mechanism of action of sildenafil in pulmonary arterial hypertension?
Answer: Inhibits PDE-5, increasing cGMP and promoting vasodilation
Sildenafil inhibits phosphodiesterase-5 (PDE-5), preventing degradation of cGMP, which leads to smooth muscle relaxation and pulmonary vasodilation via the NO-cGMP pathway.
A 58-year-old coal miner presents with progressive dyspnea and a chest X-ray showing 'eggshell calcifications' of hilar lymph nodes and upper-lobe nodules. What is the most likely diagnosis?
Answer: Silicosis
Eggshell calcification of hilar lymph nodes is pathognomonic of silicosis, caused by crystalline silica inhalation with upper-lobe predominant nodularity.