Respiratory Medicine

Topics in this chapter

• Obstructive Airway Diseases
• Interstitial and Occupational Lung Disease
• Pleural Disease and Pneumothorax
• Respiratory Failure and ABG Interpretation
• Lung Cancer and Paraneoplastic Syndromes

Practice questions

1. Question 1Q-196E0D

   A 55-year-old chronic smoker presents with worsening dyspnea and cough with purulent sputum. Arterial blood gas analysis on room air reveals pH 7.31, PaCO2 62 mmHg, PaO2 54 mmHg, and HCO3- 31 mEq/L. Which of the following is the most appropriate next step in acute management?

   1. A.High-flow oxygen therapy via a non-rebreather mask to target SpO2 > 98%
   2. B.Controlled oxygen therapy with Venturi mask to target SpO2 88-92% and non-invasive positive pressure ventilation (NIPPV)
   3. C.Immediate endotracheal intubation and invasive mechanical ventilation
   4. D.Administration of respiratory stimulants like Doxapram
   See the answer and solution
2. Question 2Q-846EDE

   A 28-year-old woman presents with bilateral hilar lymphadenopathy and Erythema nodosum on her shins. Serum calcium is slightly elevated, and serum angiotensin-converting enzyme (ACE) levels are high. Transbronchial biopsy reveals non-caseating granulomas. What is the most appropriate initial management for this asymptomatic or mildly symptomatic patient?

   1. A.Lifelong systemic corticosteroids
   2. B.Observation with serial clinical and pulmonary function evaluations
   3. C.Immediate initiation of Methotrexate
   4. D.Incisional surgical biopsy of the mediastinal lymph nodes
   See the answer and solution
3. Question 3Q-098CE3

   A 65-year-old male with a 40 pack-year smoking history presents with a 3-month history of cough and hemoptysis. Chest X-ray reveals a cavitary lesion in the right upper lobe with thick, irregular walls. Sputum cytology is suspicious for squamous cell carcinoma. Which of the following paraneoplastic syndromes is most characteristically associated with this specific histological subtype?

   1. A.Hyponatremia secondary to SIADH
   2. B.Hypercalcemia secondary to PTH-related protein (PTHrP) secretion
   3. C.Cushing syndrome due to ectopic ACTH production
   4. D.Lambert-Eaton myasthenic syndrome
   See the answer and solution
4. Question 4Q-8533EC

   A 45-year-old cement worker presents with progressive dyspnea and dry cough. Chest radiograph shows bilateral upper lobe calcified nodular opacities, and some lymph nodes show peripheral 'eggshell' calcification. High-resolution computed tomography (HRCT) confirms these findings. He has a high risk of developing which of the following secondary pulmonary infections?

   1. A.Pneumocystis jirovecii pneumonia
   2. B.Mycobacterium tuberculosis (Silicotuberculosis)
   3. C.Mycoplasma pneumoniae
   4. D.Cytomegalovirus pneumonitis
   See the answer and solution
5. Question 5Q-6BED4A

   A 32-year-old man presents with recurrent episodes of wheezing, fleeting pulmonary infiltrates on chest radiography, and peripheral blood eosinophilia. Total serum IgE is markedly elevated, and skin test is positive for Aspergillus fumigatus antigens. Which of the following is the hallmark diagnostic finding for Allergic Bronchopulmonary Aspergillosis (ABPA)?

   1. A.Central bronchiectasis
   2. B.Panacinar emphysema
   3. C.Peribronchial honeycombing in the lower lobes
   4. D.Pleural plaques with calcification
   See the answer and solution