Free Pulmonary Disease Practice Questions

Question 1

Pulmonary function testing for exertional dyspnea produces acceptable, repeatable maneuvers. The FEV1/FVC ratio is 0.56 (lower limit of normal, 0.68), FEV1 is 43% predicted, and FVC is 61% predicted. Plethysmography shows a total lung capacity of 103% predicted, within the laboratory reference range, and an RV/TLC ratio of 0.58 (upper limit of normal, 0.42). How should the reduced FVC be interpreted?

Accepted Answer

Air trapping accompanying airflow obstruction, without demonstrated restriction

Answer

A restrictive ventilatory defect superimposed on airflow obstruction

Answer

A nonspecific ventilatory pattern because total lung capacity is preserved

Answer

Premature termination of expiration creating a falsely low vital capacity

Question 2

Three days of fever, purulent sputum, and a new right lower-lobe consolidation lead to hospitalization of a 74-year-old man with poststroke dysphagia. Ceftriaxone and azithromycin are started for nonsevere community-acquired pneumonia. CT shows no lung abscess, necrosis, or empyema. He has no risk factors for MRSA or Pseudomonas infection. His swallowing evaluation documents recurrent aspiration. What antibiotic change is warranted solely because aspiration contributed to this episode?

Accepted Answer

None; continue the current pneumonia regimen

Answer

Add metronidazole for dedicated anaerobic coverage

Answer

Replace both drugs with clindamycin monotherapy

Answer

Stop antibiotics and treat this as chemical pneumonitis

Question 3

At an interstitial lung disease conference, a 72-year-old former smoker is discussed after 18 months of progressive dyspnea and bibasal inspiratory crackles. A detailed evaluation finds no relevant exposure, causative medication, or connective tissue disease. High-resolution CT shows basal, subpleural reticulation and traction bronchiectasis without honeycombing or features suggesting an alternative diagnosis. The radiologist classifies the scan as probable usual interstitial pneumonia. Which statement accurately describes the role of lung biopsy here?

Accepted Answer

A multidisciplinary diagnosis of idiopathic pulmonary fibrosis can be made without biopsy

Answer

Surgical biopsy is required because traction bronchiectasis without honeycombing cannot support a clinical diagnosis

Answer

Biopsy can be avoided only after serial CT demonstrates that honeycombing has developed

Answer

Transbronchial lung cryobiopsy is required to establish the diagnosis when surgical biopsy is deferred

Question 4

A 66-year-old former smoker with COPD takes a long-acting beta2 agonist/long-acting muscarinic antagonist combination correctly and consistently. Despite pulmonary rehabilitation and smoking cessation, he has had two exacerbations requiring prednisone in the past year. FEV1 is 58% predicted. Blood eosinophil counts measured well after recovery are 410 and 390 cells/microliter. He has no asthma history, recurrent pneumonia, or chronic sputum production. Which maintenance change is best supported at this point?

Accepted Answer

Add an inhaled corticosteroid to the existing dual bronchodilator regimen

Answer

Add daily roflumilast while leaving inhaled treatment unchanged

Answer

Add long-term azithromycin before introducing an inhaled corticosteroid

Answer

Add low-dose oral prednisone each day to prevent further exacerbations

Question 5

A patient with newly diagnosed HIV infection and a CD4 count of 38 cells/microliter has confirmed Pneumocystis jirovecii pneumonia. Trimethoprim-sulfamethoxazole has just been started. Before oxygen is applied, a room-air arterial blood gas at sea level shows PaO2 76 mm Hg and PaCO2 24 mm Hg. Using PAO2 = 150 - (PaCO2 / 0.8), which pairing correctly gives the alveolar-arterial oxygen gradient and its treatment implication?

Accepted Answer

44 mm Hg; add adjunctive corticosteroids

Answer

55 mm Hg; add adjunctive corticosteroids

Answer

44 mm Hg; withhold adjunctive corticosteroids

Answer

55 mm Hg; withhold adjunctive corticosteroids

Question 6

An outpatient sleep evaluation identifies an apnea-hypopnea index of 62 events/hour, almost all obstructive, in a 49-year-old woman with a BMI of 43 kg/m2. Oxygen saturation falls to 76% during sleep. While awake and clinically stable, her PaCO2 is 52 mm Hg, pH 7.38, and serum bicarbonate 30 mmol/L. COPD, neuromuscular disease, hypothyroidism, and sedating medications have been excluded. She has not had a recent admission for respiratory failure. For this combination of obesity hypoventilation and severe obstructive sleep apnea, which nocturnal treatment is preferred initially?

Accepted Answer

Continuous positive airway pressure

Answer

Bilevel positive airway pressure with a backup rate

Answer

Supplemental oxygen without positive airway pressure

Answer

Adaptive servo-ventilation targeting breath-to-breath ventilation

Question 7

A patient has completed two months of directly observed isoniazid, rifampin, pyrazinamide, and ethambutol for pulmonary tuberculosis, with substantial symptomatic improvement. The pretreatment radiograph had an upper-lobe cavity. A sputum specimen obtained at completion of two months of therapy remains culture-positive, and susceptibility testing confirms susceptibility to all first-line agents. Doses have not been missed. After completing this intensive phase, what continuation regimen is indicated?

Accepted Answer

Isoniazid and rifampin for seven additional months

Answer

Isoniazid and rifampin for four additional months

Answer

Isoniazid and rifampin for ten additional months

Answer

All four initial drugs for four additional months

Question 8

Recurrent episodes of wheezing and expectoration of brown mucus plugs prompt evaluation of a 35-year-old woman with asthma. CT demonstrates central bronchiectasis and mucus plugging without cavitation. Total IgE is 780 IU/mL, Aspergillus fumigatus-specific IgE is 3.1 kUA/L, and blood eosinophils are 920 cells/microliter. She has not recently received systemic corticosteroids and is not immunocompromised. Applying the revised ISHAM diagnostic criteria, how should this Aspergillus-related presentation be classified?

Accepted Answer

Allergic bronchopulmonary aspergillosis

Answer

Aspergillus sensitization without allergic bronchopulmonary aspergillosis

Answer

Chronic cavitary pulmonary aspergillosis

Answer

Invasive pulmonary aspergillosis

Question 9

Six hours after confirmation of bilateral pulmonary emboli, a 61-year-old patient remains alert with a blood pressure of 122/76 mm Hg, heart rate 116/min, lactate 1.4 mmol/L, and oxygen saturation 95% on 2 L/min. CT shows an RV/LV diameter ratio of 1.3, and troponin is elevated. There is no syncope, oliguria, or other evidence of hypoperfusion. Therapeutic anticoagulation has been initiated. Which disposition and reperfusion plan fits the findings?

Accepted Answer

Continue anticoagulation with inpatient monitoring; reserve reperfusion for deterioration

Answer

Administer systemic thrombolysis now because both right ventricular injury markers are abnormal

Answer

Arrange immediate catheter thrombectomy despite the absence of hemodynamic compromise

Answer

Discharge on oral anticoagulation because preserved blood pressure establishes low risk

Question 10

An 8-mm pure ground-glass nodule is found incidentally in an asymptomatic, immunocompetent 58-year-old never-smoker with no cancer history. Thin-section CT six months later confirms persistence without growth or a solid component. This is not a lung cancer screening examination. Under the Fleischner Society recommendations, what subsequent surveillance is appropriate if the nodule remains unchanged?

Accepted Answer

CT every two years until five years of follow-up have been completed

Answer

CT at 12 and 24 months, with surveillance ending after two years of stability

Answer

Annual CT indefinitely, using the same schedule as lung cancer screening

Answer

PET/CT now, followed by biopsy if the nodule demonstrates FDG uptake

Free Pulmonary Disease Practice Questions

Domain 3: Chronic bronchitis and emphysema (4-8%)

Question 1

Domain 4: Sleep disorders (3-7%)

Question 2

Domain 5: Bronchiectasis/cystic fibrosis (1-3%)

Question 3

Domain 6: Interstitial lung disease (10-14%)

Question 4

Domain 7: Pneumonia/pulmonary infections (10-14%)

Question 5

Question 6

Domain 8: Tuberculosis (6-10%)

Question 7

Domain 9: Benign/malignant neoplasms (2-6%)

Question 8

Domain 17: PE/DVT (1-5%)

Question 9

Domain 19: Interpretation PFTs (7-11%)

Question 10

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