1. Pulmonary Board Review

2. A patient receives PFTs with results of a normal FEV1, FVC, and TLC
A patient receives PFTs with results of a normal FEV1, FVC, and TLC. DLCO 140% of predicted. This patient most likely has
A) Asthma
B) COPD
C) Bronchitis
D) Alveolar hemorrhage
E) Iron deficiency anemia

3. A patient receives PFTs with results of a normal FEV1, FVC, and TLC
A patient receives PFTs with results of a normal FEV1, FVC, and TLC. DLCO 140% of predicted. This patient most likely has
A) Asthma
B) COPD
C) Bronchitis
D) Alveolar hemorrhage
E) Iron deficiency anemia

4. Patient with a history of asthma presents to the ED with an acute exacerbation. Initial ABG 7.46/34/70/94%. Patient receives neb treatment with albuterol. After the third treatment, exam reveals decreased breath sounds, RR >30/min, HR 130/min. ABG 7.38/46/70/92%. The most appropriate management is
A) Start IV steroids
B) Intubate the patient
C) Start IV antibiotics
D) Increase O2 to 50% by ventimask
E) Continue neb treatments

5. Patient with a history of asthma presents to the ED with an acute exacerbation. Initial ABG 7.46/34/70/94%. Patient receives neb treatment with albuterol. After the third treatment, exam reveals decreased breathsounds, RR >30/min, HR 130/min. ABG 7.38/46/70/92%. The most appropriate management is
A) Start IV steroids
B) Intubate the patient
C) Start IV antibiotics
D) Increase O2 to 50% by ventimask
E) Continue neb treatments

6. A patient is incidentally found to have an aspergilloma on a screening chest CT. There is no surrounding fibrosis and the patient has no symptoms. Which of the following is the best management?
A) Monitor
B) Surgical Resection
C) Itraconazole PO
D) IV Micafungin
E) Amphotericin B instillation into the cavity

7. A patient is incidentally found to have an aspergilloma on a screening chest CT. There is no surrounding fibrosis and the patient has no symptoms. Which of the following is the best management?
A) Monitor
B) Surgical Resection
C) Itraconazole PO
D) IV Micafungin
E) Amphotericin B instillation into the cavity

8. Patient recently immigrated from Peru
Patient recently immigrated from Peru. She has a history of asthma, but has recurrent cough and wheeze despite increased use of B2 agonist. CBC shows eosinophils of 20%. ANCA neg, ANA neg. CXR shows round infiltrates. Most likely diagnosis is
A) Hypersensitivity pneumonitis
B) ABPA
C) MTB
D) Strongyloides infection
E) Churg-Strauss syndrome

9. Patient recently immigrated from Peru
Patient recently immigrated from Peru. She has a history of asthma, but has recurrent cough and wheeze despite increased use of B2 agonist. CBC shows eosinophils of 20%. ANCA neg, ANA neg. CXR shows round infiltrates. Most likely diagnosis is
A) Hypersensitivity pneumonitis
B) ABPA
C) MTB
D) Strongyloides infection
E) Churg-Strauss syndrome

10. Patient with a history of high altitude pulmonary edema gets sick every time he goes up to the mountain to ski. He wants to go back next year. What is the best advice for prevention?
A) Lasix
B) ACE inhibitor
C) HCTZ
D) Acetazolamide

11. Patient with a history of high altitude pulmonary edema gets sick every time he goes up to the mountain to ski. He wants to go back next year. What is the best advice for prevention?
A) Lasix
B) ACE inhibitor
C) HCTZ
D) Acetazolamide

12. 38 yo chronic smoker presents with progressive dyspnea
38 yo chronic smoker presents with progressive dyspnea. CXR shows interstitial disease with honeycomb appearance in the upper lung fields. PFTs show restrictive pattern. BAL shows Langerhan cells and Biopsy shows giant cells with fibrosis. What is the most likely diagnosis?
A) Desquamitive interstitial pneumonia
B) Histiocytosis X
C) Multiple myeloma
D) Hemophagocytic lymphohistiocytosis
E) Cryptogenic organizing pneumonia

13. 38 yo chronic smoker presents with progressive dyspnea
38 yo chronic smoker presents with progressive dyspnea. CXR shows interstitial disease with honeycomb appearance in the upper lung fields. PFTs show restrictive pattern. BAL shows Langerhan cells and Biopsy shows giant cells with fibrosis. What is the most likely diagnosis?
A) Desquamitive interstitial pneumonia B) Histiocytosis X C) Multiple myeloma D) Hemophagocytic lymphohistiocytosis
E) Cryptogenic organizing pneumonia

14. Patient presents with nasal congestion and rhinorrhea for the past several months. She has a history of allergies which is usually controlled with nasal decongestants and antihistamines. She has been using over the counter medications and it has gotten worse. Exam reveals red edematous mucosa of the nares. Most likely diagnosis is
A) Allergic rhinitis
B) Rhinitis Medicamentosa
C) Nasal polyps
D) Deviated nasal septum
E) Chronic sinusitis

15. Patient presents with nasal congestion and rhinorrhea for the past several months. She has a history of allergies which is usually controlled with nasal decongestants and antihistamines. She has been using over the counter medications and it has gotten worse. Exam reveals red edematous mucosa of the nares. Most likely diagnosis is
A) Allergic rhinitis
B) Rhinitis Medicamentosa
C) Nasal polyps
D) Deviated nasal septum
E) Chronic sinusitis

16. 25 year old presents with purulent nasal discharge and headache for the past 2 days. Has had cough. You would treat with
A) IV antibiotics
B) Erythromycin
C) Amoxicillin
D) Decongestants and analgesics
E) Sinus CT

17. 25 year old presents with purulent nasal discharge and headache for the past 2 days. Has had cough. You would treat with
A) IV antibiotics
B) Erythromycin
C) Amoxicillin
D) Decongestants and analgesics
E) Sinus CT

18. Patient with 30 year history if asthma, central bronchiectasis, peripheral eosinophilia worse when prednisone tapered off. What is the diagnosis ?
A ABPA
B Eosinophilic Pnumonia
C Loeffgrens Syndome
D Small cell carcinoma

19. Patient with 30 year history if asthma, central bronchiectasis, peripheral eosinophilia worse when prednisone tapered off. What is the diagnosis ?
A ABPA
B Eosinophilic Pnumonia
C Loeffgrens Syndome
D Small cell carcinoma

20. 75 Year old man with past medical history of polio and kyphoscoliosis now presents with increased fatigue, daytime somnolence, peripheral edema. Patient also reports poor cough. Which of he following investigations will be normal ?
A FVC
B Pco2
C TLC
D DLCO

21. 75 Year old man with past medical history of polio and kyphoscoliosis now presents with increased fatigue, daytime somnolence, peripheral edema. Patient also reports poor cough. Which of he following investigations will be normal ?
A FVC
B Pco2
C TLC
D DLCO

22. 66 year old male with long smoking history and h/o COPD is admitted to the ICU with community acquired pneumonia. CXR shows LLL infiltrate and small pleural effusion. He is started on ceftriaxone and levofloxacin and improves clinically, now off 02 and afebrile. His repeat CXR shows LLL infiltrate but larger pleural effusion. What should be done in his management?
A Cont IV fluids
B Add Macrolide
C Thoracentesis
D Switch to oral antibiotics

23. 66 year old male with long smoking history and h/o COPD is admitted to the ICU with community acquired pneumonia. CXR shows LLL infiltrate and small pleural effusion. He is started on ceftriaxone and levofloxacin and improves clinically, now off 02 and afebrile. His repeat CXR shows LLL infiltrate but larger pleural effusion. What should be done in his management?
A Cont IV fluids
B Add Macrolide
C Thoracentesis
D Switch to oral antibiotics

24. 31 year old asthmatic is managed on budesonide inhalers and a prn albuterol inhaler. She presents with ongoing cough at night . Which of the following is the best next step in management ?
A increase the frequency of albuterol
B add ipratropium
C add long acting beta agonist
D Oral steroids

25. 31 year old asthmatic is managed on budesonide inhalers and a prn albuterol inhaler. She presents with ongoing cough at night . Which of the following is the best next step in management ?
A increase the frequency of albuterol
B add ipratropium
C add long acting beta agonist
D Oral steroids

26. 35 Year old women with 3 months of SOB, PFTs reveal FEV1 95%, fvc 100%,TLC 100%, DLCO 60% Predicted. What is the most likely diagnosis?
A Alpha 1 antitrypsin deficiency
B Chronic bronchitis
C IPF
D Pulm. Hypertension
E Emphysema

27. 35 Year old women with 3 months of SOB, PFTs reveal FEV1 95%, fvc 100%,TLC 100%, DLCO 60% Predicted. What is the most likely diagnosis?
A Alpha 1 antitrypsin deficiency
B Chronic bronchitis
C IPF
D Pulm. Hypertension
E Emphysema

28. 50 year old male with a 10 pack year smoking history presents with non productive cough. His PFT’s show mild obstruction. What is the best way to differentiate between emphysema and asthma?
A Elevated residual volume in emphysema
B FEV1 is lower in emphysema
C FEV1 response to bronchodilators is diagnostic for asthma
D Lower DLCO suggests emphysema

29. 50year old male with a 10 pack year smoking history presents with non productive cough. His PFT’s show mild obstruction. What is the best way to differentiate between emphysema and asthma?
A Elevated residual volume in emphysema
B FEV1 is lower in emphysema
C FEV1 response to bronchodilators is diagnostic for asthma
D Lower DLCO suggests emphysema

30. 23 Year old firefighter is caught in a forest fire and presents to ER with hypoxia and smoke inhalation Your testing shows carboxyhemoglobin level of 70%. What is the best management?
A 100% O2
B 2- PAM
C Sodium thiosulfate
D methylene blue

31. 23 Year old firefighter is caught in a forest fire and presents to ER with hypoxia and smoke inhalation Your testing shows carboxyhemoglobin level of 70%. What is the best management?
A 100% O2
B 2- PAM
C Sodium thiosulfate
D methylene blue

32. Patient with hilar adenopathy, and no infiltrates found on CXR is diagnosed with Sarcoidosis. What is the most likely disease course?
A) 10% remission at the end of 5 years
B) 30% remission at the end of 5 years
C) 50% remission at the end of 5 years
D) 90% remission at the end of 5 years

33. Patient with hilar adenopathy, and no infiltrates found on CXR is diagnosed with Sarcoidosis. What is the most likely disease course?
A) 10% remission at the end of 5 years
B) 30% remission at the end of 5 years
C) 50% remission at the end of 5 years
D) 90% remission at the end of 5 years

34. 44 year old male has multiple pelvic and hip fractures and undergoes hip replacement. Two days later he develops fever, mental confusion and SOB. Petechia on the chest are noted. CXR shows diffuse pulmonary infiltrates. Blood gases reveals po2 44, pCO2 of 30, pH EKG shows sinus tach. Patient is intubated and transferred to the ICU. Most likely diagnosis?
A) ARDS due to sepsis
B) Acute Septic Shock
C) Non cardiogenic pulmonary edema due to fat emboli
D) Alveolar hemorrhage

35. 44 year old male has multiple pelvic and hip fractures and undergoes hip replacement. Two days later he develops fever, mental confusion and SOB. Petechia on the chest are noted. CXR shows diffuse pulmonary infiltrates. Blood gases reveals po2 44, pCO2 of 30, pH EKG shows sinus tach. Patient is intubated and transferred to the ICU. Most likely diagnosis?
A) ARDS due to sepsis
B) Acute Septic Shock
C) Non cardiogenic pulmonary edema due to fat emboli
D) Alveolar hemorrhage