Pulmonology (COPD, asthma, interstitial lung disease) Practice Questions

Question 1

A 56-year-old man presents with progressive dyspnea and dry cough. HRCT shows honeycombing and traction bronchiectasis in lower lobes. He has clubbing. What is the most likely diagnosis?

Accepted Answer

Idiopathic pulmonary fibrosis

Answer

COPD

Answer

Asthma

Answer

Sarcoidosis

Answer

Hypersensitivity pneumonitis

Question 2

A patient presents with respiratory difficulty and a history of chronic smoking. Pulmonary function testing shows a decrease in FEV1/FVC ratio. What is the most probable diagnosis?

Accepted Answer

Chronic Obstructive Pulmonary Disease (COPD)

Answer

Interstitial Lung Disease

Answer

Pulmonary Fibrosis

Answer

Asthma

Question 3

Which of the following is/are characteristic pathological findings in asthma?

Accepted Answer

All of the options

Answer

Curschmann spirals

Answer

Charcot-Leyden crystals

Answer

Occlusion of bronchi and bronchioles by mucus

Question 4

A 32-year-old woman presents to the Emergency Department with an acute asthma exacerbation. She receives nebulised salbutamol 5mg and ipratropium 500 micrograms with oxygen, oral prednisolone 40mg, and controlled oxygen therapy. Initial peak flow was 30% of her best. After 1 hour of treatment, repeat observations show: heart rate 128 bpm, respiratory rate 30 breaths/min, oxygen saturation 91% on 40% oxygen, peak flow 32% of best. She appears exhausted and is speaking in words only. Arterial blood gas shows: pH 7.28, PaCO2 6.8 kPa, PaO2 8.1 kPa, HCO3- 24 mmol/L on 40% oxygen. What is the most critical next step in management?

Accepted Answer

Involve senior medical staff and ICU team immediately

Answer

Commence intravenous magnesium sulphate 2g over 20 minutes

Answer

Start intravenous aminophylline infusion

Answer

Repeat nebulised bronchodilators continuously

Answer

Arrange transfer to high dependency unit for non-invasive ventilation

Question 5

A 35-year-old pregnant woman at 24 weeks gestation with moderate persistent asthma presents with worsening symptoms over 3 days. She has been using albuterol 6-8 times daily. She discontinued her ICS/LABA inhaler when she learned she was pregnant due to concerns about fetal safety. Current medications include prenatal vitamins only. Vital signs: respiratory rate 24/min, oxygen saturation 94% on room air, heart rate 98/min. Peak flow is 60% of her personal best. Fetal heart monitoring is reassuring. Synthesizing the management approach that balances maternal asthma control and fetal safety, what is the most appropriate treatment plan?

Accepted Answer

Restart ICS/LABA, give oral prednisone burst, close monitoring

Answer

Continue albuterol only until delivery to minimize fetal medication exposure

Answer

Start oral prednisone and continue albuterol only

Answer

Give IM corticosteroids and restart ICS after delivery

Answer

Hospitalize for IV corticosteroids and continuous monitoring

Question 6

A 56-year-old woman presents with 6 months of progressive dyspnea. She has no occupational exposures or smoking history. HRCT shows bilateral peripheral and basal predominant reticular opacities with honeycombing and minimal ground-glass opacities. No significant mediastinal lymphadenopathy. PFTs show FVC 62% predicted, FEV1/FVC 0.84, DLCO 52% predicted. She was started on prednisone 40 mg daily by another physician 3 weeks ago with minimal improvement. Surgical lung biopsy shows usual interstitial pneumonia pattern with fibroblastic foci and temporal heterogeneity. Evaluate the most appropriate management modification.

Accepted Answer

Discontinue prednisone, start nintedanib

Answer

Increase prednisone dose to 60 mg daily

Answer

Continue prednisone and add azathioprine

Answer

Continue prednisone and add N-acetylcysteine

Answer

Continue prednisone and add mycophenolate

Question 7

A 68-year-old man with COPD (FEV1 38% predicted) presents with his third exacerbation in 4 months despite LAMA/LABA/ICS therapy. Each exacerbation has required oral antibiotics and prednisone. He quit smoking 2 years ago. Blood eosinophil count is 80 cells/μL. Sputum cultures from previous exacerbations grew Haemophilus influenzae twice and Moraxella catarrhalis once. He remains symptomatic with mMRC dyspnea score of 3. Evaluating strategies to reduce future exacerbations, what intervention would provide the most benefit?

Accepted Answer

Add azithromycin 250 mg three times weekly

Answer

Switch to LAMA/LABA and discontinue ICS

Answer

Add N-acetylcysteine 600 mg twice daily

Answer

Add roflumilast to current regimen

Answer

Increase ICS to high dose

Question 8

A 42-year-old woman with severe asthma on high-dose ICS/LABA has had 4 hospitalizations in the past year despite good adherence. Her pre-bronchodilator FEV1 is 65% predicted, improving to 78% post-bronchodilator. Laboratory studies show peripheral eosinophil count of 420 cells/μL, total IgE 180 IU/mL. She has no history of nasal polyps. Skin testing is positive for dust mites and cat dander, but she has no pets and uses allergen-proof bedding. Analyzing this case, which biologic therapy is most appropriate?

Accepted Answer

Mepolizumab (anti-IL-5)

Answer

Benralizumab (anti-IL-5Rα)

Answer

Omalizumab (anti-IgE)

Answer

Tezepelumab (anti-TSLP)

Answer

Dupilumab (anti-IL-4Rα)

Question 9

A 48-year-old woman presents with 8 months of progressive dyspnea and dry cough. She works as a dental technician. Exam reveals bibasilar fine crackles. HRCT shows bilateral lower lobe reticular opacities with honeycombing and traction bronchiectasis. Pulmonary function tests show FVC 58% predicted, FEV1/FVC ratio 0.82, DLCO 48% predicted. Bronchoalveolar lavage shows lymphocytosis with CD4/CD8 ratio of 0.8. Transbronchial biopsy is non-diagnostic. Analyzing the pattern of findings, what is the most likely diagnosis?

Accepted Answer

Chronic hypersensitivity pneumonitis

Answer

Idiopathic pulmonary fibrosis

Answer

Sarcoidosis

Answer

Cryptogenic organizing pneumonia

Answer

Nonspecific interstitial pneumonia

Question 10

A 55-year-old man with COPD presents with progressive dyspnea. Chest CT shows upper lobe-predominant emphysema with heterogeneous distribution and a giant bulla in the right upper lobe compressing adjacent lung tissue. FEV1 is 32% predicted, DLCO 35% predicted. Six-minute walk distance is 280 meters. He has stopped smoking 8 months ago and completed pulmonary rehabilitation. Despite maximal medical therapy including LAMA/LABA/ICS, he remains severely limited. Arterial blood gas on room air shows pH 7.38, PaCO2 48 mmHg, PaO2 62 mmHg. Analyzing this presentation, what intervention would provide the greatest potential benefit?

Accepted Answer

Bullectomy procedure

Answer

Long-term oxygen therapy initiation

Answer

Lung transplantation evaluation

Answer

Lung volume reduction surgery evaluation

Answer

Roflumilast addition to current regimen

Pulmonology (COPD, asthma, interstitial lung disease)

Study Resources

Lessons

Questions

Flashcards

Lessons

COPD pathophysiology and diagnosis

COPD management and exacerbations

Asthma pathophysiology and diagnosis

Asthma management and exacerbations

Interstitial lung disease classification

Idiopathic pulmonary fibrosis

Hypersensitivity pneumonitis

Sarcoidosis

Pulmonary function testing interpretation

Bronchiectasis

Cystic fibrosis in adults

Sleep-disordered breathing

Pulmonary rehabilitation

Practice Questions

Flashcards

About Pulmonology (COPD, asthma, interstitial lung disease) for USMLE

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