TEST 1: COMPREHENSIVE PULMONARY
MEDICINE – NURS 5432 TEST QUESTIONS
COMPLETE WITH 100% VERIFIED ANSWERS
1. A 68-year-old male with a history of heavy smoking and asbestos
exposure presents with progressive dyspnea and a non-productive
cough. A high-resolution CT scan shows peripheral, basal-predominant
reticular opacities with honeycombing. Which of the following
pathological findings is most characteristic of this condition?
A. Pleural plaques with ferruginous bodies
B. Interstitial infiltration by eosinophils
C. Fibroblastic foci with temporal heterogeneity
D. Intra-alveolar accumulation of lipoproteinaceous material
Correct answer: C – Fibroblastic foci with temporal heterogeneity are
the hallmark of usual interstitial pneumonia (UIP), which correlates with
idiopathic pulmonary fibrosis. The HRCT findings described are classic
for UIP. Asbestos exposure increases risk, but the pattern is UIP not
asbestosis alone. Pleural plaques (A) are seen in asbestosis but not
pathognomonic for UIP. Eosinophils (B) suggest eosinophilic pneumonia.
Lipoproteinaceous material (D) is seen in pulmonary alveolar
proteinosis.
2. A 45-year-old woman presents with episodic wheezing, nasal
polyps, and marked peripheral eosinophilia. Which medication is most
,likely to have caused this syndrome if used chronically for asthma?
A. Montelukast
B. Ipratropium bromide
C. Zafirlukast
D. Zileuton
Correct answer: A – Montelukast, a leukotriene receptor antagonist,
has been associated with Churg-Strauss syndrome (eosinophilic
granulomatosis with polyangiitis) when systemic corticosteroids are
withdrawn. The triad of asthma, eosinophilia, and vasculitis can be
unmasked. Zafirlukast (C) is another leukotriene antagonist but has
weaker association; Zileuton (D) is a 5-lipoxygenase inhibitor.
Ipratropium (B) is not linked.
3. A 72-year-old man with COPD on long-term oxygen therapy is found
unresponsive. Arterial blood gas on room air shows pH 7.18, PaCO2 90
mm Hg, PaO2 45 mm Hg, HCO3 28 mEq/L. Which of the following best
explains the primary acid-base disturbance?
A. Metabolic acidosis with respiratory compensation
B. Acute-on-chronic respiratory acidosis
C. Chronic respiratory acidosis with metabolic alkalosis
D. Mixed metabolic acidosis and respiratory alkalosis
Correct answer: B – Acute-on-chronic respiratory acidosis: Chronic
elevation of PaCO2 (baseline likely ~60 mm Hg in severe COPD) with
acute worsening causing severe hypercapnia and acidemia. HCO3 28
shows some renal compensation but insufficient for PaCO2 90
(expected HCO3 ~36 if fully compensated chronic). Metabolic acidosis
(A) would have low HCO3. Chronic respiratory acidosis with metabolic
,alkalosis (C) would have higher HCO3. Respiratory alkalosis (D) has low
PaCO2.
4. A 55-year-old with rheumatoid arthritis develops progressive
dyspnea. HRCT shows bilateral ground-glass opacities with septal
thickening (crazy-paving pattern). Bronchoalveolar lavage fluid is milky
and periodic acid–Schiff (PAS) positive. What is the most likely
diagnosis?
A. Usual interstitial pneumonia
B. Pulmonary alveolar proteinosis
C. Lymphocytic interstitial pneumonia
D. Cryptogenic organizing pneumonia
Correct answer: B – Pulmonary alveolar proteinosis: autoimmune (anti-
GM-CSF antibodies) or secondary to rheumatoid arthritis. Crazy-paving
on HRCT and milky PAS-positive BAL fluid are diagnostic. UIP (A) shows
honeycombing, not crazy-paving. Lymphocytic interstitial pneumonia (C)
has lymphoid infiltrates. Organizing pneumonia (D) shows patchy
airspace consolidation.
5. A 30-year-old male IV drug user presents with fever, chills, and
pleuritic chest pain. Chest x-ray shows multiple cavitary nodules in
both lungs. Blood cultures grow methicillin-resistant Staphylococcus
aureus. Which valve abnormality is most likely found on
echocardiography?
A. Aortic valve vegetations with leaflet perforation
B. Mitral valve prolapse with regurgitation
C. Tricuspid valve vegetations with septic pulmonary emboli
D. Pulmonic valve stenosis with vegetation
, Correct answer: C – Tricuspid valve infective endocarditis is classic in IV
drug users, leading to septic emboli to lungs causing cavitary nodules.
Aortic (A) and mitral (B) are more common in non-IVDU endocarditis.
Pulmonic (D) is rare.
6. A 48-year-old nonsmoker has unilateral diaphragm elevation on
chest x-ray. Sniff test shows paradoxical upward movement of the
affected hemidiaphragm. Which nerve is most likely involved?
A. Phrenic nerve
B. Long thoracic nerve
C. Recurrent laryngeal nerve
D. Vagus nerve
Correct answer: A – Phrenic nerve (C3-C5) injury causes diaphragm
paralysis. Sniff test: paradoxical rise due to negative intrathoracic
pressure pulling paralyzed hemidiaphragm up. Long thoracic (B) causes
winged scapula. Recurrent laryngeal (C) causes vocal cord paralysis.
Vagus (D) affects GI motility and heart rate.
7. A 62-year-old with suspected lung cancer undergoes EBUS-TBNA of
a subcarinal lymph node. Pathology shows clusters of small round
blue cells with nuclear molding, scant cytoplasm, and abundant
mitoses. Immunostaining is positive for TTF-1, chromogranin, and
synaptophysin. What is the diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Large cell neuroendocrine carcinoma
D. Small cell lung cancer
Correct answer: D – Small cell lung cancer: neuroendocrine markers
(chromogranin, synaptophysin), TTF-1 positive, small round blue cells
MEDICINE – NURS 5432 TEST QUESTIONS
COMPLETE WITH 100% VERIFIED ANSWERS
1. A 68-year-old male with a history of heavy smoking and asbestos
exposure presents with progressive dyspnea and a non-productive
cough. A high-resolution CT scan shows peripheral, basal-predominant
reticular opacities with honeycombing. Which of the following
pathological findings is most characteristic of this condition?
A. Pleural plaques with ferruginous bodies
B. Interstitial infiltration by eosinophils
C. Fibroblastic foci with temporal heterogeneity
D. Intra-alveolar accumulation of lipoproteinaceous material
Correct answer: C – Fibroblastic foci with temporal heterogeneity are
the hallmark of usual interstitial pneumonia (UIP), which correlates with
idiopathic pulmonary fibrosis. The HRCT findings described are classic
for UIP. Asbestos exposure increases risk, but the pattern is UIP not
asbestosis alone. Pleural plaques (A) are seen in asbestosis but not
pathognomonic for UIP. Eosinophils (B) suggest eosinophilic pneumonia.
Lipoproteinaceous material (D) is seen in pulmonary alveolar
proteinosis.
2. A 45-year-old woman presents with episodic wheezing, nasal
polyps, and marked peripheral eosinophilia. Which medication is most
,likely to have caused this syndrome if used chronically for asthma?
A. Montelukast
B. Ipratropium bromide
C. Zafirlukast
D. Zileuton
Correct answer: A – Montelukast, a leukotriene receptor antagonist,
has been associated with Churg-Strauss syndrome (eosinophilic
granulomatosis with polyangiitis) when systemic corticosteroids are
withdrawn. The triad of asthma, eosinophilia, and vasculitis can be
unmasked. Zafirlukast (C) is another leukotriene antagonist but has
weaker association; Zileuton (D) is a 5-lipoxygenase inhibitor.
Ipratropium (B) is not linked.
3. A 72-year-old man with COPD on long-term oxygen therapy is found
unresponsive. Arterial blood gas on room air shows pH 7.18, PaCO2 90
mm Hg, PaO2 45 mm Hg, HCO3 28 mEq/L. Which of the following best
explains the primary acid-base disturbance?
A. Metabolic acidosis with respiratory compensation
B. Acute-on-chronic respiratory acidosis
C. Chronic respiratory acidosis with metabolic alkalosis
D. Mixed metabolic acidosis and respiratory alkalosis
Correct answer: B – Acute-on-chronic respiratory acidosis: Chronic
elevation of PaCO2 (baseline likely ~60 mm Hg in severe COPD) with
acute worsening causing severe hypercapnia and acidemia. HCO3 28
shows some renal compensation but insufficient for PaCO2 90
(expected HCO3 ~36 if fully compensated chronic). Metabolic acidosis
(A) would have low HCO3. Chronic respiratory acidosis with metabolic
,alkalosis (C) would have higher HCO3. Respiratory alkalosis (D) has low
PaCO2.
4. A 55-year-old with rheumatoid arthritis develops progressive
dyspnea. HRCT shows bilateral ground-glass opacities with septal
thickening (crazy-paving pattern). Bronchoalveolar lavage fluid is milky
and periodic acid–Schiff (PAS) positive. What is the most likely
diagnosis?
A. Usual interstitial pneumonia
B. Pulmonary alveolar proteinosis
C. Lymphocytic interstitial pneumonia
D. Cryptogenic organizing pneumonia
Correct answer: B – Pulmonary alveolar proteinosis: autoimmune (anti-
GM-CSF antibodies) or secondary to rheumatoid arthritis. Crazy-paving
on HRCT and milky PAS-positive BAL fluid are diagnostic. UIP (A) shows
honeycombing, not crazy-paving. Lymphocytic interstitial pneumonia (C)
has lymphoid infiltrates. Organizing pneumonia (D) shows patchy
airspace consolidation.
5. A 30-year-old male IV drug user presents with fever, chills, and
pleuritic chest pain. Chest x-ray shows multiple cavitary nodules in
both lungs. Blood cultures grow methicillin-resistant Staphylococcus
aureus. Which valve abnormality is most likely found on
echocardiography?
A. Aortic valve vegetations with leaflet perforation
B. Mitral valve prolapse with regurgitation
C. Tricuspid valve vegetations with septic pulmonary emboli
D. Pulmonic valve stenosis with vegetation
, Correct answer: C – Tricuspid valve infective endocarditis is classic in IV
drug users, leading to septic emboli to lungs causing cavitary nodules.
Aortic (A) and mitral (B) are more common in non-IVDU endocarditis.
Pulmonic (D) is rare.
6. A 48-year-old nonsmoker has unilateral diaphragm elevation on
chest x-ray. Sniff test shows paradoxical upward movement of the
affected hemidiaphragm. Which nerve is most likely involved?
A. Phrenic nerve
B. Long thoracic nerve
C. Recurrent laryngeal nerve
D. Vagus nerve
Correct answer: A – Phrenic nerve (C3-C5) injury causes diaphragm
paralysis. Sniff test: paradoxical rise due to negative intrathoracic
pressure pulling paralyzed hemidiaphragm up. Long thoracic (B) causes
winged scapula. Recurrent laryngeal (C) causes vocal cord paralysis.
Vagus (D) affects GI motility and heart rate.
7. A 62-year-old with suspected lung cancer undergoes EBUS-TBNA of
a subcarinal lymph node. Pathology shows clusters of small round
blue cells with nuclear molding, scant cytoplasm, and abundant
mitoses. Immunostaining is positive for TTF-1, chromogranin, and
synaptophysin. What is the diagnosis?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Large cell neuroendocrine carcinoma
D. Small cell lung cancer
Correct answer: D – Small cell lung cancer: neuroendocrine markers
(chromogranin, synaptophysin), TTF-1 positive, small round blue cells
