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EXAMS
PULMONARY (PART ONE) COMPLETE REVISED EXAM WITH
CORRECT ANSWERED QUESTIONS WITH VERIFIED
RATIONALES 100% GUARANTEED PASS. | Questions & Answers
(Verified Answers) With Rationales ( Update)
This Document Contains:
150 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
In a patient with chronic obstructive pulmonary disease (COPD) presenting with acute
exacerbation and hypercapnic respiratory failure (pH 7.25, PaCO2 65 mmHg, PaO2 55 mmHg on
room air), which noninvasive ventilation strategy is most appropriate to reduce the need for
intubation?
A) Continuous positive airway pressure (CPAP) at 10 cm H2O
B) Bilevel positive airway pressure (BiPAP) with inspiratory positive airway pressure (IPAP) 15 cm
H2O and expiratory positive airway pressure (EPAP) 5 cm H2O
C) High-flow nasal cannula (HFNC) at 60 L/min with FiO2 0.5
D) Noninvasive positive pressure ventilation (NPPV) with IPAP 20 cm H2O and EPAP 10 cm H2O
Answer: B) Bilevel positive airway pressure (BiPAP) with inspiratory positive airway pressure
(IPAP) 15 cm H2O and expiratory positive airway pressure (EPAP) 5 cm H2O
Explanation: BiPAP with moderate IPAP (15 cm H2O) and low EPAP (5 cm H2O) is first-line for
hypercapnic respiratory failure in COPD exacerbation, as it unloads respiratory muscles
and improves alveolar ventilation without excessive airway pressure. CPAP alone does
not assist ventilation; HFNC provides oxygenation but less ventilatory support; high
pressures (IPAP 20, EPAP 10) may cause barotrauma and patient intolerance.
Question 2
A patient with suspected pulmonary embolism (PE) has a Wells' score of 4.5, D-dimer elevated at
1.2 mg/L, and a CT pulmonary angiogram (CTPA) shows a filling defect in the left lower lobe
segmental artery. Which of the following best explains the pathophysiological consequence of this
embolus on pulmonary gas exchange?
A) Increased alveolar dead space and ventilation-perfusion mismatch
B) Diffusion impairment due to alveolar-capillary membrane thickening
C) Right-to-left intrapulmonary shunt causing hypoxemia refractory to oxygen
D) Hypoventilation due to central nervous system depression
Answer: A) Increased alveolar dead space and ventilation-perfusion mismatch
Explanation: A pulmonary embolus obstructs blood flow to ventilated alveoli, creating increased
alveolar dead space (high V/Q). This leads to ventilation-perfusion mismatch and
hypoxemia. Diffusion impairment (B) is typical of interstitial lung disease; refractory
hypoxemia from shunt (C) occurs in severe ARDS or atelectasis; hypoventilation (D) is
not a direct consequence of PE.
Page 2
,Question 3
In a patient with community-acquired pneumonia (CAP) and a CURB-65 score of 3, which of the
following is the most appropriate initial antibiotic regimen according to current IDSA/ATS
guidelines?
A) Amoxicillin-clavulanate alone
B) Azithromycin alone
C) Ceftriaxone plus azithromycin
D) Levofloxacin monotherapy
Answer: C) Ceftriaxone plus azithromycin
Explanation: For CAP with CURB-65 2 (moderate severity), guidelines recommend combination
therapy with a beta-lactam (e.g., ceftriaxone) plus a macrolide (e.g., azithromycin) to
cover typical and atypical pathogens. Monotherapy with amoxicillin-clavulanate (A)
lacks atypical coverage; azithromycin alone (B) risks resistance; levofloxacin
monotherapy (D) is an alternative but not first-line in this severity due to
fluoroquinolone stewardship concerns.
Question 4
A patient with asthma has a forced expiratory volume in 1 second (FEV1) of 60% predicted,
FEV1/forced vital capacity (FVC) ratio of 0.65, and a positive bronchodilator response (increase in
FEV1 of 15% and 300 mL). According to the Global Initiative for Asthma (GINA) 2023 guidelines,
which step of pharmacologic therapy is most appropriate?
A) Step 1: As-needed low-dose inhaled corticosteroid (ICS)-formoterol
B) Step 2: Low-dose ICS plus as-needed short-acting beta-agonist (SABA)
C) Step 3: Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
D) Step 4: Medium-dose ICS-formoterol as MART
Answer: C) Step 3: Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
Explanation: This patient has moderate persistent asthma (FEV1 60-80% predicted, symptoms not
well controlled). GINA 2023 recommends Step 3 for adults with uncontrolled asthma on
Step 2, using low-dose ICS-formoterol as MART. Step 1 (A) is for mild intermittent;
Step 2 (B) is for initial therapy but not with symptoms; Step 4 (D) is for more severe
disease.
Page 3
, Question 5
In a patient with idiopathic pulmonary fibrosis (IPF) and a forced vital capacity (FVC) of 65%
predicted, which of the following pharmacologic interventions has been shown to reduce the rate of
decline in lung function?
A) Prednisone 0.5 mg/kg/day
B) Nintedanib 150 mg twice daily
C) Azathioprine 2 mg/kg/day plus prednisone
D) N-acetylcysteine 600 mg three times daily
Answer: B) Nintedanib 150 mg twice daily
Explanation: Nintedanib, a tyrosine kinase inhibitor, slows FVC decline in IPF (INPULSIS trials).
Corticosteroids (A) and triple therapy with azathioprine and prednisone (C) are harmful
(PANTHER trial). N-acetylcysteine (D) has no benefit and may be harmful when
combined with immunosuppressants.
Question 6
A patient with acute respiratory distress syndrome (ARDS) (PaO2/FiO2 ratio 120 mmHg, PEEP
10 cm H2O) is being managed with lung-protective ventilation. Which of the following ventilator
settings is most consistent with current evidence-based practice?
A) Tidal volume 8 mL/kg predicted body weight (PBW), plateau pressure 30 cm H2O
B) Tidal volume 6 mL/kg PBW, plateau pressure 25 cm H2O
C) Tidal volume 10 mL/kg PBW, plateau pressure 35 cm H2O
D) Tidal volume 4 mL/kg PBW, plateau pressure 20 cm H2O
Answer: B) Tidal volume 6 mL/kg PBW, plateau pressure 25 cm H2O
Explanation: Lung-protective ventilation for ARDS targets tidal volume 6 mL/kg PBW and plateau
pressure <30 cm H2O (ARDSNet). Option B meets both. Option A has tidal volume 8
mL/kg, which is higher than recommended; C is injurious; D may cause hypoventilation
and is not standard.
Page 4
Download Download
EXAMS
PULMONARY (PART ONE) COMPLETE REVISED EXAM WITH
CORRECT ANSWERED QUESTIONS WITH VERIFIED
RATIONALES 100% GUARANTEED PASS. | Questions & Answers
(Verified Answers) With Rationales ( Update)
This Document Contains:
150 Questions with Correct, Detailed and Verified Answers
2026/2027 Actual Exam Testbank
Questions & Answers (Verified Answers) With Rationales
100% Guaranteed Pass
Complete A+ Guide
Page 1
,Question 1
In a patient with chronic obstructive pulmonary disease (COPD) presenting with acute
exacerbation and hypercapnic respiratory failure (pH 7.25, PaCO2 65 mmHg, PaO2 55 mmHg on
room air), which noninvasive ventilation strategy is most appropriate to reduce the need for
intubation?
A) Continuous positive airway pressure (CPAP) at 10 cm H2O
B) Bilevel positive airway pressure (BiPAP) with inspiratory positive airway pressure (IPAP) 15 cm
H2O and expiratory positive airway pressure (EPAP) 5 cm H2O
C) High-flow nasal cannula (HFNC) at 60 L/min with FiO2 0.5
D) Noninvasive positive pressure ventilation (NPPV) with IPAP 20 cm H2O and EPAP 10 cm H2O
Answer: B) Bilevel positive airway pressure (BiPAP) with inspiratory positive airway pressure
(IPAP) 15 cm H2O and expiratory positive airway pressure (EPAP) 5 cm H2O
Explanation: BiPAP with moderate IPAP (15 cm H2O) and low EPAP (5 cm H2O) is first-line for
hypercapnic respiratory failure in COPD exacerbation, as it unloads respiratory muscles
and improves alveolar ventilation without excessive airway pressure. CPAP alone does
not assist ventilation; HFNC provides oxygenation but less ventilatory support; high
pressures (IPAP 20, EPAP 10) may cause barotrauma and patient intolerance.
Question 2
A patient with suspected pulmonary embolism (PE) has a Wells' score of 4.5, D-dimer elevated at
1.2 mg/L, and a CT pulmonary angiogram (CTPA) shows a filling defect in the left lower lobe
segmental artery. Which of the following best explains the pathophysiological consequence of this
embolus on pulmonary gas exchange?
A) Increased alveolar dead space and ventilation-perfusion mismatch
B) Diffusion impairment due to alveolar-capillary membrane thickening
C) Right-to-left intrapulmonary shunt causing hypoxemia refractory to oxygen
D) Hypoventilation due to central nervous system depression
Answer: A) Increased alveolar dead space and ventilation-perfusion mismatch
Explanation: A pulmonary embolus obstructs blood flow to ventilated alveoli, creating increased
alveolar dead space (high V/Q). This leads to ventilation-perfusion mismatch and
hypoxemia. Diffusion impairment (B) is typical of interstitial lung disease; refractory
hypoxemia from shunt (C) occurs in severe ARDS or atelectasis; hypoventilation (D) is
not a direct consequence of PE.
Page 2
,Question 3
In a patient with community-acquired pneumonia (CAP) and a CURB-65 score of 3, which of the
following is the most appropriate initial antibiotic regimen according to current IDSA/ATS
guidelines?
A) Amoxicillin-clavulanate alone
B) Azithromycin alone
C) Ceftriaxone plus azithromycin
D) Levofloxacin monotherapy
Answer: C) Ceftriaxone plus azithromycin
Explanation: For CAP with CURB-65 2 (moderate severity), guidelines recommend combination
therapy with a beta-lactam (e.g., ceftriaxone) plus a macrolide (e.g., azithromycin) to
cover typical and atypical pathogens. Monotherapy with amoxicillin-clavulanate (A)
lacks atypical coverage; azithromycin alone (B) risks resistance; levofloxacin
monotherapy (D) is an alternative but not first-line in this severity due to
fluoroquinolone stewardship concerns.
Question 4
A patient with asthma has a forced expiratory volume in 1 second (FEV1) of 60% predicted,
FEV1/forced vital capacity (FVC) ratio of 0.65, and a positive bronchodilator response (increase in
FEV1 of 15% and 300 mL). According to the Global Initiative for Asthma (GINA) 2023 guidelines,
which step of pharmacologic therapy is most appropriate?
A) Step 1: As-needed low-dose inhaled corticosteroid (ICS)-formoterol
B) Step 2: Low-dose ICS plus as-needed short-acting beta-agonist (SABA)
C) Step 3: Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
D) Step 4: Medium-dose ICS-formoterol as MART
Answer: C) Step 3: Low-dose ICS-formoterol as maintenance and reliever therapy (MART)
Explanation: This patient has moderate persistent asthma (FEV1 60-80% predicted, symptoms not
well controlled). GINA 2023 recommends Step 3 for adults with uncontrolled asthma on
Step 2, using low-dose ICS-formoterol as MART. Step 1 (A) is for mild intermittent;
Step 2 (B) is for initial therapy but not with symptoms; Step 4 (D) is for more severe
disease.
Page 3
, Question 5
In a patient with idiopathic pulmonary fibrosis (IPF) and a forced vital capacity (FVC) of 65%
predicted, which of the following pharmacologic interventions has been shown to reduce the rate of
decline in lung function?
A) Prednisone 0.5 mg/kg/day
B) Nintedanib 150 mg twice daily
C) Azathioprine 2 mg/kg/day plus prednisone
D) N-acetylcysteine 600 mg three times daily
Answer: B) Nintedanib 150 mg twice daily
Explanation: Nintedanib, a tyrosine kinase inhibitor, slows FVC decline in IPF (INPULSIS trials).
Corticosteroids (A) and triple therapy with azathioprine and prednisone (C) are harmful
(PANTHER trial). N-acetylcysteine (D) has no benefit and may be harmful when
combined with immunosuppressants.
Question 6
A patient with acute respiratory distress syndrome (ARDS) (PaO2/FiO2 ratio 120 mmHg, PEEP
10 cm H2O) is being managed with lung-protective ventilation. Which of the following ventilator
settings is most consistent with current evidence-based practice?
A) Tidal volume 8 mL/kg predicted body weight (PBW), plateau pressure 30 cm H2O
B) Tidal volume 6 mL/kg PBW, plateau pressure 25 cm H2O
C) Tidal volume 10 mL/kg PBW, plateau pressure 35 cm H2O
D) Tidal volume 4 mL/kg PBW, plateau pressure 20 cm H2O
Answer: B) Tidal volume 6 mL/kg PBW, plateau pressure 25 cm H2O
Explanation: Lung-protective ventilation for ARDS targets tidal volume 6 mL/kg PBW and plateau
pressure <30 cm H2O (ARDSNet). Option B meets both. Option A has tidal volume 8
mL/kg, which is higher than recommended; C is injurious; D may cause hypoventilation
and is not standard.
Page 4
