Pance Pulmonology Exam
Final Test Review
(Questions & Solutions)
2025
1
,A 58-year-old male smoker presents with progressive dyspnea and
chronic cough producing scant sputum. Spirometry shows an FEV1/FVC
ratio of 62%, FEV1 45% predicted, and a DLCO reduced to 50% predicted.
What is the most likely diagnosis? A) Asthma B) Chronic bronchitis C)
Emphysema-predominant COPD D) Bronchiectasis
ANS: C) Emphysema-predominant COPD
Rationale: Reduced FEV1/FVC confirms obstructive disease. A decreased
DLCO is typical of emphysema due to alveolar wall destruction,
differentiating it from chronic bronchitis where DLCO can be near
normal.
2. A 23-year-old woman is diagnosed with severe asthma poorly
controlled on high-dose inhaled corticosteroids and LABA. She has
frequent exacerbations requiring oral steroids. Which biologic agent is
most appropriate?
A) Omalizumab
B) Mepolizumab
C) Roflumilast
D) Ipratropium
ANS: B) Mepolizumab
Rationale: Mepolizumab targets IL-5 and is indicated for severe
eosinophilic asthma, especially with frequent exacerbations and steroid
dependence.
3. In assessing a patient with bronchodilator responsiveness, which
clinical feature best differentiates asthma from COPD?
A) Presence of crackles
B) Complete reversibility of airflow obstruction
C) History of exposure to toxins
D) Chronic sputum production
ANS: B) Complete reversibility of airflow obstruction
2
,Rationale: Asthma characteristically shows >12% and 200 mL increase in
FEV1 post-bronchodilator, indicating reversible obstruction. COPD
typically shows incomplete reversibility.
Infectious Pulmonary Disease
4. A 45-year-old man with alcoholic cirrhosis presents with fever, cough,
and right lower lobe infiltrate. Sputum gram stain shows gram-negative
rods. Which organism is the most likely cause?
A) Streptococcus pneumoniae
B) Klebsiella pneumoniae
C) Mycoplasma pneumoniae
D) Haemophilus influenzae
ANS: B) Klebsiella pneumoniae
Rationale: Klebsiella pneumoniae often causes severe pneumonia in
alcoholics, with typical upper lobe/lower lobe involvement and currant
jelly sputum.
5. A patient with a history of travel to the Ohio River Valley develops
fever, cough, and hilar lymphadenopathy. Which diagnostic test is most
specific for Histoplasmosis?
A) Sputum acid-fast bacilli stain
B) Serum Histoplasma antigen assay
C) Mantoux tuberculin skin test
D) Viral culture
ANS: B) Serum Histoplasma antigen assay
Rationale: The serum (and urine) Histoplasma antigen test is sensitive
and specific for acute pulmonary histoplasmosis, especially in endemic
areas.
6. A 65-year-old immunocompromised patient develops dyspnea and
diffuse bilateral infiltrates on chest x-ray. Bronchoalveolar lavage reveals
foamy exudate with cyst-like structures. What is the likely diagnosis?
A) Pneumocystis jirovecii pneumonia
3
, B) Cytomegalovirus pneumonia
C) Aspergillosis
D) Tuberculosis
ANS: A) Pneumocystis jirovecii pneumonia
Rationale: Pneumocystis pneumonia is common in immunocompromised
hosts, characterized by diffuse infiltrates and foamy alveolar exudate on
lavage.
Pulmonary Vascular Disease
7. A 30-year-old woman presents with sudden onset chest pain and
dyspnea six weeks postpartum. CT pulmonary angiogram shows multiple
segmental emboli. What is the initial anticoagulation therapy of choice?
A) Warfarin
B) Unfractionated heparin or LMWH
C) Aspirin
D) Thrombolytics
ANS: B) Unfractionated heparin or LMWH
Rationale: Initial anticoagulation in acute PE is started with heparin (UFH
or LMWH) before transitioning to oral anticoagulation.
8. A patient presents with severe hypoxemia and signs of right heart
failure. Echocardiogram shows an elevated pulmonary artery systolic
pressure. Which condition can lead to secondary pulmonary
hypertension?
A) COPD
B) Mitral stenosis
C) Pulmonary embolism
D) All of the above
ANS: D) All of the above
Rationale: COPD (hypoxic vasoconstriction), mitral stenosis
(postcapillary), and pulmonary embolism (obstruction) can all cause
secondary pulmonary hypertension.
4
Final Test Review
(Questions & Solutions)
2025
1
,A 58-year-old male smoker presents with progressive dyspnea and
chronic cough producing scant sputum. Spirometry shows an FEV1/FVC
ratio of 62%, FEV1 45% predicted, and a DLCO reduced to 50% predicted.
What is the most likely diagnosis? A) Asthma B) Chronic bronchitis C)
Emphysema-predominant COPD D) Bronchiectasis
ANS: C) Emphysema-predominant COPD
Rationale: Reduced FEV1/FVC confirms obstructive disease. A decreased
DLCO is typical of emphysema due to alveolar wall destruction,
differentiating it from chronic bronchitis where DLCO can be near
normal.
2. A 23-year-old woman is diagnosed with severe asthma poorly
controlled on high-dose inhaled corticosteroids and LABA. She has
frequent exacerbations requiring oral steroids. Which biologic agent is
most appropriate?
A) Omalizumab
B) Mepolizumab
C) Roflumilast
D) Ipratropium
ANS: B) Mepolizumab
Rationale: Mepolizumab targets IL-5 and is indicated for severe
eosinophilic asthma, especially with frequent exacerbations and steroid
dependence.
3. In assessing a patient with bronchodilator responsiveness, which
clinical feature best differentiates asthma from COPD?
A) Presence of crackles
B) Complete reversibility of airflow obstruction
C) History of exposure to toxins
D) Chronic sputum production
ANS: B) Complete reversibility of airflow obstruction
2
,Rationale: Asthma characteristically shows >12% and 200 mL increase in
FEV1 post-bronchodilator, indicating reversible obstruction. COPD
typically shows incomplete reversibility.
Infectious Pulmonary Disease
4. A 45-year-old man with alcoholic cirrhosis presents with fever, cough,
and right lower lobe infiltrate. Sputum gram stain shows gram-negative
rods. Which organism is the most likely cause?
A) Streptococcus pneumoniae
B) Klebsiella pneumoniae
C) Mycoplasma pneumoniae
D) Haemophilus influenzae
ANS: B) Klebsiella pneumoniae
Rationale: Klebsiella pneumoniae often causes severe pneumonia in
alcoholics, with typical upper lobe/lower lobe involvement and currant
jelly sputum.
5. A patient with a history of travel to the Ohio River Valley develops
fever, cough, and hilar lymphadenopathy. Which diagnostic test is most
specific for Histoplasmosis?
A) Sputum acid-fast bacilli stain
B) Serum Histoplasma antigen assay
C) Mantoux tuberculin skin test
D) Viral culture
ANS: B) Serum Histoplasma antigen assay
Rationale: The serum (and urine) Histoplasma antigen test is sensitive
and specific for acute pulmonary histoplasmosis, especially in endemic
areas.
6. A 65-year-old immunocompromised patient develops dyspnea and
diffuse bilateral infiltrates on chest x-ray. Bronchoalveolar lavage reveals
foamy exudate with cyst-like structures. What is the likely diagnosis?
A) Pneumocystis jirovecii pneumonia
3
, B) Cytomegalovirus pneumonia
C) Aspergillosis
D) Tuberculosis
ANS: A) Pneumocystis jirovecii pneumonia
Rationale: Pneumocystis pneumonia is common in immunocompromised
hosts, characterized by diffuse infiltrates and foamy alveolar exudate on
lavage.
Pulmonary Vascular Disease
7. A 30-year-old woman presents with sudden onset chest pain and
dyspnea six weeks postpartum. CT pulmonary angiogram shows multiple
segmental emboli. What is the initial anticoagulation therapy of choice?
A) Warfarin
B) Unfractionated heparin or LMWH
C) Aspirin
D) Thrombolytics
ANS: B) Unfractionated heparin or LMWH
Rationale: Initial anticoagulation in acute PE is started with heparin (UFH
or LMWH) before transitioning to oral anticoagulation.
8. A patient presents with severe hypoxemia and signs of right heart
failure. Echocardiogram shows an elevated pulmonary artery systolic
pressure. Which condition can lead to secondary pulmonary
hypertension?
A) COPD
B) Mitral stenosis
C) Pulmonary embolism
D) All of the above
ANS: D) All of the above
Rationale: COPD (hypoxic vasoconstriction), mitral stenosis
(postcapillary), and pulmonary embolism (obstruction) can all cause
secondary pulmonary hypertension.
4
