Pulmonary
Final Test Review
(Questions & Solutions)
2025
1
, 1. Acute Respiratory Distress Syndrome (ARDS)
1.1 A 55-year-old septic patient meets Berlin criteria for ARDS. His
PaO₂/FiO₂ is 90 mm Hg on PEEP 12 cm H₂O. How would his ARDS severity
be classified?
A) Mild
B) Moderate
C) Severe
D) Not ARDS
ANS: C
Rationale: PaO₂/FiO₂ ≤ 100 mm Hg on PEEP ≥ 5 cm H₂O defines severe
ARDS.
1.2 A patient with ARDS on mechanical ventilation has plateau pressures
of 34 cm H₂O. What ventilator adjustment reduces barotrauma risk?
A) Increase tidal volume
B) Lower tidal volume to 4–6 mL/kg PBW
C) Decrease PEEP
D) Increase respiratory rate
ANS: B
Rationale: Low‐tidal‐volume ventilation (4–6 mL/kg predicted body
weight) limits plateau pressure (< 30 cm H₂O).
1.3 Which cytokine is most implicated in ARDS pathogenesis?
A) IL-1β
B) IL-6
C) TNF-α
D) IL-10
ANS: C
Rationale: TNF-α drives the inflammatory cascade and increases alveolar
capillary permeability in ARDS.
1.4 In ARDS fluid management, what strategy improves ventilator‐free
2
, days?
A) Liberal fluids
B) Conservative fluids
C) Normal saline boluses only
D) Avoid diuretics entirely
ANS: B
Rationale: Conservative fluid strategy minimizes pulmonary edema and
aids weaning.
1.5 Prone positioning in severe ARDS primarily improves oxygenation by:
A) Increasing cardiac output
B) Redistributing perfusion to well‐ventilated lung zones
C) Raising PEEP
D) Stimulating surfactant release
ANS: B
Rationale: Proning redistributes blood flow away from dorsal atelectatic
areas to ventral regions, improving V/Q matching.
---
2. Foreign Body Aspiration
2.1 A 2-year-old with sudden onset wheezing and unilateral decreased
breath sounds. What is the next best step?
A) Immediate rigid bronchoscopy
B) Chest CT
C) Trial of bronchodilator
D) Chest X-ray only
ANS: A
Rationale: Incomplete airway obstruction in children warrants prompt
rigid bronchoscopy for removal.
2.2 An adult aspirates a peanut and develops a localized obstructive
pneumonia in right lower lobe. Which imaging finding is most likely?
A) Hyperinflation above the obstruction
3
Final Test Review
(Questions & Solutions)
2025
1
, 1. Acute Respiratory Distress Syndrome (ARDS)
1.1 A 55-year-old septic patient meets Berlin criteria for ARDS. His
PaO₂/FiO₂ is 90 mm Hg on PEEP 12 cm H₂O. How would his ARDS severity
be classified?
A) Mild
B) Moderate
C) Severe
D) Not ARDS
ANS: C
Rationale: PaO₂/FiO₂ ≤ 100 mm Hg on PEEP ≥ 5 cm H₂O defines severe
ARDS.
1.2 A patient with ARDS on mechanical ventilation has plateau pressures
of 34 cm H₂O. What ventilator adjustment reduces barotrauma risk?
A) Increase tidal volume
B) Lower tidal volume to 4–6 mL/kg PBW
C) Decrease PEEP
D) Increase respiratory rate
ANS: B
Rationale: Low‐tidal‐volume ventilation (4–6 mL/kg predicted body
weight) limits plateau pressure (< 30 cm H₂O).
1.3 Which cytokine is most implicated in ARDS pathogenesis?
A) IL-1β
B) IL-6
C) TNF-α
D) IL-10
ANS: C
Rationale: TNF-α drives the inflammatory cascade and increases alveolar
capillary permeability in ARDS.
1.4 In ARDS fluid management, what strategy improves ventilator‐free
2
, days?
A) Liberal fluids
B) Conservative fluids
C) Normal saline boluses only
D) Avoid diuretics entirely
ANS: B
Rationale: Conservative fluid strategy minimizes pulmonary edema and
aids weaning.
1.5 Prone positioning in severe ARDS primarily improves oxygenation by:
A) Increasing cardiac output
B) Redistributing perfusion to well‐ventilated lung zones
C) Raising PEEP
D) Stimulating surfactant release
ANS: B
Rationale: Proning redistributes blood flow away from dorsal atelectatic
areas to ventral regions, improving V/Q matching.
---
2. Foreign Body Aspiration
2.1 A 2-year-old with sudden onset wheezing and unilateral decreased
breath sounds. What is the next best step?
A) Immediate rigid bronchoscopy
B) Chest CT
C) Trial of bronchodilator
D) Chest X-ray only
ANS: A
Rationale: Incomplete airway obstruction in children warrants prompt
rigid bronchoscopy for removal.
2.2 An adult aspirates a peanut and develops a localized obstructive
pneumonia in right lower lobe. Which imaging finding is most likely?
A) Hyperinflation above the obstruction
3
