Pance Pulmonology - Final Test Review(Qns & Ans) - 2025, Exams of Nursing

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Pance Pulmonology Exam

Final Test Review

(Questions & Solutions)

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

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.

9. Which biomarker is prognostically significant in pulmonary arterial hypertension? A) Troponin I B) B-type natriuretic peptide (BNP) C) C-reactive protein (CRP) D) D-dimer ANS : B) B-type natriuretic peptide (BNP) Rationale: Elevated BNP levels correlate with right ventricular strain and poorer prognosis in PAH. Restrictive & Interstitial Lung Disease
10. A 55-year-old man with a history of asbestos exposure presents with progressive dyspnea and bibasilar crackles. CT chest shows pleural plaques and honeycombing. What is the diagnosis? A) Usual interstitial pneumonia (UIP) from idiopathic pulmonary fibrosis B) Asbestosis C) Sarcoidosis D) Hypersensitivity pneumonitis ANS : B) Asbestosis Rationale: Occupational asbestos exposure, pleural plaques, and interstitial fibrosis with honeycombing suggest asbestosis.
11. Which pulmonary function test pattern is typical in restrictive lung disease? A) Reduced FEV1 with normal FVC B) Decreased FVC and preserved or increased FEV1/FVC ratio C) Decreased FEV1/FVC ratio D) Normal FVC and FEV ANS : B) Decreased FVC and preserved or increased FEV1/FVC ratio Rationale: Restrictive diseases show reduced total lung volumes and FVC; FEV1/FVC ratio may be normal or elevated due to proportional

ANS : A) Pleural fluid protein/serum protein > 0. Rationale: Light’s criteria use pleural fluid protein/serum protein ratio

0.5 as one diagnostic indicator of exudates. Neoplastic Pulmonology

15. A 65-year-old heavy smoker has a lung mass in the right upper lobe with central cavitation. Biopsy reveals squamous cell carcinoma. Which paraneoplastic syndrome might be associated with this tumor? A) SIADH B) Hypercalcemia C) Cushing syndrome D) Lambert-Eaton syndrome ANS : B) Hypercalcemia Rationale: Squamous cell lung carcinoma commonly secretes PTH-related peptide causing hypercalcemia.
16. Which mutation is most commonly targeted in non-small cell lung cancer adenocarcinoma? A) EGFR B) ALK translocation C) KRAS D) BRAF ANS : A) EGFR Rationale: EGFR mutations are common therapeutic targets in adenocarcinoma of the lung. Critical Care & Injury
17. An intubated patient develops sudden hypoxemia and hypotension. Chest x-ray shows a white out of the left lung. What is the most likely diagnosis? A) Acute respiratory distress syndrome (ARDS) B) Tension pneumothorax C) Endobronchial intubation of the right mainstem bronchus

D) Pleural effusion ANS : C) Endobronchial intubation of the right mainstem bronchus Rationale: Overintubation into the right mainstem bronchus causes collapse or atelectasis of the left lung resulting in sudden hypoxemia and X-ray whiteness.

18. Which ventilator setting primarily impacts oxygenation in ARDS? A) FiO B) Tidal volume C) Respiratory rate D) PEEP ANS : D) PEEP Rationale: Positive end-expiratory pressure (PEEP) prevents alveolar collapse, improving oxygenation. Sleep Disordered Breathing
19. A 45-year-old obese man presents with loud snoring, daytime sleepiness, and witnessed apneas. Polysomnography reveals an apnea- hypopnea index (AHI) of 35. What is the first-line treatment? A) CPAP (Continuous positive airway pressure) B) Modafinil C) Weight loss alone D) Oxygen therapy ANS : A) CPAP (Continuous positive airway pressure) Rationale: CPAP is the gold standard treatment for moderate to severe obstructive sleep apnea.
20. Which of the following conditions most strongly predisposes to central sleep apnea? A) Obesity B) Congestive heart failure C) COPD

C) Diffuse uptake D) Normal ventilation and perfusion ANS : B) Mismatched perfusion defect Rationale: V/Q mismatch is hallmark of PE with perfusion defect but preserved ventilation.

24. What histopathological pattern is seen in idiopathic pulmonary fibrosis? A) Usual interstitial pneumonia (UIP) B) Desquamative interstitial pneumonia (DIP) C) Noncaseating granulomas D) Organizing pneumonia ANS : A) Usual interstitial pneumonia (UIP) Rationale: UIP is the classic pattern in idiopathic pulmonary fibrosis.
25. Which pleural fluid characteristic is typical of rheumatoid pleuritis? A) High glucose (>60 mg/dL) B) Low glucose (<60 mg/dL) C) Transudative effusion D) Chylous effusion ANS : B) Low glucose (<60 mg/dL) Rationale: Rheumatoid pleuritis causes exudative effusion with low glucose due to high metabolic demand of inflammatory cells.
26. A 62-year-old former smoker is diagnosed with small cell lung cancer. What treatment modality is usually indicated? A) Surgical resection B) Chemotherapy and radiation C) Observation D) Bronchodilators ANS : B) Chemotherapy and radiation

Rationale: Small cell lung cancer is generally treated with chemo- radiation due to early metastasis; surgery is rarely used.

27. Which ARDS criterion is defined by PaO2/FiO2 ratio? A) Mild ARDS > B) Moderate ARDS 100- 200 C) Severe ARDS < D) All of the above ANS : D) All of the above Rationale: Berlin criteria define ARDS severity based on PaO2/FiO2 ratios.
28. Which portable monitoring device is useful in evaluating suspected obstructive sleep apnea? A) Pulse oximetry alone B) Home overnight polysomnography C) ECG D) Chest x-ray ANS : B) Home overnight polysomnography Rationale: Home sleep study can detect apneas, hypopneas, and oxygen desaturations.
29. Which medication is approved for use in pulmonary arterial hypertension? A) Sildenafil B) Prednisone C) Ipratropium D) Azithromycin ANS : A) Sildenafil Rationale: Phosphodiesterase-5 inhibitors like sildenafil improve pulmonary vasodilation in PAH.
30. Which interstitial lung disease is common in patients with

C) No PEEP D) High inspiratory pressures ANS : B) Low tidal volume ventilation (6 mL/kg) Rationale: Low tidal volume strategy prevents volutrauma and improves survival.

34. What risk factor is most associated with central sleep apnea? A) Opioid use B) Smoking C) Allergic rhinitis D) COPD ANS : A) Opioid use Rationale: Opioids depress central respiratory drive, leading to central apnea.
35. A patient with a pleural effusion shows chylous fluid on thoracentesis. What is the most common cause? A) Thoracic duct injury or obstruction B) Tuberculosis C) Rheumatoid arthritis D) Congestive heart failure ANS : A) Thoracic duct injury or obstruction Rationale: Chylothorax results from thoracic duct leakage or obstruction.
36. What is the gold standard test for diagnosing pulmonary embolism? A) V/Q scan B) CT pulmonary angiography C) D-dimer D) Chest x-ray ANS : B) CT pulmonary angiography Rationale: CTA is now preferred for direct visualization of emboli.

37. Which parameter is most sensitive for early interstitial lung disease detection? A) DLCO B) FEV C) FVC D) ABG ANS : A) DLCO Rationale: DLCO decreases earlier than volumes in ILD due to alveolar- capillary membrane thickening.
38. Mesothelioma is most strongly associated with exposure to which of the following? A) Silica B) Asbestos C) Coal dust D) Radon ANS : B) Asbestos Rationale: Mesothelioma of pleura is strongly linked to asbestos exposure.
39. Which factor increases the risk of ventilator-associated pneumonia? A) Duration of mechanical ventilation B) Use of corticosteroids C) Immunosuppression D) All of the above ANS : D) All of the above Rationale: These factors increase susceptibility to VAP.
40. In obstructive sleep apnea, repeated airway collapse during sleep leads to all except: A) Sympathetic activation

B) Sarcoidosis C) COPD D) Cystic fibrosis Correct ANS : B) Sarcoidosis Rationale: Sarcoidosis often leads to granulomatous inflammation and fibrosis, causing restrictive lung disease. A patient presents with pleuritic chest pain and dyspnea. A physical examination reveals decreased breath sounds on the left side. What is the most likely diagnosis? A) Pneumonia B) Pleural effusion C) Pulmonary embolism D) Lung cancer Correct ANS : B) Pleural effusion Rationale: Decreased breath sounds and pleuritic chest pain are classic signs of pleural effusion, where fluid accumulation occurs in the pleural space. In obstructive sleep apnea, what is the most common anatomical site of obstruction? A) Nasopharynx B) Oropharynx C) Hypopharynx D) Larynx Correct ANS : B) Oropharynx Rationale: The oropharynx is the most common site for obstruction in obstructive sleep apnea due to relaxation of the soft tissues during sleep. Which of the following is a common infectious cause of a pulmonary abscess? A) Mycobacterium tuberculosis B) Staphylococcus aureus C) Streptococcus pneumoniae D) Klebsiella pneumoniae

Correct ANS : D) Klebsiella pneumoniae Rationale: Klebsiella pneumoniae is often associated with lung abscesses, particularly in individuals with compromised immune systems or chronic alcohol use. A 70-year-old female with a history of COPD presents with increasing dyspnea. A sputum culture grows Pseudomonas aeruginosa. What is the most appropriate initial treatment? A) Oral amoxicillin B) Intravenous cefepime C) Inhaled albuterol D) Oral azithromycin Correct ANS : B) Intravenous cefepime Rationale: Pseudomonas aeruginosa infections in COPD patients often require broad-spectrum intravenous antibiotics like cefepime. Which pulmonary condition is most associated with a significant increase in pulmonary vascular resistance? A) Pulmonary hypertension B) Asthma C) Restrictive lung disease D) Sleep apnea Correct ANS : A) Pulmonary hypertension Rationale: Pulmonary hypertension is characterized by elevated blood pressure in the pulmonary arteries, leading to increased vascular resistance. In the context of lung cancer, which of the following types is most commonly associated with paraneoplastic syndromes? A) Adenocarcinoma B) Squamous cell carcinoma C) Small cell lung cancer D) Large cell carcinoma Correct ANS : C) Small cell lung cancer Rationale: Small cell lung cancer is frequently associated with

prioritized in the differential diagnosis? A) Pneumonia B) Pulmonary embolism C) Pneumothorax D) Congestive heart failure Correct ANS : B) Pulmonary embolism Rationale: The sudden onset of symptoms is characteristic of pulmonary embolism, which is a life-threatening condition requiring immediate intervention. In patients with obstructive lung disease, which of the following spirometry findings is expected? A) Increased forced vital capacity (FVC) B) Decreased forced expiratory volume in one second (FEV1) C) Normal total lung capacity (TLC) D) Increased peak expiratory flow rate (PEFR) Correct ANS : B) Decreased forced expiratory volume in one second (FEV1) Rationale: In obstructive lung disease, FEV1 is decreased due to airflow limitation, while FVC may be normal or decreased. A patient develops a persistent cough and hemoptysis after being treated for pneumonia. A follow-up chest X-ray shows a cavitary lesion. What is the most likely cause? A) Tuberculosis B) Lung abscess C) Bronchiectasis D) Lung cancer Correct ANS : A) Tuberculosis Rationale: Cavitary lesions in the lungs are commonly associated with tuberculosis, particularly in patients with a history of pneumonia. Which of the following is the most common cause of transudative pleural effusion? A) Malignancy

B) Congestive heart failure C) Pulmonary embolism D) Infection Correct ANS : B) Congestive heart failure Rationale: Congestive heart failure is the leading cause of transudative pleural effusion, resulting from increased hydrostatic pressure in the pulmonary circulation. In patients with sleep-disordered breathing, which of the following is a common consequence of chronic untreated obstructive sleep apnea? A) Hypertension B) Anemia C) Hyperglycemia D) Osteoporosis Correct ANS : A) Hypertension Rationale: Chronic obstructive sleep apnea is associated with the development of hypertension due to intermittent hypoxia and sympathetic activation. A patient with known pulmonary fibrosis presents with worsening dyspnea. Which of the following findings would most likely be observed on a high-resolution CT scan? A) Ground-glass opacities B) Consolidation C) Honeycombing D) Pleural effusion Correct ANS : C) Honeycombing Rationale: Honeycombing is a classic radiological sign associated with advanced pulmonary fibrosis, indicating severe interstitial lung disease. Which of the following is a characteristic feature of cystic fibrosis? A) Increased lung compliance B) Thick, viscous mucus production C) Decreased risk of infection D) Hyperinflation of the lungs