DFT-EMREE-PULMONOLOGY🫁-18-10-2025-STUDYWITHMAXEMO

74 Y/O M, a chronic smoker, c/o persistent cough & SOB x3 months. Hx of recent weight loss. O/E, he appears cachectic. Vitals: BP 155/95 mmHg, HR 102/min. Noteworthy findings include hyperpigmentation of the oral mucosa, palmar creases, and soles. Ix reveal: Glucose 190 mg/dL, K+ 2.9 mEq/L. A chest X-ray shows a right-sided hilar mass. What is the most likely Dx?

• Cushing's disease

• Addison's disease

• Conn's syndrome

• Ectopic ACTH syndrome

• Bronchial carcinoid tumor

Answer explanation

The combination of a lung mass in a smoker (suggesting lung cancer, most commonly small cell), hyperpigmentation (due to excess ACTH and co-secreted MSH), hypertension, hyperglycemia, and severe hypokalemia is the classic presentation of ectopic ACTH production. Small cell lung cancer is the most common cause.

A 26-year-old male with a four-year history of heavy smoking presents to the emergency department with an acute onset of severe, sharp left-sided chest pain and progressive shortness of breath. He has no history of trauma or known underlying lung disease. On examination, he is tachypneic. Auscultation reveals markedly diminished air entry over the entire left hemithorax. Percussion of the left chest is hyperresonant. A chest radiograph confirms a large left-sided primary spontaneous pneumothorax. The underlying pathophysiology of this patient's condition is most commonly associated with which of the following findings?

• Rupture of subpleural apical blebs

• Necrotizing pneumonia leading to a bronchopleural fistula

• Rupture of large bullae secondary to emphysematous changes

• Fracture of a rib penetrating the visceral pleura

• Iatrogenic injury during central venous catheter placement

Answer explanation

Primary spontaneous pneumothorax (PSP) classically occurs in young, tall, thin males, with smoking being a major risk factor. The universally accepted mechanism is the rupture of small, previously unseen subpleural blebs or bullae, typically located at the lung apex.

A 35-year-old male presents with a 2-month history of progressive shortness of breath and a dry cough. He also complains of pain in both ankles and notes the recent appearance of tender, reddish nodules on his shins. He is afebrile. His chest X-ray is provided, demonstrating prominent bilateral hilar and right paratracheal lymphadenopathy. What is the most likely diagnosis?

• Tuberculosis

• Hodgkin's lymphoma

• Sarcoidosis

• Histoplasmosis

• Silicosis

Answer explanation

The combination of respiratory symptoms, bilateral hilar lymphadenopathy on CXR, polyarthralgia (pain in ankles), and erythema nodosum (tender nodules on shins) in a young adult is the classic presentation of Löfgren's syndrome, an acute form of sarcoidosis.

A child diagnosed with moderate persistent bronchial asthma, presents to the clinic in Sharjah with a two-week history of a progressively hoarse voice. The patient's asthma symptoms have been well-controlled since starting a new maintenance therapy which includes a high-dose inhaled corticosteroid. There is no associated fever, sore throat, or cough. Examination of the oropharynx is unremarkable. What is the most likely cause of this patient's hoarseness?

• Acute viral laryngitis

• Laryngeal candidiasis

• Vocal cord nodules from chronic coughing

• Laryngopharyngeal reflux

• Spasmodic dysphonia

Answer explanation

The use of inhaled corticosteroids (ICS) is a major risk factor for oropharyngeal and laryngeal candidiasis (thrush). The steroid has a local immunosuppressive effect, allowing for the overgrowth of Candida albicans on the vocal cords, which leads to dysphonia (hoarseness). The timeline following the initiation of ICS therapy is classic for this complication.

A patient c/o intermittent wheeze and cough. Symptoms occur 4-5 days per week, and the patient is awakened by cough approximately twice a week. A SABA (short-acting beta-agonist) is used almost daily for relief. The patient also has a Hx of eczema. Based on the frequency of symptoms, what is the most accurate classification of this patient's asthma?

• Intermittent

• Mild Persistent

• Moderate Persistent

• Severe Persistent

Answer explanation

According to GINA/NHLBI guidelines, daily symptoms, SABA use daily, and nocturnal awakenings more than once a week are hallmarks of moderate persistent asthma. This level of severity requires daily controller therapy.

65 Y/O M presents to the ED with a 1-day Hx of sudden-onset high fever, shaking chills, and a productive cough with rust-colored sputum. The patient c/o sharp right-sided chest pain that worsens with inspiration. O/E: T 39.5°C, HR 110/min, RR 24/min. Auscultation reveals crackles and bronchial breath sounds over the R lower lobe. CXR shows dense consolidation in the R lower lobe. What is the most appropriate initial antibiotic Rx for this inpatient?

• Amoxicillin

• Vancomycin + Piperacillin-tazobactam

• Ceftriaxone + Azithromycin

• Doxycycline

• Oseltamivir

Answer explanation

This patient has a classic presentation of community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae, requiring inpatient admission. Standard guidelines recommend combination therapy with a beta-lactam (like Ceftriaxone) to cover typical pathogens like pneumococcus, plus a macrolide (like Azithromycin) or a doxycycline to cover atypical pathogens (Mycoplasma, Legionella).

On a chest X-ray, the key diagnostic finding that confirms a pneumothorax is the visualization of the ________ line, which represents the edge of the collapsed lung.

• mediastinal

• diaphragmatic

• costophrenic

• visceral pleural

Answer explanation

The visceral pleura is the membrane that directly covers the lung. When the lung collapses, this edge becomes visible as a thin white line on the X-ray, separated from the chest wall by air. This is the definitive sign of a pneumothorax.

A patient presents with chronic sinusitis, coughing up blood (hemoptysis), and signs of kidney failure. This classic triad of symptoms is most characteristic of which disease?

• Goodpasture's Syndrome

• Sarcoidosis

• Granulomatosis with Polyangiitis

• Systemic Lupus Erythematosus

Answer explanation

 Granulomatosis with Polyangiitis (GPA) is defined by the classic triad of upper airway disease (sinusitis), lower airway disease (hemoptysis), and kidney disease (glomerulonephritis).

A patient presents with fever and cough. A chest X-ray is performed. What is the primary abnormality seen on this chest X-ray?

• Normal chest

• Right lower lobe consolidation

• Left-sided pneumothorax

• Enlarged heart

Answer explanation

The image clearly shows a white, opaque area in the right lower lung field, obscuring the right heart border and diaphragm. This finding is characteristic of consolidation, which is fluid or pus filling the airspaces, as seen in pneumonia.

A 32-year-old female with no smoking history presents with recurrent spontaneous pneumothorax. A high-resolution computed tomography scan shows diffuse, uniformly distributed, thin-walled pulmonary cysts. What is the most likely diagnosis?

• Langerhans Cell Histiocytosis

• Lymphangioleiomyomatosis

• Birt-Hogg-Dubé Syndrome

• Centrilobular Emphysema

Answer explanation

The combination of a young female patient, a history of recurrent pneumothorax, and the characteristic imaging finding of diffuse, thin-walled cysts is the classic presentation of Lymphangioleiomyomatosis (LAM).