Clin Med Pulmonology Practice Questions

What kind of disorder is cystic fibrosis?

autosomal recessive

A two year old female presents to your primary care clinic with recurrent bacterial respiratory infections. The child's parent said she's been having wheezing and productive cough for several months. The patient is small and underweight for her age. Immunoreactive trypsinogen (IRT) was positive after birth. What is your suspected diagnosis?

cystic fibrosis

A 17 year old male presents to your clinic complaining of productive cough, recurrent respiratory infections, abdominal pain, diarrhea, and foul-smelling stool. On physical exam, you find that the patient is underweight, has increased AP diameter, and hyperresonance to percussion. PFTs show an obstructive pattern, decline in FEV1, reduction of FEV1/FVC ratio, and reduced FVC and TLC. CT Chest shows hyperinflation, peribronchial cuffing, mucous plugging, bronchiectasis, scarring, and increased interstitial markings. Which of the following tests is most consistent with your suspected diagnosis?

positive sweat test

Which of the following spirometry findings is most indicative of cystic fibrosis?

Decline in FEV1 and FEV1/FVC ratio with reduction in FVC and decreased TLC

Which of the following PFTs is the best predictor of survival/prognosis for patients with cystic fibrosis?

FEV1

A 20 year old male presents to the ED with abdominal pain, diarrhea, and steatorrhea. He also notes productive cough, decreased tolerance to exercise, and recurrent respiratory infections. Physical exam reveals low BMI, tenderness in the upper abdomen, digital clubbing, increased AP diameter, and crackles in the apices of the lungs. CT shows hyperinflation, mucus plugging, scarring, and bronchiectasis. Which of the following physical exam findings would be most consistent with your suspected diagnosis?

bilateral absence of the vas deferens

PANCE PEARL: Young patient with bronchiectasis + steatorrhea + male infertility → cystic fibrosis.

A 3 month old male presents to your clinic for a check-up. The patient's mother is concerned about poor growth. She says he has had productive cough, runny nose, and watery eyes on and off since birth. She also says that he failed to have a bowel movement for a while after birth. He also had a positive IRT. Previous CT shows mild hyperinflation and a flattened diaphragm. Which of the following is consistent with the pathophysiology of your suspected diagnosis?

defect in CFTR protein

What are the most common pathogens seen in cystic fibrosis?

early: s aureus

late: p aeruginosa

Which of the following CT chest findings is most consistent with cystic fibrosis?

hyperinflation, peribronchial cuffing, mucus plugging, bronchiectasis, increased interstitial markings/scarring, small/rounded peripheral opacities, focal atelectasis

Which of the following medications is first-line for maintenance of cystic fibrosis?

elexacaftor + tezacaftor + ivacaftor

What is the preferred long-term antibiotic for patients with cystic fibrosis (especially if they have p aeruginosa infection)?

oral azithromycin

chronic inhaled tobramycin/aztreonam or

azithromycin for P. aeruginosa

• Airway Clearance: Chest physio, dornase-alpha, 7% hypertonic saline, bronchodilators

• GI/End Stage: Pancreatic enzymes, fat-soluble vitamins, lung transplant, palliative care

A 72 year old female presents to your clinic with a chronic cough. She said she has had it for a very long time but it has been getting progressively worse over the past few months. She said she decided to come in because she noticed blood in her sputum. She said her sputum is usually copious and foul-smelling. She also complains of diffuse chest pain, shortness of breath, and weight loss. She has a history of cystic fibrosis, rheumatoid arthritis, and hypertension. She denied history of tobacco or alcohol use. Physical exam reveals crackles at the bases of the lungs and wheezing. Non-contrast CT reveals dilated and thickened bronchi, mucous plugs, tram tracks, end on ring, and signet ring markings. What is your suspected diagnosis?

inital tx?

long term tx?

bronchiectasis

• Initial / Acute: Airway clearance, bronchodilators, empiric 10–14d antibiotics (fluoroquinolones, amoxicillin, doxycycline, cephalosporin)

• Long-term: Preventative azithromycin or inhaled gentamicin (for ≥3 flares/yr); pulmonary rehab

Which of the following bacteria is a marker of disease severity and poor prognosis in patients with bronchiectasis?

p aeruginosa

Which of the following PFTs is most consistent with a diagnosis of bronchiectasis?

obstructive pattern

What is the imaging test of choice for bronchiectasis?

non-contrast CT

Which of the following imaging findings is most consistent with a diagnosis of bronchiectasis?

tram tracks, end on ring and signet ring markings

A 75 year old female presents to your primary care clinic for a check-up. She complains of chronic productive cough, dyspnea, and wheezing. She noted productive purulent sputum with small amounts of blood. She has been previously diagnosed with alpha-1 antitrypsin deficiency. Physical exam reveals crackles at the lung bases. Sputum culture is obtained and awaiting results. Non-contrast CT reveals tram tracks and dilated/thickened bronchi. After sufficient workup, you arrive at the diagnosis of bronchiectasis. Which of the following antibiotics would be most appropriate for empiric therapy?

fluoroquinolones

Which of the following medications should NOT be given to patients with bronchiectasis?

corticosteroids

What is the preferred diagnosis for bronchiectasis-related hemoptysis?

CTA

PANCE PEARL: CT identifies the dilated airways; CTA maps the vessels responsible for bleeding.

Patients who have recurrent exacerbations of bacterial infection with bronchiectasis should receive which of the following as preventative therapy?

azithromycin

A 4 year old female presents to your clinic with insidious onset of cough and shortness of breath. PFTs show airflow obstruction and air trapping. CXR is unremarkable. CT confirms air trapping. She was recently diagnosed with RSV. What is your suspected diagnosis?

acute bronchiolitis

A 45 year old female presents with an insidious onset of cough and dyspnea. She has a history of vaping for the past several years. Lung biopsy reveals histopathology that shows patchy chronic inflammation, concentric submucosal and peribronchiolar fibrosis, and smooth muscle hypertrophy causing luminal obstruction. PFTs show airflow obstruction and airway trapping. CXR is unremarkable. CT chest shows air trapping. What is the most likely diagnosis?

hint type of bronchiokits

constrictive bronchiolitis

What is the preferred diagnostic test for constrictive bronchiolitis?

lung tissue biopsy

What is the only treatment that may help for constrictive bronchiolitis?

azithromycin

• Progressive course, relatively unresponsive to corticosteroids

• Azithromycin may slow progression in lung transplant recipients

patho: • Concentric submucosal & peribronchiolar fibrosis with smooth muscle hypertrophy causing airway obliteration

Patchy inflammation

• Triggered by toxic fumes, RA, drugs, graft rejection

A 68 year old male presents to your clinic with chronic dry cough and dyspnea. He has a history of recurrent episodes of pneumonia due to aspiration. He has difficulty swallowing from a previous stroke. He denies a history of tobacco or alcohol use. Histopathology shows organizing intraluminal exudate, fibroblasts, lipid-laden (foamy) macrophages, and obstruction of bronchiolar lumen. PFTs show restrictive ventilatory defect. CXR shows patchy consolidation, ground-glass opacities, and a nodular appearance. What is the most likely diagnosis?

proliferative bronchiolitis

What is the treatment of choice for proliferative bronchiolitis?

high-dose prednisone with slow taper

• Initial & Long-term: Oral prednisone

(1 mg/kg/day for 1–3 months, followed by a slow taper over 3–6 months)

A restrictive ventilatory defect on PFTs is reflective of what kind of bronchiolitis?

proliferative bronchiolitis

Which diagnostic test should be ordered first for proliferative bronchiolitis?

CXR

A 52 year old female presents to your clinic with complaints of progressive dyspnea. She has a history of Sjogren syndrome and hypertension. She denies history of tobacco and alcohol use. Histopathology shows chronic peribronchiolar inflammation and hyperplastic lymphoid follicles. CXR shows ground glass opacities and centrilobar and peribronchial nodules. What is your suspected diagnosis?

diffuse bronchiolitis

proliferative bronchiolitis

respiratory bronchiolitis

follicular bronchiolitis

follicular bronchiolitis

What is the preferred treatment for follicular bronchiolitis?

systemic steroids and azithromycin

A 58 year old male presents to your clinic with complaints of cough and progressive dyspnea. He has a 50 pack-year history of tobacco use. He has been previously diagnosed with COPD. Histopathology shows accumulation of alveolar macrophages, mild interstitial fibrosis and chronic inflammation. PFTs show a mixed obstructive and restrictive pattern. CT chest shows centrilobar nodules, patchy ground-glass opacities, and "tree-in-bud" opacities. What is your suspected diagnosis?

respiratory bronchiolitis

“Respiratory = cigarette Residue”

What is the best treatment for respiratory bronchiolitis?

smoking cessation + systemic steroids

A 62 year old male presents to your clinic complaining of progressive cough and dyspnea. He has a history of chronic pansinusitis and moved to the US from Japan two years prior. He has no history of smoking or alcohol use. Histopathology shows peribronchiolar mixed inflammatory cell infiltrate and accumulation of macrophages. PFTs reveal obstructive abnormalities. CXR shows diffuse, small, nodular shadows with hyperinflation. What is your suspected diagnosis?

Diffuse Panbronchiolitis

What is the treatment of choice for diffuse bronchiolitis?

azithromycin

• Definitive: Long-term macrolide therapy (azithromycin)

What is the most common cause of bronchiolitis and pneumonia in children under the age of 1?

RSV

Which of the following is a major cause of morbidity/mortality at the extremes of age (

RSV

A 3 year old female presents to the ED after her father noticed that she stopped breathing temporarily. He says that she's had a runny nose, cough, and sneezing for the past couple of days. Physical exam reveals low-grade fever, tachypnea, wheezing, hyperinflated lungs, and increased work of breathing. The father says she is one of five children and has recently started attending day care. What is the most likely diagnosis?

RSV

Which of the following is considered a risk factor for RSV?

prematurity

Memory trick: “Small, early, young; heart, lungs, siblings, daycare.”

PANCE PEARL: A premature infant with underlying lung or heart disease is especially vulnerable to severe RSV.

A 1 year old male presents to the ED by EMS after suffering an apneic episode. The patient's mother says that he had what she thought was a cold that has gotten progressively worse. She said she began to notice a cough, wheezing, and lethargy earlier that day. Physical exam reveals low-grade fever, hypoxia, hyperinflated lungs, and increased work of breathing. He has a history of prematurity and bronchopulmonary dysplasia. Supplemental oxygen and hydration are initiated. Which medication is the best treatment for your suspected diagnosis?

this is rsv

• Management: Supportive care (supplemental oxygen, hydration)

• Routine steroids and bronchodilators are not recommended

• Prevention: RSV vaccines (pregnancy, older adults), nirsevimab/monoclonal antibody for high-risk infants

Which of the following medications should be considered in high risk RSV patients?

aerosolized ribavirin or RSV-enriched IVIG

Which treatment is best for RSV?

• Management: Supportive care (supplemental oxygen, hydration)

• Routine steroids and bronchodilators are not recommended

• Prevention: RSV vaccines (pregnancy, older adults), nirsevimab/monoclonal antibody for high-risk infants

Which of the following is the most common cause of croup?

human parainfluenza virus type 1

Which of the following is characterized by acute inflammation of the larynx and subglottic airway?

croup

• Croup: “A seal barks beneath a steeple.”

• Epiglottitis: “The 3 Ds”—Drooling, Dysphagia, Distress.

A 9 month old female presents to your clinic with congestion, runny nose, and fever. Her mother says that she has a loud, barking cough with a "high pitched sound" on inspiration. She says it happens especially at nighttime. What is your suspected diagnosis?

croup

A 1 year old male presents to the ED with respiratory distress and cyanosis. The patient's father says that he has had a loud, spasmodic cough at night, as well as a high pitched sound when he inhales for the past few days. He says that his symptoms usually improve in the morning. Physical exam reveals crackles in lower airways, tachypnea, retractions, and cyanosis. Which of the following diagnostic findings would be most consistent with your suspected diagnosis?

sub-epiglottic narrowing on AP and lateral X ray

• Initial: Clinical exam & Westley croup severity score

• Definitive / Imaging: AP and lateral neck X-rays showing subglottic narrowing ("Steeple Sign")

remember treatment is supportive

Which of the following infections is usually self limiting and lasts 3-4 days?

croup

A 1 year old male presents to the ED with respiratory distress and cyanosis. The patient's father says that he has had a loud, spasmodic, barking cough at night, as well as a high pitched sound when he inhales for the past few days. He says that his symptoms usually improve in the morning. Physical exam reveals lethargy, crackles in lower airways, tachypnea, retractions, and cyanosis. Which of the following treatments is best for your suspected diagnosis?

hospitalization, oxygen, nebulized epi, glucocorticoids

tx:

• Mild: Hydration, cool humidified air, single dose dexamethasone

• Moderate to Severe: Oxygen, nebulized racemic epinephrine, oral/IV steroids, hospital admission

Which of the following is most common in children under 2 with symptoms lasting up to 6 weeks?

pertussis

Answer: Pertussis. The deciding clue is symptoms lasting up to 6 weeks.

Your lecture describes three stages:

1. Catarrhal: runny nose, sneezing, mild cough.

2. Paroxysmal: coughing fits, inspiratory “whoop,” and post-tussive vomiting.

3. Convalescent: coughing gradually decreases.

It also states that half of cases occur before age 2. RSV, Croup, Pertussis 2026

Why not RSV? RSV is strongly associated with infants, but the prolonged, staged coughing illness points to pertussis. Croup instead causes a barking cough and stridor, typically lasting only a few days.

Memory trick: Pertussis = persistent, paroxysmal cough.

A 1.5 year old female presents to your clinic with a cough. The patient's mother says that she thought she had a cold for a couple weeks with a hacking cough at night. She says that the baby now has rapid coughs followed by a high-pitched inspiration. She says that she wanted to bring her in because the cough has lasted longer than she expected. Labs reveal striking leukocytosis. What is your suspected diagnosis?

pertussis

A 9 month old male presents to your clinic with an apneic episode and cough. The patient's mother describes the cough as bursts of rapid coughs followed by a high pitched inspiration lasting for the past 2.5 weeks. Labs reveal strikingly high WBC count. Which of the following is the preferred treatment for your suspected diagnosis?

azithromycin/clarithromycin

remember: Bordetella pertussis (gram-negative coccobacillus) infection via droplets

• Treatment: Oral macrolides ABx (Azithromycin 5-day course or Clarithromycin 7-day course)

• Prevention / Prophylaxis: Macrolide prophylaxis for close contacts;

DTaP series for infants,

Tdap boosters for adolescents, adults, and pregnancy

Infants and susceptible adults who are exposed to pertussis can be given what antibiotic for prophylaxis?

oral macrolides

How is tuberculosis spread?

aerosolized droplets

A 38 year old female presents to your clinic for annual exams. She currently has no complaints. CXR reveals caseating granulomas. She has a PMH of homelessness and IV drug use. What is your suspected diagnosis?

latent tuberculosis

A 40 year old male presents to your clinic for an annual checkup. He has a PMH of appendicitis and appendectomy 20 years ago. He has no complaints. He is currently a caregiver for his elderly mother who has active TB infection. Which skin test result would be considered a positive for TB in this patient?

5 mm

Which of the following underlying conditions would be most concerning for someone who has been recently diagnosed with active tuberculosis?

HIV

A TB skin test result of 5 mm would be positive for which of the following patient populations?

someone with fibrotic changes on CXR

An interferon gamma release assay (blood test) for TB would be best indicated in which of the following patients?

someone who has previously received the BCG vaccine

A 55 year old female presents to the ED with hemoptysis, cough, anorexia, and weight loss. She notes difficulty sleeping due to persistent sweating at night. She says this has been going on for a while and has been progressively getting worse. She works as a nurse in the ICU. She denies any history of smoking or alcohol use. PMH of a hysterectomy and hypertension. Physical exam reveals fever, enlarged cervical lymph nodes, crackles in apices on auscultation, and the patient has an overall ill appearance. CXR reveals small, ill-defined patchy consolidation, lymph node enlargement, and pleural effusions. What is your first step for diagnosis of the suspected condition?

AFB sputum stain

Which of the following CXR findings is most consistent for a patient with healed tuberculosis?

dense nodules in pulmonary hila

A 28 year old female presents to your clinic for annual checkups. She has no complaints. She is recently became the primary caregiver for her older sister who has active TB infection. CXR shows caseating granulomas. What is the best treatment for her suspected diagnosis?

isoniazid for 9 months

TB survives inside macrophages → T cells activate macrophages → immune cells surround the bacteria to contain them → inflammation and tissue injury produce central caseous necrosis.

For your exam, remember:

• Caseating → think TB

• Noncaseating → think sarcoidosis

Why is the keyed answer isoniazid for 9 months? The writer likely intends latent TB: she has exposure but no symptoms, and her immune system has contained the infection. Nine months of isoniazid is an accepted latent-TB regimen, although shorter rifamycin-based regimens are currently preferred. Active TB must be excluded before using isoniazid alone.

A 58 year old female presents to your clinic with a dry cough, fever, night sweats, fatigue, anorexia, and weight loss. She says this has been going on for several months and has progressively gotten worse. She moved to the US from India five years prior. She has a PMH of breast cancer for which she is on immunosuppressants. Physical exam reveals lymphadenopathy, apical crackles on auscultation, and ill appearance. CXR reveals fibrocavitary lesions in apices, discrete nodules, and infiltrates in the apices. AFB stain is positive on three consecutive smears. What is the initial treatment of choice for your suspected diagnosis?

rifampentine + moxifloxacin + isoniazid + pyrazinamide for 8 weeks

*Why that treatment? Your lecture includes a 4-month active-TB regimen:

• First 8 weeks: rifapentine + moxifloxacin + isoniazid + pyrazinamide

• Next 9 weeks: rifapentine + moxifloxacin + isoniazid

PANCE PEARL: Chronic constitutional symptoms + apical cavities + immunosuppression → think reactivation TB.

Patients with latent TB receiving isoniazid should be monitored monthly for changes in what lab values?

AST, ALT and bilirubin

All drugs used for active TB cause elevations in what?

liver enzymes

Which of the following is a side effect of the drug ethambutol (given for active TB)?

optic neuritis

Patients on isoniazid should be also given what to prevent peripheral neuropathy?

pyridoxine (B6)

Which of the following drugs cannot be given to pregnant patients with active TB?

pyrazinamide

Which of the following drugs is given for active TB and has a side effect of liver enzyme elevation, gout flares, polyarthralgias, and generates the most liver damage?

pyrazinamide

Which of the following side effects is most consistent for the drug rifampin (given for active TB)?

turns bodily fluids reddish-orange, thrombocytopenia, polyarthralgias, liver enzyme elevation, and lots of drug interactions

Directly observed therapy (DOT) is a very important aspect in the treatment plan of what disease?

tuberculosis

If a patient with tuberculosis is resistant to isoniazid (INH), what drug can it be replaced with?

fluoroquinolones

Pulmonary embolisms occur in 50-60% of patients with DVTs proximal to what vessels?

popliteal vessels

What are the components of Virchow's triad?

venous stasis, vessel wall injury, hypercoagulability

Which of the following should always be considered in any patient with "chest symptoms"?

pulmonary embolism

A 32 year old female presents to the ED with chest pain and cough. She says that the chest pain worsens upon deep inspiration. She said she first noticed yesterday and has felt short of breath since it started. She says the chest pain radiates to her back. She has a hx of obesity and is currently on oral contraception. Physical exam reveals tachypnea, tachycardia, diaphoresis, and abnormal heart sounds. ECG shows sinus tach with nonspecific ST/T wave changes. Which of the following labs would be most consistent with your suspected diagnosis?

elevated d-dimer

A 68 year old male admitted to the med surg floor is complaining of a new onset of cough, chest pain, and hemoptysis. He originally came in for a total hip replacement which was successfully completed the previous day. He has not ambulated since surgery. Physical exam reveals tachypnea, profound hypoxia, rales, tachycardia, and lower extremity edema. CXR is normal. Which of the following manifestations is most highly suggestive of your suspected diagnosis?

profound hypoxia with normal CXR

A 29 year old female presents to the ED with chest pain, dyspnea, and cough. She said her symptoms started that morning while laying in bed. She recently gave birth a week prior and has been on bed rest ever since. Physical exam reveals profound hypoxia, tachypnea, tachycardia, fever, diaphoresis, and a heart murmur. CXR is normal. Plasma d-dimer is elevated. What is the imaging modality of choice for your suspected diagnosis?

CTA Chest

Westermark's sign (focal oligemia), hampton hump (increased opacity that is indicative of intraparenchymal hemorrhage), and palla's sign (a prominent central pulmonary artery) are all uncommon signs of what?

pulmonary embolism

Which of the following is the treatment of choice for a high risk, massive PE?

tPA (alteplase, reteplase, tenecteplase)

tPA (Intravenous Thrombolysis)

Which of the following patients with a high risk, massive PE would not qualify for thrombolysis?

a 65 year old female with a history of hemophilia A

Which of the following is the treatment of choice for a patient with an intermediate risk, submassive PE?

mechanical embolectomy

Which of the following anticoagulants is the first-line therapy for inpatient treatment of a PE?

unfractionated heparin

Memory trick: UFH = “Usually Fast to Halt.” Anticoagulants prevent clot extension and new clots; they do not directly dissolve the existing PE.

Which of the following anticoagulants is the preferred therapy for inpatient treatment of a PE in a patient that also has COVID and/or cancer?

LMWH (lovenox)

Which of the following is the first-line treatment for outpatient/post-discharge for a PE?

DOACs (apixaban, rivaroxaban)

A 25 year old male in the ED receives a CT chest/abdomen/pelvis following an MVA. You notice a small (< 3 cm) isolated, rounded opacity surrounded by normal healthy lung. The patient denies any previous or current respiratory symptoms. He denies any history of smoking. He has no PMH. What is the most likely diagnosis?

benign pulmonary nodule

tx:

Lecture finding	Approach
Low probability of malignancy	Observation with serial imaging
Benign calcification or documented stability	Further supports benignity
Larger size, growth, or spiculated margins	Further evaluation

What is the treatment of choice for a pulmonary nodule with intermediate probability of malignancy?

diagnostic biopsy, sputum cytology, and/or video-assisted thoracoscopic surgery (VATs)

• Initial: Non-contrast Chest CT to assess size,

borders (spiculated = malignant),

calcification (popcorn/diffuse = benign vs ground-glass/eccentric = malignant),

doubling time (<30 days = infection; >465 days = benign) -

Low Risk (<5% prob; <6 mm, stable >2 yrs): Serial CT surveillance -

Intermediate Risk (5–60% prob): PET-CT scan or diagnostic biopsy -

High Risk (>60% prob; >2 cm, spiculated, older smoker): PET-CT staging followed by VATS surgical excision

• Gold Standard / Definitive: Tissue biopsy (CT needle biopsy, bronchoscopy, or VATS excisional biopsy)

What is the treatment of choice for a pulmonary nodule with a high probability of malignancy?

resection

• Low Risk: Serial CT monitoring (Fleischner / Lung-RADS)

• High Risk / Malignant: VATS surgical resection (wedge, lobectomy)

A 68 year old female presents to the ED with shortness of breath, nonspecific chest pain, weakness, and weight loss. She says that this has been going on for several months but she became concerned after she started to notice blood in her sputum. She also notes chronically progressive pain in her bones which she attributed to "getting old". She denies history of tobacco or alcohol use, but says her husband has smoked a pack daily for the entire time they've been married (about 40 years). Physical exam reveals facial edema, jugular venous distention, and digital clubbing. What is the next best step to confirm your suspected diagnosis?

diagnosis and staging with a single biopsy

A 62 year old male presents to your clinic with complaints of anorexia, weight loss, and weakness. He has a history of chronic cough but he has noticed a recent change in the nature of his cough. He also notes changes to his voice. He has a PMH of current smoking (30 pack/year), COPD, and hypertension. CT-guided lung biopsy reveals non-small lung cancer found in an early stage. What is your treatment of choice?

surgical resection

Which of the following is the best possible treatment for small cell lung cancer?

chemo with cisplatin and etoposide

A 58 year old female presents to your clinic with a cough, hemoptysis, and recurrent postobstructive pneumonia. Physical exam reveals focal wheezing. She has worked as a diesel mechanic for 36 years. She has a PMH of tobacco use (20 pack/year hx). Fiberoptic bronchoscopy reveals a pink tumor in the central airway.

• A pulmonary carcinoid tumor is suspected.

• Diagnosis: Bronchoscopy may reveal a pink-purple central airway mass; tissue sampling confirms the diagnosis.

• Biopsy precaution: The tumor is highly vascular, so biopsy carries a bleeding risk.

• Treatment: Surgical excision for localized, operable disease; most carcinoids are resistant to chemotherapy and radiation.

Which of the following types of lung cancer usually presents as an asymptomatic pulmonary nodule with a possible pedunculated/sessile appearance?

bronchial carcinoid tumors

Which type of lung cancer accounts for 14% of lung cancers, is typically centrally located, is more aggressive/fast growing, and is usually metastatic at presentation?

small cell lung cancer

Which of the following types of lung cancer represents 80% of lung cancers, spreads more slowly, and can be cured by resection if caught early?

non-small cell lung cancer

SCLC often spreads beyond the original tumor early, so removing the lung tumor alone would leave cancer elsewhere. Your lecture notes that surgery is possible rarely in very early SCLC, followed by chemotherapy—but this is the exception.

PANCE PEARL: “80% + slower spread + early surgical cure” → NSCLC.

Which of the following types of non-small cell lung cancer arises from mucous glands, is the MC type of NSCLC, is MC in women, non-smokers, and younger patients, and usually occurs in the peripheral airways?

adenocarcinoma

Which of the following types of non-small cell lung cancer typically arises from the bronchial epithelium, is MC linked with smoking, is more aggressive, and presents with hemoptysis?

squamous cell

What is the most common presentation of pulmonary metastases?

multiple nodules or masses on imaging

A 62 year old female presents to the ED with an insidious onset of dyspnea, dry cough, feelings of chest fullness, weakness, and fever. She has been recently diagnosed with breast cancer and received her first radiation treatment 6 weeks ago. She has also been started on immunotherapy. Labs reveal elevated WBCs and ESR. CXR reveals alveolar opacities. What is the most likely diagnosis?

acute radiation lung injury

Which of the following is the preferred treatment for acute radiation lung injury?

corticosteroids with taper

A 29 year old female presents to your clinic with dyspnea, cough, fatigue, and chest pain. Physical exam reveals dermal papules around the nose, parotid gland enlargement, hepatosplenomegaly, and lymphadenopathy. Biopsy of the lymph node reveals non-caseating granulomas. PFTs show airflow obstruction, decreased lung volume, and decreased diffusing capacity. CXR shows bilateral hilar adenopathy. Which of the following labs would be most consistent with your suspected diagnosis?

hypercalcuria

A 22 year old male presents to your clinic for an annual exam with no complaints. Physical exam reveals erythema nodosum, iritis, parotid gland enlargement, and lymphadenopathy. Labs reveal elevated ESR, hypercalcemia, and elevated ACE. Urinalysis reveals hypercacluria. Biopsy of the lymph nodes reveals noncaseating granulomas. What is the first-line treatment for your suspected diagnosis?

methotrexate X 24 weeks