PULMONOLOGY FEEDBACK

Question 1
Which of the following disorders will cause an increase in functional residual capacity?

a. Emphysema
b. Myasthenia Gravis
c. Obesity
d. Pulmonary fibrosis
Question 1
Which of the following disorders will cause an increase in functional residual capacity?

a. Emphysema
b. Myasthenia Gravis
c. Obesity
d. Pulmonary fibrosis
Question 2
Which of the following patients is appropriately diagnosed with asthma

a. A 24F treated with inhaled corticosteroids for cough and wheezing that has persisted
for 6 weeks following a viral upper respiratory infection
b. A25M who coughs and occasionally wheezes following exercise
c. A 34 F evaluated for chronic cough with an FEV1/FVC ratio of 68% with an FEV1
that increases from 1.68L to 1.98L after albuterol
d. A 60/M who was smoked 2 packs of cigarettes per day for 40 years who has dyspnea
and cough and who has airway hyperactivity in response to metacholine
Question 2
Which of the following patients is appropriately diagnosed with asthma

a. A 24F treated with inhaled corticosteroids for cough and wheezing that has persisted
for 6 weeks following a viral upper respiratory infection
b. A25M who coughs and occasionally wheezes following exercise
c. A 34 F evaluated for chronic cough with an FEV1/FVC ratio of 68% with an
FEV1 that increases from 1.68L to 1.98L after albuterol
d. A 60/M who was smoked 2 packs of cigarettes per day for 40 years who has dyspnea
and cough and who has airway hyperactivity in response to metacholine
Question 3
Which of the following regarding the epidemiology of asthma is true?
a. Air pollution has not been convincingly shown to impact the prevalence of
asthma in a given
b. Atopy is the most important risk factor in developing asthma
c. The incidence of asthma is decreasing in developing countries
d. There is a clearly established link between early childhood viral infections and
the development of asthma
e. Vitamin D deficiency has been shown to be an important risk factor for asthma
Question 3
Which of the following regarding the epidemiology of asthma is true?
a. Air pollution has not been convincingly shown to impact the prevalence of
asthma in a given
b. Atopy is the most important risk factor in developing asthma
c. The incidence of asthma is decreasing in developing countries
d. There is a clearly established link between early childhood viral infections and
the development of asthma
e. Vitamin D deficiency has been shown to be an important risk factor for asthma
Question 5
A 51F presents with cough productive of yellow to greenish phlegm which is worse early
morning. Cough has been noted for more than 5 years and progressively worse. She has
frequent episodes of respiratory tract infections. Bilateral coarse crackles are heard in the
lower lung zones. Pulmonary function test showed an FEV1 of 1.68L (53.3% of
predicted), FVC of 3L (75% of predicted), and FEV1/FVC ratiuo of 56%. What test would
you perform next in the evaluation of this patient?

A. Barium swallow study

B. Bronchoscopy
C. Chest radiography
D. High resolution CT
Question 5
A 51F presents with cough productive of yellow to greenish phlegm which is worse early
morning. Cough has been noted for more than 5 years and progressively worse. She has
frequent episodes of respiratory tract infections. Bilateral coarse crackles are heard in the
lower lung zones. Pulmonary function test showed an FEV1 of 1.68L (53.3% of
predicted), FVC of 3L (75% of predicted), and FEV1/FVC ratiuo of 56%. What test would
you perform next in the evaluation of this patient?

A. Barium swallow study

B. Bronchoscopy
C. Chest radiography
D. High resolution CT
Question 6
56F was admitted to the ICU with a 4 day history of increasing shortness of breath and
cough with copious sputum production. She has known severe chronic obstructive
pulmonary disease. Arterial blood gas taken at room air showed pH of 7.27 paCO2
78mmHg, PaO2 50mmHg. She is in respiratory distress with diffuse expiratory wheezing
and rhonchi. No infiltrates are present on the chest radiograph. Which of the following
therapies has been demonstrated to have the greatest reduction in mortality rate for the
patient?
A. Inhaled glucocorticoids
B. IV glucocorticoids
C. Broad spectrum antibiotics with coverage for Pseudomonas aeruginosa
D. Early intubation with mechanical ventilation
E. Use on noninvase positive pressure ventilation
GOLD 2022
Question 6
56F was admitted to the ICU with a 4 day history of increasing shortness of breath and
cough with copious sputum production. She has known severe chronic obstructive
pulmonary disease. Arterial blood gas taken at room air showed pH of 7.27 paCO2
78mmHg, PaO2 50mmHg. She is in respiratory distress with diffuse expiratory wheezing
and rhonchi. No infiltrates are present on the chest radiograph. Which of the following
therapies has been demonstrated to have the greatest reduction in mortality rate for the
patient?
A. Inhaled glucocorticoids
B. IV glucocorticoids
C. Broad spectrum antibiotics with coverage for Pseudomonas aeruginosa
D. Early intubation with mechanical ventilation
E. Use on noninvase positive pressure ventilation
Question 7
A 65M known COPD presents for routine follow up. His symptoms have been
stable on daily long acting Tiotropium and occasional salbutamol. He has not had an
exacerbation in the last year. He smokes half a pack of cigarettes per day. Plays
tennis twice a week. Which of the following would be the most effective
management strategy at this time?

A. Addition of a long acting beta agonist

B. Addition of an inhaled corticosteroid twice daily
C. Referral to pulmonary rehab
D. Smoking cessation counseling and consider pharmacologic therapyt
Question 7
A 65M known COPD presents for routine follow up. His symptoms have been
stable on daily long acting Tiotropium and occasional salbutamol. He has not had an
exacerbation in the last year. He smokes half a pack of cigarettes per day. Plays
tennis twice a week. Which of the following would be the most effective
management strategy at this time?

A. Addition of a long acting beta agonist

B. Addition of an inhaled corticosteroid twice daily
C. Referral to pulmonary rehab
D. Smoking cessation counseling and consider pharmacologic therapyt
Question 8
57F with COPD presents to the ER with worsening shortness of breath in the past 3
days. She has diffuse wheezes bilateral and oxygen saturation on room air is at 87%.
Arterial blood gas reveals pH 7.3 PaCO2 75, PaO2 65 on 3L oxygen. Her serum
bicarbionate is 30mEq/dL and creatinine is normal. Which of the following best
explains her current acid base status

A. Metabolic acidosis and respiratory acidosis

B. Metabolic alkalosis with compensatory metabolic acidosis
C. Acute on chronic respiratory acidosis with compensatory metabolic alkalosis
D. Acute respiratory acidosis
E. Chronic respiratory acidosis with compensatory metabolic acidosis
Match each of the following pulmonary function test results to the respiratory disorder in which it is most likely to be found
Myasthenia gravis
A. Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)

B. Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)

C. Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)

D. Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 2

Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
2 (14%)
 Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
11 (79%)
Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%) Increased total lung capacity
(TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 1 (7%)
Familial pulmonary hypertension
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
2 (14%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
2 (14%)
 Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
7 (50%)
Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 3 (21%)
Chronic obstructive pulmonary disease
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
4 (27%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
3 (20%) Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%)  Increased total lung
capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 8 (53%)
Idiopathic pulmonary fibrosis
A. Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)

B. Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory
pressure (MIP)

C.Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%) Increased total
lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio

D. Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)

Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%) Increased total
lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 1 (7%)
Familial pulmonary hypertension
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
2 (14%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory
pressure (MIP)
2 (14%)
 Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
7 (50%)
Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 3 (21%)
Chronic obstructive pulmonary disease
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
4 (27%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory
pressure (MIP)
3 (20%) Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%) 
Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 8 (53%)
Familial pulmonary hypertension
A. Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)

B. Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure
(MIP)

C. Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)

D. Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio

Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
4 (27%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
3 (20%) Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%)  Increased total
lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 8 (53%)Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC
ratio, normal maximum inspiratory pressure (MIP) 0 (0%) Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 1 (7%)
Familial pulmonary hypertension
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
2 (14%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
2 (14%)
 Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
7 (50%)
Increased total lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 3 (21%)
Chronic obstructive pulmonary disease
Decreased total lung capacity (TLC), increased residual volume (RV), normal FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)
4 (27%)
Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased residual volume (RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)
3 (20%) Normal total lung capacity (TLC), normal residual volume (RV), normal FEV1/FVC ratio, normal maximum inspiratory pressure (MIP) 0 (0%)  Increased total
lung capacity (TLC), decreased vital capacity (VC), decreased FEV1/FVC ratio 8 (53%)
Chronic obstructive pulmonary disease
Decreased total lung capacity (TLC), increased residual volume (RV), normal
FEV1/FVC ratio, decreased maximum inspiratory pressure (MIP)

Decreased total lung capacity (TLC), decreased vital capacity (VC), decreased
residual volume (RV), increased FEV1/FVC ratio, normal maximum
inspiratory pressure (MIP)

Normal total lung capacity (TLC), normal residual volume (RV), normal
FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)

Increased total lung capacity (TLC), decreased vital capacity (VC), decreased
FEV1/FVC ratio