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

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Pulmonary

Final Test Review

(Questions & Solutions)

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

B) Atelectasis of the right lower lobe C) Diffuse interstitial infiltrates D) Mediastinal shift to left ANS: B Rationale: Post‐obstruction collapse (atelectasis) is common distal to a foreign body. 2.3 Which bronchoscopic modality is preferred for removing a sharp metallic foreign body in the proximal trachea of an adult? A) Flexible bronchoscopy with forceps B) Rigid bronchoscopy C) Fiberoptic bronchoscopy only D) Percutaneous tracheostomy ANS: B Rationale: Rigid bronchoscopy provides airway control and larger working channel for sharp object retrieval. 2.4 A radiolucent foreign body is suspected after an episode of choking. Which test helps localize it? A) Inspiratory/expiratory chest X-ray B) Standard PA chest X-ray C) ECG D) Spirometry ANS: A Rationale: Comparison films often show air‐trapping on the affected side in radiolucent aspiration. 2.5 Chronic foreign body retention can lead to all EXCEPT: A) Bronchiectasis B) Localized abscess C) Pulmonary fibrosis D) Acute respiratory distress syndrome ANS: D Rationale: Retained aspirates cause localized damage (bronchiectasis, abscess, fibrosis), not diffuse ARDS.

3. Hyaline Membrane Disease (Neonatal RDS) 3.1 A 28-week preterm newborn develops tachypnea and grunting at birth. Surfactant therapy reduces mortality by: A) Increasing alveolar surface tension B) Decreasing alveolar collapse C) Decreasing lung compliance D) Raising pulmonary vascular resistance ANS: B Rationale: Exogenous surfactant lowers surface tension, improves compliance, and prevents atelectasis. 3.2 Which maternal factor accelerates fetal lung maturity? A) Maternal diabetes B) Antenatal corticosteroids C) Smoking D) Preeclampsia ANS: B Rationale: Betamethasone accelerates surfactant production and reduces RDS incidence. 3.3 Which ABG pattern suggests RDS in a neonate? A) pH 7.50, PaCO₂ 28 mm Hg, PaO₂ 70 mm Hg B) pH 7.30, PaCO₂ 55 mm Hg, PaO₂ 35 mm Hg C) pH 7.40, PaCO₂ 40 mm Hg, PaO₂ 100 mm Hg D) pH 7.25, PaCO₂ 30 mm Hg, PaO₂ 80 mm Hg ANS: B Rationale: RDS causes hypoxemia and hypercapnia (respiratory acidosis). 3.4 Chest radiograph in neonatal RDS typically shows: A) Air bronchograms and ground-glass opacities B) Hyperinflation

ANS: B

Rationale: Mycoplasma causes atypical pneumonia in young adults with mild symptoms. 4.3 A nursing home–acquired aspiration pneumonia is most often due to: A) Staphylococcus aureus B) Anaerobic bacteria C) Mycoplasma pneumoniae D) Candida species ANS: B Rationale: Aspiration pneumonia commonly involves oral anaerobes. 4.4 A 70-year-old presents with high fever, productive cough, and lobar consolidation. Treatment should include: A) Macrolide monotherapy B) Beta-lactam plus macrolide C) RSV prophylaxis D) TMP/SMX ANS: B Rationale: CAP with lobar consolidation in an older adult warrants combination beta-lactam and macrolide. 4.5 A 25-year-old traveler returns with fever, cough, and cavitary lung lesions on CT. Acid-fast bacilli on sputum. Next step? A) Initiate RIPE therapy for tuberculosis B) Begin broad-spectrum antibiotics for lung abscess C) Order HIV test only D) Watchful waiting ANS: A Rationale: Cavitary lesions with AFB require prompt TB treatment with Rifampin, Isoniazid, Pyrazinamide, Ethambutol.

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5. Neoplasms

5.1 A 65-year-old smoker has a 2 cm solitary lung nodule on CT. PET scan shows intense uptake (SUV > 2.5). Next best step? A) PET-guided biopsy B) CT surveillance in 6 months C) Empiric radiation D) Bronchodilator therapy ANS: A Rationale: A PET‐avid solitary pulmonary nodule in a high‐risk patient warrants tissue diagnosis via biopsy. 5.2 Small cell lung cancer is characterized by: A) Paraneoplastic SIADH and rapid metastasis B) Slow growth and lobectomy cure C) Pancoast syndrome D) EGFR mutation responsiveness ANS: A Rationale: SCLC is aggressive, often causes SIADH, and is treated with chemo/radiation rather than surgery. 5.3 Non–small cell lung cancer with EGFR mutation responds best to: A) Gefitinib (EGFR TKI) B) Sunitinib C) Platinum monotherapy D) Methotrexate ANS: A Rationale: EGFR‐tyrosine kinase inhibitors like gefitinib are effective in EGFR‐mutated NSCLC. 5.4 A 50-year-old with a history of asbestos exposure presents with pleuritic chest pain and unilateral pleural thickening on CT. Suspected tumor? A) Mesothelioma B) Adenocarcinoma C) Small cell carcinoma

Rationale: BiPAP improves alveolar ventilation, corrects hypercapnia, and is first-line in OHS. 6.3 Which comorbidity is most strongly associated with OHS? A) Obstructive sleep apnea B) Asthma C) COPD D) Pulmonary fibrosis ANS: A Rationale: OHS frequently coexists with obstructive sleep apnea; treatment addresses both. 6.4 Weight loss in OHS primarily improves: A) Chest wall mechanics and ventilation B) Myocardial contractility C) Airway hyperreactivity D) Diaphragmatic hernia ANS: A Rationale: Weight reduction improves respiratory mechanics, reduces work of breathing, and lowers PaCO₂. 6.5 OHS without treatment can lead to: A) Pulmonary hypertension and cor pulmonale B) Decreased cardiac output only C) Predominant restrictive lung pattern D) Spontaneous pneumothorax ANS: A Rationale: Chronic hypoventilation and hypoxemia cause pulmonary vasoconstriction, leading to pulmonary hypertension and right-heart failure.

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7. Obstructive Pulmonary Diseases

7.1 A 25-year-old with exercise-induced wheezing has a normal baseline spirometry but FEV₁ increases 20% with albuterol. Diagnosis? A) Asthma B) COPD C) Pulmonary fibrosis D) Bronchiectasis ANS: A Rationale: Significant reversibility (> 12% FEV₁ increase) after bronchodilator is diagnostic of asthma. 7.2 A 60-year-old smoker with chronic productive cough for 2 years and FEV₁/FVC = 65% suggests: A) COPD—chronic bronchitis phenotype B) Asthma C) Interstitial lung disease D) Normal aging ANS: A Rationale: Persistent airflow obstruction in smoker with productive cough defines chronic bronchitis–COPD. 7.3 Alpha-1 antitrypsin deficiency typically manifests as: A) Panacinar emphysema in lower lobes B) Centriacinar emphysema upper lobes C) Pulmonary edema D) Lymphangioleiomyomatosis ANS: A Rationale: AAT deficiency causes panacinar emphysema predominantly in lower lobes in young adults. 7.4 Theophylline toxicity risk increases with: A) Ciprofloxacin coadministration B) High-flow oxygen C) Beta-agonist use D) Nasal decongestant use ANS: A

empyema requiring drainage. 8.3 A tall, thin 19-year-old with sudden pleuritic chest pain and dyspnea. CXR shows apical lucency without lung markings. A) Primary spontaneous pneumothorax B) Tension pneumothorax C) Hemothorax D) Pleural effusion ANS: A Rationale: Primary spontaneous pneumothorax in young, tall patients presents with spontaneous apical collapse. 8.4 In tension pneumothorax, immediate management is: A) Needle decompression in the 2nd ICS midclavicular line B) High-flow oxygen only C) Urgent thoracentesis D) Observation ANS: A Rationale: Tension requires emergent needle decompression before chest tube placement. 8.5 A patient with rheumatoid arthritis develops chronic pleuritic chest pain and pleural thickening. Pleural fluid shows low glucose. Diagnosis? A) Rheumatoid pleuritis B) Malignant effusion C) Empyema D) Transudate from CHF ANS: A Rationale: RA‐associated pleural effusions are exudative, with low glucose and pH due to immune complex deposition.

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A 52-year-old patient develops sudden hypoxemia 48 hours after pancreatitis onset, with bilateral infiltrates on chest X-ray and no evidence of left atrial hypertension. What is the most appropriate initial ventilatory strategy? A) High tidal volume B) Low tidal volume C) High PEEP D) Routine use of inhaled nitric oxide ANS: B Rationale: Lung-protective ventilation with low tidal volume (~6 mL/kg predicted body weight) reduces mortality in ARDS by minimizing ventilator-induced lung injury.

Which parameter best reflects the severity of ARDS according to the Berlin definition? A) PaO₂/FiO₂ ratio B) Arterial pH C) Respiratory rate D) Alveolar-arterial gradient ANS: A Rationale: The PaO₂/FiO₂ ratio is used to classify the severity of ARDS (mild, moderate, severe) per the Berlin definition.

ARDS secondary to sepsis is associated with which of the following histopathological findings? A) Caseating granulomas B) DAD (Diffuse Alveolar Damage) C) Bronchiolitis obliterans D) Lymphocytic infiltration ANS: B

suggest foreign body aspiration.

The gold standard for diagnosing foreign body aspiration is: A) Chest X-ray B) Spirometry C) CT scan D) Rigid bronchoscopy ANS: D Rationale: Rigid bronchoscopy allows both diagnosis and retrieval of the foreign body.

Which is the most common site of foreign body lodgment in adults? A) Right main bronchus B) Left main bronchus C) Larynx D) Esophagus ANS: A Rationale: The right main bronchus is more vertical and wider, making it the most common site for aspirated foreign bodies in adults.

A chest X-ray in a child with foreign body aspiration may show all except: A) Unilateral hyperinflation B) Atelectasis C) Mediastinal shift D) Bilateral lower lobe infiltrates ANS: D Rationale: Bilateral lower lobe infiltrates suggest pneumonia rather than foreign body; the others can be present due to obstruction/air trapping.

Following removal of a bronchial foreign body, the most common complication is:

A) Pulmonary embolism B) Post-obstructive pneumonia C) Cardiac arrhythmia D) Pulmonary fibrosis ANS: B Rationale: Post-obstructive infection (pneumonia) is a common complication after foreign body removal. Hyaline Membrane Disease (Neonatal RDS)

A preterm infant (28 weeks) with tachypnea, grunting, and retractions, has a chest X-ray showing air bronchograms with ground-glass opacity. The initial management includes: A) Immediate antibiotics B) High-flow nasal cannula only C) CPAP and surfactant administration D) Inhaled corticosteroids ANS: C Rationale: Early CPAP and exogenous surfactant are mainstays of treatment for hyaline membrane disease in preterm neonates.

Deficiency of which substance is key in the pathophysiology of neonatal hyaline membrane disease? A) Alpha-1 antitrypsin B) Surfactant C) Mucus D) Immunoglobulin ANS: B Rationale: Surfactant deficiency in preterm infants leads to increased surface tension and alveolar collapse in hyaline membrane disease.

Which maternal intervention is most effective in preventing hyaline membrane disease in preterm births?

A) Streptococcus pneumoniae B) Mycoplasma pneumoniae C) Staphylococcus aureus D) Candida albicans ANS: B Rationale: Mycoplasma pneumoniae causes atypical pneumonia, often in young adults, with patchy or interstitial infiltrates.

Hospital-acquired pneumonia is most commonly caused by: A) Haemophilus influenzae B) Pseudomonas aeruginosa C) Streptococcus pneumoniae D) Influenza virus ANS: B Rationale: Gram-negative bacteria, notably Pseudomonas, are common causes of hospital-acquired pneumonia.

A patient’s sputum Gram stain shows Gram-negative coccobacilli. Which organism is most likely? A) Klebsiella pneumoniae B) Haemophilus influenzae C) Streptococcus pneumoniae D) Legionella pneumophila ANS: B Rationale: Haemophilus influenzae is a Gram-negative coccobacillus associated with pneumonia.

Empiric outpatient therapy for community-acquired pneumonia in a previously healthy adult usually includes: A) IV vancomycin B) Macrolide or doxycycline C) Amoxicillin-clavulanate only

D) Inhaled corticosteroids ANS: B Rationale: Macrolides or doxycycline target common pathogens for uncomplicated outpatient pneumonia.

A 30-year-old presents with night sweats, weight loss, and apical lung infiltrates. Sputum AFB stain is positive. The diagnosis is: A) Sarcoidosis B) Tuberculosis C) Mycoplasma pneumonia D) Lung cancer ANS: B Rationale: Apical cavitary lesions with positive acid-fast bacilli (AFB) stain are characteristic of active tuberculosis. Neoplasms

A 65-year-old smoker presents with hemoptysis and central lung mass on CT. Which lung cancer subtype is most likely? A) Adenocarcinoma B) Small cell carcinoma C) Squamous cell carcinoma D) Large cell carcinoma ANS: C Rationale: Squamous cell carcinoma is associated with central lesions and smoking.

Paraneoplastic hypercalcemia is most commonly due to which lung cancer? A) Adenocarcinoma B) Small cell carcinoma C) Squamous cell carcinoma D) Carcinoid tumor