Practice Pulmonary Questions for the Physician Assistant Exam
Pulmonary embolism and pulmonary hypertension are two pulmonary circulation conditions that are high-yield for the Physician Assistant Exam (known as PANCE). And for good reason, too — you see these conditions clinically time and time again. These practice questions are similar to the PANCE questions about pulmonary matters.
Example PANCE Questions
You’re treating a 74-year-old male nursing home resident who was admitted with shortness of breath and fever. His temperature on admission was 38.3°C (101°F). On physical exam, the gentleman is toxic looking and has decreased lung sounds at the right base. The chest radiograph shows an infiltrate at the right lower lobe. What’s the most likely causative organism?
(A) Streptococcus pneumoniae
(B) Legionella pneumophila
(C) Viral pneumonia
(D) Klebsiella pneumoniae
A 35-year-old man develops worsening dyspnea on exertion, occurring over the last few weeks. He has no cardiac risk factors. A chest radiograph reveals bilateral hilar adenopathy. Labs show an elevated erythrocyte sedimentation rate and an elevated angiotensin converting enzyme (ACE) level. What is this person’s likely diagnosis?
(E) Caplan’s syndrome
Which one of the following is a cause of a respiratory alkalosis?
(A) Neuromuscular disease
(B) Pulmonary embolism
(E) Nasogastric section
What is the treatment of choice for mild persistent asthma?
(A) Inhaled steroids
(B) Daily albuterol
(C) Methacholine (Provocholine)
(D) Daily ipratropium bromide (Atrovent)
(E) Nebulized albuterol and Atrovent
Steroids are used in treating severe asthma and COPD exacerbations. Side effects of long-term steroid use include which of the following?
(D) Adrenal insufficiency
(E) Weight loss
Which one of the following statements about acute respiratory distress syndrome (ARDS) is false?
(A) A chest radiograph can show bilateral opacification of both lung fields.
(B) Causes of this acute lung injury can include severe sepsis, trauma, and blood transfusions.
(C) The role of steroids in the treatment of ARDS is controversial.
(D) Many patients with ARDS will experience multi-organ dysfunction syndrome (MODS).
(E) Treatment includes using high tidal volumes to maintain oxygenation.
Example PANCE Answers and Explanations
Use this answer key to score the practice pulmonary questions. The answer explanations give you some insight into why the correct answer is better than the other choices.
1. D. A nursing home resident is likely to have a healthcare-associated pneumonia caused by Gram-negative bacteria, such as Klebsiella pneumoniae, or by Staphylococcus aureus. Choices (A) and (B), Streptococcus pneumoniae and Legionella pneumophila, represent causes of community-acquired pneumonia (CAP). For the answer to be anaerobes, Choice (E), the question would have to contain clues such as a history of aspiration of food contents or bad dentition (the mouth is dirty).
2. C. Although many of the answers could demonstrate bilateral hilar adenopathy on a chest radiograph as well as an elevated sed rate (nonspecific), only sarcoidosis, Choice (C), is associated with an elevated ACE level. Remember that Choice (E), Caplan’s syndrome, is a combination of rheumatoid arthritis plus lung nodules.
3. B. Pulmonary embolism can cause respiratory alkalosis. Choices (A) and (C), neuromuscular disease and kyphosis, are causes of a respiratory acidosis. Diarrhea, with loss of bicarbonate in the stool, is a cause of a metabolic acidosis. Choice (E), nasogastric section, causes a metabolic alkalosis. Other causes of a metabolic alkalosis include vomiting and diuretic use.
4. A. Inhaled steroids are the treatment of choice for mild persistent asthma. For intermittent asthma, the use of a short-acting inhaler like albuterol, Choice (B), is okay. But after someone begins to have more frequent asthma exacerbations, using an inhaled steroid is recommended. The key word here is persistent. Choice (C), methacholine, can be used to test for asthma, not to treat it. Ipratropium bromide (Atrovent), Choice (D), is used in the treatment of COPD. Nebulized albuterol and Atrovent together, Choice (E), are used in the treatment of advanced COPD — many patients actually have their own nebulizers.
5. A. Steroids are a leading cause of osteoporosis, Choice (A). Steroid use can be associated with a steroid psychosis, not lethargy. They can elevate blood pressure, not cause hypotension. Steroid use can cause Cushing’s syndrome, and abrupt discontinuation of steroids — not the long-term use of steroids — can precipitate adrenal insufficiency. They’re associated with weight gain, not weight loss.
6. E. Patients with ARDS can be difficult to oxygenate; the use of low tidal volumes plus the use of positive end expiratory pressure (PEEP) is vital in the management of ARDS. You don’t want to use high tidal volumes, because the lungs won’t tolerate it.
All the other choices are true statements. Choice (A) is true because a chest radiograph can show bilateral opacification of both lung fields. Differentiating between pulmonary edema and multilobar pneumonia can be difficult.
Choice (B) is true because severe sepsis, trauma, and blood transfusions are the main causes of ARDS. You can think of ARDS as a hyperactive immune system reacting to some inciting event that causes the lung problems. Infections and significant trauma are the leading etiologies. Transfusion-associated acute lung injury (TRALI) is another cause, and as the name suggests, it’s associated with blood transfusions.
Choice (C) is true because although steroids have been tried in treating ARDS, they aren’t considered a standard of care in ARDS.
Choice (D) is true because ARDS can affect multiple organs, especially the liver and kidney. ARDS has a high fatality rate.