Sample Pulmonary System Test Questions for PANRE Exam
Based on the most recent pulmonary medicine competency guidelines, I've created sample test questions that reflect key knowledge areas for physician assistants preparing for the PANRE exam. 1
Core Knowledge Areas
Obstructive Lung Disease Questions
A 62-year-old male with a 40 pack-year smoking history presents with progressive dyspnea, chronic cough, and decreased exercise tolerance. Spirometry shows FEV1/FVC ratio of 0.65 and FEV1 of 68% predicted. Which of the following is the most appropriate next step?
- A) Prescribe short-acting beta-agonist as needed
- B) Order high-resolution chest CT
- C) Perform bronchodilator reversibility testing
- D) Start combination inhaled corticosteroid/long-acting beta-agonist
A 45-year-old female with asthma uses her albuterol inhaler 3-4 times daily despite being on a medium-dose inhaled corticosteroid. Her FEV1 is 75% predicted. After using albuterol, her maximum improvement in pulmonary function typically occurs at:
- A) 5 minutes
- B) 30 minutes
- C) 1 hour
- D) 3 hours
Pulmonary Function Testing Questions
When interpreting pulmonary function tests, which of the following patterns is consistent with obstructive lung disease?
- A) Decreased FEV1, normal FVC, decreased FEV1/FVC ratio
- B) Decreased FEV1, decreased FVC, normal FEV1/FVC ratio
- C) Normal FEV1, decreased FVC, increased FEV1/FVC ratio
- D) Decreased FEV1, decreased FVC, decreased TLC
A 58-year-old male undergoes pulmonary function testing. His FEV1 is 65% predicted, FVC is 80% predicted, and TLC is 110% predicted. Which of the following best describes these findings?
- A) Restrictive lung disease
- B) Obstructive lung disease
- C) Mixed obstructive and restrictive disease
- D) Normal pulmonary function
Respiratory Infections Questions
A 32-year-old healthcare worker has a positive tuberculin skin test with 15mm induration. Chest X-ray is normal and the patient is asymptomatic. Which of the following is the most appropriate management?
- A) No treatment necessary; repeat chest X-ray in 6 months
- B) Isoniazid for 9 months
- C) Rifampin, isoniazid, pyrazinamide, and ethambutol for 2 months
- D) Repeat tuberculin skin test in 3 months
A 70-year-old male presents with fever, productive cough with green sputum, and right-sided chest pain for 3 days. Vital signs show temperature 101.5°F, heart rate 105, respiratory rate 22, and oxygen saturation 93% on room air. Chest X-ray shows right lower lobe consolidation. Which of the following is the most appropriate initial antibiotic regimen?
- A) Azithromycin
- B) Levofloxacin
- C) Ceftriaxone plus azithromycin
- D) Vancomycin plus piperacillin-tazobactam
Lung Cancer Questions
A 60-year-old male with a 30 pack-year smoking history has an incidental 2.5 cm spiculated nodule in the right upper lobe on chest CT. Which of the following is the most appropriate next step?
- A) Repeat CT scan in 3 months
- B) PET scan
- C) Bronchoscopy with transbronchial biopsy
- D) Surgical resection
Which of the following paraneoplastic syndromes is most commonly associated with small cell lung cancer?
- A) Hypertrophic pulmonary osteoarthropathy
- B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- C) Hypercalcemia
- D) Eaton-Lambert myasthenic syndrome
Critical Care and Respiratory Failure Questions
A 68-year-old male with COPD exacerbation is admitted with respiratory distress. ABG shows pH 7.28, PaCO2 65 mmHg, PaO2 58 mmHg, HCO3 30 mEq/L. Which of the following ventilatory support options is most appropriate?
- A) Intubation and mechanical ventilation
- B) Non-invasive positive pressure ventilation
- C) High-flow nasal cannula
- D) Conventional oxygen therapy via nasal cannula
A 55-year-old female with severe ARDS is on mechanical ventilation with FiO2 0.8 and PEEP 14 cmH2O. Her PaO2/FiO2 ratio is 120. Which of the following strategies has been shown to improve mortality in this scenario?
- A) Prone positioning
- B) Inhaled nitric oxide
- C) High-frequency oscillatory ventilation
- D) Extracorporeal membrane oxygenation
Technical Skills Questions
When performing arterial blood gas sampling, which of the following is the preferred initial site?
- A) Femoral artery
- B) Brachial artery
- C) Radial artery
- D) Dorsalis pedis artery
During thoracentesis of a large pleural effusion, which of the following is the maximum recommended volume to remove in a single procedure to minimize the risk of re-expansion pulmonary edema?
- A) 500 mL
- B) 1000 mL
- C) 1500 mL
- D) 2000 mL
Common Pitfalls to Avoid
- Remember that spirometry alone cannot diagnose restrictive lung disease - lung volumes are required 1
- Be careful not to confuse COPD with asthma - both are obstructive diseases but have different treatment approaches and prognoses
- Recognize that pulmonary function tests must be interpreted in the context of appropriate reference values based on age, sex, height, and ethnicity 1
- When interpreting arterial blood gases, always assess the acid-base status systematically (pH, PaCO2, HCO3-)
- For questions about respiratory medications, know the onset and duration of action for common drugs like albuterol (onset within 5 minutes, peak effect at approximately 1 hour) 2
Key Abbreviations to Know
- FEV1: Forced Expiratory Volume in 1 second
- FVC: Forced Vital Capacity
- TLC: Total Lung Capacity
- RV: Residual Volume
- DLCO: Diffusing capacity of the lungs for carbon monoxide
- PFT: Pulmonary Function Test
- ABG: Arterial Blood Gas
- ARDS: Acute Respiratory Distress Syndrome
- PEEP: Positive End-Expiratory Pressure 1
These sample questions cover the core competencies expected of physician assistants in pulmonary medicine as outlined in the multisociety task force recommendations 1. Focus on understanding the pathophysiology, diagnostic approaches, and management strategies for common respiratory conditions to succeed on the PANRE exam.