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ABIM IM Recert > Boards Vitals Pulmonary > Flashcards

Boards Vitals Pulmonary Flashcards

1
Q

When a patient has asthma, polyposis (nasal polyps) and NSAID sensitivity - what should you think of?

A

Aspirin exacerbated respiratory disease

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2
Q

What should you do for patients with ARDS, hypoxia and worsening mental status?

A

Intubation and mechanical ventilation

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3
Q

What cells are involved in inflammation in COPD?

A
  • CD8-positive T lymphocytes
  • Neutrophils
  • CD68-positive macrophages
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4
Q

Which cells are involved in the pathogenesis of all cases of asthma, but not in the inflammation related to COPD?

A

CD4-positive T lymphocytes

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5
Q

Are mast cells involved in the pathogenesis of COPD?

A

No

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6
Q

Which cells are involved in the pathogenesis of some cases of asthma, but not in the inflammation related to COPD?

A

Eosinophils

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7
Q

Which conditions cause decreased surface area of alveolar-capillary membranes?

A
  • Emphysema
  • Lung resection
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8
Q

What causes the hypoxemia in a lobar pneumonia?

A

Ventilation-perfusion mismatch

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9
Q

Silicosis predisposes to tuberculous infection because crystalline silica can inhibit the ability of macrophages to kill phagocytized mycobacteria due to disruption of phagolysosomes (impaired macrophage-phagolysosome function).

True or false?

A

True

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10
Q

Patient presents with progressive shortness of breath and fatigue. Oxygen saturation is on the lower side. Physical examination shows prominent jugular venous pulsations and a parasternal heave.

Diagnosis?

A

Pulmonary hypertension

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11
Q

How many categories of pulmonary hypertension are there?

A

5

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12
Q

What happens to endothelin in pulmonary hypertension?

A

Increases

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13
Q

What happens to nitric oxide in pulmonary hypertension?

A

Decreases

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14
Q

What group is pulmonary artery hypertension?

A

Group 1

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15
Q

What is the cause of pulmonary hypertension Group 2?

A

Left heart failure

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16
Q

What is the cause of pulmonary hypertension Group 3?

A

Intrinsic lung disease

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17
Q

What is the cause of pulmonary hypertension Group 4?

A

Chronic thromboembolic disease

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18
Q

What is the cause of pulmonary hypertension Group 5?

A

Multifactorial etiologies

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19
Q

What happens to prostacyclin in pulmonary hypertension?

A

Decreases

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20
Q

Does acetazolamide help high altitude pulmonary edema?

A

No

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21
Q

What is the mainstay of treatment of high-altitude pulmonary edema?

A

Oxygen
(Descent also important)

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22
Q

In normal pleural fluid what is the predominant cell type?

A

Macrophages

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23
Q

Is macrolide monotherapy indicated for outpatient community acquired pneumonia therapy in the United States?

A

No (> 25% macrolide resistance)

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24
Q

What is used to predict the likelihood of a pulmonary embolism?

A

Wells score

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25
Q

What are patients treated with Bleomycin at risk for?

A

Lung toxicity

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26
Q

What percentage of patients on Bleomycin develop fatal interstitial lung disease?

A

Up to 10%

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27
Q

Immunocompromised patient has bilateral ground glass opacities, cough, fever and elevated beta-D-glucan assay.

Diagnosis?

A

Pneumocystis pneumonia

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28
Q

Does cryptococcal pneumonia have ground glass opacities on imaging?

A

No

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29
Q

Does cryptococcal pneumonia have clustered nodular pattern and cavitation on imaging?

A

Yes

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30
Q

Does the alveolar-arterial O2 gradient change with hyperventilation?

A

No

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31
Q

Does the partial pressure of carbon dioxide (PaCO2) increase, decrease or stay the same with hyperventilation?

A

Decreases

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32
Q

Bronchoalveolar lavage is notable for a thick, milky, opaque fluid, in a patient with bilateral, diffuse ground glass opacities.

Diagnosis?

A

Silicosis

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33
Q

Does decreasing tidal volume improve oxygenation in ARDS?

A

No

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34
Q

Does increasing PEEP improve oxygenation in ARDS?

A

Yes

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35
Q

Does treating patients with glucocorticoids improve oxygenation in ARDS?

A

No

36
Q

Does treating patients with glucocorticoids reduce mortality in ARDS?

A

Yes

37
Q

How is Legionella diagnosed?

A

Urinary antigen

38
Q

Can a chest X-ray diagnose the specific type (organism) of pneumonia?

A

No

39
Q

What is the first line drug for pulmonary artery hypertension in patients with positive vasoreactivity?

A

Calcium channel blockers

40
Q

What is the first line drug for pulmonary artery hypertension in patients with negative vasoreactivity and severe symptoms?

A

Epoprostenol
(Prostacyclin or prostacyclin analogue)

41
Q

What happens to nitric oxide levels when patient is given a phosphodiesterase type 5 inhibitor?

A

Increase

42
Q

In mild Alzheimer’s dementia should you use galantamine or memantine?

A

Galantamine

43
Q

Is a solid or semi-solid pulmonary nodule more likely to be malignant?

A

Semi-solid (solid with ground glass opacity)

44
Q

Does small cell lung cancer usually occur in people who smoke or don’t smoke?

A

Smoke

45
Q

Lung mass with pathology showing undifferentiated small round blue cells.

Diagnosis?

A

Small cell lung carcinoma

46
Q

Lung mass with pathology showing sheets of epithelial cells with psammoma bodies.

Diagnosis?

A

Mesothelioma

47
Q

Lung mass with pathology showing anaplastic pleomorphic giant cells.

Diagnosis?

A

Large cell carcinoma

48
Q

Lung mass with pathology showing sheets of large pleomorphic cells containing keratin and intracellular bridges.

Diagnosis?

A

Squamous cell carcinoma

49
Q

Which treatment has evidence of greatest reduction in mortality in COPD?

A

Oxygen therapy

50
Q

Does lung transplantation reduce mortality significantly in COPD?

A

No

51
Q

Does lung transplantation improve quality of life in COPD patients?

A

Yes

52
Q

Do systemic corticosteroids decrease morbidity and mortality in patients with COPD?

A

No

53
Q

What is the gold standard for ruling out asthma?

A

Methacholine challenge test

54
Q

What is the first line treatment for allergic rhinitis?

A

Nasal steroids

55
Q

Young women with history of spontaneous pneumothorax and CT chest showing diffuse thin-walled cysts.

Diagnosis?

A

Pulmonary lymphangioleiomyomatosis

56
Q

What does TGF-beta (transforming growth factor beta) do?

A

Induces fibroblast proliferation

57
Q

What is the mechanism of action of pirfenidone?

A

Inhibits TGF-beta

58
Q

What is the mechanism of action of pirfenidone?

A

Inhibits TGF-beta (reduces fibroblast proliferation)

59
Q

What is the mechanism of action of bosentan?

A

Endothelin 1 receptor antagonist

60
Q

What is bosentan used to treat?

A

Pulmonary hypertension

61
Q

What is omalizumab used to treat?

A

Allergic asthma

62
Q

Is spirometry and bronchoprovocation typically normal at rest in exercise induced asthma?

A

No

63
Q

What is seen on pleural biopsy in mesothelioma?

A

Spindle cells

64
Q

Alpha-1 antitrypsin deficiency increases the activity of which enzyme?

A

Neutrophil elastase

65
Q

Is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD) due to decreased respiratory drive?

A

No

66
Q

What is the mechanism of oxygen-induced hypercapnia in chronic obstructive pulmonary disease (COPD)?

A

Increased ventilation/perfusion mismatch

67
Q

What is the most common organism causing community acquired pneumonia?

A

Streptococcus pneumoniae

68
Q

Patient with asthma has symptoms more than 2 days a week but not every day - what severity of asthma is this?

A

Mild persistent asthma

69
Q

What is the primary method of hypoxemia in ARDS?

A

Intrapulmonary shunt (V/Q mismatch)

70
Q

Which variable is monitored to indicate prognosis in case of septic shock?

A

Lactic acid

71
Q

What is the pleural LDH in SLE related ILD?

A

Elevated

72
Q

What percentage of SLE patients develop ILD?

A

3 - 7%

73
Q

What drug class is nintedanib?

A

Tyrosine kinase inhibitor

74
Q

Are nighttime headaches associated with obstructive sleep apnea?

A

No

75
Q

Can a lung abscess be seen on CXR?

A

Yes - lucent area surrounded by consolidation

76
Q

Which syndromic cause of infertility is associated with dextrocardia?

A

Primary ciliary dyskinesia (Kartagener syndrome)

77
Q

Is silicosis reversible?

A

No

78
Q

Can antitussives help in acute bronchitis?

A

Yes

79
Q

Streptococcus pneumoniae has a capsular polysaccharide that acts as a major virulence factor.

True or false?

A

True

80
Q

How is the diagnosis of sarcoidosis confirmed?

A

Biopsy

81
Q

What, when associated with life-threatening hypoxia is an indication for administering a neuromuscular blocking agent, in mechanically ventilated patients?

A

Severe ventilator desynchrony

82
Q

Which ventilatory injury can later lead to pulmonary fibrosis?

A

Diffuse alveolar damage from high inspired oxygen

83
Q

What is the treatment of organophosphate toxicity?

A

Atropine plus pralidoxime

84
Q

Absence of breath sounds on one side, with new hypoxemia and hypotension.

Diagnosis?

A

Tension pneumothorax

85
Q

Smoking cessation eight weeks before surgery reduces the risk of complications.

True or false?

A

True

86
Q

Which selective endothelin A receptor antagonist has been shown to limit the progression of idiopathic pulmonary hypertension?

A

Ambrisentan

ABIM IM Recert (42 decks)

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