Common Respiratory Symptoms, Pulmonary Imaging, & Procedures

Question 1

Platypnea is shortness of breath when upright and is commonly associated with hepatopulmonary syndrome.

Question 2

Hypertrophic osteoarthropathy is most commonly associated with primary bronchogenic carcinoma, involves the long bones of the upper and lower extremities, and resolves with curative surgery.

Question 3

Question 4

Pulmonary rehabilitation improves symptoms. The greatest effect is found when high-intensity endurance exercises are used in patients with COPD.

Question 5

Question 6

Tracheobronchial tree abnormalities that spare the posterior membrane are tracheobronchopathia osteochondroplastica and relapsing polychondritis

Question 7

Question 8

Carcinoid, adenocarcinoma in situ, and nodules < 10 mm can cause false- negative findings on PET scan.

Question 8

Question 8

Question 8

The cutoff of a standard uptake value of 2.5 is used to distinguish between benign and malignant lesions.

Question 9

For diseases that have a cystic pattern, which ones are predominant in the upper lobe, predominant in the lower lobe, and diffuse?

Answer 9

Upper lobe: Langerhans cell histiocytosis

Lower lobe:
Lymphocystic interstitial pneumonia and
Birt-Hogg-Dubé syndrome

Diffuse: Lymphangioleiomyomatosis

Question 10

A patient undergoes a difficult central line placement. Ultrasound is used to evaluate the lungs after the procedure. Lung sliding is absent, with an A- line-predominant pattern. What is the likely explanation for the ultrasound finding?

Answer 10

PTX

Question 11

Acceptable spirometry results are extrapolated volume < 5% or FVC of 0.15 L, plateau on volume– time curve, exhalation time > 6 seconds, and no artifacts.

Question 12

Repeatability criteria are met if the two largest values of FEV1 and FVC are within 0.15 L of each other.

Question 13

Conditions that increase pulmonary capillary blood volume –>
(polycythemia, left- to-right shunt, asthma, Müller’s maneuver, exercise, supine position, and obesity) increase DLCO.

Those that decrease pulmonary capillary blood volume –>
(anemia, pulmonary vascular disease, Valsalva maneuver) decrease DLCO.

Question 14

A patient is receiving a long-acting anticholinergic and a methacholine test is ordered for further evaluation. How long should the medication be withheld before testing?

Answer 14

Up to 7 days

Question 15

An isolated reduction in DLCO can suggest pulmonary vascular disease or early interstitial lung disease.

Question 16

In pregnancy, ERV, residual volume, and FRC are reduced, whereas total lung capacity is essentially unchanged.

Increases in minute ventilation occur almost exclusively as a result of increases in tidal volume caused by a direct progesterone-mediated increase in central respiratory drive and enhancement of hypercapnic ventilatory drive.

Tachypnea is an unusual finding and warrants investigation.

Question 17

Question 18

A 26-year-old woman is evaluated for dyspnea on exertion. PFTs show FEV1 84%, total lung capacity 96%, ERV 50%, FRC 76%, and DLCO 119%. These findings are most consistent with what diagnosis?

Answer 18

Obesity can cause a reduction in ERV and FRC and an increase in DLCO.

Question 19

Oscillatory breathing response during exercise can be seen in patients with congestive heart failure and is predictive of a poor outcome.

Question 20

A 70-year-old man who is undergoing cardiopulmonary exercise testing for further evaluation of dyspnea on exertion has a reduced O2 pulse and an oscillatory pattern of changes on ventilation. What is the most likely diagnosis?

Answer 20

Congestive heart failure

Question 21

The typical pattern of cardiovascular disease is reduced O2 pulse, variable HRR depending on severity, increase in VD/VT and VE/VCO2, and normal VR.

Question 22

The typical pattern of lung disease is reduced VR with significant HRR.

Question 23

There is no firm guideline for the timing of bronchoscopy after myocardial infarction. However, the British Thoracic Society recommends waiting 6 weeks after myocardial infarction, if possible.

Question 24

A 78-year-old man who is undergoing cardiopulmonary exercise testing for evaluation of dyspnea has increased ventilator equivalents, increased VE/MVV ratio, and significant oxygen desaturation. Baseline spirometry results show no obstructive ventilatory impairment. What is the most likely diagnosis?

Answer 24

Interstitial lung disease

Question 25

When performing TBBx, how long should Plavix be withheld?

Answer 25

Plavix should be withheld 5–7 days before TBBx. It is safe to perform TBBx in a patient taking aspirin.