Day 6 - Pulm2 Quiz

Question 1

Next step in w/u of solitary pulmonary nodule

Answer 1

Compare to prior CXR; If none, CT scan

Question 2

Dx chronic bronchitis

Answer 2

Chronic productive cough for 3+ mo per yr for 2+ yrs (almost always smokers)

Question 3

COPD indication for home O2

Answer 3

O2 sat

Question 4

Lung cancer: elevated ACTH resulting in Cushing syndrome

Answer 4

Small cell lung CA

Question 5

Lung cancer: PTHrP & hypercalcemia

Answer 5

Squamous cell lung ca

Question 6

Lung cancer: SIADH & hyponatremia

Answer 6

Small cell lung CA

Question 7

Lung cancer: Antibodies to presynaptic calcium channels & Lambert-Eaton

Answer 7

Small cell lung CA

Question 8

Tx small cell lung CA

Answer 8

Chemotherapy

Question 9

Initial tx for localized non-small cell lung CA

Answer 9

Surgical resection (may followed by adjuvant chemotherapy)

Question 10

Findings making solitary pulmonary nodule more likely to be malignant

Answer 10

Smoker, age>45, new or progressive lesions, no or irregular calcifications, > 2 cm, irregular margins

Question 11

Define & Tx asthma: Mild persistent

Answer 11

Episodes during day 3-6x per wk or more than 2x at night per mo; Tx: as needed albuterol plus inhaled low dose steroid (may or may not add montelukast or cromolyn)

Question 12

Classic radiographic findings of idiopathic pulmonary fibrosis

Answer 12

CXR: reticular/nodular or honeycomb pattern; Serum markers, Changes in PFTs

Question 13

Tx idiopathic pulmonary fibrosis

Answer 13

3-drug cocktail: steroids, azathioprine (or cyclophosphamide - beware of bladder damage/hematuria/cancer risk), & n-acetylcysteine

Question 14

Pneumoconiosis: progressive fibrosis

Answer 14

Coal worker’s, Silicosis

Question 15

Pneumoconiosis: increased risk of Tb

Answer 15

Silicosis

Question 16

Pneumoconiosis: Electronics, increased cancer risk

Answer 16

Berryliosis

Question 17

Pneumoconiosis: Malignant mesothelioma & Bronchogenic carcinoma

Answer 17

Asbestosis

Question 18

Pt chronically has FEV1 of 40%, Tx for daily mgt

Answer 18

Stage 3 COPD: Inhaled steroids, long term bronchodilator (beta2-agonist or anticholinergic like tiotropium), and as needed short-acting bronchodilator; Risk factor reduction & annual influenza vaccine

Question 19

Sinusitis, hemoptysis, hematuria - Dx & Tx

Answer 19

Wegener’s - Steroids & cyclophosphamide

Question 20

Anti-GBM antibodies - Dx & Tx

Answer 20

Goodpasture - Plasmapharesis; Steroids & immunosuppresants may also be helpful

Question 21

JVD, facial swelling, AMS - Dx & Tx

Answer 21

Superior vena cava syndrome - High dose steroids, endovascular stenting