Medicine- Pulmonary

Question 1

List 3 Radiologic factors that increase the risk for malignancy in incidental solitary solid pulmonary nodule

Answer 1

1. large nodule size (> 8 mm)
2. location in the upper lung fields
3. irregular, spiculated, or scalloped borders

Question 2

List 3 Clinical risk factors that increase the risk for malignancy in incidental solitary solid pulmonary nodule

Answer 2

1. > 40 years
2. history of smoking or asbestos exposure
3. positive family or personal history of malignancy

Question 3

Next step for low risk malignancy with a solid lesion <4mm

Answer 3

No follow up needed

Question 4

Features of microscopic polyangiitis

Answer 4

chronic cough and hemoptysis in addition to nonspecific symptoms such as fatigue, myalgia, and weight loss. Skin lesions such as palpable purpura are also a common feature as well as glomerulonephritis

Question 5

What is the next best step in management in a hemodynamically stable patient with CXR showing a diaphragmatic rupture?

Answer 5

A CT of the chest, abdomen, and pelvis is the most appropriate next step in the management. A CT would be able to directly visualize the discontinuity of the affected hemidiaphragm and confirm the diagnosis.

Question 6

What CXR finding is highly sensitive in children with TB

Answer 6

Hilar adenopathy

Question 7

Opacification on CXR

Answer 7

Opacification means that the x-rays are being blocked from passing through.. seen in pneumonia, cancer which are more focal and pulmonary edema (blood, fluid etc.)

Question 8

At what percentage is FiO2 usually weaned to and wha t happens if its too high for too long?

Answer 8

<60%.. prolonged FiO2 increases risk of oxygen toxicity (formation of pro inflammatory radicals)

Question 9

How is a definitive diagnosis of bronchieactesis made?

Answer 9

CT scan of the chest

Question 10

Criteria for initiating Long-term supplemental oxygen therapy in patients with COPD with significant chronic hypoxemia

Answer 10

1. Resting PaO2 <55 mm Hg or SaO2 <88% on room air
   OR
2. PaO2 <59 mm Hg or SaO2 <89% in patients with cor pulmonale, right HF or Hematocrit >55%

Question 11

In the lateral decubitus position what happens to the perfusion & ventilation of the lungs (especially in a patient with a consolidation)

Answer 11

The dependent lung is better perfused & ventilated due to the effect of gravity ( Putting this patient in the left lateral decubitus position will therefore increase the perfusion of the left, diseased lung, not of the right (healthy) lung.)

Question 12

What happens to the V/Q and A-a gradient in a patient with pneumonia in the left lung put in the left lateral decubitus position

Answer 12

In the left lateral decubitus position results in increased perfusion of the non-ventilated alveoli resulting in a V/Q mismatch, and an increase in the A-a gradient.

Question 13

The influenza vaccine (either live-attenuated or inactivated) is recommended for which months

Answer 13

October–May in the northern hemisphere
and
May–October in the southern hemisphere

Question 14

First line tx for asthma that comes <1 daily and <1 weekly every night

Answer 14

SABA + Inhaled steroids

Question 15

Treatment for acute asthma exacerbation

Answer 15

Nebulizer + steroids + O2

Question 16

Features of Obesity hypoventilation syndrome (OHS)

Answer 16

BMI >30 
Awake day time hypercapnia (PaCo2 >45)
Daytime hypersomnolence, dyspnea
polycythemia 
resp acidosis with concurrent metabolic alkalosis 
pulmonary HTN

Question 17

What kind of lung disease is seen in OHS

Answer 17

Restrictive Lung Disease

Question 18

Treatment for OHS

Answer 18

Nocturnal PPV (1st line)
weight loss
avoid sedatives
Respiratory stimulants as last resort

Question 19

Physiology of OHS

Answer 19

Obesity reduces chest wall compliance –> decreased TV and TLC and increased airway resistance

Question 20

EKG readings seen in patient with a PE

Answer 20

Irregular PR intervals, absent P waves and narrow QRS complex
Also see S1Q3T3

Question 21

1t line therapy for allergic rhinitis in children

Answer 21

Intranasal cromolyn

Question 22

Next best step in relieving dyspnea in a patient acute pulmonary oedema

Answer 22

Position patient into sitting position (helps pool blood into different areas of body)

Question 23

How do you differentiate Pulmonary edema from ARDs in patients with sever SOB

Answer 23

Pulmonary edema will have a capillary wedge pressure >18 mmHg