MKSAP Pulm V

Question 1

____ should be strongly considered when a patient with silicosis develops constitutional symptoms, worsening respiratory impairment, hemoptysis, or changes in the chest radiograph, particularly new cavities.

Answer 1

Tuberculosis

Chronic silicosis adversely affects macrophage function and is clearly associated with the development of infection with tuberculosis. Concomitant silicosis and tuberculosis is associated with a substantially increased risk of mortality. Therefore, a high index of suspicion for this complication of chronic silicosis is essential to ensure early and appropriate medical therapy.

Question 2

Flattening of both the inspiratory and expiratory curve of the flow-volume loop suggests a ____; direct examination of the airways is indicated to confirm the finding and identify the cause.

Answer 2

fixed intrathoracic lesion (upper airway obstruction)

Question 3

fairly normal initial portion of the expiratory flow loop, with increased concavity of the terminal portion, indicating airway narrowing during exhalation.

Answer 3

Obstructive pattern

Question 4

Evaluate recurrent unilateral exudative effusion for malignancy. For patients with negative cytology in whom malignancy is suspected, ____ allows for direct visualization of the pleural surface and has a diagnostic sensitivity for malignant disease of greater than 90%.

Answer 4

thoracoscopy with pleural biopsy (note cytology is only 60% sensitive for malignancy)

Question 5

Cute off of TG for chylothorax

Answer 5

TG > 110. Most commonly associated with thoracic surgical procedures but can also be seen in some cancers.

Question 6

An effusion is considered an exudate if any of the following criteria are met:

Answer 6

1. pleural fluid total protein/serum total protein greater than 0.5
2. pleural fluid lactate dehydrogenase (LDH)/serum LDH greater than 0.6
3. pleural fluid LDH greater than 2/3 the upper limit of normal for serum LDH.

Question 7

For patients with a malignant pleural effusion and rapid reaccumulation of fluid, ____ provide significant symptom relief, and 50% to 70% of patients achieve spontaneous pleurodesis after 2 to 6 weeks.

Answer 7

indwelling pleural catheters

Question 8

The features of hyperthermia, tremor, hyperreflexia, ocular clonus (slow, continuous, horizontal eye movements), other clonus (spontaneous or induced), and anxiety are classic features of this syndrome.

Answer 8

Serotonin syndrome

Hyperreflexia and clonus help distinguish serotonin syndrome from other hyperthermic syndromes and toxic ingestions. (Ecstasy can lead to increased 5HT so bad to take with SSRIs).

Treat with BDZs to keep pt calm and control BP/HR

Question 9

____ is the procedure of choice for diagnosing and staging mediastinal and hilar lymphadenopathy in patients with suspected thoracic malignancy.

Answer 9

Endobronchial ultrasound-guided transbronchial needle aspiration

Question 10

Patients should be observed for at least ___ after the last dose of naloxone.

Answer 10

60 minutes

Question 11

What is a pulmonary shunt?

Answer 11

When alveoli fill with fluid causing parts of lung to be unventilated though they are still perfused. VQ mismatch with shunting does not improve with supplemental O2

Question 12

What is dead space?

Answer 12

Area of lung that does not participate in gas exchange

Question 13

Obesity hypoventilation syndrome is characterized by _____ defined as an arterial pCO2 greater than ____.

Answer 13

hypercapnea, 45

Question 14

If previous data on bronchiectasis exacerbations are not available, a ____should be started to ensure Pseudomonas coverage until the sputum culture is completed.

Answer 14

Fluoroquinolone (levo or moxi)

Although duration of therapy is not well defined, most experts treat for 10 to 14 days.