MKSAP: Pulmonary

Question 0

What position should a pt with suspected hemothorax be examined in? Why?

Answer 0

• upright

- supine position will obscure the findings

Question 1

Most common cause of hemothorax

Answer 1

-trauma –> blunt or penetrating (including iatrogenic)

Question 2

Tx for secondary pneumothorax?

Answer 2

-tube thoracostomy

Question 3

What is more serious, primary or secondary pneumothorax?

Answer 3

-secondary, becuase it is due to an underlying lung disease, so the lung function is already compromised!

Question 4

What 3 characteristics mean chest tube drainage should be used for a parapneumonic effusion?

Answer 4

1. Pus detected
2. Gram-positive pleural fluid
3. pH < 7.0

Question 5

Describe malignant pleural effusions?

Answer 5

1. Lymphocytic

2. Exudative

Question 6

What 3 things can a erythrocyte count in pleural fluid of >100,000 mean?

Answer 6

1. Trauma
2. Pulmonary infarction
3. Pleural malignancy

Question 7

Malignant pleural effusions: usually transudative or exudative?

Answer 7

-exudative

Question 8

What characteristic means that a malignant pleural effusion has poor prognosis?

Answer 8

• pleural fluid glucose of < 60mg/dL

- means less than 6 mnth survival!

Question 9

Dx of a cough-variant asthma?

Answer 9

-trail of albuterol inhaler that resolves sx

Question 10

Cough that occurs with sensitivity to cold is a clinical marker of? How can it be confirmed?

Answer 10

• clinical marker of airway hyperresponsiveness

- can be confirmed via methacholine challenge test

Question 11

Dx of exercise-induced asthma?

Answer 11

-confirmed with an exercise challenge test in which there is a post exercise > 20% fall in FeV1

Question 12

Exercise induced asthma tx?

Answer 12

• SABA 5-10 min before exercise

- works 80% of the time

Question 13

Methacholine test: describe

Answer 13

• give a pt suspected to have asthma increasing doses of methacholine until they have a fall in FEV1 of > 20%
• calculate the provocative concentration (PC20) using a dose response curve
• a PC20 of < 4 mg/mL = asthma
• PC20 of 4-16 = hyperreactivity
• PC20 > 16 = normal

Question 14

What contains isocyanates? What health consequence can they have?

Answer 14

• found in polyurethane paints

- can be potent sensitizers in some pts with asthma

Question 15

PCO2 in asthma attacks?

Answer 15

• decrease in mild acute asthma exacerbations
• normal in moderate to severe exacerbations
• elevated in very severe exacerbations –> ominous sign, can be a sign of respiratory distress!

Question 16

Tx for a previously well controlled asthmatic following a respiratory tract infection?

Answer 16

-short course of oral steroids

Question 17

Tx of acute severe asthma?

Answer 17

-bronchodilators after systemic corticosteroid tx

Question 18

What do you do next in a pt on low or moderate -dose inhaled corticosteroids that still has persistent asthma sx?

Answer 18

-add a LABA

Question 19

How many years does the pneumovax kast?

Answer 19

-about 5 yrs

Question 20

3 Benefits of pulmonary rehab?

Answer 20

1. Improves sx
2. Improves exercise endurance
3. Improves quality of life
   * * does NOT increase survival of pt though!

Question 21

Lofgren’s syndrome?

Answer 21

• triad of sx in the presentation of sarcoidosis:
  1. Bilateral hilar lymphadenopathy
  2. Polyarthraligias
  3. Erythema nodosum
• triad of presenting sx is seen in 25-50% of pts with sarcoidosis, esp in females

Question 22

Preferred test for dx of PE?

Answer 22

-contrast-enhanced spiral CT

Question 23

DVT/PE prophylaxis in a pt who is at risk but heparin is contraindicated?

Answer 23

-intermittent pneumatic compression

Question 24

Maintenance Tx for a pt with a malignancy and venous thromboembolism?

Answer 24

-low-molecular-weight heparin

Question 25

Tx for pt who is heterozygous for factor V Leiden mutation with recurrent thrombosis?

Answer 25

-long-term warfarin

Question 26

DLCO in emphysema?

Answer 26

-reduced due to loss of parenchyma –> less surface area for diffusion