MKSAP - Respiratory

Question 0

Hydropneumothorax pathogenesis?

Imaging findings?

Answer 0

Bleb rupture causes lung to collapse toward hilum.

Bleeding from rupture produces flat-line junction between the air and fluid at the base of hemithorax

Question 1

Signs that respiratory failure is due to neuromuscular problem?

Answer 1

1. Increased RV/TLC ratio (also seen in obstructive disorders)
2. Normal FEV1/FVC ratio
3. Low maximal respiratory pressures
4. Normal DLCO

Question 2

Tuberculosis effusion – typical duration of symptoms? Type of effusion? WBCs in effusion? Diagnose by?

Answer 2

Subacute duration of symptoms (weeks to months); exudative with lymphocytes; diagnose with pleural biopsy

Question 4

Nebulizer therapy for asthma reserved for which patients?

Answer 4

Patients who cannot use a metered dose inhaler appropriately

Question 5

Treatment of the patient with COPD exacerbation?

Answer 5

1. Oral or intravenous corticosteroids
2. Albuterol/ipratropium (Short acting bronchodilators)
3. Supplemental oxygen
4. Levofloxacin or macrolide + ceftriaxone

Question 6

Suitable candidates for noninvasive positive-pressure ventilation? Contraindications?

Answer 6

Respiration rate >25
PH under 7.35
PCO2 over 45

Contraindications: impending respiratory arrest, cardiovascular instability, altered mental status, I aspiration risk, extreme obesity

Question 7

Patient with COPD – goal oxygen saturation?

Answer 7

90%

Question 8

COPD – consider lung volume reduction surgery when? transplantation when?

Answer 8

1. Predominantly upper lobe disease with limited exercise performance after rehabilitation
2. FEV1 between 20% to 35%
3. DLCO greater than 20
4. PCO2 >50
5. Both FEV1 and DCLO <20

Question 9

Complications of untreated obstructive sleep apnea?

Answer 9

Pulmonary artery hypertension, a true fibrillation, heart failure, treatment resistant hypertension

Question 10

Findings and Cushing’s syndrome?

Answer 10

Hypertension, muscle weakness, bruises, diabetes, osteoporosis

Question 11

Findings in drug-induced long toxicity? Well known cause?

Answer 11

Fatigue, fever, cough, eosinophilia. Amiodarone

Question 12

Acute eosinophilic pneumonitis?

Answer 12

Rapidly progressive illness associated with

1. fever
2. sputum production
3. eosinophilia
4. peripherally distributed lung infiltrate

Question 13

Patient with suspected PE (Well’s score > 4) – test?

Answer 13

1. CT angiogram

2. In patient with elevated creatinine: ventilation/perfusion scan

Question 16

Patient with previously well-controlled asthma who experiences unstable asthma after respiratory infection – treatment?

If unstable asthma persists?

Answer 16

Short course of oral steroids

Long acting beta agonist

Question 17

Causes of low DLCO?

Answer 17

1. Barriers to diffusion (Edema, infiltrates, fibrosis)

2. Loss of lung tissue (emphysema)

Question 18

Exam Signs of pulmonary artery hypertension?

Answer 18

1. loud P2
2. Fixed split S2
3. Tricuspid regurgitation
4. JVD

Question 19

Physical exam findings in atrial septal defect?

Answer 19

1. Fixed split of S2

2. Right ventricular Heave

Question 20

Symptoms of vocal cord dysfunction? Test?

Answer 20

1. Wheezing, Strider
2. No response to asthma therapy. 3. Decreased lung volumes
3. normal unsaturation

Laryngoscopy

Question 21

Pulmonary function tests in PAH? Early diagnostic test?

Answer 21

isolated decreased DLCO with normal airflow and lung volumes

Echo to r/o heart problems

Question 22

When is chest tube drainage needed for pleural effusion?

Answer 22

1. Loculated
2. PH under 7.2
3. Glucose under 60
4. LDH over 1000

Question 23

Indications for video assisted thorascopic surgery?

Answer 23

Empyema not drained soon enough leading to loculations that need to be surgically removed

Question 24

Consider chylothorax if effusion studies show?

Answer 24

Triglycerides >110

Question 25

Signs of respiratory failure?

Answer 25

Pulse ox < 75
Respiration rate >30
heart rate > 120

Question 26

Adjust criteria for home oxygen patients with COPD with these comorbidities?

Answer 26

Cor pulmonale, pulmonary hypertension, right heart failure

Question 27

When to give a COPD patient inhaled corticosteroids?

Answer 27

Lung function <50%

Question 28

Rule out alpha-1 anti-trypsin deficiency when?

Answer 28

Patient <45 years old with bilateral basilar emphysema

Question 29

Factors which increased BNP? Factors which decrease BNP?

Answer 29

Renal failure, old age, female sex

Obesity

Question 30

Typical cryptogenic organizing pneumonia patient?

Answer 30

Non-smoker with acute to subacute development of respiratory symptoms and opacification on CXR

Question 31

DVT prophylaxis in hospitalized, medically ill patients?

In patients with renal impairment?

In HIT?

Answer 31

Heparin, LMWH, fondaparinux

Adjusted dose of LMWH,

Direct thrombin inhibitors