OMED Pulmonology

Question 1

Mild intermittent asthma

Answer 1

Intermittent asthma

Symptoms < 2 days a week
Symptoms do not interfere with normal activities.
Nighttime symptoms < 2 days a month.

Lung function tests (spirometry and peak expiratory flow[PEF]) = normal when the person is not having an asthma attack

Question 2

Mild persistent

Answer 2

Symptoms > 2 days a week
Symptoms do not occur every day.
Attacks interfere with daily activities.

Nighttime symptoms - 3 to 4 times a month.
LFTs normal when the person is not having an asthma attack.

Question 3

Moderate persistent asthma

Answer 3

Symptoms= daily.
Inhaled short-acting asthma medication is used every day.

Symptoms interfere with daily activities.
Nighttime symptoms occur more than 1 time a week, but do not happen every day.

LFTs abnormal (more than 60% to less than 80% of the expected value), and PEF varies more than 30% from morning to afternoon.

Question 4

severe persistent asthma

Answer 4

Symptoms occur throughout each day.
Severely limit daily physical activities.
Nighttime symptoms occur often, sometimes every night.

Lung function tests are abnormal (60% or less of expected value), and PEF varies more than 30% from morning to afternoon.

Question 5

Chronic Asthma Treatment

Answer 5

I - SABA
II- SABA + ICS 
III - SABA + ICS + LABA 
IV - SABA + ↑ ICS + LABA 
Ref. oral prednisone

Question 6

Asthma Drugs

SABA
LABA
ICS
LTA
Steroids 
Stabilizers

Answer 6

SABA- albuterol
LABAs- formoterol, salmeterol
ICS- beclomethasone, budesonide, fluticasone, mometasone
LTA- monetlukast, mometasone
steroids- predinsone (oral)
stabilizers - nedocromil, leukotriene antagonists

Question 7

shortness of breath, wheezing, hyperresonant, prolonged expiration, exposure to trigger (cold air and allergens), CBC = eosinophilia
nasal polyps

Answer 7

Asthma

Path: reversible inflammation and bronchoconstriction

Dx:
pulmonary function tests (FEV1/FVC ↓, Reversible with bronchodilation, inducible with methacholine), skin tests = identify triggers

Tx - beta agonists, steroids, stabilizers

Question 8

Wheezing, dyspnea, prolonged exhalation,

CBC showing eosinophilia, nasal polyps

Answer 8

asthma exacerbations

path- exposure to triggers 
Dx- clinical, but 
-xray to rule out worse causes
-peak flow 
-NO PFTs 

Tx

• IV methylprednisolone
• albuterol+ipratroprium
• steroid taper

f/u

• racemic epinephrine
• magnesium
• “stops wheezing” or CO2 rising –> intubate

Question 9

wt loss, hemoptysis, dyspnea, pleural effusion in smoker or pt with exposure RFs

Answer 9

lung cancer

Question 10

lung cancer

dx with biopsy choices and why

Answer 10

dx:
CXR –> CT scan –> biopsy (best)

biopsy:
- percutaneous if peripheral
- endoscopic US if proximal
- VATs if in the middle
- lobectomy ok too

Question 11

lung cancer

tx
fu

Answer 11

tx

diagnose–> stage–> PFTs to discern if they can tolerate surgery or if they need chemo

f/u

annual low dose CT scan screen

• smoker within 15 yrs
• 55-80 yo
• > 30 pack year history

Question 12

central mass in the lungs, hyponatremia or cushing’s like presentation

Answer 12

Small Cell Lung Cancer

path- smoking
dx- broncho/EUS
tx- chemo

Question 13

central mass, hypercalcemia

Answer 13

Squamous Cell Lung Cancer

path: smoking
pt: central mass + paraneoplastic syndrome PTH-rp secreting tumor
Dx: broncho/EUS
tx: resection, chemo, rads

Question 14

peripheral mass, pleural plaques

Answer 14

adenocarcinoma

path: peripheral mass, pleural plaques.
dx: percutaneous biopsy
tx: chemo/rads