Others

Question 1

The most common second solid malignancy in a pt with previously treated and cured Hodgkin lymphoma is

Answer 1

Lung ca

Question 2

A pt with significant smoking hx, hypercalcemia and hilar mass, suspect——?

Answer 2

Squamous cell ca of the lung

Question 3

Clinical presentation and risk factor for amniotic fluid embolism

Answer 3

Inflammatory response leading to vasospasm, cardiogenic shock, hypoxemic respiratory failure, seizure secondary to hypoxia, DIC
Risk factors include advanced maternal age and multigravidity

Question 4

What is the route of administration of epinephrine in anaphylaxis?

Answer 4

IM! IV is only when there is no response for initial IM epinephrine. This is because of ADR, arrhythmia

Question 5

Chronic low back pain in an otherwise healthy young man, esp at night, improving with activity, increased ESR is suggestive of———?
PFT pattern would be? Why?

Answer 5

Ankylosing spondylitis
Mildly restrictive pattern
Fixation of the rib cage in the inspiratory position( limitation in lung expansion due to diminished chest wall n spinal mobility.

Question 6

Most common cancer associated with asbestos exposure is ———? Risk is increased to 59fold if the pt is also a ————?

Answer 6

Bronchogenic carcinoma

Risk increased in smokers

Question 7

ATELECTASIS
  Typical ABG
  At which post op day?
  Imaging would demonstrate? 
  Treatment
The most effective way of preventing postop atelectasis is

Answer 7

-Hypoxemia, hypocapnia, resp alkalosis (hyperventilation)
-second to fifth pod
-loss of lung volume due to collapsed lung
-adequate pain control, deep breathing exercise, directed coughing, incentive spirometry, early mobilization
The most effective preventive… is incentive spirometry

Question 8

CXR findings in diaphragmatic rupture

Definitive diagnostic modality

Answer 8

NG tube in the pulmonary cavity; bowel loops in the chest

CT scan of the chest and abdomen is more sensitive

Question 9

Upper airway cough syndrome is diagnosed n treated with———

Answer 9

1st generation antihistamines

Question 10

Recurrent pneumonia in the same anatomical location raises the suspicion for———?

Answer 10

Localized airway obstruction.
Do different investigations to look for internal or external bronchial obstructions depending on associated sxs patients present with or exposure to risk factors. eg chest CT for a 50yr old pt with smoking hx n evidence of localized airway obstruction

Question 11

In a pt with advanced COPD, oxygen should b used cautiously with a goal of PaO2 n SaO2 of——? Why?

Answer 11

PaO2- 60-70 mm Hg
SaO2- 90-93%
This is because supplemental O2, although it improves the hypoxia, it can cause CO2 retention. Loss of compensatory vasoconstriction in areas of ineffective gas exchange worsens v/q mismatch, decreased respiratory derive n slowing of the RR reduces minute ventilation

Question 12

In a child with respiratory distress from epiglottitis what should b the 1st step in the mx?

Answer 12

Intubation in a controlled setting

Question 13

Primary mediastinal germ cell tumors, how can u tell whether they r seminomatous or non seminomatous based on biochemical studies?

Answer 13

HCG is typically elevated in both but non seminomatous typically also produce alpha feto protein (AFP)

Question 14

Common mediastinal tumors,, anterior, middle, posterior

Answer 14

Anterior- 5Ts
Middle- bronchogenic cyst, tracheal tumor, …
Posterior- neurogenic tumors
Lymphomas can b found in all the regions

Question 15

In burn pts with inhalational injury, early intubation is important. Clinical indicators include…

Answer 15

Burns on face, oropharyngeal carbon deposits, strider, carboxy hemoglobin level>10%

Question 16

The best treatment of hypersensitivity pneumonitis eg. Bird fancier’s lung is

Answer 16

Avoidance of antigen exposure

Question 17

A pt presented with digital clubbing, sudden-onset arthropathy affecting wrist n hand joints and has smoking hx what should b the initial study to identify the underlying cause? What is it?

Answer 17

CXR
Hypertrophic pulmonary osteoarthropathy(HPOA) the underlying pulmonary disease could b lung ca, TB, bronchiectasis, empyema

Question 18

A pt with flat neck veins, decreased mentation, abdominal distention and bruises after sustaining RTA,, he develops asystole as soon as mechanical ventilation is started. Y?

Answer 18

Positive pressure mechanical ventilation causes an acute increase in intrathoracic pressure. In the setting of hypovolemic shock, this can cause acute loss of RV preload, loss of CO n sudden death

Question 19

OHS- obesity hypoventilation syndrome is characterized by (ABG)?

Answer 19

Day time hypercapnia >45mm Hg leading to chronic resp acidosis compensated by met alkalosis most have coexisting OSA(but here hypoventilation is only at night with transient hypoxia n hypercapnia that resolve while awake)

Question 20

A post op pt presenting with syncope, hypotension and or rt heart strain( raised jvp, rt BBB on ECG) most likely has?

Answer 20

Massive pulmonary embolism(not just segmental but massive!)

Question 21

PE Rx in a pt with severe renal insufficiency is?

Answer 21

Unfractionated heparin. Because decreased renal clearance increases anti- xa activity levels and bleeding risk, LMWH(enoxaparin), fondaparinux, rivaroxaban cant b used