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PANCE/PANRE Book > Pulm > Flashcards

Pulm Flashcards

1
Q

What is increased in patients with emphysema-dominant chronic obstructive pulmonary disease?

A

Residual volume

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2
Q

Which tuberculosis drug is associated with hepatitis and peripheral neuropathy? This drug may also interact with tyramine-containing foods

A

Isoniazid

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3
Q

A 44 year old male is involved in a motor vehicle accident. On physical exam, he has distended jugular veins with decreased pulses only on inspiration. There are decreased breath sounds on the entire right side. The heart sounds are not muffled. What do you do?

A

Insert a large bore needle into the second intercostal pleural space followed by chest tube thoracostomy

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4
Q

Distended juglar veins and decreased breath sounds indicate a….

A

Tension pneumothorax

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5
Q

Which type of pneumothorax is defined as a pneumothorax in which the increasingly positive pressure displaces or kinks the great vessels, leading to a marked decrease in cardiac output and forward flow. The blood that can’t go forward backs up into the jugular veins and causes JVD

A

Tension pneumothorax

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6
Q

Emergent management is needle decompression to restore cardiac output followed by chest tube placement

A

Tension pneumothorax

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7
Q

What is typical for a physical exam finding consistent with a right middle lobe pneumonia?

A

Dullness to percussion, Bronchial breath sounds, Egophony on the R side

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8
Q

Bronchial breath sounds and ego phony are associated with..

A

Lobar pneumonia

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9
Q

Hyperresonance to percussion with trachea deviation to opposite side

A

Tension pneumothorax

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10
Q

Resonance to percussion, vesicular breath sounds, normal fremitus

A

Normal exam!

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11
Q

Dullness to percussion, decreased breath sounds, decreased fremitus

A

Pleural effusions

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12
Q

Hyperresonance on percussion, decreased breath sounds, decreased fremitus

A

Pneumothorax or hyperinflation (i.e. severe emphysema)

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13
Q

Any disease that decreases the alveolar total surface area will decrease..

A

diffusing lung capacity for carbon monoxide (DLCO)

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14
Q

Protein in the lungs that prevents macrophage enzymes (such as elastase) from destroying the elastic tissue of the lung

A

Alpha-1 antitrypsin

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15
Q

Smoking can cause a relative ______ deficiency?

A

Alpha-1 antitrypsin

leading to decreased elasticity

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16
Q

55 year old male presents with a persistent cough. A CT scan of the chest shows lack of tapering of the bronchi and bronchial wall thickening. Pulmonary function tests show a decreased FEV1 and a decreased FEV1/FVC ratio of 65%. What is the dx?

A

Bronchiectasis

Hallmark=lack of tapering of bronchi and bronchial wall thickening**

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17
Q

Enlargement of the larger airways

Hallmark is lack of tapering of the enlarged bronchi and bronchial wall thickening*

A

Bronchiectasis

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18
Q

What kind of general disorder is associated with a FEV1/FVC ratio of

A

Obstructive disorder

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19
Q

Which of the following is considered a positive PPD test?
A. HIV pos female with a PPD of 4 mm induration and 8 mm erythema
B. A Physician Assistant with a PPD of 11mm induration and 5mm erythema
C. 40 yo male w no risk factors with PPD of 11mm induration and 5 mm erythema
D. 45 yo male w history of a granuloma on chest radiograph w a PPD of 4 mm induration and 10mm erythema
E. 32 yo prison inmate w PPD of 8mm induration and 10mm erythema

A

B, a Physician Assistant w a PPD of 11 mm induration and 5 mm erythema.

In evaluation of a PPD, the erythema is NOT part of the measurement, only the transverse induration. Because the pt is a health care worker and is at risk of occupational TB exposure, >10mm induration is considered a positive finding

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20
Q

An HIV pos pt needs what measurement to be considered pos for a PPD test

A

> or equal to 5mm

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21
Q

A pt with hx of granuloma on chest X ray needs ____ mm on PPD test for it to be positive

A

5mm or greater

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22
Q

A pt with no risk factors needs what size PPD to be positive?

A

15 mm or higher

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23
Q

A prison inmate needs what size PPD to be positive?

A

10 mm or higher

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24
Q

A 40 yo female presents w bilateral anterior shin redness that is tender to palpation. She is also complaining of eye pain and redness as well as the insidious onset of a nonproductive cough. A chest radiograph is performed, showing bilateral hilar lymphadenopathy. You notice a rash on her face consistent with lupus perinea. What is her dx and what is the pathophysiology going on?

A

Dx= Sarcoidosis

Pathophysiology= idiopathic, exaggerated T cell response with the formation of noncaseating granulomas

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25
Q

Why are corticosteroids used in the tx of Sarcoidosis

A

They blunt the immune response and decrease the granuloma formation

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26
Q

If a pt has erythema nodosum (bilateral anterior shin redness that is tender to palpation), ALWAYS consider…

A

Sarcoidosis

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27
Q

Uveitis (eye pain and redness) and pulmonary involvement (non productive cough w a chest radiograph showing BILATERAL HILAR LYMPHADENOPATHY), think….

A

Sarcoidosis

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28
Q

The production of caseating granulomas w central caseous necrosis in tissues is seen in..

A

TB

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29
Q

Inflammation reaction to an organic antigen describes the pathophysiology of

A

Hypersensitivity pneumonitis

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30
Q

What is the most common cause of a transudative pleural effusion?

A

Congestive Heart Failure (CHF)

accounts for 90%

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31
Q

A _______ effusion is caused by fluid shift out of capillaries either due to 1) increased hydrostatic pressure or 2)decreased oncotic pressure (albumin makes up the majority of oncotic pressure)

A

Transudative

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32
Q

If you don’t make any albumin in cirrhosis or you lose albumin in the urine in nephrotic syndrome, what can happen?

A

Transudative effusion

bc Albumin needed for oncotic pressure

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33
Q

A 36 yo woman w no past medical hx presents to the ER with sudden onset of L sided chest pain and SOB. She denies any trauma but states that she recently drove 24 hours from Florida to NY in her car. She is on an oral contraceptive pill and she smokes half a pack of cigarettes a day. Her vitals: Temp 98.6, HR:128 and regular, BP 130/88, RR:26, O2 sat 92% on room air. Physical exam is unremarkable. What is the next step?

A. Pulmonary angiography
B. Venous doppler of the lower extremities 
C. VQ scan
D. Spiral CT scan of chest w contrast
E. D-Dimer
A

D, Spiral CT scan of chest w contrast

Classic PE presentation.
A Spiral CT scan of the chest w IV contrast is considered the BEST initial screening test for a PE in a pt w moderate to high clinical suspicion

(if this Q asked for the Gold Standard, it would be Pulmonary Angiography, bc it is noninvasive!

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34
Q

What is the best initial test for PE in a patient with moderate to high clinical suspicion? (i.e. young female smoker on OCP and recent hx of long travel)

A

Spiral CT scan of chest w contrast

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35
Q

What is the GOLD STANDARD for diagnosing a PE? (due to its lack of invasiveness)

A

Pulmonary Angiography

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36
Q

What diagnostic to use if suspecting a DVT?

A

Venous doppler

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37
Q

A D-Dimer should only be used for possible PE in..

A

low risk patients

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38
Q

Can you do a VQ scan to look for a PE if the pt has an allergy or contraindication to dye?

A

YES!

cannot use spiral CT scan w contrast tho!

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39
Q

A 33 yo male has been complaining of progressive SOB w exertion. Physical exam reveals pursed lip breathing, increased AP diameter, decreased remits, hyper resonance to percussion and decreased breath sounds. Chest radiographs show darkened lung fields with flattened diaphragms. Upon questioning the pt, he says he has never smoked nor lived w smokers. Which test would likely show the etiology of his symptoms?

A

Alpha-1 antrypsin levels

always suspect AAT deficiency in a young pt w emphysema who is not a smoker

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40
Q

Angiotensin converting enzyme (ACE) is elevated in..

A

Sarcoidosis

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41
Q

Sweat chloride test is seen with..

A

Cystic Fibrosis

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42
Q

A 32 yo physician who recently moved to the US from China presents t clinic for yearly TB screening. A PPD reveals 10 mm induration and 5mm erythema. Nothing abnormal seen on CXR. What is the treatment of choice?

A

isoniazid + pyridozine (B6) total duration of tx for 9 months

*must first realize his PPD test was pos, but the lack of results on CXR means he has LTBI (not active)

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43
Q

DOC for latent TB infection

A

Isoniazid (INH) + B6 (to prevent peripheral neuropathy from INH)

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44
Q

Isonizaid + rifampin + ethambutol + pyrazinamide

A

Tx for ACTIVE TB if treating for 9 month duration

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45
Q

Isoniazid + rifampin+ ethambutol+ streptomycin

A

Tx for ACTIVE TB if treating for 6 month duration

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46
Q

Ceftriaxone + azithromycin is DOC for..

A

Inpatient Community Acquired Pneumonia

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47
Q

A 66 yo old male w chronic bronchitis has symptoms consistent w cor pulmonale. Which medication has been shown to reduce overall mortality?

A

OXYGEN!

Oxygen has been shown to decrease mortality by reducing the hypoxemia-mediated vasoconstriction, decreasing the workload of the right side of the heart

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48
Q

In chronic bronchitis, chronic hypoxemia leads to hypoxemia-mediated vasoconstriction, leading to pulmonary hypertension and increased after load on which side of the heart?

A

Right side

49
Q

The right side of the heart has to work against pulmonary hypertension, causing right ventricular hypertrophy and eventually…

A

Right sided heart failure

50
Q

A 45 yo male is being evaluated for a chronic cough. A chest radiograph is obtained, which shows honeycombing consistent with idiopathic pulmonary fibrosis. Which pulmonary function test is consistent with restrictive pulmonary disease?
A. Increased total lung capacity
B. Increased residual volume
C. Increased FEV1/FVC ratio
D. Increased lung compliance
E. Increased functional residual capacity

A

C, increased FEV1/FVC ratio

In restrictive disorders, both the FEV1 and FVC are decreased..but the decrease in FVC is more than that of FEV1…resulting an a higher than 80% FEV1/FVC ratio

51
Q

Idiopathic pulmonary disorder is a type of _______ disorder?

A

Restrictive

The scarring, fibrosis, restricts the movement of the lung

52
Q

An FEV1/FVC ratio greater than 80% seen in….

A

Restrictive disorders

Both FEV1 and FVC decrease, but FVC decreases more

53
Q

What happens to lung volume (capacity) in restrictive disorders?

A

They decrease

54
Q

A 54 yo pt presents w hemoptysis and cough. He complains of intermittent episodes of wheezing, diarrhea, flushing and tachycardia. A bronchoscopy reveals a purple, well vascularized, central lesion. What is the dx?

A

Bronchial carcinoid tumor

55
Q

Neuroendocrine tumors that can intermittently secrete serotonin (causing diarrhea) and histamine (causing bronchoconstriction, flushing, and hemodynamic instability)

A

Carcinoid tumors

56
Q

On bronchoscopy, CLASSIC** finding is a pink/purple well vascularized lesion

A

Bronchial carcinoid tumor

57
Q

A 45 yo male presents with acute onset of right sided chest pain and SOB 7 days post ACL repair. His vital signs: Temp: 98.6, HR: 140 regular, BP: 130/82, RR: 29, O2 sat: 92% room air. Which of the following is the most common chest radiograph finding based on the most likely diagnosis?
A. Pleural effusion
B. Normal chest radiograph
C. Wedge-shaped infarct in lung
D. Tram track markings
E. Dilation of the pulmonary artery and collapse of the distal vessels w a sharp cutoff

A

B, normal chest radiograph.

This pt presenting classically w a PE. MOST COMMON radiograph in a PE is normal.

A Wedge-Shaped infarct (C) is classically seen in PEs, but it is not the most common finding. The most common finding is a normal CXR. The question asked for the MOST COMMON

In fact, A, C, and E all can be seen w PE patients, but they are not the most common

58
Q

What is the most common arterial blood gas finding in early pulmonary embolism (due to hyperventilation, bc tachypnea is a common sign of PE!)

A

Respiratory alkalosis (a higher than normal pH level)

59
Q

Tram track markings on a chest X ray indicate..

A

Bronchiectasis

60
Q

33 yo male presents to ER with intermittent right sided pleuritic chest pain. The chest pain is not positional. There is dullness to percussion, decreased breath sounds and decreased fremitus all on the right side. ECG shows no ST elevations or T wave changes. What is the appropriate management?

A

Thoracentesis

this pt has a pleural effusion

61
Q

A pneumothorax that is greater than 20% requires..

A

insertion of a chest tube

62
Q

52 yo male presents w fever and productive cough w brownish colored sputum. Chest radiograph shows a left lower lobe infiltrate with a left sided pleural effusion. A thoracentesis is done and fluid examination reveals a pH of 6.8, glucose: 32 mg/dL, effusion to serum lactate ratio: 1.2, effusion to serum protein ratio: 0.8. What is the next step in management?

A

Administration of IV antibiotics and drainage of pleural effusion

*this is an exudate pleural effusion based on Light’s criteria

63
Q

The management of empyema is..

A

antibiotics and pleural fluid drainage

64
Q

What severity of asthma is defined as daily symptoms, daily use of short term beta 2 agonists and nighttime awakenings greater than once a week
(also associated w Forced expiratory volume of 60-80% predicted)

A

Moderate persistent asthma

65
Q

What severity of asthma is defined as symptoms >2 days of the week, use of short tern beta 2 agonists >2 days a week (not daily), and nighttime awakening 3-4 times a month
(also associated w FEV greater or equal to 80% predicted)

A

Mild persistent asthma

66
Q

What severity of asthma is defined as symptoms throughout the day, use of short term beta 2 agonists several times a day and nightly awakenings.
(also associated w FEV less than 60% predicted)

A

Severe persistent asthma

67
Q

What severity of asthma is defined as symptoms less than or equal to twice daily and less than or equal to twice weekly with a normal FEV1

A

Intermittent asthma

68
Q

In which of the following patients is the pneumococcal vaccine not indicated?
A. a 7 yo with sickle cell
B. a 70 yo who lives in nursing home
C. a 50 yo w chronic renal failure
D. a 40 yo w hx of hypertension
E. a 45 yo male w hx of diabetes mellitus

A

D, a 40 yo with history of hypertension

the pneumococcal vaccine is recommended for patients over 65. It is also recommended for patients between 2-64 with chronic diseases or who are immnocompromised

69
Q

Which vaccine is recommended for 65+. It is also recommended for ages 2-64 if they have chronic diseases, such as congenital cardiac, pulmonary dz, alcoholism, diabetes, asplenia and immunocompromised patients.

A

Pneumococcal vaccine

70
Q

Which test is the gold standard (definitive diagnostic test) in a pt suspected of having a PE?

A

Pulmonary angiography

(it is invasive so it is not usually the first test done, but it is the most definitive and therefor is the gold standard!)

71
Q 
In comparison to emphysema, which of the following is most consistent with chronic bronchitis?
A. hyperresonance to percussion
B. decreased breath sounds
C. increased AP diameter
D. pursed lip breathing
E. rales, rhonchi, and wheezing
A

E, rales rhonchi and wheezing.

*the hallmark of chronic bronchitis is cough. Rales, rhonchi and wheezing are classic signs of chronic bronchitis. All the other choices are associated w emphysema

72
Q

What type of respirations are characterized by irregular respirations characterized by quick, shallow breaths of EQUAL depth and irregular periods of apnea
*can be seen in opiod induced respiratory depression**

A

Biot’s breathing

seen in opiod overdose

73
Q

What type of respiration is characterized by periods of deep breathing alternating with periods of apnea. Commonly seen during sleep as well as in patients w heart failure, respiratory depression, uremia and brain damage

A

Cheyne-Stokes

74
Q

Deep rapid continuous respirations, often as a result of metabolic acidosis

A

Kussmal’s respirations

75
Q

A 3 yo girl presents to the pediatric ER with drooling, dysphagia, muffled voice and difficulty swallowing her secretions. She is sitting in a tripod position. A lateral film shows a thumb print sign. Which of the following is the best next step in management of this patient?
A. visualize a cherry red epiglottis by using a tongue depressor
B. initiate IV ceftriaxone and clindamycin
C. protect the airway
D. initiate supportive therapy and keep child comfortable
E. initiate botulism antitoxin and penicillin G

A

C, protect the airway

Classic presentation of acute epiglottis. In children, airway compromise can occur if the child is agitated or spontaneously, so protection of the airway is ABSOLUTELY NECESSARY!

76
Q

What kind of allergy would be a contraindication to the influenza vaccine?

A

Egg allergy

77
Q

A 56 yo male w a recent diagnosis of small cell lung carcinoma develops weakness that improves with repeated use of the muscle throughout the day. What is the pathophysiology of the symptoms?

A

Antibodies against the presynaptic calcium gated acetylcholine releasing channels

(one of the paraneoplastic syndromes that may be seen with small cell carcinoma is Eaton-Lambert syndrome)

78
Q

A paraneoplastic syndrome that may be seen with small cell carcinoma
Caused by malignancy induced development of antibodies against the presynaptic calcium gated channels that release Ach

A

Eaton-Lambert syndrome

79
Q 
Which of the following is considered the best management for acute exacerbations of COPD?
A. ipratropium bromide
B. albuterol
C. theophylline
D. methylprednisone 
E. ipratropium bromide and albuterol
A

E, ipratropium bromide and albuterol

Unlike asthma, anticholinergics are preferred over short term beta-2 agonists, but studies have shown that the combo of the 2 show a greater response that using either alone!

80
Q

A 44 yo male who attended a hunter’s convention a week ago in July presented to the ER with a 4 day history of fever, productive cough, nausea, diarrhea and progressive dyspnea. Lab tests revel an increase in liver function tests and hyponatremia. A chest radiograph shows atypical infiltrates. He is told that numerous attendees who were sitting near the AC also developed similar symptoms. What is likely the diagnosis?

A

Legionella pneumophila

Legionella is not transferred person to person, it is MOST commonly transmitted from contaminated water sources such as air conditioners or cooling towers.

81
Q

A 40 yo male presents with rapid onset of fever, chills, productive cough and chest tightness occurring 4-8 hours after working a new job. On physical examination, there is presence of inspiratory crackles. A lung biopsy shows micro nodular interstitial involvement with poorly formed noncaseating granulomas. What is likely the patients occupation?

A

Bird breeder

Hypersensitivity pneumonitis is an inflammatory reaction to organic antigen (i.e. birds). Acute pneumonitis is classically associated w rapid onset of fever, chills, and productive cough with chest tightness occurring 4-8 hours after exposure

82
Q

This is an inflammatory reaction to organic antigens (i.e. birds)

A

Hypersensitivity pneumonitis

83
Q

______ _______ is classically associated with rapid onset of fever, chills and productive cough with chest tightness occurring 4-8 hours after exposure

A

Acute pneumonitis

84
Q

Ship building is associated with..

A

asbestosis

85
Q

Sandblasting is associated with

A

Silicosis

86
Q

A 23 yo thin male with a 5 PPY smoking history presents to the ER with sudden onset of sharp chest pain worsened w inspiration and SOB. CXR shows a pneumothorax occupying 35% of the lung field and an otherwise unremarkable Xray. What is the most appropriate next step?

A

Chest tube thoracostomy

the presence of a pneumothorax greater than 25-30% is treated w insertion of a chest tube

87
Q

________ inhibits mast cell mediated degranulation in patients with exercise or cold air induced asthma

A

Nedocromil

88
Q

A 5yo boy is brought to pediatric clinic with a five day hx of nonproductive cough, runny nose and sneezing. This has progressed to severe coughing fits that can occur spontaneously or when he yawns sometimes accompanied by posttussive vomiting. On physical exam, you notice that when the child coughs, there is a whooping sound on inspiration. What is the etiologic agent?

A

Bordetella pertussis

89
Q

A 54 yo male is admitted for a knee replacement. 2 days after surgery, he suddenly develops tachycardia, tachypnea, pleuritic chest pain and SOB. A D-dimer is obtained and is elevated. Which of the following radiographic findings are classic for this disorder?
A. Hampton’s hump
B. hyperinflation of the lung
C. Kerley B lines
D. companion lines
E. reticular-nodular honeycombing pattern

A

A, Hampton’s hump

This is a classic PE case. Hampton’s hump (wedge shaped infiltrate) and Westermark’s sign (decreased vascular markings after the embolism) are both classic for PE (but NOT common)

90
Q

A wedge shaped infiltrated seen on PE CXR

A

Hampton’s hump

not common

91
Q

Decreased vascular markings after the embolism on a PE CXR

A

Westermark’s sign

not common

92
Q

What is considered the first line long term management for mild, persistent asthma?

A

Inhaled fluticasone

93
Q

The hallmark of ______ is unresponsiveness to oxygen therapy and a low PaO2/FiO2 ratio

A

ARDS

94
Q

A 45 yo patient with a recent bout of sepsis is thought to have developed ARDS. What is consistent with ARDS?

A

PaO2/FiO2 less than 200 mmHg

95
Q

A 53 yo male w history of chronic bronchitis states he has had an increase in the production of mucus. He also complains of a low grade fever and sharp chest pain that worsens with inspiration. A CXR is obtained and shows an infiltrate. What is likely the etiology of his symptoms?

A

Haemophilus influenzae

H.Influenzae is the second most common cause of CAP (after Strep pneumoniae). Pts with underlying dz such as COPD, bronchiectasis, CF, diabetics, children and elderly at an increased risk of H.influenzae pneumonia.

96
Q

Second most common cause of CAP (behind strep pneumoniae)

A

H. influenzae

97
Q

Patients with underlying disease such as COPD, bronchiectasis, CF, diabetics, children and elderly are an increased risk of what kind of pneumonia?

A

H. influenzae

98
Q

A 57 yo male with no significant past medical or smoking history was found to have an incidental peripheral mass on chest radiograph. Biopsy of the lesion shows a malignancy. Based on the patient’s history, what is likely the diagnosis?

A

Adenocarcinoma

Adenocarcinoma is the most common lung tumor in smokers, non smokers, and women. It causes 35% of cancers

99
Q

What is the most common lung tumor in smokers, non smokers, and women? It causes 35% of cancers

A

Adenocarcinoma

100
Q

Squamous cell carcinoma and small cell carcinoma are associated with…

A

Smoking

101
Q 
Which of the following is the most common physical exam finding in a patient with suspected acute PE?
A. respiratory rate >20/min
B. accentuated second heart sound
C. pulse rate >100
D. sweating
E. cyanosis
A

A, respiratory rate >20/min

**Tachypnea is the most common sign seen in PE

102
Q

What is the most common sign seen in a individual having a PE?

A

Tachypnea

103
Q 
A 37 yo male construction worker presents with a nonproductive cough. Recently, he bought a house. He states he has been digging in the soil and recently cleaned out the attic and removed an old bat's nest. CXR shows atypical infiltrates. Which of the following is most likely the diagnosis?
A. Pneumocystis jirovecii pneumonia
B. Haemophilus influenza pneumonia
C. Histoplasma capsulatum pneumonia
D. Influenza virus pneumonia
E. Severe acute respiratory syndrome
A

C, Histoplasma capsulatum pneumonia

Histoplasma capsulatum is associated with soil containing bat and bird droppings, especially in the Mississippi and Ohio river valley areas

104
Q

Histoplasma capsulatum is associated with…

A

Soil containing bat and bird droppings, especially in the Mississippi and Ohio river valley areas

105
Q

A 65 yo male is being treated for a recent diagnosis of small cell carcinoma. A few weeks into the treatment, he develops sharp chest pain worse w inspiration, SOB, hemoptysis, fever, and chills. A chest radiograph shows an upper lobe consolidation. He is placed on isolation and the first acid-fast bacilli smear is positive. Which of the following is the treatment of choice?
A. isoniazid + vitamin B6 for 12 months
B. place a PPD and look for positivity
C. isoniazid + vitamin B6 for 9 months
D. isoniazid, rifampin, pyrazinamide and ethambutol for 6 months
E. CT scan without IV contrast

A

D, isonizaid, rifampin, pyrazinamide and ethambutol for total duration of 6 months

The pt has pulmonary symptoms, a postive AFB smear, and an upper lobe consolidation all consistent with active TB. The management of choice is initiation of 4 drugs “RIPE” or “RIPS”..the total treatment duration for active TB is 6 months

106
Q

A 10 yo patient is being evaluated for a well visit. He is below the weight percentile for his age. He has been complaining of bulky, fatty, foul-smelling stools as well as intermittent constipation. The pt also has had a lifetime hx of recurrent pulmonary infections What would be elevated in this pt?

A

Sweat chloride test

he has CF

107
Q

an ECG showing negative QRS complex in Lead I, positive QRS complex in lead aVF seen in…

A

Chronic bronchitis

(because of severe hypoxemia, which leads to hypoxemic vasoconstriction of the pulmonary circulation, leading to pulmonary hypertension)

108
Q

pH: 7.56 (norm= 7.34-7.45)
PCO2: 23mmHg (norm=35-45)
PO2: 70mmHg (norm=75-100)
HCO3: 21 mEq/L (norm=22-28)

What is going on here?

A

Respiratory alkalosis (can be caused by hyperventilation)

109
Q

What class of medications is used as first line management to reduce pulmonary arterial pressure in patients who are diagnosed with idiopathic pulmonary hypertension?

A

Calcium channel blockers

110
Q

A 70 yo male sandblaster presents to your office with progressive SOB especially with exertion. Which of the following chest radiograph findings is most commonly associated with this clinical presentation based upon his occupation?
A. pleural thickenings (plaques)
B. small upper lobe nodules w hyperinflation of lower lobes
C. eggshell calcifications of the hilar and mediastinal lymph nodes
D. pleural effusion
E. presence of a companion line

A

C, eggshell calcifications of the hilar and mediastinal lymph nodes

This patient has silicosis (occupation working with sand and quartz). Eggshell calcifications are classic for silicosis (they can also be seen in sarcoidosis)

111
Q

Eggshell calcifications are classic** for….

A

Silicosis!

they can also be seen in sarcoidosis

112
Q 
A 40 yo African-American woman with a 4 month history of nonproductive cough presents to the clinic with progressive SOB. A chest Xray is obtained and shows bilateral hillier lymphadenopathy. Which of the following is the management of choice in this patient?
A. azithromycin
B. oral prednisone
C. inhale fluticasone
D. ceftriaxone and azithromycin
E. levofloxacin
A

B, oral prednisone

The clues here are a young African American (it could have also been Northern European), longstanding nonproductive cough and bilateral hillier lymphadenopathy, which all indicate sarcoidosis! 40% of sarcoidosis patients spontaneously resolve and 40% respond to treatment

113
Q

An 18 yo college student presents to the school clinic with a 5 day history of runny nose, sneezing and a productive cough. She denies chest pain and SOB. Her vital signs are all within normal limits. On physical exam, her lungs are clear to auscultation bilaterally with no adventitious breath sounds. A CXR shows no infiltrates or other abnormalities. An ECG shows NSR, a D-dimer is within normal limits. What is likely the diagnosis?

A

Acute bronchitis

114
Q

A 63 yo female with a hx of bronchiectasis develops an increased cough w increased sputum. Mycobacterium avid complex is suspected. DOC?

A

Clarithromycin plus ethambutol

115
Q

A 6yo girl is brought to the ER for acute onset of a severe, barky cough that began 2 days ago. Her mother states she has had a week of runny nose, coughing, a nasal congestion. On examination, there is inspiratory stridor and some intercostal retractions. Which of the following radiographic findings are consistent with the suspected diagnosis?
A. thumb printing sign
B. air bronchograms
C. companion lines
D. steeple sign
E. diffuse bilateral pulmonary infiltrates

A

D, steeple sign

A barking, seal like cough is classic for viral croup (which is most associated with parainfluenza virus). Steeple sign classically seen**

116
Q

Croup is most often associated with what virus?

A

Parainfluenza

117
Q

Air bronchograms are seen on CXR of what patients?

A

infant respiratory distress syndrome

118
Q

Companion lines on CXR are associated with..

A

Pneumothorax

119
Q

A 28 yo male presents to the clinic with a 3 month history of persistent, nonproductive cough and SOB that is worsened with exertion. Chest radiographs are positive for bilateral hillier lymphadenopathy. Which of the following biopsies would be most consistent with the suspected diagnosis?
A. tissue infiltrated with streptococcus pneumoniae
B. tissue infiltrated with caseating granulomas
C. tissue infiltrated with cells consistent w squamous cell carcinoma
D. tissue infiltrated with noncaseating granulomas
E. tissue infiltrated with enlarged alveoli and enlarged small airways

A

D, tissue infiltrated with noncaseating granulomas

The bilateral hillier lymphadenopathy is classic for sarcoidosis. Noncaseating granulomas are seen in sarcoidosis.

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