Pulm Crit

Question 1

Pulm Crit

Answer 1

Treatment of aspirin-exacerbated respiratory disease consists of symptom treatment with glucocorticoids and removal of the exposure; treatment can also include a leukotriene receptor antagonist.

Question 2

Pulm Crit

Answer 2

Roflumilast, a selective phosphodiesterase-4 inhibitor, is used as add-on therapy in severe COPD associated with chronic bronchitis and a history of recurrent exacerbations to reduce risk and frequency of exacerbations.

chronic macrolide therapy is associated with a reduction in the rate of exacerbation in patients with moderate to severe COPD despite optimal maintenance inhaler therapy.

Question 3

Pulm Crit

Answer 3

Home sleep testing is the first test indicated in a patient with a high probability of obstructive sleep apnea without underlying cardiopulmonary or neuromuscular disease.

multiple sleep latency testing (MSLT) is used to provide an objective measure of sleepiness. necessary to establish the diagnoses of narcolepsy and idiopathic hypersomnia.

Question 4

Pulm Crit

Answer 4

Subsolid lung nodules 6-8 mm in size should be initially followed up at 6-12 months and then every 2 years for 5 years because of the slow rate of growth if such masses are malignant.

Question 5

Pulm Crit

Answer 5

Nonspecific interstitial pneumonia (NSIP) is a disease that predominantly affects the lower lobes of the lung. NSIP tends to affect a younger patient population and is strongly associated with connective tissue disease

Hypersensitivity pneumonitis is the result of an immunologic response to repetitive inhalation of antigens and high-level exposure and will often be associated with fevers, flulike symptoms, cough, and shortness of breath, typically during a period of 48 hours.

Question 6

Pulm Crit

Answer 6

Early mobilization with physical and occupational therapy and interruption of sedation should be used to prevent and treat delirium in critically ill patients.

Question 7

Pulm Crit

Answer 7

Noninvasive bilevel positive airway pressure ventilation does not provide a secure airway and is contraindicated in patients with altered mental status or risk of vomiting because it can increase the risk of aspiration if the patient were to vomit into the mask.

Question 8

Pulm Crit

Answer 8

Idiopathic pulmonary fibrosis typically occurs in older individuals with nonproductive cough and progressive dyspnea on exertion; the diagnosis is supported by findings of usual interstitial pneumonitis on a high-resolution CT scan of the chest.

he finding of bilateral, peripheral, and basal predominant septal line thickening with honeycomb changes on CT scan is consistent with usual interstitial pneumonia pathologic p

Hypersensitivity pneumonitis, is associated with an environmental exposure, which was not elicited in this patient.

Question 9

Pulm Crit

Answer 9

The most appropriate method to evaluate volume status remains the physical examination; several technologies can help confirm the assessment.

Question 10

Pulm Crit

Answer 10

Typical imaging findings in patients with small cell lung cancer (SCLC) include a large mediastinal mass; hyponatremia due to ectopic production of antidiuretic hormone is most often due to SCLC and is rarely seen with other lung tumors.

Typical imaging findings in patients with small cell lung cancer (SCLC) include a large mediastinal mass; hyponatremia due to ectopic production of antidiuretic hormone is most often due to SCLC and is rarely seen with other lung tumors.

Question 11

Pulm Crit

Answer 11

Early intubation is indicated for patients with obesity hypoventilation syndrome and hypercapnic respiratory failure who do not improve with noninvasive positive pressure ventilation.

Question 12

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Answer 12

Measurement of α1-antitrypsin level is indicated for patients experiencing symptoms of COPD and who are younger than 45 years of age or have a strong family history of COPD.

Question 13

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Answer 13

In patients with moderate to severe uncontrolled asthma with the eosinophilic phenotype, treatment with mepolizumab can reduce emergency department visits, hospitalizations, and requirements for inhaled and oral glucocorticoids.

Question 14

pulm crit

Answer 14

Cited indications for hyperbaric oxygen therapy include loss of consciousness, ischemic cardiac changes, neurological deficits, significant metabolic acidosis, or carboxyhemoglobin level greater than 25%.

Treat carbon monoxide poisoning with levels of carboxyhemoglobin over 25%, with oxygen.

Cited indications for hyperbaric oxygen therapy include loss of consciousness, ischemic cardiac changes, neurological deficits, significant metabolic acidosis, or carboxyhemoglobin level greater than 25%.

Question 15

pulm crit

Answer 15

Transthoracic echocardiography can estimate pulmonary artery pressures and is the preferred initial test if pulmonary hypertension is suspected.

Findings include jugular venous distention, a prominent jugular venous a wave, parasternal heave, a widened split S2 with a prominent pulmonic component, or murmurs of tricuspid regurgitation as the right ventricle dilates.

Question 16

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Answer 16

Weight loss in patients with obesity-related asthma improves asthma control, lung function, and quality of life; reduces asthma medication use; and should be considered an essential part of the treatment plan.

Question 17

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Answer 17

Both Mepolizumab and omalizumab have been shown to reduce asthma exacerbations in patients with difficult-to-control asthma BUT the patient has to have elevated blood eosinophil counts.

Question 18

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Answer 18

Initial treatment of central sleep apnea should target modifiable risk factors; medical optimization of heart failure has been shown to improve central sleep apnea and Cheyne-Stokes breathing and should precede other therapies for sleep apnea.

Question 19

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Answer 19

Patients with a history of asthma-COPD overlap syndrome should not be prescribed a long-acting β2-agonist without concurrent therapy with an inhaled glucocorticoid because of the increased risk of mortality in patients with asthma who are prescribed long-acting β2-agonist monotherapy.

Question 20

Pulm crit

Answer 20

Lung volume reduction surgery improves quality of life and survival for patients with upper-lobe predominant emphysema and significant exercise limitations.

Question 21

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Answer 21

A postbronchodilator FEV1/FVC of less than 0.70 is diagnostic of airflow obstruction and is consistent with the diagnosis of COPD.

Question 22

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Answer 22

For individuals with idiopathic pulmonary fibrosis who develop severe respiratory distress that has no underlying reversible cause, supportive mechanical ventilation is of little long-term benefit; in these circumstances, the focus should be on palliation of the patient’s underlying dyspnea.

Question 23

Pulm crit

Answer 23

Patients with diffuse cutaneous systemic sclerosis are at high risk for the development of diffuse parenchymal lung disease, which is the leading cause of death in these patients.

Cardiopulmonary exercise testing is routinely performed to assess prognosis in patients being evaluated for transplantation

Patients with a pulmonary nodule or other findings suggestive of malignancy may require PET/CT

Question 24

Pulm crit

Answer 24

Cough-variant asthma refers to asthma in which the predominant manifestation is cough, and without other typical asthma symptoms; the diagnosis is supported by abnormal spirometry or methacholine challenge testing if spirometry is normal.

Question 25

Pulm crit

Answer 25

Patients with a solid indeterminate lung nodule larger than 8 mm and high probability of malignancy should be staged using a PET/CT scan followed by definitive management.

The first step when evaluating a solid pulmonary nodule that is larger than 8 mm is to estimate the probability of malignancy.

If the lesion is larger than 30 mm, the likelihood of malignancy is so high that it typically is resected; in contrast, when the lesion is smaller than 8 mm, the likelihood of malignancy is low and the patient should undergo routine radiological surveillance with serial CT scans.

Question 26

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Answer 26

Biopsy of the nodule or a transthoracic approach is preferred when the probability of malignancy is intermediate

Furthermore, the sampling procedure is chosen according to size and location of the nodule, availability, and local expertise. Typically, peripheral nodules are sampled using CT-guided transthoracic needle aspiration, and more central lesions are sampled using bronchoscopic techniques.

Question 27

pulm crit

Answer 27

Parietal plaques are the most common radiologic finding in patients with asbestos exposure and are the features that differentiate asbestosis from other interstitial lung diseases.

Although this patient has some CT scan findings consistent with idiopathic pulmonary fibrosis, that diagnosis can only be made in a patient who does not have another plausible cause for fibrosis.

Question 28

pulm crit

Answer 28

Intravenous magnesium sulfate reduces hospital admissions and improves lung function in adults with acute asthma who have not responded sufficiently to oxygen, nebulized short-acting β2-agonists, and intravenous glucocorticoids.

Question 29

Pulm Crit

Answer 29

Glucocorticoids are indicated in patients with sepsis who have not achieved hemodynamic stability from intravenous fluid administration and vasopressor therapies.

Question 30

Pulm Crit

Answer 30

Ratio of fev1/fvc less than 70 is obstructive.

recommends an inhaled short-acting bronchodilator (anticholinergic or β2-agonist) for patients with an FEV1 between 60% and 80% of predicted.

Question 31

Pulm Crit

Answer 31

Assisted breathing devices, such as bilevel positive airway pressure, can be prescribed to support gas exchange in patients with neuromuscular disorders and may prolong survival in amyotrophic lateral sclerosis.

Question 32

Pulm Crit

Answer 32

Patients with a primary spontaneous pneumothorax should be encouraged to stop smoking to prevent recurrence.

Question 33

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Answer 33

Conditions suggesting the diagnosis of cystic fibrosis in adults include chronic asthma-like symptoms, chronic sinusitis, nasal polyposis, recurrent pancreatitis, infertility, and bronchiectasis.

Question 34

Pulm Crit

Answer 34

Patients with pulmonary hypertension secondary to lung disease and associated hypoxemia should be treated with supplemental oxygen.

Question 35

Pulm Crit

Answer 35

Before administering advance therapy for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH, vasoreactivity testing directs agent selection by identifying those who may respond to calcium channel blockers.

CCBs such as diltiazem may be used in the setting of PAH when a response to a vasodilator such as nitric oxide is demonstrated during right heart catheterization. When a response is not found, CCBs are not indicated.

Question 36

Pulm Crit

Answer 36

Flumazenil, a γ-aminobutyric acid (GABA)–receptor antagonist, is the antidote for benzodiazepine toxicity, but reversing the benzodiazepine he took could put him at risk for seizures, especially if he is a chronic user.

Fomepizole inhibits alcohol dehydrogenase. It is used to block the metabolism of ethylene glycol and methanol into toxic metabolites when either of these alcohols is ingested.

Question 37

Pulm Crit

Answer 37

Removal of the offending antigen is the most appropriate treatment of acute hypersensitivity pneumonitis.

Question 38

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Answer 38

In patients with severe COPD and frequent exacerbations, chronic macrolide therapy has been shown to decrease COPD exacerbations.

Question 39

Pulm crit

Answer 39

Pulmonary arterial hypertension is commonly associated with connective tissue diseases, such as limited cutaneous systemic sclerosis.

Question 40

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Answer 40

Recurrence prevention with pleurodesis is recommended after the first occurrence of secondary spontaneous pneumothorax.

For patients who are surgical candidates, video-assisted thoracoscopic surgery (VATS) is recommended to locate and staple or resect blebs followed by mechanical pleurodesis.

Clamping or removing the thoracostomy tube is not appropriate when the patient has a secondary spontaneous pneumothorax and the likelihood of recurrence is high.

Question 41

Pulm crit

Answer 41

Patients with COPD who have had two or more acute exacerbations within the last year, who have an FEV1 of less than 50% of predicted, or who have ever been hospitalized for an acute exacerbation are considered to be at high risk for recurrent acute exacerbations.

Question 42

Pulm crit

Answer 42

The patient has chronic respiratory acidosis with a normal alveolar-arterial (A-a) oxygen gradient. BPAP delivers both inspiratory positive airway pressure and expiratory positive airway pressure and improves survival and quality of life of patients with neuromuscular disease. The settings generate a pressure difference that augments the patient’s own respiratory muscle activity, leading to an increase in the size of each breath. The PCO2 level will decrease due to the increase in minute ventilation and efficiency of breathing.

Question 43

Pulm crit

Answer 43

Hydroxocobalamin effectively removes cyanide from the mitochondrial respiration system and is the preferred antidote for cyanide poisoning.

Question 44

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Answer 44

Negative sweat chloride testing does not exclude the diagnosis of cystic fibrosis in patients with high pretest probability of disease.

Question 45

pulm crit

Answer 45

Patients recommended for lung cancer screening are those aged 50 to 80 years with a greater than 20-pack-year history of tobacco use within the previous 15 years.

Question 46

pulm crit

Answer 46

Daily protocolized interruptions of sedation and analgesia have been shown to decrease the incidence of delirium, the need for diagnostic testing, and the amount of time spent on mechanical ventilation and in the ICU.

Question 47

pulm crit

Answer 47

Patients with nonexertional heat stroke should be treated with evaporative cooling to lower their core temperature to a safe level.

This patient should be sprayed with water, and fans should be used to lower his body temperature to a safe level (usually 38.5 °C (101 °F) through evaporative cooling.

Question 48

pulm crit

Answer 48

A critical first step entails removing wet clothing and covering the patient with insulating material, especially the head and neck. For mildly hypothermic, healthy individuals capable of shivering, this strategy of passive external rewarming alone suffices. Active external rewarming using warm blankets or a forced heated air blanket is commonly used in hemodynamically stable patients with moderate hypothermia. Body cavity lavage with warm fluids is an option for patients with hypothermia that is severe or does not respond to external rewarming.

Question 49

pulm crit

Answer 49

Although the most important treatment of high-altitude cerebral edema is descent to lower elevation, dexamethasone should be administered immediately upon recognition of high-altitude cerebral edema.

Acute mountain sickness is characterized by nonspecific symptoms such as headache, fatigue, nausea, and vomiting, in addition to disturbed sleep. High-altitude cerebral edema is a more extreme manifestation of acute mountain sickness

Acetazolamide accelerates the acclimatization process to high altitude by inducing a slight metabolic acidosis to stimulate ventilation and enhance gas exchange; it can be used prophylactically in patients with a history of altitude illness.

Question 50

pulm crit

Answer 50

This patient should be managed with observation and clinical follow-up. She is incidentally discovered to have bilateral hilar lymphadenopathy likely representing pulmonary sarcoidosis.

Treatment of pulmonary sarcoidosis should be based on symptoms rather than radiographic findings.

Question 51

pulm crit

Answer 51

The use of low tidal volume ventilation and positive end-expiratory pressure is associated with prevention of ventilator-associated lung injury and a reduction in mortality related to acute respiratory distress syndrome.

Question 52

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Answer 52

The initial step in the evaluation of the patient with excessive daytime sleepiness is to ensure adequate quantities of sleep on a regular basis using either actigraphy or a sleep diary.

Question 53

pulm crit

Answer 53

An empyema is defined as a bacterial infection of the pleural space that results in frank pus on visual inspection of the pleural fluid or a positive Gram stain.

parapneumonic effusions associated with a pH less than 7.2 or pleural fluid glucose level less than 60 mg/dL (3.3 mmol/L) require thoracostomy drainage in addition to antibiotics.

An uncomplicated parapneumonic effusion is characterized by a pH greater than 7.2 and glucose greater than 60 mg/dL (3.3 mmol/L). These effusions do not require drainage and typically resolve with antibiotic therapy alone.

Pleural fluid acidosis (pH less than 7.3) is seen in complicated parapneumonic effusions, tuberculous pleuritis, rheumatoid and lupus pleuritis, esophageal rupture, and malignancy.

Question 54

pulm crit

Answer 54

Annual influenza vaccination and the pneumococcal polysaccharide vaccine are recommended for all patients with chronic lung disease (COPD, emphysema, asthma).

PPSV23 has the same indications as the PCV13 vaccine, plus it is indicated in immunocompetent people with certain chronic medical conditions such as heart, liver, and lung disease (COPD, emphysema, asthma) and diabetes, as well as in cigarette smokers.

Question 55

pulm crit

Answer 55

Surgical intervention is the only definitive therapy for chronic thromboembolic pulmonary hypertension (CTEPH), and most patients with CTEPH should be referred for evaluation at a specialty surgical center.

Question 56

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Answer 56

Patients should be assessed daily for their readiness to be removed from mechanical ventilation by performing a spontaneous breathing trial; one criterion for success is the ability to tolerate a spontaneous breathing trial for 30 minutes.

Question 57

pulm crit

Answer 57

Patients should be assessed daily for their readiness to be removed from mechanical ventilation by performing a spontaneous breathing trial; one criterion for success is the ability to tolerate a spontaneous breathing trial for 30 minutes.

Question 57

pulm crit

Answer 57

Patients should be assessed daily for their readiness to be removed from mechanical ventilation by performing a spontaneous breathing trial; one criterion for success is the ability to tolerate a spontaneous breathing trial for 30 minutes.

Question 58

pulm crit

Answer 58

A “cuff leak” refers to measurable airflow around the endotracheal tube after the cuff of the endotracheal tube is deflated. Absent or minimal cuff leak following deflation of the cuff indicates reduced space between the endotracheal tube and the larynx. Minimal or absent cuff leak may be due to laryngeal edema, laryngeal stenosis, and thick secretions.

Question 59

pulm crit

Answer 59

Instillation of intrapleural tissue plasminogen activator-deoxyribonuclease has been shown to decrease the radiographic pleural opacity, lower the rate of surgical referral, and decrease hospital stay of patients with empyema.

Question 60

pulm crit

Answer 60

The diagnosis of asthma requires demonstrating reversible airflow obstruction; for a patient with symptoms of asthma and normal spirometry, methacholine challenge testing to evaluate for bronchial hyperresponsiveness is indicated.

Question 61

pulm crit

Answer 61

Patients with severe acute respiratory distress syndrome have a demonstrated mortality benefit from low tidal volume ventilation in the prone position.

In chronic bronchitis, the walls of the airways are thickened without dilation of the airways themselves.

Pulmonary Langerhans cell histiocytosis is a rare s

Question 62

pulm crit

Answer 62

Patients who work in industries that expose them to silica dust are at risk for silicosis.cute silicosis, a rare presentation characterized by onset of cough and dyspnea (but no fever) just a few weeks after intense exposure, patchy bilateral opacities on chest radiograph, and a milky effluent from bronchoalveolar lavage (BAL).

Question 63

pulm crit

Answer 63

Initial evaluation for ICU-acquired weakness can be done at the bedside using the Medical Research Council muscle scale.

ICU-acquired weakness is the presence of profound muscles weakness in the setting of a current or recent critical illness. The MRC scale is most appropriately used in awake and cooperative patients.

Question 64

pulm crit

Answer 64

A typical presentation of cryptogenic organizing pneumonia includes cough, fever, and malaise for 6 to 8 weeks that does not respond to antibiotics; patchy opacities on chest radiograph; and ground-glass opacities on CT scan that are peripherally distributed; glucocorticoids are first-line therapy.

Idiopathic pulmonary fibrosis (IPF) is a disease that affects older patients (the mean age of presentation is in the mid- to late 60s) and presents with chronic (longer than 6 months) symptoms of dry cough and shortness of breath.

Question 65

pulm crit

Answer 65

In patients with pulmonary embolism and hemodynamic collapse, treatment with thrombolytics is associated with decreased mortality and improvement in clinical and echocardiographic parameters.

If a patient has a large pulmonary embolism they can become hypotensive from acute right ventricular (RV) failure.

Question 66

pulm crit

Answer 66

Parenteral nutrition should be started as soon as possible for severely malnourished patients or those at high risk of malnutrition for whom enteral nutrition is not possible.

Initiation of enteral nutrition is recommended at 24 to 48 hours following admission if the patient is hemodynamically stable, with advancement to goal by 48 to 72 hours.

Question 67

pulm crit

Answer 67

Respiratory bronchiolitis–associated interstitial lung disease is found in active smokers who have chest CT scan findings of centrilobular micronodules.

RB-ILD is used to describe disease in active smokers who have imaging findings of centrilobular micronodules with a pathologic finding of respiratory bronchiolitis and tan-pigmented macrophages (smokers’ macrophages) on biopsy

Question 68

pulm crit

Answer 68

Treatment of asthma during pregnancy is similar to treatment in nonpregnant patients.

Inhaled glucocorticoids are considered safe in pregnancy, and abundant long-term safety evidence exists for budesonide. With the exception of zileuton, most leukotriene modifiers are also considered safe in pregnancy. The treatment of asthma in pregnancy is very similar to treatment in nonpregnant patients.

For patients with persistent symptoms and/or exacerbations despite use of a low-dose glucocorticoid and an as-needed SABA, the preferred step-up therapy is a combination low-dose inhaled glucocorticoid and long-acting β2 agonist such as fluticasone-salmeterol.

Question 69

pulm crit

Answer 69

High-resolution chest CT scan is the preferred advanced imaging modality for suspected diffuse parenchymal lung disease; it can help narrow the differential diagnosis based on the character and distribution of the lung parenchymal abnormalities.

Question 70

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Answer 70

For patients with negative cytology in whom malignancy is suspected, thoracoscopy with pleural biopsy allows for direct visualization of the pleural surface and has a diagnostic sensitivity for malignant disease of greater than 90%.

Question 71

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Answer 71

High-resolution CT scan of the chest is standard care for evaluating parenchymal opacities seen on a plain radiograph.

Question 72

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Answer 72

Obesity is the strongest risk factor for snoring and obstructive sleep apnea, and in patients with obesity who are otherwise healthy and without other sleep-related symptoms, weight loss is a reasonable first step that often relieves snoring and improves mild obstructive sleep apnea.

Question 73

pulm crit

Answer 73

For patients with a malignant pleural effusion and rapid reaccumulation of fluid, indwelling pleural catheters provide significant symptom relief, and 50% to 70% of patients achieve spontaneous pleurodesis after 2 to 6 weeks.

Repeat therapeutic thoracentesis is appropriate for patients with poor prognosis (less than 3 months) and slow reaccumulation of fluid

Question 74

pulm crit

Answer 74

Classic features of serotonin syndrome include hyperthermia, tremor, hyperreflexia and clonus; treatment is mainly supportive, using benzodiazepines as needed to keep the patient calm and to control blood pressure and heart rate. serotonin syndrome typically develops within hours

Malignant hyperthermia usually occurs with a history of inhaled anesthesia agents or neuromuscular blockade. Clinical features of malignant hyperthermia usually include higher fever, muscle rigidity, and, occasionally, hemorrhage but not hyperreflexia or clonus.

Neuroleptic malignant syndrome happens with neuroleptic medications, such as haloperidol. It usually develops subacutely during days or weeks, Rigidity with hyporeflexia is more common, rather than hyperreflexia and myoclonus in serotonin syndrome.

Question 75

pulm crit

Answer 75

Endobronchial ultrasound-guided transbronchial needle aspiration is the procedure of choice for diagnosing and staging mediastinal and hilar lymphadenopathy in patients with suspected thoracic malignancy.

Most patients undergo chest CT scan as the first imaging modality, either after an abnormal chest radiograph or in evaluation of a symptom. The findings on the chest CT scan determine whether a PET/CT scan is necessary. A PET/CT scan can help in staging and therefore also help guide where to biopsy. For example, if a patient has a solitary pulmonary nodule, a PET/CT scan may help determine if any lymph node involvement is present that was not visible on the chest CT scan.

The next step is to obtain tissue diagnosis. The choice of initial diagnostic testing should be aimed first at identifying potential lymph node involvement or metastatic disease. Tissue diagnosis should then be targeted at the lesion that would result in the highest potential staging.

Question 76

pulm crit

Answer 76

An apnea-hypopnea index (AHI) of 5 to 15 is indicative of mild obstructive sleep apnea (OSA). This patient has mild OSA based upon an AHI of 6. OSA is typically encountered on sleep testing in those with obesity hypoventilation syndrome, with upper airway collapse superimposed on obesity-related hypoventilation. Severe OSA is defined as an AHI of at least 30; OSA severity is not defined by degree or duration of hypoxemia

Obesity hypoventilation syndrome is characterized by daytime hypercapnia, defined as an arterial PCO2 greater than 45 mm Hg that is thought to be a consequence of diminished ventilatory drive and capacity related to extreme obesity.

Question 77

pulm crit

Answer 77

If previous data on bronchiectasis exacerbations are not available, a fluoroquinolone should be started to ensure Pseudomonas coverage until the sputum culture is completed.

Question 78

Which clinical syndrome is associated with organic antigen exposure (e.g.,agricultural dusts, thermophilic fungi, bacteria), fever, cough, and fatigue develop 12 hours later?

Answer 78

Hypersensitivity pneumonitis

Question 79

What major physical exam finding is associated with Hypersensitivity pneumonitis?

Answer 79

Physical examination reveals inspiratory crackles.

Question 80

What is see on CXR and CT in patients with Hypersensitivity pneumonitis?

Answer 80

Chest x-ray may be normal or show diffuse micronodular disease. HRCT shows diffuse
centrilobular micronodules and ground-glass opacities.

Question 81

What is first-line therapy for anaphylaxis?

Answer 81

IM or IV epinephrine is first-line therapy even if the only presenting signs are hives or
pruritus. Repeated doses are often necessary. Adjuvantly use inhaled bronchodilators
for bronchospasm and IV saline for shock or hypotension.

Question 82

What cause of anaphylaxis should be considered in a case of anaphylaxis during surgery or
in a woman during sex?

Answer 82

Consider latex allergy as the cause of anaphylaxis during surgery or anaphylaxis
in a woman during coitus.

Question 83

When should Patients with anaphylaxis undergo venom skin testing and immunotherapy?

Answer 83

Patients with diffuse rash or anaphylaxis from hymenoptera sting (bee, yellow jacket,

and wasp) should undergo venom skin testing and immunotherapy.

Question 84

what is the main difference between Bradykinin-mediated angioedema and Mast cell–mediated angioedema?

Answer 84

Bradykinin-mediated angioedema is NOT associated with urticaria. Mast cell–mediated angioedema is often associated with urticaria, bronchospasm, or
hypotension.

Question 85

How is Bradykinin-mediated angioedema diagnosed?

Answer 85

Diagnose by testing for
quantitative and functional levels of C1 esterase inhibitor and C4 complement levels.

Question 86

How are acute episodes of hereditary angioedema treated?

Answer 86

For hereditary angioedema, treatment of
severe acute episodes of swelling with C1 inhibitor concentrate.

Question 87

What are the 4 cardinal features of asthma?

Answer 87

The cardinal features of asthma are reversible airway
obstruction, inflammation, and airway hyperreactivity.

Question 88

When are PFTs required in the workup of patients with asthma?

Answer 88

In patients with atypical features of asthma, perform PFTs.

Question 89

When is Bronchial challenge testing is indicated for patients with suspected asthma?

Answer 89

Bronchial challenge testing is indicated for patients with a suggestive clinical history for
asthma but normal spirometry.

Question 90

In patients who have dyspnea following exercise but normal spirometry., what test can be used to dx asthma?

Answer 90

Bronchial challenge testing with exercise is indicated to
diagnose exercise-induced asthma in patients who have dyspnea following exercise but
normal spirometry.i

Question 91

What is the clinical significance of a normal bronchoprovocation test?

Answer 91

A normal bronchoprovocation test rules out asthma;

Question 92

Which clinical syndrome is associated with Upper airway and sinus disease that precedes difficult-to-treat asthma and also has flares associated with
use of leukotriene inhibitors and glucocorticoid tapers?

Answer 92

Eosinophilic granulomatosis
with polyangiitis

Question 93

which elevated lab is well known in Eosinophilic granulomatosis with polyangiitis?

Answer 93

Serum p-ANCA may be elevated

Question 94

which clinical syndrome is associated with asthma with eosinophilia, markedly high serum IgE levels, and intermittent pulmonary
infiltrates?

Answer 94

Allergic bronchopulmonary
aspergillosis

Question 95

which clinical syndrome is associated with Chest x-ray shows “photographic-negative” pulmonary edema (peripheral pulmonary edema), striking peripheral blood eosinophilia, fever, and weight loss in a long-term
smoker?

Answer 95

Chronic eosinophilic
pneumonia

Question 96

How is Allergic bronchopulmonary
aspergillosis diagnosed?

Answer 96

Diagnose with positive skin test for Aspergillus and IgG and IgE antibodies to Aspergillus,
characteristic radiographic opacities in the upper lobes

Question 97

How is Chronic eosinophilic
pneumonia diagnosed?

Answer 97

Diagnose by bronchoscopy with biopsy or bronchoalveolar lavage showing a high eosinophil count

Question 98

What is the Hallmark diagnostic finding of Eosinophilic granulomatosis
with polyangiitis?

Answer 98

Hallmark diagnostic finding is eosinophilic tissue infiltrates

Question 99

Which clinical syndrome is associated with Seasonal exacerbations; hay fever and allergen sensitization?

Answer 99

Allergic asthma

Question 100

Which clinical syndrome is associated with Cough without other symptoms. Normal baseline spirometry, (+) bronchoprovocation testing.?

Answer 100

Cough-variant
asthma

Question 101

Which clinical syndrome is associated with Airway obstruction only with exercise or can trigger symptoms in patients with asthma (common)?

Answer 101

Exercise-induced
bronchoconstriction

Question 102

Which clinical syndrome is associated with upper airway obstruction.
Throat tightness, voice dysfunction.?

Answer 102

Vocal cord dysfunction, Paradoxical adduction of the vocal cords during inspiration, causing functional upper airway obstruction.

Question 103

Which clinical syndrome is associated with Follows single high-level exposure to fumes, gases, vapors; persistent asthma ≥3 mo; (+) spirometry or
bronchoprovocation testing?

Answer 103

Reactive airways
dysfunction
syndrome

Question 104

Which clinical syndrome is associated with Asthma and rhinosinusitis precipitated by aspirin or NSAIDs. Adult onset, airway and blood eosinophilia, sinusitis + nasal polyps ?

Answer 104

Aspirin-exacerbated
respiratory disease

Question 105

All patients with asthma require what tx at a minimum?

Answer 105

All patients require a rescue medication (usually a SABA).

Question 106

What tx do All patients with PERSISTENT asthma require?

Answer 106

All patients with persistent asthma require a controller medication (inhaled glucocorticoid–formoterol or inhaled glucocorticoid plus LABA like salmeterol, formoterol.

Question 107

what is the tx for severe asthma associated with type 2 inflammation (↑ IgE or ↑ sputum/blood
eosinophils often associated with atopy?

Answer 107

Treat severe asthma associated with type 2 inflammation (↑ IgE or ↑ sputum/blood
eosinophils often associated with atopy).

Elevated IgE: Omalizumab is a monoclonal antibody directed at IgE for patients with
moderate to severe persistent asthma with the following characteristics:

Question 108

which sx of asthma warrant treatment with Omalizumab?

Answer 108

• inadequate control of symptoms with inhaled glucocorticoids
• evidence of allergies to perennial aeroallergen
• elevated IgE levels

Question 109

what is the tx for resistant asthma with Elevated eosinophils?

Answer 109

Elevated eosinophils: Anti–interleukin-monoclonal antibodies (mepolizumab,
reslizumab, benralizumab, dupilumab). Treatment is reserved for patients with an
absolute eosinophil count >150 cells/μL and severe asthma not controlled with
standard therapy.

Question 110

for asthma patients taking chronic glucocorticoid
treatment what early screening is recommended?

Answer 110

calcium and vitamin D supplements for patients taking chronic glucocorticoid
treatment; early screening for osteoporosis with DEXA

Question 111

In the tx of asthma, when you administer theophylline what other drugs have to be avoided?.

Answer 111

Do not administer theophylline with fluoroquinolones or macrolides (may result
in theophylline toxicity).

Question 112

which asthma meds can not be used as single agents due to increased mortality rate?

Answer 112

Do not use LABAs as single agents in asthma (increased mortality rate).

Question 113

which IV med can be used for patients who have life-threatening asthma exacerbations?

Answer 113

IV magnesium sulfate for patients who have life-threatening exacerbations may
be helpful

Question 114

what is the clinical significance of A normal arterial PCO2 in a patient with severe symptomatic asthma ?

Answer 114

A normal arterial PCO2 in a patient with severe symptomatic asthma indicates
impending respiratory failure.

Question 115

In patients with “asthma” that improves
immediately with intubation, what clinical syndrome should be considered?

Answer 115

Consider vocal cord dysfunction for patients with “asthma” that improves
immediately with intubation.

Question 116

Which clinical syndrome is associated with unexplained flulike symptoms, frontal headache,
lightheadedness, difficulty concentrating, confusion, delirium, coma, dyspnea, nausea,
and chest pain that are often associated with use of a grill or burning heat source
indoors.

Answer 116

Carbon Monoxide Poisoning

Question 117

how do you dx Carbon Monoxide Poisoning?

Answer 117

Order ABG studies and serum carboxyhemoglobin measurement for all patients with neurologic changes, dyspnea, chest pain, or smoke exposure.

Question 118

In evaluating carbon monoxide poisoning, does pulse oximetry help in any way?

Answer 118

Pulse oximetry data are unreliable because the oximeter is unable to differentiate
carboxyhemoglobin from oxyhemoglobin.

Question 119

Which clinical syndrome is associated with Obstructive pulmonary disease , recurrent respiratory infections and infertility ?

Answer 119

Cystic fibrosis

Question 120

Which clinical syndrome is associated with lung dz in current or former smokers; may be idiopathic or associated with other diseases such as RA?

Answer 120

Adult
bronchiolitis

Question 121

Which clinical syndrome is associated with Large-volume sputum production with purulent exacerbations; hemoptysis
Chest x-ray showing “tram lines”; diagnose with HRCT, which will show airway diameter greater than that of its
accompanying vessel and lack of distal airway tapering ?

Answer 121

Bronchiectasis

Question 122

What is the treatment of choice for carbon monoxide poisoning?

Answer 122

Normobaric oxygen therapy is the treatment of choice.

Question 123

What is the treatment of choice for carbon monoxide poisoning vs severe carbon monoxide poisoning?

Answer 123

Hyperbaric oxygen therapy is
indicated for patients with severe carbon monoxide poisoning (characterized by loss of
consciousness and persistent neurologic deficits), patients who are pregnant, or
patients with evidence of cardiac ischemia.

Question 124

What FEV1/FVC ratio level is associated with COPD?

Answer 124

Diagnose COPD when postbronchodilator spirometry shows an FEV1/FVC ratio <0.7 (or
below LLN) associated with symptoms of chronic bronchitis, emphysema, or both.

Question 125

What lab value should be Measured in all patients with COPD?

Answer 125

Measure Alpha-1 antitrypsin (AAT) level in all patients with COPD.

Question 126

what is the MAIN recommendation that is essential in the management of all patients with COPD to reduce the rate of decline in lung function?

Answer 126

Smoking cessation is essential in the management of all patients with COPD to reduce
the rate of decline in lung function.

Question 127

When is pulmonary rehabilitation recommended for patients with COPD?

Answer 127

For symptomatic patients with an FEV1 <50% of predicted, pulmonary
rehabilitation is recommended.

Question 128

What is the recommended tx for patients with COPD and FEV1 <60% of predicted?

Answer 128

For symptomatic patients with COPD and FEV1 <60% of predicted, monotherapy
using long-acting anticholinergic agents (LAMAs or LABAs) is recommended.

Question 129

When is continuous oxygen therapy is recommended For patients with COPD ?

Answer 129

For patients with COPD who have severe resting hypoxemia (arterial PO2 <55 mm
Hg or O2 saturation <88%), continuous oxygen therapy is recommended.

Question 130

Aside from (arterial PO2 <55 mm
Hg or O2 saturation <88%), for patients with COPD what is the other indication for which long-term oxygen therapy?

Answer 130

An additional indication for which long-term oxygen therapy should be considered is an arterial blood PO2 ≤59 mm Hg with signs of tissue hypoxia (polycythemia, PH, right-
sided HF)

Question 131

For patients with severe COPD (bronchitis
variant), what 2 therapy can be added to prevent recurrent exacerbations?

Answer 131

PDE-4 inhibitor (roflumilast) as add-on therapy for severe COPD (bronchitis variant) to prevent recurrent exacerbations

long-term macrolide therapy (bronchitis variant) to prevent recurrent
exacerbations

Question 132

In COPD patients, what therapy can help improve oxygenation, sleep, and decrease daytime somnolence in patients with chronic hypercapnia?

Answer 132

nocturnal noninvasive mechanical ventilation to improve oxygenation, improve
sleep, and decrease daytime somnolence in patients with chronic hypercapnia

Question 133

For severe COPD with
unremitting dyspnea at end of life, what rx is recommended?

Answer 133

palliative use of oral or parenteral opioids in patients with severe COPD and
unremitting dyspnea at end of life

Question 134

Which COPD patients should be considered for lung volume reduction surgery?

Answer 134

consideration of lung volume reduction surgery for patients with upper lobe
emphysema (heterogeneous disease) and low baseline exercise capacity to
improve mortality, exercise capacity, and quality of life

Question 135

For patients with severe Alpha-1 antitrypsin
deficiency, AAT activity level <11 μm, and FEV1 <65%, what is the tx?

Answer 135

augmentation therapy with IV human AAT for patients with severe AAT
deficiency, AAT activity level <11 μm, and FEV1 <65%

Question 136

in what situations can you not use noninvasive ventilation for acute hypercapnic respiratory failure with acidosis?

Answer 136

noninvasive ventilation for acute hypercapnic respiratory failure with acidosis
(unless patient is obtunded, vomiting, or has excessive secretions)

Question 137

Which clinical syndrome is associated with ?

Question 138

Which clinical syndrome is associated with Chronic airway inflammation and bacterial infection, recurrent or persistent respiratory infections with Pseudomonas aeruginosa,
Staphylococcus aureus, Haemophilus influenzae, or Burkholderia cepacia; bronchiectasis;
or hyperinflation. ?

Answer 138

Cystic Fibrosis

Question 139

How is Cystic Fibrosis dx ?

Answer 139

The diagnosis is confirmed by a sweat chloride test followed by genetic testing.

Question 140

Which clinical syndrome is associated with cough and chronic progressive dyspnea after infection and HF have been excluded?

Answer 140

Diffuse Parenchymal Lung Disease

Question 141

How is Cystic Fibrosis treated?

Answer 141

antipseudomonal antibiotics for acute pulmonary exacerbations, aerosolized tobramycin for suppression of chronic pulmonary infections

Question 142

which lung exam findings are seen in Diffuse Parenchymal Lung Disease?

Answer 142

Lung examination findings can range from normal to inspiratory Velcro-like crackles, or
inspiratory squawks suggestive of fibrosis.

Question 143

In a patient with Diffuse Parenchymal Lung Disease what should be seen on CXR?

Answer 143

Look for interstitial reticular or nodular infiltrates on chest x-ray;

Question 144

In a patient with Diffuse Parenchymal Lung Disease and a history of automobile mechanics,
ship builders, what dx should be considered?

Answer 144

asbestos exposure

Question 145

In a patient with Diffuse Parenchymal Lung Disease and a history of active smoking history, what dx should be considered?

Answer 145

(suggests respiratory bronchiolitis–associated interstitial
lung disease, desquamative interstitial pneumonia, pulmonary Langerhans cell
histocytosis, smoking-related interstitial fibrosis)

Question 146

What is a KEY hallmark of Diffuse Parenchymal Lung Disease?

Answer 146

Desaturation >4% with ambulation is consistent with a diffusion limitation, a hallmark
of DPLD.

Question 147

What findings are seen on PFTs for DPLD?

Answer 147

Look for restrictive or combined restrictive/obstructive findings on PFTs and low DLCO measurement.

Question 148

If clinical suspicion for DPLD is high, chest x-ray is normal, what should be done next?

Answer 148

Obtain chest HRCT, even if chest x-ray is normal, if clinical suspicion is high.

Question 149

Which clinical syndrome is associated with the presence of DPLD and mediastinal and/or hilar lymphadenopathy?

Answer 149

(sarcoidosis)

Question 150

Which clinical syndrome is associated with DPLD and pleural plaques?

Answer 150

asbestosis

Question 151

what is the tx for DPLD?

Answer 151

When possible, treatment is directed toward the underlying cause (connective tissue
disease), limiting exposure (drug discontinuation), and smoking cessation. The evidence
for glucocorticoid efficacy is weak.

Question 152

What are the 3 most common causes of hemoptysis?

Answer 152

Bronchitis, bronchogenic carcinoma, and bronchiectasis are the most common causes
of hemoptysis.

Question 153

in a pat with hemoptysis, what is important to rule out first?

Answer 153

Confirm that a patient has hemoptysis rather than epistaxis or GI bleeding; then check the platelet count and coagulation parameters.

Question 154

What is the initial study/test, for hemoptysis?

Answer 154

Chest x-ray, a Crucial initial study, but normal findings do not exclude lung cancer

Question 155

In a pt with hemoptysis, high suspicion of cancer and a normal cxr, what is the next in evaluation?

Answer 155

Fiberoptic bronchoscopy, For patients at high risk for lung cancer even if chest x-ray is normal

Question 156

In a pt with hemoptysis, when fiberoptic bronchoscopy is contraindicated or when bleeding persists despite normal bronchoscopic findings, what is the next step in evaluation?

Answer 156

Chest CT

Question 157

What is the cause of death from massive hemoptysis ?

Answer 157

The cause of death from massive hemoptysis is asphyxiation
from airway obstruction.

Question 158

In a pt with hemoptysis, what position should you put them in bed?

Answer 158

If the bleeding site can be localized to one lung, position the
patient with the bleeding lung in the dependent position.

Answer 159

COPD and asthma
* neuromuscular disease (MG, ALS, MS)
* restrictive lung diseases (chest wall skeletal disorders, obesity)
* depressed respiratory drive (opioids and sedatives)Chronic hypercapnic respiratory failure occurs most
often in patients with:

Question 160

what 4 conditions are associated with Chronic hypercapnic respiratory failure?

Answer 160

COPD and asthma
* neuromuscular disease (MG, ALS, MS)
* restrictive lung diseases (chest wall skeletal disorders, obesity)
* depressed respiratory drive (opioids and sedatives)

Question 161

In patients with neuromuscular disease, what is shown on PFTs, and diffusing capacity?

Answer 161

In patients with neuromuscular disease, PFTs show restriction on spirometry and lung
volume measurement but normal diffusing capacity. neuromusc wouldnt show any issues with diffusion

Question 162

what level FVC is Suggestive of Neuromuscular Weakness?

Answer 162

> 20% decrement in FVC while supine compared with upright position

Question 163

what level Maximal inspiratory pressure (MIP) is Suggestive of Neuromuscular Weakness?

Answer 163

Less than −60 cm H2O or 50% of predicted

Question 164

what level Maximal expiratory pressure (MEP) is Suggestive of Neuromuscular Weakness?

Answer 164

Less than +60 cm H2O or 50% of predicted

Question 165

What test should be ordered if nocturnal hypoventilation is suspected? (daytime sleepiness,
nocturnal awakenings, morning headaches).

Answer 165

Order
polysomnography if nocturnal hypoventilation is suspected (daytime

Question 166

Which clinical syndrome is associated with loss of consciousness, muscle rigidity, seizures, and rhabdomyolysis with kidney failure, DIC, and ARDS?

Answer 166

Severe hyperthermia

Question 167

Which clinical syndrome is associated with loss of consciousness, muscle rigidity, seizures, and rhabdomyolysis with kidney failure, DIC, and ARDS?

Answer 167

Severe hyperthermia

Question 168

what is the tx for Severe
serotonin syndrome?

Answer 168

Stop the inciting
drug
Benzodiazepines
Cyproheptadine

Question 169

Which clinical syndrome is associated with the use of SSRIs and the addition of a
second drug that increases serotonin release or blocks its uptake or metabolism?

Answer 169

The serotonin syndrome

Question 170

Which clinical syndrome is associated with Exposure to volatile anesthetics and Masseter muscle rigidity and ↑ arterial
PCO2?

Answer 170

Malignant
hyperthermia

Question 171

Which clinical syndrome is associated with Altered mentation, severe rigidity, after use of Haloperidol, olanzapine, quetiapine, and
risperidone or withdrawal from L-dopa?

Answer 171

Neuroleptic
malignant
syndrome

Question 172

what is the main symptoms that differentiates Neuroleptic malignant syndrome from Severe
serotonin syndrome?

Answer 172

Severe serotonin syndrome has myoclonus, ↑
reflexes while Neuroleptic malignant syndrome has no myoclonus

Question 173

what is the tx for Neuroleptic malignant syndrome?

Answer 173

Stop the inciting
drug
Dantrolene
Bromocriptine

Question 174

Which clinical syndrome is associated with hypoxemic respiratory failure presenting as noncardiogenic pulmonary edema?

Answer 174

Acute Respiratory Distress Syndrome

Question 175

Which clinical syndrome is associated with Arterial PO2/FIO2 ratio of 201-300 mm Hg, measured with PEEP ≥5 cm H2O ?

Answer 175

Mild ARDS

Question 176

Which clinical syndrome is associated with Arterial PO2/FIO2 ratio of 100-200 mm Hg, measured with PEEP ≥5 cm H2O?

Answer 176

Moderate ARDS

Question 177

Which clinical syndrome is associated with Arterial PO2/FIO2 ratio <100 mm Hg, measured with PEEP ≥5 cm H2O?

Answer 177

Severe ARDS

Question 178

what are the 3 main strategies for prevention of ventilator-associated
lung injury includes:
* lung-protective ventilation using volume-controlled ventilation with a tidal
volume of 4 to 8 mL/kg of ideal body weight (low tidal volume)
* plateau (end-inspiratory) pressure <30 cm H2O (even if this results in
“permissive” hypercapnia and acidosis)
* PEEP

Answer 178

Optimal mechanical ventilation associated with the prevention of ventilator-associated
lung injury includes:
* lung-protective ventilation using volume-controlled ventilation with a tidal
volume of 4 to 8 mL/kg of ideal body weight (low tidal volume)
* plateau (end-inspiratory) pressure <30 cm H2O (even if this results in
“permissive” hypercapnia and acidosis)
* PEEP

Question 179

what strategy treatment in ARDS has mortality benefit?

Answer 179

Use of prone positioning in severe ARDS has a mortality benefit.

Question 180

Which clinical syndrome is associated with critical illness polyneuropathy (with axonal nerve
degeneration) and critical illness myopathy (with muscle myosin loss), resulting in
profound weakness?

Answer 180

ICU-Acquired Weakness

Question 181

what is the most common of the idiopathic interstitial pneumonias?

Answer 181

Idiopathic Pulmonary Fibrosis

Question 182

Which clinical syndrome is associated with gradual onset of a nonproductive cough and dyspnea over several months in older
adults. Physical examination findings include bibasilar crackles (“dry,” end-inspiratory, and “Velcro-like” in quality)?

Answer 182

Idiopathic Pulmonary Fibrosis

Question 183

what is seen on cxr in Idiopathic Pulmonary Fibrosis?

Answer 183

Chest x-ray shows peripheral reticular opacities and honeycomb changes at the lung
bases.

Question 184

what is seen on HRCT in Idiopathic Pulmonary Fibrosis?

Answer 184

HRCT scan reveals subpleural cystic changes and traction bronchiectasis.

Question 185

Should you Do not intubate and mechanically ventilate patients with respiratory failure
caused by IPF.?

Answer 185

Do not intubate and mechanically ventilate patients with respiratory failure
caused by IPF.

Question 186

Which clinical syndrome is associated with this pic ?

Answer 186

Idiopathic Pulmonary Fibrosis

Question 187

Which clinical syndrome is associated with
High-resolution, thin-section chest CT scan showing extensive parenchymal
involvement with fibrotic and honeycomb changes compatible with IPF?

Answer 187

Idiopathic Pulmonary Fibrosis

Question 188

High-resolution, thin-section chest CT scan showing extensive parenchymal
involvement with fibrotic and honeycomb changes compatible with IPF.

Question 189

what are the 2 ways to Improve
respiratory acidosis?

Answer 189

Increasing respiratory rate
Increasing tidal volume:

Question 190

what are the 2 ways to Improve
Improve
respiratory
alkalosis?

Answer 190

Decreasing respiratory rate
Decreasing tidal volume

Question 191

what are the 2 ways to Alleviate
hypoxemia?

Answer 191

Increasing FIO2
Increasing PEEP

Question 192

when can patients be extubated? 4 criteria

Answer 192

When a patient can maintain an arterial O2 saturation >90% breathing FIO2 ≤0.5, PEEP
<5 cm H2O, and pH >7.30, it is reasonable to consider extubation.

Question 193

What is the main method used to reduce in mechanical ventilation time, ICU and hospital
length of stay, and 1-year mortality rates?

Answer 193

Paired daily
spontaneous awakening trials (withdrawal of sedatives) with daily spontaneous
breathing trials result in a reduction in mechanical ventilation time, ICU and hospital
length of stay, and 1-year mortality rates.

Question 194

Which method should not be used as a weaning
mode, because studies have demonstrated it actually takes longer to liberate
patients from the ventilator?

Answer 194

Do not select synchronized intermittent mandatory ventilation as a weaning
mode, because studies have demonstrated it actually takes longer to liberate
patients from the ventilator.

Question 195

Which clinical syndrome is associated with high respiratory rates, which can cause hypotension by
reducing preload?

Answer 195

Watch for auto-PEEP at high respiratory
rates, which can cause hypotension by
reducing preload

Question 196

When should you stop lung cancer screening with annual low-dose CT imaging in patients ?

Answer 196

Stop screening in patients who have
stopped smoking for 15 years.

Question 197

who should be screened for Lung Cancer?

Answer 197

Screen patients between the ages of 50 and 80 years (guidelines vary) who
have a 20-pack-year history of smoking and who are currently smoking or have quit
within the last 15 years.

Question 198

what is the most common tumor of anterior mediastinum; 40% have MG?

Answer 198

Thymus

Question 199

what is the Second most common anterior mediastinal tumor?

Answer 199

Second most common anterior mediastinal tumor; Hodgkin disease is the most common lymphoma

Question 200

what is the most common cause of middle mediastinal masses?

Answer 200

Lymphadenopathy is the most common cause of middle mediastinal masses

Question 201

which route of nutrition is
associated with GI mucosal atrophy and translocation of gut bacteria into the
bloodstream?

Answer 201

Total parenteral nutrition is
associated with GI mucosal atrophy and translocation of gut bacteria into the
bloodstream, which predisposes patients to infection.

Question 202

when is the initiation of enteral nutrition is recommended in ICU pts?

Answer 202

Initiation of enteral nutrition is recommended at 24 to 48 hours following admission.

Question 203

In ICU pts, if necessary, when should patients who cannot tolerate enteral feeding, start total parenteral nutrition?

Answer 203

For patients who cannot tolerate enteral feeding, total parenteral nutrition
should not be started before day 7 of an acute illness.

Question 204

As opposed to TPN, when should parenteral nutrition be started as soon as possible for severely malnourished patients and those at
high risk of malnutrition when enteral nutrition is not possible?

Answer 204

Parenteral nutrition
should be started as soon as possible for severely malnourished patients and those at
high risk of malnutrition when enteral nutrition is not possible. Caloric and protein

Question 205

Which clinical syndrome is associated with daytime hypercapnia, defined as a PCO2 >45 mm Hg, also HF, PH, and volume overload are common?

Answer 205

Obesity-Hypoventilation Syndrome

Question 206

what is the recommended tx for Obesity-Hypoventilation Syndrome?

Answer 206

Weight loss, including bariatric surgery, and bilevel positive airway pressure ventilation
are recommended.

Question 207

some tests for OSA can be done at home and some have to be done in a lab. What are indications to do this in a lab?

Answer 207

In-laboratory polysomnography is the gold standard test for:
* mission critical workers (truck drivers, pilots)
* complicated OSA
* patients with HF, neuromuscular disease, or advanced pulmonary disease

Question 208

what is the main difference between Obesity-
hypoventilation syndrome and OSA?

Answer 208

Obesity-hypoventilation syndrome is usually associated with COPD and always with elevated arterial PCO2 levels when awake.

Question 209

What is the initial treatment of choice for OSA ?

Answer 209

CPAP is the initial treatment of choice for OSA and has been shown to improve quality
of life, cognitive function, and symptoms of daytime sleepiness.

Question 210

for OSA patients who do not benefit from or tolerate CPAP, what alternative tx option is available to improves outcomes?

Answer 210

Maxillomandibular advancement surgery improves the AHI and can be considered for
patients who do not benefit from or tolerate positive airway pressure therapy.

Question 211

Which surgery is recommended in OSA pts if they have to have it?

Answer 211

Uvulopalatopharyngoplasty is a recommended surgical option in patients
requiring surgery.

Question 212

In pts with silicosis, fever, and cough, what else should they be evaluated for?

Answer 212

The incidence of TB is increased in those with silicosis and should be evaluated in
patients with silicosis, fever, and cough.

Question 213

how is occupational asthma dx?

Answer 213

For management occupational asthma, select
spirometry or PEF measurement before and after work (or during vacation).

Question 213

how is occupational asthma dx?

Answer 213

For management occupational asthma, select
spirometry or PEF measurement before and after work (or during vacation).

Question 214

what is the initial management for any new unexplained effusion?

Answer 214

A thoracentesis is indicated for any new unexplained effusion.

Question 215

What Pleural fluid LDH–serum LDH ratio >0.6 suggest an exudative ?

Answer 215

Pleural fluid protein–serum protein ratio >0.5
Pleural fluid LDH >200 U/L (or >2/3 the ULN)
Pleural fluid LDH–serum LDH ratio >0.6

Question 216

What Pleural fluid LDH suggest an exudative ?

Answer 216

Pleural fluid LDH >200 U/L (or >2/3 the ULN)

Question 217

What Pleural fluid protein–serum protein ratio suggest an exudative ?

Answer 217

Pleural fluid protein–serum protein ratio >0.5

Question 218

how many of the criteria have to be met to be exudative?

Answer 218

An effusion is considered an exudate if any one of the above criteria is met.

Question 219

What are the 2 most common exudates vs transudates?

Answer 219

transudates: HF and Cirrhosis

exudates include Parapneumonic and Malignancy

Question 220

In evaluating pleural studies , if you see Bloody pleural fluid (RBC count 5000-10,000/μL), what should you think?

Answer 220

Malignancy, pulmonary infarction, asbestos related

Question 221

In evaluating pleural studies , if you see Lymphocytosis >80%, what should you think?

Answer 221

TB, lymphoma, chronic rheumatoid pleuritis, sarcoidosis, malignancy

Question 222

In evaluating pleural studies , if you see Nucleated cells >50,000/μL, what should you think?

Answer 222

Complicated parapneumonic effusions and empyema

Question 223

In evaluating pleural studies , if you see pH <7.2, what should you think?

Answer 223

Complicated parapneumonic effusion

Question 224

In evaluating pleural studies , if you see Pleural fluid amylase to serum amylase
ratio >1, what should you think?

Answer 224

Pancreatic disease, esophageal rupture

Question 225

In evaluating pleural studies , if you see Glucose <60 mg/dL, what should you think?

Answer 225

Complicated parapneumonic effusion or empyema, TB, rheumatoid pleuritis, esophageal rupture

Question 226

In evaluating pleural studies , if you see Chylothorax (triglycerides >110 mg/dL), what should you think?

Answer 226

Disruption of thoracic duct (surgery, trauma), lymphoma, TB

Question 227

Which Pleural fluid lab is elevated in most TB effusions?

Answer 227

Pleural fluid adenosine deaminase is elevated in most TB effusions.

Question 228

After how many samples of pleural fluid is the yield for positive malignant cytology maximized ?

Answer 228

The yield for positive malignant cytology is maximized after two samples.

Question 229

When should thoracoscopy should be performed for an effusion ?

Answer 229

Thoracoscopy should be performed for an undiagnosed exudative effusion (two
negative cytology examinations) when malignancy is suspected.

Question 230

in what 3 circumstances do Parapneumonic pleural effusion requires chest tube drainage ?

Answer 230

Parapneumonic pleural effusion requires chest tube drainage if Gram stain or culture is
positive, when the pH is <7.2, or if it appears loculated on imaging.

Question 231

What coverage should empyemas include at a minimum?

Answer 231

Anaerobes are cultured in up to 72% of empyemas; empiric antibiotic therapy should
include anaerobic coverage.

Question 232

For patients with malignant effusions what two options do you have to provide symptom relief? and which is more effective?

Answer 232

For patients with malignant effusions, indwelling pleural catheters provide symptom
relief, and up to 70% of patients achieve spontaneous obliteration of the pleural space
(pleurodesis) after 6 weeks. Chemical pleurodesis with talc has a 90% success rate.

Question 233

what syndrome should be evaluated in pts with Pleural effusions associated with nephrotic syndrome?

Answer 233

Pleural effusions associated with nephrotic syndrome are common, but PE should
be excluded in such patients because PE and renal vein thrombosis often occur in
patients with nephrotic syndrome.

Question 234

When chylothorax is diagnosed in a premenopausal
woman, what other dx should be considered?

Answer 234

Consider pulmonary Lymphangioleiomyomatosis when chylothorax is diagnosed in a premenopausal
woman.

Question 235

what is seen on CT in pts with primary
pneumothorax?

Answer 235

Subpleural blebs
and bullae are commonly detected on CT scan and predispose to primary
pneumothorax.

Question 236

Clinical syndrome associated with SOB and no
underlying lung disease in Tall men who smoke ?

Answer 236

Spontaneous pneumothorax

Question 237

Which clinical syndrome is associated with ?

Question 238

Which clinical syndrome is associated with ?

Answer 238

pulmonary LAM in a premenopausal woman presenting with a spontaneous
pneumothorax and lung disease

Question 239

Which clinical syndrome is associated with SOB, in patients with HIV and Pneumocystis jirovecii
pneumonia ?

Answer 239

secondary pneumothorax in patients with HIV and Pneumocystis jirovecii
pneumonia

Question 240

Which clinical syndrome is associated with with falling BP and oxygen saturation, tracheal deviation, and absence of breath sounds in one hemithorax?

Answer 240

tension pneumothorax with falling BP and oxygen saturation, tracheal deviation,
and absence of breath sounds in one hemithorax

Question 241

Which clinical syndrome is associated with premenopausal woman presenting with a spontaneous
pneumothorax and lung disease ?

Answer 241

Lymphangioleiomyomatosis (LAM)?

Question 242

What is the most common cause of secondary pneumothorax?

Answer 242

emphysema as the most common cause of secondary pneumothorax

Question 243

Which clinical syndrome is associated with this pic ?

Answer 243

Large Pneumothorax

Question 244

In evaluating pneumothorax, what is the clinical significance of The presence of lung sliding vs the presence of a lung point ?

Answer 244

The presence of lung sliding with ultrasound imaging indicates no pneumothorax at
that specific location, and the presence of a lung point confirms the edge of a
pneumothorax.

Question 245

Should you wait for chest x-ray results before treating suspected tension
pneumothorax with needle decompression?

Answer 245

Do not wait for chest x-ray results before treating suspected tension
pneumothorax with needle decompression.

Question 246

for patients who have had a repeat primary spontaneous pneumothorax what tx should be considered?

Answer 246

Pleurodesis is performed for a second primary spontaneous pneumothorax and may be
performed after a first occurrence in secondary spontaneous pneumothorax.

Question 247

How does the Management of Pneumothorax change with a pneumo <2 cm on chest x-ray and minimal symptoms vs a lesion >2 cm on chest x-ray, breathlessness, and chest pain?

Answer 247

If GREATER than 2 cm with sxs, Insertion of a small-bore (<14 Fr) thoracostomy tube with connection to a high-volume low-pressure suction system. If LESS than 2 cm wiyh no sxs, Needle aspiration or admit to hospital for observation and supplemental oxygen

Question 248

In dx airflow obstruction such as asthma, COPD, and bronchiectasis, what number indicated obstruction?

Answer 248

FEV1/FVC <0.7 (or below the LLN) indicates airflow obstruction.

Question 249

After use of a bronchodilator, an increase in which numbers and by how much indicates reversible airway obstruction?

Answer 249

A ≥12% increase in either FEV1 or FVC and an increase ≥200 mL from baseline in
either parameter with bronchodilator therapy indicates reversible airway
obstruction.

Question 250

Which type of changes in in FEV1 and FVC suggest restrictive lung disease?

Answer 250

Equal reductions in FEV1 and FVC suggest restrictive lung disease.

Question 251

what does DLCO evaluate?

Answer 251

DLCO evaluates gas transport across the alveolar-capillary membrane.

Question 252

How does the TLC change in obstructive disease vs restrictive diseases?

Answer 252

The TLC is normal or even increased in pure obstructive disease and decreased in restrictive
diseases.

Question 253

Which pulmonary clinical syndrome is associated with ↓ DLCO and reduced lung volumes ?

Answer 253

DPLD

Question 254

Which pulmonary clinical syndrome is associated with ↓ DLCO and normal lung volumes ?

Answer 254

Pulmonary vascular disease, anemia

Question 255

Which pulmonary clinical syndrome is associated with ↓ DLCO and airflow obstruction ?

Answer 255

COPD, bronchiectasis

Question 256

Which pulmonary clinical syndrome is associated with ↑ or normal DLCO and airflow obstruction ?

Answer 256

Asthma

Question 257

Which pulmonary clinical syndrome is associated with ↑ DLCO ?

Answer 257

Pulmonary hemorrhage, left-to-right shunt, polycythemia

Question 258

Which clinical syndrome is associated with the following flow volume loop??

Answer 258

Restrictive

Question 259

Which clinical syndrome is associated with the following flow volume loop??

Answer 259

Obstructive

Question 260

Which clinical syndrome is associated with the following flow volume loop??

Answer 260

Upper airway obstruction

Question 261

What clinical syndrome is suggested by patients with low lung volumes, but a normal DLCO ?

Answer 261

In patients with low lung volumes, a normal DLCO suggests an extrapulmonary
cause (e.g., obesity).

Question 262

How does the Pulse oximetry change in patients with carbon monoxide and cyanide
poisoning?

Answer 262

Pulse oximetry is normal in patients with carbon monoxide and cyanide
poisoning.

Question 263

If smoke inhalation or carbon monoxide poisoning is suspected what should be used instead of pulse ox?

Answer 263

Use co-oximetry when carboxyhemoglobin is suspected (e.g., smoke inhalation, carbon monoxide poisoning)

Question 264

In what unique situation should Cardiopulmonary
exercise testing be done?

Answer 264

Performed for unexplained dyspnea, symptoms disproportionate to the measured pulmonary function abnormality, and other exercise-related symptoms

Question 265

Which test is Useful to assess disability, need for supplemental oxygen, and prognosis in chronic lung conditions?

Answer 265

6-Minute walk test

Question 266

Which clinical syndrome is associated with elevated Fractional exhaled nitric oxide (FeNO) levels?

Answer 266

1. Elevated FeNO levels correlate modestly with blood and sputum eosinophilia (inflammation)
2. Can predict glucocorticoid responsiveness in patients with respiratory symptoms;

Question 267

What is the resting mean pulmonary arterial pressure and a
pulmonary capillary wedge pressure

Answer 267

PH is defined by a resting mean pulmonary arterial pressure of ≥20 mm Hg and a
pulmonary capillary wedge pressure ≤15 mm Hg.

Question 268

Which clinical syndrome is associated with unexplained dyspnea, decreased exercise tolerance, syncope and near-syncope, lower extremity edema with Physical examination findings of RV failure, RV heave, right-
sided S3, widely split S2, increased P2, increased jugular venous distention with a large a wave, and a murmur of TR.?

Answer 268

Pulmonary Hypertension

Question 269

what is the initial evaluation for the Pulmonary Hypertension?

Answer 269

echocardiography as the initial study

Question 270

What is the next step in evaluation after a diagnosis of Pulmonary Hypertension is confirmed?

Answer 270

If the diagnosis of PAH is confirmed, the next step is a vasoreactivity test using
vasodilating agents to measure changes in pulmonary artery pressure with a right heart
catheter in place.

Question 271

In evaluation of pulmonary hypertension, what other diagnostic tests can be used after echo has been done?

Answer 271

right heart catheterization to confirm the diagnosis and quantify the degree of
PH

• left heart catheterization and coronary angiography exclude LV dysfunction as a
  cause of PH

Question 272

Which clinical syndrome is associated with after an acute PE, thromboemboli within the pulmonary arteries become remodeled into large occlusive scars?

Answer 272

In some patients (<5%) after an acute PE, thromboemboli within the pulmonary arteries
become remodeled into large occlusive scars, causing Chronic thromboembolic pulmonary hypertension and leading to right-sided
HF.

Question 273

Which clinical syndrome is associated with pulmonary artery pressure ≥20 mm Hg in the absence of left-sided HF and compatible imaging evidence of chronic thromboembolism by V/Q scanning?

Answer 273

Chronic thromboembolic pulmonary hypertension

Question 274

What are the 2 most common causes of pulmonary hypertension?

Answer 274

Most cases of PH are attributed to left-sided heart disease and hypoxic
respiratory disorders.

Question 275

Can a CTA be used to diagnose CTEPH?

Answer 275

Do not select CTA to diagnose CTEPH. A V/Q scan is superior.

Question 276

For patients with diagnosed PAH, what therapy should be used if a patient has been shown to demonstrate a vasodilator response on right heart catheterization?

Answer 276

Calcium channel blockers are used for patients demonstrating a vasodilator
response on right heart catheterization.

Question 277

what is the recommended first-line therapy for PAH if the patient is willing and
able to tolerate it?

Answer 277

Combination therapy with ambrisentan (prostacyclin analogue) and tadalafil (
PDE-5 inhibitor) is the recommended first-line therapy if the patient is willing and
able to tolerate it.

Question 278

What is the only definitive therapy for CTEPH?

Answer 278

Pulmonary
thromboendarterectomy is the only definitive therapy for CTEPH.

Question 279

What additional life-long treatment is indicated in all patients with CTEPH?

Answer 279

Life-long anticoagulant therapy is indicated in all patients with CTEPH.

Question 280

In patients with PAH, which therapy should NOT be used in patients if pulmonary artery pressure is not decreased with a vasoreactivity test?

Answer 280

Do not select calcium channel blockers if pulmonary artery pressure is not
decreased with a vasoreactivity test.

Question 281

What other syndrome is associated sarcoidosis and has 95% diagnostic specificity for sarcoidosis?

Answer 281

Löfgren syndrome (fever, bilateral hilar lymphadenopathy, EN, and often ankle
arthritis)

Question 282

Which clinical syndrome is associated with chest x-ray (bilateral hilar lymphadenopathy ± parenchymal lung disease, or lung
parenchymal disease)?

Answer 282

(sarcoidosis

Question 283

which 3 lab abnormalities can be associated with sarcoidosis?

Answer 283

serum calcium level (kidney stones and hypercalcemia)
* serum PTH level (low) for patients with hypercalcemia/hypercalciuria
* 1,25-dihydroxy vitamin D3 level (high) in patients with kidney stones and
hypercalcemia

Question 284

Which clinical syndrome is associated with this pic ?

Answer 284

Waxy papular lesions on the nose consistent with sarcoidosis.

Question 285

In a pt with suspected sarcoidosis, what other 2 conditions should also be ruled out? and how?

Answer 285

Always rule out TB and fungal infections by ordering appropriate stains and
culture on tissue biopsy.

Question 286

what occupational exposure may cause a sarcoidosis-like clinical syndrome?

Answer 286

Exposure to beryllium (often found in workers in light bulb or semiconductor
factories) may cause a sarcoidosis-like clinical syndrome.

Question 287

what occupational exposure may cause a sarcoidosis-like clinical syndrome?

Answer 287

Exposure to beryllium (often found in workers in light bulb or semiconductor
factories) may cause a sarcoidosis-like clinical syndrome.

Question 288

wat is the tx for progressive or symptomatic pulmonary sarcoidosis; hypercalcemia; or cardiac, ophthalmologic, or neurologic sarcoidosis?

Answer 288

Oral glucocorticoids are
indicated for progressive or symptomatic pulmonary sarcoidosis; hypercalcemia; or cardiac, ophthalmologic, or neurologic sarcoidosis.

Question 289

in treating sarcoidosis, how does the tx differ for associated skin lesions or anterior uveitis, vs nasal polyps or airway disease?

Answer 289

Topical glucocorticoids are prescribed for skin lesions or anterior uveitis, and inhaled
glucocorticoids are used for nasal polyps or airway disease.

Question 290

in treating sarcoidosis, how are patients with glucocorticoid-
refractory disease treated?

Answer 290

Patients with glucocorticoid-
refractory disease are treated with immunosuppressive, cytotoxic, and antimalarial

agents.

Question 291

what is the tx for Do not treat asymptomatic pulmonary sarcoidosis?

Answer 291

Do not treat asymptomatic pulmonary sarcoidosis.

Question 292

Which clinical syndrome is associated with this pic ?

Answer 292

X-ray shows bilateral hilar lymphadenopathy characteristic of sarcoidosis.
Sarcoidosis can be associated with interstitial lung disease.

Question 293

for pts with suspected sarcoidosis, what dx test should be done for interstitial lung disease or nodular lung involvement?

Answer 293

fiberoptic bronchoscopy with transbronchial biopsy and bronchoalveolar lavage
for interstitial lung disease or nodular lung involvement

Question 294

Which clinical syndrome is associated with ?

Question 295

Which clinical syndrome is associated with Low cardiac output, elevated PCWP, and high SVR

also Elevated CVP, S3, pulmonary crackles, edema,?

Answer 295

Cardiogenic shock

Question 296

Which clinical syndrome is associated with Low cardiac output, low PCWP, and high SVR?

Answer 296

Hypovolemic shock
Obvious source of volume loss (hemorrhage, dehydration, diarrhea, nausea/vomiting)

Question 297

Which clinical syndrome is associated with Low cardiac output, variable PCWP, and high SVR ?

Answer 297

Obstructive shock
Consider cardiac tamponade, PE, and tension pneumothorax

Question 298

Which clinical syndrome is associated with High cardiac output, normal PCWP, and low SVR ?

Answer 298

Anaphylactic shock

Rash, urticaria, angioedema, and wheezing/stridor

Question 299

Which clinical syndrome is associated with High cardiac output (early) that can become depressed (late) and low SVR ?

Answer 299

Septic shock

Known or suspected infection

Question 300

How do you diffe cardiac shock from hypveolmic shock?

Answer 300

Both have Low cardiac output and high SVR, but cardiogenic has elevated PCWP, but hypovolemic has low PCWP.

Question 301

How do you differ obstructive shock from hypovolemic shock?

Answer 301

Both have Low cardiac output and high SVR, but hypovolemic low PCWP while obstructive has a variable PCWP.

Question 302

Which two types of shock have low SVR?

Answer 302

septic and Anaphylactic shock

Question 303

what are the 3 components of treating Sepsis and Septic Shock?

Answer 303

1. Fluid resuscitation: Balanced crystalloids
   30 mL/kg within first hour
2. Vasopressors: Norepinephrine and then Vasopressin (norepinephrine-sparing agent)
   Indicated for persistent hypotension unresponsive to fluids
3. Source identification and control: Blood cultures, cultures of potential sites of infection, chest x-ray, urinalysis
4. Antibiotic therapy: Initiate within 1 h of diagnosis
   Narrow coverage based on culture and sensitivity findings

Question 304

In treating patients with septic shock, what is the treatment for persistent hypotension despite fluids and vasopressors?

Answer 304

Hydrocortisone 200-400 mg/d IV for persistent hypotension despite fluids and vasopressors

Question 305

what is the glucose goal for septic shock pts?

Answer 305

Insulin therapy to maintain glucose between 140 and 180 mg/dL

Question 306

In treating patients with Smoke Inhalation, what is the tx for Patients with a visibly damaged airway or stridor?.

Answer 306

Patients with a visibly damaged airway or stridor require immediate intubation.

Question 307

In treating patients with Smoke Inhalation, what lab must be assessed?

Answer 307

Assess carbon monoxide level.

Question 308

if this lab is normal, cyanide poisoning is excluded?

Answer 308

A normal
LDH level excludes cyanide poisoning.

Question 309

Cyanide exposure is common in house fires. How is cyanide poisoning treated?

Answer 309

. Treat cyanide poisoning with hydroxocobalamin.

Question 310

what does a normal oxygen level tell you about a patient with a smoke inhalation injury?

Answer 310

Normal oxygen saturation does not exclude either carbon monoxide or cyanide
poisoning.

Question 311

Which Toxic Syndrome is associated with Tachycardia
Hypertension
Diaphoresis
Agitation
Seizures
Mydriasis

Answer 311

Sympathomimetics:
Cocaine
Amphetamines
Ephedrine
Caffeine

Question 312

Which Toxic Syndrome is associated with Tachycardia
Hypertension
Diaphoresis
Agitation
Seizures
Mydriasis

Answer 312

Sympathomimetics:
Cocaine
Amphetamines
Ephedrine
Caffeine

Question 313

Which Toxic Syndrome is associated with
“SLUDGE”
Confusion
Bronchorrhea
Bradycardia
Miosis

Answer 313

Cholinergic
Organophosphates
(insecticides, sarin)
Carbamates
Physostigmine
Edrophonium
Nicotine

Question 314

Which Toxic Syndrome is associated with
Hyperthermia
Dry skin and mucous
membranes
Agitation, delirium
Tachycardia, tachypnea
Hypertension
Mydriasis

Answer 314

Anticholinergic:
Antihistamines
Tricyclic antidepressants
Antiparkinson agents
Atropine
Scopolamine

Question 315

Which Toxic Syndrome is associated with:
Miosis
Respiratory depression
Lethargy, confusion
Hypothermia
Bradycardia
Hypotension

Answer 315

Opioids
Morphine and related drugs
Heroin

Question 316

what is The first step in evaluation of a Solitary Pulmonary Nodule?

Answer 316

The first step in evaluation is
comparison with previous imaging studies. Stability over time reduces the possibility of
cancer.

Question 317

what is The first step in evaluating a solid pulmonary nodule larger than 8 mm?

Answer 317

Solid
nodules with moderate probability of malignancy should be characterized further with a
PET scan.

Question 318

in evaluating a solid pulmonary nodule larger than 8 mm, a PET scan is done and is negative, what should be done next? what if its positive?

Answer 318

If the PET scan is negative, continued surveillance is warranted, whereas a
positive PET scan result may require resection.

Question 319

in evaluating a solid pulmonary nodule larger than 8 mm, If the probability of malignancy is initially
high, what should be done?

Answer 319

If the probability of malignancy is initially
high, obtain PET scan followed by surgical resection or chemotherapy and radiation.

Question 320

what side lung nodules are considered low risk? and how are these monitored?

Answer 320

Solid nodules 8 mm or smaller are estimated for risk of malignancy. Most can be
monitored with serial CT according to guidelines.

Question 321

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule <6 mm in a pt with no risk factors for lung cancer?

Answer 321

No follow-up

Question 322

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule 6-8 mm in a pt with no risk factors for lung cancer?

Answer 322

CT at 6-12 months, then consider CT at 18-24 months

Question 323

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule >8 mm in a pt with no risk factors for lung cancer?

Answer 323

Consider CT at 3 months, PET/CT, or tissue sampling

Question 324

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule >8 mm in a pt with high risk factors for lung cancer?

Answer 324

Consider CT at 3 months, PET/CT, or tissue sampling

Question 325

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule 6-8 mm in a pt with high risk factors for lung cancer?

Answer 325

CT at 6-12 months, then CT at 18-24 months

Question 326

What is the recommended CT interval/follow up for a Single Solid Pulmonary Nodule <6 mm in a pt with high risk factors for lung cancer?

Answer 326

Optional CT at 12 months

Question 327

in terms of a pulm nodule, what features related to ground glass nodule suggest malignancy, vs what suggests malignancy in a solid nodule?

Answer 327

Development of a solid
component in a pure ground-glass nodule or enlargement of the solid component
suggests malignancy.

Question 328

what size ground glass lung nodules require follow up with CT at 6-12 months to confirm persistence? and what size requires no follow up?

Answer 328

Pure ground glass <6 mm require No follow-up while those ≥6 mm need CT at 6-12 months to confirm persistence, then CT every 2 years until 5

years

Question 329

As opposed to a sole ground glass nodule, how is a nodule with Part solid nodule monitored when less than 6mm vs more than 6mm?

Answer 329

<6 mm needs no No follow-up while ≥6 mm CT at 3-6 months to confirm persistence. If unchanged and solid
component remains <6 mm, annual CT should be performed for 5 years

Question 330

what sized Pulmonary mass, is highly suspicious for malignancy in a patient with risk factors?

Answer 330

Pulmonary mass, defined as >3 cm in diameter, is highly suspicious for malignancy
in a patient with risk factors.

Question 331

what is the first step in the evaluation of a pulmonary mass, defined as >3 cm in diameter, is highly suspicious for malignancy
in a patient with risk factors?

Answer 331

Either a biopsy for tissue diagnosis (in the absence of
suspected metastases) or surgical resection (if no evidence of metastatic disease) is
typically the first step in the evaluation.

Question 332

As opposed to pts with no mets or without advanced disease, whats the best way to evaluate a pulmonary mass, defined as >3 cm in diameter in patients with radiographic evidence of
advanced-stage disease?

Answer 332

In patients with radiographic evidence of
advanced-stage disease, diagnosis and staging are best accomplished with a single
invasive test at a location that will establish the diagnosis and the stage of disease.

Question 333

Before ordering contrast CT, bronchoscopy, or PET scan to evaluate a parge pulm mass, what should be done first?

Answer 333

Before ordering contrast CT, bronchoscopy, or PET scan, compare current image
with previous image to determine stability over time.

Question 334

In evaluating a large pulm mass, does A nonspecific negative result from fiberoptic bronchoscopy or transthoracic
needle aspiration biopsy reliably exclude the presence of a malignant
growth?

Answer 334

A nonspecific negative result from fiberoptic bronchoscopy or transthoracic
needle aspiration biopsy does not reliably exclude the presence of a malignant
growth.

Question 334

In evaluating a large pulm mass, does A nonspecific negative result from fiberoptic bronchoscopy or transthoracic
needle aspiration biopsy reliably exclude the presence of a malignant
growth?

Answer 334

A nonspecific negative result from fiberoptic bronchoscopy or transthoracic
needle aspiration biopsy does not reliably exclude the presence of a malignant
growth.

Question 335

Which clinical syndrome is associated with patients with acute onset dyspnea, hypoxemia, and pulmonary infiltrates that occur during or within 6 hours after transfusion of any plasma containing blood product.?

Answer 335

Transfusion-related acute lung injury (TRALI) should be considered in patients with acute onset dyspnea, hypoxemia, and pulmonary infiltrates that occur during or within 6 hours after transfusion of any plasma containing blood product. Treatment involves mainly supportive care, stopping the transfusion, and vasopressor support for hypotension. The blood bank should be notifled and the blood donor investigated to prevent future incidents in other recipients.

Question 336

How does Transfusion-related acute lung injury differ from Transfusion-related circulatory overload ?

Answer 336

Transfusion-associated circulatory overload (TACO) usually presents with physical findings suggesting volume overload (e.g., elevated JD, presence of an 53). Measurement of serum brain natriuretic peptide (BNP) or NT-Pro-BNP can also help in distinguishing TRALI from TACO.

Question 337

which 3 types of procedures do not require endocarditis prophylaxis?

Answer 337

1. Gl procedures (eg, endoscopic retrograde cholangiopancreatography, esophagogastroduodenoscopy)
2. • GU procedures (eg, prostatectomy, catheter insertions)
3. Vaginal or cesarean delivery

Question 338

Multifocal atrial tachycardia is most commonly associated with what other underlying condition?

Answer 338

Multifocal atrial tachycardia most commonly occurs in elderly patients with an exacerbation of underlying pulmonary disease (eg, chronic obstructive pulmonary disease), and is characterized by ECG showing an atrial rate > 100/min, irregular R-R intervals, and ≥3 distinct P wave morphologies. Treatment is aimed at correcting the underlying inciting disturbance.