Pulm/crit

Question 1

Asthma with eosinophilia, high serum IgE, intermittent pulmonary infiltrates In the upper lobes. Dx?

Answer 1

Allergic bronchopulmonary aspergillosis (ABPA)

Question 2

Chest x-ray with photographic negative pulmonary edema (peripheral Pulmonary edema), Striking peripheral blood eosinophilia, fever, weight loss in a long-term smoker. Dx?

Answer 2

Chronic eosinophilic pneumonia

Question 3

Upper airway and sinus disease precedes difficult to treat asthma, flares associated with use of leukotriene inhibitors and glucocorticoid tapers. Dx?

Answer 3

Eosinophilic granulomatosis with polyangiitis

Question 4

Allergic bronchopulmonary aspergillosis diagnostic tests?

Answer 4

Positive skin test for aspergillus and IgG and IgE antibodies for aspergillus

Question 5

Chronic eosinophilic pneumonia Dx test? 2

Answer 5

Diagnose by bronchoscopy with biopsy or bronchoalveolar lavage W/High eosinophils

Question 6

Eosinophilic granulomatosis with polyangiitis Dx test?

Answer 6

Elevated P anca, diagnostic finding is eosinophilic tissue infiltrates

Question 7

What are the three components of lights criteria?

Answer 7

1) Pleural LDH greater than 2/3 upper limit of normal serum LDH 2) Pleural LDH/serum LDH greater than 0.6 3) Pleural protein /serum protein greater than 0.5

Question 8

What are the two most common causes of an exudate?

Answer 8

Infection and malignancy

Question 9

What kind of pleural effusion is Caused by a pulmonary embolism?

Answer 9

Transudative or exudative

Question 10

What are the three indications for a chest tube placement for pleural effusion?

Answer 10

1) Pus in pleural space 2) Positive culture on pleural space fluid 3) complicated parapneumonic effusion

Question 11

How do residual lung volumes and DLCO change with kyphosis compared to normal lungs?

Answer 11

DLCO remains normal while residual lung volumes are increased compared to normal

Question 12

Parapneumonic effusions typically arise As a result of which three conditions?

Answer 12

Lung Abscess, Bronchiectasis, pneumonia.

Question 13

Oxygen should be given if the patient has PA O2 less than what, or O2 saturation less than what during rest, Exercise or sleep?

Answer 13

PA O2 <55, 02 sat <88%.

Question 14

Bilateral hilar adenopathy, uveitis Dx?

Answer 14

Sarcoidosis (noncaseating granulomas)

Question 15

With allergic bronchopulmonary aspergillosis (ABPA), what two labs will be increased?

Answer 15

IgE and peripheral eosinophils greater than 10 percent

Question 16

Cystic Fibrosis Dx test?

Answer 16

sweat Chloride > 60 mmol. If sweat chloride neg but suspicion still high, tx as CF. Tx w/mucolytics, hydrating agents, inhaled abx,macrolides

Question 17

Rapid fire assoc: Desquamated epithelium casts in sputum

Answer 17

Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)

Question 18

What is the main pulmonary function test that helps differentiate obstructive from restrictive lung disease?

Answer 18

Total lung capacity (TLC)

Question 19

Rapid fire assoc: “Honeycomb lung” on x-ray or CT

Answer 19

Interstitial pulmonary fibrosis

Question 20

Rapid fire assoc: Iron-containing nodules in alveolar sputum

Answer 20

Ferruginous bodies (asbestosis: ↑ chance of mesothelioma)

Question 21

Rapid fire assoc: Colonies of mucoid Pseudomonas in lungs

Answer 21

Cystic fibrosis (autosomal recessive mutation in CFTR gene > fat-soluble vitamin deficiency and mucous plugs)

Question 22

Rapid fire assoc: Hexagonal, double-pointed, needle-like crystals in bronchial secretions

Answer 22

Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)

Question 23

Rapid fire assoc: Hilar lymphadenopathy peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Answer 23

Ghon complex (1º TB: Mycobacterium bacilli)

Question 24

Transient airway hyper responsiveness that occurs during or after strenuous activity is known as what?

Answer 24

Exercise induced Bronchoconstriction

Question 25

What are treatments for exercise induced Bronchoconstriction?

Answer 25

SABAs, Inhaled corticosteroids, leukotriene receptor antagonists

Question 26

What are the components of curb 65?

Answer 26

Confusion, urea>20, respirations >30,SBP (hypotension), age>65