Pulmo 1

Question 1

Treatment of lung abscess

Answer 1

• Ampicillin-sulbactam is considered first-line therapy.
• Clindamycin is reserved for those with beta-lactam allergy due to high risk of subsequent Clostridioides (formerly Clostridium) difficile infection.
• A prolonged course is indicated; surgical intervention (eg, pneumonectomy, lobectomy) may be required in the rare cases that do not improve with antibiotic therapy.

Question 2

Lung abscess diagnosis made by

Answer 2

Chest x-ray and CT scan typically reveal cavitary infiltrates, often with air-fluid levels in the superior lower lobe or posterior upper lobe (sections that are dependent with recumbency).

Question 3

Oxygenation in mechanically ventilated patients may be improved by increasing the __________

Answer 3

fraction of inspired oxygen (FiO2) or increasing positive end-expiratory pressure (PEEP).

Question 4

If high levels (>60%) of FiO2 are required to maintain oxygenation, _____ should be increased to allow for reductions in the FiO2 as oxygenation improves.

Answer 4

PEEP levels

Question 5

Metabolic abnormalities in obesity hypoventilation syndrome

Answer 5

chronic hypoxia and hypercapnia.

the kidneys increase bicarbonate retention and decrease chloride reabsorption (via bicarbonate-chloride exchangers in intercalated cells of the distal nephron) to create a compensatory metabolic alkalosis.

Question 6

______ and _____ are associated with poor prognosis in PE.

Answer 6

Low oxygen saturation and atrial fibrillation

Question 7

_________ are the most common symptoms of Pulmonary embolism

Answer 7

Acute-onset dyspnea and pleuritic chest pain

Question 8

classic findings of PE on ECG and chest x-ray

Answer 8

(prominent S in lead I, Q in lead III, and inverted T in lead III [S1Q3T3])

(Hampton hump, Westermark sign)

Question 9

_______ is associated with PE;

Pathopgysiology:

Answer 9

Atrial fibrillation

some cases may result from atrial strain due to increased right atrial pressure

Question 10

________ may occur in the post-ictal state.

Answer 10

Hypoventilation → respiratory acidosis

Question 11

A _____ year interval is generally recommended for screening colonoscopy in hyperplastic polyp

Answer 11

10-year as there is no increased risk of it being converted into cancer

Question 12

Recommendation for screening for abdominal aortic aneurysm

Answer 12

One-time screening for abdominal aortic aneurysm with an abdominal ultrasound is recommended for men age 65-75 who have ever smoked (lifetime tobacco use ≥100 cigarettes).

Question 13

Recommendations for lung cancer screening

Recommended test

Recommended interval

Answer 13

Low-dose chest CT scan

Yearly

Question 14

Recommendations for lung cancer screening

Age for screening

Answer 14

55-80

Question 15

Recommendations for lung cancer screening

Eligibility

Answer 15

Patient has ≥30-pack-year smoking history
AND

Patient is a current smoker or quit smoking within the last 15 years

Question 16

Invasive pulmonary aspergillosis is characterized by the classic triad of .

Answer 16

fever, pleuritic chest pain, and hemoptysis

Question 17

Invasive pulmonary aspergillosis Diagnostic testing includes

Answer 17

serum biomarkers for cell wall components (eg, galactomannan assay)
and
sputum stain/culture.

bronchoscopy with bronchoalveolar lavage (BAL) and biopsy are required if noninvasive testing (eg, sputum stain/culture) is inconclusive.

Question 18

Invasive pulmonary aspergillosis treatment

Answer 18

Patients are treated with 1-2 weeks of intravenous voriconazole plus an echinocandin (eg, caspofungin)
and then
transitioned to prolonged therapy with oral voriconazole alone.

Question 19

______ is the second most common cause of adrenal insufficiency worldwide

Answer 19

Tuberculous adrenalitis

Question 20

If an immunocompromised patient (on prednisone) with community acquired pneumonia has a normal CXR then what is next best step?

Answer 20

high-resolution CT scan of the chest to identify pulmonary infiltrate.

Question 21

__________is characteristic of bronchiectasis due to CF and helps differentiate it from bronchiectasis due to other causes.

Answer 21

upper lung lobe involvement

Question 22

pleuritic chest pain and hemoptysis in PE is due to

Answer 22

Pulmonary infarction - inflammation and irritation of the lung parenchyma and adjacent visceral and parietal pleura

Question 23

A 2/6 midsystolic murmur is heard at the left upper sternal border

Answer 23

Fever induces a hyperdynamic state, which most likely accounts for this murmur (flow murmur).

Question 24

Pneumonia causes hypoxemia due to __________

Answer 24

right-to-left intrapulmonary shunting, a form of ventilation/perfusion (V/Q) mismatch

Question 25

The criteria for initiating long-term home oxygen therapy (LTOT) in patients with COPD include:

Answer 25

Resting arterial oxygen tension (PaO2) <55 mm Hg or pulse oxygen saturation (SaO2) <88% on room air
PaO2 <59 mm Hg or SaO2 <89% in patients with cor pulmonale, evidence of right heart failure, or hematocrit >55%

Question 26

The dose of supplemental oxygen should be titrated so that SaO2 is maintained at

Answer 26

> 90% during sleep, normal walking, and at rest.

Question 27

Survival benefits of home oxygen therapy are significant when it is used for

Answer 27

> 15 hours a day.

Question 28

Tidal volumes should be about

Answer 28

6 mL/kg of ideal body weight

Question 29

In patients taking diuretics, ________ is often used as an indicator of decreased renal perfusion.

Answer 29

low fractional excretion of urea (eg, <35%)

Question 30

Chest x-ray is not diagnostic for bronchiectasis but can reveal suggestive findings such as

Answer 30

linear atelectasis, dilated and thickened airways, and irregular peripheral opacities

Question 31

A high-resolution CT (HRCT) scan of the chest, the best diagnostic test for bronchiectasis, can demonstrate

Answer 31

characteristic bronchial dilation, lack of airway tapering, and bronchial wall thickening.