Pulmo 2

Question 1

Uncomplicated parapneumonic effusion -
due to:
pleural fluid analysis:

Answer 1

increased flow of interstitial edema into pleural space

pH >7.20
normal glucose (nearly that of serum)

Question 2

complicated parapneumonic effusion - pleural fluid analysis:

Answer 2

pH <7.20

low glucose <60 mg/dL

Question 3

Malignant effusion

Answer 3

Lymphocyte predominant
erythrocytes >10,000
pH <7.20
low glucose

Question 4

______ can be used in patients with severe renal insufficiency (estimated glomerular filtration rate <30 mL/min/1.73 m2) for anticoagulation

Answer 4

unfractionated heparin

Question 5

Treatment of pulmonary embolism:

Answer 5

Once the heparin produces therapeutic anticoagulation (goal PTT >1.5-2 times normal), warfarin is initiated. Warfarin can take up to 5-7 days to reach therapeutic levels. After reaching a therapeutic INR, heparin can be stopped and warfarin can be continued long-term

Question 6

granulomatosis with polyangiitis (GPA)

Lower respiratory tract involvement may lead to

Answer 6

■ tracheal narrowing with ulceration,
c chest x-ray findings:
•multiple lung nodules with cavitation
•alveolar opacities.

Question 7

Cor pulmonale Chest x-ray findings

Answer 7

• enlarged central pulmonary arteries without evidence of vascular congestion.
• loss of retrosternal air space due to right ventricular hypertrophy.

Question 8

Antibiotics requirement in COPD exacerbation in:

Answer 8

■ Moderate to severe COPD exacerbation (defined as >2 cardinal symptoms), especially with increased sputum purulence or
■ Mechanical ventilation needed

Question 9

Roflumilast

Answer 9

phosphodiesterase inhibitor with anti-inflammatory properties that helps decrease mucociliary malfunction and pulmonary remodeling.

It is useful as maintenance therapy to reduce future exacerbations in patients with severe COPD and history of exacerbations, but it is not indicated during an acute exacerbation.

Question 10

_________ are the three tumors that cause approximately 75% of all malignant pleural effusions.

Answer 10

Lung carcinoma, breast carcinoma, and lymphoma

Question 11

Undiagnosed pleural effusion is best evaluated with _____ , except in patients ______

Answer 11

thoracentesis

with clear-cut evidence of congestive heart failure.

Question 12

Alkylosing spodylitis

Pulmonary function tests (PFT) may reveal

Answer 12

a mildly restrictive pattern with
■ ↓vital capacity (VC) and ↓ total lung capacity (TLC) but normal FEV1/FVC ratio.
■ Functional residual capacity (FRC) and residual volume (RV) are normal or increased due to fixation of the rib cage in an inspiratory position.

Question 13

Theophylline toxicity can manifest as

Answer 13

central nervous system stimulation (eg, headache, insomnia, seizures), gastrointestinal disturbances (eg, nausea, vomiting), and cardiac toxicity (arrhythmia).

Question 14

Theophylline toxicity antidote

Answer 14

Beta blocker

Question 15

The 3 most common causes of chronic cough (lasting _________ ) are ____________

Answer 15

> 8 weeks

■ upper-airway cough syndrome (postnasal drip),
■ asthma,
■ gastroesophageal reflux disease (GERD).

Question 16

DLCO increased, FEV1 and TLC are normal.

Answer 16

Alveolar hemorrhage

Question 17

Pneumothorax and Pulmonary edema follows _______ pattern of FLOW VOLUME CURVES

Answer 17

Restrictive

Question 18

In acute exacerbation of COPD Jugular venous distension (JVD) may be observed, especially during _______

Answer 18

expiration, due to increased intrathoracic pressure.

Question 19

The _______ nerve can be injured during cardiac surgery.

Symptoms:

Answer 19

phrenic nerve

■ dyspnea on exertion,
■ orthopnea,
■ paradoxical breathing movement (ie, abdomen moving inward on inspiration).

Question 20

Contraindications of NPPV:

Answer 20

1. Uncooperative / agitated patient
2. Inability to clear secretions or risk of aspiration (unconscious)
3. Severe acidosis <7.10
4. GI bleed
5. Encephalopathy (Glasgow coma scale <10
6. ARDS
7. Airway obstruction

Question 21

Systemic glucocorticoids decrease _____ associated with COPD exacerbation, improve lung function and hypoxemia, and have been shown to decrease __________

Answer 21

inflammation

risk of relapse, treatment failure, and length of hospital stay.

Question 22

Asthma and COPD are fundamentally distinguished by the ______. Therefore, the best test for discriminating between them is __________

Answer 22

reversibility of airflow obstruction

spirometry before and after a short-acting bronchodilator (eg, albuterol)

Question 23

Proper distinction is critical for the selection of long-term controller therapy: inhaled corticosteroids are preferred for_______, whereas inhaled antimuscarinic therapy is preferred for ________.

Answer 23

asthma

COPD

Question 24

Intermittent asthma is caused by _______

Answer 24

leukocyte-induced acute and reversible bronchoconstriction.

Question 25

a rare exception when left-sided preload and PCWP are discordant.

Answer 25

In tamponade, left-sided preload is decreased, but measured PCWP is paradoxically increased due to external compression by pericardial fluid.

Question 26

Medications such as ____ or ______ can exacerbate anaphylaxis by resulting in, __________ or __________ respectively.

Answer 26

nonsteroidal anti-inflammatory drugs or
beta-adrenergic blockers

nonimmunologic mast cell activation or unopposed alpha-adrenergic effects

Question 27

Acute Hypersensitivity pneumonitis. CXR findings

Answer 27

Chest x-ray: scattered micronodular interstitial opacities

Question 28

chronic Hypersensitivity pneumonitis Chest x-ray

Answer 28

Chest x-ray: diffuse reticular interstitial opacities