Pulmonary Flashcards
1
Q
What causes bronchiolitis
A
RSV
2
Q
How to manage broncholitis
A
Rehydration
3
Q
Ptn with mild asthma, treatment
A
SABA with ICS
4
Q
How many years the average smoker loses
A
10 years
5
Q
Smoking will increase risk of lung cancer by ..,,folds
A
30 folds
6
Q
Smoking incubation period in lung cancer is
A
20 years
7
Q
Risk of MI in smoker vs non smoker
A
2
8
Q
Ptn with lung cancer has dyspnea, raised JVP and clear lungs with low heart sound what to do for investigation
A
Echo
9
Q
Lung cancer ptn has picture of superior vena cava obstruction ( face flushing ect, ) what type of lung cancer
A
Small cell lung cancer
10
Q
Alteplase is the treatment for
A
PE
11
Q
Smoker presents with hemoptysis and pleural effusion without shifting apex beat and trachea, what’s the cause?
A
Cancer in the ipsilateral main bronchi
12
Q
Name leukotriene receptor antagonist
A
Montelukast
13
Q
Ptn present with asthma exacerbation, name drug that affect mucous secretion more than bronchodilation ?
A
Prednisone
14
Q
52 year old smoker for 40 years is now complaining of cough for 4 months that happened on fall and last year as well same time with cold symptoms, also she has a mild dyspnea, No hemoptysis what your diagnosis
A
Chronic bronchitis
15
Q
COPD Ptn on salbutamol but now not controlled, what to add
A
Tiotropium
16
Q
Female ptn with progressive dyspnea and fatigue is having crackles on auscultation, when examining her lower limb she has red tender induration on her shin, what the next step
A
Chest X-ray
17
Q
Improve survival in COPD ?
A
Stop smoking
18
Q
Sever case of COPD with full secretions
A
Invasive MV
19
Q
Indication of oxygen therapy in COPD
A
…??? 7.3?…
20
Q
Smoker recently diagnosed with SLE what’s life style changes
A
Stop smoking
21
Q
Tall ptn developed dyspnea after long flight, pneumothorax is found what’s next
A
If <3cm = conservative, if >3cm then chest tube
22
Q
Ptn coming back from east Asia with symptoms of tb , X-ray showing cavitation what’s next
A
Sputum for acid fast bacilli, isolation
23
Q
Ptn with productive cough + dyspnea + fever, X-ray shows bilateral middle lobe consolidation, test shows reticulocytes cold agglutination test. Whats diagnosis
A
Atypical pneumonia
24
Q
Most common organism that causes lobar pneumonia is
A
Streptococcus pneumoniae
25
Tb drug that causes hyperurecemia
Pyrazinamide
26
Which one of the asthma drugs cause hypokalemia
Salbutamol
27
Ptn with exudative pleural effusion has positive gamma interferon, what’s your diagnosis
TB pleural effusion
28
What’s the best diagnostic test for occupational asthma?
Serial PFTS at work and home
29
Pregnant ptn presents with dyspnea, productive cough of white sputum she tells you that she’s allergic to dust what to do in diagnosis
Spirometry
30
………is ass, with pulmonary TB
Silicosis
31
What’s prevalence of disease effect
Predictive value
32
What’s the only approved drug to help quit smoking
Varenicline
33
Community acquired pneumonia is treated by….
Azithromycin
34
Heavy smoker with facial plethora + distended JVP ,what’s your diagnosis
Small cell lung cancer
35
Ptn with known asthma present cough, night sweats, with cavitation on his new X-ray which before didn’t exist on old X-ray wha to do ?
Isolate him in negative room pressure
36
What’s the definitive diagnostic test for ptn with bronechtasis?
HRCT
37
Case with TB, what test should be done before giving treatment
LFT
38
Cancer ptn with pleural effusion who did multiple tab but recurrence keep happening what’s the solution?
Chemical pleurodesis
39
Side effect of BB……
Bronchospam
40
Elderly ptn with breast mass and pulmonary symptoms, what’s the most likely diagnosis
Exudative pleural effusion due to malignancy
41
Old ptn has chest infection 4 weeks ago which initially improved on antibiotics but now he developed pleural effusion, diagnosis?
Para-pneumonic pleural effusion
42
Obese Ptn with sleep apnea symptoms, what is the best for diagnosis
Polysomnography
43
Case of TB with pleural effusion, What test can confirm that this pleural effusion is due to TB
High pleural fluid ADA level
44
Ptn with pulmonary embolism, unstable, BP is less than 90/60 what your management
Give thrombolytics
45
Ptn with recurrent chest infection and weight loss, diagnosis
Cystic fibrosis
46
Ptn with highly productive cough ( maybe bronchiectasis) what’s the diagnostic test?
CT scan
47
Male smoker with weight loss and dry cough? Diagnosis
Lung cancer
48
What causes false positive BNP?
COPD
49
Pregnant ptn on SABA complains of cough 2/week and 2 hospital admission, treatment
LABA with ICS
50
Asthma Ptn with anxiety, what to give
Sertaline
51
Ptn has immotile sperms on semen analysis, he had history of chronic sinusitis and chronic URI , what’s the diagnosis
Kartagner syndrome
52
Male Ptn presents with multiple episodes of forceful vomiting, abdominal pain , dyspnea, and subcutaneous emphysema in the chest, what is the diagnosis?
Borehaave syndrome
53
Parents have confirmed TB infection and they have a close contact to their child, the child tuberculin test shows 10mm induration what does it mean
The child is positive
54
Ptn with schistosomiasis , what’s the expected complication?
Pulmonary hypertension
55
Ptn with suspected TB is has pleural effusion, how can you confirm
Adenosine diamines more than 45IU
56
……. Can cause TB
Silicosis
57
Name anti TB drugs that causes hyperurecemia
Pyrazinamide, Ethambutol
58
Old Ptn with small nodule , asymptotic, not smoker, No FH of cancer, what to do next
CT scan
59
Ptn has garlic odor with other non constitutional symptoms , what’s the case
Organophosphate poisoning
60
Immigrant pregnant woman with productive cough, night chills, cervical lymphadenopathy. interferon gamma release test was positive, how to confirm diagnosis?
Sputum culture
61
Ptn with barking cough , what’s the most likely on auscultation
Stridor
62
Indication of sever asthma when the PEF is less than ……and inability……..
< 250, inability to complete sentence in one breath
63
Young male working in wood factory is having dyspnea, occupational asthma is suspected, how to diagnose
Serial peak flow measurement in work and in house
64
What’s the type of pneumoconiosis that will turn to TB
Silicosis
65
Before giving anti-TB drug what should you check?
LFT
66
Pleural effusion can be malignant if the glucose level
Less than 60 or PH less than 7.30
67
What’s the indication for thoracosentesis?
Loculated pleura
68
Ptn with pleurisy. Whats the site for thoracosentesis?
Mid axillary line between 8th-10th intercostal space
69
Ptn had spontaneous pneumothorax which resolved spontaneously, what to advise him?
Not to travel for 1 week
70
Patient 50 yrs. Old. Came for. Routine check. Up visit, by CXR you. Find.Solitary Cheast nodule. About 2*3 patient is asymptomatic ,what is most useful thing to ask.
Ask about old chest X-ray
71
Patient presenting with symptoms of obstructive lung disease. PFTs show decreased vital capacity and decreased FEV1/FVC ratio.what is associated with this condition?
Female with 3 wks hs of productive cough With decrease both FEV and ratio
What other finding?
Elderly patient with hx of excessive smoking presented with 2 weeks history of dry cough, nocturnal Spirometry showed decreased ratio FVC/FEF and decreased vital capacity. What else would be associated?
.
Patient with obstructive about Pulmonary function testing
Increased lung compliance
72
Asthma medications in pregnancy, what to take and what to stop?
pregnant women with asthma what tocolytics that C/I for her?
Continue the same / misoprostol
73
asthmatic patient, last OPD peak flow was 600, when to say it is acute sever asthma:
What indicates severe asthma?
A- peak flow of less 250
RR > 25
Inability to complete one sentence in one breath
74
Asthma salbutamol before exercise Not control ?add
Patient known case of asthma on albuterol , diagnosed as moderate persistent asthma what you will add ?
Add ICS
75
Patient using many drugs but he came with decreased K ? Cause?
He has HF and came with asthma attack then in ER they manag him with salbutamol and
he has decreased K what is the cause?
Salbutamol reduces serum potassium levels by increasing the shift of extracellular potassium into the intracelluar space.
76
```
Severe asthma (daily use of SABA and more than 2-3times night symptoms) on LABA and ICS, what to add

```
Theophylline
77
Asthma management: The best initial test in an acute exacerbation:
Peal expiratory flow
78
The best diagnostic test for asthma is ?
The most accurate diagnostic test is pulmonary function testing is ………
will show a decrease in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC
Spirometry
79
Asthma exacerbation after pneumonia whats the tx?
Ventolin + antibiotics
80
Asthma severe cant complete one sentence management?
Best treatment for obstructive sleep apnea?
obese snoring , lack sleep , sleep study done (OSA), how you will ventilate:
CPAP
81
Copd patient not responding to Salbutamol what’s the next drug?
Ipratropium
| Salbutamol + ICS in asthma
(Salbutamol + Ipratropium in COPD)
82
Male smoker since 3-4 years has dyspnea.Fev1/fvc is less than 0.7,Dlco is low,FEV1/FVC mildly improved after administration of beta blocker
What is the likely dx:
Emphysema
83
Case about moderat asthma on saba and ics what add ?
Long acting B agonist ( LABA )
84
Case of sever copd with full secretion :
Invasive mechanical ventilation
85
smoker with recurrent respiratory infection and productive cough, diagnosis
Chronic Bronchitis
86
Young female came to the clinic complaining of episodes of SOB, wheeze and cough for the last 6 months not related to certain provoker. She says that these episodes comes suddenly and resolve suddenly. She used ventolin but improved slightly. Upon physical exam she has equal air entry with no wheezing. She is not allergic to anything and no one in her family has the same problem.All test were normal and spirometry is normal. What is the dx ?
Female 20 y/o with dyspnea intermittently resolves suddenly. Minimal improvement with b agonist. Dx
Vocal cord dysfunction
87
Sever asthma exacerbation ( in distress )how to manage :
Magnesium sulfate
88
in case of acute asthma exacerbation what study is most accurate to monitor improvement=
PFTs
89
asthma exacerbation: ………. and …….
Ventoline and steroids
90
about Exercise induced asthma, management? ………. pre exercise
Salbutamol
91
Asthmatic patient on SABA + steroid, free of symptoms for 1 year, next?
decrease steroid to half dose + SABA
92
Pt pregnant with bronchial asthma have SOB and whezzes and some times have night attacks of asthma
Give SABA & ICS
93
55yr old chronic smoker with chronic non productive cough presented with stable vitals. X ray done is normal.whats the likely diagnosis?
COPD
94
child presented with sinusitis and recurrent lower respiratory tract infections.Mcs of bronchial aspirate had pseudomonas aeruginosa.Whats the diagnosis?
Cystic fibrosis
95
Pt known to have emphysema, undergo some GIT operation (lap choly i think),
then pt is complaining of progressive dyspnea. ABG: high CO2 and high O2
Your management
Intubation and hyperventilation
96
Pt known case of COPD or asthma non compliant to medications with recurrent admissions:
Ask his partner or family to give medicine ( maybe )
97
Patient have anxiety for 4 years and have asthma she noticed when she use salbutamol symptoms get worse
-Patient with social anxiety and asthmatic, how to treat?
A-Propanalol. B-Bupropion c _ psychotherapy CBT if not mentioned SSRI.✅
Sertaline
98
Management of moderate asthma with night symptoms 6/ month
LDICS + LABA
99
case of poorly controlled asthma ?
Check the use of inhalers
100
COPD patient on salmeterol and albuterol, still not controlled as he needs to
use albuterol more often now and he had multiple exacerbations in the last 6 months, what to give him for maintenance
Tiotropium
101
Smoker, SOB, cough yellowish sputum, fever, examination wheezing, febrile, Dx?
Pneumonia
102
Patient presented with SOB only exertional, did spirometry and was normal, next?
methacholine challenge test
103
Pregnant lady presents with cough of white sputum, cough increased in severity and she developed SOB she is allergic to dust, mites and pollens what is the most imp investigation?
🌷accurate test for Asthma =…….?
🌹How to monitor asthmatic response to treatment ?
Spirometry
104
Copd cor pulmonale whats best thing to improve survival ?
Oxygen therapy
105
COPD patient with lower limb edema and hepatosplenomehay Right heart failure signs What to do to confirm dx?
Echo
106
What improves survival or reduce mortality in COPD?
Smoking cessation
107
Emphysema = …….DLCO
Low
108
Most common symptom of emphysema ?
Dyspnea
109
Scenario about a man with epilepsy poor controlled, have productive cough and fever Asked about what the source of infection?
Aspiration
110
How to assess COPD severity/prognosis:
FEV1
111
Indication of home therapy for copd pt?
resting PaO2 = 7.3 kPa (55 mm Hg) or SaO2 88% or less
112
best way to deliver oxygen in COPD pt?
Venture mask
113
COPD patient developed sudden symptoms of spontaneous pneumothorax, x ray was done and showed *2 cm* pneumothorax, mx
Needle
114
Scenario of SBP mx:
lactulose enema+ceftriaxone✅
115
COPD, affected conscious level, low pH?
COPD & heavy smoker hypoxia co2 retention patient drowsy?
COPD exacerbation and he is in coma, what to do?
```
#COPD elderly patient presented to the ER distress and full of secretion how
you will manage =
```
COPD pt came with respiratory functions detotriation and LOC with sever secretions in the throat mx?
....
COPd with signs of respiratory acidosis ?
Mechanical ventilation
116
Patient k/c of COPD alert, has moderate respiratory distress.SO2 93%, ABG showed hypoxia, hypercapnia and acidosis. What is next step:
Non invasive ventilation
117
When to consider invasive mechanical ventilation
➔ PaO2 < 40 mmhg. ➔ Ph < 7.25. (Acidosis) ➔ CO2 > 60 mmhg. ➔ Respiratory arrest. ➔ Cardiovascular collapse. ➔ Severe exacerbation with a lot of secretions.
118
Copd acute exacerbation with a mouth full of secretions =
Invasive mechanical ventilation
119
Copd acute exacerbation with a mouth full of secretions =
Invasive mechanical ventilation
120
exacerbation COPD Best management
COPD patient with exacerpation, given SABA and not improved, next management is: (O2 sat is 89%) and he is conscious:
Non invasive mechanical ventilation
Non invasive positive pressure ventilation
121
OPD patient came with severe cough, sputum production and cyanosis what to do
Bipap
122
patient with COPD develop *reproductive cough* for 3 months, what is the diagnosis?
Chronic bronchitis
123
What gives BNP false positive?
COPD
124
Pt smoker and dyspnea and character of clubbing?
Case of old smoker c/o cough, loss of nail bed angle?
Lung cancer
125
Smoker pt, c/o with dyspnea and couph with hemoptysis, trachea wasn’t shifted, xray showed massive right plueral effusion, whats the cause
Brochogenic carcinoma with ipsilatral bronchus compression
126
Pleural effusion because of malignancy is usually…..
Exudate
127
COPD C/O SOB palpitation O/E irregular pulse , treatment
Amiodarone
128
COPD monitoring ?
COPD Best indication of disease progression
FEV1
129
Know case of copd with cor pulmonale. which of the following will decrease mortality ?

( no answer )

A. oxygen mask therapy B. inhaled long acting beta blocker C.Long term 02 therapy D.NPPV
130
child with SOB and *Stony dullness* in percussion, what is the diagnosis?
Pleural effusion
131
carbon monoxide inhalation how you will mange ?
Inhalation 100% oxygen
132
smoker with non productive cough, fatigue and loss of 15% of weight what is the diagnosis
Lung cancer
133
Proper ET position how to check
Pt with orotracheal intubation who can detect it is in normal position:
Co2 monitor
continuous capnography for of carbon dioxide (CO2) in exhaled air, which assesses ventilation
134
Old patient, heavy smoker present with symptoms of Horner syndrome. what type of cancer
Pt smoker with lung cancer & Hypercalcemia ?
CXR on hilar mass , hypercalcemia?
Elderly smoker s&s of bronchogenic carcinoma which type:
Squamous cell cancer
135
Patient with Pulmonary hypertension to be evaluated for chronic thromboembolism, which investigation has the highest diagnostic yield?
V/Q scan
136
Patient with bronchiolitis and given supportive treat, what to do next?
Observe in ER
137
pulmonary HT type 3 other name is ?
Hypoxic
138
4 hrs post op patient has dyspnea and hypoxia cause?
A. lower lobe atelectasis ✅ B. PE
139
Cerebral palsy pt develops respiratory failure type ( signs of hypoxia )
Hypoxic
140
CO2 poisoning hbco 40% tx?
Hyperbaric
141
Case of lung cancer: non smoker male with sx found nodule in the lung whats your next step?
56 Y/O non smoker , asymptotic . Discovered lung nodule during the Old x-ray
Previous X-ray
Repeat X-ray
142
Dyspnea at night, sternal pain, Midline mass compressed trachea , diagnosis
Lymphoma
143
Pt came with lymph node enlargement his family concern about it to be cancer because
his son of uncle diagnosis before 3 weeks with lymphoma which think indicated biopsy:
A. It is size above 1 cm
B. Came with hepatosplenomegaly
C. Fever✅
D.tenderness
biopsy indicantion (especially if regional lymphadenopathy persistent >6 wk and/ or constitutional symptoms)
Constitutional symptoms = fever, chills, night sweats, unexplained weight loss
144
After mechanical ventilation what will happen:
Hypocapenia
