Pulmonary

Question 1

criteria for exudative effusion

Answer 1

light’s criteria:

1. pleural/serum protein > 0.5
2. pleural/serum LDH > 0.6
3. pleural fluid LDH > 2/3 ULN of serum LDH

Question 2

causes of exudative effusion

Answer 2

think of leak capillaries - malignancy, TB, bacterial or viral infections, pneumonia, PE w/ infarct, and pancreatitis

Question 3

causes of transudative effusion

Answer 3

think of intact capillaries - CHF, liver or kidney dz, and protein losing enteropathy

Question 4

normalizing pCO2 in a pt having an asthma exacerbation may indicate?

Answer 4

fatigue and impending respiratory failure

Question 5

dyspnea, lateral hilar lymphadenopathy on CXR, non-caseating granulomas, increased ACE, and hypercalcemia. Dx?

Answer 5

sarcoidosis

Question 6

PFTs of obstructive pulmonary disease

Answer 6

decreased FEV1/FVC

Question 7

PFTs of restrictive pulmonary disease

Answer 7

increased FEV1/FVC and decreased TLC

Question 8

honeycomb pattern on CXR. Tx?

Answer 8

diffuse interstitial pulmonary fibrosis - tx is supportive care; steroids may help

Question 9

tx for SVC syndrome

Answer 9

radiation

Question 10

tx for mild persistent asthma

Answer 10

inhaled beta-agonists and inhaled corticosteroids

Question 11

tx for COPD exacerbation

Answer 11

O2 (target O2sat at 88-92%), bronchodilators (beta-2 agonists and anti-cholinergics), abx, systemic corticosteroids w/ taper, and smoking cessation

Question 12

tx for chronic COPD

Answer 12

smoking cessation, home O2, beta-agonists, anti-cholinergic, systemic or inhaled corticosteroids, flu and pneumococcal vaccines

Question 13

acid-base disorder in PE

Answer 13

respiratory alkalosis w/ hypoxia and hypocarbia

Question 14

non-small cell lung cancer associated w/ hypercalcemia

Answer 14

squamous cell carcinoma

Question 15

lung cancer highly related to cigarette exposure

Answer 15

small cell lung cancer

Question 16

lung cancer associated w/ SIADH

Answer 16

small cell lung cancer

Question 17

tall white male presents w/ acute shortness of breath. Dx? Tx?

Answer 17

spontaneous pneumothorax. spontaneous regression w/ supplemental O2 may be helpful

Question 18

risk factors for DVT

Answer 18

stasis, endothelial injury, and hyper-coagulability (virchow’s triad)

Question 19

tx of tension pneumothorax

Answer 19

immediate needle thoracostomy

Question 20

characteristics favoring carcinoma in an isolated pulmonary nodule

Answer 20

age > 45-50; lesions new or larger in comparison to old films; absence of calcifications or irregular calcifications; size > 2 cm; irregular margins

Question 21

hypoxemia and pulmonary edema w/ normal pulmonary capillary wedge pressure

Answer 21

ARDS

Question 22

sequelae of asbestos exposure

Answer 22

pulmonary fibrosis, pleural plaques, bronchogenic carcinoma (mass in lung field), mesothelioma (pleural mass)

Question 23

increased risk of what infection w/ silicosis?

Answer 23

mycobacterium tuberculosis

Question 24

causes of hypoxemia

Answer 24

right-to-left shunt, hypoventilation, low inspired O2 tension, diffusion defect, V/Q mismatch

Question 25

classic CXR findings for pulmonary edema

Answer 25

cardiomegaly, prominent pulmonary vessels, kerley b lines, bats wing appearance of hilar shadows, and perivascular and peribronchial cuffing

Question 26

CXR findings suggestive of PE

Answer 26

westermark's sign and hampton's hump

Question 27

fever + cough productive of foul-smelling sputum + hx concerning for aspiration pna. tx?

Answer 27

clindamycin

Question 28

findings on CT of bronchial dilation, lack of airway trapping, and bronchial wall thickening are signs of?

Answer 28

bronchiectasis

Question 29

two modalities shown to decreased mortality in COPD pts

Answer 29

home O2 and smoking cessation

Question 30

most common adverse effect of inhaled corticosteroids

Answer 30

thrush (oral candida)

Question 31

glucocorticoids cause neutrophilia how?

Answer 31

by increasing the BM release and mobilizing the marginated neutrophil pool

Question 32

indicators of severe asthma

Answer 32

normal to increased pCO2 values, speech difficulty, diaphoresis, altered sensorium, cyanosis, and silent lungs

Question 33

pts w/ impaired consciousness, advanced dementia, and other neuro disorders are predisposed to aspiration pna due to?

Answer 33

impaired epiglottic function

Question 34

a mobile, cavitary mass in the lung which presents w/ intermittent hemoptysis. dx?

Answer 34

aspergilloma

Question 35

pt presents w/ atypical CAP symptoms, concurrent GI and CNS symptoms. dx?

Answer 35

legionnaires

Question 36

3 most common causes of chronic cough

Answer 36

postnasal drip (upper-airway cough syndrome), asthma, and GERD

Question 37

hypoxia, hypocapnia, and respiratory alkalosis suggests?

Answer 37

CHF

Question 38

exudative effusions w/ low glucose

Answer 38

empyemas - low glucose due to the high metabolic activity of leukocytes and bacteria w/in the pleural fluid

Question 39

PE findings for pneumothorax... percussion - ? breath sounds - ? fremitus - ?

Answer 39

percussion - hyperresonant breath sounds - decreased or absent fremitus - decreased or absent

Question 40

PE findings for pleural effusion... percussion - ? breath sounds - ? fremitus - ?

Answer 40

percussion - dull breath sounds - decreased fremitus - decreased

Question 41

PE findings for emphysema... percussion - ? breath sounds - ? fremitus - ?

Answer 41

percussion - diffusely hyperresonant breath sounds - decreased fremitus - decreased