Pulmonary 5

Question 1

These are tumors located in the superior sulcus near the apex of the lung. These are Squamous cell lung carcinomas.
MC initial symptom is shoulder pain.
Horner syndrome, and weakness atrophy of the muscle of the hand. May have ulnar neuropathy.

Answer 1

Superior sulcus (Pancoast tumor)

Question 2

This is a tumor originating from the pleura. Most are due to chronic asbestos exposure.
CXR shows unilateral pleural thickening.

Answer 2

Mesothelioma

Question 3

What are the Light’s criteria for an exudative cause of pleural effusion?

Answer 3

Exudate is present if any are present.

1. Protein > 0.5
2. LDH > 0.6
3. Pleural fluid LDH > 2/3 the upper limit of normal

Question 4

What conditions are transudative?

Answer 4

HF, Cirrohsis, Nephrotic syndrome, PE.

Question 5

Criteria for an exudative pleural effusion?

Answer 5

protein > .5
LDH > .6
LDH >2/3 serum

Question 6

This bacteria commonly associated as a superimposed infection after a viral infection such as post influenza, hospital-acquired pneumonia.
CXR shows bilateral multilobar infiltrates or abscesses (cavitary lesions)

Answer 6

Staph aureus

Question 7

an acute viral disease resulting in small airway inflammation and is associated with signs and symptoms of an upper respiratory infection. Patients are typically less than two years of age, and the disease is more frequently present in the winter months. Patients may be febrile, tachycardic, tachypneic, or hypoxic. Lung auscultation can demonstrate decreased air movement, crackles, or wheezing. Emergency Department management is focused on supportive care and risk assessment.

Answer 7

Bronchiolitis caused by RSV

Question 8

First line treatment for pediatric pneumonia caused by S. pneumoniae?

Answer 8

Amoxicillin

Question 9

Asthma classification shows an increase in daytime symptoms to daily, nighttime awakenings more than once per week, daily use of the rescue inhaler, limitations in ADLs and home readings of lung function between 60-80% of normal.

Answer 9

Moderate persistent

Question 10

Asthma classification of more than two daytime symptoms per week but less than daily, 3-4 nighttime awakenings in the past month, use of rescue inhaler more than twice in one week but less than daily, mild impairment in ADLs, home readings of lung function within normal range and two or more exacerbations in the past year requiring treatment with oral glucocorticoids.

Answer 10

Mild persistent

Question 11

FEV1/FVC > 80%

FVC < 80%

Answer 11

Restrictive lung pattern

Question 12

Labs for a chronic bronchitis patient

Answer 12

Respiratory acidosis and elevated H/H