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AMC MCQ > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

Child with prologed cough >2 Ws and fever… Next step:

A

serology for pertussis

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2
Q

Best inv of BA:

A

spirometry before and after SABA (++ FEV1> 15% at least)

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3
Q

Most imp parameter to be assessed in spirometry of pt with BA:

A

FEV-1

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4
Q

Most imp parameter to be assessed in spirometry of pt with GB$:

A

FVC

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5
Q

Management of acute attack???
Pt with low O2 saturation next step
1st step:
If no response:

A

give O2
inhaled salbutamol…..up to 12 puffs
oral cortisone

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6
Q

Best way to give puffs to the kids:

A

spacer

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7
Q

Most common SE of inhaled cortisone:

A

oropharyngeal candida

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8
Q

Most serious sign in status asthmaticus:

A

silent chest

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9
Q

If cyanosis in asthma first step:

A

intubation

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10
Q

Long term management:
First line:
If still symptomatic:
If still symptomatic:

A

SABA
inhaled cortisone
LABA

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11
Q

Prevention of asthma

Best way:

A

avoid dust and smoking

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12
Q

Drug used for prevention by inhalation:

A

fluticasone

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13
Q

Asthma with exercise what to use?

A

salbutamol before the exercise

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14
Q

HOW TO ASSES CRITICAL CASES???

A

Confused/drowsy, AGITATION vv IMP

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15
Q

Pt returned from long flight develops acute chest pain& dyspnea. Exam shows clear lung… Dx:

A

pulmonary embolism (PE)

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16
Q

Best inv of PE/ Inv of choice of PE:

A

CTPA

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17
Q

Inv of choice in pregnant, pt with ESRD or allergy:

A

V/Q scan

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18
Q

TTT of choice of PE:

A

LMWH followed by warfarin

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19
Q

Duration of warfarin use:

A

3-6 Ms with target INR of 2-3

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20
Q

Pt with contra-indication to anti-coagulation, non-compliant with anti-coagulation recurrent despite anticoagulant…… next step:

A

IVC filter

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21
Q

Pt with cough and dyspnea. Exam shows dullness to percussion& ++ TVF… Dx:

A

pneumonia.

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22
Q

Pt with cough and dyspnea. CXR shows pneumonic patch… Dx:

A

pneumonia

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23
Q

Pt with cough and dyspnea. Exam shows dullness to percussion& – TVF… Dx:

A

pleural effusion

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24
Q

MC CO:

A

strep pneumonia

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25
Q

Best way to give O2 in pneumonia:

A

1st: mask 2nd: venture (NOT nasal canula)

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26
Q

TTT:

Criteria of severity:

A

1-confusion/ empyema
2-respiratory distress
3-tachycardia
4-hypoxia or cyanosis

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27
Q

When to say severe:

A

2 or more of the above criteria

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28
Q

Mild cases ……Outpatient ttt:

A

………oral Amoxycillin

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29
Q

Severe cases…….Inpatient ttt:

A

Iv flucloxacillin + IV cefotriaxone

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30
Q

If MRSA:

A

add vancomycin

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31
Q

If mycoplasma pneumonia:

A

doxycyclin

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32
Q

Pneumonia with dry cough+ skin lesion (EM)… Dx:

A

mycoplasma pneumonia

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33
Q

TTT of mycoplasma pneumonia:

A

Doxycycline

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34
Q

Trauma + dullness + decreased breath sound:

A

pleural effusion

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35
Q

Management of pleural effusion:

A

tube decompression

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36
Q

Site of chest tube insertion:

A

5th intercostal space at MAL

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37
Q

Trauma + resonance + decreased breath sound:

A

pneumothorax

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38
Q

Management of tension pneumothorax:

A

immediate needle decompression

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39
Q

Site of needle insertion:

A

2nd Inercostal Space at MCL

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40
Q

Tall smoker young male with pneumothorax and no obvious cause:

A

1ry pneumothorax (spontaneous pneumothorax)

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41
Q

When to do aspiration in primary pneumothorax???

A

Symptomatic even if small

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42
Q

if aspiration failed:

A

chest tube

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43
Q

if pneumothorax not symptomatic :

A

conservative and follow up CXR

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44
Q

Pt with pneumothorax of any cause (asthma, COPD…etc):

A

2ry pneumothorax

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45
Q

TTT of 2ry pneumothorax:

If more than 30%:

A

chest drain

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46
Q

If less than 15-30%:

A

aspiration…..if failed…..chest drain

47
Q

If less than 15%:

A

conservative

48
Q

Most imp inv of pleural effusion:

A

thoracocentesis

49
Q

COPD Pt came with fever OR yellow sputum:

A

infection

50
Q

Middle age male smoker with history of chronic productive cough and and hyperinflated lung:

A

COPD

51
Q

MCC of distress in pt with COPD:

A

infection

52
Q

Most imp Sign of distress in pt with COPD:

A

pursing lips

53
Q

Spirometry of pt with COPD “Obstructive lung disease”:

A

FEV1, FVC and FEV1/FVC ratio ………………… decreased
Residual volume and total lung capacity… increased
Lung compliance……………………………………increased

54
Q

Most imp way to decrease mortality in pt with COPD:

A

stop smoking

55
Q

Types of ABG WITH COPD pt??

A

vvvvvvvvvvvv imp

56
Q

NORMALLY= NO EXAGGERATION

A

PO2……….DECREASED
PCO2………INCREASED
PH………….RESPIRATORY ACIDOSIS

57
Q

When he comes with EXAGGERATED SYMPTOMS in the ER:

A

PO2……….decreased
PCO2……..INCREASED)
PH………..RESPIRATORY ACIDOSIS

58
Q

If you by mistake give the pt high flow oxygen????? Vvv imp

A

PO2……..INCREASED
PCO2…….INCREASED
PH…….RESPIRATORY ACIDOSIS
First step…….decrease the O2 flow

59
Q

If respiratory failure???

A

PO2……..MARKED DROP (USUALLY BELOW 60%)
PCO2……..INCREASED
PH…………RESPIRATORY ACIDOSIS
1st step… intubation

60
Q

Common scenario in the AMC exam:

A

COPD patient with marked dyspnea in the ER

First step……..O2

61
Q

How you know that you caused o2 toxicity????

A

By ABG……….. HIGH O2, HIGH CO2& RESPIRATORY ACIDOSIS

First step …………decrease the flow of oxygen

62
Q

COPD WITH very LOW O2 saturation (<60%) first step:

A

intubation

63
Q

COPD pt with sudden chest pain:

A

pneumothorax (rupture of bleb)

64
Q

TTT of pneumothorax in COPD pt= TTT of 2ry pneumothorax:

A

If more than 30%…………..chest drain
If less than 15-30%………..aspiration…..if failed…..chest drain
If less than 15%……..conservative

65
Q

MCC of blood stained mucous:

A

Acute bronchitis

66
Q

MC RF of TB:

A

immigrant, nurse

67
Q

Immigrant from endemic areas came with prolonged cough, dyspnea, night sweat and wt loss……………… 1st step:

A

chest X-ray

68
Q

Definitive test of TB:

A

sputum analysis

69
Q

Inv of choice of asymptomatic pt:

A

mantoux test OR quantiferon

70
Q

Interpretation of mantoux test:

A

-ve test………………………….. Reassure
+ve test………………………… Chest X-ray
Then;
If +ve chest X-ray….. Isolation and quadriple therapy
If -ve chest X-ray… isoniazide+ vitamin B6 for 6-9 ms

71
Q

Imp complication of isoniazid:

A

peripheral neuropathy (give vitamin B6)

72
Q

Imp complication of rifampin:

A

red coloration of urine

73
Q

Nurse with suspected TB:

A

immediate isolation

74
Q

Immigrant with suspected TB and +ve mantoux test… next step:

A

isolation (before X-ray)………..VVVVVVVVV IMP

75
Q

Most common affected lobe of the lung in TB:

A

Upper lobe

76
Q

MCC of decreased TB incidence at Australia:

A

good isolation (NOT vaccination)

77
Q

Old smoker with any chest complaint+ wt loss… Dx:

A

lung cancer until proven

78
Q

Old smoker with weakness, parathesia at hand, CXR shows mass at apex… Dx:

A

pancost tumor

79
Q

Old smoker with congested neck veins and arm swelling, CXR shows mass at apex… Dx:

A

pancost tumor

80
Q

1st step in lung cancer pt with pleural effusion:

A

horacocentesis

81
Q

Lung cancer with systemic manifestation:

A

para-neoplastic $

82
Q

1st step in pt with suspected lung cancer:

A

chest CT

83
Q

Inv of choice of lung cancer:

A

BRONCHOSCOPY and biopsy

84
Q

Asymptomatic pt with small lung mass at CXR … 1st step:

A

ask for old x-ray

85
Q

Spirometry of pt with lung fibrosis “Restrictive lung disease”:

A

FEV1, FVC………………… decreased
FEV1/FVC ratio……… normal
Residual volume, total lung capacity& lung compliance… decreased

86
Q

TTT of pulmonary fibrosis:

A

cortisone

87
Q

Rt sided heart failure 2ry to pulmonary HTN:

A

cor- pulmonale

88
Q

Child with FTT+ recurrent chest infection+ steatorrhea… Dx:

A

cystic fibrosis (CF)

89
Q

Genetic of CF :

A

AR

90
Q

MCC of infertility in pt with CF:

A

absence vas deference

91
Q

Child with rectal prolapse, most imp to ask about:

A

Bowel habit (NOT family H/O of cystic fibrosis)

92
Q

Most imp inv of CF:

A

sweat chloride test

93
Q

Male pt with bronchiectasis, sinusitis, male sterility… Dx:

A

immotile cilia $

94
Q

Male pt with bronchiectasis, sinusitis, dextro-xardia… Dx:

A

Kartagner $

95
Q

MCC of acute hemoptysis:

A

Acute bronchitis

96
Q

MCC of chronic hemoptysis:

A

Bronchiectasis

97
Q

Inv of choice of bronchiectasis:

A

spiral CT scan

98
Q

TTT of infection with bronchiectasis:

A

amox clav ( augmentin )

99
Q

Farmer with cough, dyspnea while on work BUT is free of symptoms on the week end :

A

= hypersensitivity pneumonitis. Most imp advice… Change the job

100
Q

Asbestosis increase risk of:

A

mesothelioma (NO screening available; try to avoid prolonged exposure)

101
Q

Silicosis increase risk of:

A

TB reactivation

102
Q

Most imp cause of confusion in respiratory failure:

A

CO2 narcosis
First test……pulse oximetry
Second inv……ABG
Management……intubation

103
Q

Most imp drug in acute pulmonary edema:

A

IV furosemide

104
Q

MC RF of mesothelioma:

A

Asbestosis

105
Q

Patient with chronic cough and pleural thickening on CXR:

A

mesothelioma…..next step……..CT chest …..vvvvvvvv imp

106
Q

Inv of choice of mesothelioma:

A

Bronchoscopy& biopsy

107
Q

Pt with prolonged symptoms of chest infection not responding to abs, CXR shows pleural effusion… Dx:

A

Empyema

108
Q

Definitive TTT of empyema:

A

chest tube + continues abs

N:B: ( 2016 statistics )

109
Q

Most common cancer causing mortality in Australia:

A

lung

110
Q

Most common cancer affecting males in Australia:

A

prostate

111
Q

Most common cancer affecting females in Australia:

A

breast

112
Q

Most common cancer in Australia overall:

A

MELANOMA

113
Q

Most common cancer in incidence in Australia:

A

prostate

114
Q

Fastest tumour to cause death:

A

pancreatic

AMC MCQ (14 decks)

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