Pulmonary

Question 1

Expected PFT in Asthma

Answer 1

FEV1/FVC ratio - <70
TLC (% pred) - increased
DLCO- Normal
Positive response to bronchodilator.
NB: Spirometry can be normal. To confirm asthma do methacholine challenge test

Question 2

Which conditions affect upper lung lobes

Answer 2

Cystic fibrosis, Tuberculosis, Silicosis, Sarcoid, ankylosing spondylitis

Question 3

Mimics of Asthma

Answer 3

Vocal cord dysfunction
Eosinophilic Granulomatosis with Polyangiitis (EGPA)
ABPA
Aspirin exacerbated respiratory disease 
Acute heart failure

Question 4

ABPA

Answer 4

Positive Aspergillus skin testing or high IgE against A. fumigatus
Total Ig E >1000
Eosinophils > 500 or Central bronchiectasis

Question 5

Asthma-like symptoms
nasal polyps
skin findings like granulomas, petechiae
Neuro symptoms- -mononeuritis multiplex

Answer 5

Eosinophilic Granulomatosis with Polyangiitis (EGPA)

Question 6

recurrent sinopulmonary infections
Unusual bugs, usually resistant
GI symptoms like diarrhea

Answer 6

Cystic fibrosis

Question 7

Chronic eosinophilic pneumonia

Answer 7

wheezing + inflammatory symptoms like fever
weight loss
elevated ESR, Elevated WBC
>25% eosinophils on bronchoscopy
CXR: photo-negative of heart failure
responds to moderate dose steroids

Question 8

Aspirin (acetylsalicylic acid)-induced asthma (AIA) triad

Samter’s Triad

Answer 8

asthma
chronic rhinosinusitis with nasal polyps
precipitation of asthma and rhinitis attacks in response to aspirin and other NSAIDs.

Question 9

Indications for ICU admission in Asthmatics

Answer 9

PAco2 > 42

PEFR < 40% after treatment

Question 10

Severe asthma

Answer 10

Unable to speak in full sentences
Accessory muscle of respiration use
Respiratoryrate> 30/min,heart rate >120/min
SpO2 <90% on room air
Agitation, confusion, drowsiness

Question 11

Side effects of biologic agents ( Omalizumab, Mepolizumab, and Reslizumab)

Answer 11

Anaphylaxis

Increased risk of malignancy

Question 12

COPD- GOLD classification

Answer 12

GOLD 1: FEV1>= 80% of predicted
GOLD 2: FEV1 50 - <80% of predicted
GOLD 3: FEV1 30- <50% of predicted
GOLD 4: FEV1 < 30% of predicted

Question 13

Criteria for Non-invasive Positive pressure ventilation in COPD exacerbation

Answer 13

use of accessory muscles of respiration
CO2 >45 mmHg
pH <7.35
Respiratory rate > 25/min

Question 14

Heerfordt Syndrome

Answer 14

Uveitis
Parotitis
Fever

Question 15

Medications that can cause interstitial lung disease

Answer 15

Nitrofurantoin
Amiodarone
Many chemotherapy agents- bleomycin, busulfan
Methotrexate
*the list is not exhaustive

Question 16

Causes of Pulmonary hypertension

Answer 16

Type I - primary pulmonary hypertension, scleroderma, HIV, Portal hypertension
Type 2 - due to heart disease - LV systolic or diastolic dysfunction, Valvular heart disease
Type 3- due to lung disease- COPD, OSA, ILDs
Type 4- Chronic PE
Type 5- hematologic disorders, sarcoidosis, thyroid disease, Glycogen storage diseases, chronic renal failure

Question 17

Anterior Mediastinum masses

Answer 17

Thymoma
Teratoma
Thyroid
Lymphoma

Question 18

Increased DLCO

Answer 18

Asthma
Hemorrhage
Polycythemia
Increased blood volume

Question 19

Decreased DLCO

Answer 19

Anemia
Pulmonary hypertension
PE
Vasculitis
Early Interstitial Lung disease

Question 20

Causes of fixed obstruction

Answer 20

Tracheal stenosis
Tracheal mass
Laryngeal mass
Goiter