Pulmonary General Review

Question 1

In the erect position, pleural pressure is most negative in the ____

Answer 1

apex

Question 2

Where is capillary pressure highest?

Answer 2

bases

Question 3

What is the eqn for O2 content of blood?

Answer 3

1.34HbSaO2 + 0.003*PaO2

Question 4

What is the most importantcontributor to oxygen content of blood

Answer 4

Hemoglobin

Question 5

PND suggest what?

Answer 5

suggestive of LV dysfunction however present in other conditions therefore requires further evaluation

Question 6

Describe normal vesicular breath sounds?

Answer 6

prominent inspiration, short passive exhalation with no gap between I & E

Question 7

Describe bronchial breath sounds?

Answer 7

exhalation also prominent; there is a gap between I & E

Question 8

High-pitched BBS and Egophony are heard in what?

Answer 8

consolidation

Question 9

Difference between CB and emphysema in PFT

Answer 9

both have low FEV1:FVC but CB has normal DLCO and emphysema has low DLCO

Question 10

A restrictive like PFT (low FVC but normal FEV1:FVC) with LOW DLCO is suggestive of what?

Answer 10

intrisnic lung disease (IPF, lung resection)

If lung resection, DLCO/Va will be near 100%

Question 11

Isolated reduced DLCO on PFT suggests what?

Answer 11

‘pulmonary vascular disease pattern’

seen in PAH and PE

Question 12

What is the rescue DOC for COPD?

Answer 12

ipratropium

Question 13

What is the rescue DOC for asthma?

Answer 13

albuterol

Question 14

What is the only modality shown to increase survival other than smoking cessation in COPD?

Answer 14

Continuous oxygen therapy if the patient has hypoxia (SpO2 less than 89%)

Question 15

T or F. Smoking cessation should be addressed at every visit in COPD

Answer 15

T.

Question 16

What is the first controller for COPD?

Answer 16

Tiotropium

Question 17

COPD definition

Answer 17

A common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases.

Question 18

T or F. Airflow obstruction is fully reversible in COPD

Answer 18

T.

Question 19

How can you try to prevent exercise-induced bronchospasm?

Answer 19

pre-treatment with B-agonist or cromolyn and

slow warm-up helps

Question 20

How to target eosinophils in asthma?

Answer 20

steroids

Question 21

How is asthma treated?

Answer 21

-Albuterol for intermittent asthma

-Add ICS, then LABA, then LTRA, then LAMA/
Omalizumab

Question 22

Why are LABA used before LAMA in asthma?

Answer 22

less prominent vagal tone in asthma (conversely, in COPD vagal tone is increased so LAMA is better)

Question 23

Repeated Beta agonist usage can lead to tachyphylaxis. How?

Answer 23

by way of down regulation of beta-2 receptors

Question 24

How long does it take pulmonary hemodynamics to return to original levels following PE?

Answer 24

in 2-8 weeks

Question 25

How does a PE present on a CXR?

Answer 25

Most common is a normal Chest radiograph Atelectasis (discoid) may be present Pleural effusions when present are small

Question 26

Why might SaO2 be normal with a PE?

Answer 26

Vasodilatation of uninvolved vasculature helps to decrease the increase in PVR and improves V/Q relationship in uninvolved areas This improves overall Oxygenation

Question 27

Lab data for a PE?

Answer 27

low PaO2, PaCo2 and increased A-a gradient

Question 28

Lights criteria for exudate in pleural effusion

Answer 28

- Fluid protein/serum protein > 0.5 - Fluid LDH/serum LDH > 0.6 - Cholesterol over 50 ANY ONE of them= exudate

Question 29

What are some characteristics of a benign lesion in the lungs?

Answer 29

- Well defined nodules (singular) - No associated lymph node or mediastinal masses - No satellite lesions - Calcified nodules

Question 30

What are some types of benign calcifications?

Answer 30

-dense, popcorn, lamellar

Question 31

What lung cancer is most associated with smoking?

Answer 31

small cell

Question 32

Staging of small cell?

Answer 32

limited versus extensive ● Limited→ can include the tumor in one radiation port ○ goal of therapy - cure by radiation + chemo (Etoposide + -platin) ● Extensive→ need multiple radiation ports ○ goal of therapy - improve survival, patients live 3 months w/o therapy, 1 year w/ therapy

Question 33

How are Stage I and II NSCLC treated?

Answer 33

Stage I surgery (if surgery cant happen, XRT is given) II- surgery then chemo

Question 34

How is Stage III NSCLC treated?

Answer 34

XRT AND chemo IIIB- lung tumor is confined to the chest but there is an integral structure involved which means the cancer cannot be removed → not eligible for surgery

Question 35

How is Stage IV NSCLC treated?

Answer 35

Chemo (targeted if appropriate); palliative XRT

Question 36

A positive CK-7 (cytokeratin) suggests what?

Answer 36

adenocarcinoma/squamous cell

Question 37

A positive CK-20 (cytokeratin) suggests what?

Answer 37

colon cancer

Question 38

A positive TTF-1/Napsin A suggests what?

Answer 38

lung adenocarcinoma

Question 39

A positive P40/P63 suggests what?

Answer 39

squamous cell center

Question 40

What paraneoplastic syndrome is associated what adenocarcinoma?

Answer 40

Hypertrophic pulmonary osteoarthropathy (HPO) / Clubbing Painful clubbing, wrists and ankles; new bone formation

Question 41

What are the goals of 'goal directed resuscitation' in sepsis?

Answer 41

Central venous pressure: 8–12 mm Hg Mean arterial pressure > 65 mm Hg Urine output > 0.5 mL/kg/hr Central venous O2 saturation > 70%

Question 42

What are some patient populations that may be afebrile in sepsis?

Answer 42

Very young/old, CKD, DM, Steroid use , NSAIDs, immunocompromised

Question 43

T or F. ARDS is associated with intense inflammation

Answer 43

T.

Question 44

Characteristics of ARDS?

Answer 44

Severe non-cardiogenic pulmonary edema Severe hypoxemia due to shunting Acute decrease in lung compliance

Question 45

What is the purpose of PEEP in ARDS?

Answer 45

improves oxygenation by recruiting atelectatic alveoli and increasing functional residual capacity (FRC)

Question 46

What is the most common cause of death in ARDS?

Answer 46

multi-organ failure

Question 47

What things improve survival in ARDS?

Answer 47

Use of lower tidal volume during mechanical ventilation (MV) reduces mortality Prone ventilation improves survival

Question 48

Pneumothorax usually seen after the ___ week of ARDS.

Answer 48

2nd week

Question 49

Proven therapy for PAH?

Answer 49

Epoprostenol and Bosentan

Question 50

What are the 4 Causes of Increased CO2 retention after Supplemental Oxygen?

Answer 50

Blunting of Hypoxic Drive Worsening V/Q mismatch Haldane Effect Neuromuscular fatigue

Question 51

Respectability of a tumor depends on what?

Answer 51

not only depends on the stage but also the condition/ability of the patient to undergo surgery For this reason clinicians evaluate patients by way of “performance status”. If performance status is poor, patients will not be able to tolerate surgery, chemotherapy, or even radiation therapy