Pulmonary MKSAP

Question 1

What defines massive hemoptysis?

Answer 1

100 mL of blood (1/2 cup)

Question 2

What defines massive hemoptysis?

Answer 2

100 mL of blood (1/2 cup)

Question 3

FEV1/FVC ratio that defines obstruction?

Question 4

Positive Bronchodilator challenge

Answer 4

Increase of FEV1 of 12% or 200 mL

Question 5

Positive Methacholine Challenge

Answer 5

Decrease of FEV1 of 20%

Question 6

What type of COPD is indicated for Lung Volume Reduction Surgery?
What are other Criteria?

Answer 6

1. Upper Lobe Emphysema
2. Severe COPD, refractory to medical therapy
3. Completed Pulmonary Rehabilitation
4. TLC >100% and RV > 150%
5. FEV1 is at least 20% (poor outcomes if its lower)
6. PaO2

Question 7

FEV1/FVC ratio that defines obstruction?

Answer 7

FEV1/FVC ratio

Question 8

Positive Bronchodilator challenge

Answer 8

Increase of FEV1 of 12% or 200 mL

Question 9

Positive Methacholine Challenge

Answer 9

Decrease of FEV1 of 20%

Question 10

Signs/Symptoms for Cystic Fibrosis

Answer 10

Recurrent pancreatitis
Chronic Sinusitis
Nasal Polyposis 
Male Infertility 
Bronchiectasis
Allergic Bronchopulmonary Aspergillosis 
(+) sputum for Pseudomonas or Burkholderia 
non-TB Mycobacteria infection

Question 11

What type of COPD is indicated for Lung Volume Reduction Surgery?

Answer 11

Upper Lobe Emphysema

Question 12

Criteria for Lung Transplantation?

Answer 12

1. History of exacerbations associated with acute hypercapnia (arterial PCO2 >50 mm Hg [6.7 kPa])
2. Pulmonary hypertension, cor pulmonale, or both despite oxygen therapy
3. or FEV1 less than 20% of predicted with DLCO less than 20% of predicted

Question 13

Indications for Omalizumab/Xolair?

Answer 13

1. IgE level btwn 30-700
2. (+) for perennial allergens
3. Moderate-Severe Persistent Asthma not controlled by ICS

Question 14

Diagnose Allergic Bronchopulmonary Aspergillosis

Answer 14

(+) skin test to Aspergillus
Increased IgE with peripheral eosinophilia
CXR: proximal bronchiectasis, pleural thickening, transient infiltrate, atelectasis

Question 15

Signs/Symptoms for Cystic Fibrosis

Answer 15

Recurrent pancreatitis
Chronic Sinusitis
Nasal Polyposis 
Male Infertility 
Bronchiectasis
Allergic Bronchopulmonary Aspergillosis 
(+) sputum for Pseudomonas or Burkholderia

Question 16

At which FEV1 % is pulmonary rehabilitation recommended?

Question 17

Name 3 drugs that cause Diffuse Parenchymal Lung Disease

Answer 17

Amiodarone
MTX
Nitrofurantoin
Bleomycin

Question 18

2 FDA approved meds for Idiopathic Pulmonary Fibrosis

Answer 18

Nintedanib (Nintendo!)

Pirfenidone

Question 19

What lobes are involved in Nonspecific Interstitial Pneumonia?

Answer 19

Lower Lobes

Question 20

How to treat Acute Interstitial Pneumonia?

Answer 20

50% Mortality

like ARDS, with glucocorticoids and low TV

Question 21

Lofgrens Syndrome?

Answer 21

Hilar Lymphadenopathy, migratory polyarthalgia, erythema nodosum, fever

Question 22

30 yo female, spontaneous pneumothorax and chlyous pleural effusions?

Answer 22

Lymphangioleiomyomatosis

Question 23

Causes of Anterior Mediastinal Mass

Answer 23

Thymoma
Lymphoma
Teratoma

Question 24

MC of Middle Mediastinal Mass

Answer 24

Lymphadenopathy

Question 25

MC of Posterior Mediastinal Mass

Answer 25

Neurogenic Tumor (Neuroblastoma or schwannoma)

Question 26

Screening for Lung Cancer, in who? Until when?

Answer 26

55-79 yo, with 30 pack year smoking hx (either still smoking or quit within 15 years) Stop screening once 80 yo or quit smoking >15 years

Question 27

Treat Bronchiectasis

Answer 27

Inhaled hypertonic saline and chest physiotherapy