Pulmonology

Question 1

What is included with PFTs?

Answer 1

Spirometry(FEV1 & FVC), lung volume, DLCO - diffusion capacity

Question 2

FEV1/FVC, TLC & DLco with: Asthma

Answer 2

FEV1/FVC: normal/low
TLC: normal
DLco: normal/high

Question 3

FEV1/FVC, TLC & DLco with: COPD

Answer 3

FEV1/FVC: low
TLC: high/normal
DLco: low

Question 4

FEV1/FVC, TLC & DLco with: Fibrotic Disease

Answer 4

FEV1/FVC: normal/low
TLC: low
DLco: low

Question 5

FEV1/FVC, TLC & DLco with: Extrathoracic Restriction(aka fat ass)

Answer 5

FEV1/FVC: normal
TLC: low
DLco: normal

Question 6

Patients with OSA have a 2-3x increased risk of —.

Answer 6

MVA

Question 7

T/F intranasal steroids can block growth of nasal polyps and may cause regression.

Answer 7

TRUE!

Question 8

When classifying Asthma when does it go from intermittent to persistent?

Answer 8

intermittent <2d/week. Once >2d/week then its mild persistent(not daily)

Question 9

When classifying asthma when does it become moderate persistent?

Answer 9

daily symptoms & at least once a week at night but not nightly

Question 10

When classifying asthma when does it become severe persistent?

Answer 10

symptoms multiple times throughout the day, nighttime symptoms weekly & often every night.

Question 11

Criteria for chronic bronchitis

Answer 11

chronic cough with phlegm for >3m for 2 consecutive years

Question 12

Stage 1 COPD has an FEV1…

Answer 12

FEV1 >80%

Question 13

Stage 2 COPD has an FEV1…

Answer 13

FEV1 50-79%

Question 14

Stage 3 COPD has an FEV1…

Answer 14

FEV1 30-49%

Question 15

Stage 4 COPD has an FEV1…

Answer 15

FEV1 <30%

Question 16

FEV1/FVC in COPD?

Answer 16

FEV1/FVC <70%

Question 17

Interstitial Lung Disease includes…

Answer 17

Idiopathic pulmonary fibrosis, sarcoidosis, etc

Question 18

Pleural-to-Serum Protein Ratio, Pleural to serum LDH & pleural to fluid LDH in transudative pleural effusions

Answer 18

Pleural-to-Serum Protein Ratio: < 0.5
Pleural to serum LDH: < 0.6
pleural to fluid LDH: < 200

Question 19

Pleural-to-Serum Protein Ratio, Pleural to serum LDH & pleural to fluid LDH in exudative pleural effusions

Answer 19

Pleural-to-Serum Protein Ratio: > 0.5
Pleural to serum LDH: >0.6
pleural to fluid LDH: >200

Question 20

In order to tap pleural effusion must be greater than —.

Answer 20

> 1 cm on decubitus film

Question 21

Pneumothorax that is —- of hemithorax & stable may be treated with supportive care only.

Answer 21

<15%

Question 22

Pneumothorax that is —- of hemithorax will require drainage and placement of chest tube.

Answer 22

> 30%

Question 23

Pulmonary Hypertension is defined as pulmonary artery mean pressure of —- with exercise.

Answer 23

> 25-30 mmHg

Question 24

Common causes of pulmonary hypertension

Answer 24

OSA, Parenchymal lung disease, congenital heart disease, advanced liver disease, HIV, chronic thromboembolic disease, drug use

Question 25

Physical exam findings in pulmonary hypertension

Answer 25

dyspnea, splitting of S2 with Loud P2, polycythemia due to chronic hypoxia

Question 26

Besides treating the underlying cause of pulmonary artery hypertension what medications can be used for treatment?

Answer 26

IV infusion of prostacyclin for severe cases. PDE5 inhibitors(sildenafil, tadalafil, cardenafil)

Question 27

What size lung nodule do you need to get a PET scan & bx? f/u CT interval?

Answer 27

> 8 mm. f/u CT at 3m, 9m & 24m

Question 28

What size lung nodule do you not need any further imaging? what if they are high risk for cancer?

Answer 28

<4mm. If high risk then repeat in 1 year, if no growth then you dont need any further w/u

Question 29

Sarcodosis vs Scleroderma sx?

Answer 29

• Sarcoidosis:GRUELING-CC Granulomas, rheumatoid arthritis, uveitis, erythema do some, lymphadenitis, interstitial fibrosis, negative PPD, gamma globe anemia, increase calcium, cardiac problems
• Scleroderma - systemic sclerosis/collagen deposits(anti scl-70(diffuse) & anti-centromere ab(CREST)) = CREST: Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly & Telangiectasias

Question 30

Significantly reversible FEV1 of —- after inhaling a SABA is diagnostic of Asthma.

Answer 30

Increase by 12% and 200mL

Question 31

First line treatment for allergic rhinitis and an individual that has asthma

Answer 31

Flonase nasal spray. Over-the-counter antihistamine in LT modulators are second line