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Clinical: General Surgery > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

what are the most common causes of hemoptysis

A

Bronchitis, tumor mass, TB

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2
Q

A 68-year-old man with a 50-pack-year smoking history presents with worsening cough and hemoptysis. A chest CT scan reveals a centrally located tumor in the left main bronchus. A biopsy confirms squamous cell carcinoma of the lung. Given the absence of distant metastasis and the tumor’s limited size, which of the following is the most appropriate initial treatment for this patient?
A Surgical resection
B Chemotherapy with cisplatin and etoposide
C Palliative radiation therapy
D Targeted therapy with gefitinib
E Immunotherapy with pembrolizumab

A

a. surgical resection

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3
Q

A 62-year-old male presents with a right hilar mass. Needle biopsy of the mass reveals the presence of small-cell lung cancer, and a bone scan reveals the presence of scattered hot spots throughout the skeleton, indicating metastatic disease. Which of the following is the most appropriate initial treatment for this patient?
A Surgical resection
B Radiation therapy alone
C Combination chemotherapy
D Targeted therapy with erlotinib
E Palliative care only

A

c. combination chemotherapy

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4
Q

Which of the following forms of lung cancer is associated with the poorest prognosis?
A Adenocarcinoma
B Squamous cell carcinoma
C Large cell carcinoma
D Small cell lung cancer
E Bronchioloalveolar carcinoma

A

d. small cell lung cancer

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5
Q

A 55-year-old man presents to the neurology clinic complaining of progressive weakness in his proximal muscles. Over the past six months. He reports difficulty climbing stairs and rising from a seated position. Recently, he has also noticed a dry mouth and intermittent diplopia. His medical history is notable for a 30-year history of smoking. Physical examination reveals diminished deep tendon reflexes and muscle strength that improves with repeated testing. Which of the following is the most likely diagnosis?
A Myasthenia Gravis
B Multiple Sclerosis
C Eaton-Lambert Syndrome
D Amyotrophic Lateral Sclerosis
E Guillain-Barré Syndrome

A

c. eaton-lambert syndrome

Eaton-Lambert syndrome, often associated with small cell lung cancer (particularly in smokers), is characterized by muscle weakness that predominantly affects the proximal limbs. It is a paraneoplastic syndrome resulting from antibodies directed against presynaptic calcium channels, leading to reduced acetylcholine release. Unlike myasthenia gravis, muscle strength and reflexes in Eaton-Lambert syndrome typically improve with repeated testing, aligning with this patient’s presentation.

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6
Q

A 58-year-old man with a long-standing history of smoking presents to his primary care physician with new onset of cough and chest pain that worsens with deep breaths. He denies any recent weight loss or night sweats. A chest CT scan reveals a 5 cm mass in the peripheral region of the right lower lobe without mediastinal lymphadenopathy or pleural effusion. A biopsy of the mass is performed, confirming the diagnosis of lung cancer. Which of the following is the most likely histologic subtype of this patient’s lung cancer?
A Adenocarcinoma
B Squamous cell carcinoma
C Large cell carcinoma
D Small cell lung cancer
E Mesothelioma

A

c. large cell carcinoma

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7
Q

A 64-year-old woman presents to the emergency department with worsening shortness of breath, a 15-pound weight loss over the last two months, and severe fatigue. She has a 30-pack-year smoking history. Physical examination reveals generalized lymphadenopathy. A chest X-ray shows a large mediastinal mass with associated hilar lymphadenopathy. Laboratory tests reveal hyponatremia. A biopsy confirms the diagnosis of lung cancer. Which of the following is the most likely histologic subtype of this patient’s lung cancer?
A Adenocarcinoma
B Squamous cell carcinoma
C Large cell carcinoma
D Small cell lung cancer
E Mesothelioma

A

d. small cell lung cancer

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8
Q

A 55-year-old woman with no significant past medical history presents with dyspnea and a persistent dry cough. She has never smoked and works as a school teacher. A CT scan shows a solitary peripheral nodule in the left lower lobe of the lung. Biopsy of the nodule indicates non-small cell lung cancer. Which of the following histologic subtypes is most likely in this patient?
A Small cell lung cancer
B Adenocarcinoma
C Squamous cell carcinoma
D Large cell carcinoma
E Mesothelioma

A

b. adenocarcinoma

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9
Q

A 68-year-old man with a 40-pack-year smoking history presents to the clinic with a recent onset of cough and unintentional weight loss of 10 kg over the last three months. On examination, he appears cachectic and you note clubbing of his fingernails. A chest X-ray reveals a mass in the right upper lobe and no pleural effusion. A biopsy of the mass is performed and confirms non-small cell lung cancer. Which of the following is the most likely histologic subtype of this patient’s lung cancer?
A Small cell lung cancer
B Adenocarcinoma
C Squamous cell carcinoma
D Large cell carcinoma
E Mesothelioma

A

c. Squamous cell carcinoma

Squamous cell carcinoma of the lung is strongly associated with smoking and typically presents as a central mass in the bronchi. This subtype can lead to symptoms like cough and weight loss, which are seen in this patient. The presence of clubbing is also more commonly associated with squamous cell carcinoma.

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10
Q

What is the usual cause of death from hemoptysis?

A

asphyxia

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11
Q

what causes a tension penumothorax

A

penetrating injury

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12
Q

what is secondary spontaneous pneumothorax

A

occurs in the presence of underlying disease - asthma, CF, interstitial lung disease

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13
Q

what is a primary spontaneous pneumothorax

A

occurs in the abscense of underlying disease - tall, thin males btwn 10-30years of age are at the greatest risk

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14
Q

what are the treatment options for post op pneumonia

A

Pipieracillin/tazobactam
cefepime
levofloxacin
imipenem
meropenem

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15
Q

what are the diagnostics tests used for postop pneumonia

A

CXR and Chest CT
sometimes bronchoscopy or blood cultures

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16
Q

what are the most common pathogens with post operative pneumonia

A

pseudomonas aeruginosa
MSSA
MRSA

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17
Q

what is the gold standard treatment for pleural effusion

A

thoracentesis

18
Q

what presents with dyspnea and a vague discomfort or sharp pain that worsens with inspiration

A

Pleural effusion

19
Q

what is the treatment of small cell cancer

A

Cannot be treated wtih surgery will need chemotherapy

20
Q

what is the treatment of non-small cell cancer

A

Depends on staging:
stage1-2: surgery
Stage 3: chemo then surgery
stage 4: palliative

21
Q

what type of non-small cell lung cancer is most common

A

adenocarcinoma

22
Q

what are the different types of non-small cell cancers

A

squamous cell
large cell
adenocarcinoma

23
Q

what is the most common type of lung cancers

A

Non-small cell

24
Q

what type of cancer affects smokers most commonly

A

small cell cancer (central mass)

25
Q

On physical examination you note diminished breath sounds over the right lower lobe with decreased tactile fremitus and dullness to percussion. Which of the following is the most likely cause?
A asthma
B consolidation
C pneumothorax
D pleural effusion

A

d. pleural effusion

26
Q

Which of the following conditions will produce a transudative pleural effusion?
A Kaposi’s sarcoma
B Pneumonia
C Cirrhosis
D Mesothelioma

A

c. cirrhosis

27
Q

A 42 year-old male is brought to the emergency department with a stab wound to his right lateral chest wall. On physical examination, the patient is stable with decreased breath sounds on the right with dullness to percussion. An upright chest x-ray reveals the presence of a moderate pleural effusion. Subsequent diagnostic thoracentesis contains bloody aspirate. Which of the following is the next most appropriate intervention?
A Thoracotomy
B Needle aspiration
C Close observation
D Tube thoracostomy

A

d. tube thoracostomy

28
Q

A 60-year-old female with a 30-pack year smoking history complains of new onset shortness of breath. On physical examination, dullness is noted on percussion with diminished breath sounds over her left base. Chest x-ray shows a new left pleural effusion. Which of the following is the next step in the management of this patient?
A Repeat chest x-ray in two months
B Perform diagnostic thoracentesis
C Order MRI of the chest
D Treat with antibiotic

A

b. perform diagnostic thoracentesis

29
Q

Which of the following physical examination findings would be most consistent with a pleural effusion?
A Hyperresonance to percussion
B Increased tactile fremitus
C Unilateral lag on chest expansion
D Egophony

A

c. unilateral lag on chest expansion

30
Q

A 45-year-old man presents to the emergency department with shortness of breath and pleuritic chest pain. A chest x-ray reveals a large left-sided pleural effusion. Thoracentesis is performed and the fluid is sent for analysis. Which of the following results would be most consistent with an exudative effusion according to Light’s criteria?
A Pleural fluid protein/serum protein ratio < 0.5
B Pleural fluid LDH/serum LDH ratio < 0.6
C Pleural fluid cholesterol < 45 mg/dL
D Pleural fluid protein/serum protein ratio > 0.5
E Pleural fluid LDH < two-thirds the upper limit of normal for serum LDH

A

d. pleural fluid protein/serum protein ratio >0.5

31
Q

In pleural effusions, vocal fremitus is _ _ _?

A

Decreased

32
Q

in pleural effusions, breath sounds are _ _ _?

A

decreased

33
Q

In pleural effusion, percussion over the affected area is _ _ _?

A

Dull

34
Q

what are the two types of pleural effusions and their etiologies?

A

Transudative - CHF, neprhotic syndrome and cirrhosis
Exudative - infection, malignancy, trauma, pancreatitis

35
Q

mcc of exudative pleural effusions worldwide?

A

Cancer and TB

36
Q

What is the diagnostic test of choice for pleural effusion?

A

US guided thoracentesis with pleural fluid analysis

37
Q

What is an empyema?

A

Infected pleural effusion; must be drained, usually with chest tubes

38
Q

A 21 year-old male presents to the ED with increasing dyspnea and pleuritic chest pain of sudden onset after getting hit in the left side of the chest during a bar fight. Examination reveals moderate respiratory distress with absence of breath sounds and hyperresonance to percussion on the left, with tracheal deviation to the right. Which of the following is the most appropriate next step?
A order a V/Q scan
B order a chest x-ray
C administer a sclerosing agent
D insert large bore needle into left 2nd ICS stat

A

d. insert large bore needle into left 2nd ICS stat

39
Q

Which of the following mechanisms leads to a primary pneumothorax?
A Penetrating or blunt trauma forces
B Underlying lung cancer
C Pressure of air in the pleural space exceeds room air pressure
D Rupture of subpleural apical blebs due to high negative intrapleural pressures

A

d. rupture of subpleural apical bleb due to high negative intrapleural pressures

40
Q

A 68 year-old male with history of COPD is brought to the emergency department following a motor vehicle collision. On physical examination there is evidence of head trauma. The left side of the chest wall appears to move inward with inspiration and outward with expiration. A chest x-ray reveals multiple rib fractures on the left. Which of the following is the most appropriate intervention?
A Surgical fixation of the fractured ribs
B Application of elastic binders and adhesive tape
C Endotracheal intubation and mechanical ventilation
D Chest physiotherapy that encourages frequent coughing

A

c. endotracheal intubation and mechanical ventilation

41
Q

A 28 year-old man presents to the emergency department complaining of sudden onset of shortness of breath associated with sharp right-sided chest pain increased with breathing. On physical examination, respirations are 20 per minute and blood pressure is 120/76 mm Hg. Auscultation of the chest reveals absent breath sounds over the right apex with normal heart sounds. Percussion of the right apex is noted to be hyperresonant. Which of the following is the most likely diagnosis?
A Hemothorax
B Pneumothorax
C Pulmonary embolus
D Foreign body aspiration

A

b. pneumothorax

Clinical: General Surgery (10 decks)

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