Pulmonology

Question 1

Pleural exudate characteristics

Answer 1

Protein pleural fluid to serum ratio > 0.5, lactate dehydrogenase (LDH) pleural fluid to serum ratio > 0.6
LDH > 2/3 upper limits of normal for serum LDH

Question 2

Common causes of respiratory acidosis

Answer 2

Exacerbations of COPD, severe exacerbation of asthma, and narcotic overdose.

Question 3

Diffusing capacity (DLCO) in chronic bronchitis and emphysema.

Answer 3

DLCO is normal in chronic bronchitis; a decreased DLCO is more consistent with a diagnosis of emphysema.

Question 4

Steps to manage a pulmonary nodule

Answer 4

depends on the lesion size, patient symptoms, and risk factors.

In a low/intermediate-risk patient with a nodule > 8 mm: characterize the lesion with a PET scan (though a biopsy can also be performed).

If the PET scan shows a lesion concerning for malignancy: surgical excision is indicated.

If the lesion is not concerning for malignancy: followed with serial CT scans.

Question 5

The most accurate test for pulmonary hypertension is?

Answer 5

right-sided heart catheterization.

Question 6

Aspirin-induced asthma

Answer 6

Triggered by hypersensitivity to NSAIDs.
Chronic rhinosinusitis and nasal polyposis There is dysregulation of arachidonic acid metabolism, causing overproduction of leukotrienes that are pro-inflammatory.

The best initial treatment is montelukast, an anti-leukotriene.

Question 7

Pulmonary contusion

Answer 7

Typically occurs in the setting of major blunt trauma to the chest and abdomen.
Symptoms: will not present until hours to days later when pulmonary edema and inflammation begin to take place.
Shortness of breath, poor oxygen saturation, and an arterial blood gas with respiratory alkalosis.
Self-resolve and all that is needed is supportive therapy.

Question 8

By definition, patients with tension pneumothorax are?

Answer 8

hemodynamically unstable.

Question 9

Solitary pulmonary nodule rx findings that suggest malignancy

Answer 9

Lack of calcification, diameter >2.2 cm, spiculated margin, located in the upper lobe and if it is associated with atelectasis or pneumonitis.

Question 10

Which pneumoconiosis resembles sarcoidosis?

Answer 10

Beryllium presents with hilar lymphadenopathy and non caseating granulomas.