Pulmonology

Question 1

What will pulmonary function testing show in asthma?

Answer 1

This will show a reduced FEV1:FVC ratio. After bronchodilator administra tion the pulmonary function should return to baseline.

Question 2

What is the last step in management for uncontrolled asthma?

Answer 2

High dose inhaled steroids plus oral corticosteroids plus a long acting beta agonist. This is last resort therapy.

Question 3

What is the most common etiology in bronchitis?

Answer 3

It is usually viral in nature (influenza, parainfluenza, and coronavirus). For this reason, antibiotics are not indicated.

Question 4

How long can the cough in bronchitis last?

Answer 4

The cough can last up to three weeks. A cough lasting for a week or two weeks does not require antibiotic treatment. Three weeks of cough is constant with viral bronchitis.

Question 5

What is the most common etiology in bronchiolitis?

Answer 5

RSV (respiratory syncytial virus)

Question 6

What x-ray finding will be present in patients with epiglottitis?

Answer 6

X-ray is not needed for diagnosis. But, when done, will show thumb sign which represents an enlarged epiglottis.

Question 7

What is the typical presentation for a patient presenting with croup?

Answer 7

Your going to look for a child presenting with a barking cough and stridor.

Question 8

What is outpatient management for croup?

Answer 8

Dexamethasone. Those with more severe symptoms are given nebulized epinephrine and oxygen.

Question 9

What is the treatment of choice if patients have had influenza type symptoms over 2 days?

Answer 9

Symptomatic treatment is indicated after two days of disease. If the patient pre sents less than 48 hours of symptom onset, then you may treat with oseltamivir or zanamivir.

Question 10

What is the first line treatment for pertussis?

Answer 10

First line treatment will be a macrolide. Remember to treat all close contacts as well prophylactically.

Question 11

What is the most common etiology in pneumonia?

Answer 11

Streptococcus pneumonia. This will be the most common etiology in all scenarios. Certain situations will have associations such as HIV and pneumocystis, but overall, strep pneumo will be the most common etiology.

Question 12

What are the three atypical organisms that cause pneumonia?

Answer 12

Mycoplasma, chlamydia, and legionella. Atypical means that they cannot be cul tured with the typical medium and will present differently. They are important to know because collectively they make up about half of all pneumonia.

Question 13

Currant jelly sputum is associated with which type of pneumonia?

Answer 13

Klebsiella, which is also associated with alcoholics. Know your associations!

Question 14

First line treatment for community acquired pneumonia in a diabetic?

Answer 14

Respiratory fluoroquinolone (due to comorbidity). Another option is ceftriaxone plus a macrolide (doxycycline can be substituted for macrolide).

Question 15

What is initial treatment for active tuberculosis?

Answer 15

Remember the acronym RIPE

R - rifampin

I - isoniazid

P - pyrazinamide
 E - ethambutol

Treat with RIPE for 2 months, then continue with rifampin and isoniazid for the re maining 4 months. This will give 6 months of treatment.

Question 16

A recent immigrant was screened with a PPD. His result was 10mm. What is the next step in management?

Answer 16

Recent immigration means that a 10mm reading is a positive reading. The next step will be chest x-ray to rule out active infection.

Question 17

What should always be concurrently given to patients whenever initiating isoniazid?

Answer 17

Always give patients vitamin B6 (pyridoxine) to prevent peripheral neuropathy.

Question 18

What paraneoplastic syndroms are small cell carcinoma associated with?

Answer 18

Look for Cushing syndrome or SIADH.

Question 19

Most common cause of bronchiectasis?

Answer 19

Cystic fibrosis

Question 20

What is the most likely etiology of emphysema when found in a young non- smoking patient?

Answer 20

This is going to be alpha 1 anti trypsin deficiency.

Question 21

What arrhythmia is associated with COPD?

Answer 21

MAT - multifocal atrial tachycardia

Question 22

What constitues an obstructive pattern on PFT?

Answer 22

The obstruction will make it difficult to blow out air - this results in a decreased
FEV1 (

Question 23

When is oxygen therapy indicated in patients with COPD?

Answer 23

All patients with an O2 saturation less than 88% or PAO2 less than 55 should be given supplemental oxygen.

Question 24

How are patients with cystic fibrosis diagnosed?

Answer 24

All newborns should be universally screened. Diagnosis is made with a sweat chloride test (>60 moml/L).

Question 25

What antibiotic is given as a daily dose for cystic fibrosis patients due to its anti inflammatory and anti bacterial properties?

Answer 25

Azithromycin

Question 26

Will heart failure lead to a transudative or exudative pleural effusion?

Answer 26

This will lead to transudative effusion. Other common causes of transudative pleural effusion will be hypoalbuminuria and cirrhosis.

Question 27

What does the classic patient look like who will present with spontaneous pneu mothorax?

Answer 27

You will look for a tall young male who smokes. A family history of pneumotho rax might also be present.

Question 28

What chest x-ray finding will be present in patients with tension pneumothorax?

Answer 28

The chest x-ray will show the trachea and heart shifted to the contralateral side of the pneumothorax.

Question 29

What is the most common cause of cor pulmonale?

Answer 29

COPD

Question 30

What is the most common presentation for pulmonary embolism?

Answer 30

The most common presentation will be a female with virchows triad presenting with dyspnea and pleuritic chest pain (pain with inhalation).

Question 31

What is the most common EKG finding in pulmonary embolism?

Answer 31

Sinus tachycardia and non specific ST segment and T wave changes. S1Q3T3 is not the most common ECG finding, and is almost never seen.

Question 32

When should a D-dimer be ordered in the workup for PE?

Answer 32

This is only ordered in patients with a low suspicion for PE. If a high clinical suspicion for PE exists, you will go straight to CTA or VQ scan.

Question 33

What is the gold standard for the diagnosis of PE?

Answer 33

Angiography, but is rarely needed because of the high sensitivity and specificity of CTA.

Question 34

What pulmonary function testing pattern will be seen in pulmonary fibrosis?

Answer 34

A restrictive pattern. A reduced FVC and total lung capacity is seen (the lungs are stiff and don’t move).

Question 35

What is the chest x-ray finding seen in sarcoidosis?

Answer 35

High yield buzz word - bilateral hilar adenopathy.