Pulmonology

Question 1

How do you diagnose Asthma?

Answer 1

History and PFT tests that improve after using bronchodilator:
FEV1 >15% and Peak expiration flow rate >20%

Question 2

What is considered intermittent asthma?

Treatment?

Answer 2

Most mild form of asthma
Daytime sxs: < or = 2 days/wk
Nighttime sxs: < or = 2 times/mo
Use of inhaler: < or = 2 days/wk
Interfering in nl activity: No
Lung Function:  FEV1 >80% of predicted; FEV1/FVC nl
SABA (Albuterol)

Question 3

What is considered mild persistent asthma?

Treatment?

Answer 3

Day Sxs: > 2 days/wk
Night Sxs: 3-4 times/mo
Use of rescue med: > 2 days per week, not daily and not more than once per day.
Normal activity: minor limitations
Lung function: FEV1>80% predicted; FEV1/FVC normal
Adding a low dose inhaled corticosteroid: fluticasone

Question 4

What is considered moderate persistent asthma?
Treatment?
What if still sxs?

Answer 4

Day Sxs: daily
Night Sxs: > once per week, not daily
Use of rescue med: daily
Activities: some limits
Lung Function: FEV1> 60%, but <80%; FEV1/FVC reduced 5%
Treatment: low dose inhaled corticosteroid (fluticasone) + LABA (Salmeterol).
Change ICS to medium dosed + LABA

Question 5

What is considered severe persistent asthma?
Treatment?
If doesn’t work?

Answer 5

Daily sxs: throughout day
Night sxs: > 7x/wk
Use of inhaler: several times/day
Activities: extreme limitation
Lung Function: FEV1 <60%; FEV1/FVC reduced>5%
Treatment: High dose inhaled corticosteroid + LABA (Salmeterol).
High dose ICS + LABA + oral corticosteroid

Question 6

What is affected with a PE?
What is Virchow’s Triad(cause of PE)?
What is the CXR finding with a PE?

Answer 6

Right side of heart: obstructing heart flow. MC emboli are coming from legs.
Injury, stasis, hypercoagulability.
Normal CXR.

Question 7

What are some paraneoplastic syndromes seen with Small Cell Lung Cancer?

Answer 7

• Superior vena cava obstruction(blood can’t get down from head)–torturous veins on neck & hands ; death imminent.
• Hoerner’s Syndrome: ptosis, miosis (pupil constriction)
• Lambert-Eaton: weakness
• SIADH: hyponatremia, seizures (Na screwed up)
• Cushings(tumor secretes steroids): round fancies, buffalo hump
• Dermatomyositis: muscle breaks down, purple rash on face and hands.
• Clubbing: large convex nails; smoker that gets clubbing think lung cancer

Question 8

What is found with Squamous Cell Lung Cancer as part of the paraneoplastic syndrome?

Answer 8

Hypercalcemia: constipated, irritable bowel, kidney stones.

Caused by tumor secreting hormone.

Question 9

What med if given to asthmatic can kill them?

Answer 9

BB: this is also called a Beta antagonist.

Asthmatics need Beta Agonist to relax muscles in the airways

Question 10

What happens with COPD?
What is considered the blue bloater?
What is the pink puffer?

Answer 10

Lungs get big, but don’t work. Increased TLC, but airflow obstruction.
Blue Bloater: Chronic bronchitis(is the mucus part). Blue Bloater is use to chronic low O2 and higher CO2 levels; lung vessels constrict, stenose and scar up.
Pink Puffer: Emphysema destroys alveoli, and patient looks emaciated and cachectic.

Question 11

What is ARDS (Acute Respiratory Distress Syndrome)?
What is seen on CXR?
DXic criteria?
Tx?

Answer 11

Acute lung failure usually from sepsis. Pulmonary edema with a normal size heart.
Kerly B lines and diffuse infiltrates.
Dx: hypoxia (paO2 <60mmHg); no evidence of CHF; diffuse infiltrates.
Supportive tx only.

Question 12

What is the MCC of acute bronchitis?

In patient with bronchitis sxs, when do you order a CXR?

Answer 12

Rhinovirus.

Fever, age >75, smoker, immunosuppressive

Question 13

What is the most consistent sx in primary TB?
How to determine if mantoux test is positive in: healthy person with low likelihood of dz; healthcare workers or in high risk settings; HIV, close contacts, immunocompromised.

Answer 13

Fever.

Mantoux test +: healthy low risk = >/= 15 mm induration; healthcare worker or high risk = >/+ 10 mm; HIV etc: >/= 5mm

Question 14

Describe exudative pleural effusion and cause?

Answer 14

Thick, gunky and needs to come out. Malignancy(lung cancer) and empyema(can develop after pneumonia)are causes.

Question 15

What is transudative pleural effusion? Causes?

Answer 15

Thin watery fluid that doesn’t need to be taken out. Caused by CHF, Cirrhosis, PE.
Treat with medications.

Question 16

What is restrictive lung disease? Type of lung disease?
Signs on exam
Signs on CXR
Treatment

Answer 16

Lung expansion is restricted, so it is Difficult to fill lungs with air and decreases ability of oxygen to diffuse.
Dry Crackles.
Honeycomb lung.
Supportive and O2.

Question 17

What is the disease the affects the lung and causes pancreatitis in a young person?
What organs are affected?

Answer 17

Cystic Fibrosis.

Affects the lungs the most, then pancreas, kidney, liver, intestine.

Question 18

What is a diffuse lung injury that is caused by something else: another process or systemic disease?

Answer 18

ARDS

Question 19

Addition of what med can improve airflow and reduce their need for hospitalization in acute severe asthma?

Answer 19

IV magnesium

Question 20

What is the condition that has abnormal dilation and destruction of alveoli either from inherited or acquired means?
What is the diagnostic test of choice?

Answer 20

Bronchiectasis is from Cystic Fibrosis or chronic infection.

CT.

Question 21

What is the treatment for a lung abscess?

Answer 21

Clindamycin or Amox-Clav

Question 22

What does restrictive Lung disease cause in systemic arterial blood gas values?

Answer 22

Respiratory Alkalosis: stiffness of lungs, hyperventilation, decreased O2 diffusion.

Question 23

What does pulmonary function testing show in idiopathic pulmonary fibrosis(idiopathic fibrosing interstitial pneumonia)

Answer 23

Restricted pattern: normal to increased FEV1/FVC

Decreased carbon monoxide diffusing capacity.

Question 24

What is the MCC of clubbing? Do you see clubbing in COPD patients? Other causes of clubbing?

Answer 24

Lung cancer. No, think lung cancer or look for other reason. Hypertrophic osteoarthropathy is found in patients when clubbing is due to lung cancer: causes pain in shoulders, knees, ankles, wrists elbows.
Interstitial pulmonary fibrosis, lung abscess, CHF

Question 25

What is the MCC of community acquired pneumonia with abrupt onset of fever and cough with consolidation seen on CXR?

Answer 25

Strep pneumonia

Question 26

What do these sxs indicate: fever, non productive cough, joint pain, weight loss. CXR shows bilateral hilar adenopathy.
How do you make the Dx?

Answer 26

Sarcoidosis.
Biopsy the mediastinal nodes
Should have noncaseating granulomas

Question 27

Sarcoidosis causes restrictive lung disease. What is this and what do you see with lung function?

Answer 27

Restricts the lung expansion so it is difficult to fully expand lungs with air: Reduced total lung capacity, decreased carbon monoxide diffusion.
Normal or increased FEV1/FVC

Question 28

Asthma and chronic bronchitis are obstructive lung diseases. What is this? What do you see with FEV1/FVC?

Answer 28

This is an airway obstruction that makes it hard to exhale all the air in the lungs: Decreased FEV1/FVC

Question 29

What disorder can be found in patients with clubbing when due to lung cancer that causes arthritis, periostitis(inflammation of membrane surrounding bone) of long bones

Answer 29

Hypertrophic osteoarthropathy

Question 30

What lung cancer commonly metastasizes to regional lymph nodes and causes a pleural effusion?
What are signs of a pleural effusion?
CXR finding?

Answer 30

Squamous Cell Carcinoma of lung.
Dyspnea, dull percussion and absent breath sounds;
Blunting of costophrenic angle, loss of sharp demarcation of diaphragm and heart, mediastinal shift to uninvolved side

Question 31

What is the physical exam finding for pleural effusion?

What is the different with pneumonia?

Answer 31

Dullness to percussion, decreased tactile fremitus, asymmetrical chest expansion.
Pneumonia: increased tactile and vocal fremitus, egophany, pectoriloquy.