Pulmonology

Question 1

Duration of chronic cough

Answer 1

> 8 weeks

Question 2

First step in evaluation of a chronic cough

Answer 2

Chest xray

Question 3

Most common causes of chronic cough in a non-smoker, not on ACEIs, with normal PE and CXR: (3)

Answer 3

1. Postnasal drip
2. Asthma
3. GERD

Question 4

Criteria for diagnosis of Bronchial Asthma on spirometry:

Answer 4

Low FEV1
FEV1/FVC ratio is <0.7
FEV1 is increased by >12% and 200mL post bronchodilator
FEV1 is increased by >12% and 200mL from baseline after 4 weeks on steroid trial

Question 5

Best diagnostic test in COPD during acute exacerbations

Answer 5

ABG

Question 6

Major site of increated resistance in most individuals with COPD

Answer 6

Small airways (<2mm)

Question 7

Most important prognostic factor for COPD

Answer 7

Degree of airflow obstruction

Question 8

When do you start supplemental O2 in COPD?

Answer 8

pO2 <55/ sat 88%

or pO2 <60/sat 90% if with signs of pulmonary hypertension or lung failure

Question 9

PDE4 inhibitor that may be beneficial for COPD

Answer 9

Roflumilast

Question 10

Target O2 sat in acute exacerbations of COPD:

Answer 10

%>=90

Question 11

Bacteria commonly implicated in COPD exacerbation:

Answer 11

H. influenzae
M. catarrhalis
S. pneumoniae

Question 12

In CAP, gross hemoptysis is suggestive of:

Answer 12

CA-MRSA

Question 13

Chest radiograph in CAP will resolve at around:

Answer 13

4-12 weeks

Question 14

Primary lung abscesses are usually due to:

Answer 14

Aspiration

Question 15

Recommended treatment for primary lung abscess

Answer 15

Clindamycin IV or

Beta lactam with BLIC IV

Question 16

Lung zones most commonly involved in primary PTB

Answer 16

Middle and lower lung zones

Question 17

Lung zones most commonly involved in post-primary PTB

Answer 17

Apical and posterior segments of upper lobes

Superior segments of lower lobes

Question 18

Target MAP for septic shock

Answer 18

65 mmHg

Question 19

PaO2/FiO2 ratio idicative of ARDS

Answer 19

<300

Question 20

These cause DIRECT lung injury which may lead to ARDS: (5)

Answer 20

Pneumonia
Aspiration
Pulmonary contusion
Near-drowning
Toxic inhalation

Question 21

After starting controller therapy for asthma, physician should monitor response after:

Answer 21

2-3 months

Question 22

Serum and pleural fluid protein gradient >___g/L suggests transudative pleural effusion

Answer 22

31 g/L

Question 23

Most common cause of pleural effusion

Answer 23

LV failure

Question 24

Pleural effusion: factors that suggest need for more invasive procedure than thoracentesis (in increasing order of importance) (5)

Answer 24

Loculated pleural fluid
Pleural fluid pH <7.20
Pleural fluid glucose <60 mg/dL
Positive gram stain or culture of pleural fluid
Presence of gross puss

Question 25

Initial recommended therapy for primary spontaneous pneumothorax

Answer 25

Simple aspiration

Question 26

Most secondary pneumothorax is due to:

Answer 26

COPD

Question 27

The major risk factor for asthma

Answer 27

Atopy

Question 28

The characteristic physiologic abnormality in asthma

Answer 28

Airway hyperresponsiveness

Question 29

If pleural effusion is clinically transudative but biochemically exudative, check________

Answer 29

Serum-pleural fluid gradient

>31 g/dL is transudative

Question 30

This is the most highly significant predictor of FEV1 in COPD

Answer 30

Pack-years of smoking

Question 31

Ventilatory failure is defined as PCO2>____mmHg

Answer 31

PCO2>45mmHg

Question 32

Single strongest predictor of COPD exacerbations

Answer 32

Previous exacerbation