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Internal Medicine Board Exam > Pulmonology and Critical Care Medicine > Flashcards

Pulmonology and Critical Care Medicine Flashcards

1
Q

What lung disease presents in patients between 50 to 70 years old, greater than 6 months duration, dry cough, dyspnea on exertion, velcro-like crackles, clubbing, honeycombing changes on HRCT scan?

A

Idiopathic Pulmonary Fibrosis

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2
Q

How does one diagnosis chronic thromboembolic pulmonary hypertension?

A

V/Q scan

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3
Q

Severe Asthma therapy that targets type 2 inflammation, what drug is this?

A

Mepolizumab

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4
Q

A patient has sepsis, how does fluid resuscitation work?

What is the lactate level?

A

1st hour, 30 cc/kg LR given, ideally

Lactate above 2 if there is an active infection

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5
Q

What is a good NIF number?

A

-20

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6
Q

What is a good RSBI number?

What is the formula?

A

less than 105

RSBI = RR (Breaths per minute) / Tidal Volume (L)

Denominator should be example (0.450)

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7
Q

Chronic Thromboembolic Pulmonary HTN what treatment should be what?

A

AC and Surgery

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8
Q

What is the only Chronic Thromboembolic Pulmonary HTN medication if no surgery will be done?

A

Riociguat, soluble guanylate cyclase, primary receptor of nitric oxide

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9
Q

Patients with Chronic Thromboembolic Pulmonary HTN, what is needed to rule out Pulmonary HTN?

A

V/Q scan, CTA not as sensitive
RHC and Pulmonary Angiography should be avoided in patients with a normal V/Q scan

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10
Q

Pulmonary: Pre-flight, what testing should be done before?

A

Resting Pulse Oximetry

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11
Q

Nitric Oxide Fraction looks at what?

A

Non-invasive measurement of eosinophils

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12
Q

Severe temperatures below what number require internal rewarming methods?

A

Below 82.4 F

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13
Q

How should active rewarming temperatures be taken?

A

Esophageal Probe

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14
Q

If Pulmonary HTN is diagnosed on echo, what is the confirmatory test?

A

Right Heart Cath

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15
Q

Group 1 Pulmonary HTN can be given what if a RHC shows improvement with nitric oxide?

A

Nifedipine

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16
Q

What medication may be given in mild to moderate Pulmonary Artery Hypertension without vasoreactivity?

A

Sildenafil

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17
Q

If a patient has COPD Gold criteria E, patient is already on LABA-LAMA-ICS, what is the next best step?

A

Roflumilast, PDE-4 inhibitor

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18
Q

COPD Gold group A is what treatment?

A

Bronchodilator (LAMA +SABA), other opitions

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19
Q

COPD Gold group B is what treatment?

A

LAMA-LABA, Anoro Ellipta, other opitions

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20
Q

COPD Gold group E is what treatment?

A

LABA+LAMA+ICS, Trelegy Ellipta or Breztri

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21
Q

COPD Gold group E, what is another thing to evaluate?

A

Eosinophils

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22
Q

Dyspnea when hurrying or walking up a slight hill is what GOLD group?

A

GOLD group A

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23
Q

Walks slower than people of the same age because of dyspnea or has to stop for breath when walking at own pace is what GOLD group?

A

GOLD group B

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24
Q

2 or more moderate COPD exacerbations is what?

A

Gold Group E

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25
Q

Montelukast can have what side effect?

A

Depression, black box warning

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26
Q

If patients have bad asthma and COPD what should be measured?

A

Eosinophils

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27
Q

When determining Lung Cancer staging, what size should the nodules be before a scan shows any benefit?

A

Greater than 8mm

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28
Q

If a CT chest shows a stable nodule after 6 months, when should the follow up CT scans be done?

A

Every 2 years for 5 years

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29
Q

Before an apical Lung mass can be removed, what should be done?

A

CT Chest Scan

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30
Q

Velcro like crackles at both lung bases, what is this, think autoimmune?

A

Idiopathic Pulmonary Fibrosis

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31
Q

Idiopathic Pulmonary Fibrosis, what should be done?

A

Pirfenidone and Ninedanib

32
Q

PE in pregnancy, what could treat this problem?

A

Low Molecular Weight Heparin

33
Q

A patient’s asthma response to steroids can be seen with what?

A

Fractional Exhaled Nitric Oxide

34
Q

The most common form of exudative effusions is what?

A

Infection and Malignancy

35
Q

An exudate effusion that has a triglyceride level above 110 and primarily lymphocytic is what?

A

Chylothorax
Lymphoma can cause

36
Q

An inflammatory effusion from what has a low pH (<7.2), low glucose (40), an elevated LDH, what is this?

A

Inflammatory Effusion

37
Q

An incidental ground glass lesion 6mm or larger, when found, will have a CT scan repeat in 6-12 months. Afterwards, how often?

A

Every 2 years for 5 years

38
Q

Ethylene Glycol and Methanol should be treated with what?

A

Fomepizole or the ethanol

39
Q

Ethylene Glycol poisoning and end organ damage, what should be done?

A

Fomepizole and Dialysis

40
Q

Neutropenic fever, antibiotics can be stopped when?

A

Full course for antibiotics or absolute neutrophil count is above 500, whichever is longest. Patient should also be afebrile.

41
Q

Spontaneous primary pneumothorax prevention in a patient with a risk occupation, is what?

A

Recurrence Prevention (pleurodesis)

42
Q

Aspiration Pneumonitis, improve after 24 hours, what can be done if on abx?

A

Can stop antibiotics

43
Q

COPD with thick purulent sputum, P. Aeruginosa history, what is the best antibiotic to give?

A

Ciprofloxacin, not azithyromycin

44
Q

COPD and does not improve with albuterol, what should be given?

A

Inhaled Fluticasone Propionate-Salmeterol (LABA-LAMA)

45
Q

Thermal injury 2/2 fire, patient has some oral swelling, oxygenating well, what procedure does the patient need?

A

Patient needs to have a Bronchoscopy

46
Q

Low risk patient with a 6 mm nodule, what is the follow up CT scan advice?

A

No further follow up

47
Q

What is the first test for a chronic PE?

A

V/Q scan

48
Q

What meds can help modify the ALS disease?

A

riluzole, edaravone

49
Q

Leukocytosis with an initial neutrophil predominance and elevated IgE, what is this associated with?

A

Acute Eosinophilic Pneumonia
Usually with new or restarted smoking history
consistent with a Hypersensitivity reaction

50
Q

What will improve mortality with ALS?

A

Non-invasive Ventilation (BiPAP)

51
Q

Cystic fibrosis has pancreatitis, chronic liver disease, and pulmonary symptoms, what will a chest xray show?

A

Cavitation, Bronchiectasis with GI symptoms, steatorrhea, diarrhea, or abdominal pain

52
Q

Pulmonary Hypertension group #1 is due to what?

A

Idiopathic, hertiable

53
Q

Pulmonary Hypertension group #2 is due to what?

A

Left Heart Disease

54
Q

Pulmonary Hypertension group #3 is due to what?

A

Lung Disease

55
Q

Pulmonary Hypertension group #4 is due to what?

A

Chronic Thromboembolic PH

56
Q

Pulmonary Hypertension group #5 is due to what?

A

Multifactorial

57
Q

What is anti-P/Q-type voltage-gated calcium channel antibodies? What disease may this be?

A

Lambert Eaton myasthenic syndrome

58
Q

What is the first medication to start with Lambert Eaton?

A

Pyridostigmine

59
Q

Incidental finding in the patient’s middle mediastinum, what is the most likely finding?

A

Bronchogenic Cyst

60
Q

What Pneumonia Vaccine should be given if no previous vaccine has been given, under the age of 65 with risk factors?

A

PCV 20

61
Q

If Patient has PCV 15 vaccine given, what vaccine should be given one year later?

A

PCV 23

62
Q

Common variable immunodeficiency, what are these people at risk of obtaining?

A

Risk of Lymphoma

63
Q

What are CVID patients, pulmonary wise, at risk of obtaining? What will the CT scan show?

A

Bronchiectasis, tram track bronchi, can see a Signet ring

64
Q

Patients with non-small cell lung cancer Stage I and II, what is the next best step?

A

Surgery and Adjuvant Chemotherapy (cisplatin based therapy)

65
Q

Patient has a PFT done, FEV1/FVC increase from 10-12% with bronchodilator, what could that be?

A

Asthma

66
Q

Patient has aspiration concerns, what is the test of choice?

A

CT chest with contrast, Contrast can help outline the abscess

67
Q

For COPD patients, what should be done first before romflumilast and Azithyromycin?

A

LAMA, LABA, and ICS

68
Q

Anti synthetase Syndrome has what positive antibody?

A

anti-Histidyl-transfer RNA synthetase antibodies

69
Q

Post primary TB, what should be done if the patient has respiratory issues and is symptommatic?

A

Sputum Cx and acid fast bacilli

70
Q

May Turner Syndrome is another name for iliac vein compression syndrome. Where is the compression?

A

Right Common Iliac Artery and 5th Lumbar Vertebrae. Will do Antiplatelet and compression stocking

71
Q

What is a common Pneumocosis that can make TB worse?

A

Silicosis

72
Q

What medication is contraindicated in active TB and Gout?

A

Pyrazinamide

73
Q

What is central sleep apnea, via mechanism?

A

Loss of Brainstem central respiratory generator output precipitating airflow pauses and subsequent hyperventilation with low PCO2

74
Q

What vaccine is recommended in COPD patients? Not PCV

A

Herpes Zoster, over the age of 50, two doses 2-6 months apart

75
Q

Elevated cholesterol of what number in the pleural fluid gives the diagnosis?

A

Cholesterol above 200

76
Q

Triglyceride level higher than what may indicate the patient has a chylothorax?

A

Above 110

Internal Medicine Board Exam (18 decks)

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