Respiratory

Question 1

Patient with PMH of Hodgkin’s disease that was cured with chemo/radiation has a nodule in the lung what is the cause? (No fever, chills)

Answer 1

Secondary malignancy.

Question 2

Patient with pneumonia admitted to the hospital with possible sepsis is at risk to develop…

Answer 2

ARDS - to differentiate with cariogenic pulmonary edema do a PCWP. The PCWP is normal in ARDS.

Question 3

What are possible structures in the middle mediastinum?

Answer 3

Bronchogenic cyst, tracheal tumors, pericaldial cysts, lymphomas, and aortic aneurysms

Question 4

Anterior mediastinum

Answer 4

Thymoma, tretrosternal thyroid, teratoma, and lymphoma

Question 5

Which lab test on the pleural fluid will determine chest tube placement in parapneumonic effusion?

Answer 5

Pleural fluid pH. it if is low <60 is also indicative of drainage.

Question 6

What are indicators of severe asthma attacks?

Answer 6

normal to increased Pco2, speech difficulty, diaphoresis, altered sensorium, cyanosis, and ‘silent’ lungs

Question 7

Raynaud phenomenon, skin thickening, telangiectasia, heartburn, HTN?

Answer 7

Systemic sclerosis. Also prone to pulmonary fibrosis.

Question 8

What parameter is a good measure for ventilation?

Answer 8

arterial Pco2, affected mainly by respiratory rate and tidal volume.

Question 9

What parameter measures oxygenation?

Answer 9

arterial pO2 influenced mainly by FiO2 and PEEP.

Question 10

What is light’s criteria for pleural fluids?

Answer 10

exudative if the fluid protein/serium protein ratio >0.5, fluid LDH/serum LDH>0.6.

Question 11

What is the next step in management in a patient with possible allergic rhinitis that doesn’t resolve with OTC anti-allergy medications?

Answer 11

nasal smear for eosinophils

Question 12

What effect do glucocorticoids have on the white blood cells?

Answer 12

Decrease eosinophils but sharp increase (leukocytosis) in neutrophils

Question 13

What are the findings in chronic bronchitis?

Answer 13

decreased FEV1/FVC ratio, but normal DLCO. decreased DLCO favors emphysema

Question 14

Patient with a history of constitutional symptoms and cough has an x-ray lesion that also moves upon changing position…

Answer 14

Aspergilloma

Question 15

Severe obesity and alveolar hypoventilation during wakefulness…

Answer 15

Obesity Hypoventilation Syndrome (Pickwickian dynrome)

Question 16

What type of electrolyte abnormality can beta blockers cause?

Answer 16

Hypokalemia = muscle weakeness, arrhythmias, headache, tremor, and palpitations.

Question 17

Patient with dyspnea and dry cough for months with no other symptoms or comorbidities….

Answer 17

Idiopathic pulmonary fibrosis. Shows an increased A-a gradient.

Question 18

patient with a long smoking history, digital clubbing and arthropathy…

Answer 18

Hypertrophic osteoarthropathy condition that is associated with lung carcer. obtain chest-xray to rule out.

Question 19

what is the most common adverse effect of inhaled corticosteroid therapy?

Answer 19

Oral thrush (candidiasis)