Respiratory Medicine

Question 1

Caused by hypersensitivity-induced lung damage due to variety of inhaled organic particles

Answer 1

Extrinsic Allergic Alveolitis

Question 2

Farmer + Dyspnea + Cough + DIffuse micronodular shadowing

Answer 2

Extrinsic Allergic Alveolitis

Question 3

Other name for Extrinsic Allergic Alveolitis

Answer 3

Hypersensitivity Pneumonitis

Question 4

In extrinsic allergic alveolitis, what findings will you appreciate?

1. CXR
2. bronchoalveolar lavage
3. Blood

Answer 4

1. Diffuse micronodular shadowing
2. Lymphocytosis
3. No eosinophilia

Question 5

A tumor in the apex of the lung causing Horner’s syndrome (miosis, anhidrosis, ptosis)

Answer 5

Pancoast Tumor

Question 6

Pancoast Tumor, a carcinoma that occurs in the apex of the lung, causes compression of what structures structures which result in the following signs:

1. Hoarseness
2. Ipsilateral ptosis
3. Ipsilateral miosis
4. Ipsilateral anhidrosis
5. SVC syndrome
6. Sensorimotor deficits

Answer 6

1. Recurrent laryngeal nerve
   2-4. Stellate ganglion
2. Superior vena cava
3. Brachial Plexus

Question 7

What type of pneumothorax occcurs in tall, young males with no apparent reason?

Answer 7

Primary Spontaneous Pneumothorax

Question 8

Diagnostic and Management for primary spontaneous pneumothorax

Answer 8

Erect CXR
<2cm - conservative management (give O2 supplement)
>2 cm (or distressed) - aspirate with needle

Question 9

Management for secondary spontaneous pneumothorax

Answer 9

<1cm - conservative management (O2 supplement)
1-2cm - needle aspiration
>2 cm - chest drain

Question 10

Management for Tension Pneumothorax

Answer 10

Needle Decompression

Question 11

Percussion and Auscultation findings of CONSOLIDATION

Answer 11

Dull, crackles

Question 12

Percussion and Auscultation findings of PLEURAL EFFUSION

Answer 12

Dull, Decreased breath sounds

Trachea Away from effusion

Question 13

Percussion and Auscultation findings of ATELECTASIS

Answer 13

Decreased breath sounds

Trachea TOWARDS collapsed lung

Question 14

Percussion and Auscultation findings of TENSION PNEUMOTHORAX

Answer 14

Hyperresonant, Reduced breath sounds

Trachea Displaced away from affected side

Question 15

CAP needing antibiotics + PCN allergic or Taking Warfarin

Answer 15

Doxycyline or Clarithromycin

Question 16

CAP needing antibiotics + PCN allergic + taking warfarin + taking statins

Answer 16

Doxycycline

Remember Clarithromycin-statin can cause rhabdomyolysis

Question 17

Warfarin + (Clarithromycin OR Doxycycline) interaction

Answer 17

Increases the anticoagulation effect of warfarin —> Monitor INR

Question 18

Prophylactic antibiotic for HIV patient whose CD4 <50

Answer 18

Azithromycin

Question 19

Prophylactic antibiotic for HIV patient whose CD4 <200

Answer 19

TMP-SMX

Question 20

Most accurate test to diagnose Bronchopleural Fistula

Answer 20

CT

Question 21

A patient scores >4 in Two-level Wells score. What’s the next step?
What if patient did not score >4?

Answer 21

Arrange for CTPA

D-dimer. If positive, then arrange for CTPA

Question 22

CTPA could not be done to a patient since patient has an allergy to a contrast media (or with renal impairment)

Answer 22

Do V/Q scan

Question 23

What initial investigation should be done on a pregnant patient if PE is being suspected?

Answer 23

CXR - to rule out other causes of dyspnea like pneumonia or pneumothorax.

Question 24

In a pregnant patient, CXR is abnormal and PE is being suspected, what is the imaging modality of choice?

Answer 24

CTPA

Question 25

In a pregnant patient, CXR is normal yet PE is still being suspected, what is the imaging modality of choice?

Answer 25

V/Q scan

Question 26

Pulmonary embolism is being suspected on a hemodynamically stable patient, however, CTPA is still not being done. What should be done?

Answer 26

Apixaban or Rivaroxaban

Question 27

In terms of imaging investigations for PE in pregnancy, what are the differences between a CTPA and a V/Q scan?

Answer 27

CTPA - good for baby, bad for mommy since it had higher radiation to maternal breast tissue (increased risk of BRCA for mom) V/Q - more risk of radiation to fetus but lower radiation to maternal breast tissue (increased risk of childhood cancer)

Question 28

Suspected PE + Pregnancy + with symptoms of DVT Next investigation?

Answer 28

Duplex ultrasound | If confirmed: continue LMWH therapeutic dose

Question 29

Blood works findings in a patient with Legionella pneumonia Treatment?

Answer 29

(LOW) Sodium, Albumin, Lymphocytes | and Elevated Liver Enzymes

Question 30

Small cell Lung CA, in terms of: 1. Association with smoking 2. Central or peripheral 3. Paraneoplastic ssx

Answer 30

1. Associated with smoking 2. Central 3. SCLC - SIADH, Cushings, Lambert-Eaton Myasthenic Syndrome, Clonus or Central

Question 31

FVC and FEV1/FVC of obstructive diseases? | Examples of Obstructive Diseases

Answer 31

FVC > 80% FEV1/FVC < 0.7 Asthma, COPD, Cystic Fibrosis, Bronchiectasis

Question 32

FVC and FEV1/FVC of Restrictive diseases? | Examples of Restrictive Diseases

Answer 32

FVC < 80% FEV1/FVC > 0.7 Pulmonary Fibrosis Interstitial Lung Disease Neuromuscular Diseases Thoracic cage deformities

Question 33

Cough + DOB + hemodynamic or respiratory compromise + post-thoracic sx + pneumonectomy or lobectomy + X-ray (high-fluid level that is normal and low air-fluid level that is abnormal)

Answer 33

Bronchopleural Fistula

Question 34

Anticipatory Meds given and for what indication?

Answer 34

SC MORPHINE - for pain and breathlessness SC HALOPERIDOL - for n/v SC MIDAZOLAM - for anxiety, delirium and agitation SC HNBB - for death rattle

Question 35

Non-blanching rash in a pediatric age group + isolated thrombocytopenia

Answer 35

ITP

Question 36

Immediate treatment for management of acute exacerbation of asthma in adults

Answer 36

O2 sat goal of 94-98% Salbutamo 5mg nebulized with O2 Hydrocortisone 100mg IV or Prednisolone 40-50mg PO

Question 37

Childhood asthma: child is on a very low dose ICS and using SABA ≥ 3x/week

Answer 37

Add a LABA ***For a child < 5 y/o, add LTRA instead

Question 38

Childhood asthma: child is on a very low dose ICS + LABA and using SABA ≥ 3x/week

Answer 38

Increase ICS dose

Question 39

Screening test for tuberculosis in a patient with BCG vaccine

Answer 39

IFN-gamma testing (Do not do Mantoux testing as Mantoux testing may be positive in a patient who had a BCG vaccine)