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dha exam > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What causes bronchiolitis

A

RSV

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2
Q

How to manage broncholitis

A

Rehydration

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3
Q

Ptn with mild asthma, treatment

A

SABA with ICS

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4
Q

How many years the average smoker loses

A

10 years

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5
Q

Smoking will increase risk of lung cancer by ..,,folds

A

30 folds

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6
Q

Smoking incubation period in lung cancer is

A

20 years

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7
Q

Risk of MI in smoker vs non smoker

A

2

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8
Q

Ptn with lung cancer has dyspnea, raised JVP and clear lungs with low heart sound what to do for investigation

A

Echo

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9
Q

Lung cancer ptn has picture of superior vena cava obstruction ( face flushing ect, ) what type of lung cancer

A

Small cell lung cancer

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10
Q

Alteplase is the treatment for

A

PE

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11
Q

Smoker presents with hemoptysis and pleural effusion without shifting apex beat and trachea, what’s the cause?

A

Cancer in the ipsilateral main bronchi

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12
Q

Name leukotriene receptor antagonist

A

Montelukast

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13
Q

Ptn present with asthma exacerbation, name drug that affect mucous secretion more than bronchodilation ?

A

Prednisone

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14
Q

52 year old smoker for 40 years is now complaining of cough for 4 months that happened on fall and last year as well same time with cold symptoms, also she has a mild dyspnea, No hemoptysis what your diagnosis

A

Chronic bronchitis

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15
Q

COPD Ptn on salbutamol but now not controlled, what to add

A

Tiotropium

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16
Q

Female ptn with progressive dyspnea and fatigue is having crackles on auscultation, when examining her lower limb she has red tender induration on her shin, what the next step

A

Chest X-ray

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17
Q

Improve survival in COPD ?

A

Stop smoking

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18
Q

Sever case of COPD with full secretions

A

Invasive MV

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19
Q

Indication of oxygen therapy in COPD

A

…??? 7.3?…

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20
Q

Smoker recently diagnosed with SLE what’s life style changes

A

Stop smoking

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21
Q

Tall ptn developed dyspnea after long flight, pneumothorax is found what’s next

A

If <3cm = conservative, if >3cm then chest tube

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22
Q

Ptn coming back from east Asia with symptoms of tb , X-ray showing cavitation what’s next

A

Sputum for acid fast bacilli, isolation

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23
Q

Ptn with productive cough + dyspnea + fever, X-ray shows bilateral middle lobe consolidation, test shows reticulocytes cold agglutination test. Whats diagnosis

A

Atypical pneumonia

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24
Q

Most common organism that causes lobar pneumonia is

A

Streptococcus pneumoniae

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25
Q

Tb drug that causes hyperurecemia

A

Pyrazinamide

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26
Q

Which one of the asthma drugs cause hypokalemia

A

Salbutamol

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27
Q

Ptn with exudative pleural effusion has positive gamma interferon, what’s your diagnosis

A

TB pleural effusion

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28
Q

What’s the best diagnostic test for occupational asthma?

A

Serial PFTS at work and home

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29
Q

Pregnant ptn presents with dyspnea, productive cough of white sputum she tells you that she’s allergic to dust what to do in diagnosis

A

Spirometry

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30
Q

………is ass, with pulmonary TB

A

Silicosis

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31
Q

What’s prevalence of disease effect

A

Predictive value

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32
Q

What’s the only approved drug to help quit smoking

A

Varenicline

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33
Q

Community acquired pneumonia is treated by….

A

Azithromycin

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34
Q

Heavy smoker with facial plethora + distended JVP ,what’s your diagnosis

A

Small cell lung cancer

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35
Q

Ptn with known asthma present cough, night sweats, with cavitation on his new X-ray which before didn’t exist on old X-ray wha to do ?

A

Isolate him in negative room pressure

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36
Q

What’s the definitive diagnostic test for ptn with bronechtasis?

A

HRCT

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37
Q

Case with TB, what test should be done before giving treatment

A

LFT

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38
Q

Cancer ptn with pleural effusion who did multiple tab but recurrence keep happening what’s the solution?

A

Chemical pleurodesis

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39
Q

Side effect of BB……

A

Bronchospam

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40
Q

Elderly ptn with breast mass and pulmonary symptoms, what’s the most likely diagnosis

A

Exudative pleural effusion due to malignancy

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41
Q

Old ptn has chest infection 4 weeks ago which initially improved on antibiotics but now he developed pleural effusion, diagnosis?

A

Para-pneumonic pleural effusion

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42
Q

Obese Ptn with sleep apnea symptoms, what is the best for diagnosis

A

Polysomnography

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43
Q

Case of TB with pleural effusion, What test can confirm that this pleural effusion is due to TB

A

High pleural fluid ADA level

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44
Q

Ptn with pulmonary embolism, unstable, BP is less than 90/60 what your management

A

Give thrombolytics

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45
Q

Ptn with recurrent chest infection and weight loss, diagnosis

A

Cystic fibrosis

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46
Q

Ptn with highly productive cough ( maybe bronchiectasis) what’s the diagnostic test?

A

CT scan

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47
Q

Male smoker with weight loss and dry cough? Diagnosis

A

Lung cancer

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48
Q

What causes false positive BNP?

A

COPD

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49
Q

Pregnant ptn on SABA complains of cough 2/week and 2 hospital admission, treatment

A

LABA with ICS

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50
Q

Asthma Ptn with anxiety, what to give

A

Sertaline

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51
Q

Ptn has immotile sperms on semen analysis, he had history of chronic sinusitis and chronic URI , what’s the diagnosis

A

Kartagner syndrome

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52
Q

Male Ptn presents with multiple episodes of forceful vomiting, abdominal pain , dyspnea, and subcutaneous emphysema in the chest, what is the diagnosis?

A

Borehaave syndrome

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53
Q

Parents have confirmed TB infection and they have a close contact to their child, the child tuberculin test shows 10mm induration what does it mean

A

The child is positive

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54
Q

Ptn with schistosomiasis , what’s the expected complication?

A

Pulmonary hypertension

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55
Q

Ptn with suspected TB is has pleural effusion, how can you confirm

A

Adenosine diamines more than 45IU

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56
Q

……. Can cause TB

A

Silicosis

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57
Q

Name anti TB drugs that causes hyperurecemia

A

Pyrazinamide, Ethambutol

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58
Q

Old Ptn with small nodule , asymptotic, not smoker, No FH of cancer, what to do next

A

CT scan

59
Q

Ptn has garlic odor with other non constitutional symptoms , what’s the case

A

Organophosphate poisoning

60
Q

Immigrant pregnant woman with productive cough, night chills, cervical lymphadenopathy. interferon gamma release test was positive, how to confirm diagnosis?

A

Sputum culture

61
Q

Ptn with barking cough , what’s the most likely on auscultation

A

Stridor

62
Q

Indication of sever asthma when the PEF is less than ……and inability……..

A

< 250, inability to complete sentence in one breath

63
Q

Young male working in wood factory is having dyspnea, occupational asthma is suspected, how to diagnose

A

Serial peak flow measurement in work and in house

64
Q

What’s the type of pneumoconiosis that will turn to TB

A

Silicosis

65
Q

Before giving anti-TB drug what should you check?

A

LFT

66
Q

Pleural effusion can be malignant if the glucose level

A

Less than 60 or PH less than 7.30

67
Q

What’s the indication for thoracosentesis?

A

Loculated pleura

68
Q

Ptn with pleurisy. Whats the site for thoracosentesis?

A

Mid axillary line between 8th-10th intercostal space

69
Q

Ptn had spontaneous pneumothorax which resolved spontaneously, what to advise him?

A

Not to travel for 1 week

70
Q

Patient 50 yrs. Old. Came for. Routine check. Up visit, by CXR you. Find.Solitary Cheast nodule. About 2*3 patient is asymptomatic ,what is most useful thing to ask.

A

Ask about old chest X-ray

71
Q

Patient presenting with symptoms of obstructive lung disease. PFTs show decreased vital capacity and decreased FEV1/FVC ratio.what is associated with this condition?

Female with 3 wks hs of productive cough With decrease both FEV and ratio
What other finding?

Elderly patient with hx of excessive smoking presented with 2 weeks history of dry cough, nocturnal Spirometry showed decreased ratio FVC/FEF and decreased vital capacity. What else would be associated?

.
Patient with obstructive about Pulmonary function testing

A

Increased lung compliance

72
Q

Asthma medications in pregnancy, what to take and what to stop?

pregnant women with asthma what tocolytics that C/I for her?

A

Continue the same / misoprostol

73
Q

asthmatic patient, last OPD peak flow was 600, when to say it is acute sever asthma:

What indicates severe asthma?

A

A- peak flow of less 250

RR > 25

Inability to complete one sentence in one breath

74
Q

Asthma salbutamol before exercise Not control ?add

Patient known case of asthma on albuterol , diagnosed as moderate persistent asthma what you will add ?

A

Add ICS

75
Q

Patient using many drugs but he came with decreased K ? Cause?

He has HF and came with asthma attack then in ER they manag him with salbutamol and
he has decreased K what is the cause?

A

Salbutamol reduces serum potassium levels by increasing the shift of extracellular potassium into the intracelluar space.

76
Q 
Severe asthma (daily use of SABA and more than 2-3times night symptoms) on LABA and ICS, what to add 

A

Theophylline

77
Q

Asthma management: The best initial test in an acute exacerbation:

A

Peal expiratory flow

78
Q

The best diagnostic test for asthma is ?

The most accurate diagnostic test is pulmonary function testing is ………
will show a decrease in the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC

A

Spirometry

79
Q

Asthma exacerbation after pneumonia whats the tx?

A

Ventolin + antibiotics

80
Q

Asthma severe cant complete one sentence management?

Best treatment for obstructive sleep apnea?

obese snoring , lack sleep , sleep study done (OSA), how you will ventilate:

A

CPAP

81
Q

Copd patient not responding to Salbutamol what’s the next drug?

A

Ipratropium

Salbutamol + ICS in asthma
(Salbutamol + Ipratropium in COPD)

82
Q

Male smoker since 3-4 years has dyspnea.Fev1/fvc is less than 0.7,Dlco is low,FEV1/FVC mildly improved after administration of beta blocker
What is the likely dx:

A

Emphysema

83
Q

Case about moderat asthma on saba and ics what add ?

A

Long acting B agonist ( LABA )

84
Q

Case of sever copd with full secretion :

A

Invasive mechanical ventilation

85
Q

smoker with recurrent respiratory infection and productive cough, diagnosis

A

Chronic Bronchitis

86
Q

Young female came to the clinic complaining of episodes of SOB, wheeze and cough for the last 6 months not related to certain provoker. She says that these episodes comes suddenly and resolve suddenly. She used ventolin but improved slightly. Upon physical exam she has equal air entry with no wheezing. She is not allergic to anything and no one in her family has the same problem.All test were normal and spirometry is normal. What is the dx ?

Female 20 y/o with dyspnea intermittently resolves suddenly. Minimal improvement with b agonist. Dx

A

Vocal cord dysfunction

87
Q

Sever asthma exacerbation ( in distress )how to manage :

A

Magnesium sulfate

88
Q

in case of acute asthma exacerbation what study is most accurate to monitor improvement=

A

PFTs

89
Q

asthma exacerbation: ………. and …….

A

Ventoline and steroids

90
Q

about Exercise induced asthma, management? ………. pre exercise

A

Salbutamol

91
Q

Asthmatic patient on SABA + steroid, free of symptoms for 1 year, next?

A

decrease steroid to half dose + SABA

92
Q

Pt pregnant with bronchial asthma have SOB and whezzes and some times have night attacks of asthma

A

Give SABA & ICS

93
Q

55yr old chronic smoker with chronic non productive cough presented with stable vitals. X ray done is normal.whats the likely diagnosis?

A

COPD

94
Q

child presented with sinusitis and recurrent lower respiratory tract infections.Mcs of bronchial aspirate had pseudomonas aeruginosa.Whats the diagnosis?

A

Cystic fibrosis

95
Q

Pt known to have emphysema, undergo some GIT operation (lap choly i think),
then pt is complaining of progressive dyspnea. ABG: high CO2 and high O2
Your management

A

Intubation and hyperventilation

96
Q

Pt known case of COPD or asthma non compliant to medications with recurrent admissions:

A

Ask his partner or family to give medicine ( maybe )

97
Q

Patient have anxiety for 4 years and have asthma she noticed when she use salbutamol symptoms get worse

-Patient with social anxiety and asthmatic, how to treat?
A-Propanalol. B-Bupropion c _ psychotherapy CBT if not mentioned SSRI.✅

A

Sertaline

98
Q

Management of moderate asthma with night symptoms 6/ month

A

LDICS + LABA

99
Q

case of poorly controlled asthma ?

A

Check the use of inhalers

100
Q

COPD patient on salmeterol and albuterol, still not controlled as he needs to
use albuterol more often now and he had multiple exacerbations in the last 6 months, what to give him for maintenance

A

Tiotropium

101
Q

Smoker, SOB, cough yellowish sputum, fever, examination wheezing, febrile, Dx?

A

Pneumonia

102
Q

Patient presented with SOB only exertional, did spirometry and was normal, next?

A

methacholine challenge test

103
Q

Pregnant lady presents with cough of white sputum, cough increased in severity and she developed SOB she is allergic to dust, mites and pollens what is the most imp investigation?

🌷accurate test for Asthma =…….?
🌹How to monitor asthmatic response to treatment ?

A

Spirometry

104
Q

Copd cor pulmonale whats best thing to improve survival ?

A

Oxygen therapy

105
Q

COPD patient with lower limb edema and hepatosplenomehay Right heart failure signs What to do to confirm dx?

A

Echo

106
Q

What improves survival or reduce mortality in COPD?

A

Smoking cessation

107
Q

Emphysema = …….DLCO

A

Low

108
Q

Most common symptom of emphysema ?

A

Dyspnea

109
Q

Scenario about a man with epilepsy poor controlled, have productive cough and fever Asked about what the source of infection?

A

Aspiration

110
Q

How to assess COPD severity/prognosis:

A

FEV1

111
Q

Indication of home therapy for copd pt?

A

resting PaO2 = 7.3 kPa (55 mm Hg) or SaO2 88% or less

112
Q

best way to deliver oxygen in COPD pt?

A

Venture mask

113
Q

COPD patient developed sudden symptoms of spontaneous pneumothorax, x ray was done and showed 2 cm pneumothorax, mx

A

Needle

114
Q

Scenario of SBP mx:

A

lactulose enema+ceftriaxone✅

115
Q

COPD, affected conscious level, low pH?

COPD & heavy smoker hypoxia co2 retention patient drowsy?

COPD exacerbation and he is in coma, what to do?

#COPD elderly patient presented to the ER distress and full of secretion how
you will manage =

COPD pt came with respiratory functions detotriation and LOC with sever secretions in the throat mx?
….
COPd with signs of respiratory acidosis ?

A

Mechanical ventilation

116
Q

Patient k/c of COPD alert, has moderate respiratory distress.SO2 93%, ABG showed hypoxia, hypercapnia and acidosis. What is next step:

A

Non invasive ventilation

117
Q

When to consider invasive mechanical ventilation

A

➔ PaO2 < 40 mmhg. ➔ Ph < 7.25. (Acidosis) ➔ CO2 > 60 mmhg. ➔ Respiratory arrest. ➔ Cardiovascular collapse. ➔ Severe exacerbation with a lot of secretions.

118
Q

Copd acute exacerbation with a mouth full of secretions =

A

Invasive mechanical ventilation

119
Q

Copd acute exacerbation with a mouth full of secretions =

A

Invasive mechanical ventilation

120
Q

exacerbation COPD Best management

COPD patient with exacerpation, given SABA and not improved, next management is: (O2 sat is 89%) and he is conscious:

A

Non invasive mechanical ventilation

Non invasive positive pressure ventilation

121
Q

OPD patient came with severe cough, sputum production and cyanosis what to do

A

Bipap

122
Q

patient with COPD develop reproductive cough for 3 months, what is the diagnosis?

A

Chronic bronchitis

123
Q

What gives BNP false positive?

A

COPD

124
Q

Pt smoker and dyspnea and character of clubbing?

Case of old smoker c/o cough, loss of nail bed angle?

A

Lung cancer

125
Q

Smoker pt, c/o with dyspnea and couph with hemoptysis, trachea wasn’t shifted, xray showed massive right plueral effusion, whats the cause

A

Brochogenic carcinoma with ipsilatral bronchus compression

126
Q

Pleural effusion because of malignancy is usually…..

A

Exudate

127
Q

COPD C/O SOB palpitation O/E irregular pulse , treatment

A

Amiodarone

128
Q

COPD monitoring ?

COPD Best indication of disease progression

A

FEV1

129
Q

Know case of copd with cor pulmonale. which of the following will decrease mortality ?


A

( no answer )

A. oxygen mask therapy B. inhaled long acting beta blocker C.Long term 02 therapy D.NPPV

130
Q

child with SOB and Stony dullness in percussion, what is the diagnosis?

A

Pleural effusion

131
Q

carbon monoxide inhalation how you will mange ?

A

Inhalation 100% oxygen

132
Q

smoker with non productive cough, fatigue and loss of 15% of weight what is the diagnosis

A

Lung cancer

133
Q

Proper ET position how to check

Pt with orotracheal intubation who can detect it is in normal position:

A

Co2 monitor

continuous capnography for of carbon dioxide (CO2) in exhaled air, which assesses ventilation

134
Q

Old patient, heavy smoker present with symptoms of Horner syndrome. what type of cancer

Pt smoker with lung cancer & Hypercalcemia ?

CXR on hilar mass , hypercalcemia?

Elderly smoker s&s of bronchogenic carcinoma which type:

A

Squamous cell cancer

135
Q

Patient with Pulmonary hypertension to be evaluated for chronic thromboembolism, which investigation has the highest diagnostic yield?

A

V/Q scan

136
Q

Patient with bronchiolitis and given supportive treat, what to do next?

A

Observe in ER

137
Q

pulmonary HT type 3 other name is ?

A

Hypoxic

138
Q

4 hrs post op patient has dyspnea and hypoxia cause?

A

A. lower lobe atelectasis ✅ B. PE

139
Q

Cerebral palsy pt develops respiratory failure type ( signs of hypoxia )

A

Hypoxic

140
Q

CO2 poisoning hbco 40% tx?

A

Hyperbaric

141
Q

Case of lung cancer: non smoker male with sx found nodule in the lung whats your next step?

56 Y/O non smoker , asymptotic . Discovered lung nodule during the Old x-ray

A

Previous X-ray

Repeat X-ray

142
Q

Dyspnea at night, sternal pain, Midline mass compressed trachea , diagnosis

A

Lymphoma

143
Q

Pt came with lymph node enlargement his family concern about it to be cancer because
his son of uncle diagnosis before 3 weeks with lymphoma which think indicated biopsy:

A

A. It is size above 1 cm
B. Came with hepatosplenomegaly
C. Fever✅
D.tenderness
biopsy indicantion (especially if regional lymphadenopathy persistent >6 wk and/ or constitutional symptoms)
Constitutional symptoms = fever, chills, night sweats, unexplained weight loss

144
Q

After mechanical ventilation what will happen:

A

Hypocapenia

dha exam (21 decks)

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