Pulmonology and Critical Care Medicine

Question 1

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?

Answer 1

Idiopathic Pulmonary Fibrosis

Question 2

How does one diagnosis chronic thromboembolic pulmonary hypertension?

Answer 2

V/Q scan

Question 3

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

Answer 3

Mepolizumab

Question 4

A patient has sepsis, how does fluid resuscitation work?

What is the lactate level?

Answer 4

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

Lactate above 2 if there is an active infection

Question 5

What is a good NIF number?

Answer 5

-20

Question 6

What is a good RSBI number?

What is the formula?

Answer 6

less than 105

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

Denominator should be example (0.450)

Question 7

Chronic Thromboembolic Pulmonary HTN what treatment should be what?

Answer 7

AC and Surgery

Question 8

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

Answer 8

Riociguat, soluble guanylate cyclase, primary receptor of nitric oxide

Question 9

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

Answer 9

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

Question 10

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

Answer 10

Resting Pulse Oximetry

Question 11

Nitric Oxide Fraction looks at what?

Answer 11

Non-invasive measurement of eosinophils

Question 12

Severe temperatures below what number require internal rewarming methods?

Answer 12

Below 82.4 F

Question 13

How should active rewarming temperatures be taken?

Answer 13

Esophageal Probe

Question 14

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

Answer 14

Right Heart Cath

Question 15

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

Answer 15

Nifedipine

Question 16

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

Answer 16

Sildenafil

Question 17

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

Answer 17

Roflumilast, PDE-4 inhibitor

Question 18

COPD Gold group A is what treatment?

Answer 18

Bronchodilator (LAMA +SABA), other opitions

Question 19

COPD Gold group B is what treatment?

Answer 19

LAMA-LABA, Anoro Ellipta, other opitions

Question 20

COPD Gold group E is what treatment?

Answer 20

LABA+LAMA+ICS, Trelegy Ellipta or Breztri

Question 21

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

Answer 21

Eosinophils

Question 22

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

Answer 22

GOLD group A

Question 23

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?

Answer 23

GOLD group B

Question 24

2 or more moderate COPD exacerbations is what?

Answer 24

Gold Group E

Question 25

Montelukast can have what side effect?

Answer 25

Depression, black box warning

Question 26

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

Answer 26

Eosinophils

Question 27

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

Answer 27

Greater than 8mm

Question 28

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

Answer 28

Every 2 years for 5 years

Question 29

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

Answer 29

CT Chest Scan

Question 30

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

Answer 30

Idiopathic Pulmonary Fibrosis

Question 31

Idiopathic Pulmonary Fibrosis, what should be done?

Answer 31

Pirfenidone and Ninedanib

Question 32

PE in pregnancy, what could treat this problem?

Answer 32

Low Molecular Weight Heparin

Question 33

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

Answer 33

Fractional Exhaled Nitric Oxide

Question 34

The most common form of exudative effusions is what?

Answer 34

Infection and Malignancy

Question 35

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

Answer 35

Chylothorax
Lymphoma can cause

Question 36

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

Answer 36

Inflammatory Effusion

Question 37

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

Answer 37

Every 2 years for 5 years

Question 38

Ethylene Glycol and Methanol should be treated with what?

Answer 38

Fomepizole or the ethanol

Question 39

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

Answer 39

Fomepizole and Dialysis

Question 40

Neutropenic fever, antibiotics can be stopped when?

Answer 40

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

Question 41

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

Answer 41

Recurrence Prevention (pleurodesis)

Question 42

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

Answer 42

Can stop antibiotics

Question 43

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

Answer 43

Ciprofloxacin, not azithyromycin

Question 44

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

Answer 44

Inhaled Fluticasone Propionate-Salmeterol (LABA-LAMA)

Question 45

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

Answer 45

Patient needs to have a Bronchoscopy

Question 46

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

Answer 46

No further follow up

Question 47

What is the first test for a chronic PE?

Answer 47

V/Q scan