Internal Medicine Essentials Questions: Pulmonary Medicine

Question 1

How can you distinguish between DLPD and respiratory muscle weakness?

Answer 1

• DLPD will have low DLCO and abnormalities on chest x-ray.
• Respiratory muscle weakness will have normal DLCO and x-ray significant only for decreased volumes.

Question 2

List three diagnoses for a chronic cough with a normal chest x-ray.

Answer 2

• Cough-variant asthma (diagnosable with bronchial challenge)
• GERD (can diagnose with a pH probe or treat empirically with PPIs)
• Postnasal drip

Question 3

____________ volume will be increased and ___________ capacity will be decreased in a person with respiratory muscle weakness.

Answer 3

Residual; total lung

They cannot exhale fully, so RV is increased, but they cannot inhale fully, so TLC is decreased.

Question 4

A woman reports chronic dyspnea at rest. Her lung exam is normal and no stridor is noted. She had an MVC one year ago and required prolonged intubation. What test should you order to evaluate her dyspnea?

Answer 4

Flow-volume PFTs

Suspect tracheomalacia or tracheal stenosis in a person with prolonged intubation. Flow-volume loops will show a flattening of the inspiratory loop.

Question 5

Describe the to-and-fro ventricular septal sign on echo.

Answer 5

This is a sign of constrictive pericarditis. Constrictive pericarditis causes a ventricular filling defect. One ventricle will fill and impede the other. The other will then fill on the next cycle and cause impedance.

This is useful because restrictive cardiomyopathy –which can resemble constrictive pericarditis –will not show this sign.

Question 6

Why is the “do not tap a pleural effusion less than 1 cm” a good rule to know?

Answer 6

Most cases of pneumonia present with pleural effusions that are small (up to 50%!). Thus, you need to know that observation is indicated in uncomplicated cases (less than 1 cm, not loculated).

Question 7

True or false: tactile fremitus is decreased in lobar consolidation.

Answer 7

False

Tactile fremitus is caused by lung consolidation and thus increases with lobar consolidation.

Question 8

To definitively diagnose alpha-1 antitrypsin deficiency, you need to _______________.

Answer 8

measure the levels of A1AT

Question 9

Start O2 therapy in patients with ______________.

Answer 9

SpO2 less than 88% or PaO2 less than 55 mm Hg

Question 10

Review the tiers of ventilatory support for those with COPD having an exacerbation.

Answer 10

• Purely hypoxic: increase NC O2
• Mildly acidotic (7.25 - 7.35): non-invasive positive-pressure ventilation
• Severely acidotic (less than 7.25): intubation

Question 11

Bibasilar interstitial fibrosis, honeycombing, increased septal thickness, and linear calcifications on x-ray are suggestive of _____________.

Answer 11

asbestosis

Question 12

Describe the presentation of cryptogenic organizing pneumonia (also called BOOP).

Answer 12

• Insidious onset of dry cough and SOB
• Diffuse crackles
• No fever
• Patchy opacities on CXR
• Responds well to glucocorticoids

Question 13

Pulmonary fibrosis typically affects which parts of the lungs?

Answer 13

Basal and peripheral

Question 14

When should you not do a CTA in assessing PE?

Answer 14

• Renal failure (because of toxic contrast)

* Pregnancy (because of radiation)